折叠式人工晶状体临床应用观察

目的:探讨白内障超声乳化摘除联合折叠式人工晶状体植入术的临床应用效果。方法:对109例(147只眼)白内障行超声乳化吸除术联合折叠式人工晶状体植入术,分别植入人工晶状体CANON STAARAQ-110NV型53眼、AMO S140NB型43眼、Pharmacia Ceeon 911型32眼、Alcon Acrysof型20眼。对术后视力、术前术后角膜散光、术后前房反应、人工晶状体位置、手术并发症进行观察。结果:术后6个月。矫正视力≥0.5眼数分别为94.3％、93.0％、90.6％、90.0％;术后6个月,AQ-110NV型和S140NB型、CeeOn 911型和Alcon Actysof型间角膜平均散光度数无显著差异,AQ-110NV型和S140NB型与Ceeon 911型和Alcon Acrysof型有显著差异(P<0.05);术后前房反应轻微;角膜水肿、后囊破裂、后囊混浊、人工晶状体破损,发生率分别为6.1％、4.1％、10.9％、3.9％;未发现人工晶体状体明显移位者。结论:各种材料的折叠式人工晶状体在临床上的应用都是有效的,推注式人工晶状体(AQ-110NV、S140NB型)植入术无须扩大切口,容易掌握,术后反应轻,并发症少,手术疗效满意。     

Improved performances of intraocular lenses by poly(ethylene glycol) chemical coatings

Cataract surgery is a routine ophthalmologic intervention resulting in replacement of the opacified natural lens by a polymeric intraocular lens (IOL). A main postoperative complication, as a result of protein adsorption and lens epithelial cell (LEC) adhesion, growth, and proliferation, is the secondary cataract, referred to as posterior capsular opacification (PCO). To avoid PCO formation, a poly(ethylene glycol) (PEG) chemical coating was created on the surface of hydrogel IOLs. Attenuated total reflectance Fourier transform infrared spectroscopy, "captive bubble" and "water droplet" contact angle measurements, and atomic force microscopy analyses proved the covalent grafting of the PEG chains on the IOL surface while keeping unchanged the optical properties of the initial material. A strong decrease of protein adsorption and cell adhesion depending on the molar mass of the grafted PEG (1100, 2000, and 5000 g/mol) was observed by performing the relevant in vitro tests with green fluorescent protein and LECs, respectively. Thus, the study provides a facile method for developing materials with nonfouling properties, particularly IOLs.     

Optical scattering measurements of laser induced damage in the intraocular lens

This study optically determines whether the amount of light scatter due to laser-induced damage to the intraocular lens (IOL) is significant in relation to normal straylight values in the human eye. Two IOLs with laser-induced damage were extracted from two donor eyes. Each IOL had 15 pits and/or cracks. The surface area of each pit was measured using a microscope. For 6 pits per intraocular lens the point spread function (PSF) in terms of straylight was measured and the total straylight for all 15 pits was estimated. The damage in the IOLs was scored as mild/moderate. The total damaged surface areas, for a 3.5 mm pupil, in the two IOLs were 0.13% (0.0127 mm(2)) and 0.66% (0.064 mm(2)), respectively. The angular dependence of the straylight caused by the damage was similar to that of the normal PSF. The total average contribution to straylight was log(s) = -0.82 and -0.42, much less than the straylight value of the normal eye.The straylight due to normal levels of laser induced damage of the IOL is much lower than normal straylight values found clinically for the normal eye and may therefore be considered not significant.     

Effect of Hydrophobic Acrylic versus Hydrophilic Acrylic Intraocular Lens on Posterior Capsule Opacification: Meta-Analysis

Purpose

This meta-analysis aims to evaluate the differences in performance of posterior capsular opacification (PCO) between hydrophobic acrylic intraocular lens (IOLs) and hydrophilic acrylic IOLs.

Setting

Tianjin Medical University, Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China.

Design

Systematic review of randomized controlled trials (RCTs) or meta-analysis.

