To report the short- and long-term outcomes of sutured scleral-fixated capsular tension segments (CTS) in patients with lens instability. This retrospective study included 21 eyes of 21 patients who underwent scleral fixation of a CTS, with or without capsular tension ring (CTR) ± intraocular lens (IOL) implantation, between 2015 and 2023 at two academic centers. The primary outcome was stability of the IOL-bag complex, defined as centration without tilt or reintervention. Secondary outcomes included corrected distance visual acuity (CDVA), refractive stability, and postoperative complications, classified as early (≤ 4weeks) or late (> 4weeks). Minimum follow-up was 6months, with a subgroup of eyes ≥ 12months. Outcomes were compared between polypropylene and Gore-Tex sutures. Mean patient age was 59.1 ± 18.6years, and mean follow-up 28.6months (range 6-80). Mean zonular dialysis was 142° ± 41° (range 60°-210°), with two cases requiring two CTSs. At final follow-up, 85.7% of eyes achieved CDVA of 20/40 or better. Early complications occurred in 5 eyes (23.8%), including cystoid macular edema (14.3%), wound leak (4.8%), and posterior capsular rupture (4.8%). Late complications were limited to one haptic displacement and one polypropylene suture rupture; no late events occurred with Gore-Tex. Scleral fixation of CTSs is a safe and effective strategy for lens subluxation, providing stable long-term centration of the IOL-bag complex with good visual outcomes and low complication rates. Gore-Tex demonstrated superior long-term durability, supporting its use when extended stability is required, particularly in cases with ≥ 120º degrees of zonular dialysis.

Objectives: This study aimed to evaluate the safety and efficacy of the eight-chop technique in cataract surgery in patients with pseudoexfoliation (PEX) syndrome and assess the intraoperative parameters, changes in corneal endothelial cells, intraocular pressure (IOP), and intraoperative complications. Methods: This technique was applied in patients with and without PEX syndrome. Preoperative and postoperative assessments were conducted on best-corrected visual acuity, IOP, corneal endothelial cell density (CECD), coefficient of variation, percentage of hexagonal cells, and central corneal thickness. Intraoperative recordings included operative time, phaco time, aspiration time, cumulative dissipated energy (CDE), and fluid of volume used. Results: We analyzed 150 eyes from 150 patients (mean age, 75.5 ± 5.7 years; 59 men, 91 women). In the PEX group, operative time, phaco time, aspiration time, CDE, and volume of fluid used were 6.7 min, 17.4 s, 85.2 s, 6.91 µJ, and 33.4 mL, respectively, demonstrating favorable surgical metrics. On the other hand, in the control group, operative time, phaco time, aspiration time, CDE, and volume of fluid used were 4.5 min, 14.3 s, 64.0 s, 5.83 µJ, and 25.5 mL, respectively. In addition, CECD losses were 3.7% at week 7 and 2.7% at week 19 in the PEX group and 2.7% and 1.6%, respectively, in the control group. Significant decreases were observed at 7 and 19 weeks postoperatively in the PEX and control groups. No eye in the PEX group required a capsular tension ring due to zonular dialysis. Conclusions: The eight-chop technique in cataract surgery demonstrates excellent intraoperative parameters in patients with PEX, is effective against zonular weakness, and does not require the use of a capsular tension ring. This technique will aid in establishing personalized treatment strategies and improve cataract management and treatment.

PurposeTo investigate the mechanism, intraoperative characteristics, management, and prevention of incision capsular bag herniation (ICBH), a previously unreported complication during cataract surgery in eyes with lens subluxation.MethodsA retrospective observational case series was conducted on five male patients who developed ICBH during phacoemulsification with intraocular lens (IOL) implantation between January 2019 and December 2024. Among 867 subluxated-lens surgeries performed during this period, the estimated incidence of ICBH was 0.58%. Clinical data was reviewed to identify predisposing factors and outcomes. Each case was managed through a stepwise intraoperative process consisting of IOP reduction, capsular decompression, capsular bag repositioning, and anterior vitrectomy.ResultsICBH occurred adjacent to the main corneal incision near areas of 1–2 quadrants of zonular dialysis. Triggers included IOL injector insertion (2 cases), ophthalmic viscosurgical device (OVD) injection (1 case), and aspiration tip withdrawal (2 cases). Contributing factors included elevated IOP and sudden decompression. The herniated tissue comprised an OVD-distended capsular bag with vitreous incarceration. The stepwise protocol led to successful capsular repositioning and in-the-bag IOL implantation in all cases. Best-corrected visual acuity improved from a preoperative range of 1.3 to 0.3 logMAR (median, 0.5) to a postoperative range of 0.7 to 0.0 logMAR (median, 0.1). No IOL decentration occurred. One case each of cystoid macular edema and choroidal detachment was noted.ConclusionICBH results from zonular weakness, incision location, IOP fluctuation, OVD dynamics, and capsular biomechanics. With appropriate intraoperative management, favorable outcomes are achievable. Prevention includes zonular assessment, incision planning, and pressure control. Further studies are needed.

