Saudi Journal of Ophthalmology RSS feed: Current Issue. Saudi Journal of Ophthalmology is an English language, peer-reviewed scholarly publication in the area of ophthalmology. Saudi Journal of Ophthalmology publishes original papers, clinical studies, reviews and case reports. Saudi Journal of Ophthalmology is the official publication of the Saudi Ophthalmological Society and is published by King Saud University in collaboration with Elsevier and is edited by an international group of eminent researchers. http://www.saudiophthaljournal.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Saudi Journal of Ophthalmology1319-4534261January 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.saudiophthaljournal.com/article/PIIS1319453412000124/abstract?rss=yesEditorial Board10.1016/S1319-4534(12)00012-4Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-Xvvihttp://www.saudiophthaljournal.com/article/PIIS1319453412000021/abstract?rss=yesCataract is one of the leading causes of preventable blindness worldwide and represents a major cause of low vision in developed and developing countries. Fortunately, cataract surgery is one of the most successful procedures in ophthalmology. However, challenges remain that require the proactive mitigation of risk. A number of steps can achieve this goal including recognition of the associated risk factors using advanced diagnostic technology, improved measurements and newer formulas for accurate IOL calculation and refined surgical techniques that minimize complications. The combined effect of these steps will contribute to greater postoperative accuracy of the intended refractive outcome and greater patient (and surgeon) satisfaction.Cataract UpdateAli A. Al-Rajhi10.1016/j.sjopt.2012.01.001Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update12http://www.saudiophthaljournal.com/article/PIIS1319453411001263/abstract?rss=yesAbstract: Investment by organizations and agencies has led to a growing body of evidence and information to assist ophthalmologists and others to meet the needs of children with cataract in Africa. The geographic distribution of research, training, and programme development across Africa has been uneven; investment has been greatest in eastern and southern Africa. Population based surveys (using key informants) suggest that 15–35% of childhood blindness is due to congenital or developmental cataract. There may be up to 82,000 children with non-traumatic cataract in Africa, with approximately 19,000 new cases each year.Effective strategies to find and refer children are those that engage the community in case detection. Identification and referral does not automatically mean surgical intervention with distance to the surgical facility being the most common reason for failure to seek care. Surgical management has become more specialized and a team based approach has been adopted by many paediatric ophthalmologists and their programmes. Although many children still present late for surgery, outcomes of surgery are much improved from previous experiences. Research suggests that post-operative follow up, still a challenge, can be improved through adoption of specific strategies. There has been limited success in ensuring that children are placed in appropriate educational settings. While eye care professionals may feel their responsibility ends with clinical care, it is important for the paediatric eye care team to be engaged with educational and rehabilitation services.Childhood cataract in sub-Saharan AfricaPaul Courtright10.1016/j.sjopt.2011.10.006Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update36http://www.saudiophthaljournal.com/article/PIIS1319453411001354/abstract?rss=yesAbstract: The introduction of new intraocular lenses (IOLs), industry marketing to the public and patient expectations has warranted increased accuracy of IOL power calculations. Toric IOLs, multifocal IOLs, aspheric IOLs, phakic lenses, accommodative lenses, cases of refractive lens exchange and eyes that have undergone previous refractive surgery all require improved clinical measurements and IOL prediction formulas. Hence, measurement techniques and IOL calculation formulas are essential factors that affect the refractive outcome.Measurement with ultrasound has been the historic standard for measurement of ocular parameters for IOL calculation. However the introduction of optical biometry using partial coherence interferometry (PCI) has steadily established itself as the new standard. Additionally, modern optical instruments such as Scheimpflug cameras and optical coherence tomographers are being used to determine corneal power that was normally the purview of manual keratometry and topography.A number of methods are available to determine the IOL power including the empirical, analytical, numerical