European Journal of Ophthalmology

To describe the tearing pattern during continuous curvilinear capsulorhexis in a patient with anterior lenticonus due to Alport syndrome.

A patient with bilateral anterior lenticonus underwent successful bilateral phacoemulsification and implantation of a single-piece intraocular lens.

The capsule tore in an atypical cogwheel-like tearing pattern during capsulorhexis. This tearing pattern likely correlates to the known ultrastructural characteristics of thinning and periodic dehiscence and breaks in the anterior capsule.

Knowing this tearing pattern preoperatively can help to prevent capsule runoff and capsule rupture.

Disturbed peripapillary microcirculation may have a role in the development of glaucoma. Recently, using noninvasive optical coherence tomography (OCT) angiography with the AngioVue OCT (Optovue Inc., ­Fremont, CA, USA), reduced peripapillary vessel density was found in glaucoma. In this case series, we investigate the relationship between retinal nerve fiber layer (RNFL) damage and peripapillary angioflow density (PAFD, % of the analyzed retinal area) in the superotemporal (ST), inferotemporal (IT), and temporal (T) peripapillary sectors in normal, ocular hypertensive (OHT), and primary open-angle glaucoma eyes.

The AngioVue OCT and the 2015.100.0.33 software version was used for PAFD measurements. The PAFD in the radial peripapillary capillary layer was similar (approximately 60%) in all 3 sectors in healthy eyes. In glaucoma with severe ST and/or IT RNFL defect, PAFD declined to 32%-45% in the damaged sectors but remained above 55% in the T sector. In the OHT eyes with no visual field defect and no RNFL sector outside the normal limits but with mild ST or IT RNFL damage, PAFD declined to 54% in the involved sector in all cases, while it remained around 60% in the other sectors.

Our cases suggest that PADF measurements can identify decreased peripapillary perfusion early in the glaucomatous RNFL thinning process, prior to the development of clinically significant RNFL damage and visual field deterioration. Decreased PAFD corresponds spatially with the damaged RNFL bundles. The results suggest that prospective studies using PAFD may help to understand the role of vascular dysfunction in glaucoma.

Drug-induced uveitis is a well-known effect of ocular inflammation that has been reported with many medications. Pembrolizumab is a newer generation of the anti-programmed cell death-1 monoclonal antibodies that was recently approved by the Food and Drug Administration for the treatment of advanced melanoma. Immune-mediated adverse events involving different organs have been reported in recent literature in association with this drug. We present the first reported case of uveitis in association with pembrolizumab therapy.

An 82-year-old man with stage IV melanoma was started on pembrolizumab infusion treatment every 3 weeks. Two months after initiating therapy, he presented with bilateral severe anterior uveitis and papillitis with fast and complete recovery after withholding further pembrolizumab infusions and treatment with topical steroid. Uveitis recurred after restarting pembrolizumab therapy.

In current clinical practice, many new drugs are being approved, requiring better characterization of the prevalence, onset, and nature of adverse events in order to aid development of effective management strategies. Ophthalmologists should keep in mind that drugs are always a possible cause of ocular inflammation in patients presenting with uveitis.

To report the safety and efficacy of intravitreal recombinant tissue plasminogen activator (rtPA) with gas for managing submacular hemorrhage.

Patients with submacular hemorrhage centered in or close to the fovea underwent hemorrhage displacement with intravitreal injection of rtPA (50 μg/0.05 mL) followed by gas injection (0.3 mL SF₆). Anatomic and visual outcomes are described.

Exudative age-related macular degeneration (AMD) (n = 4) and blunt trauma (n = 2) were the etiologies of submacular hemorrhage in this sample. Intravitreal injection of rtPA decreased the extent of submacular hemorrhage in all eyes, with complete hemorrhage displacement in 2 and partial displacement in 4. Visual acuity remained stable (n = 4) or improved (n = 2) after the procedure. Improvements in anatomic and visual outcomes were less evident in exudative AMD cases, which also had longer hemorrhage duration. Recurrence occurred only in 1 eye. No evident rtPA-associated retinal toxicity was observed.

Untreated submacular hemorrhage has poor visual prognosis. Our results suggest that rtPA injection is a minimally invasive, simple, inexpensive procedure with few related complications. Cost-benefit of this injection seems acceptable.

Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure.

This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens.

Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.

To report a case of retinal and vitreous hemorrhage after intravitreal injection of dexamethasone implant (0.7 mg Ozurdex) and its management.

A 49-year-old man treated for diabetic macular edema developed vitreous and retinal hemorrhage after intravitreal injection of dexamethasone implant caused by a retinal impact during the injection procedure.

Retinal and vitreous hemorrhage absorbed spontaneously after 3 months. No retinal damage was detected. Intraocular pressure increased to 38 mm Hg after the injection and was well-controlled by medical therapy (dorzolamide hydrochloride-timolol maleate ophthalmic solution administered BID and oral acetazolamide 250 mg once a day). Since the surgeon performed the injection carefully without exerting any pressure on the eye, a device malfunction likely caused the implant to be injected too powerfully.

Vitreous and retinal hemorrhage can occur after direct impact of an Ozurdex implant against the retina during the injection. So far this has never been described in the literature. Intraocular pressure elevation can worsen due to trabecular blockage by red blood cells. Spontaneous resolution can occur but vitrectomy is a therapeutic option if the hemorrhage persists.

Sometimes, a conventional recess-resect surgery may not be sufficient to obtain satisfactory ocular alignment. Patients who have previously undergone surgery and/or have a large difference in visual acuity between both eyes and do not wish to undergo surgery on the sound eye provide a surgical challenge. In these cases, tendon elongation with bovine pericardium may be an option.

We retrospectively reviewed the charts of 38 patients who underwent strabismus surgery with tendon elongation. Before surgery, 31 had exotropia (angle −21.8 ± 5.7 degrees) and 7 esotropia (angle +19.1 ± 5.4 degrees). Reasons for tendon elongation included the following: 15 patients refused surgery on their sound eye; in 15 patients, conventional recess-resect was not possible; and in 7 patients, the elongation best fitted the motility pattern. In one patient, tendon elongation was preferred over conventional recession because of a thin sclera. Follow-up was 0.5 to 4 years.

At last follow-up visit, in patients with previous exotropia, the angle was −3.3 ± 5.9 degrees; in patients with previous esotropia, +0.2 ± 0.5 degrees. Most had some duction limitation in the direction of the elongated muscle. All patients but one were satisfied with the result. In the patients with previous exotropia, there was a small but nonsignificant regression to recurrence of the exodeviation (on average 0.5 degree per year).

Tendon elongation is a valuable addition to our strabismus surgery repertoire. However, because of duction limitations after surgery, it should be reserved for those cases in which conventional surgery is not an option.

To study the recurrence rate and complications after primary pterygium removal using pterygium extended removal followed by extended conjunctival transplant.

Sixty-eight eyes of 57 consecutive patients with primary pterygia underwent pterygium removal using pterygium extended removal followed by extended conjunctival transplant between April 2010 and October 2014. The follow-up period lasted for at least 36 months after the procedure.

No recurrences were reported after a mean follow-up period of 40.0 ± 5.7 months (minimum of 36 months). One case (1.4%) developed Tenon granuloma at the donor site 2 weeks after surgery, and it was surgically removed. Transient graft swelling was observed in 22% of the cases, and transient diplopia was observed in 17.6%. Both graft swelling and diplopia resolved gradually in all cases during the early postoperative period. Loss of corrected distance visual acuity was not reported.

Pterygium extended removal followed by extended conjunctival transplant is an effective technique for primary pterygia and resulted in a 0% recurrence rate with minimal intraoperative and postoperative complications.

To evaluate irregularity of the anterior cornea before and after Descemet stripping endothelial keratoplasty (DSEK) for bullous keratopathy and its effect on visual acuity.

Corneal data were acquired using a topographic unit before and up to 12 months after DSEK. Anterior corneal elevation data were decomposed into a set of Zernike polynomials up to the 8^th order within a 6.0-mm diameter region. Total higher-order aberrations (HOAs) and root mean square from the 3^rd to 8^th order were calculated. The effects of anterior surface irregularity on visual acuity were evaluated.

