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Advances in Minimally Invasive Ophthalmic Surgery

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (15 March 2023) | Viewed by 10182

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Dr. Otman Sandali

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1. Centre Hospitalier National d’Ophtalmologie des XV-XX, Pierre & Marie Curie University Paris 06, ResearchTeam 968, Institut de laVision, 75571 Paris, France
2. Service de Chirurgie Ambulatoire, Hôpital Privé Guillaume De Varye – ELSAN, 18230 Bourges, France
Interests: cataract surgery; heads-up three-dimensional (3D) digital visualization system; vitreoretinal surgery; retina imaging; microinvasive glaucoma surgery; keratoconus imaging

Prof. Dr. Marc D. De Smet

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MIOS—Retina and Ocular Inflammation Center, 1005 Lausanne, Switzerland
Interests: retinal diseases; vitreoretinal surgery; ocular inflammation; pharmacology and pharmacotherapeutics; micro invasive and robotic surgery; retinal imaging; OCT

Prof. Dr. Walid Zbiba

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University Hospital of Mohamed Tahar Maâmouri, 8000 Nabeul, Tunisia
Interests: retina cataract and ocular trauma microsurgeon; microinvasive glaucoma surgery

Prof. Dr. Frédéric J. Matonti

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Centre Monticelli Paradis, 433 Bis Rue Paradis, 13008 Marseille, France
Interests: eyes; surgery; OCT; vision science; macular degeneration; retinal degeneration; retinal imaging fluorescein angiography; retinal physiology; vitreoretinal surgery

Special Issue Information

Dear Colleagues,

Minimally invasive surgical techniques have led to revolutions in many surgical disciplines. The use of such techniques decreases the rates of tissue trauma and accelerates postoperative recovery while reducing complications, patient discomfort, lengths of hospital stays, and time off work.

In cataract surgery, microincisions of less than 2 mm are now the gold standard, superseding the large corneal incisions of extracapsular surgery and improving outcomes, with a faster recovery of vision in patients. In vitreoretinal surgery, suture-less small-gauge (25-27 gauge) vitrectomy also reduces recovery times and improves outcomes relative to 20-gauge approaches requiring conjunctival incision even in complex procedures.

Microinvasive techniques are also used in non-penetrating keratoplasty procedures in corneal surgery, the insertion of miniature drainage implants for glaucoma, endoscopic techniques for the lacrimal system, and small incisions for lid and strabismus surgery. These examples are not exhaustive, and the list of uses continues to grow.

The development of these techniques has been made possible by improvements in instrumentation and ophthalmologic technology and the improvement of technical approaches by innovative surgeons.

This Special Issue aims to attract original research and review articles on "Advances in Minimally Invasive Ophthalmic Surgery".

We are particularly interested in articles reporting novel concepts, surgical techniques, or technologies that can be applied in various ophthalmic subspecialties using minimally invasive ophthalmic surgery.

Dr. Otman Sandali
Prof. Dr. Marc D. De Smet
Prof. Dr. Walid Zbiba
Prof. Dr. Frédéric J. Matonti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

minimally invasive cataract surgery
minimally invasive oculoplastic surgery
minimally invasive glaucoma surgery
minimally invasive vitreoretinal surgery
minimally invasive strabismus surgery
minimally invasive corneal surgery
minimally invasive lacrimal surgery
minimally invasive conjunctival surgery
minimally invasive iris surgery

Published Papers (6 papers)

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19 pages, 8658 KiB

Open AccessArticle

Theoretical Impact of Intraocular Lens Design Variations on the Accuracy of IOL Power Calculations

by Damien Gatinel, Guillaume Debellemanière, Alain Saad, Radhika Rampat and Jacques Malet

