Next-Generation FSYX Goggles Approved for Glaucoma

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The FDA approves wireless pressure-modulating goggles for at-home glaucoma treatment; Bausch + Lomb launches a new PreserVision AREDS eye vitamin formation; and an Executive Strategic Advisor discusses the regulation environment for communication in eye care.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Cataract Surgery in Patients with Corneal Opacities

When the view through the cornea is poor, adjustments in illumination, capsular staining, and pupil expansion can help.

Boris Malyugin, MD, PhD

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Corneal opacities can compromise visualization during cataract surgery, but microscope illumination adjustments and supplemental light can improve the surgical view Transcorneal, intracameral, or pars plana chandelier illumination can enhance lens visualization by using reflected retinal light when coaxial light is insufficient Capsular staining, posterior capsule–safe phaco technique, and pupil expansion with a Malyugin Ring 2.0 or iris hooks can further improve control In eyes with corneal opacities, visualization of the capsule and lens can be challenging. The degree of difficulty depends on the density and location of the opacity. When cataract surgery alone, rather than a combined corneal and cataract procedure, is planned, several techniques can improve visualization. OPTIMIZING VISUALIZATION The first technique to improve visualization is to adjust the intensity of the operating microscope light and the balance between the coaxial and paraxial illumination. The second is to add supplemental illumination. A light pipe borrowed from a vitreoretinal setup can be positioned on the cornea near the limbus for transcorneal illumination or introduced into the anterior chamber through a paracentesis incision for intracameral illumination. Pars plana chandelier illumination can be useful in these cases. This technique was first described by Oshima et al in 2007.1 The approach is illustrated in Figures 1 and 2. When the coaxial microscope light is turned off and the chandelier illuminator is turned on, light reflects off the retina and improves visualization of the lens structures.

Beyond One-Size-Fits-All: The Move Toward Personalized Vitreoretinal Therapy

By calculating the vitreous volume exact, clinicians can treat eyes with greater precision.

Andreas F. Borkenstein, MD

Retina Today

KEY TAKEAWAYS Because the vitreous cavity is not a uniform 4- to 5-mL reservoir, the author advocates for the use of the vitreous volume exact (VIVEX) to personalize intravitreal therapeutics. Using VIVEX-derived vitreous volumes of 2.98 mL, 5.12 mL, and 11.76 mL for small, emmetropic, and large eyes, the author’s model predicted an approximately fourfold difference in initial intravitreal concentration despite identical dosing. The vitreous cavity is a dynamic therapeutic compartment with meaningful biomechanical and pharmacokinetic properties. When the vitreous volume exact (VIVEX) concept was first introduced,1 its central message was simple: The vitreous cavity is not a uniform 4- to 5-mL reservoir, and intravitreal therapy is therefore not delivered into a standard compartment in every patient. We now know that vitreous volume varies substantially with axial length, ranging from approximately 2 mL in short hyperopic eyes to more than 10 mL in highly myopic eyes. If concentration is determined by dose divided by volume, identical intravitreal doses must inevitably produce different intraocular concentrations in different eyes. Since my 2024 article in Retina Today, this idea has moved from concept toward validation. In a first real-world clinical case series, VIVEX-predicted vitreous volumes were compared with intraoperatively measured volumes in 27 eyes undergoing vitreoretinal surgery. The correlation was strong (R = 0.961), the mean absolute error was 0.48 mL, and 89% of estimates were within ±1.0 mL of the measured volume. Most importantly, this study showed that individualized vitreous volume estimation is not only mathematically plausible but clinically usable.