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Soraya Alamsjah SHZ, Yulia DE, Tan S. Scleral-fixated vs Iris-fixated intraocular lens in pediatric ectopia lentis: A systematic review. Eur J Ophthalmol 2024:11206721241242158. [PMID: 38533559 DOI: 10.1177/11206721241242158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Numerous intraocular lens (IOLs) options are available for treating pediatric ectopia lentis, and this paper reviews recent literature on pediatric ectopia lentis treatment with iris-fixated and scleral-fixated IOLs. A comprehensive search was undertaken on PubMed, Embase, ProQuest, Cochrane, Wiley, SCOPUS, and EBSCO. Studies published in the last ten years that met the inclusion criteria were included in this review. Seventeen studies exhibiting low to moderate risk of bias were included in this review, with eight on iris-fixated IOL (IFIOL), six on scleral-fixated IOL (SFIOL), and three on both IOLs. From the included studies, these data were extracted and compared: best-corrected visual acuity, endothelial cell density, postoperative complications, IOL stability, and intraocular pressure. IFIOL and SFIOL show comparable lens stability, offer good visual rehabilitation, and demonstrate equivalent safety profiles. There is no discerning superiority between IFIOL and SFIOL in treating pediatric ectopia lentis. The choice of which IOL to implant depends on the surgeon's preference.
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Affiliation(s)
- Siti Halida Zoraida Soraya Alamsjah
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Dian Estu Yulia
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Sabrina Tan
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Schlatter A, Kronschläger M, Ruiss M, Bayer N, Blouin S, Findl O. Attaining the optimal flange technique for transscleral capsular bag stabilization using iris hooks. J Cataract Refract Surg 2024; 50:295-300. [PMID: 37994093 PMCID: PMC10878459 DOI: 10.1097/j.jcrs.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To investigate the flange properties of different iris hooks. SETTING Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria. DESIGN Laboratory study. METHODS The flanging properties of 4 different iris hooks made from polypropylene (PP), elastic polymer (EP), and nylon were investigated with different heating distances and both with and without forceps gripping. The maximum diameter of the flanges was measured, and the shape of the flanges was evaluated. RESULTS Although both nylon and EP iris hooks had too small flange diameters for intrascleral fixation, PP iris hooks had a sufficient flange diameter (>330 μm) and mushroom-like shape. Furthermore, in PP hooks, heating distance was directly proportional to flange diameter. CONCLUSIONS The findings of this study suggest that only PP iris hooks are suitable for flanged intrascleral fixation, which is off-label, to secure adequate fixation.
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Affiliation(s)
- Andreas Schlatter
- From the Vienna Institute for Research in Ocular Surgery (VIROS), Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Schlatter, Kronschläger, Ruiss, Bayer, Findl); Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of ÖGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria (Blouin)
| | - Martin Kronschläger
- From the Vienna Institute for Research in Ocular Surgery (VIROS), Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Schlatter, Kronschläger, Ruiss, Bayer, Findl); Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of ÖGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria (Blouin)
| | - Manuel Ruiss
- From the Vienna Institute for Research in Ocular Surgery (VIROS), Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Schlatter, Kronschläger, Ruiss, Bayer, Findl); Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of ÖGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria (Blouin)
| | - Natascha Bayer
- From the Vienna Institute for Research in Ocular Surgery (VIROS), Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Schlatter, Kronschläger, Ruiss, Bayer, Findl); Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of ÖGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria (Blouin)
| | - Stéphane Blouin
- From the Vienna Institute for Research in Ocular Surgery (VIROS), Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Schlatter, Kronschläger, Ruiss, Bayer, Findl); Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of ÖGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria (Blouin)
| | - Oliver Findl
- From the Vienna Institute for Research in Ocular Surgery (VIROS), Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Schlatter, Kronschläger, Ruiss, Bayer, Findl); Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of ÖGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria (Blouin)
