To describe a sutureless technique for iris fixation of a 3-piece intraocular lens (3P-IOL) in the anterior chamber in eyes without capsular support, and to evaluate its outcomes. Twelve patients (10 aphakic, 2 with 3P-IOL subluxation post-Yamane technique) underwent detailed ophthalmologic evaluation. In required cases, anterior vitrectomy and 0.01% carbachol (Miostat, Alcon Laboratories, Fort Worth, TX, USA) were used to achieve miosis. Two mid-peripheral iridectomies were created with a vitrectomy probe. After viscoelastic injection, a 3P-IOL (SENSAR, Johnson and Johnson Vision, USA) was inserted into the anterior chamber using a cartridge. Haptics were positioned behind the iris through the iridectomy sites using microforceps. In subluxated intraocular lens (IOL) cases, the lens was repositioned similarly. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial density (CED) were recorded preoperatively, at 1 month, and at the final visit. The cohort included eight males and four females (mean age: 71.08 ± 4.07 years). Postoperative BCVA improved significantly (P < 0.001). No significant differences were found in IOP, CMT, or CED (P > 0.05). One case of transient IOP elevation was managed medically. Over a mean follow-up of 20.9 ± 4.8 months, no complications such as pigment dispersion, uveitis, hemorrhage, IOL decentration, macular edema, or corneal decompensation occurred. Iris fixation of a 3-piece IOL without sutures is a fast and effective technique that has demonstrated favorable short-term safety in patients without capsular support, provided that adequate anterior chamber depth and endothelial health are present.

PurposeTo examine the visual outcomes and complication rates for IOL (intraocular lens) exchange, analysed by combination of surgical indication and secondary IOL implantation site.DesignRetrospective case series of IOL exchange procedures performed between June 1998 and July 2018 from a single tertiary referral centre, London, United Kingdom.MethodsConsecutive IOL exchange procedures with pre-operative and 6-month post-operative visual acuity and complication data were eligible.Results318 eyes from 288 patients were included. Mean best-corrected visual acuity (BCVA) improved from 0.82 ± 0.77 to 0.47 ± 0.60 LogMAR at 6 months (p < 0.001), in particular following complete IOL dislocation (adjusted p < 0.001), partial IOL dislocation (adjusted p = 0.001), refractive indications (adjusted p = 0.02), and pseudophacodonesis (adjusted p = 0.02). The most performed and the greatest BCVA improvement was found with subsequent anterior chamber IOL implantation (-0.44 ± 0.72 LogMAR, n = 214, 67%). The poorest BCVA at 6 months was following IOL exchange for corneal oedema (1.13 ± 0.81 LogMAR, n = 16, 5%). 26% of cases underwent concurrent pars plana vitrectomy, and 15% underwent anterior vitrectomy, with 8% experiencing post-operative cystoid macular oedema.ConclusionsIOL exchange is safe and effective, however careful patient selection and pre-operative counselling assisted by such data should determine when surgery should be undertaken.

