Purpose: The objective of this study is to compare the recurrence and complication rates of surgical treatment and interferon treatment for OSSN.

Participants: Ninety-eight patients with OSSN, 49 of whom were treated with interferon (IFN) a2b therapy and 49 of whom were treated with surgical intervention.

Methods: Patients with OSSN were treated with surgery versus IFNa2b therapy, either in topical or injection form. Median follow-up after lesion resolution was 21 months (range, 0e173 months) for the IFNa2b group and 24 months (range, 0.9e108 months) for the surgery group.

Main Outcome Measures: The primary outcome measure for the study was the rate of recurrence of OSSN in each of the treatment groups. 

Results: Mean patient age and sex were similar between the groups. There was a trend toward higher clinical American Joint Committee on Cancer tumor grade in the IFNa2b group. Despite this, the number of recurrences was equal at 3 per group. The 1-year recurrence rate was 5% in the surgery group versus 3%in the IFNa2b group (P ¼ 0.80). There was no statistically significant difference in the recurrence rate between the surgically and medically treated groups. Nonlimbal location was a risk factor for recurrence (hazard ratio, 8.96) in the entire study population. In patients who were treated successfully, the side effects of the 2 treatments were similar, with mild discomfort seen in the majority of patients in both groups. There was no limbal stem cell deficiency, symblepharon, or diplopia noted in either group. Two patients were excluded from the IFNa2b group because of intolerance to the medication.

Conclusions: No difference in the recurrence rate of OSSN was found between surgical versus IFNa2b therapy.

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                Post-keratoplasty astigmatismremains a challenge for corneorefractive surgeons.While maintaining a healthy graft is the most crucial issue in keratoplasty procedures, astigmatismis a limiting factor in the visual rehabilitation of otherwise successful corneal grafts. The management of post-keratoplasty astigmatism takes place at 2 stages: when sutures are still present at the graft–host junction and when all sutures have been removed. Excessive suture-in post-keratoplasty astigmatism is usually managed by selective suture manipulation, ie, suture adjustment and/or suture removal along the steep meridian of astigmatism. A small amount of suture-out post-keratoplasty astigmatism can be managed by spectacles. Higher magnitudes of astigmatism can be addressed by contact lenses or surgical intervention, such as relaxing and compressing procedures. Laser lamellar refractive surgery can also be used to manage post-keratoplasty astigmatism, and toric phakic intraocular lenses have recently been recommended. In this review, we discuss the etiology and management of post-keratoplasty astigmatism and provide recommendations and tips to minimize it.

This review of wavefront technology looks at 2 aspects. The first is the basics and principles of the optics of the eye, how to decompose the wavefront in a more adequate way for interpretation and how these aberrations affect the visual acuity. It addresses the diversity and complexity of wavefront sensors; how these devices transform the principles into clinically useful data, with the advantages and limitations of each system. The second major aspect is the clinical uses of the technology: wavefront-guided and newer and enhanced profiles related to wavefront as well as the limitations of the technology. Recent innovations made possible by wavefront technology that are not limited to refractive surgery are reviewed.

  Iris prolapse is not an uncommon occurrence during cataract surgery. It usually occurs through the main incision during hydrodissection and is commonly associated with floppy-iris syndrome; however, it can manifest in cases with no known predisposition and can occur at any stage during surgery. The mechanism is explained by the Bernoulli principle and its effect on iris position during the movement of fluid within the eye. Predisposing factors are iris configuration, anterior chamber depth, and position and architecture of the corneal tunnel. Strategies for prevention and management include the use of pharmacological agents, ophthalmic viscosurgical devices, and iris retractors. These strategies can be augmented by alteration and adaptation of the surgeon’s technique.

Purpose: To compare the success and complications of trabeculectomy performed with limbus-based and fornix-based conjunctival approaches.
Design: Retrospective case series with some prospective data collection.
Main Outcome Measures: (1) Success rate of trabeculectomy, as determined by the achievement of each of our different IOP goals, with or without IOP-lowering medications; and (2) incidence of surgical complications.
Results: During the 4 years after surgery, the success rates of limbus-based and fornix-based trabeculectomy were not statistically different for any of our IOP criteria. Blebs after limbus-based surgery were more likely to be graded as higher and to be avascular (GEE model, both P 0.0001). Four percent of eyes experienced late-onset bleb leaks within 4 years after both limbus- and fornix-based operations; however, limbus-based cases developed bleb leaks significantly later than did fornix-based cases (2.1 vs. 1.0 years; P 0.002, GEE model). Late bleb-associated infection during the first 4 years after surgery occurred more often in limbus-based operations, although statistical significance was borderline (P 0.054, Cox model). Symptomatic hypotony during all available follow-up was more common with fornix-based operations (P 0.01, GEE model). Eyes undergoing the fornix-based operation had a greater risk of cataract surgery in the 4-year period after surgery (P 0.02, Cox model), and fornix-based cases requiring cataract surgery had the operation earlier than limbus-based cases(P 0.002, GEE model).
Conclusions: Success rates are similar between limbus-based and fornix-based trabeculectomy. Limbus-based procedures produce higher, more avascular blebs, with a greater risk of infection. Fornix-based procedures have more symptomatic hypotony and more and earlier cataract development.

PURPOSE: To compare visual, refractive, and satisfactory outcomes between a new-generation sectorial addition multifocal intraocular lens (IOL) (Lentis Mplus LS-312; study group) and a diffractive apodized multifocal IOL (Restor SN6AD1; control group).

SETTING: Private practice, Driebergen, and Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands.

METHODS: Refractive and visual outcomes at near and distance, patient satisfaction, and dysphotopsia scores were recorded 3, 6, and 12 months postoperatively.

RESULT: The study group comprised 90 eyes and the control group, 143 eyes. Three months postoperatively, the mean uncorrected distance visual acuity (UDVA) was not statistically significantly different between the study group and the control group (0.04G0.15 logMAR [SD] versus 0.06G 0.25 logMAR). The control group had significantly better uncorrected near visual acuity than the study group at 30 cm (0.05 G 0.14 logMAR versus 0.15 G 0.08 logMAR) and 40 cm (0.05 G 0.14 versus 0.16 G 0.21) (P<.01 and P<.03, respectively). Patients in the control group were more satisfied with their vision (P<.001). Dissatisfaction was related to younger age at surgery and male sex (P<.0001 and P<.033 respectively). Dysphotopsia occurred in approximately 18% of cases in both groups.

CONCLUSIONS: The new sectorial addition multifocal IOL performed comparably to the diffractive apodized multifocal IOL in terms of UDVA and the presence of dysphotopsia. The diffractive apodized multifocal IOL performed better at 30 cm and 40 cm reading distances and had higher patient satisfaction.

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In this post I want to announce an update to my Atlas with more than 30 interresting cases under the following categories :
- Circumscribed choroidal haemangioma.- Punctate Inner Choroidopathy with CNVM.
- Subluxated lens in Homocystinemia.- Conjunctival cyst.- canalicular laceration.and more ,,,

Here I am again after a vacation I spent between rivers, gardens, lakes, ice skating, skydiving or paragliding and more in Europe's paradise. I want to share with you the feeling as a compensation for my abscence from my blog. Keep around for more hot topics in ophthalmology that it is always up-to-date.

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