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Lian Z, Hu Y, Liu Z, Young CA, Liu S, Zheng D, Jin G. Longitudinal changes of refractive error in preschool children with congenital ectopia lentis. Int Ophthalmol 2024; 44:85. [PMID: 38363416 DOI: 10.1007/s10792-024-02953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Congenital ectopia lentis (CEL) is a hereditary eye disease which severely impacts preschool children's visual function and development. This study aimed to evaluate the longitudinal changes in spherical equivalent (SE) refractive error in preschool children with CEL. METHODS A retrospective cohort study was conducted at Zhongshan Ophthalmic Center, Guangzhou, China. Medical records of CEL patients under 6-year-old who were diagnosed with Marfan syndrome at the initial visit from January 2014 to March 2022 were collected and were divided into surgery and non-surgery groups. Mean change rate of SE in the two groups was evaluated, and the potential associated factors of SE change rate were investigated by mixed-effect regression model. RESULTS A total of 94 preschool patients from 14 provinces of China were included. Among the 42 children of the surgery group, the mean age with standard deviation (SD) was 5.02 ± 0.81 years and patients experienced a myopic shift of -0.05 ± 0.09 D/month in average. The mean age with SD of the 52 children of the non-surgery group was 4.34 ± 1.02 years, and the mean myopic shift was -0.09 ± 0.14 D/month. The mixed-effect regression model identified that higher degree of myopia at baseline was associated with slower myopic shift both in surgery (β = 0.901, 95% CI: 0.822 ~ 0.980, P < 0.001) and in non-surgery group (β = 1.006, 95% CI: 0.977 ~ 1.034, P < 0.001) in CEL patients. Surgical treatment (β = 2.635, 95% CI: 1.376 ~ 3.894, P < 0.001) was associated with slower myopic shift in all participants CEL patients. CONCLUSIONS Myopic progression was slower in the surgery group than in the non-surgery group of CEL. Preschool CEL patients who met the surgical indication are suggested being performed with timely surgery to slow down the myopic progression.
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Affiliation(s)
- Zhangkai Lian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, #54 Xianlie South Road, Yuexiu District, Guangzhou, 510060, China
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, #54 Xianlie South Road, Yuexiu District, Guangzhou, 510060, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, #54 Xianlie South Road, Yuexiu District, Guangzhou, 510060, China
| | | | - Siyuan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, #54 Xianlie South Road, Yuexiu District, Guangzhou, 510060, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, #54 Xianlie South Road, Yuexiu District, Guangzhou, 510060, China.
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, #54 Xianlie South Road, Yuexiu District, Guangzhou, 510060, China.
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Liu S, Lian Z, Young C, Ng K, Zhang X, Zheng D, Jin G. Postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome. J Cataract Refract Surg 2024; 50:134-139. [PMID: 37753933 DOI: 10.1097/j.jcrs.0000000000001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To evaluate the postoperative longitudinal refractive changes in children younger than 8 years with ectopia lentis and Marfan syndrome (MFS). SETTING Zhongshan ophthalmic center, Guangzhou, China. DESIGN Retrospective cohort study. METHODS Medical data of patients diagnosed with ectopia lentis and MFS that underwent surgery younger than 8 years were collected. Refractive errors and ocular biometric parameters were collected preoperatively and at each follow-up visit. Patients were stratified into groups according to age at surgery, and only the eye operated on first was selected. Multivariate analysis was performed to determine the association between refractive shift and potential risk factors. RESULTS In total, 54 eyes of 54 patients were enrolled. The median age at surgery was 6.21 years (interquartile range [IQR], 5.25 to 6.85), and the median follow-up was 2.0 years (IQR, 1.2 to 2.8 years). At age 8 years, patients demonstrated a median myopic shift ranged from -1.75 diopters (D) (IQR, -2.75 to -1.00 D) for the 4-year-old group to -0.13 D (IQR, -0.50 to -0.06 D) for the 7-year-old group. Multivariate analysis showed that greater myopic shift was associated with younger age at surgery ( P = .004), male sex ( P = .026), and shorter preoperative axis length ( P = .005). CONCLUSIONS A tendency toward increasing postoperative myopic was demonstrated in children with ectopia lentis and MFS, with the greatest myopic shift in the younger age groups. If the goal is to reach emmetropia by age 8 years, the immediate postoperative hypermetropic targets should be 1.75 D for age 4 years, 1 D for age 5 years, 0.5 D for age 6 years, and 0 to 0.25 D for age 7 years.
