short eyes ophthalmology
Long Eye … But we have to assure them we have a plan in place in case the surgery varies a little from the standard operation,” Dr. Raju said. Free; Metrics Abstract. On the other hand, short eyes have more positive pressure and shallow anterior chambers with less room for surgical maneuvers. The older, non-aspheric SA/SN60AT lens is available in powers up to +40 D, which will accommodate the majority of short axial length eyes, he said. Changing the IOL power by a little makes a big difference. An analysis of the studies published in the past 50 years reveals that the Haigis, Hoffer Q, and Holladay 2 formulas are the best options for intraocular lens power prediction in short eyes (<22 mm). Even small errors in axial length measurement can result in larger IOL power errors than in highly myopic eyes. The standard range of most acrylic lenses will accommodate all but the most extreme long eyes, he added. Raju and Zavodni do a fantastic job walking us through the entire pre-, peri-, and intraoperative process. He added that when performing a tap, it is “essential to immediately, if not simultaneously, inject an OVD through the paracentesis to deepen the anterior chamber and to lessen the potential for a suprachoroidal hemorrhage.” However, Dr. Raju said that if the need for a vitrectomy occurs in some of the earlier cases for young eye surgeons and they do not feel comfortable with this procedure, they should contact a glaucoma specialist or another senior colleague familiar with vitrectomy to step in. But its power range is only up to +30 D, he said. Ultrasound axial length determination is frequently more difficult compared to normal eyes because these eyes have distorted geometries which make it difficult to get a good-quality A-scan. For the extreme axial myope, a low power lens or even a minus lens may be required. Another way short eyes are penalized is that they are much more sensitive to minor displacements. During the exam, Dr. Zavodni said he looks closely at the extent of anterior segment crowding. Zachary Zavodni, MD, The Eye Institute, Salt Lake City, said that p… He also uses a coaxial I/A. In extremely short eyes with very shallow chambers it may be helpful to perform a limited pars plana vitrectomy, he said. This can be prevented by lowering the bottle height or infusion pressure. Of course, there are many clinical and surgical things you can do to help manage these cases and achieve safe and targeted outcomes. This shows the technique of doing a 25-gauge pars plana anterior vitrectomy tap in order to deepen the anterior chamber. In very short eyes, the pars plana may not be where you expect, so you do not want to do a tap in that situation. Tipperman: For long, myopic eyes you should avoid flattening of the anterior chamber so you dont put pressure or traction on the vitreous base, he said. In long eyes, you basically have the opposite, Dr. Devgan said. As a result, Dr. Haigis recommends optical biometry. “In eyes with notably narrow angles, I will perform gonioscopy prior to dilation to assess if the angle is occludable. Even if the surgery goes perfectly, IOL selection formulas are less accurate, so patients should be counseled appropriately. In those cases, he would perform laser peripheral iridotomy first. A pars plana vitreous tap is an option for extreme cases as well. Selection of a suitable IOL calculation formula is critical in these eyes. The shallow chamber and potential for positive pressure puts patients with a short eye at risk for significant iris prolapse. When you break up the cataract, do it within the capsular bag, he added. Rare pediatric disease and orphan drug designations granted for retinoblastoma treatment, Bausch Health licenses microdose formulation of atropine, Phase 2 trial for acute exacerbations of blepharitis, First patient dosed in a Phase 1 study for DME therapy, Open-label safety study for bevacizumab-vikg for wet AMD. Youre in very close proximity to the corneal endothelium because the anterior chamber is so shallow, he said. “If I still have shallowing after the viscoelastic is placed, I will consider a vitreous tap or dry vitrectomy,” she said. “If you are aware of complications, you can achieve excellent outcomes with refractive lens exchange in high hyperopes,” Dr. Barrett said. In these cases it is still preferable to place an IOL within the capsular bag since: 1) this decreases the potential for PCOand because high axial myopes are at risk for RD this is especially beneficial, and 2) in the event the patient does require a YAG capsulotomy, the IOL will act as a physical barrier and prevent vitreous from coming forward into the anterior segment, Dr. Tipperman said. 1. These eyes often have synechiae as well as convex anterior capsules that may make the capsulorhexis run out. If such a situation is suspected, the surgeon should stop the procedure, suture the incision, and assess the choroid using an intraoperative ophthalmoscope. Dr. Devgan offered tips for both short and long eyes. Short eyes also tend to have shallow chambers and may have posterior synechiae and peripheral anterior synechiae, Dr. Tipperman said. “Short, hyperopic eyes tend to have narrow angles, which can be exacerbated by phacomorphic narrowing in eyes with more advanced cataracts,” he said. Therefore, an acrylic lens is favored, he said. This procedure is still his first choice for patients with narrow angles who do not have a cataract yet. This results in a deeper than normal anterior chamber and alters the vector forces required to create a capsulorhexis. Zachary Zavodni, MD, The Eye Institute, Salt Lake City, said that patients with extremely short axial lengths (less than 20 mm) and small white-to-white measurements (less than 11 mm) may be at higher risk for suprachoroidal hemorrhage, which should be discussed. Intracameral lidocaine may lessen the discomfort of reverse pupillary block, and its use is advised for eyes at risk for this phenomenon. Optical biometry is ideal for measuring these patients, assuming that lens density does not preclude obtaining a valid measurement, he said. But Dr. Haigis has a few recommendations to help. Patients with high hyperopia, or short axial lengths, have their own set of challenges associated with cataract surgery, he said. Preventing iris prolapse, increasing chamber depth, IOL calculations, and more. A myopic shift in the early postoperative period may be the first sign that aqueous misdirection is developing. Copyright © 2020 EyeWorld News Service. Additionally, lens exchange can also lower the risk of angle closure, and it’s a relatively predictable procedure compared with LASIK. Dr. Haigis recommends the following formulae: Haigis, HofferQ and Holladay-2 with optimized IOL constants.


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