or combined methods. Ray tracing techniques or paraxial approximation by matrix methods or classical analytical ‘IOL formulas’ are actively used in for the prediction of IOL power. There is no universal formula for all cases – phakic and pseudophakic cases require different approaches, as do short eyes, long eyes, astigmatic eyes or post-refractive surgery eyes. Invariably, IOLs are characterized by different methods and lens constants, which require individual optimization. This review describes the current methods for biometry and IOL calculation.Challenges and approaches in modern biometry and IOL calculationWolfgang Haigis10.1016/j.sjopt.2011.11.007Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update712http://www.saudiophthaljournal.com/article/PIIS1319453411001305/abstract?rss=yesAbstract: Globe axial length (AL) in children is commonly measured using either contact or immersion technique. Office measurement of AL can be difficult in young children and infants and must often be done under anesthesia in an eye that is unable to cooperate with precise fixation and centration. Contact A-scan measurements yield shorter AL, on average, than immersion A-scan measurements in pediatric eyes. This difference is mainly the result of the anterior chamber depth rather than the lens thickness value. During intraocular lens power calculation, if globe axial length is measured by the contact technique, it will result in the use of an average 1-D stronger IOL power than is actually required. This can lead to induced myopia in the postoperative refraction. In our studied patients, there was a significant difference in prediction error between contact A-scan biometry and immersion A-scan biometry. The immersion A-scan technique is recommended for pediatric IOL power calculation. We also provide a review of biometry in pediatric eyes. The overall mean AL of pediatric cataractous eyes is significantly different than the mean AL of non cataractous eyes. More importantly, the standard deviation is higher in eyes with cataract than in those without. Three phases of eye growth in children have been documented: A rapid, postnatal phase from birth to 6months of age, followed by a slower, infantile phase from 6 to 18months of age, and finally a slow, juvenile phase from 18months forward. In our study, girls had shorter ALs than boys and African-American subjects had longer ALs than Caucasians. Eyes with unilateral cataract had shorter ALs than eyes with bilateral cataract during the earlier years, but had longer ALs during later childhood.Axial length measurement techniques in pediatric eyes with cataractM. Edward Wilson, Rupal H. Trivedi10.1016/j.sjopt.2011.11.002Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update1317http://www.saudiophthaljournal.com/article/PIIS131945341100124X/abstract?rss=yesAbstract: Purpose: To use optical coherence tomography (OCT) to measure corneal power and calculate intraocular lens (IOL) power in cataract surgeries after myopic and hyperopic laser vision correction (LVC).Methods: Patients with previous LVC were enrolled in this prospective study at two centers (Doheny Eye Institute, Los Angeles, CA, USA and Cullen Eye Institute, Houston, TX, USA). Corneal power was measured with a Fourier-domain OCT system. The intravisit repeatability of OCT corneal power measurement was evaluated by the pooled standard deviation of repeat scans. Axial length, anterior chamber depth, and automated keratometry were measured with the IOLMaster. An OCT-based IOL formula was developed. The mean absolute error (MAE) of refractive prediction for OCT-based IOL formula was calculated. The results were compared with the MAE for Haigis-L formula.Results: A total of 31 eyes of 24 subjects who had uncomplicated cataract surgery with monofocal IOL implantation were enrolled in the two sites. Twenty-two eyes of 16 subjects had previous myopic LVC that ranged from −12.46D to −0.88D. Nine eyes of 8 subjects had previous hyperopic LVC that ranged from 0.66D to 5.52D. The intravisit repeatability of OCT corneal power measurement was 0.24D. For the myopic LVC group, the OCT formula had a MAE of 0.57D compared to an MAE of 0.73D for the Haigis-L formula (p=0.19). For the hyperopic LVC group, the MAE for OCT and Haigis-L formula was 0.26D and 0.54D, respectively (p>0.05).Conclusions: Corneal power can be precisely measured with OCT. The predictive accuracy of OCT-based IOL power calculation is equal to current standards for post-LVC eyes.Intraocular lens power calculation after myopic and hyperopic laser vision correction using optical coherence tomographyMaolong Tang, Li Wang, Douglas D. Koch, Yan Li, David Huang10.1016/j.sjopt.2011.10.004Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update1924http://www.saudiophthaljournal.com/article/PIIS1319453411001287/abstract?rss=yesAbstract: Since the Scheimpflug principle was first described over a century ago, there has been a great interest among ophthalmologists for the use of Scheimpflug camera in anterior segment imaging. Scheimpflug imaging has since advanced significantly and modern day instruments provide comprehensive imaging and topographic data of the anterior segment. In this article the clinical applications and limitations of Scheimpflug imaging in modern cataract surgery patients are discussed. This article reviews recent work on assessment of lens transparency for cataract grading and integrity, using preoperative lens density measurements to help predict phacoemulsification parameters, its utility in challenging situations like capsular bag distension syndrome and traumatic cataract and assessment of density of the posterior capsule for objectively quantifying posterior-capsule opacification.Clinical applications of Scheimpflug imaging in cataract surgeryDilraj Singh Grewal, Satinder Pal Singh Grewal10.1016/j.sjopt.2011.11.001Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update2532http://www.saudiophthaljournal.com/article/PIIS1319453411001275/abstract?rss=yesAbstract: A critical step in phacoemulsification (as well as extracapsular cataract extraction) is making a window in anterior capsule wall (i.e. anterior capsulotomy). Continuous Curvilinear Capsulorhexis (CCC) has become recognized as the standard method of anterior capsulectomy. Techniques employed for CCC have undergone sustained evolution. The present review evaluates elementary principles of CCC. Management of CCC in the presence of small pupil and pseudoexfoliation syndrome is discussed. Main differences of pediatric CCC from its adult-style counterpart and finally several techniques of rescue of an extending capsulorhexis are also reviewed.Capsulorhexis: Pearls and pitfallsMehrdad Mohammadpour, Reza Erfanian, Nasser Karimi10.1016/j.sjopt.2011.10.007Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update3340http://www.saudiophthaljournal.com/article/PIIS1319453411000609/abstract?rss=yesAbstract: Posterior polar cataract is a rare form of congenital cataract. It is usually inherited as an autosomal dominant disease, yet it can be sporadic. Five genes have been attributed to the formation of this disease. It is highly associated with complications during surgery, such as posterior capsule rupture and nucleus drop. The reason for this high complication rate is the strong adherence of the opacity to the weak posterior capsule. Different surgical strategies were described for the handling of this challenging entity, most of which emphasized the need for gentle maneuvering in dealing with these cases. It has a unique clinical appearance that should not be missed in order to anticipate, avoid, and minimize the impact of the complications associated with it.Posterior polar cataract: A reviewHatem Kalantan10.1016/j.sjopt.2011.05.001Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update4149http://www.saudiophthaljournal.com/article/PIIS1319453411001342/abstract?rss=yesAbstract: Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection – instead performing ‘inside-out’ hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract.Approaches to a posterior polar cataractAbhay R. Vasavada, Viraj A. Vasavada, Shetal M. Raj10.1016/j.sjopt.2011.11.006Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update5154http://www.saudiophthaljournal.com/article/PIIS1319453411001238/abstract?rss=yesAbstract: Cataract surgery in patients with uveitis is not as simple as any senile cataract surgery. Recent evidence suggests that useful visual outcome can be achieved in most of the cases if they are handled meticulously. Key factors leading to improved visual outcome are absolute control of preoperative inflammation with diligent use of immunomodulatory drugs, meticulous surgery along with early detection and care of postoperative complications. Modern technologies in the intraocular lens designs and materials have contributed to the success. In this article, we review the literature on this subject with emphasis on the importance of the use of immunomodulatory drugs to control preoperative and postoperative intraocular inflammation and avoid complications.Cataract surgery in patients with history of uveitisUjwala Baheti, Sana S. Siddique, C. Stephen Foster10.1016/j.sjopt.2011.10.003Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update5560http://www.saudiophthaljournal.com/article/PIIS131945341100110X/abstract?rss=yesAbstract: Purpose: To report the outcomes of intraocular lens (IOL) dislocation management in 6 cases with Retinitis Pigmentosa (RP).Setting: Private practice, Los Angeles, USA.Design: Retrospective interventional case series.Methods: The medical reports of