Temporal Incision Research Articles

Incision-related astigmatism on the anterior and total cornea after implantable collamer lens implantation.

To evaluate incision-related astigmatism (IRA) on the anterior and total cornea after implantable collamer lens (ICL) implantation through superior and temporal corneal incisions. The retrospective study included 141 eyes of 80 consecutive patients who underwent ICL implantation. An ocular examination was performed preoperatively and at 1 and 6 months postoperatively. The magnitude and axis of corneal astigmatism were assessed with keratometry (AstigK) and total corneal refractive power (TCRP, AstigTCRP) using a Scheimpflug camera, while the IRA obtained from keratometry (IRAK) and TCRP (IRATCRP) were evaluated using vector analysis. At 6 months, AstigK significantly decreased from 1.45 ± 0.72 D to 1.15 ± 0.75 D in the superior incision group, whereas it increased from 1.70 ± 0.74 D to 1.88 ± 0.79 D in the temporal incision group (both P < 0.001). AstigTCRP significantly decreased from 1.32 ± 0.74 D to 1.09 ± 0.80 D in the superior incision group, while it increased from 1.61 ± 0.78 D to 1.83 ± 0.86 D in the temporal incision group (both P < 0.001). IRAK was 0.55 ± 0.30 D and 0.35 ± 0.25 D in the superior and temporal incision groups, respectively, while IRATCRP was 0.50 ± 0.28 D and 0.40 ± 0.26 D in the superior and temporal incision groups, respectively. IRAK was larger in the superior incision group than in the temporal incision group for both low- (P = 0.009) and high-astigmatism (P = 0.017). Incisions in ICL surgery cause corneal flattening in the meridian of the incision. The superior incision had a greater IRAK compared to the temporal incision.

Rhytidectomy Incision Techniques and Scar Outcomes: A Scoping Review.

Although scar outcomes in rhytidectomy are crucial to patients and surgeons alike, there is a lack of consensus on incision techniques for optimizing rhytidectomy scars. A comprehensive scoping review of the literature was performed on rhytidectomy incision techniques and associated scar outcomes.The PRISMA protocol was utilized to conduct a scoping review of the literature through MEDLINE, EMBASE, and Science Citation Index databases to identify articles discussing rhytidectomy incision techniques and scar outcomes.A total of 49 studies were included in this scoping review. Four themes were identified related to rhytidectomy scars within these studies: temporal incision placement, tragal incision placement, lobule management, and postauricular incision design. Techniques within each theme were described and reported scar outcomes summarized.There are many approaches to rhytidectomy incisions described in the literature, with reportedly low rates of scar complications for each of the techniques described. It cannot be elucidated which techniques are superior due to the heterogeneity of outcomes reported in the literature with significant variability in outcome measures, study design, and follow-up time. Future studies should focus on utilizing a standardized rating system to aid in objective determination of the superiority of one technique versus another. LEVEL OF EVIDENCE:: Level I.

Visual Prognosis Following Cataract Surgery in Highly Myopic Patients with Prior History of Verisyse Phakic Intraocular Lens Implantation.

Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. The Verisyse pIOL was disenclaved and removed through a superior scleral tunnel incision. Cataract extraction with phacoemulsification was then performed through a temporal clear corneal incision. Results: An occurrence rate of 7.9% of eyes with cataract formation was found. Both uncorrected (UDVA) and corrected visual acuity (CDVA) three months after cataract surgery were significantly improved (0.24 ± 0.30 vs. 0.73 ± 0.48; p < 0.001 and 0.10 ± 0.14 vs. 0.30 ± 0.31; p = 0.004, respectively). The UDVA was 20/20 or better in 41% of eyes and 20/40 or better in 65% of eyes. The CDVA was 20/20 or better in 53% of eyes and 20/40 or better in 88% of eyes. The safety and efficacy indices were 1.96 ± 1.68 and 1.60 ± 1.36, respectively. Conclusions: Various complications including cataracts may develop in these patients. Verisyse pIOLs have a lower incidence of cataract formation and are more likely to lead to age-related cataracts rather than the anterior subcapsular cataracts commonly seen in implantable collamer lens (ICL) patients. Patients with a prior history of Verisyse pIOL can expect to have a good visual prognosis after cataract extraction.