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Affiliation(s)
- Siyuan Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (Liu, Lian, Ng, Zhang, Zheng, Jin); Albany Medical College, Albany, New York (Young)
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Grassi P, Ramkissoon Y. Nontraumatic bilateral inferior ectopia lentis. Oman J Ophthalmol 2023; 16:195-196. [PMID: 37007252 PMCID: PMC10062097 DOI: 10.4103/ojo.ojo_278_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/12/2022] [Indexed: 02/25/2023] Open
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Yulia DE, Soeharto DA. Efficacy and Safety of Iris-Claw Intraocular Lens in Pediatric Ectopia Lentis: A Literature Review. J Curr Ophthalmol 2023; 35:1-10. [PMID: 37680281 PMCID: PMC10481981 DOI: 10.4103/joco.joco_249_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To review current evidence regarding the use of iris-claw intraocular lens (IOL) in terms of its efficacy and safety in the population of pediatric ectopia lentis. Methods A comprehensive literature search of six electronic databases (PubMed-NCBI, Medline-OVID, Embase, Cochrane, Scopus, and Wiley) and secondary search through reference lists was conducted using keywords selected a priori. All primary studies on the use of iris-claw in pediatric ectopia lentis that evaluated visual acuity (VA), complications, and endothelial cell density (ECD) were included and critically appraised using the Newcastle-Ottawa Scale. Results Ten studies were eligible for inclusion with an overall sample size of 168 eyes of children with ectopia lentis, and the majority of studies evaluated anterior iris-claw IOL. All studies reported improvement in postoperative VA. The most commonly reported complication across studies was IOL decentration. All studies reported decreasing ECD, and this was observed in both anterior and retropupillary iris-claw IOL. Conclusion Current evidence shows that iris-claw IOL is effective in terms of improving VA in pediatric ectopia lentis. Due to the lack of long-term evidence of its safety in children, one must remain cautious regarding potential endothelial cell loss. Further high-quality, interventional, long-term studies are needed.
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Affiliation(s)
- Dian Estu Yulia
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
| | - Diajeng Ayesha Soeharto
- Department of Ophthalmology, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
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Venkataraman P, Haripriya A, Mohan N, Rajendran A. A systematic approach to the management of microspherophakia. Indian J Ophthalmol 2022; 70:2262-2271. [PMID: 35791105 PMCID: PMC9426104 DOI: 10.4103/ijo.ijo_2888_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.
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Affiliation(s)
| | | | - Neethu Mohan
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Glaucoma Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
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Yulia D, Barliana J, Soeharto D. Visual outcome of intraocular Iris–Claw lens implantation in Indonesian children with ectopia lentis. Taiwan J Ophthalmol 2022. [DOI: 10.4103/tjo.tjo_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Accuracy of intraocular lens power calculation formulas for eyes with scleral-sutured intraocular lens in congenital ectopia lentis. J Cataract Refract Surg 2021; 48:469-474. [PMID: 34978783 DOI: 10.1097/j.jcrs.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
Purpose To compare the accuracy of intraocular lens calculation formulas in eyes with congenital ectopia lentis (CEL) that underwent scleral-fixated intraocular lens (IOL) implantation. Setting Zhongshan Ophthalmic Center, Guangzhou, China. Design Retrospective, consecutive case-series study. Methods A total of 158 eyes from 158 patients diagnosed from December 12, 2017 to November 16, 2020 with congenital ectopia lentis and undergoing a lensectomy and a Rayner 920H or 970C model IOL scleral-fixation were retrospectively reviewed. The prediction errors (PEs) of the spherical equivalent of eight formulas, Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), Haigis, Hoffer Q, Holladay 1, Kane, Hill-Radial Basis Function 3.0 (RBF 3.0) and SRK/T were compared. Results For CEL patients with sclera-sutured IOL, all eight formulas yielded myopic PEs without constants optimization. After such optimization, the performance of each formula ranked by median absolute error (MedAE) from lowest to highest in diopter, was SRK/T (0.47), EVO (0.48), Kane (0.52), BUII (0.53), Hoffer Q (0.58), Holladay 1 (0.59), Haigis (0.61), and RBF 3.0 (0.62). The EVO and SRK/T formulas had the highest prediction accuracy concerning the percentage of cases within the +/- 0.50 D range of PE and within +/- 1.00 D range of PE in eyes experienced sclera-sutured IOL surgery, respectively. Conclusion All formulas with unoptimized constants produced myopic PEs. After optimization, the SRK/T and EVO formula were the two recommended formulas due to having the lowest MedAE and the highest percentage of PE in the range of +/- 0.50 D for CEL patients with sclera-sutured IOL implantations.
