Little Capsulorhexis Tear-Out Rescue
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Utah Eye Centers Now Offers the Latest Advance in Laser Eye Surgery
Mark G. Ballif, M.D. Scott O. Sykes, M.D. Michael B. Wilcox, M.D. John D. Armstrong, M.D. Robert W. Wing, M.D., FACS Keith Linford, O.D. Jed T. Poll, M.D. Claron D. Alldredge, M.D. Devin B. Farr, O.D. Michael L. Bullard, M.D. Court R. Wilkins, O.D. Utah Eye Centers Now Offers the Latest Advance In Laser Eye Surgery The New VICTUS® Femtosecond Laser Platform, from Bausch + Lomb is Designed to Support Positive Patient Experience and Outstanding Visual Results in Cataract and LASIK Procedures FOR RELEASE April 17, 2015 Ogden, Utah— Utah Eye Centers, the leading comprehensive ophthalmology practice in northern Utah, announced today the Mount Ogden facility now offers eye surgery for cataracts and LASIK with an advanced laser system, the VICTUS® femtosecond laser platform. They are the only practice north of Salt Lake City with a fixed site femtosecond laser for cataracts and LASIK. The versatile VICTUS platform is designed to provide greater precision compared to manual cataract and LASIK surgery techniques. According to Scott Sykes, M.D., the Victus laser is the only laser approved to perform treatments for both cataract and LASIK surgeries. "With the VICTUS platform, we are able to automate some of the steps that we have commonly performed manually," said Mark Ballif, M.D. "While we have performed thousands of successful cataract and LASIK surgeries, the VICTUS platform helps us to improve the procedures to give our patients the best outcomes possible." The VICTUS platform features a sophisticated, curved patient interface with computer-monitored pressure sensors designed to provide comfort during the procedure. -
Nd:YAG CAPS ULOTOMY AS a PRIMARY TREATMENT
PSEUDOPHAKIC MALIGNANT GLAUCOMA: Nd:YAG CAPS ULOTOMY AS A PRIMARY TREATMENT B. C. LITTLE and R. A. HITCHINGS London SUMMARY anisms of ciliolenticular block of aqueous flow leading to Malignant glaucoma is one of the most serious but rare the misdirection of aqueous posteriorly into or in front of complications of anterior segment surgery. It is best the vitreous gel leading to the characteristic diffuse shal known following trabeculectomy but has been reported lowing of the anterior chamber accompanied by a precipi following a wide variety of anterior segment procedures tous rise in intraocular pressure. The mechanistic including extracapsular cataract extraction with pos understanding of its pathogenesis has led to the use of the terior chamber lens implantation. It is notoriously refrac synonyms 'ciliolenticular block',7 'ciliovitreal block', tory to medical treatment alone and surgical intervention 'iridovitreal block',8 'aqueous misdirection' and 'aqueous has had only limited success. An additional treatment diversion syndrome'. Although probably more precise option in pseudophakic eyes is that of peripheral these are unlikely to succeed the original term 'malignant Nd:YAG posterior capsulotomy, which is minimally glaucoma', which more accurately evokes the fulminant invasive and can re-establish forward flow of posteriorly nature of the condition as well as the justified anxiety asso misdirected aqueous through into the drainage angle of ciated with it. Medical treatment alone is rarely successful the anterior chamber. We report our experience of seven in establishing control of the intraocular pressure.2•8 Pars cases of malignant glaucoma in pseudophakic eyes and of plana vitrectomy has been used in the surgical managment the successful use of Nd:YAG posterior capsulotomy in of malignant glaucoma with some definite but limited suc re-establishing pressure control in' five of these eyes, cess in phakic as well as pseudophakic eyes.9•10 thereby obviating the need for acute surgical However, when malignant glaucoma develops in intervention. -
Outcome of Lens Aspiration and Intraocular Lens Implantation in Children Aged 5 Years and Under