Analysis of surgically induced astigmatism of the anterior, posterior, and total cornea after implantable collamer lens implantation: a comparative study between temporal and superior clear corneal incisions

BackgroundTo comparatively analyze the surgically induced astigmatism (SIA) of the anterior, posterior, and total corneas of eyes undertaking implantable collamer lens (ICL) implantation with temporal or superior corneal incisions.MethodsOne hundred and nine eyes of 109 patients who received ICL implantation were recruited: 40 eyes had temporal incisions and 69 eyes had superior incisions. Total corneal refractive power (TCRP); simulated keratometry of the anterior (Sim-KAnt) and posterior (Sim-KPost) corneal curvature; and astigmatism of the anterior (CAAnt), posterior (CAPost), and total (CATCRP) cornea were recorded through a Pentacam preoperatively and 3 months postoperatively. The SIA of the anterior, posterior, and total cornea were also compared between the two groups.ResultsThere were no significant intergroup differences for TCRP, Sim-KAnt, Sim-KPost, CAAnt, CAPost, or CATCRP, preoperatively. However, values of CAAnt, CAPost, and CATCRP with temporal incision were significantly higher than those parameters with superior incision postoperatively. All of the SIA of the anterior, posterior, and total cornea were significantly lower for temporal incision than those with a superior incision (p < 0.001, p = 0.006 and p = 0.001 respectively). Meanwhile, the superior incisions created against-the-rule (ATR) astigmatism, and temporal incisions always induce with-the-rule (WTR) astigmatism in total cornea.ConclusionsA superior incision may be suitable for correcting WTR astigmatism, while a temporal incision for correcting ATR astigmatism when using a non-toric ICL. Meanwhile, temporal incision could be a better choice with little preoperative astigmatism or that preoperative astigmatism would be corrected with toric ICLs.Trial registrationRegistration number: ChiCTR2100051739. Prospectively registered: 01 October 2021.

Comparison of Surgically Induced Astigmatism Following Manual Sics: Superior and Temporal Approach

Aim: The operable cataract cases in the developing world is high compared to the cataract surgical rate, and economical and effective methods are required to deal with this curable blindness, in order to provide the highest achievable uncorrected distance visual acuity. This study aimed to compare the surgically induced corneal astigmatism in patients undergoing manual small incision cataract surgery by superior (s-MSICS) and temporal (t-MSICS) scleral tunnel incisions. Methods: Prospective, interventional cases series of 60 eyes of 60 patients. Uncorrected distance visual acuity (UDVA), mean keratometry (KMean) and surgically induced astigmatism (SIA) were the main outcome measures which were compared between the two groups, s-MSICS and t-MSICS. Results: The mean patient age was 58.60 ± 7.11 years and 59.63 ± 8.39 years in the s-MSICS and t-MSICS groups respectively. Uncorrected distance visual acuity (UDVA) on day 90 was 0.27 ± 0.14 logMAR in the s-MSICS group and 0.18 ± 0.16 logMAR in the t-MSICS group (p=0.05). At the final assessment s-MSICS had 1.43 ± 0.99D of SIA and t-MSICS had 0.76 ± 0.66D of SIA (p=0.02). Four patients in the s-MSICS group and 25 patients in the t-MSICS group had WTR astigmatism (p&lt;0.001). Likewise, there were 26 cases of ATR and one case of ATR in the s-MSICS and t-MSICS respectively (p&lt;0.001). Conclusion: In this prospective study, t-MSICS had significantly lesser surgically induced astigmatism than s-MSICS. The temporal incision decreased against the rule astigmatism, as well, which is the astigmatism prevalent in the adult population.

Transmalar Kirshner Wire Fixation Under Ultrasound Scanning is Useful for Unstable Zygomatic Arch Fracture Combined With Zygomatic Body Fracture.

