Intermittent Pain and Blur After PRK

This patient was told nothing could be done about a nodular, keloid-type subepithelial scar.

Abi Tenen, MBBS (Hons), FRANZCO; Andrea Ang, MBBS (Hons), MPH, FRANZCO; Dena Ballouz, MD; Parag A. Majmudar, MD; Allon Barsam, MA(Cantab), MBBS, FRCOphth, FWCRS; and Marguerite B. McDonald, MD, FACS

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Surgeons consider how to manage persistent intermittent pain, blurred vision, and foreign body sensation in an eye with a nodular, keloid-type subepithelial scar 8 years PRK Initial steps in this situation include optimization of the ocular surface Recurrence is possible, so patients should be counseled accordingly CASE PRESENTATION A 36-year-old woman presents with pain, blurred vision, and foreign body sensation in her left eye. Eight years ago, she underwent bilateral PRK for myopia and high astigmatism by another surgeon. The patient has experienced these symptoms intermittently since the surgery, and they have neither improved nor worsened. She was told that the left cornea has a scar and that nothing further can be done. On examination, the patient’s UCVA is 6/7.5+2 OD, 6/9.5+2 OS, and 6/6 with both eyes open. Her manifest refraction is 0 -0.75 x 50º = 6/6 OD and -0.25 -1.25 x 20º = 6/6 OS. The IOP is 10 mm Hg OD and 12 mm Hg OS. A slit-lamp examination of the left eye finds a nodular, keloid-type subepithelial scar with surrounding haze in the paracentral cornea. A reactive ptosis and brow overaction are also present on the left. The right cornea exhibits mild central haze.

The Essential Role of Capsule Retractors

These instruments provide temporary zonular support that can help surgeons safely remove the lens and plan for permanent capsular stabilization.

Beeran Meghpara, MD

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Capsule retractors act as temporary artificial zonules, centering the capsular bag and preventing posterior displacement, anterior vitreous prolapse, and phaco-tip aspiration Early placement after continuous curvilinear capsulorhexis and before hydrodissection stabilizes eyes with phacodonesis, flaccid lens behavior, or significant zonular compromise Unlike iris hooks, capsule retractors provide equatorial support; after lens removal, permanent support requires a capsular tension ring or scleral-fixated segment Managing profound zonular compromise is one of the most demanding challenges in anterior segment surgery—one that tests the surgeon’s composure and technical acumen. Whether caused by pseudoexfoliation syndrome, prior ocular trauma, Marfan syndrome, or advanced age-related changes, generalized or localized zonulopathy threatens the stability of the capsular bag. The primary surgical goal in these cases is to remove the lens without damaging the capsule or allowing lens fragments to become posteriorly displaced into the vitreous. One useful tool in this setting is the capsule retractor; it is designed to provide atraumatic support and centration of the capsular bag throughout cataract extraction. These instruments feature an elongated nylon shaft and a broad, blunt terminal paddle or loop that cradles the capsular equator without causing iatrogenic trauma. A sliding silicone element on the shaft rests externally against the limbus and allows the surgeon to adjust the amount of tension required. Although retractors can be placed as a rescue maneuver when unexpected zonular dialysis becomes apparent during phacoemulsification or cortical aspiration, the instruments are most effective when used prophylactically. WHEN TO DEPLOY CAPSULE RETRACTORS The timing of capsule retractor deployment is critical to preventing progressive capsular instability. If significant phacodonesis is observed at the slit lamp preoperatively or if the lens appears flaccid during initial capsulorhexis creation, early intervention is warranted. Ideally, capsule retractors are inserted immediately after completion of the continuous curvilinear capsulorhexis and before hydrodissection or any manipulation of the nucleus.

Retinal Perfusion, Sensitivity, and Function in DR

Barton Blackorby, MD; Katherine Talcott, MD; and Hong-Uyen Hua, MD

Eyetube

Does retinal capillary non-perfusion reliably predict functional vision loss in DR? And does the answer change how retina specialists treat it? In this episode of New Retina Radio Journal Club with VBS, Barton Blackorby, MD; Katherine Talcott, MD; and Hong-Uyen Hua, MD, discuss a prospective longitudinal cohort study examining the association between retinal sensitivity and perfusion over 2 years in patients with DR.