This clinical study comprised 20 consecutive eyes of 20 patients with bullous keratopathy. The mean corrected distance visual acuity (CDVA) was 1.00 ± 0.12 logMAR (SD) preoperatively and 0.24 ± 0.16 logMAR 12 months postoperatively. Before DSEK, corneas with bullous keratopathy had higher total HOAs compared with those in controls (p<0.05). There were no significant differences in anterior surface HOAs between preoperatively and 12 months (p>0.05).

Postoperative CDVA correlated with irregularity of the corneal anterior surface. Corneal anterior HOAs are higher in patients with bullous keratopathy than in controls, and remain higher through 12 months after DSEK. In addition to corneal transparency, regularity of the corneal anterior surface is an important factor in visual acuity after DSEK.

To evaluate the current status of glaucoma diagnostics and care in Europe.

A questionnaire addressing glaucoma patient organizations, resident education, access to an ophthalmologist, use and reimbursement of techniques/instruments for glaucoma diagnostics and follow-up, prescription rules, and glaucoma drug reimbursement was sent to all national representatives of the European Glaucoma Society (EGS) in 2015. The country-specific responses were analyzed and summarized.

Completed questionnaires were returned for 24 countries. In 2015, a glaucoma patient organization is functioning in 57% of the respondent countries. Waiting time for an ophthalmology resident position varies between ≤6 months and >2 years. The duration of ophthalmology resident training varies between 3 and 7 years. Nonemergency access to an ophthalmologist is available directly in 45.8% and via the general practitioner in 25% of the countries. Disc photography/imaging is always done during glaucoma diagnostics in 9.5% and for follow-up in 55.5% of the respondent countries. Initial therapy of glaucoma is medical in 100% (monotherapy in 91.3%) of the respondent countries. Clinical and visual field examination but not disc photography/imaging is reimbursed in 47.5% of the countries, while in another 47.5% all examinations are reimbursed. Dispensing of the prescribed original eyedrops by the pharmacists is mandatory in 43.5% of the countries, while the aut idem rule applies in 52.2%, and the aut simile rule in 4.3%.

Diagnostics, treatment, and follow-up of glaucoma remains diverse in Europe. The differences are due to financial/reimbursement differences. When reimbursement allows, the EGS Guidelines are followed.

To compare the use of mitomycin C (MMC) or bevacizumab (BEV) as adjunctive in the needling revision of failed trabeculectomy blebs.

Glaucoma patients with failed trabeculectomy were included. Cystic blebs were excluded. All procedures were performed by the same surgeon at the operating room under peribulbar blockade. Rate of success, intraocular pressure (IOP), and number of antiglaucoma drugs in use were compared before and after the procedures. The IOP was measured postoperatively at days 1, 30, 90, and 180. Absolute success was defined as IOP ≤18 mm Hg, without any complication or use of any antiglaucomatous drugs. Qualified success was the same criteria, but with the use of any antiglaucomatous drugs.

Twenty-nine eyes of 29 patients were included: 15 eyes with MMC and 14 eyes with BEV. There was no statistical difference in the IOP reduction between the groups (MMC 32.6 ± 16.1% vs BEV 30.1 ± 12.0%, p = 0.6). The BEV group showed similar reduction in the number of antiglaucoma drugs compared to the MMC group (p = 0.6). Absolute success was found in 28.5% of the BEV group and in 6.6% of patients with MMC. Qualified success was found in 64.3% and 73.4%, respectively, both limited to 180 days.

In this selected and limited group of patients, bevacizumab can be considered as an alternative to MMC in the needling revision of failed trabeculectomy. Studies with a larger number of patients and longer follow-up are needed to confirm the hypothesis suggested here.

Operating room (OR) time is an expensive resource that should be optimized to reduce costs. Individual preoperative risk parameters (PORS) assessment may aid in predicting cataract surgery time.

Dedicated software was developed and known risk factors for cataract surgery were integrated into it. Preoperative risk parameters were assigned to each patient in the preoperative meeting and the risk score was calculated. A total of 153 patients were divided according to a standard classification into low-risk group (PORS ≤2) and high-risk group (PORS >5). Duration of surgery for each group was compared by Student t test and linear regression analysis was used to calculate the relation between change in OR time and change in risk score.