six eyes of four RP patients with capsule bag fixated posterior chamber IOL dislocation were retrospectively reviewed. Pre-operative data included demographics, systemic or ocular disorders, history of trauma, previous intraocular surgery and pre-operative visual acuity. Outcome measures included the type of surgery, surgical complications, elevation of intraocular pressure (IOP), ocular inflammation, cystoid macular edema (CME) and IOL dislocation at 3 months or greater post-operatively.Results: The medical records of six eyes of four patients operated on between December 2009 and May 2011 were evaluated. In four cases, dislocated PC IOL implants were sutured to the sclera. In two eyes of one patient anterior chamber IOLs (AC IOLs) were implanted after PC IOLs were explanted. One eye developed CME during the follow-up period. Despite modest tilt in one case and modest decentration in another, stability and centration of the IOLs was excellent during the follow-up period. No eyes had intraocular inflammation requiring long term medical treatment, new onset glaucoma or retinal detachment. Mean follow-up time was 6.9 months (range 3-20).Conclusions: Cataract surgeons should be aware of the increased risk for decentration and malposition of PC IOLs in patients with RP. Satisfactory results can be achieved by fixation of the PC IOL or AC IOL implantation.Spontaneous dislocation of posterior chamber intraocular lenses (PC IOLs) in patients with retinitis pigmentosa – Case seriesSamuel Masket, Basak Bostanci Ceran, Nicole R. Fram10.1016/j.sjopt.2011.09.003Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update6165http://www.saudiophthaljournal.com/article/PIIS1319453411001299/abstract?rss=yesAbstract: Hereditary pediatric cataract on the Arabian Peninsula does not follow the same epidemiological patterns as described for Western populations. This article describes selected genetic causes for inherited pediatric cataract in the region.Hereditary pediatric cataract on the Arabian PeninsulaArif O. Khan10.1016/j.sjopt.2011.10.008Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update6771http://www.saudiophthaljournal.com/article/PIIS1319453411001317/abstract?rss=yesAbstract: Cataract surgery remains the most widely performed intraocular procedure throughout the world. Safety and accuracy of the procedure are paramount and techniques should remain under constant review. Recently, the introduction of the femtosecond laser to assist cataract surgery has provided ophthalmologists with an exciting tool that may further improve outcomes. We review the existing literature and discuss the installation and initial experience of a femtosecond laser into our practice.Femtosecond cataract surgery: A review of current literature and the experience from an initial installationChris Hodge, Shveta Jindal Bali, Michael Lawless, Colin Chan, Timothy Roberts, David Ng, Simon Chen, Paul Hughes, Gerard Sutton10.1016/j.sjopt.2011.11.003Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCataract Update7378http://www.saudiophthaljournal.com/article/PIIS1319453411000658/abstract?rss=yesAbstract: Purpose: To study the histopathological findings of the early cases of failed DSAEK grafts and to analyze the causes of graft failure.Methods: Retrospective study of 13 failed DSAEK grafts (four grafts submitted alone with no host cornea) of 12 patients. The histopathologic features are correlated with the clinical and operative findings.Results: Significant attenuation of the endothelial cells found in 10/13 cases (77%), retained recipient Descemet’s membrane in 7/13 (54%), variability of graft thickness in 5/13 (38%) and two of these had stromal irregularity. Retrocorneal fibrous membrane along the donor’s Descemet’s membrane was found in 4/13 (31%) resulting in endothelial detachment in one case. Eight of the nine host cornea–graft specimens were found to have: total graft-cornea detachment (in one), subtotal in four and partial (⩽50% of graft length) in three. The detached flaps showed infection at the interface of the graft–host cornea in two, epithelial ingrowth and fibrous proliferation along the anterior stromal surface of the graft (one case each). An additional histopathological finding was secondary amyloid deposition within the host stroma (in one).Conclusion: Irregular or thick graft, graft–host interface fibrous/epithelial ingrowth, and infection all predispose to DSAEK failures related to graft detachment. Endothelial cells attenuation and retrocorneal fibrous membrane are major causes for primary graft failure.Histopathological findings of failed grafts following Descemet’s stripping automated endothelial keratoplasty (DSAEK)Hind Alkatan, Ali Al-Rajhi, Ali Al-Shehri, Ali Khairi10.1016/j.sjopt.2011.05.006Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XOriginal