Methods

An electronic literature search was performed using the PubMed, EMBASE and Cochrane Library database before May in 2013 to identify prospective RCTs comparing hydrophobic acrylic IOLs and hydrophilic acrylic IOLs in patients after phacoemulsification with IOL implantation with a follow-up time of at least 1 year. Pertinent studies were selected by meeting predefined criteria and reviewed systematically by meta-analysis. The PCO scores and YAG capsulotomy rate, as indicator of PCO, were measured and discussed in a meta-analysis. Standardized mean differences (SMD), relative risk ratio (RR), and the pooled estimates were computed according to a random effect model or fixed effect model.

Results

Nine prospective RCTs involving 861 eyes were included in the current meta-analysis. The hydrophobic acrylic IOLs were favored and the pooled SMD of PCO severity was1.72 (95% confidence interval (CI), 0.20 to 1.23, P = 0.0002) and 1.79 (95% CI, 0.95 to 2.64, P<0.0001) with 1-year follow-up and 2-year follow-up respectively. The pooled RR of Nd:YAG laser capsulotomy rates at postoperative 2-year follow-up was 6.96 (95% CI, 3.69 to 13.11, P<0.00001) comparing hydrophilic acrylic IOLs with hydrophobic acrylic IOLs.

Conclusions

Compared with hydrophilic acrylic IOLs, the hydrophobic acrylic IOLs showed superior reduction in rates of PCO and laser capsulotomy in 2-year follow-up. More RCTs with standard methods for longer follow-up are needed to validate the association.     

Intraocular lens power calculations using a Scheimpflug camera to measure corneal power

We measured corneal power using an Oculus Pentacam^® to assess its accuracy for calculating intraocular lens (IOL) power after myopic refractive surgery. A series of corneal power measurements were performed on 22 patients (43 eyes) who had undergone myopic refractive surgery. In 37 of the 43 eyes, phacoemulsification and IOL implantation subsequently were performed. Conventional keratometry and three corneal measurements (mean true net power, central true net power, and 4.5 mm equivalent K reading) obtained using a Pentacam were analyzed and compared to values derived from the clinical history method. Prediction errors of three Pentacam corneal power measurements inserted in third generation IOL formulas also were compared. Analysis of the variance showed that only two Pentacam corneal measurements, mean true net power and central true net power, were not significantly different from those of the clinical history method. Mean true net power was correlated more closely with the clinical history method corneal power than other corneal power values. The one-sample t-test showed that of three Pentacam corneal measurements combined with third-generation formulas, only the mean true net power inserted in the SRK/T implant power calculation formula was not significantly different from zero. The percentages of eyes within ± 0.50 D and ± 1.00 D of the refractive prediction error of this method were 67.6% and 86.5%, respectively. Mean true net power inserted in the SRK/T formula can be used to calculate directly IOL power after myopic refractive surgery.     

Ocular Hypertension after Pediatric Cataract Surgery: Baseline Characteristics and First-Year Report

Monitoring intraocular pressure (IOP) is essential for pediatric cataract treatment but always difficult due to lack of cooperation in young children. We present the baseline characteristics and the first-year results of a long-term prospective cohort study, which are aimed to determine the relationship of the incidence of ocular hypertension (OH) in children after cataract surgery during the first-year period and the risk of developing late-onset glaucoma. Children were included with the following criteria: they were≤10 years old and scheduled to undergo cataract surgery with/without intraocular lens implantation; they were compliant with our follow-up protocol, which included monitoring IOP using a Tono-Pen under sedation or anesthesia. Incidence of OH, peak OH value, OH onset time and OH duration within a 12-month period following surgery were measured. In brief, 206 patients (379 eyes) were included and OH developed in 66 of 379 (17.4%) eyes. The mean follow-up period was 14.0±3.2 months (median, 12 months; range, 10–16 months). Moreover, 33 of 196 (16.8%) aphakic eyes and 33 of 183 (18.0%) IOL eyes were diagnosed with OH. The peak OH onset times were at 1-week (34/66, 51.5%) and 1-month (14/66, 21.2%) appointments postsurgery. The peak IOP value in the OH eyes was 29.9±7.5 mmHg (median, 29 mmHg; range, 21–48 mmHg). The duration of OH was 30.9±31.2 days (median, 30 days; range, 3–150 days). OH recurred in 13 eyes with a history of OH diagnosed within 1 month postsurgery (13/54, 24.1%), which needed temporary or long term use of antiglaucoma medications. In conclusion, the incidence of OH in children after cataract surgery was 17.4% during the first-year period. Children who have suffered elevated IOP in the first year after cataract surgery should be followed closely to determine if there is an increased risk of developing late-onset glaucoma.     