Infectious endophthalmitis is a rare but vision-threatening complication following keratoplasty. With the evolution of corneal transplantation techniques toward endothelial keratoplasty (EK) and anterior lamellar keratoplasty (ALK), contemporary pooled incidence estimates stratified by surgical technique and geographic region are required to inform perioperative prevention strategies and postoperative surveillance. This study aimed to provide an updated systematic review and single-arm meta-analysis evaluating the incidence and risk factors of infectious endophthalmitis after keratoplasty. This systematic review and meta-analysis was conducted according to PRISMA guidelines. Five databases (PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane Library) were searched from inception to December 31, 2025. Observational studies reporting incidence of infectious endophthalmitis after keratoplasty were included. A random-effects single-arm meta-analysis of proportions with logit transformation was performed. Subgroup analyses were conducted by keratoplasty type, geographic region, study period, and follow-up duration. Heterogeneity was assessed using the I2 statistic and τ2, and prediction intervals (PIs) were calculated when appropriate. Twenty-one studies comprising multiple keratoplasty procedures were included. The pooled incidence of infectious endophthalmitis after keratoplasty was 0.40% (95% CI 0.30-0.50), with a prediction interval of 0.08-1.95%, indicating substantial between-study variability. Significant heterogeneity was observed (I2 = 95.75%, τ2 = 0.59, p < 0.001). Stratified analyses showed higher incidence after penetrating keratoplasty (0.50%; 95% CI 0.30-0.60) compared with ALK (0.20%; 95% CI 0.01-0.30) and EK (0.20%; 95% CI 0.20-0.30) (p < 0.0001). By region, incidence was 0.40% in North America, 0.30% in Asia, and 0.70% in Europe (p = 0.007). Incidence varied by follow-up duration: 0.20% (≤ 1month), 0.60% (1-12months), and 0.30% (> 12months) (p = 0.007). Frequently reported risk factors included penetrating keratoplasty, combined intraocular procedures, anterior vitrectomy, donor-related contamination, delayed suture removal, and higher systemic comorbidity burden. Visual outcomes were generally poor, with frequent graft failure and limited visual recovery. Post-keratoplasty infectious endophthalmitis remains uncommon but clinically consequential. Penetrating keratoplasty showed a higher pooled incidence than lamellar techniques in this synthesis, and meaningful geographic variation persists. These findings indicate lower pooled incidence estimates with lamellar techniques in this synthesis and highlight the importance of rigorous perioperative infection-prevention strategies.

To compare complication risks and visual outcomes between pars plana vitrectomy (PPV) and anterior vitrectomy (AV) in scleral-fixated intraocular lens (SFIOL) implantation. We searched PubMed, MEDLINE, Scopus, EMBASE, the Cochrane Library and Google Scholar. Primary outcomes included postoperative complications-retinal detachment (RD), vitreous prolapse, cystoid macular edema (CME), elevated intraocular pressure (IOP), vitreous Haemorrhage and intraocular lens (IOL) capture-and changes in best-corrected visual acuity (BCVA). We performed random-effects meta-analyses and assessed certainty of evidence using the GRADE framework. We included five studies comprising 522 eyes. PPV was associated with lower odds of retinal detachment (RD) (OR = 0.11, 95% CI: 0.02-0.57, p < 0.01) and vitreous prolapse (OR = 0.10, 95% CI: 0.02-0.60, p < 0.01) compared with AV; however, no events occurred in the PPV arm for both outcomes. The two groups did not differ significantly in the risks of CME, elevated IOP, or vitreous haemorrhage. PPV was associated with a higher risk of IOL capture (OR = 3.12, 95% CI: 1.30-7.46, p < 0.01) and postoperative BCVA improvement was comparable (MD = -0.05, 95% CI: -0.12 to 0.02). GRADE certainty was very low to low. PPV may be associated with a reduced risk of retinal detachment and vitreous prolapse, but increased risk of IOL capture compared with AV in SFIOL implantation, with comparable visual outcomes. Given the lower certainty of evidence for most outcomes, surgeons should interpret these findings in the context of their surgical expertise and individual patient characteristics.

• IVI within 90 days of cataract surgery increased postoperative macular edema risk. • Vitreous hemorrhage risk was greater at 90 days in patients with preoperative IVI. • No increased risk found for infection, retinal detachment, or other complications. To evaluate whether a recent history of intravitreal injection is associated with postoperative complications after cataract surgery in a large, real-world cohort. Retrospective, propensity score–matched cohort study. Adults undergoing cataract surgery with or without at least one intravitreal injection within 90 days before surgery were identified from the U.S. TriNetX research network. Cohorts were matched for demographic characteristics and ocular and systemic comorbidities. Postoperative complications at 14, 30, and 90 days were compared using risk ratios with 95% confidence intervals. After matching, 10,107 patients with recent intravitreal injection and 10,107 controls were included. A recent intravitreal injection history was associated with higher rates of postoperative macular edema at 14, 30, and 90 days (RR range 2.07–2.69) and vitreous hemorrhage at 90 days (RR 1.74). Absolute risk differences were modest. No significant associations were observed for infection, retinal detachment, anterior vitrectomy, lens dislocation, anterior uveitis, or secondary lens procedures. In this large retrospective analysis, patients undergoing cataract surgery with a recent history of intravitreal injection had higher observed rates of postoperative macular edema and vitreous hemorrhage, while other major complications were not increased. These associations likely reflect the presence of underlying retinal disease rather than a direct effect of the injection procedure itself and should be interpreted as non-causal.