Abstract Purpose: We aimed to evaluate the effectiveness and safety of anterior chamber intraocular lens (ACIOL) implantation in vitrectomized eyes following complicated resident-performed cataract surgeries at a teaching institute in Mumbai. Patients and Methods: This retrospective study analyzed 109 patients who underwent ACIOL implantation post-vitrectomy for aphakia secondary to complications such as posterior capsular tear, nucleus drop, and zonular dialysis. All procedures were performed by a single experienced surgeon to ensure consistency. The mean follow-up duration was 29 months. Two patients were lost to follow-up. Outcomes, including best-corrected visual acuity (BCVA), intraocular pressure (IOP) changes, and postoperative complications, were assessed. Results: The majority of patients demonstrated significant visual improvement or stability at their last follow-up. ACIOL placement was associated with repeatable, predictable outcomes in a teaching hospital setting where junior residents perform high-risk cataract surgeries. Postoperative cystoid macular edema (CMO) was observed in a small subset, but medical management yielded good responses. Transient IOP elevation was noted in some cases, which was managed effectively with topical medications. The incidence of corneal decompensation was rare, underscoring the safety of modern open-loop ACIOL designs when implanted correctly with adequate vitrectomy. Conclusions: ACIOL implantation in vitrectomized eyes remains a viable, economical, and efficient solution for treating aphakia in non-affording patients within a teaching institution. The short learning curve and ease of implantation make it a practical choice for secondary IOL placement, ensuring satisfactory outcomes even in cases of intraoperative complications.

This video introduces a novel approach to anterior segment surgeries, specifically addressing the challenges of iridodialysis repair and modified capsular tension ring fixation. Unlike routine cataract surgeries, these procedures demand a high level of expertise due to their infrequent occurrence and intricate nature. The proposed technique, named the “Easy pass technique,” involves the creation of a scleral pocket, precise needle handling, and innovative use of a carrier-cannula system, eliminating the need for a needle holder. The method was successfully applied in cases of iridodialysis repair and modified capsular tension ring fixation, showcasing its adaptability. The technique is superior for novice surgeons, enhancing stability and control, especially when using the nondominant hand. The modified approach of reverse docking within the anterior chamber proves valuable in challenging scenarios. Furthermore, the technique allows for bimanual handling, offering an extra hand for delicate maneuvers. This innovative approach provides a simplified and effective method for training novice surgeons and presents potential advancements in safety and applicability through future customization. Background: Among anterior segment surgeries, procedures such as iridodialysis repair and modified capsular tension ring fixation demand a high level of expertise and ambidextrity. Many existing techniques involve the intricate handling of a lengthy needle with nonabsorbable suture.[1,2] This makes the learning curve for mastering these surgeries quite prolonged. We introduce an innovative technique in this video, named the “Easy pass technique,” designed to facilitate the learning process for novice surgeons in performing these intricate procedures. Purpose: The proposed technique simplifies iridodialysis repair by using a carrier-cannula attached to a syringe, providing better control and preventing inadvertent upward, downward, or sideward movements. This technique also minimizes difficulties during maneuvers in cases of nasal iridodialysis, especially in patients with short palpebral fissures or deep sockets, where using the non-dominant hand is challenging. Synopsis: The reverse scleral pocket technique is used for iridodialysis and zonular dialysis after localized limbal conjunctival peritomy. A 1 mm paracentesis is made opposite the scleral pocket site, and a hypodermic 26G needle is bent at the proximal 1/4th site. A long straight needle of the 9-0 prolene suture is docked inside the bent needle, ensuring the needle remains in the cannula. The needle-cannula complex is then introduced through the paracentesis, guided through the iris tissue, and exited through the scleral pocket. A modification, introducing the 26G cannula initially through the paracentesis and reverse docking inside the anterior chamber, would ease the procedure. If an inadvertent needle exit occurs, the cannula can be withdrawn first, allowing the long needle, which is 16 mm long, to remain in the paracentesis and be pulled out using a needle holder. Highlights: The technique is similar to the modified sewing machine technique described by Kumar KV R et al.,[3] which involves passing a hypodermic needle (threaded with Prolene suture) through iris tissue, creating a larger hole (external diameter of 26G cannula is 0.46 mm)[4] than the one created by fine needle (diameter is 0.15 mm).[5] A smaller hole made in the iris would decrease the chance of cheese wiring during suture tying in thin, floppy iris. The alternate iris bypass technique is another technique described by Balamurugan et al.,[6] in which a needle is inserted entirely into a 26G cannula for an ab interno approach, with the cannula used to pierce the sclera. While this method benefits from using the cannula as a carrier, our technique differs in that the needle is inserted straight, and it is the needle—not the cannula—that pierces the iris and sclera, resulting in a tiny hole and exit point. In conclusion, the easy pass technique simplifies both iridodialysis repair and modified capsular tension ring fixation. It is especially beneficial for beginners, allowing them to perform these procedures more easily and with increased safety, owing to the creation of minimal entry and exit points. Additionally, it proves advantageous for surgeons in situations where one needs to operate using their nondominant hand. Video Link: https://youtu.be/0rOFz0iTv68