Complications after primary and secondary transsclerally sutured posterior chamber intraocular lens implantation

This retrospective study analyses and compares early complications during the first month after primary and secondary posterior chamber implantation of transsclerally sutured IOL. The analysis covered medical records of 65 patients who underwent posterior chamber implantation of transsclerally sutured IOL at the Eye Clinic in Rijeka between 1998 and 2003. In 30 patients (group 1) lenses were implanted in one eye during complicated cataract surgery (primary implantation), whereas 35 patients (group 2) had lenses implanted afterwards (secondary implantation). There were 77 early complications, equally represented in both groups, i.e. 40 in (51.9%) the first and 37 (48.1%) in the second group. The most frequent complications were: vitreous hemorrhages 24.7% (14.3% and 10.4%), cystoid macular edema 19.5% (9.1% and 10.4%), keratopathy 14.3% (6.5% and 7.8%), pupil distortion 11.7% (9.1% and 2.6%), IOL decentration and tilt 10.4% (6.5% and 3.9%), high intraocular pressure 9.1% (2.6% and 6.5%), inflammation 6.5% (2.5% and 3.9%). Retinal and choroidal detachment had low incidence: 2.6% (1.3% and 1.3%) and 1.3% (0% and 1.3%) respectively. As concerns early complications, there were no statistically significant differences between the two groups, except for pupil distortion, which was more frequent in primary IOL implantation (p = 0.045). After primary implantation of IOL, the average visual acuity was 0.38 +/- 0.27, whereas after secondary implantation visual acuity was 0.52 +/- 0.21. The difference was not statistically significant.     

Penetrating keratoplasty and Verisyse iris-claw lens--is it safe for corneal graft?

The loss of the corneal endothelial cells, especially in a first postoperative year, has been observed in patients who underwent penetrating keratoplasty (PK). The implantation of new generation of "iris claw" phakic IOL (Verisyse) in refractive cases has been shown to cause clinicaly insignificant endothelial cell loss. In our prospective case series we investigated the endothelial cell loss and clinical outcome in patients that either underwent PK and implantation of PCIOL or PK and implantation of Verisyse IOL. In the first group of 9 patients scheduled for PK, implantation of Verisyse was performed due to the absence of the posterior capsule support. 2 of these patients had angle supported ACIOL, 4 patients were aphakic and 3 had posttraumatic cataract with ruptured posterior capsule. The second group of 12 patients had standard "triple" procedure (PK + ECCE + PCIOL). BCVA of both groups of patients prior the operation was hand movement in 12 patients, light perception in 7 patients and 0.05 in 3 patients. The preoperative endothelial cell count of the donor grafts obtained from the eye bank was 2800 cells/mm2 on average. The follow up was 6-10 months. Six months after the operation all "Verysise" patients maintained transparent graft. Postoperative visual acuity improvement was recorded in 18 out of 21 eyes (85.7%). Best spectacle corrected visual acuity of > or = 0.3 was achived in 55.5% in the Verisyse group and in 50.0% of "triple procedure" group. The endothelial cell count and morphology were estimated on the specular microscope on a monthly basis. Mean endothelial cells loss in patients with PK and Verysise was 40 +/- 8% and in patients with "triple" procedure was 42 +/- 12% at 10 postoperative months. There was no significant difference in the endothelial cell loss and clinical outcome between the group of patients who had PK and Verysise as compared to those with implanted PCIOL.     

