JCRS HIGHLIGHTS

Sticky topic
Glued intrascleral haptic fixation of an intraocular lens (IOL) is a technique for posterior chamber IOL fixation in eyes with absent or insufficient capsule support. First described in 2008, the technique continues to evolve and the method is being applied to an increasing array of scenarios. The intraoperative externalisation of the IOL haptics is the key step in glued-IOL surgery. Amar Agarwal describes a modification of the glued-IOL procedure in which the IOL haptic is bimanually transferred from one glued IOL forceps to another under direct visualisation in the pupillary plane. Called the “handshake†techniqueâ€, the modification provides better intraocular manoeuvrability throughout the surgery and extends applicability of the technique to challenging cases that require haptic manipulation, such as IOL drop and haptic slippage. It also provides the intraoperative advantage of a well-formed globe throughout the surgery. Dr Agarwal notes that one of the significant factors in the technique is the use of a foldable IOL. This provides all the advantages of small-incision surgery. A 3-piece foldable IOL with a C-loop or a modified C-loop configuration is used. Based on the surgeon's preference, an infusion cannula or an anterior chamber maintainer is fixed and the flaps and sclerotomies are made. The corneal incision is fashioned with a 2.8mm keratome, which is slightly enlarged to allow easy insertion of the IOL. A side port is made to provide better manoeuvrability and also serve as a future access point when required. A video of the complete procedure can be viewed online at http://www.jcrsjournal. org/article/S0886-3350%2813%2900030-8/ fulltext.

A Agarwal et al., JCRS, “Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lensâ€, Volume 39, No. 3, 317-322.

LASIK for low astigmatism
The surgical correction of low astigmatism remains controversial. One recent study found that uncorrected astigmatism, even as low as 1.00 D, can cause significantly decreased vision. However, there are pitfalls when performing LASIK to correct astigmatism because residual or induced astigmatism can lead to patient dissatisfaction. German researchers studied the refractive and visual outcomes of wavefront-optimised laser in situ keratomileusis in 448 myopic eyes with low astigmatism of 0.75 D or less. Preoperative subjective sphere ranged from −2.75 D to −11.50 D. By four months postoperatively, the mean UDVA was 0.10 Â} 0.13 logMAR and the mean manifest refraction spherical equivalent −0.05 Â} 0.68 D. There was no statistically significant difference in efficacy or safety between the preoperative cylinder groups. Astigmatic overcorrection for a preoperative cylinder of 0.25 D and 0.50 D was suggested by the correction index, the magnitude of error, the index of success and the flattening index. Considering that preoperative cylinder of 0.50 D or less was significantly overcorrected, the researchers suggest that caution should be used when considering full astigmatic correction for manifest cylinder of 0.50 D or less.

A Frings et al., JCRS, 366 - Efficacy and predictability of laser in situ keratomileusis for low astigmatism of 0.75 dioptre or less, Volume 39, No. 3, 366-377.

Femto flap accuracy at 200kHz
The femtosecond laser has been widely adopted by surgeons performing LASIK surgery. Advances in femtosecond technology, including higher laser repetition rates, have resulted in a reduction in the time taken to create the cut and in the energy requirements. Cummings and colleagues compared the intended versus the resultant thickness of laser in situ keratomileusis (LASIK) flaps created with a new 200 kHz femtosecond laser in 431 eyes of 258 patients. At three months' follow-up, the mean post-LASIK flap thickness was 120.23 μm Â} 13.94, with the intended flap thickness of 120 μm.

A Cummings et al., JCRS, “Predictability of corneal flap thickness in laser in situ keratomileusis using a 200kHz femtosecond laserâ€, Volume 39, No. 3, 378-385.