J. Clin. Med. 2023, 12(10), 3404; https://doi.org/10.3390/jcm12103404 - 11 May 2023

Cited by 2 | Viewed by 2741

Abstract

To ascertain the theoretical impact of optical design variations of the intraocular lens (IOL) on the accuracy of IOL power formulas based on a single lens constant using a thick lens eye model. This impact was also simulated before and after optimization. We modeled 70 thick-lens pseudophakic eyes implanted with IOLs of symmetrical optical design and power comprised between 0.50 D and 35 D in 0.5-step increments. Modifications of the shape factor resulting in variations in the anterior and posterior radii of an IOL were made, keeping the central thickness and paraxial powers static. Geometry data from three IOL models were also used. Corresponding postoperative spherical equivalent (SE) were computed for different IOL powers and assimilated to a prediction error of the formula due to the sole change in optical design alone. Formula accuracy was studied before and after zeroization on a uniform and non-uniform realistic IOL power distribution. The impact of the incremental change in optic design variability depended on the IOL power. Design modifications theoretically induce an increase in the standard deviation (SD), Mean Absolute Error (MAE), and Root Mean Square (RMS) of the error. The values of these parameters reduce dramatically after zeroization. While the variations in optical design can affect refractive outcomes, especially in short eyes, the zeroization of the mean error theoretically reduces the impact of the IOL’s design and power on the accuracy of IOL power calculation. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Ophthalmic Surgery)

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8 pages, 428 KiB

Open AccessArticle

Efficacy, Safety, and Outcomes following Accelerated and Iontophoresis Corneal Crosslinking in Progressive Keratoconus

by Sami Saad, Rana Saad, Isabelle Goemaere, Roxane Cuyaubere, Marie Borderie, Vincent Borderie and Nacim Bouheraoua

J. Clin. Med. 2023, 12(8), 2931; https://doi.org/10.3390/jcm12082931 - 18 Apr 2023

Cited by 4 | Viewed by 1037

Abstract

Purpose: To investigate the outcomes of accelerated (A-CXL) and iontophoresis (I-CXL) corneal crosslinking in a large retrospective cohort with progressive keratoconus. Methods: This retrospective observational cohort study included consecutive patients treated by A-CXL (9 mW/5.4 J/cm²) or I-CXL with a minimal follow-up of 12 months. Visual acuity, manifest refraction, topography, specular microscopy, and corneal optical coherence tomography (OCT) were evaluated at baseline and at the last visit. Progression was defined as an increase in the maximum topographic keratometry (Kmax) of 1D. Results: 302 eyes of 241 patients with a mean age of 25.2 ± 7.5 years were included from 2012 to 2019: 231 and 71 eyes in the A-CXL and I-CXL groups, respectively. The mean follow-up was 27.2 ± 13.2 months (maximum: 85.7 months). Preoperatively, the mean Kmax was 51.8 ± 4.0D, with no differences between groups. Mean topographic measurements and spherical equivalent remained stable during the follow-up. At the last visit, CXL failure was reported in 60 eyes (19.9%): 40 (14.7%) versus 20 (28.2%) in A-CXL versus I-CXL, respectively, p = 0.005. The likelihood of progression after CXL was significantly higher following I-CXL: RR = 1.62, CI95 = [1.02 to 2.59], p = 0.04. Demarcation line presence at 1 month was positively correlated with higher efficacy of CXL, p = 0.03. No endothelial damage was reported, especially in 51 thin corneas (range = 342–399 µm). Conclusions: A-CXL seems more effective than I-CXL in stabilizing keratoconus; this is to be taken into account when a therapeutic indication is posed according to the aggressiveness of the keratoconus. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Ophthalmic Surgery)

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21 pages, 3356 KiB

Open AccessArticle

Asymmetric Intrastromal Corneal Ring Segments with Progressive Base Width and Thickness for Keratoconus: Evaluation of Efficacy and Analysis of Epithelial Remodeling

by Abdelmajid Benlarbi, Sofiene Kallel, Clementine David, Raphael Barugel, Quentin Hays, Isabelle Goemaere, Roxane Cuyaubere, Marie Borderie, Vincent Borderie and Nacim Bouheraoua