Phacoemulsification and silicone oil removal through the planned posterior capsulorhexis

The purpose of the study was to present operative technique and results of a passive hydrodynamic expression of silicone oil through planned posterior capsulorhexis during cataract surgery in patients after pars plana vitrectomy. The retrospective analysis was done on 57 eyes with cataract after a previous pars plana vitrectomy, operated on between 2001 and 2004 at the Clinical hospital "Sestre milosrdnice" Zagreb. Preoperative and postoperative best corrected visual acuity (BCVA), preoperative and postoperative intraocular pressure (IOP), and postoperative complications were reviewed. Visual acuity improved or stabilized in all patients with an attached retina. Retinal detachment occurred in 11 eyes. Transient vitreous hemorrhage, that resolved within 1 week of surgery without treatment, was observed in 4 eyes. Asymptomatic intraocular lens (IOL) decentration occurred in 2 eyes. Our findings suggest that silicone oil removal and cataract surgery can be performed as a single procedure in selected patients in the absence of macular pucker and retinal reproliferation, and in a presence of a stable retina.     

Retropupillary Fixation of Iris-Claw Intraocular Lens for Aphakic Eyes in Children

Purpose

To report outcome, complications and safety of retropupillary fixated iris-claw intraocular lenses in a pediatric population.

Design

Retrospective study.

Patients and Methods

Ten consecutive pediatric patients (15 eyes) underwent placement of retropupillary fixated iris-claw intraocular lenses between October 2007 and July 2013 at the Department of Ophthalmology, Medical University Graz and General Hospital Klagenfurt, Austria. Postoperative visual acuity and complications were analyzed.

Results

Median final best-corrected visual acuity improved by 0.12 logMAR from preoperative baseline. Mean postoperative spherical equivalent was -0.05 ± 1.76 D. No serious complications were observed intra- or postoperatively during the entire follow-up period of up to 40 months. One patient experienced a haptic disenclavation with IOL subluxation immediately after a car accident.

Conclusion

Our study demonstrates that iris-claw intraocular lens implantation behind the iris is safe in children with lack of capsular support and yields excellent visual outcome with low complication rate.     

Anterior Chamber Depth and Refractive Change in Late Postoperative Capsular Bag Distension Syndrome: A Retrospective Analysis

Purpose

To assess the characteristic findings and effects of laser capsulotomy in patients with late postoperative capsular bag distension syndrome (CBDS).

Methods

Twenty patients diagnosed with late postoperative CBDS between July 2010 and August 2013 were retrospectively reviewed. Before and 1 week after capsulotomy, changes in the anterior chamber depth (ACD) were assessed using ultrasound biomicroscopy. Changes in the refractive status and uncorrected visual acuity (UCVA) were also measured 1 week and 1 month after capsulotomy. For patients who received bilateral cataract surgery, preoperative ACD and axial length measured by IOLMaster were compared between the two eyes.

Results

Twenty-two eyes from 20 patients who had undergone laser capsulotomy showed a mean UCVA improvement of 0.27 ± 0.24 logMAR (range, 0.00–0.90). ACD was increased by an average of +0.04 mm (95% confidence interval, +0.01 to +0.06 mm, p = 0.034), equivalent to predicted refractive change of +0.10 D. The discrepancy between actual (+1.33 D) and predicted refractive change after capsulotomy suggests that refractive change may not be generated from IOL displacement in late postoperative CBDS. Preoperative ACD was deeper in the eye with late postoperative CBDS in all bilaterally pseudophakic patients (mean, 3.68 mm vs. 3.44 mm in the fellow eye, p = 0.068).

Conclusions

Late postoperative CBDS showed refractive changes that were resolved successfully after laser capsulotomy. The convex lens effects of opalescent material in the distended capsular bag may play a major role in myopic shift. A larger preoperative ACD is possibly associated with the development of late postoperative CBDS.     

Blue light filtering intraocular lenses in phacoemulsification cataract surgery

Blue light can damage retina and cause age related macular degeneration. After cataract surgery and lens removal retina stays unprotected. Blue light filtering intraocular lenses (IOL) increase protection of the retina. In our prospective study we investigated clinical results after bilateral implantation of Acrysof Natural IOL to 30 patients (N = 60 eyes). In a control group (N = 60 eyes, 30 patients), standard acrysof IOL was implanted bilaterally. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and Nd YAG laser capsulotomy rate were measured and compared with control group. Subjective patient's satisfaction and subjective colour perception were also investigated. There was no significant difference in UCVA, BCVA and Nd YAG laser capsulotomy rate between the two groups. High patient's satisfaction was noticed (96.7% of patients would implant Acrysof Natural IOL again). Acrysof Natural IOL enables good visual acuity VA, low rate of Nd YAG laser capsulotomy and high patient's satisfaction without colour perception disturbances.     