Plate fixation to zygomatic arch fractures carries the risk of facial nerve palsy and scarring of the cheek; however, without plate fixation, bone deviation or displacement may reoccur after surgery. Furthermore, zygomatic arch fractures combined with zygomatic body fractures are more postoperatively unstable than single zygomatic arch fractures. Few reports have focused on this combined fracture type, and no consensus has been reached regarding treatment. Because plate fixation for slight deviation of the zygomatic body has little advantage for stabilization, the authors, usually opt for transmalar pinning alone instead of plate fixation at the hospital. This study is a retrospective case series of 7 patients, among 100 zygomatic fractures excluding isolated zygomatic arch fractures, treated using transmalar pinning under ultrasound scanning. The reduction was performed through the oral and temporal incision as a surgical procedure. Under ultrasound observation, a Kirshner wire was inserted into the zygomatic body from the unaffected side while maintaining the reduced position. The wire was removed at an outpatient visit 2 to 3 months following surgery. In all cases, the zygomatic body was of the laterally rotated type, and postoperative morphologic evaluation showed improvement without postoperative complications. Scores were higher in middle-aged and older than in young people. Correction of zygomatic rotation also scored higher than zygomatic arch morphology. Transmalar Kirshner wire fixation under ultrasound observation is a simple and minimally invasive method for zygomatic arch fractures, which avoids the possible complications related to plate fixation.

TO COMPARE KERATOMETRY ASTIGMATISM FROM TEMPORAL AND SUPERIOR CORNEAL INCISIONS DURING PHACOEMULSIFICATION

Objective: To examine the average change in keratometry’s medically produced astigmatism between lateral andphacoemulsification corneal incisions.Study Design: Randomized Controlled TrialStudy Duration and place of study: Department of Ophthalmology, Khyber Institute of Ophthalmic Sciences HMC,Peshawar. From 20-07- 2020 to 21-01-2021.Materials and Methods: A random allocation process divided 140 cataract patients into two groups. Phacoemulsification was performed using a superior corneal incision in group A and a temporal incision in group B. Baselineand follow-up keratometry readings were used to compute the average astigmatism change.Results: Patient age averaged 49.6 + 5.3 years throughout the research group. Group B patients averaged 50.4 +4.9 years old (p 0.04), whereas group A patients averaged 48.9 + 5.8 years. Group A included 82.9% males and17.1% women, whereas group B had 74.3% men and 25.7% women (p 0.217). Group A’s mean BMI was 24.9+ 3.8 kg/m2, whereas Group B’s was 25.2 + 3.7. A and B had mean baseline BCVAs of 0.8 + 0.2 and 0.8 +0.2, respectively (p 0.858). Keratometry showed group A’s mean baseline astigmatism was 0.2 + 0.06D and groupB’s 0.1 + 0.07 (p 0.614). Keratometry showed that group A’s mean follow-up astigmatism was 1.2 + 0.2D andgroup B’s 1.1 + 0.2 (p 0.836). According to keratometry, group A’s astigmatism changed by 1.0 + 0.17D andgroup B’s by 1.0 + 0.2 (p 0.707).Conclusion: We found no statistically significant difference in mean astigmatism before and after phacoemulsificationin corneal vs temporal incision groups. Our study had a limited sample size and did not account for effect modifiers, thuswe urge additional studies with higher sample sizes and accounting for confounders that may affect patients’ medicallyinduced astigmatism after phacoemulsification.Keywords: Senile Cataract, phacoemulsification, temporal incision superior corneal incision, astigmatism, keratometry.

Is Gillies Temporal Incision Necessary to Successfully Reduce Zygomaticomaxillary Fracture Combined With Orbital Wall Fracture?

