Toxic anterior segment syndrome (TASS) developed in four cases after uneventful implantation of a foldable iris-fixated phakic intraocular lens (pIOL). Two cases occurred sequentially in one patient. The TASS subsided without complications in all cases after intensive topical steroid treatment. A multitude of possible causes is considered for the occurrence of these TASS cases. From the sterilization and cleaning of surgical instruments to the possibility of endotoxines in ophthalmic viscosurgical devices (OVD). These rare cases should alert the surgeon to the possibility of TASS after pIOL implantation.

Artiflex PIOL implantation for the correction of moderate to high myopia seems to be a safe and predictable procedure, which resulted in increased high and low contrast visual acuity under photopic and mesopic conditions.

Foldable pIOL implantation increased total HOAs and spherical aberration less than wavefront-guided PRK to correct low to moderate myopia, suggesting foldable pIOL implantation maintains the cornea's prolate shape better.

Purpose:The purpose of this study was to compare the efficacy of Müller muscle-conjunctival resection (MMCR) with or without suturing for the correction of ptosis.Methods: A retrospective chart review was performed of 30 patients (56 eyelids) undergoing sutureless (sMMCR) (34 eyelids) or conventional MMCR (cMMCR) (22 eyelids). Primary outcome measures were the change in MRD1 and vertical eyelid height (VLH). Secondary outcome measures were the amount of resection of MMCR (rMMCR) and postoperative symmetry of 1 mm or less.Results: In total, 49 eyelids (87.5%) had involutional ptosis and 7 (12.5%) had contactlens induced ptosis. The age and follow up between the sMMCR and cMMCR groups was, respectively, 65.1 ± 11.0 versus 65.5 ± 11.0 years and 4.0 ± 2.5 versus 6.5 ± 2.1 months. Preoperatively there were no significant differences noted between the sMMCR and cMMCR groups. Postoperatively there was a statistically significant difference in change of MRD1 between the sMMCR and cMMCR groups, 2.74 ± 0.20 mm and 2.02 ± 0.25 mm (p = 0.026). The difference in change of VLH and rMMCR was not significant between the sMMCR and cMMCR groups, 2.28 ± 0.13 mm and 2.14 ± 0.15 mm (p = 0.49) and 9.29 ± 2.14 versus 9.46 ± 1.97 mm (p = 0.83). There were no significant differences in postoperative symmetry. Conclusion:The sMMCR and cMMCR techniques demonstrated equal effectiveness for the correction of ptosis. The rapid sMMCR could become the procedure of choice for the correction of involutional and contact lens induced ptosis.

Topical anesthesia is not widely used for foldable Artiflex phakic intraocular lens (pIOL) (Ophtec BV) implantation. Retrobulbar, peribulbar, and even general anesthesia are the more common techniques. 1 As a less invasive technique, topical anesthesia reduces the risk for systemic complications and eliminates the complications from injection anesthesia such as globe perforation, retrobulbar hemorrhage, retinal vascular occlusion, ptosis, and optic nerve damage. 2 The advantages of topical anesthesia are faster visual recovery, higher patient satisfaction, easy application, minimal discomfort on administration, rapid onset of anesthesia, and lower costs. To my knowledge, this is the first report of the efficacy of topical anesthesia for implantation of an Artiflex pIOL for the correction of myopia. The study used the visual analog pain scale described by Stevens. 3 PATIENTS, METHODS, AND RESULTSPrior to cataract surgery, 26 patients received preservativefree pilocarpine nitrate 2%, preservative-free oxybuprocaine hydrochloride 0.4 %, and preservative-free tetracaine hydrochloride 1% eyedrops. Four doses (approximately 40 mL per dose) of each eyedrop were instilled on the ocular surface 10 minutes apart starting 30 minutes before surgery. All surgery was performed by the same surgeon (L.A.M. van P.). One or 2 weeks before surgery, a laser peripheral iridotomy was created with a neodymium:YAG laser. Fluorometholone drops were used 4 times a day for 1 week. First, 2 vertical paracenteses were made at the 2 and 10 o'clock positions and directed toward the enclavation site. Intracameral acetylcholine and an ophthalmic viscosurgical device (sodium hyaluronate 1.4%, Healon GV) were introduced. After a corneoscleral incision of 3.2 mm was made at the 12 o'clock incision, the Artiflex pIOL was inserted with the use of a specially designed spatula that allows the surgeon to fold and insert the IOL. A special curved forceps was used for the enclavation by holding the poly(methyl methacrylate) haptics at the base. Suturing was not necessary since the incisions were checked and watertight. There were no intraoperative complications, and no patient required additional anesthesia to complete surgery safely, and there were no intraoperative complications.Before, during, and after surgery, the patients were shown a visual analog pain scale (VAS) with ratings from 0 (no pain) to 10 (severe pain) and their responses recorded. Table 1 and Figure 1 show the pain score for all 3 periods. A VAS score of 0 (no pain) was reported by 53%, 28%, and 50% of patients, respectively, and of 0-1 (no pain, slight discomfort) by 81%, 37%, and 53%, respectively. There was a significant increase in the mean VAS pain score from preoperatively to intraoperatively; however, 91% of patients preferred topical anesthesia to peribulbar or general anesthesia. DISCUSSIONAlthough a higher percentage (56%) of patients with an intraoperative VAS score of 0-1 during cataract surgery has been reported, 4 the mean postoperative pain score of 1.84 G 2.49 (SD) compa...