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Yuan A, Ma K, Sharifi S, Pineda R. Biomechanical Testing of Flanged Polypropylene Sutures in Scleral Fixation. Am J Ophthalmol 2021; 230:134-142. [PMID: 33945819 PMCID: PMC10560604 DOI: 10.1016/j.ajo.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To optimize the flanged belt-loop technique of scleral fixation through biomechanical testing and report clinical outcomes of resultant modifications. DESIGN Experimental study. METHODS The force to disinsert flanged polypropylene suture from human cadaveric sclera was assessed using a tensile testing machine and compared to the breaking strengths of 9-0 and 10-0 polypropylene. The effects of modifying suture gauge (5-0, 6-0, 7-0, or 8-0), amount of suture cauterized (0.5 or 1.0 mm), and sclerotomy size (27, 30, 32, 33 gauge) were investigated. Belt-loop intrascleral fixation using 6-0 and 7-0 polypropylene with 30 and 32 gauge needles, respectively, was performed in 4 patients. Main outcome measures were flanged suture disinsertion forces in cadaveric sclera. RESULTS The average force to disinsert a flange created by melting 1.0 mm of 5-0, 6-0, 7-0, and 8-0 polypropylene suture from human cadaveric sclera via 27, 30, 32, and 33 gauge needle sclerotomies was 3.0 ± 0.5 N, 2.1 ± 0.3 N, 0.9 ± 0.2 N, and 0.4 ± 0.1 N, respectively. The disinsertion forces for flanges formed by melting 0.5 mm of the same gauges were 72%-79% lower (P < .001). In comparison, the breaking strengths of 9-0 and 10-0 polypropylene were 0.91 ± 0.4 N and 0.52 ± 0.03 N. Belt-loop fixation using 6-0 and 7-0 polypropylene with 30 and 32 gauge sclerotomies demonstrated good outcomes at 6 months. CONCLUSIONS The flanged belt-loop technique is a biomechanically sound method of scleral fixation using 1.0 mm flanges of 5-0 to 7-0 polypropylene paired with 27, 30, and 32 gauge sclerotomies. In contrast, 8-0 polypropylene and 0.5 mm flanges of any suture gauge will likely be unstable with this technique.
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Affiliation(s)
- Amy Yuan
- From the Department of Ophthalmology, University of Washington, Seattle, Washington, USA (A.Y.)
| | - Kevin Ma
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (K.M., R.P.)
| | - Sina Sharifi
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA (S.S.)
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA (K.M., R.P.).
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Meng X, Cao X, Jia Y, Pan J, Du Y, Li X. Sutured scleral fixation of posterior chamber intraocular lens in children under the age of 9 with congenital ectopia lentis. Ophthalmic Res 2021; 64:837-843. [PMID: 34247162 DOI: 10.1159/000516324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Xuyun Meng
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xi Cao
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yiyue Jia
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianhui Pan
- Department of Ophthalmology, Guiping City People's Hospital, Guiping, China
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xia Li
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Chen Z, Zhang M, Deng M, Chen T, Chen J, Zheng J, Jiang Y. Surgical outcomes of modified capsular tension ring and intraocular lens implantation in Marfan syndrome with ectopia lentis. Eur J Ophthalmol 2021; 32:11206721211012868. [PMID: 33887970 DOI: 10.1177/11206721211012868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate surgical outcomes of modified capsular tension ring (MCTR) and intraocular lens (IOL) implantation in eyes of Marfan syndrome (MFS). METHODS This retrospective case series included MFS patients receiving MCTR transscleral fixation and IOL in-the-bag implantation. The MCTR was sutured to the sclera through a sulcus by 9-0 polypropylene with the modified knotless Z-suture technique. Main outcomes were visual acuity and postoperative complications. RESULTS A total of 109 MFS patients (187 eyes) had the surgery. Patients were 15.47 ± 14.36 years old and followed up for 10.07 ± 8.99 months. MCTR and IOL implantations were performed in 174 eyes (93.05%). The postoperative BCVA (LogMAR) was 0.24 ± 0.24 (1 month), 0.26 ± 0.20 (3 months), 0.22 ± 0.20 (6 months), 0.20 ± 0.19 (12 months) and 0.25 ± 0.32 (over 12 months), which was significantly better than preoperatively (0.63 ± 0.35) (p < 0.001). Major complications included posterior capsular opacification (PCO) in 41 eyes (23.56%) and decentered anterior capsular opacification (ACO) in 15 eyes (8.62%). The mean occurrence time was 9.44 ± 7.08 and 8.87 ± 15.08 months respectively. Other complications included transient intraocular pressure elevation in seven eyes (4.02%), retinal detachment in two eyes (1.15%), cystoid macula edema in one eye (0.57%), and endophthalmitis in one eye (0.57%). No eye had suture breakage or IOL dislocation. CONCLUSIONS The visual improvement is significant in eyes of MFS undergoing MCTR transscleral fixation and IOL in-the-bag implantation. The long-term monitoring of complications is warranted, especially in the first-two years.