Gillies temporal approach has been widely used to reduce zygoma fractures. Traditionally, it is the preferred method to reduce the isolated zygomatic arch fracture. It can be combined with other approaches, such as subciliary and intraoral incisions for more complex zygomatic fractures, so-called tripod fractures. In this study, the author hypothesized that complex zygomaticomaxillary bone fracture reduction can successfully be achieved without Gillies temporal incision. The author retrospectively analyzed the medical records and 3D facial Computed Tomography (CT) scans of 80 patients who had orbitozygomaticomaxillary fractures that affected >3 sites among the frontozygomatic suture, zygomaticomaxillary buttress, zygomatic arch, and orbital walls from May 2021 to August 2023. A single surgeon performed all surgical operations. All fractures were reduced with 2 incisions, lower eyelid incisions (subciliary or subconjunctival) and intraoral incisions (gingivobuccal approach), within a week of the initial traumatic event. After sufficient exposure to fractured sites using 2 incisions, the author reduced the fracture with a bony hook at the inferior orbital rim, lateral wall, or Boise elevator at the intraoral incision. All cases were successfully corrected without any complications. In conclusion, the author can successfully reduce complex zygomaticomaxillary fracture combined with orbital wall fractures without temporal Gillies approach.

Differences in Keratometry Before and After Surgery Between Superior and Temporal Chevron Incision in Small Incision Cataract Surgery

Abstract&#x0D; Introduction &amp; Objectives : Cataracts are the most common cases that cause blindness globally, where the lense was haze and characterized by decreased visual acuity and is reversible if optimal treatment is given. Examination before surgery is very important for outcome, where keratometry is one of the examinations before the surgery. Small incision cataract surgery (SICS) is one of cataract surgery technique, where a chevron incision is used in the superior or temporal regions. This study aims to determine which location is the best for an incision based on the results of keratometry.&#x0D; Methods : This research is an analytical observational study, bidirectional (prospective-retrospective) with a cohort study approach conducted at the eye polyclinic of Sanglah Hospital and Surya Husadha Hospital, Denpasar. The study sample consisted of 46 eyes which were divided into two groups, 23 superior and 23 temporal incision, then the results were compared between groups.&#x0D; Results : The results showed that the oldest age was the temporal incision group, which was 66.78±7.11. In the keratometry measurements, it was found that there were differences between the two groups, where the temporal incision resulted in smaller keratometric changes (p=&lt;0.001). After analyzing the covariates, the temporal incision group still had smaller keratometry changes (p=&lt;0.001) with astigmatism as an influential confounding factor. Meanwhile, post-op visual acuity was found in the temporal incision group which was better than the superior incision after analysis with covariates (p=0.002).&#x0D; Conclusion : This study showed that the temporal incision group gave lower keratometry results and better post- op visual acuity than the superior incision group.

Long Term Evaluation of Surgically Induced Astigmatism and Corneal Higher-Order Aberrations After 2.2 Mm Clear Corneal Incisions in Femtosecond Laser-Assisted Cataract Surgery: Temporal versus Superior Approach.

To assess long term changes of the surgically induced astigmatism (SIA) and corneal higher-order aberrations (HOAs) after 2.2 mm clear corneal incisions (CCIs) in femtosecond laser-assisted cataract surgery and compare them between 2 types of CCIs: temporal and superior approach. Patients received the temporal CCIs (Group A) or the superior CCIs (Group B). Outcome measures included visual acuity, manifest refraction, corneal astigmatism, SIA, flattening effect, and corneal HOAs. Correlation between postoperative corneal HOA and SIA at each follow-up were analysed. This study assessed data from 106 eyes, of which 64 in Group A and 42 in Group B. The two groups had similar postoperative visual acuity of distance, intermediate and near (all P > 0.05). SIA and corneal HOAs were significantly lower in Group A than Group B in the early postoperative period, while there was no significant difference in the late postoperative period. At 6 months after surgery, the arithmetic mean of SIA over corneal 4mm zone was 0.33 ± 0.19D for temporal incision, and 0.37 ± 0.25D for superior incision. For Group A, the correlations of HOAs and SIA persisted from 1 week to 6 months after surgery. For Group B, the changes in corneal HOAs were significantly related to the SIA at 1 week and 1 month postoperatively. This study suggested the consistency of increasing and recovering process of corneal HOAs and SIA after surgery. Compared to the superior incisions, temporal incisions might induce quicker corneal recovery and less change in SIA and corneal HOAs.