Patients in the high PORS group had longer surgery times when compared with patients in the low PORS group (37.6 vs 19.6, p<0.001). Risk scores positively correlated with surgery time (r = 0.30, p<0.001). Prediction equations for the OR time demonstrated for 2 surgeons that every increase in 1 risk point added 2.2 or 3.3 minutes to the OR time. Outliers (more than 1 standard deviation [SD] from each surgeon's surgery mean time) had more than twice the risk score of cases within 1 SD from the mean.

The PORS system may be a useful tool for predicting OR time based on individual patient risk and may improve OR scheduling.

To assess efficacy and patient satisfaction after cataract surgery and implantation of a new accommodative bioanalogic intraocular lens (IOL).

We evaluated the collected data of 48 patients with bilateral cataract surgery and Wichterle IOL (WIOL) implantation included in the Czech national observational registry. Monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity, uncorrected near visual acuity (UNVA), best spectacle-corrected visual acuity for distance (CDVA), best spectacle-corrected visual acuity for near (CNVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity were evaluated 6 months after surgery. Subjective patient satisfaction was assessed at 3 months postoperatively.

The mean monocular UDVA was 0.074 ± 0.108 logMAR, the mean monocular CDVA was 0.047 ± 0.125 logMAR, the mean monocular UNVA was 0.328 ± 0.146 logMAR, the mean monocular DCNVA was 0.339 ± 0.131 logMAR, and the mean monocular CNVA was 0.139 ± 0.107 logMAR. A total of 24 patients (50%) had no problems with any light phenomena. A total of 18 patients were very satisfied (37.5%), 11 were satisfied (22.9%), 15 (31.2%) were rather satisfied, 4 (8.3%) were rather dissatisfied, and 0 were dissatisfied.

The WIOL–continuous focus polyfocal lens offers very good vision at far and intermediate distance comparable with other types of multifocal IOLs, and relatively good near vision, while the incidence of adverse side phenomena is relatively low.

To compare the efficacy and short-term stability of toric intraocular lenses (tIOL) and peripheral cornea relaxing incisions (PCRI) during phacoemulsification.

Patients with preexisting corneal astigmatism had cataract surgery either with tIOL (AcrySof Toric) (39 eyes of 35 patients) or standard intraocular lens (AcrySof) + PCRIs (38 eyes of 33 patients). Patients were retrospectively evaluated for manifest refraction, corneal topography, and uncorrected and corrected visual acuities preoperatively and at postoperative 1 and 6 months. The Alpins vectorial method was used to analyze the target induced astigmatism (TIA) and surgically induced astigmatism (SIA), magnitude of error (the difference between the magnitude of SIA and TIA) (ME), and correction index.

Mean preoperative corneal astigmatism was 2.21 ± 1.32 D in the tIOL group and 2.24 ± 0.96 D in the PCRI group; the difference was not significant. The decrease in astigmatism was significant in both groups at last follow-up (64% tIOL group, 32% PCRI group, p<0.01, Wilcoxon signed rank test). The mean remaining refractive astigmatism was significantly higher in the PCRI group than in the tIOL group at 1-month (1.42 ± 1.22, 0.89 ± 0.68, respectively) and 6-month follow-ups (1.75 ± 1.37 D, 0.92 ± 0.72, respectively) (p<0.01). The mean ME was significantly lower (−0.35 versus −0.88) with a higher correction index (0.96 versus 0.56) in the tIOL group at 6 months postoperatively.

Both tIOL implantation and using PCRI were effective methods to reduce preoperative astigmatism at the time of the cataract surgery. However, tIOLs provided better remaining astigmatism with a more stable refraction than PCRI.

To determine the safety of the Laser SoftFit™ patient interface by comparing intraoperative results with the contact interface of the LenSx® femtosecond laser platform (FSL).

In this nonrandomized, consecutive case series, 50 eyes underwent femtosecond laser-assisted cataract surgery (FLACS) using the LenSx® laser platform (group 1); FLACS was performed in another 50 eyes, using the Laser SoftFit™ patient interface (group 2). Intraoperative complications (corneal folds) and surgical results (incomplete and free capsulotomies, incomplete phacofragmentation, and unopened incisions) were compared.