透明角膜切口白内障术后角膜曲率的临床观察*

目的:观察年龄相关性白内障行透明角膜切口超声乳化吸除及人工晶体植入术后角膜曲率的变化及相对稳定的时间。方法:收集2016年6月-8月在哈尔滨医科大学附属第一医院伍连德纪念医院进行的3.0 mm透明角膜切口白内障超声乳化吸除及人工晶体植入术的患者200例216眼,其中男88例、女128例,平均年龄71.2岁,进行相应的术前检查,并检查术前、术后第一天、一周、一个月、和三个月时的角膜曲率、视力、眼压并行相应的统计学分析。结果:术后不同时间点视力0.5的恢复情况:第一天为147眼(68.05%)、一周为175眼(81.02%)、一个月为193眼(89.35%)、三个月为197眼(91.20%);术前角膜曲率为43.94±1.35、术后第一天、术后一周的角膜曲率分别为44.98±1.06、44.45±1.18,与术前相比有显著性差异(p0.05),术后一个月、三个月的角膜曲率分别为44.13±1.27、44.02±1.24,与术前相比无显著性差异(p0.05);术源性散光于术后一天达到最大,随后逐渐减小,术后一个月、三个月与术后一天比较有显著性差异(p0.05),术后三个月与一个月比较无显著性差异(p0.05),术源性散光术后逐渐下降,并于一个月时趋于稳定。结论:3.0 mm透明角膜切口白内障超声乳化吸除及人工晶体植入术患者在术后一个月的角膜曲率基本稳定,恢复至术前状态,屈光状态趋于稳定,术源性角膜散光较小,术后视力恢复至较好状态。     

Comparison of blue light-filtering IOLs and UV light-filtering IOLs for cataract surgery: a meta-analysis

Background

A number of published randomized controlled trials have been conducted to evaluate visual performance of blue light-filtering intraocular lenses (IOL) and UV light-filtering intraocular lenses (IOL) after cataract phacoemulsification surgery. However, results have not always been consistent. Therefore, we carried out a meta-analysis to compare the effectiveness of blue light-filtering IOLs versus UV light-filtering IOLs in cataract surgery.

Methods and Findings

Comprehensive searches of PubMed, Embase, Cochrane Library and the Chinese BioMedical literature databases were performed using web-based search engines. Fifteen trials (1690 eyes) were included for systematic review, and 11 of 15 studies were included in this meta-analysis. The results showed that there were no significant differences in postoperative mean best corrected visual acuity, contrast sensitivity, overall color vision, or in the blue light spectrum under photopic light conditions between blue light-filtering IOLs and UV light-filtering IOLs [WMD = −0.01, 95%CI (−0.03, 0.01), P = 0.46; WMD = 0.07, 95%CI (−0.04, 0.19), P = 0.20; SMD = 0.14, 95%CI (−0.33, 0.60), P = 0.566; SMD = 0.20, 95%CI (−0.04, 0.43), P = 0.099]. However, color vision with blue light-filtering IOLs was significantly reduced in the blue light spectrum under mesopic light conditions [SMD = 0.74, 95%CI (0.29, 1.18), P = 0.001].

Conclusion

This meta-analysis demonstrates that postoperative visual performance with blue light-filtering IOLs is approximately equal to that of UV light-filtering IOLs after cataract surgery, but color vision with blue light-filtering IOLs demonstrated some compromise in the blue light spectrum under mesopic light conditions.     