The clinical, radiological, and surgical characteristics of anterior perforated substance glioma: a retrospective study

BackgroundTo explore the clinical, radiological, and surgical characteristics of anterior perforated substance (APS) gliomas.MethodsTwenty patients with APS glioma who were treated with surgery between March 2019 and January 2022 from Tiantan hospital were retrospectively reviewed. The clinical, histological and radiological data were collected.ResultsTwenty patients, including 7 males (55%) and 13 females (45%), with a mean age at diagnosis of 37.9 years (range, 28–53 years) underwent operative intervention for APS. Headaches and dizziness were the most common preoperative symptoms in the majority patients (14, 70%). Based on radiological features of MRI, the APS was classified into two subtypes, type A and type B. Seven patients (40%) in type A indicated a clear tumor margin, while 13 patients (60%) in type B showed an ill-defined margin. The surgical approach including frontal, temporal, and coronal frontal incisions for type A and type B tumors, respectively. Three patients in type A received total resection, while one patient in type B were total resected. Pathologically, 12 cases (60%, 12/20) were diagnosed as astrocytoma and 8 cases (20%, 8/20) were oligodendroglioma. Meanwhile, 17 cases (85%, 17/20) had MGMT promotor methylation.ConclusionIn this study, we performed the first systematic research of patients with APS glioma. Most of patients with APS presented headaches and dizziness symptoms. The APS glioma was further divided into two major radiological subtypes with relevant different surgical approaches. The APS glioma in type A were more likely to receive total resection.

Is Astigmatism Correction Necessary for Patients With Cataract Who Have Corneal Astigmatism of Less Than 0.75 D?

Purpose: To investigate the proportion of patients with predicted refractive astigmatism (PRA) of 0.75 diopters (D) or greater and associated risk factors among cataract surgery candidates with low corneal astigmatism. Methods: A retrospective cross-sectional study was conducted in Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract who had preoperative simulated keratometric astigmatism of less than 0.75 D were recruited. The PRA was calculated by Barrett toric calculator using posterior corneal astigmatism (PCA) measured by the IOLMaster 700 (Carl Zeiss Meditec AG) and corneal surgically induced astigmatism (SIA). Two corneal incision locations (temporal [0°/180°], 135° incision) and varying magnitudes (0.10 to 0.60 D) were considered for SIA. Multiple logistic regression analysis was used to explore risk factors associated with PRA of 0.75 D or greater and build predictive model. Sensitivity analysis was performed using PRA threshold of 0.50 D. Results: A total of 1,750 eyes from 1,750 patients were included (mean age: 60.14 ± 13.24 years, 42.91% male, 1,010 right eyes and 740 left eyes). The 135° incision (odds ratio [OR]: 17.86) and against-the-rule (ATR) astigmatism (OR: 37.55) are the major risk factors for PRA of 0.75 D or greater. Higher simulated keratometric astigmatism (OR: 2.03), larger PCA (OR: 1.64), and surgically induced astigmatism (OR: 1.29) also significantly increased the risk of PRA of 0.75 D or greater. Nomogram model were constructed with an area under curve of 0.90. Conclusions: For patients with corneal astigmatism of less than 0.75 D, temporal incision and measured PCA is preferred. Those patients with ATR astigmatism should be considered for astigmatism correction when using a 135° incision. [ J Refract Surg . 2023;39(12):850–855.]

Cutaneous Layer and SMAS Suspension (CaSS) Lift as a Minimally Invasive Lateral Midface Lift.