Sympathetic ophthalmia (SO) is a rare bilateral granulomatous uveitis occurring after ocular trauma or intraocular surgery. Pediatric case has special diagnostic challenges due to limited cooperation and overlapping presentations with other inflammatory disorders. An 8-year-old boy presented with progressive bilateral visual impairment 6 months after sustaining a penetrating corneoscleral injury to the right eye caused by a metallic object. At the initial presentation, the right eye showed corneal edema with sutures from the previous corneal repair. The previously uninjured left eye also demonstrated active inflammatory changes. Both eyes showed severe anterior segment inflammation characterized by iris bombe, irregular pupil, pupillary membrane formation, lens opacity, and choroidal thickening consistent with bilateral panuveitis. Based on the history of penetrating trauma, the latent period, and the presence of bilateral granulomatous uveitis, a clinical diagnosis of SO was established. Initial management consisted of topical and systemic corticosteroids, followed by surgical intervention, including corneal wound revision with anterior chamber washout in the right eye and synechiolysis, anterior chamber irrigation–aspiration, posterior capsulotomy, anterior vitrectomy, and foldable intraocular lens implantation in the left eye. Postoperatively, visual acuity did not improve significantly, but the intraocular inflammation and other clinical symptoms were successfully controlled. SO is a case that could occur after penetrating ocular trauma or intraocular surgery. In pediatric patients, the disease often follows a more aggressive pattern with rapid progression and a higher risk of complications. Therefore, early recognition, prompt systemic immunosuppression, and timely surgical intervention remain essential to preserve ocular structure and prevent further deterioration. This case emphasized that every child presenting with bilateral intraocular inflammation after ocular trauma should be promptly evaluated for SO to avoid irreversible vision loss through early multidisciplinary intervention and long-term follow-up.

To assess the outcomes of surgical management of aqueous misdirection (AM) by endoscopic pars plana vitrectomy with hyaloido-zonulo-iridectomy. In this prospective, longitudinal, noncomparative interventional study, 53 eyes from 46 patients with AM refractory to medical and laser therapy after intraocular surgery were enrolled. All eyes underwent lens removal (if phakic), endoscopic pars plana vitrectomy, and hyaloido-zonulo-iridectomy. Primary outcomes included intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior chamber depth (ACD), postoperative complications, relapse rate, and composite surgical success. Surgical success was defined as the combination of IOP control and anterior chamber reformation, using two alternative IOP thresholds ( ≥ 6 and ≤18 mmHg, or ≥6 and ≤21 mmHg). Continuous variables were analysed using linear mixed models and expressed as estimated means (est)± standard error. Mean age was 59.7 ± 12.2 years. The est. IOP decreased from 34.36 ± 0.82 mmHg to 17.47 ± 0.82 mmHg at 12 months (p < 0.001). The est. BCVA improved from 1.50 ± 0.07 to 0.70 ± 0.07 logMAR at 12 months (p < 0.001). The est. ACD increased from 0.70 ± 0.06 to 3.34 ± 0.06 mm (p < 0.001), with complete anterior chamber reformation in all eyes. Postoperative complications occurred in 22 eyes (41.8%), mostly transient and resolved with medical or YAG laser treatment; only one required glaucoma surgery. At 12 months, overall success was 98.1% using the ≤21 mmHg criterion and 75.5% using the ≤18 mmHg criterion. No relapses were observed. Surgical management using lens removal, endoscopic anterior vitrectomy, and hyaloido-zonulo-iridectomy is a significantly effective and safe treatment for AM.