Postoperative outcomes after implantation of intraocular lenses in eyes with cataract and uveitis

Despite advances in surgical technique and implant materials, cataract surgery in patients with uveitis is still a challenging procedure. We retrospectively evaluated postoperative outcomes of cataract surgery in 35 eyes of 29 patients with uveitis. Phacoemulsification with posterior chamber intraocular lens implantation was performed in all eyes. Postoperative evaluations were performed at day 2, and then at 7 days, 1, 3, and 6 months respectively. There were 16 males, and 13 females, aged 31 to 68 years. Follow-up ranged from 4 to 35 months. At final follow-up 33 eyes (94%) had an improvement in visual acuity compared with preoperative levels (p < 0,05). Giant cells were observed in the intraocular lens optic in 7 eyes (20%). Posterior capsule opacification occurred in 10 eyes (29%). Clinical cystoid macular edema was observed in 4 eyes, and 2 eyes required trabeculectomy with mitomycin C due to secondary glaucoma. Cataract surgery in patients with uveitis leads to successful visual results after correct surgical timing, and adequate anti-inflammatory therapy. There were no significant differences in the degree of inflammation after implantation of various types of intraocular lenses.     

Redistribution of strain and curvature in the porcine anterior lens capsule following a continuous circular capsulorhexis

Cataract surgery is the most commonly performed surgical procedure in the US, it consists of three steps: introduction of a hole into the lens capsule, removal of the clouded lens through this access hole, and insertion of an artificial lens. We hypothesize that errant behavior by the residual epithelial cells of the lens capsule following surgery are due, in part, to surgically-induced changes of the native stress and strain fields in the lens capsule. Because the capsular bag can be regarded mechanically as a membrane, here we study changes in curvature and strains due to the most common means of introducing the initial access hole: a continuous circular capsulorhexis (CCC). We show that a modest sized CCC increases circumferential strains and decreases meridional strains by up to approximately 20% and that curvatures change by up to approximately 13%, particularly near the edge of the CCC. We submit that such changes can induce mechanobiological responses that are responsible, in part, for some of the long-term complications following cataract surgery.     

Cataract surgery and intraocular lens implantation in children with juvenile rheumatoid arthritis associated uveitis

Clinical records of 6 children (7 eyes) with juvenile rheumatoid arthritis (JRA) who underwent cataract surgery with IOL implantation between January 1998 and December 2002 were reviewed. The median age at the time of cataract surgery was 8 years (range 5-14 years). The median follow up was 48 months (range 26 to 60 months). Five of six children (6 eyes) were on systemic immunosuppressive or anti-inflammatory therapy. Glaucoma was present in three eyes before surgery, and all three eyes underwent combined cataract surgery and trabeculectomy with mitomycin C. A final best corrected visual acuity of 0.5 or better was achieved in all eyes Postoperative complications included posterior capsule opacification (n = 5), glaucoma (n = 1), and cystoid macular edema (n = 1). Intraocular lens implantation in children with control of preoperative and postoperative ocular inflammation could lead to favorable visual results.     

超声乳化联合小梁切除术治疗闭角型青光眼合并白内障的临床研究

目的:探讨超声乳化白内障吸除术(Phaco)、人工晶状体植入术(IOL)联合小梁切除术(TBL)治疗原发性闭角型青光眼(PACG)伴厚晶状体白内障的临床疗效和安全性。方法:将82例(98眼)原发性闭角型青光眼伴厚晶状体白内障患者随机分为A组(41例52眼)和B组(41例46眼),A组行Phaco+IOL+TBL治疗,B组单纯行TBL治疗,比较两组的手术前后眼压、最佳矫正视力、中央前房深度(ACD)、小梁虹膜角(TIA)、房角开放距离500(AOD500)及小梁睫状体距离(TCPD)的变化、视力提高率及并发症的发生情况。结果:两组术后眼压均较术前显著降低,且A组的降低幅度显著高于B组(P0.05);两组术后最佳矫正视力均显著提高,且A组显著高于B组(P0.05);A组术后视力提高率为86.54%,显著高于B组的32.61%(P0.05);两组术后ACD、TIA、AOD500及TCPD均显著提高,且A组显著高于B组(P0.05);A组手术并发症发生率为5.77%,显著低于B组的17.39%(P0.05)。结论:超声乳化白内障摘除术、人工晶状体植入术联合小梁切除术治疗PACG伴厚晶状体白内障的疗效较单用小梁切除术更好,且安全性更高。     