J. Clin. Med. 2023, 12(4), 1673; https://doi.org/10.3390/jcm12041673 - 20 Feb 2023

Cited by 2 | Viewed by 1459

Abstract

Purpose: The aim of this study is to describe visual outcomes and epithelial remodeling following the implantation of asymmetric intracorneal ring segments (ICRSs) of variable thickness and base width for the management of duck-type keratoconus. Methods: A prospective observational study of patients with duck-type keratoconus was conducted. All patients received one ICRS AJL PRO + implant (AJL Ophthalmic). We analyzed demographic and clinical data, anterior segment optical coherence tomography (AS-OCT) data and Scheimpflug camera images obtained with a Placido disc MS-39 (CSO, Firenze, Italy) one and six months after surgery to determine keratometric and aberrometric outcomes and epithelial remodeling. Results: We studied 33 keratoconic eyes. ICRS implantation significantly improved both corrected distance visual acuity (CDVA) and uncorrected distance visual acuity at six months, as assessed with the logMAR (minimum angle of resolution) system, from 0.32 ± 0.19 to 0.12 ± 0.12 (p < 0.001) and from 0.75 ± 0.38 to 0.37 ± 0.24 (p < 0.001), respectively. Overall, 87% of implanted eyes gained ≥ 1 line of CDVA, and 3% of patients (n = 1) lost one line of CDVA; 55% of eyes attained a manifest refraction spherical equivalent between +1.50 and −1.50 D. Epithelial remodeling was greater at the wider and thicker end (+11.33 µm ± 12.95; p < 0.001 relative to the initial value) than at the narrower and thinner end (+2.24 µm ± 5.67; p = 0.01). Coma aberration was significantly reduced from 1.62 ± 0.81 µm to 0.99 ± 0.59 µm (p < 0.001). Conclusions: AJL-PRO + ICRS implantation for duck-type keratoconus improves refractive, topographic, aberrometric and visual parameters and induces progressive epithelial thickening along the segment. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Ophthalmic Surgery)

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10 pages, 1633 KiB

Open AccessArticle

Using the First-Eye Back-Calculated Effective Lens Position to Improve Refractive Outcome of the Second Eye

by Nicole Mechleb, Guillaume Debellemanière, Mathieu Gauvin, Avi Wallerstein, Alain Saad and Damien Gatinel

J. Clin. Med. 2023, 12(1), 184; https://doi.org/10.3390/jcm12010184 - 26 Dec 2022

Cited by 3 | Viewed by 1774

Abstract

The present study is a retrospective, monocentric case series that aims to compare the second-eye IOL power calculation precision using the back-calculated lens position (LP) as a lens position predictor versus using a predetermined correction factor (CF) for thin- and thick-lens IOL calculation formulas. A set of 878 eyes from 439 patients implanted with Finevision IOLs (BVI PhysIOL, Liège, Belgium) with both operated eyes was used as a training set to create Haigis-LP and PEARL-LP formulas, using the back-calculated lens position of the contralateral eye as an effective lens position (ELP) predictor. Haigis-CF, Barrett-CF, and PEARL-CF formulas using an optimized correction factor based on the prediction error of the first eye were also designed. A different set of 1500 eyes from 1500 patients operated in the same center was used to compare the basal and enhanced formula performances. The IOL power calculation for the second eye was significantly enhanced by adapting the formulas using the back-calculated ELP of the first eye or by using a correction factor based on the prediction error of the first eye, the latter giving slightly higher precision. A decrease in the mean absolute error of 0.043D was observed between the basal PEARL and the PEARL-CF formula (p < 0.001). The optimal correction factor was close to 60% of the first-eye prediction error for every formula. A fixed correction factor of 60% of the postoperative refractive error of the first operated eye improves the second-eye refractive outcome better than the methods based on the first eye’s effective lens position back-calculation. A significant interocular biometric dissimilarity precludes the enhancement of the second-eye IOL power calculation according to the first-eye results. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Ophthalmic Surgery)