540 Br J Ophthalmol 2001;85:540–542 Outcome of lens aspiration and intraocular lens implantation in children aged 5 years and under Lorraine Cassidy, Jugnoo Rahi, Ken Nischal, Isabelle Russell-Eggitt, David Taylor Abstract However, final refraction is variable, such that Aims—To determine the visual outcome emmetropia in adulthood cannot be guaran- and complications of lens aspiration with teed, as there are insuYcient long term studies. intraocular lens implantation in children There have been many reports of the visual aged 5 years and under. outcome and complications of posterior cham- Methods—The hospital notes of all chil- ber lens implantation in children.4–12 Most of dren aged 5 years and under, who had these have been based on older children, undergone lens aspiration with intraocu- secondary lens implants, a high number of lar lens implantation between January traumatic cataracts, and many have reported 1994 and September 1998, and for whom early outcome. We report visual outcome and follow up data of at least 1 year were avail- complications of primary IOL implantation at able, were reviewed. least 1 year after surgery, in children aged 5 Results—Of 50 children who underwent years and under, with mainly congenital or surgery, 45 were eligible based on the juvenile lens opacities. follow up criteria. 34 children had bilat- eral cataracts and, of these, 30 had surgery Methods on both eyes. Cataract was unilateral in 11 SUBJECTS cases; thus, 75 eyes of 45 children had sur- We reviewed the notes of all children aged 5 gery. Cataracts were congenital in 28 years and under, who had undergone lens aspi- cases, juvenile in 16, and traumatic in one ration with primary posterior chamber in- case. -
Laser Learning Lecture and Lab: YAG Caps, LPI, And
5/9/17 Overview Laser Learning Lecture and Lab: • Why we use lasers YAG caps, LPI, and SLT • YAG capsulotomy • Laser Peripheral Iridotomy (LPI or PI) Aaron McNulty, O.D., F.A.A.O. • Argon Laser Peripheral Iridoplasty (ALPI) Nate Lighthizer, O.D., F.A.A.O. • Argon Laser Trabeculoplasty (ALT) • Selective Laser Trabeculoplasty (SLT) • Other Laser Trabeculoplasty Why do we use lasers? Posterior Capsular Opacification (PCO) • Vision is decreased from PCO following cataract surgery • Lens capsular bag has an anterior and • Narrow angles/angle closure posterior surface • Glaucoma is progressing in a pt on max meds – Anterior surface usually removed w/ capsulorhexis – Something else needs to be done – Surgery not wanted yet • PCO is the formation of a cloudy membrane • Compliance issues on the posterior surface of the capsular bag • Cost issues following ECCE • Convenience issues – AKA: Secondary cataract • Doctor preference PCO YAG Laser • Incidence: • Nd: YAG laser – Most common complication of post ECCE – Neodymium: Yttrium aluminum garnet laser – 10-80% of eyes following cataract surgery – Can form anywhere from a few days to years post surgery • Tissue interaction: Photodisruptive laser – Younger patients higher risk of PCO – High light energy levels cause the tissues to be reduced – IOL’s to plasma, disintegrating the tissue • Silicone > acrylic – A large amount of energy is delivered into very small focal spots in a very brief duration of time • Prevention: • 4 nsec – – Capsulotomy during surgery No thermal reaction/No coagulation when bv’s are hit – Posterior capsular polishing – Pigment independent* 1 5/9/17 YAG Cap Risks, Complications, YAG Cap Pre-op Exam Contraindications • Visual acuity, glare testing, PAM/Heine lambda Contraindications Risks/complications – Vision 20/30 or worse 1. -
Early Postoperative Rotational Stability and Its Related Factors of a Single-Piece Acrylic Toric Intraocular Lens
Eye (2020) 34:474–479 https://doi.org/10.1038/s41433-019-0521-0 ARTICLE Early Postoperative Rotational stability and its related factors of a single-piece acrylic toric intraocular lens 1,2 3 4 5 1 1 1 Shuyi Li ● Xi Li ● Suhong He ● Qianyin Zheng ● Xiang Chen ● Xingdi Wu ● Wen Xu Received: 30 November 2018 / Accepted: 18 June 2019 / Published online: 12 July 2019 © The Author(s) 2019. This article is published with open access Abstract Purpose In the present study, we aimed to evaluate the early postoperative rotational stability of TECNIS toric intraocular lens (IOL) and analyse its correlation with preoperative and intraoperative parameters. Methods A total of 102 eyes from 87 cataract patients who underwent implantation of TECNIS toric IOL during July 2016 to November 2017 were enrolled in this retrospective study. Preoperative parameters