To investigate the morphologic characteristics of lens in cataract patients with zonular dialysis (ZD) before and after cycloplegia by anterior-segment optical coherence tomography (AS-OCT). Peking University Third Hospital, Beijing, China. Cross-sectional observational study. 56 eyes from 56 participants who would undergo cataract operations were included, with 29 eyes of normal controls and 27 eyes of patients with ZD. Lens morphologic parameters were then evaluated by AS-OCT, including anterior chamber depth (ACD), lens thickness (LT), lens diameter, lens vault, anterior curvature radius, posterior curvature radius, decentration, and tilt of lens. After participants were treated with 3-time tropicamide solution, AS-OCT was repeated to acquire postcycloplegia results. SPSS 22.0 software was used for statistical analysis. The comparison of basic lens morphologic parameters without cycloplegia found that only anterior curvature ( P = .039) showed significant differences between normal and ZD groups. AS-OCT measured after 30-minute cycloplegia treatment showed significantly increased ACD, larger lens diameter, larger posterior curvature and decreased vault in both groups, decreased LT in the normal group, and increased anterior curvature and decreased lens decentration in the ZD group (all P < .05). The logistic regression model showed the ZD group had greater alterations of ACD ( P = .014), anterior curvature ( P = .009), and decentration ( P = .031) after cycloplegia treatment when compared with the normal group. Lens in patients with ZD was characterized by steeper anterior curvature and greater alterations of ACD, anterior curvature, and decentration after cycloplegia. The comparison of lens morphologic parameters before and after cycloplegia might be the potential method to evaluate the stability of zonular fibers.

To evaluate the efficiency and safety of iris retractor-assisted cataract surgery with modified scleral fixation for treating subluxated lenses. We developed a modified technique combining iris retractors with intrascleral intraocular lens (IOL) fixation for the treatment of moderate or severe lens subluxation due to non-progressive or progressive zonular defects. A retrospective case series study was conducted, including patients diagnosed with severe zonular dialysis who underwent this technique. Clinical data were collected and analyzed, including comprehensive ophthalmic examinations, anterior segment optical coherence tomography, surgical procedures, and outcome measures such as visual acuity and IOL positioning. Fourteen eyes from fourteen patients (four females and ten males), with a mean age of 56.36 ± 17.74years and severe zonular loss, were enrolled in the study. All patients were followed up for a mean of 22.5 ± 15.4months (range 4-49months). The mean visual acuity improved significantly after surgery (p < 0.001), and the IOLs were well-centered. Postoperative transient intraocular hypertension was observed in one patient. This modified technique simplifies the surgical procedures for treating severe lens subluxation and reduces postoperative complications.