Cataract Surgery with IOL Implantation in Children with Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis (JIA) or Antinuclear Antibody (ANA)-Positive Uveitis: Mid-term Results and Predictors for Outcome.

The aim of the multilevel revision is asingle-stage, ideally definitive surgical treatment of corneal-endothelial-epithelial decompensation and bullous keratopathy caused by an anterior chamber iris claw intraocular lens (IOL) by means of IOL explantation, complete pars plana vitrectomy, secondary IOL implantation and simultaneous Descemet membrane endothelial keratoplasty (DMEK). The prerequisite for surgery is the absence of pre-Descemet corneal scars. For complete mobilization of the dislocated anterior chamber IOL the haptics are severed and the lens is removed through a6 mm wide superior sclerocorneal tunnel. Complete anterior and posterior 25-gauge vitrectomy is performed including removal of the active posterior vitreous detachment. After manual iris tissue stretching, aretroiridal iris claw IOL is implanted. In the end, DMEK with adonor graft size of 7.5 mm is performed via temporal access for treatment of the corneal decompensation. In patients with corneal-endothelial-epithelial decompensation and bullous keratopathy due to adislocated anterior chamber IOL, IOL explantation with complete vitrectomy, secondary implantation of aretroiridal, iris-fixated IOL and combined DMEK is an effective, single-stage surgical treatment. The online version of this article contains avideo.

This study evaluated the effectiveness of surgeon self-reporting and anterior vitrector equipment billing in identifying intraoperative posterior capsular tears (PCT) with vitreous loss during cataract surgery. A total of 19,258 cataract surgeries performed over six years at the John A. Moran Eye Center were analyzed, with 343 potential complications identified through billing or self-reporting, and 193 confirmed PCT cases based on chart review. Billing data captured 83.9% of PCTs but lacked specificity, including many non-PCT uses of anterior vitrectomy. Surgeon self-reporting was highly specific, with 100% accuracy according to operative reports, but detected only 58.5% of total PCT cases. The findings highlight the strengths and limitations of both methods-billing is sensitive but overinclusive, while self-reporting is accurate but underutilized. Neither method alone was sufficient to identify all complications, emphasizing the need for a standardized, comprehensive approach to intraoperative complication monitoring to enhance patient safety and quality assurance in ophthalmic surgery.

Purpose: This study evaluates the association between supervising attending surgeons’ post-residency experience and complication rates during resident-performed phacoemulsification (cataract extraction) surgeries, and to determine whether this relationship changes as the academic year progresses. Methods: A retrospective analysis of 1263 cataract surgeries performed by eight PGY-4 residents under 14 board-certified attendings was conducted at a New York City residency program over two years. Attendings were divided into four groups based on years of post-residency experience. Primary complications included posterior capsule (PC) tears, anterior vitrectomy (AV), capsulorrhexis extensions (CE), and inability to place a one-piece intraocular lens (IOL). Chi-square analyses compared complication rates between attending groups overall, and between the first and second halves of the academic year. Results: A total of 167 primary complications (13.2%) were identified. Attendings with the fewest years of experience (Group 1) supervised significantly more cases with PC tears (χ2 = 8.173, p = 0.004), AV usage (χ2 = 7.748, p = 0.005), and inability to place a one-piece IOL (χ2 = 4.753, p = 0.029), particularly during the first half of the academic year. Notably, supervising attending experience was not correlated with resident complications in the second half of the academic year. Conclusions: Early in the academic year, less experienced attendings supervised cases with higher complication rates, underscoring the critical role of strategic case assignment and targeted mentorship during early surgical training. These findings suggest that aligning resident progression with appropriate supervision can enhance outcomes and support skill development, optimizing both education and patient safety.