In our prior study, the authors determined that pulling on the superficial adipose layer is more effective in lifting the skin than pulling on the superficial musculoaponeurotic system (SMAS). Applying this concept of using the superficial adipose layer to transmit the lifting force to the skin, this study examined improvements in patients who underwent lateral midface lifting using our minimally invasive multilayer lifting technique and measured the duration of those improvements. Along the hairline in front of the sideburns, a W-shaped zigzag incision of 3 to 8mm in width and 3 to 4cm in length was made. On the temporal scalp, 3 to 4cm away from the first incision, a second incision was made more lateral/posterior to the first incision, and an elliptical excision of 3 to 5mm in width and 3 to 4cm in length was made. From the medial cut margin of the anterior first incision, the superficial temporal fascia/SMAS (the deep layer), and the superficial adipose layer (the superficial layer) were purchased with 3-0 polyester sutures, tunneled under the soft tissue, and fixed to the deep temporal fascia of the second posterior temporal incision. Prior to the excised temporal scalp closure, the dermis in the medial cut margin of the second incision was pulled to the rear as much as possible and fixed to the deep temporal fascia. The effects of surgery were monitored for 6 to 42 months after surgery. The nasolabial folds were improved. Skin elasticity also showed significant improvements, which lasted throughout the follow-up period (up to 42mo). Unlike traditional wide dissection SMAS facelift, our method requires minimal incisions and does not require skin undermining. Therefore, the operating time is shorter, and postoperative swelling is minimized. In our technique, the superficial adipose layer, the superficial temporal fascia/SMAS, and the dermis were pulled individually to lift all layers of the lateral midface soft tissues. This results in a significant and long-lasting lateral midface rejuvenation.

Comparative Evaluation of Astigmatic Changes Induced by Superior and Temporal Corneal Incisions in Sutureless Phacoemulsification Surgery: A Case Series.

Background In cataract surgery, the effect of corneal incision astigmatism has been widely recognized for many years. The incision's size, shape, and location can all impact the patient's postoperative visual outcomes. Currently, phacoemulsification is considered the most preferred surgical technique for cataract extraction. However, there is still some debate about whether temporal incisions, which are smaller and considered nearly astigmatic neutral, result in more astigmatism than other incisions. As a result, it is important to continue studying the refractive changes induced by corneal incisions made at different sites during phacoemulsification surgery. Aim and objective To compare the incidence, extent, and course of postoperative astigmatic changes associated with superior versus temporal clear corneal incisions for sutureless phacoemulsification cataract surgery. Materials and method In this prospective study, 50 patients of the civil hospital in Gujrat with cataracts who underwent sutureless, small incision (2.8 mm) phacoemulsification surgery were included. The preoperative evaluation comprised visual acuity assessment, refraction, keratometry, fundus examination, and intraocular lens (IOL) power calculation. The superior incision was made in 25 patients, and the temporal incision was made in another 25 patients. Patients were examined preoperatively on day 1, at one week (day 7), after one month (day 30), and after two months (day 60). Result Postoperatively, two months (on day 60) postoperatively, in group A (superior approach), the mean surgically induced astigmatism (SIA) was 0.39±0.34 SD diopters, and in group B (temporal approach), it was 0.5±0.42 SD diopters. A significant statistical difference was not seen between these two groups. Conclusion Surgically induced astigmatism was minimal and comparable with both superior and temporal approaches to clear corneal incisions for phacoemulsification surgery.

Clinical study of functional visual recovery following phacoemulsification with IOL implantation

Aim To evaluate the functional visual recovery following phacoemulsification cataract surgery with foldable intraocular lens implantation through a temporal clear corneal incision. Methodology This prospective study was conducted at a tertiary health care centre in Western Maharashtra over a period of 2 years. Detailed history was taken and thorough ocular examination of was done. Visual Acuity, Color vision, Contrast sensitivity, Binocular vision was noted. Visual Fields were examined and Glare Disability was assessed. All patients underwent temporal clear corneal Phacoemulsification surgery through a 3.2 mm incision with implantation of an Aspheric Monofocal Foldable IOL under LA. All patients were started on tapering dose of antibiotic − steroid over 6 weeks and followed up post operatively on day 1, week 1, week 2, 6 weeks, 3months and at 6 months. Results 50 eyes of 46 patients with immature cataract aged between 40 to 80 years were included. At the end of 24 weeks the Distance Vision was ≥ 6/9 in 31 eyes, 6/18–6/12 in 17 eyes and &lt; 6/18 in 2 eyes. It was a statistically significant difference (P&lt;0.0001). No significant difference in near vision was seen at the end of 6 months. The difference in astigmatism post operatively in all 50 eyes was not statistically significant at the end of 6 months (P&lt;0.05). Significant improvement in contrast sensitivity was seen post operatively (P&lt;0.0001). The mean glare disability was 14.06 s at 24 weeks. No significant difference was seen (P&gt;0.05). Colour vision and Field of vision were similar postoperatively. All the patients maintained grade 3 binocular vision at end of the study. Conclusion Phacoemulsification with monofocal foldable intraocular lenses can be the choice of technique in treatment of cataract as being able to provide excellent visual results and also being cost effective.