Corneal folds and incomplete capsulotomies were less common (p = 0.0001 for both) and free-floating capsulotomies were more frequent (p = 0.0001) with the Laser SoftFit™ patient interface. Incomplete phacofragmentation and unopened incision exhibited similar rates in both groups (p = 0.436 and 0.204, respectively).

Using the Laser SoftFit™ patient interface decreased the incidence of corneal folds, resulting in better capsulotomy outcomes during FLACS.

To detect the inflow of trypan blue through grooved and nongrooved sutureless self-sealing clear corneal incisions at the end of phacoemulsification as compared to a control group.

A prospective randomized masked trial considered 52 eyes randomized into 3 groups in which phacoemulsification was performed: group A, nongrooved incisions; group B, grooved incisions; and group C, controls. By the end of each surgery, trypan blue was instilled on the ocular surface in groups A and B and rinsed out after 2 minutes. A sample of the anterior chamber content was collected and analyzed by high-performance liquid chromatography to identify and quantify the trypan blue concentration. The presence of trypan blue was expressed as a specific single peak graphic image. The mean areas of these peaks were used to assess the groups using a nonparametric Mann-Whitney test.

There was a statistically significant difference between the nongrooved incisions group and the control group (p = 0.0448). No significant difference was observed between group B (grooved incision) and controls (p = 0.1800).

Trypan blue was detected in the anterior chamber when nongrooved clear corneal incision was used. There was no trypan blue detection in the group with grooved clear corneal main incisions.

The Light on DME survey was designed to address several issues concerning the management of diabetic macular edema (DME) with the objective of producing practical recommendations for the appropriate treatment of this condition.

The recommendations considered aspects of DME treatment that are controversial and insufficiently supported by the evidence and were based on a consensus reached by an expert panel. Consensus was achieved by means of the Delphi method. Thirty-one Italian retinologists were asked to rate the appropriateness of a comprehensive set of scenarios typically encountered in the management of DME in clinical practice. The results of the appropriateness evaluation were analyzed by the study panel and a second assessment round was conducted for those scenarios on which no consensus was reached.

Consensus was reached on several relevant aspects of current DME management, namely the initiation and course of treatment with anti-vascular endothelial growth factor (VEGF) therapy, assessment of the outcomes of anti-VEGF therapy based on both functional and morphologic outcomes, combination of anti-VEGF with laser therapy, and management of nonresponders to anti-VEGFs. A few issues, including the definition of DME based on novel diagnostic tools, the need for stable metabolic parameters before initiating anti-VEGF therapy, and the use of a second anti-VEFG after failure of the first anti-VEGF, proved controversial.

A clear consensus among DME experts was reached on several relevant aspects of DME management. Based on this consensus, detailed and practical recommendations to guide ophthalmologists in the use of novel approaches to DME could be developed.

To compare the efficacy and safety of bevacizumab vs ranibizumab for the treatment of idiopathic choroidal neovascularization (ICNV).

This retrospective study included 60 eyes of 60 patients with ICNV who underwent intravitreal injection of bevacizumab (1.25 mg/0.05 mL, n = 30 eyes) or ranibizumab (0.5 mg/0.05 mL, n = 30 eyes). Multiple treatments were based on complete ophthalmologic investigation including slit-lamp biomicroscopy, fundus examination, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and best-corrected visual acuity (BCVA). The BCVA, central retinal thickness (CRT), intraocular pressure (IOP), FFA results, and complications were compared between the 2 groups during the 2-year follow-up.

Visual acuity was significantly better at 1, 3, 6, 12, and 24 months after treatment (p<0.01), with no significant difference in visual acuity between the bevacizumab and ranibizumab groups. In both groups of patients, the CRT after treatment was significantly less than before. At 12 and 24 months, the CRT in the ranibizumab group was significantly less than in the bevacizumab group (p<0.05). The FFA examination showed that CNV was reduced after intravitreal injection of either drug, with no significant difference in IOP between the 2 groups. No ophthalmologic or systemic complications occurred.

Bevacizumab and ranibizumab are effective and safe in the treatment of ICNV, with similar effects in improving visual acuity and reducing retinal edema. The long-term efficacy of ranibizumab is superior to bevacizumab in reducing CRT.