PurposeTo compare the clinical and refractive outcomes of anterior vitrectomy (AnV) and pars plana vitrectomy (PPV) in patients undergoing modified Yamane intrascleral fixation for secondary intraocular lens (IOL) implantation.MethodsIn this retrospective, comparative study, 74 eyes of 74 patients who underwent modified Yamane intrascleral fixation between January 2021 and August 2024 were included. Patients were categorized into two groups: AnV (n = 45) for subluxated IOLs and PPV (n = 29) for nucleus drop or IOL luxation. Postoperative visual acuity (uncorrected [UDVA] and corrected distance [CDVA]), refractive stability, IOL tilt, endothelial cell count (ECC), lenticular astigmatism, and complications were assessed. IOL tilt was measured by using swept-source optical coherence tomography.ResultsPostoperative UDVA and CDVA were significantly higher in the AnV group (p < 0.001). IOL tilt was similar between groups (p = 0.591). Corneal astigmatism was lower in the AnV group (-1.00 D vs. -1.75 D, p < 0.001), while ECC was significantly better preserved compared to the PPV group (1784 ± 520 vs. 1234 ± 652 cells/mm2, p < 0.001). The median tilt angle was 1.87° (range: 0.15°-10°) in the AnV group and 1.85° (range: 0.47°-8.50°) in the PPV group (p = 0.591). Postoperative lenticular astigmatism values were similar between the groups (p = 0.124). Lenticular astigmatism correlated with IOL tilt (r = 0.794, p < 0.001). Complication rates, including cystoid macular edema and epiretinal membrane formation, were similar between groups (p = 0.383, p = 0.780).ConclusionsBoth AnV and PPV yielded comparable refractive and IOL positioning outcomes in modified Yamane intrascleral fixation. However, AnV demonstrated superior endothelial preservation, lower corneal astigmatism, and better visual acuity, suggesting an advantage.

To report the outcomes of lensectomy, anterior vitrectomy, and iris-claw lens implantation in patients with spherophakia- or microspherophakia-related glaucoma. In this retrospective case series, we focused on patients with isolated microspherophakia or microspherophakia associated with various syndromes and mild to moderate angle-closure glaucoma who had undergone lensectomy, anterior vitrectomy, and iris-claw lens implantation. We analyzed a total of 12 eyes of 6 patients with a mean age of 19 6 years and a mean postoperative follow-up of 66 12 months. All patients had lenticular myopia, and the mean refraction improved from 7.26 0.67 diopters (D) to 1.18 1.04 D after surgery. The mean corrected visual acuity improved from 0.92 0.57 logMAR before surgery to 0.17 0.15 logMAR at the last follow-up (P = 0.001). The mean intraocular pressure (IOP) decreased from 21.2 3.9 mmHg on 1.9 0.7 anti-glaucoma medications at baseline to 15.0 1.5 mmHg (P = 0.006) on 0.8 0.7 medications (P = 0.006) at the last follow-up. Lensectomy and iris-claw lens implantation in our cases not only decreased the IOP and reduced the number of glaucoma medications, but also improved the best-corrected visual acuity. Removal of the abnormally shaped lens likely contributed to these changes.

Rationale:Malignant glaucoma (MG) results from aqueous misdirection and entrapment in the vitreous cavity. This process drives anterior displacement of the lens-iris diaphragm, causing uniform shallowing of the central and peripheral anterior chamber, typically with elevated intraocular pressure (IOP). Clear lens extraction with anterior vitrectomy remains the definitive intervention.Patient concerns:We report a rare case of MG following combined pars plana vitrectomy (PPV) and intraocular lens (IOL) implantation and detail its management. A 49-year-old Chinese male presented with a history of ocular trauma in the left eye, which was treated 17 years ago by PPV with lensectomy. After secondary IOL implantation with pupilloplasty was successfully performed, the patient experienced recurrent episodes of shallow anterior chamber and elevated IOP (peaking at 44 mm Hg), which could not be resolved by maximal medical therapy, suture-leakage assisted incision, or laser peripheral iridotomy.Diagnoses:The condition was considered postoperative MG.Interventions:The patient underwent a second surgery, which was trabeculectomy combined with partial irido-zonulo-hyaloid-vitrectomy.Outcomes:Subsequent follow-up demonstrated stable anterior chamber depth and normalized IOP.Lessons:To resolve MG, the fundamental objective must be restoring pressure equilibrium across the ciliary body-zonules-lens-hyaloid-anterior vitreous complex. Achieving this requires reconstructing the complex’s structural integrity and normalizing its regulatory function in aqueous humor circulation.

