To compare the predictive refractive accuracy of intraoperative aberrometry (ORA) to the preoperative Barrett True-K formula in the calculation of intraocular lens (IOL) power in eyes with prior refractive surgery undergoing cataract surgery at the Loma Linda University Eye Institute, Loma Linda, California, USA. We conducted a retrospective chart review of patients with a history of post-myopic or hyperopic LASIK/PRK who underwent uncomplicated cataract surgery between October 2016 and March 2020. Pre-operative measurements were performed utilizing the Barrett True-K formula. Intraoperative aberrometry (ORA) was used for aphakic refraction and IOL power calculation during surgery. Predictive refractive accuracy of the two methods was compared based on the difference between achieved and intended target spherical equivalent. A total of 97 eyes (69 patients) were included in the study. Of these, 81 eyes (83.5%) had previous myopic LASIK/PRK and 16 eyes (16.5%) had previous hyperopic LASIK/PRK. Median (MedAE)/mean (MAE) absolute prediction errors for preoperative as compared to intraoperative methods were 0.49 D/0.58 D compared to 0.42 D/0.51 D, respectively (P = 0.001/0.002). Over all, ORA led to a statistically significant lower median and mean absolute error compared to the Barrett True-K formula in post-refractive eyes. Percentage of eyes within ± 1.00 D of intended target refraction as predicted by the preoperative versus the intraoperative method was 82.3% and 89.6%, respectively (P = 0.04). Although ORA led to a statistically significant lower median absolute error compared to the Barrett True-K formula, the two methods are clinically comparable in predictive refractive accuracy in patients with prior refractive surgery.

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Purpose: To describe optical principles and utility of inexpensive, portable, non-contact digital smartphone-based camera for the acquisition of fundus photographs for the evaluation of retinal disorders. Methods: The digital camera has a high-quality glass 25 D condensing lens attached to a 21.4-megapixel smartphone camera. The white-emitting LED light of the smartphone at low illumination levels is used to visualize the fundus and limit source reflection. The camera captures a high-definition fundus (5344 × 4016) image on a complementary metal oxide semiconductor (CMO) with an area of 6.3 mm × 4.5 mm. The auto-acquisition mode of the device facilitates the quick capture of the image from continuous video streaming in a fraction of a second. Results: This new smartphone-based camera provides high-resolution digital images of the retina (50° telescopic view) in patients at a fraction of the cost (USD 1000) of established, non-transportable, office-based fundus photography systems. Conclusions: The portable user-friendly smartphone-based digital camera is a useful alternative for the acquisition of fundus photographs and provides a tool for screening retinal diseases in various clinical settings such as primary care clinics or emergency rooms. The ease of acquisition of photographs from a continuously streaming video of fundus obviates the need for a skilled photographer.

Submacular hemorrhage (SMH) is often a result of trauma, wet age-related macular degeneration or IPCV and frequently leads to blindness secondary to extreme toxicity of hemoglobin products on photoreceptors. We describe a new technique of subretinal aflibercept injection during pars plana vitrectomy for the treatment of SMH in idiopathic polypoidal choroidal vasculopathy (IPCV). A 55-old male presented with sudden loss of vision (HM) secondary to massive subretinal hemorrhage associated with IPCV. Subretinal injection of aflibercept with a 25 g/42 g cannula coupled to the viscous fluid control unit of a standard vitrectomy system was performed during parsplana vitrectomy. Controlled injection of aflibercept intra-operatively has resulted in a resolution of SMH (confirmed with OCT and ICG). Visual acuity improved from HM to 20/20. This combined approach delivered anti-VEGF agent to target tissue in controlled fashion with the assistance of VFC system (similar to gene therapy) and restored full vision with resolution of SMH.