Article7985http://www.saudiophthaljournal.com/article/PIIS1319453411001020/abstract?rss=yesAbstract: Background: Myopia has been identified as a risk factor for globe perforation during regional anaesthesia for cataract surgery. We conducted this study to evaluate efficacy of single injection percaruncular peribulbar anaesthesia for phacoemulsification in patients with axial myopia.Methods: Eighty patients with axial myopia received percaruncular peribulbar anaesthesia and were evaluated for incidence of major or minor complications. Also surgeon and patients’ satisfaction and their comment on operative conditions were noted.Results: Of the 80 patients 51 patients had posterior staphylomas. About three quarters of the patients developed adequate akinesia in 10min. Remaining 25% received second injection with the same technique but with less volume after which the percent of patients with adequate akinesia rose to 91%. Adequate analgesia developed in almost all patients and only in one patient, intravenous analgesia was necessary to complete the operation. All operations were completed uneventfully. No perforations or penetrations were recorded and no other major complications were encountered. About 97% of the surgeons and 96% of the patients found the operative conditions satisfactory.Conclusion: Using single injection percaruncular peribulbar local anaesthesia for phacoemulsification in patients with axial myopia is an effective technique.Percaruncular single injection peribulbar anaesthesia in patients with axial myopia for phacoemulsificationAhmed Samir, Ahmed Gabal10.1016/j.sjopt.2011.07.006Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XOriginal Article8790http://www.saudiophthaljournal.com/article/PIIS1319453411001056/abstract?rss=yesAbstract: Purpose: To investigate the characteristics of retinal function in myopia using full-field electroretinogram (ERG) and multifocal ERG (MF-ERG) and to determine the correlation among MF-ERG, ocular axis length, retinal thickness and degree of myopia.Methods: Twenty emmetropes (20) and sixty-eight myopes (68) underwent manifest refraction, A- and B-scan, fundus examination, fluorescein angiography (FA), optical coherence tomography (OCT), full field ERG and MF-ERG. The amplitudes and implicit times of ERG were determined. The results were further analyzed by comparing ocular axis length, refraction, retinal thickness, and macular function detected by ERG parameters.Results: There was a significant difference in implicit times of MF-ERG of an emmetrope and a moderate and high myopia whereas implicit times of mild myopia patients and emmetropes were similar. There was a statistically significant difference in amplitude densities of first positive peak of MF-ERG P1 wave between an emmetrope and a moderate and high myopia. In central ring and four quadrants, amplitude densities showed negative correlation to ocular axis length and diopter of myopia. There was no statistically significant difference between the average retinal thickness in emmetropic and physiological myopic eyes (low, medium, high), but there was significant difference between physiological and pathological myopia.Conclusion: Decreased foveal function as determined by MF-ERG is associated with high degree of myopia. Retinal function impairment is correlated with increase in the diopter of myopia, decrease of corrected visual acuity (VA), elongation of ocular axis and increased macular degeneration.Electrophysiological study of myopiaMona Abdel Kader10.1016/j.sjopt.2011.08.002Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XOriginal Article9199http://www.saudiophthaljournal.com/article/PIIS1319453410001177/abstract?rss=yesAbstract: Aim: To determine whether anterior capsule polishing during cataract surgery done by phacoemulsification has any effect on the rate of posterior capsule opacification.Materials and methods: We conducted a 3year retrospective analytical study at our hospital. The medical records of patients who underwent cataract extraction by phacoemulsification with foldable square edge hydrophilic PCIOL between April 2007 and March 2010 were reviewed.The study included 1009 eyes of 950 patients who underwent phacoemulsification with foldable square edge hydrophilic IOL in the bag implantation with anterior capsular polishing. The control group included 981 eyes of 957 patients in whom anterior capsular polishing was not done.Patients in the age group of 45–65years with well dilating pupils were included in the study. They were evaluated at 1week, 1month and 1year post-operatively. Exclusion criteria included glaucoma, shallow anterior chamber, uveitis, high myopia, pseudoexfoliation, diabetes mellitus, traumatic cataracts, posterior polar cataract, subluxated cataracts, previous ocular surgeries, patients