Patient: Male, 37-year-oldFinal Diagnosis: Intraocular lens (IOL) opacitySymptoms: Decrease of visionClinical Procedure: —Specialty: OphthalmologyObjective: Unusual clinical courseBackgroundGyrate atrophy is a rare metabolic disease that profoundly impacts the choroid and retina. This condition is recognized for its ocular comorbidities, including a predisposition to the development of posterior subcapsular cataract and compromised zonular integrity, both of which ultimately necessitate surgical management. While cataract surgery is a common intervention, it can have long-term sequelae. Intraocular lens (IOL) opacity is a known complication, with various morphological patterns documented in the ophthalmic literature. However, no specific pattern of IOL opacification has been previously reported in an individual with gyrate atrophy. This paper describes a novel and previously unreported pattern of intraocular lens (IOL) opacification in a patient with gyrate atrophy.Case ReportWe present the case of a 37-year-old man with genetically confirmed gyrate atrophy who experienced a significant decline in vision following an initially uncomplicated cataract surgery. He later developed a late subluxation of the IOL and subsequently formed distinctive rosette-shaped opacities on the lens implant. He underwent successful surgical removal and insertion of a scleral-tucked IOL along with anterior vitrectomy. Analysis of the material on microscopy and histopathology revealed unique crystalline deposits that stained positive with von Kossa stain and showed birefringence under polarized light, consistent with calcium oxalate – a finding not previously associated with IOL opacification.ConclusionsTo the best of our knowledge, these opacities have never been described in a patient with gyrate atrophy. This case report shows the need for regular monitoring for patients with gyrate atrophy after cataract surgery and proposes a potential pathophysiological mechanism linking this complication to gyrate atrophy.

To evaluate the efficacy and safety of multifocal versus monofocal intraocular lens (IOL) implantation in children with cataracts in a real-world setting. Prospective, nonrandomized comparative clinical study. Pediatric patients who underwent cataract surgery with multifocal IOL optic implantation in Berger space or monofocal IOL implantation with primary posterior capsulorhexis (PCCC) and anterior vitrectomy (AV) were recruited for this study. The efficacy outcome was postoperative visual acuity (corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA)), modulation transfer function (MTF), Strehl ratio (SR), ocular scatter index (OSI) and stereopsis. The safety outcomes were postoperative complications. A total of 571 eyes of 402 children were included in our study. Multifocal IOLs were implanted in 219 children (311 eyes) and monofocal IOLs in 183 children (260 eyes). Visual results in bilateral or unilateral patients were better after multifocal IOL implantation than after monofocal IOL implantation, regardless of CDVA and DCNVA (P < .05). More patients developed postoperative Titmus stereopsis ≤100 arcseconds after multifocal IOL implantation compared to monofocal IOL implantation (both P < .05). The MTF and SR values showed a significant increase, and the OSI values showed a significant decrease after surgery (both P < .001). MTF cut-off, Strehl ratio, and OSI values showed no significant differences between unilateral and bilateral patients with multifocal or monofocal IOLs (P > .05). Multifocal IOL patients achieved higher spectacle independence than monofocal IOL patients (51.67% vs 37.31%, P = .033). IOL optic implantation in Berger space was achieved in 93.25% of the eyes with the multifocal IOL implantation (290/311). After surgery, the incidences of corneal edema, transient intraocular hypertension and visual axis opacification (VAO) of children after multifocal IOL implantation in Berger space were lower (2.28% vs 9.84%, P = .017; 2.28% vs 12.02%, P = .006; 0% vs 6.56%, P = .014). During the follow-up period of this study, multifocal intraocular lens optic implantation in Berger space demonstrated favorable safety and efficacy in improving visual function for rigorously screened pediatric cataract patients.

