Circular YAG laser anterior capsulotomy for anterior capsule contraction syndrome

[Circular or radial capsulotomy for the treatment of capsular phimosis: Which is the better option?]

INTRODUCTION

Capsular phimosis is a common postoperative complication of cataract surgery, resulting from fibrous metaplasia of residual epithelial cells. It leads to capsular contraction, which affects visual quality and the stability of the intraocular lens (IOL). Nd:YAG laser capsulotomy, performed using either circular or radial techniques, remains the standard treatment.

PURPOSE

To compare the outcomes of circular vs. radial capsulotomies in terms of visual gain, postoperative complications, and IOL stability.

MATERIALS AND METHODS

A prospective, randomized, single-center study was conducted on 108 eyes (54 per technique) followed for six months. The parameters evaluated included best corrected visual acuity (BCVA), intraocular pressure (IOP), and complications (capsular debris, IOL dislocation).

RESULTS

The circular technique provided a mean gain of 3.2 lines on the ETDRS scale, compared to 2.6 lines for the radial technique (P<0.05). Although associated with an increased rate of capsular debris (9.2%), no major complications occurred. In contrast, the radial technique was associated with a risk of partial IOL dislocation in 3 cases (5.6%).

CONCLUSION

Circular capsulotomy appears to offer better functional outcomes and enhanced IOL stability compared to the radial technique. However, larger-scale studies with longer follow-up are needed to confirm these findings.

Stability of a ZEISS LISA tri 839MP multifocal IOL with a missing haptic segment in a high myopic patient: A 3-year follow-up case report

RATIONALE

The purpose of this study was to present the long-term outcomes of a monobloc multifocal intraocular lens (IOL) (ZEISS LISA tri 839MP) with a missing haptic segment in a patient with high myopia.

PATIENT CONCERNS

A 51-year-old female with high myopia presented for cataract surgery.

DIAGNOSES

The patient was diagnosed with cataracts in both eyes, with high myopia as a pre-existing condition.

INTERVENTIONS

Phacoemulsification with implantation of a ZEISS LISA tri 839MP multifocal IOL was performed. During surgery, 1 haptic was torn and removed. The remaining 3 haptics of the plate-haptic-designed IOL were positioned in the capsular bag.

OUTCOMES

Postoperative uncorrected distance visual acuity improved to 20/20 on the first day, with stable intraocular pressure and good centration of the IOL. Over the 3-year follow-up period, the IOL remained well-centered with no significant decentration, and the patient maintained stable visual acuity of 20/20.

LESSONS

The ZEISS LISA tri 839MP multifocal IOL demonstrated long-term stability and favorable visual outcomes despite the missing haptic segment, suggesting that conservative management may be effective in similar cases.

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches

Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.

Evaluation of Clinical Results of Implantation of Toric Intraocular Lenses Including their Rotational Stability

PURPOSE

The aim of the study was to evaluate the clinical results of the implantation of the toric intraocular lens Acrysof IQ Toric SN6AT3_8 (Alcon Laboratories, Inc., Fort Worth, TX, USA), including an evaluation of its rotational stability.

MATERIAL AND METHODS

30 eyes of 16 patients (4 males, 12 females; mean age 68 years) with regular corneal astigmatism ranging from -1.5 to -4.0 Dcyl were included in this retrospective study. All the patients underwent uncomplicated cataract surgery with the implantation of a toric intraocular lens (TIOL) at the Department of Ophthalmology of the Faculty of Medicine and Dentistry of Palacký University in Olomouc and University Hospital Olomouc during the course of 2020. Follow-up examinations were performed 3-6 months after cataract surgery. We monitored the resulting uncorrected distance visual acuity (UDVA), postoperative refraction, rotational stability of the implanted lens and subjective patient satisfaction.

RESULTS

mean preoperative corneal astigmatism was -2.41 ±0.67 Dcyl. UDVA improved from a mean value of 0.45 ±0.25 (expressed in decimal Snellen optotype values) to 0.91 ±0.16. The spherical equivalent value of 0.41 ±2.92 improved to -0.11 ±0.27 postoperatively. The mean deviation from the planned axis was 4.87 ±4.75. Subjective satisfaction was rated by patients on a scale of 1-5, with a mean score of 1.5.

CONCLUSION

TIOL implantation is a safe and effective solution for patients with corneal astigmatism and cataract. Our results demonstrate improved UDVA, rotational stability of the TIOL and subjective patient satisfaction with the outcome of the surgery.

Lens Epithelial Cell Removal in Routine Phacoemulsification: Is It Worth the Bother?

PURPOSE

To review the literature on crystalline lens epithelial cell (LEC) removal in routine phacoemulsification and determine whether it should be incorporated as part of a surgeon's standard technique.

DESIGN

Perspective.

METHODS

Expert commentary with video demonstrations on techniques of removal of LECs and associated potential complications. Discussion incorporates the importance of LEC removal, a review of techniques to prevent posterior capsular opacification (PCO), and the effects of intraocular lens design on LEC proliferation and PCO.

RESULTS

The evidence suggests that LEC removal should be routinely performed as it can be carried out safely and with considerable short- and long-term benefits for patients. With effective cleanup, there is reduced anterior capsule opacification, fibrosis, and decentration of the capsular bag as well as reduced rates of posterior capsular opacification. Techniques for removal are easy to learn, with very low complication rates, and can reduce the risk of the long-term need for technically complex procedures such as intraocular lens explantation.

CONCLUSIONS

LEC removal from both the anterior and posterior capsule is part of a continuous, incremental improvement of cataract surgery and should be introduced to ophthalmology trainees during their formative years as part of their regular cataract surgery armamentarium.