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9 pages, 981 KiB

Open AccessArticle

Safety and Efficacy of the Preserflo^® Microshunt in Refractory Glaucoma: A One-Year Study

by Alexandre Majoulet, Benjamin Scemla, Pascale Hamard, Emmanuelle Brasnu, Alexandre Hage, Christophe Baudouin and Antoine Labbé

J. Clin. Med. 2022, 11(23), 7086; https://doi.org/10.3390/jcm11237086 - 29 Nov 2022

Cited by 6 | Viewed by 1283

Abstract

Purpose: To evaluate the safety and efficacy of Preserflo^® microshunt implantation in eyes with refractory glaucoma. Methods: In this retrospective study, a cohort of patients who underwent Preserflo^® microshunt implantation between April 2019 and August 2020 for refractory glaucoma were evaluated. At the time of surgery, all eyes had uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy and at least one previous failed glaucoma filtering surgery. The primary outcome was a complete success, defined as postoperative IOP ≤ 21 mm Hg with an IOP reduction ≥ 20% and no repeat filtering surgery. The secondary outcome was qualified success, defined as a complete success with the use of antiglaucoma medications. The rates of needling, bleb repair, and postoperative complications were also recorded. Results: Forty-seven eyes with a mean preoperative IOP of 30.1 ± 7.1 mm Hg and a mean of 3.4 ± 1 glaucoma medications were included. The mean number of previous surgeries prior to microshunt implantation was 2.3 ± 1.3. After 1 year, the mean IOP was significantly reduced to 18.8 ± 4.6 mm Hg, with the mean number of medications significantly reduced to 1.4 ± 1.2. Complete success was achieved in 35% of eyes, and a qualified success in 60% of eyes. A decrease in IOP of at least 30% was found in 55% of eyes. Needling or bleb repair was performed in 49% of eyes. Complications were minimal and transient, except for one eye which presented with tube extrusion, and another eye with a transected tube. A repeat glaucoma surgery had to be performed in 17% of eyes. Conclusions: The Preserflo^® Microshunt provided moderate success but a significant reduction in IOP, with a good safety profile after one year of follow-up in eyes at high risk for failure of filtering surgery. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Ophthalmic Surgery)

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7 pages, 2653 KiB

Open AccessBrief Report

Operative Digital Enhancement of Macular Pigment during Macular Surgery

by Otman Sandali, Rachid Tahiri Joutei Hassani, Ashraf Armia Balamoun, Alan Franklin, Ahmed B. Sallam and Vincent Borderie

J. Clin. Med. 2023, 12(6), 2300; https://doi.org/10.3390/jcm12062300 - 16 Mar 2023

Viewed by 1042

Abstract

Purpose: To describe the feasibility of intraoperative digital visualization and its contribution to the enhancement of macular pigmentation visualization in a prospective series of macular surgery interventions. Materials and Methods: A prospective, single-center, single-surgeon study was performed on a series of 21 consecutive cases of vitrectomy for various types of macular surgery using a 3D visualization system. Two optimized filters were applied to enhance the visualization of the macular pigment (MP). For filter 1, cyan, yellow, and magenta color saturations were increased. Filter 2 differed from filter 1 only in having a lower level of magenta saturation for the green-magenta color channel. Results: Optimized digital filters enhanced the visualization of the MP and the pigmented epiretinal tissue associated with the lamellar and macular holes. In vitreomacular traction surgery, the filters facilitated the assessment of MP integrity at the end of surgery. Filter 1 enhanced MP visualization most strongly, with the MP appearing green and slightly fluorescent. Filter 2 enhanced MP visualization less effectively but gave a clearer image of the retinal surface, facilitating safe macular peeling. Conclusion: Optimized digital filters could be used to enhance MP and pigmented epiretinal tissue visualization during macular surgery. These filters open new horizons for future research and should be evaluated in larger series and correlated with intraoperative OCT. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Ophthalmic Surgery)

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