including corneal astigmatism, axial length (AL), lens thickness (LT), anterior chamber depth (ACD) and sulcus-to-sulcus (STS), were determined. The area of capsulorhexis was measured with Rhinoceros 5.0 software. The follow-up examinations including the residual astigmatism (RAS) and postoperative toric IOL axis, were performed at 1 month and 3 months after surgery. − − 1234567890();,: 1234567890();,: Results RAS was 0.84 ± 0.88 D at 1 month and 0.81 ± 0.89 D at 3 months after surgery. The rotation of toric IOL at 3 months was 4.83 ± 3.65°. The Pearson’s r of ACD, horizontal and vertical STS, and toric IOL target axis was 0.011, 0.039, 0.045 and 0.082. The toric IOL rotation was positively correlated with the area of capsulorhexis (r = 0.522, P = 0.0003), LT (r = 0.288, P = 0.003) and AL (r = 0.259, P = 0.009). -
(YAG) Laser Capsulotomy Reference Number: CP.VP.65 Coding Implications Last Review Date: 12/2020 Revision Log
Clinical Policy: Yttrium Aluminium Garnet (YAG) Laser Capsulotomy Reference Number: CP.VP.65 Coding Implications Last Review Date: 12/2020 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description This policy describes the medical necessity requirements for yttrium aluminium garnet (YAG) laser capsulotomy. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® (Centene) that YAG laser capsulotomy is medically necessary for the following indications: A. Posterior capsular opacification following cataract surgery resulting in best corrected visual acuity of 20/30 or worse associated with symptoms of blurred vision, visual distortion or glare affecting activities of daily living; B. Contraction of the posterior capsule with resulting displacement of the intraocular lens; C. Posterior capsular opacification resulting in best corrected visual acuity of 20/25 or worse, reducing the ability to evaluate and treat retinal detachment. Background YAG capsulotomy is the incision of an opaque posterior lens capsule in an aphakic or pseudophakic eye. This incision allows the capsule to retract and no longer serve as an obstruction to the passage of light through the media to the retina. The incision is performed with YAG laser. The eye examination must confirm the diagnosis of posterior capsular opacification and excludes other ocular causes of functional impairment by one of the following methods: The eye examination should demonstrate decreased light transmission (visual acuity worse than 20/30 or 20/25 if the procedure is performed to assist in the diagnosis and treatment of retinal detachment). Manifest refraction must be recorded with decrease in best-corrected visual acuity. -
Retinal Detachment Following YAG Laser Capsulotomy
Eye (1989) 3, 759-763 Retinal Detachment Following YAG Laser Capsulotomy C. 1. MacEWEN and P. S. BAINES Dundee Summary A retrospective study of 12 patients with rhegmatogenous retinal detachment follow ing YAG posterior capsulotomy is reported. Eleven out of these 12 were at increased risk of detachment. Three had lattice degeneration, three had previous detachment and five had axial myopia. Only 50% of the holes were typical "aphakic" post-oral breaks. Extra-capsular extraction, currently the tech 2% of patients.26 ,27 It has been suggested that nique of choice in cataract surgery, has the there may be a direct relationship between the main advantage over the previously preferred two events and that retinal detachments after intra-capsular method of facilitating intra YAG laser are distinct from other aphakic ocular lens implantation.1 In addition it is detachments, with most patients having pre associated with fewer posterior segment com disposing risk factors (myopia, lattice degen plications such as cystoid macular oedema2 eration or previous detachment).26 ,28 Other and retinal detachment.3 studies have indicated that they are indis An important disadvantage of extra-capsu tinguishable from other aphakic lar surgery is opacification of the posterior detachments.25,27,29 capsule, resulting in reduction of visual acuity We therefore carried out a retrospective in up to 50% of cases, depending on the length study of 12 patients who developed rheg of follow-up and the age of the patients matogenous retinal detachment following studied.4.9 At present posterior capsulotomy YAG capsulotomy to determine the charac can be carried out either by surgical discis teristics of these detachments and any pre sion6,7 or by photo-disruption using the neo disposing risk factors. -