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Affiliation(s)
- Zexu Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Min Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Michael Deng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Tianhui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jiahui Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jialei Zheng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yongxiang Jiang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Anisimova NS, Arbisser LB, Shilova NF, Kirtaev RV, Dibina DA, Malyugin BE. Late dislocation of the capsular bag-intraocular lens-modified capsular tension ring complex after knotless transscleral suturing using 9-0 polypropylene. Digit J Ophthalmol 2021; 26:7-16. [PMID: 33867876 DOI: 10.5693/djo.02.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of late breakage of a 9-0 polypropylene transscleral suture used for fixation of a dislocated capsular bag-intraocular lens-modified capsular tension ring complex in a 52-year-old woman with Marfan syndrome. Breakage occurred despite use of a cow-hitch technique for external and internal fixation. We believe breakage was caused by the suture chafing on the sharp edges of the modified capsular tension ring eyelet. Cross-sectional analysis of Malyugin-modified capsular tension rings from two different manufacturers revealed a difference with respect to radius of curvature. Suturing intraocular implants with relatively sharp edges may cause suture breakage; further studies are needed to identify the critical parameters for the surface quality of sutured intraocular implants.
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Affiliation(s)
- Natalia S Anisimova
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Lisa B Arbisser
- John A. Moran Eye Center, University of Utah, Salt Lake City
| | | | - Roman V Kirtaev
- Moscow Institute of Physics and Technology, Dolgoprudny, Russia
| | - Daria A Dibina
- S. Fyodorov Eye Microsurgery Institution, Moscow, Russia
| | - Boris E Malyugin
- A. I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,S. Fyodorov Eye Microsurgery Institution, Moscow, Russia
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14
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Cai L, Han X, Jiang Y, Qiu X, Qian D, Lu Y, Yang J. Three-Year Outcomes of Cionni-Modified Capsular Tension Ring Implantation in Children Under 8 Years Old With Ectopia Lentis. Am J Ophthalmol 2021; 224:74-83. [PMID: 33253663 DOI: 10.1016/j.ajo.2020.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE This study evaluated visual outcomes and complications at 3 years post-implantation of a Cionni-modified capsular tension ring (MCTR) with an intraocular lens (IOL) in ectopia lentis patients ≤8 years old. DESIGN Prospective clinical cohort study. METHODS Included were 101 eyes from 57 patients <8 years of age, who underwent surgery for nontraumatic ectopia lentis between November 2015 and December 2016. Exclusion criteria were planned IOL fixation in the ciliary sulcus, severe intraoperative complications, and incomplete follow-up. All eyes received in-the-bag implantation of a posterior IOL and Cionni-MCTR. Posterior capsulectomy and anterior vitrectomy were performed through the pars plana in 23 eyes of children <5 years of age. Patients were examined at 1 day, and 1, 6, and 12 months, and at 2 and 3 years postoperatively. Outcome; measurements included best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and posterior capsule opacification (PCO). RESULTS In all eyes, BCVA improved significantly after surgery, especially during the first 12 months (P < .05). Three years post-operatively, 44 eyes had BCVA 0.9 or better. Prophylactic Nd:YAG laser capsulotomy was performed 3 months post-surgery in 24 eyes; 34 eyes underwent this; procedure 6 months post-surgery because of PCO. A second surgery was; warranted in 4 eyes because of severe IOL decentration and combined anterior capsule contraction. No severe postoperative complications, such as retinal detachment or endophthalmitis, occurred. CONCLUSIONS Implantation of in-the-bag IOL with Cionni MCTR is effective for visual rehabilitation in young children with ectopia lentis. A close follow-up of these patients is necessary to monitor IOL centration and stability.