A Novel Technique of Rescuing Capsulorhexis Radial Tear-out using a Cystotome

Part 1 : Purpose: To demonstrate a capsulorhexis radial tear out rescue technique using a cystotome on a virtual reality cataract surgery simulator and in a human eye. Part 2 : Method: Steps: When a capsulorhexis begins to veer radially towards the periphery beyond the pupillary margin the following steps should be applied without delay. 2.1) Stop further capsulorhexis manoeuvre and reassess the situation. 2.2) Fill the anterior chamber with ophthalmic viscosurgical device (OVD). We recommend mounting the cystotome to a syringe containing OVD so that the anterior chamber can be reinflated rapidly. 2.3) The capsulorhexis flap is then left unfolded on the lens surface. 2.4) The cystotome tip is tilted horizontally to avoid cutting or puncturing the flap and is engaged on the flap near the leading edge of the tear but not too close to the point of tear. 2.5) Gently push or pull the leading edge of tear opposite to the direction of tear. 2.6) The leading tearing edge will start to do a ''U-Turn''. Maintain the tension on the flap until the tearing edge returns to the desired trajectory. Part 3 : Results: Using our technique, a surgeon can respond instantly to radial tear out without having to change surgical instruments. Changing surgical instruments at this critical stage runs a risk of further radial tear due to sudden shallowing of anterior chamber as a result of forward pressure from the vitreous. Our technique also has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. Part 4 : Discussion The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis tear-out techniques. Capsulorhexis is the most important and complex part of phacoemulsification and endocapsular intraocular lens implantation procedure. A successful cataract surgery depends on achieving a good capsulorhexis. During capsulorhexis, surgeons may face a challenging situation like a capsulorhexis radial tear-out. A surgeon must learn to tackle the problem promptly without making the situation worse. Some other methods of rescuing the situation have been described using a capsulorhexis forceps. However, we believe our method is quicker, more effective and easier to manipulate as demonstrated on the EYESi surgical simulator and on a human eye. Acknowledgments: List acknowledgements and funding sources. We would like to thank Dr. Wael El Gendy, for video clip. Disclosures: describe potential conflicting interests or state We have nothing to disclose. References: 1. Brian C. Little, Jennifer H. Smith, Mark Packer. J Cataract Refract Surg 2006; 32:1420 1422, Issue-9. 2. Neuhann T. Theorie und Operationstechnik der Kapsulorhexis. Klin Monatsbl Augenheilkd. 1987; 1990: 542-545. 3. Gimbel HV, Neuhann T. Development, advantages and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg. 1990; 16: 31-37. 4. Gimbel HV, Neuhann T. Continuous curvilinear capsulorhexis. (letter) J Cataract Refract Sur. 1991; 17: 110-111.     

The importance of neuromuscular rate of force development for physical function in aging and common neurodegenerative disorders – a systematic review

We systematically reviewed existing literature regarding lower extremity neuromuscular rate of force development (RFD), maximal muscle strength (Fmax), and physical function in neurodegenerative populations, and to what extent these outcomes are affected and/or associated. Following PRISMA guidelines, 4 databases (Pubmed, Embase, SPORTDiscus, Web of Science) were searched. Across aging, Parkinson Disease (PD), Alzheimer’s Disease (AD), Multiple Sclerosis (MS), or Stroke, included studies should report (Part 1) deficits in lower extremity RFD, Fmax, and physical function (~ individuals having inferior vs. superior physical function), and/or (Part 2) associations between RFD (or Fmax) and physical function. A total of N=32 studies (n=1087 participants) were included. Part 1: deficits in RFD (-31%, mean; N=22) were comparable to deficits in physical function (-26%; N=7), yet both deficits exceeded that of Fmax (-21%; N=20). Part 2: associations between RFD and physical function (r²=0.13, mean; N=16) were comparable to associations between Fmax and physical function (r²=0.15; N=12). Lower extremity RFD is (1) particularly sensitive (i.e. adapts earlier and/or more extensively) towards neurodegeneration, and more so than Fmax, and (2) of importance for physical function but apparently not superior to Fmax. RFD could serve as a useful indicator/biomarker of changes in neuromuscular function elicited by neurodegeneration.