AIMS:The aim is to study the outcome of uveal coloboma patients undergoing manual small incision cataract surgery (MSICS) and intraocular lens (IOL) implantation.SUBJECTS AND METHODS:The study included 14 patients with uveal coloboma who underwent small incision cataract surgery and IOL implantation between March 2022 and February 2023. The systemic analysis of preoperative, intraoperative, and postoperative data was done.RESULTS:The average patient age at the time of surgery was 58.5 years (range 45–74 years). Out of a total of 14 patients, 10 patients had unilateral coloboma and four patients had bilateral presentation. Of these, two patients had only one functioning eye, two had bilateral microcornea, and two had unilateral phacodonesis. Small incision cataract surgery was performed in all cases in one eye. Intraoperative zonular dialysis was noted in five cases where a capsular tension ring was used in two cases and IOL was placed in the bag and an iris-claw was tucked in three cases. Two patients had descemets membrane detachment, where DM repositioning was done with air. None of the cases underwent pupilloplasty.CONCLUSIONS:The cataract patient with congenital iridochoroidal coloboma can be better managed with an MSICS. Although phacoemulsification is the treatment of choice nowadays, a small incision cataract surgery can be considered rescuer in a patient with a hard cataract and microcornea.

ABSTRACT Purpose To evaluate the association between intraoperative complications of cataract surgery and postoperative mortality. Methods A retrospective review of patients who underwent cataract surgery at our institution from 2014 to 2020 was conducted. Intraoperative complications included choroidal hemorrhage, posterior capsule rupture, vitreous loss, retained lens, and/or severe zonular dialysis in either eye. All-cause mortality statistics were obtained through a collaborative agreement with the Colorado Department of Public Health and Environment. Hazard ratios (HRs) from Cox proportional hazard models were used to estimate survival following cataract surgery. Results Among 8,054 patients, the mean follow-up time was 4.4 (SD = 2.3) years and the mortality rate was 15% (n = 1,175). The overall complication rate was 2.2% (n = 181), and the rate of retained lens was 0.7% (n = 58). In univariate analysis, retained lens (HR: 1.86, 95% CI: 1.08–3.21, p = 0.026), severe zonular dialysis (HR: 2.00, 95% CI: 1.29–3.12, p = 0.002), and any intraoperative complication (HR: 1.51, 95% CI: 1.09–2.11, p = 0.015) were associated with higher hazard of mortality. When adjusted for demographic factors, comorbid medical conditions, and pre-operative visual acuity, intraoperative complications were not associated with mortality. Conclusion Intraoperative cataract surgery complications were associated with mortality in univariate analysis. However, this association was not significant in the multivariable analysis as it is confounded by other factors such as pre-operative visual acuity.

BackgroundPupillary capture can cause complications after intrascleral intraocular lens (IOL) fixation; however, no method has been established to definitively prevent pupillary capture. Therefore, we aimed to examine the differences in the incidence of pupillary capture in patients who underwent intrascleral IOL fixation and had intraoperative lens capsule preservation or lens capsule loss.MethodsThis single-center, retrospective study, conducted at a University Hospital, included 83 eyes from 83 patients. The eyes were allocated to the capsule and no-capsule groups based on the presence or absence of capsule, respectively. Patient demographics, causative diseases, incidence of pupillary capture at 1 year postoperatively, anterior chamber depths (ACDs), IOL tilts, and decentrations of the two groups were analyzed and compared.ResultsThe capsule and no-capsule groups comprised 26 and 57 eyes, respectively. The indications for intrascleral IOL fixation were: IOL dislocation in 6 (23.1%) and 41 (71.9%), artificial aphakia in 4 (15.4%) and 2 (3.5%), conversion during cataract surgery due to complications (zonular dialysis or posterior capsule rupture) in 14 (53.9%) and 3 (5.3%), lens dislocation in 0 and 11 (19.3%), and IOL opacification in 2 (7.7%) and 0 eyes in the capsule and no-capsule groups, respectively (P < 0.05). The postoperative outcomes including ACD, magnitude of tilt, or decentration of the fixed IOL did not differ between the two groups (P > 0.05). Pupillary capture was observed in eight eyes, all in the no-capsule group (P < 0.05).ConclusionsWhen performing intrascleral fixation in cases where the lens capsule remains, preserving the capsule and fixing the IOL under the capsule may prevent postoperative pupillary capture.