Nd:Y AG LASER CLEARANCE of the ANTERIOR SURFACE of POSTERIOR CHAMBER INTRAOCULAR LENSES
Nd:Y AG LASER CLEARANCE OF THE ANTERIOR SURFACE OF POSTERIOR CHAMBER INTRAOCULAR LENSES S. J. TALKS Northampton SUMMARY CASE REPORTS Purpose: To demonstrate the use of Nd:YAG laser in Case 1. Post-operative Haemorrhage clearing the anterior surface of posterior chamber A 73-year-old Caucasian insulin-dependent diabetic intraocular lenses. man, on aspirin, who had previously had a right Method: Six cases are presented with the following trabeculectomy, had a right extracapsular cataract conditions: haemorrhage, inflammatory deposits, a extraction (ECCE) + pcIOL. At surgery a broad fibrinous papillary membrane, capsulorhexis shrinkage. iridectomy was performed through the original Nd:YAG laser was successful in managing Results: peripheral iridectomy to enable adequate pupil each of these cases. dilation. This was sutured with 10.0 Prolene. No Conclusion: With careful use Nd:YAG laser clearance haemorrhage was noted during surgery but the next of the anterior surface of a posterior chamber day a large blood clot covered the pupil. This did not intraocular lens can be carried out successfully without clear with the use of prednisolone acetate 1 % damaging the lens. (Predforte) and mydriatics. The patient did not wish further surgery. Following cataract surgery the anterior surface of After 3 months the visual acuity was still hand posterior chamber intraocular lenses (pcIOL) can movements and so Nd:YAG laser was used. The sometimes become obscured.1 This may be due to laser was applied to the organised clot at the edge of haemorrhage, inflammatory deposits, the formation the pupil (171 pulses, at 2-3 mJ, Q switched). Most of of a fibrinous pupillary membrane, or the shrinkage the clot cleared leaving a fibrinous membrane. -
The Capsulotomy: from There to Where?
JUNE 2017 # 42 In My View NextGen Profession Sitting Down With Presbyopia correction in Dry eye: how the humble Louis Pasquale believes it’s Innovator extraordinaire, younger patients – what’s best? eyedrop is evolving time to redefine POAG Sean Ianchulev 17 36 – 38 42 – 45 50 – 51 The Capsulotomy: From There to Where? A tale of jealousy, rivalry and pride… The unfolding story of the capsulotomy over time 18 – 27 www.theophthalmologist.com It’s all in CHOOSE A SYSTEM THAT EMPOWERS YOUR EVERY MOVE. Technique is more than just the motions. Purposefully engineered for exceptional versatility and high-quality performance, the WHITESTAR SIGNATURE PRO Phacoemulsification System gives you the clinical flexibility, confidence and control to free your focus for what matters most in each procedure. How do you phaco? Join the conversation. Contact your Phaco Specialist today. Rx Only INDICATIONS: The WHITESTAR SIGNATURE PRO System is a modular ophthalmic microsurgical system that facilitates anterior segment (cataract) surgery. The modular design allows the users to configure the system to meet their surgical requirements. IMPORTANT SAFETY INFORMATION: Risks and complications of cataract surgery may include broken ocular capsule or corneal burn. This device is only to be used by a trained, licensed physician. ATTENTION: Reference the labeling for a complete listing of Indications and Important Safety Information. WHITESTAR SIGNATURE is a trademark owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. © 2017 Abbott Medical Optics Inc. | PP2017CT0929 Image of the Month In a Micropig’s Eye This Wellcome Image Award winner depicts a 3D model of a healthy mini-pig eye. -
History of Posterior Continuous Curvilinear Capsulorhexis and Optic