A comparative study: Changes in endothelial cell count in phacoemulsification with temporal clear corneal incision vs superior scleral incision in grade II &amp; III cataract

Endothelial cell loss is a key indicator of the quality of anterior segment surgery like cataract surgery. The amount and integrity of corneal endothelial cells are the two most essential factors determining corneal transparency.Aim of this study was to compare the endothelial cell loss between the superior scleral tunnel incision and the temporal clear corneal incision for phacoemulsification.Prospective observational study. This prospective observational study included 50 patients with grade II and III cataracts undergoing phacoemulsification with a temporal clear corneal incision and 50 patients with a superior scleral tunnel incision. Specular microscopy was used to count ocular endothelial cells before and one month after the surgery.The mean endothelial cell loss was significantly higher with temporal clear corneal incision (14.91% ± 5.13%) in comparison to the superior scleral tunnel incision group (6.58% ± 2.06%). A superior scleral tunnel incision is associated with less postoperative endothelial cell loss as compared to a temporal clear corneal incision and could provide a better visual outcome.

Analysis of Posterior Corneal Surgically Induced Astigmatism Following Cataract Surgery With a 1.8-mm Temporal Clear Corneal Incision.

To determine posterior corneal surgically induced astigmatism (SIA) when using a temporal clear corneal incision and the IOLMaster 700 (Carl Zeiss Meditec AG) for biometric measurements and to determine whether posterior corneal SIA can be predicted from preoperative data. A total of 258 consecutive eyes of 258 patients underwent cataract surgery with a 1.8-mm temporal clear corneal incision. Biometry measurements were taken preoperatively and 6 weeks postoperatively using the IOLMaster 700. Using vector analysis, the SIA of the posterior cornea was calculated. The centroid of posterior corneal SIA was 0.01 diopters (D) @159 ± 0.14 D. The mean posterior corneal SIA was 0.12 D ± 0.07 D. Posterior corneal SIA magnitude was 0.25 D or less in 95% of patients. There was no correlation found between posterior corneal SIA magnitude and any preoperative measurement. The authors suggest not adjusting for posterior corneal SIA if using a small caliber, temporal incision. It was not possible to predict posterior corneal SIA from preoperative biometric measurements. [J Refract Surg. 2023;39(6):381-386.].

'Microincisional trabeculectomy for glaucoma".

To evaluate the short-term clinical outcomes of microincisional trabeculectomy (MIT), a new technique of ab-interno trabeculectomy. Consecutive patients with open-angle glaucoma identified from the hospital database that underwent MIT with or without cataract surgery between September 2021 to June 2022 at a tertiary eye centre in East India, were screened. Those with a follow-up of < 6 months or with incomplete data were excluded. MIT was done ab-interno using microscissors and microforceps in 2-4 clock hours of the nasal angle via a temporal incision. The intraocular pressure (IOP) reduction at 6 months, and reduction in the number of medications after surgery were analysed. Surgical success (IOP>6 and <22 mm Hg), complications, angle features on anterior segment optical coherence tomography (ASOCT), and the need for additional surgeries were analysed. We included thirty-two eyes of 32 patients with open-angle glaucoma (including n = 9 eyes that underwent concurrent cataract surgery) with a preoperative mean IOP of 22 ±11.1 mm Hg and visual field index of 47±37.9%. All eyes achieved >30% IOP reduction, with a final IOP of 14±6.9 mm Hg at 6 months. Surgical success in 31 of 32 eyes with complete success seen in 28 eyes with none of the eyes requiring >1 medication for IOP control. Hyphema was seen in 4 eyes, while transient IOP spikes at 1 day-1 month were seen in 5 eyes, none of which required any additional interventions. One eye with persistent raised IOP at 1 month required incisional trabeculectomy for uncontrolled IOP with 2 medications. MIT, a new technique of ab-interno trabeculectomy, is effective in terms of IOP control and reduction in the number of medications while having fewer complications. Long-term studies comparing the efficacy of MIT with incisional trabeculectomy, or other procedures are warranted in the future.