BackgroundIn cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement. We aim to compare cataract surgery complication rates and clinical outcomes using different pupil expansion methods.MethodsThis retrospective cohort study grouped patients according to four techniques of mechanical pupil expansion techniques: sphincterotomy (N = 339), iris stretching (N = 242), iris hooks (N = 391) and expansion rings (N = 294). Incidences and odds ratios for major complications and outcomes were compared between the groups.ResultsThis single-center study included 1266 adult patients who underwent routine cataract surgery with mechanical pupil dilatation. The mean (± SD) age was 75.5 (± 13.0) years and 727 (57%) patients were male. The risk of pseudophakic cystoid macular edema (PCME) did not differ between the groups. Iris hooks were associated with the highest incidence of posterior capsular rupture (PCR) (3.3%) as compared to sphincterotomy, stretching and expansion rings (0.9%, 0.4% and 1.4%, respectively, P = 0.016). However, this effect was not supported by multivariable analysis. Zonular dialysis tended to be higher among eyes operated with iris hooks and pupil expansion rings, compared with iris stretching and sphincterotomy (2.0% and 1.7%, respectively, P = 0.058) and was found to be independently associated with a specific mechanical pupil expansion method on multivariable analysis (P = 0.050). No differences were observed for other complications, intraocular pressure or best-corrected visual acuity (VA) gain. Surgeon seniority was a significant protective factor from postoperative uveitis on multivariable analysis (P = 0.032).ConclusionsOur large cohort study found no difference between the groups regarding major complications or clinical outcomes, suggesting that all four methods may be equally safe.Key messagesWhat is known• In cataract surgery, inadequate pupil dilation presents a major surgical challenge by narrowing the operation field and restricting visibility and movement.• Different pupil dilation methods have been used, ranged from topical and intracameral mydriatics and visco-mydriasis to mechanical dilation maneuvers.• Four principal techniques of mechanical pupil expansion, including sphincterotomies, manual iris stretching, iris retracting hooks and pupil expansion rings, are available.What is new• This single-center study included 1266 adult patients found no difference between the groups regarding major complications or clinical outcomes such as pseudophakic cystoid macular edema (PCME), posterior capsular rupture, zonular dialysis, intraocular pressure, uveitis or best-corrected visual acuity gain.• Surgeon seniority was a significant protective factor from postoperative uveitis.

A 52 years old male presented with severe pain, redness, watering and swelling of left eye since 4 days after cataract surgery. Surgery performed was small incision cataract surgery with temporal scleral section performed under peri-bulbar anesthesia. Patient had posterior capsular rent and iatrogenic zonular dialysis intra-operatively and iris claw lens was placed. On clinical examination, patient had developed Orbital cellulitis with pan-ophthalmitis post cataract surgery.

To evaluate the risk of zonular dialysis (ZD) in fellow eye phacoemulsification cataract surgery and to identify risk factors, including prior first eye ZD. 8 United Kingdom National Health Service clinical centers. Retrospective database study. Overall risk of ZD in the fellow eye was calculated and the odds ratio (OR) for the various risk factors was reported, including first eye ZD. The main outcome measures were the risk and the predictors of intraoperative ZD in the fellow eye. There was a total of 66 288 patients. At the time of the first surgery, the mean age of patients was 75.3 ± 10.2 years and 39.2% were male. Intraoperative ZD occurred during the first eye surgery in 333 patients (0.5%) and the fellow eye in 349 patients (0.5%). The risk of fellow eye developing ZD in patients with first eye ZD was higher than in patients without first eye ZD: 23 of 333 patients (6.9%) vs 326 of 65 955 patients (0.5%) (unadjusted OR 14.9, P < .001). In the adjusted logistic regression model, first eye ZD was the most significant risk factor (OR 13.3, 95% confidence interval [CI] 8.2-21.7). Other significant covariates of ZD in the fellow eye were pseudoexfoliation (OR 6, 95% CI 3.8-9.7), previous pars plana vitrectomy (OR 4.5, 95% CI 1.1-18.5), and poor pupillary dilation (OR 2.2, 95% CI 1.4-3.3). The most important risk factor for the development of ZD in the fellow eye during cataract surgery was the occurrence of ZD in the first eye. These findings have implications for patient counseling and surgery allocation.