To evaluate the psychological impact and depression prevalence in patients with Stargardt disease.

We conducted a case-control study including 39 patients with Stargardt disease and 32 age- and sex-matched healthy controls. All participants underwent a complete ophthalmologic examination and completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Depression Inventory questionnaire. Results were analyzed using IBM SPSS 22.0 software.

The patient group consisted of 19 men and 20 women with mean age of 36.9 ± 5.4 years and control group of 19 men and 13 women with mean age of 42.5 ± 10.1 years. The mean values of PHQ-9 and Zung scores for patients and healthy individuals were 10.9 ± 4.9, 46.7 ± 11.1, 6.7 ± 5.4, and 41.1 ± 8.5, respectively. There were statistically significant differences between the 2 groups in PHQ-9 scores (independent samples t test: p = 0.001), but not in Zung scores (Mann-Whitney test: p = 0.053). The PHQ-9 and Zung scores appeared to be moderately but significantly correlated (Pearson coefficient 0.44, p<0.0001). In addition, PHQ-9 score seems to be raised along with age, whereas both scores are low when best-corrected visual acuity is high.

Patients with Stargardt disease exhibited more depressive symptoms compared to healthy individuals according mainly to PHQ-9 scores. Moderate depression was significantly correlated visual function decline.

To evaluate the anatomical and functional course without surgical intervention in patients with nontractional epiretinal membrane (ERM) using spectral-domain optical coherence tomography (SD-OCT) in a long-term follow-up of 38.2 ± 30.6 months.

Participants were 58 patients with nontractional ERM, which was defined as a tear or rip of the ERM in at least one line of OCT scan. All patients were observed without any surgical intervention. All patients underwent ophthalmologic examination, including best-corrected visual acuity (BCVA) measurement, funduscopy, and SD-OCT. Routine follow-up visits were performed every 6 months or earlier at the discretion of the investigator.

There was no statistically significant difference in BCVA or central foveal thickness (CFT) at all time points of the follow-up. About 84.4% of patients presented improvement or stabilization in BCVA at the end of the follow-up, while 53.4% of patients had a decrease in CFT. All patients had intact ellipsoid zone and none of them needed surgical intervention at the end of the follow-up of 38.2 ± 30.6 months.

In patients with nontractional ERM, BCVA and CFT may remain stable in a long-term follow-up. Therefore, if ellipsoid zone is intact and there is a tear or rip of ERM in at least one OCT scan, patients can be monitored and surgery may be deferred because of high percentage of structural and functional stability.

To evaluate the efficacy and outcomes of intracameral illuminator-assisted nucleofractis technique in cataract surgery.

Since June 2012, this novel technique has been performed in all cataract cases by one surgeon (approximately 300 cases of various densities). Trenching continues until the posterior plate white reflex between an endonucleus and an epinucleus is identified (enhanced depth trench). After trenching, cracking is initiated with minimal separation force, and completion of cracking is confirmed by posterior capsule reflex (one-shot crack). With followability enhanced by an elliptical phaco mode, the divided nucleus is efficiently cut into small fragments by a chisel-shaped illuminator (phaco cut).

We have not experienced any capsular bag or zonular complications, and the effective phacoemulsification time seemed to be shorter than that with the conventional technique.

This technique simplifies the complete division of the nucleus, which is the most challenging step in safe and efficient phacoemulsification.

To describe a novel technique to release sticking haptic of a single-piece hydrophobic acrylic intraocular lens (IOL) using irrigation-aspiration (I/A) probe.

In our technique, the I/A probe is introduced into the anterior chamber on Visco mode. Using the aspiration port of the I/A probe, the sticking haptic is held at its tip and suction force is built up until occlusion is noted. Then the haptic is nudged towards the center of the IOL along its curve. After the haptic is free from optic, the suction is released.

Several techniques have been described to release the sticking haptic such as squeezing the haptic at the site where it sticks to the IOL or using Sinskey hook for releasing the adhesion. These techniques require extra manipulation of the IOL by introduction of surgical instruments. In our technique, we used the I/A probe itself for separating the sticky haptic successfully.

This technique allows separation of sticking haptic without any extra instrumentation, thus reducing intraocular maneuvering and total surgery time.