Complications of Descemet stripping endothelial keratoplasty - A retrospective interventional study at a tertiary eye care center in Southern India.

To analyze the visual outcome and complications of Descemet stripping endothelial keratoplasty (DSEK) with their management in 256 eyes at a tertiary eye care center in southern India. This is a retrospective interventional study of 62 months duration conducted at a tertiary eye care center in southern India. Two hundred and fifty-six eyes of 205 patients were included in the study after obtaining written informed consent from the patients. All cases of DSEK were performed by a single experienced surgeon. In all cases, donor dissection was performed manually. A Sheet's glide was inserted through the temporal corneal incision and donor button was placed on the Sheet's glide with the endothelial side down. The lenticule was separated and inserted into the anterior chamber by pushing the lenticule into the anterior chamber using Sinskey's hook. Any complication, either intraoperative or postoperative, was recorded and managed either medically or by appropriate surgical means. The mean best corrected visual acuity (BCVA) before surgery was CF-1 m, which improved to 6/18 after surgery. Intraoperative donor graft perforation during dissection was seen in 12 cases, thin lenticule in three eyes, and repeated artificial Anterior Chamber (AC) collapse in three eyes. Dislocation of lenticule was the most common complication seen in 21 eyes, which was managed by graft repositioning and rebubbling. Eleven cases had minimal separation of the graft and seven cases had interface haze. Pupillary block glaucoma was seen in two cases that resolved with partial release of bubble. Surface infiltrate was seen in two cases, which was managed with topical antimicrobial agents. Primary graft failure was seen in two cases. DSEK is a promising alternative to penetrating keratoplasty for corneal endothelial decompensation, but it also has its own merits and limitations, and most often, merits overweigh limitations.

Ten-Year Changes in Vision, Refractive Error, and Corneal Thickness After Descemet Stripping Automated Endothelial Keratoplasty for Fuchs Endothelial Corneal Dystrophy.

The goal of this study was to determine changes in best-corrected visual acuity (BCVA), refractive error, and central corneal thickness (CCT) during the first decade after Descemet stripping automated endothelial keratoplasty (DSAEK). Outcomes of all consecutive eyes undergoing DSAEK for Fuchs endothelial corneal dystrophy (FECD) were reviewed; eyes with untreatable comorbidities before DSAEK were excluded. DSAEK was performed through a temporal incision and all eyes were pseudophakic postoperatively. Changes in BCVA, manifest spherical equivalent, manifest cylinder (vector analysis), and CCT were assessed by using generalized estimating equation models. BCVA improved between 6 months (0.18 ± 0.12 logarithm of the minimum angle of resolution (logMAR); Snellen equivalent, 20/30) and 5 years (0.10 ± 0.10 logMAR; 20/25; n = 74, P < 0.001) and then remained stable at 10 years (0.09 ± 0.10 logMAR, n = 48, P = 0.22). There was a myopic shift of -0.20 ± 0.51 D between 6 months and 5 years (n = 65, P = 0.002) that remained stable at 10 years (-0.09 ± 0.44 D; 20/25; n = 34, P = 0.33). Manifest cylinder drifted with-the-rule between 6 months and 5 years (n = 65, P < 0.001) and between 5 and 10 years (n = 34, P < 0.001). CCT was stable between 6 months (672 ± 57 μm) and 5 years (677 ± 55 μm, n = 67, P = 0.47), but increased at 10 years (702 ± 60 μm, n = 39, P = 0.001). Excellent BCVA can be achieved during the first decade after DSAEK for FECD, although improvement seems to plateau after 5 years. Changes in manifest refractive error were not clinically significant. The gradual increase in CCT was consistent with longer-term changes found after other types of keratoplasty.