Purpose To compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes. Methods A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12–24 weeks and the rates of CME and additional associated complications. Results We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group (p < 0.001). Mean postoperative VA was worse in the ZD group (p < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4–12 weeks and 12–24 weeks, respectively. At 12–24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group (p < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% (p = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal. Conclusions The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME.

The objective of this study was to assess the clinical characteristics and biometric parameters, as measured by the IOLMaster, of patients suffering from acute secondary angle closure due to zonular dialysis (ASAC-ZD) who were misdiagnosed with acute primary angle closure (APAC). In this retrospective study, 34 ASAC-ZD and 39 APAC eyes were examined. Sex, age, best-corrected visual acuity, axial length (AL), anterior chamber depth (ACD), anterior chamber depth standard deviation (ACDSD), lens thickness (LT), and lens thickness standard deviation (LTSD) were measured using the IOLMaster and compared between the two groups. In addition, the difference in ACD (ACD difference) between the affected eye and the contralateral eye was analyzed. Logistic regression analysis was performed to determine the predictive factors of lens subluxation. To determine the appropriate cutoff values for biometric parameters, ROC curves were constructed to distinguish between ASAC-ZD, APAC, and cataracts. Compared to the APAC group, the ASAC-ZD group was younger (69.92 ± 9.345, 63.74 ± 6.947), had longer AL (22.39 ± 0.7852, 23.23 ± 1.168), shallower ACD (2.120 ± 0.2986, 1.889 ± 0.5167), higher ACDSD (7.605 ± 5.425, 9.941 ± 6.120), higher LTSD (28.00 ± 19.52, 39.79 ± 22.74), and larger ACD differences (-0.1249 ± 0.2349, -0.7306 ± 0.5332) in the affected eye. Younger age, longer AL, lower ACD, higher LTSD, and higher ACD differences were associated with lens subluxation in the univariate logistic regression analysis. ACD difference (p = 0.0003), age (p = 0.0024), and ACD (p = 0.0491) were significantly associated with lens subluxation in the multivariable logistic regression analysis. Furthermore, the ROC curve analysis showed that the cutoff values for lens subluxation were a difference in ACD of 0.225 mm and 1.930 mm. Asymmetric ACD in both eyes with normal AL and increasing ACDSD and LTSD may support the clinical diagnosis of lens subluxation.

ABSTRACT Purpose To quantify the risk of posterior capsule rupture (PCR) in fellow-eye phacoemulsification surgery and to determine risk factors. Methods We pooled data from 8 United Kingdom sites for patients undergoing bilateral non-simultaneous phacoemulsification. Main outcome measures were the incidence and risk factors of the development of PCR during the fellow-eye phacoemulsification. Results We included 66,288 patients with a mean age of 75.3 ± 10.2 years. PCR during phacoemulsification occurred in the first eye in 932 patients (1.4%) and the fellow eye in 1039 patients (1.5%). The risk of fellow eye developing PCR in patients with PCR in the first eye was significantly higher than in patients without first eye PCR: 30 patients (3.2%) vs. 1009 (1.5%), respectively (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.7). Other risk factors for fellow-eye PCR included zonular dialysis (OR = 5.4, CI = 3.3-7.8) and advanced cataract (OR = 2.8, CI = 2.1-3.7). Conclusions History of PCR in the first-operated eye is an independent risk factor for PCR in the fellow eye.

To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.

The purpose of this study is to evaluate the surgical outcome of capsular tension ring and iris hook use during phacoemulsification in dogs with zonular weakness and miotic pupils. This study includes nineteen dogs (29 eyes) that underwent phacoemulsification (15 dogs/25 eyes) and extracapsular cataract extraction surgery (4 dogs/4 eyes) between February 2014 and February 2015. Patients with any ophthalmic problem other than cataracts were not included in the study. Some dogs did not achieve pharmacologic pupil dilation. These dogs required the use of iris hooks or the insertion of capsular tension rings. The capsular tension ring insertion was used in dogs with zonular rupture in more than half of the zonules. Capsular tension rings were inserted in cases of zonular dialysis and iris hooks were placed to widen the pupil. Fifteen dogs (25 eyes) underwent phacoemulsification, while 4 (4 eyes) received extracapsular cataract extraction (ECCE) surgery due to the difficulty of phacoemulsification in hypermature cataracts. Iris hooks were used in four dogs (8 eyes) for drug-resistant miotic pupils. Capsular tension rings were inserted to stabilize the lens capsule during phacoemulsification and to centralize the intraocular lens (IOL) in the bag. Capsular tension rings in cases of zonular dialysis and iris hooks in drug-resistant miotic pupils improved the success of cataract operations with phacoemulsification. Both are safe and useful for zonular weakness and for maintaining mydriasis during surgery.

