Piggyback implantable collamer lens implantation for the correction of residual refractive errors after cataract surgery: a multicenter study

Analysis of acupoint massage combined with touch on relieving anxiety and pain in patients with oral implant surgery

BACKGROUND

Oral implant surgery is an effective procedure for artificial implants in missing tooth areas under local anesthesia. Because patients under local anesthesia are conscious during this procedure, compared with general anesthesia-related operations, they are more likely to experience negative emotions, such as anxiety and tension. These emotional reactions result in shivering and chills in the limbs, leading to poor doctor-patient cooperation and even avoidance of treatment. In traditional Chinese medicine, it is believed that acupoint massage regulates blood and Qi, dredge menstruation, and relieve pain, which is beneficial for patients' emotional adjustment; however, there are few related clinical studies.

AIM

To observe the changes in anxiety and pain in patients with oral implant after acupoint massage combined with touch therapy.

METHODS

One hundred patients undergoing oral implantation in our hospital between May 2020 and May 2023 were randomly divided into control and study groups, according to a random number table, with 50 patients in each group. The control group received routine intervention, and the study group received acupoint massage combined with touch on the basis of the control group. Anxiety [assessed using the Modified Dental Anxiety Scale (MDAS)], pain severity, blood pressure, heart rate, and satisfaction were compared between the two groups.

RESULTS

Before intervention, the difference in MDAS score between the two groups was not significant (P > 0.05), while after the intervention, the MDAS scores decreased in both groups compared with those before the intervention (P < 0.05); the MDAS score of the study group was lower than that of the control group, with a statistically significant difference (P < 0.05). The degree of pain in the intervention group was significantly lower than that in the control group (P < 0.05). Before the intervention, there were no significant differences in systolic and diastolic blood pressures or heart rate between the two groups (P > 0.05). The systolic and diastolic blood pressures and heart rate in the intervention group, during and after the intervention, were significantly lower than those in the control group (P < 0.05). The total degree of satisfaction in the study group was significantly higher than that in the control group (P < 0.05).

CONCLUSION

Acupoint massage combined with touch better relieves anxiety and pain in patients undergoing dental implant surgery, improving the perioperative comfort of these patients and ensuring safety and a smooth operation.

Rotational stability of two different piggyback toric intraocular lenses for correction of high post-keratoplasty pseudophakic ametropia

We present the case of a 65-year-old man with bilateral keratoconus and history of bilateral penetrating keratoplasty (PK) who developed gradual visual decline in the left eye due to cataract formation. Following successful left eye cataract surgery and monofocal, non-toric intraocular lens (IOL) in-the-bag implantation, the patient experienced persistently low uncorrected distance visual acuity (UDVA) due to high residual refractive error and intolerance to contact lenses. A supplementary toric IOL was placed in the ciliary sulcus, but subsequent rotational instability of the lens required repeated realignment. Despite two attempts at IOL repositioning, the rotational instability persisted, necessitating the replacement of the original Sulcoflex IOL with a toric, implantable Collamer lens. Following the implantation of the toric ICL, the patient achieved excellent UDVA with no adverse events over a 4-year follow-up period. This case highlights the potential rotational instability associated with toric piggyback IOLs in keratoconic, post-PK, pseudophakic eyes and the special considerations on choosing the type of piggyback lens in these eyes.

Successful surgical management of interlenticular membrane by vitreoretinal interlenticular membranectomy (VIM)

The formation of a light scattering interlenticular membrane (ILM) is a known complication of polypseudophakia and has been particularly noted with the use of dual intracapsular Alcon AcrylSof intraocular lenses (IOLs). The treatment options for this condition have largely been restricted to either Nd:YAG laser membranotomy or explantation of the dual IOL complex. In this case report, we describe an unusual case of ILM in a 76-year-old woman whose ILM had formed between her primary intracapsular IOL and her piggyback sulcal IOL. Furthermore, we describe vitreoretinal interlenticular membranectomy (VIM), a novel technique involving a translimbal anterior interlenticular membranectomy using vitreoretinal instrumentation. There were no intraoperative or postoperative complications. Postoperative best-corrected visual acuity was 6/4, maintained for 3 years of follow-up. VIM is offered as a management option for surgeons to address ILM when Nd:YAG laser therapy fails, and the IOLs cannot be safely explanted.

[Evolution of IOL exchange. Part 2. Modern problems of IOL exchange]

The review discusses modern problems of intraocular lens (IOL) exchange. Making an adequate choice between IOL reposition and IOL exchange in pseudophakic patients with problems of lens fixation remains a largely unsolved issue. The literature data shows a noticeable increase in the number of supporters of retropupillary fixation of an iris-claw lens during the exchange procedure.

Phakic intraocular lenses: Recent advances and innovations

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.