allergic to dilating drops, and steroid intake. Intraoperatively, the exclusion criteria were not achieving the total anterior capsule cover on the IOL optic, sulcus fixated IOL, and any intraoperative complications like posterior capsule rupture. After bimanual irrigation/aspiration, all enrolled patients were randomly assigned to receive either 360 degree anterior capsular polishing or No anterior capsular polishing and results were studied.Results: The rate of posterior capsule opacification in the study group and in the control group was not statistically significant.Conclusion: Though it was thought that anterior capsular polishing will lead to reduced rate of PCO formation, our study showed that there was no significant difference in PCO formation between the two groups. However, it was seen that the rate of anterior capsule opacification and capsular phimosis showed a significant reduction in cases in which anterior capsular polishing was done.Effect of anterior capsular polishing on the rate of posterior capsule opacification: A retrospective analytical studyRahul Baile, Meghana Sahasrabuddhe, Snehal Nadkarni, Vasudeo Karira, Juilee Kelkar10.1016/j.sjopt.2010.11.006Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XOriginal Article101104http://www.saudiophthaljournal.com/article/PIIS1319453411001366/abstract?rss=yesAbstract: Snowflake degeneration is a slow progressive opacification of polymethyl methacrylate (PMMA) intraocular lenses (IOLs). This late postoperative complication can occur a decade or later after implantation. The deposits are composed of IOL materials that tend to aggregate centrally. There is a relative paucity of the literature on snowflake degeneration of IOLs. Symptoms can range from mild visual disturbance to significant loss of visual acuity. In cases of opacification after IOL implantation, the different diagnosis should include snowflake degeneration to prevent surgical intervention such as lens exchange or explantation unless clinically warranted. We report a case of late optical opacification of a PMMA IOL, the clinical diagnosis and treatment that increased best corrected vision.Polymethyl methacrylate intraocular lens opacification 20 years after cataract surgery: A case report in a tertiary eye hospital in Saudi ArabiaAbdullah G. Al-Otaibi, Elham S. Al-Qahtani10.1016/j.sjopt.2011.12.001Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCase Report105107http://www.saudiophthaljournal.com/article/PIIS1319453411001329/abstract?rss=yesAbstract: A heterogeneous group of conditions can cause changes to the intraocular lens (IOL) during or after implantation in uneventful cataract surgery.We describe a series of 5 patients presenting distinctive deposits on the surface of hydrophilic intraocular lenses, implanted during routine cataract surgery, with a follow-up of 1 to 24months.Disposable forceps were found to be the source of the pigmented marks when used to hold the lens during the injector loading process. At the slit-lamp examination, the pigments were located in the centre of the lens optic, easily detectable. Although involving the visual axis, none of the patients were visually affected.To our knowledge, this is the first time such unusual occurrence has been described. The reported case-series shows the importance of in-house follow-up after cataract surgery.Pigment deposits on hydrophilic intraocular lenses after phacoemulsification cataract surgeryBruno Zuberbuhler, Gianluca Carifi10.1016/j.sjopt.2011.11.004Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCase Report109111http://www.saudiophthaljournal.com/article/PIIS1319453410001153/abstract?rss=yesAbstract: One of the greatest issues facing the cataract surgeon today is accurate prediction of post-operative refractive error. With use of intraoperative autorefractometry (IOAR), such errors can be detected and post-operative refractive errors avoided. An 83-year-old woman was admitted for right eye phacoemulsification, with aimed at −1.78D with Sanders/Retzlaff/Kraff/T (SRK/T) formula implantation under local anesthesia. IOAR was performed after IOL insertion. The first estimate was +1.1D, indicating hyperopia, and far from the desired refraction above 2D. IOL exchange to +11.5D was, therefore, performed. The second estimate was −0.13D and the operation was completed. The final refraction (3years after operation) was −0.25D.With IOAR, we were able to avoid the unpleasant surprise of a mistaken intraocular lens power. Intraoperative autorefractometry is useful for avoiding errors in IOL power.To avoid post-operative refractive error in cataract surgeryRui Hiramatsu, Kunimi Fujisawa10.1016/j.sjopt.2010.11.004Saudi Journal of Ophthalmology 26, 1 (2012)2012-01-01Saudi Journal of Ophthalmology2012-01-01261S1319-4534(12)X0002-XCase Report113114