Background Pseudoexfoliation syndrome (PEX) is characterized by a dandruff-like substance in the anterior chamber, composed of various glycoproteins that have an unclear origin. Its deposition is observed on the pupillary margin, lens zonules, and trabecular meshwork. Proteomic studies have identified numerous proteins in the affected individuals, suggesting associations with systemic conditions like heart disease, stroke, and Alzheimer's disease. However, the systemic associations of PEX remain inconclusive, particularly in regions like southern India. Materials and methods A cross-sectional study was conducted on 114 participants. Pseudoexfoliation was graded as mild, moderate, and severe as per standard photographic grading. Systemic examinations included blood pressure measurements, electrocardiography (ECG), and blood investigations for serum lipid profile, fasting and postprandial blood sugar levels, and serum C-reactive protein levels. Small incision cataract surgery was performed for all the patients. Intraoperative complications and postoperative status were recorded. Results Thirty-eight patients (33.3%) had mild PEX, 44 (38.6%) had moderate PEX, and 32 (28.1%) had severe PEX. Hypertension was present in 54 participants (47.4%), diabetes in 21 (18.4%), coronary artery disease in nine (7.9%), and cerebrovascular accidents in three (2.6%). The mean systolic blood pressure was 140.39 mmHg and the mean diastolic blood pressure was 90.37 mmHg. Systolic blood pressure exceeded 140 mmHg in 29 participants (90.6%) with severe PEX, while diastolic blood pressure surpassed 90 mmHg in 26 participants with severe PEX, both with a p-value of 0.001. Mean fasting and postprandial blood sugar levels were 103.80 ± 31.81 mg/dl and 131.72 ± 48.24 mg/dl, respectively. Serum lipid profiles showed mean low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), cholesterol, and triglyceride levels of 103.00 ± 34.49 mg/dl, 29.04 ± 15.51 mg/dl, 172.73 ± 43.34 mg/dl, and 129.33 ± 64.65 mg/dl respectively. Electrocardiographic results indicated that 54 participants (47.37%) had abnormal ECG including rate abnormality in 13.2%, conduction defects in 12.3%, ischemic changes in 10.5%, and structural defects in 11.4%. Eighty-seven percent of patients had non-dilating pupils and iris atrophy, 13.2% had zonular dialysis and intraoperatively, 78% had capsulorhexis extension, 49.12% had difficult nucleus prolapse, and 28.95% had posterior capsular rent. Conclusion This study highlights the significantly elevated parameters of systemic vascular diseases in PEX patients, like elevated blood pressure and more frequent cardiac anomalies, emphasizing the need for comprehensive systemic evaluation and careful preoperative assessment for ocular comorbidities.

Purpose. The authors present a case of both traumatic subluxated lens with zonular dialysis and a traumatic retinal detachment with posterior retinal tear. Methods. Some fragments have dropped into the vitreous chamber during phaco-emulsification and one of them has even passed through the retinal tear and has been removed from the subretinal space. A 3-piece intraocular lens with a tension ring supporting the capsular bag was implanted. Pars plana vitrectomy with accurate vitreous base shaving was approached by 23-gauge system. Subretinal fluid was removed by a complete fluid-air exchange. A large macular internal limiting membrane (ILM) peeling was performed and the posterior retinal tear was covered by multiple inverted ILM flaps. Results. Postoperatively, retinal reattachment was achieved, the retinal break was flat. The ILM flaps were well positioned within the retinal tear and covered the preoperatively bared RPE. Conclusions. The surgical treatment of injuries after a blunt ocular trauma are not standardizable. In this case surgical outcomes suggest the effectiveness of the surgeon’s intraoperative unusual maneuvers.