We report a rare case of penetrating corneal and lens injury with a pars plana foreign body in a teenager and a technique for removing such an intraocular foreign body (IOFB) during complex reconstructive surgery. A 16-year boy was admitted urgently to the Pediatric Ophthalmology Department with complaints of decreased vision in his right eye. He had received a mowing-related injury to the eye three days before presentation. Urgent surgical intervention included initial surgical treatment of the wound, phacoaspiration of traumatic cataract with anterior vitrectomy and endocapsular implantation of a +23.0 D Acrysof SN60WF intraocular lens (IOL), and removal of IOFB from the pars plana. We used wide-spatula scleral compression at the ciliary body not only for visualizing and removing the IOFB, but also for assessing the status of the surrounding tissue (the presence or absence of mild suppurative lesions). The IOFB was removed anteriorly (via cataract incision and anterior and posterior capsulorhexes) with a magnet under direct intraoperative microscopic control. The preservation of residual capsular fornices enabled us to perform primary endocapsular IOL implantation immediately. Therefore, we managed to perform a complete rehabilitation of the injured teenager (IOFB and traumatic cataract removal and endocapsular IOL implantation) using one limbal incision in a single surgery.

Posterior capsule opacification in children: comparison of posterior continuous curvilinear capsulorhexis alone and pars plana posterior capsulectomy with anterior vitrectomy.

PurposeTo describe the intraoperative Flutter Sign as a real-time indicator of anterior hyaloid face (AHF) integrity following posterior capsule tear (PCT) during phacoemulsification.DesignSingle-centre observational study combining retrospective review of twelve intraoperative PCT cases with prospective evaluation of eight additional cases. Retrospective observations guided structured assessment in the prospective arm, focusing on PCT edge behaviour and AHF integrity.MethodsSurgical videos of twelve eyes with intraoperative PCT were analysed for tear edge morphology and motility. Based on these findings, eight prospectively observed PCT cases were examined intraoperatively for edge behaviour and AHF status. Additional parameters included need for vitreous surgery, type of intraocular lens (IOL) implanted, and intraoperative and postoperative complications associated with PCT.ResultsEleven eyes demonstrated sharp, fluttering PCT edges with intact AHF, no vitreous prolapse, and no need for anterior vitrectomy. Of these, five received in-the-bag IOLs, while six underwent sulcus fixation. All achieved a best corrected visual acuity (BCVA) of 20/20. Nine eyes exhibited scalloped, non-fluttering edges, consistent with AHF rupture and vitreous prolapse. All required anterior vitrectomy and sulcus-fixated IOLs. Three patients in this group experienced posterior migration of lens material: two had small cortical or nuclear fragments that were clinically insignificant and required no intervention, while one patient had a large nuclear fragment that necessitated a secondary procedure for removal. BCVA was reduced in two eyes to 20/30. Two patients experienced transient elevation of intraocular pressure. No cases of retinal detachment or endophthalmitis were observed.ConclusionThe Flutter Sign is a simple, dye-free, real-time indicator of AHF integrity after PCT, with fluttering edges signifying intact AHF and scalloped static edges indicating vitreous prolapse.

We report on two cases of transient maculopathy following uneventful cataract surgery with intracameral administration of cefuroxime. Both patients achieved a visual acuity of no more than 20/200 on day 1 after surgery. Optical coherence tomography revealed a neurosensory detachment of the retina with schisis-like alterations in the outer nuclear layer. These findings completely resolved within 6 days of treatment with prednisolone acetate and nepafenac eye drops, resulting in full visual recovery.Intracameral administration of antibiotics, in Europe as cefuroxime 1 mg/0.1 ml, is recommended for endophthalmitis prophylaxis at the end of cataract surgery. At the same time, an association appears to exist between the rare occurrence of specific maculopathies and the application of cefuroxime, particularly in cases of overdose, but also sporadically. Patients who have undergone pars plana or anterior vitrectomy apparently have an inherently higher risk of developing maculopathy.Transient cefuroxime maculopathy usually has a benign, self-limiting course. Cataract surgeons should be aware of this condition and avoid overdosing that otherwise safe and effective drug.