Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders.

Topic: To provide recommendations for the use of anti-tumor necrosis factor α (TNF-α) biologic agents in patients with ocular inflammatory disorders.

Clinical Relevance: Ocular inflammatory diseases remain a leading cause of vision loss worldwide. Anti-TNF-α agents are used widely in treatment of rheumatologic diseases.

Reorientation of inverted endothelial graft during Descemet stripping automated endothelial keratoplasty.

We describe a technique during Descemet stripping automated endothelial keratoplasty for reorientation of an inverted endothelial graft. This technique allows the inversion to be predictably corrected with minimal manipulation and trauma to the endothelium, thereby reducing the risk of primary failure and subsequent repeat of the transplant.

Kyrieleis plaques associated with acute retinal necrosis from herpes simplex virus type 2.

Purpose: To present the case of a 19-year-old woman with acute retinal necrosis syndrome due to herpes simplex virus type 2, who developed segmental periarterial (Kyrieleis) plaques six and one half weeks into her clinical course.

Methods: Retrospective case report.

Patients: Single patient with the diagnosis of acute retinal necrosis syndrome.

A new method for measuring progression in patients with ocular cicatricial pemphigoid.

Objectives: To describe a method to measure the progression of ocular cicatricial pemphigoid and to compare its facility with traditional methods used to measure the progression of the disease.

Methods: The proposed method consists of measuring (in millimeters) the total relative inferior conjunctival surface available in 3 gaze positions. This method was used to monitor 7 eyes of 4 patients with ocular cicatricial pemphigoid over 2 years.

Sutured piggyback toric intraocular lenses to correct high astigmatism.

A 74-year-old woman presented for bilateral cataract surgery, which was performed 3 days apart. Corneal astigmatism was 4.25 diopters (D) in the right eye and 4.

Combined toric intraocular lens implantation and relaxing incisions to reduce high preexisting astigmatism.

Purpose: To evaluate whether combining toric intraocular lens (IOL) implantation with astigmatic keratotomy (AK) can correct higher levels of astigmatism while minimizing undue effects on the optical qualities of the cornea.

Setting: St. Luke's Cataract and Laser Institute, Tarpon Springs, Florida, USA.

Correcting high astigmatism with piggyback toric intraocular lens implantation.

An 86-year-old man presented for cataract surgery with corneal astigmatism of 5.12 diopters (D). After cataract extraction with small-incision techniques, 2 toric plate-haptic silicone intraocular lenses (IOLs) were implanted in the capsular bag, each with a 3.

Treating astigmatism at the time of cataract surgery.

Correcting astigmatism at the time of cataract surgery can be accomplished either by incisional techniques, such as use of a cataract incision for flattening or astigmatic keratotomy, or by implanting a toric intraocular lens. Both methods can reduce mild to moderate astigmatism. For correcting larger amounts of astigmatism, a combination of techniques can produce greater correction.

Piggyback intraocular lens implantation.

The piggyback method of implanting two intraocular lenses in one eye has been successfully expanded to address pseudophakic refractive error in normal eyes and eyes that have undergone post-penetrating keratoplasty. Piggyback implantation has been combined with the use of newly available minus-power lenses to provide appropriate power for a cataract patient with keratoconus, as well as to correct pseudophakic myopia. The phenomenon of increased depth of focus in piggybacks may be explained by a contact zone between the lenses.

Minus-power intraocular lenses to correct refractive errors in myopic pseudophakia.

Purpose: To evaluate the effectiveness of a secondary, piggyback, minus-power intraocular lens (IOL) to correct the refractive error in patients with myopic pseudophakia.

Methods: In this prospective noncomparative cohort study, 51 myopic pseudophakic patients received implantation of a minus-power IOL as a secondary procedure to correct residual pseudophakic myopia.

Results: The mean residual myopia of -3.

Refractive and visual outcome of hyperopic cataract cases operated on before and after implementation of the Holladay II formula.

Objective: The primary objective was to evaluate the refractive and visual outcomes in a series of hyperopic cataract cases in which the Holladay II intraocular lens (IOL) power formula was used in conjunction with added eye measurements (measured anterior chamber depth [ACD], lens thickness, and corneal diameter) to improve predictability of refractive outcome. In addition, the impact of use of a double ("piggyback") IOL on refractive outcome was evaluated.

Design: Prospective, nonrandomized comparative clinical trial.

Unpreserved lidocaine to control discomfort during cataract surgery using topical anesthesia.

Purpose: To determine whether intraoperative unpreserved lidocaine further decrease discomfort or pain during sutureless small incision cataract surgery and intraocular lens (IOL) implantation under topical anesthesia.

Setting: Outpatient ambulatory surgical center.

Methods: In this prospective controlled study, comparable eligible patients were randomized to receive 0.

Anesthesia, preoperative, and postoperative medications.

Retrobulbar and peribulbar anesthesia remain the principle means of ophthalmic anesthesia. Methods, needles, and medications continue to vary in the search for what works best, and that is a very individual preference as is seen by the literature over the past year. The increased role of nonsteroidal anti-inflammatory drugs is discussed, along with prophylactic antibiotic use.