HISTORY OF POSTERIOR CONTINUOUS CURVILINEAR BY HOWARD V. GIMBEL, MD, MPH, FRCSC CAPSULORHEXIS AND OPTIC CAPTURE This useful technique is not just for pediatric surgery. econdary cataracts after pedi- I first used this technique in 1987 children in a publication coauthored atric cataract surgery have long to remove a dense posterior capsular with DeBroff in 1994.4 been recognized as an expected plaque and in 1988 to convert a PC In my early experience, the PCCC complication when the posterior tear to a PCCC.2 was done after the IOL was in the bag capsule is left intact. Planned Optic capture in the anterior con- so that, in the event of an unsuccess- Santerior vitrectomy after posterior tinuous curvilinear capsulorhexis was ful PCCC, the IOL would already be capsulectomy or capsulotomy is now described by Neuhann and Neuhann safely in the bag. To keep the vitreous performed routinely with cataract and in a film, “The Rhexis-Fixated Lens,” from coming through the PCCC as it IOL surgery in children. This is because, in 1991.3 With the experience I was being fashioned, a highly cohesive even with the posterior capsule open gained using that technique in adult OVD was placed through the first and the IOL in the bag, lens epithelial cataract surgery, it seemed obvious small tear in the PC. Then more OVD cell migration can proceed through that, after performing a PCCC, the was added as the tear was completed the posterior continuous curvilinear same capture technique could be with forceps. Optic capture was then capsulorhexis (PCCC), behind the IOL, used with the haptics left in the bag performed slowly, one edge at a time, and across the visual axis, making it and the optic captured by the PCCC. -
Tips and Techniques for Cataract Surgery in Glaucoma Patients
Tips and Techniques for Cataract Surgery in Glaucoma Patients Joey Yen-Cheng Hsia, MD Assistant Professor of Ophthalmology Glaucoma Service University of California, San Francisco No Financial Disclosures Introduction • Visually significant cataract often co-exist with glaucoma in the elderly population. • Glaucoma incisional surgery can lead to accelerated cataract formation. • Glaucoma patients are at risk for perioperative complications • Set realistic expectation preoperatively Preoperative Evaluation – Is the cataract or glaucoma causing the decreased vision? – PAP or PAM – Set realistic expectation – Is the IOP at target? – Role of combined surgery? – No. of medications – Anticoagulation – ⍺-1 blocker – Prior incisional surgeries Examination – angle grading, trab ostium - Prior incisional surgery - endothelial dysfunction – shallowing – dilation, prior LPI, iridectomy – PXE, phacodynesis – cupping, pallor, retinal pathology Postoperative IOP Spike • Note the of glaucoma – Foveal involving scotoma – At risk for progression with IOP spike : – Advanced glaucoma, IFIS, No. of gtts, long AXL, PXE • IOP spike occurs after surgery – Same day check up for high risk patients History of Trabeculectomy – Modify incisions accordingly – Avoid suction / fixation ring – High function bleb may lead to chemosis / chamber instability – Age<50, Preop IOP > 10, iris manipulation, postop IOP spike, and short interval time between trabeculectomy and cataract – Longer steroid +/- anti- metabolite Grover-Fellman spatula; Epislon History of Tube Shunt – -
Collecting Empirical Physician Time Data
H EA LTH POLI CY CEN TER RESEARCH REPORT Collecting Empirical Physician Time Dat a Piloting an Approach for Validating Work Relative Value Units St ephen Zuckerman, PhD Kat ie Merrell, BA Robert Berenson, MD Susan Mitchell, RHIA URBAN INSTITUTE ACTUARIAL RESEARCH URBAN INSTITUTE RTI INTERNATIONAL CORPORATION (FORM ERLY SOCIAL & SCIENTIFIC SYSTEM S, I N C.) Divvy Upadhyay, MD, MPH Rebecca Lewis, MPH URBAN INSTITUTE RTI INTERNATIONAL December 2016 ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is dedicat ed to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Copyright © December 2016. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image by Tim M eko. Contents Acknowledgments v Execut ive Summary vi Background 1 Collecting Empirical Service Time Dat a 3 Analytic Approach and Methods 6 Preparing t he Empirical Time Data for Analysis 6 Empirical Measure of Intraservice Physician Time 6 Clinical Expert Review Met hods 10 Physician Int erviews 13 Result s 15 Empirical Time Analysis 15 Empirical Time Estimates for Selected Services 15 Implications for Physician Work Values 21 Clinical Expert Review Results 29 Representativeness of Vignettes 29 Accuracy of Service Descriptions 30 Intraservice Time Estimates 34 Limitat ions: Challenges of Empirical Time Data Collection 36 Summary 38 Recommendations for Further Data Collection 39 Appendix A.