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Affiliation(s)
- Lei Cai
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Xiaoyan Han
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Yongxiang Jiang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Xiaodi Qiu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Dongjin Qian
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Yi Lu
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China
| | - Jin Yang
- Department of Ophthalmology, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, People's Republic of China; Key Laboratory of Myopia, Ministry of Health, Shanghai, People's Republic of China; Key Laboratory of Visual Impairment and Restoration, Shanghai, People's Republic of China; Visual Rehabilitation Professional Committee, Chinese Association of Rehabilitation Medicine, People's Republic of China.
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15
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Gotzaridis S, Georgalas I, Papakonstantinou E, Spyropoulos D, Kouri A, Kandarakis S, Karamaounas A, Gkiala A, Sideri AM, Droutsas K, Petrou P. Scleral Fixation of Carlevale Intraocular Lens in Children: A Novel Tool in Correcting Aphakia With No Capsular Support. Ophthalmic Surg Lasers Imaging Retina 2021; 52:94-101. [PMID: 33626170 DOI: 10.3928/23258160-20210201-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the clinical outcomes of the use of a novel, specially designed, scleral-fixated intraocular lens (IOL) for the correction of aphakia in the absence of capsular support of variable etiology in children. PATIENTS AND METHODS This is a retrospective, noncomparative, interventional case series of five eyes of five consecutive patients who underwent three-port pars plana vitrectomy and scleral fixation of the IOL. Inclusion criteria were at least 6 months of follow-up in children who underwent vitrectomy and IOL placement for aphakia and inadequate capsular support. Patients were excluded from the analysis if there was a previous open globe injury or any other ocular comorbidity such as macular pathology or previous surgery for retinal detachment, glaucoma, corneal transplantation, or strabismus. RESULTS The median follow-up period was 9 months (range: 7-13 months). The median age was 8 years (range: 2-10 years), and the male-to-female ratio was 5 to 0. Mean postoperative best-corrected visual acuity (VA) at the last follow-up visit was 20/32 (0.26 ± 0.32 logMAR [mean ± standard deviation]), improving from a mean baseline uncorrected VA of 20/800 (1.6 ± 0.7 logMAR), a statistically significant change (P = .003). The uncorrected postoperative VA was 20/63 (0.54 ± 0.37 logMAR). No significant postoperative complications were noted and all patients had good IOL position at the end of the follow-up without IOL capture. The mean tilt in four eyes (the 2-year-old was excluded from the analysis) was 2.1 ± 1.9 degrees. None of the patients required reoperation. CONLCUSIONS The present study represents the first to date in evaluating the use of a scleral-fixated IOL in patients with aphakia and in pediatric patients with inadequate capsular support. The technique is safe and provides excellent postoperative IOL fixation without IOL capture in any of the patients studied. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:94-101.].
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16
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Le T, Rhee D, Sozeri Y. Uveitis–Glaucoma–Hyphema Syndrome: a Review and Exploration of New Concepts. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Jin G, Lin J, Xiao B, Chen A, Young CA, Zheng D. Characteristics and Risk Factors for Pupillary Capture of Intraocular Lens in Congenital Ectopia Lentis. Curr Eye Res 2019; 45:477-482. [PMID: 31523990 DOI: 10.1080/02713683.2019.1668418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Importance: To analyze the characteristics and risk factors for pupillary capture (PC) of the intraocular lens (IOL) in congenital ectopia lentis (CEL) patients.Methods: Data of CEL patients who underwent lens extraction and intraocular implantation from 2013 to 2016 at Zhongshan Ophthalmic Center in China were collected. Best-corrected visual acuity (BCVA), axial length (AL), refractive status, corneal curvature, intraocular pressure (IOP), degree of lens dislocation, presence of strabismus, and methods of IOL fixation were recorded. Postoperative data were collected from the routine one-month postoperative follow-up. Patients with PC of IOL were characterized and risk factors for PC of IOL were analyzed using age-sex adjusted multiple logistic regression analysis.Results: Of the 89 included CEL subjects, 43.8% (39/89) of them suffered from PC after IOL implantation. There was no statistically significant difference in BCVA, AL, refractive status and IOP between the eyes which developed PC versus those which did not. Age-sex multiple logistic regression analysis shows that PC of IOL was associated with a more severe degree of lens dislocation and eyes with strabismus before surgery.Conclusions: Eyes with strabismus and more severe degrees of lens dislocation before surgery are risk factors for PC of IOL. When treating patients that present these risk factors, preoperative communication, and postoperative follow-up should be strengthened. Considering that PC of IOL has little effect on visual acuity, patients with slight PC of IOL can be exempt from surgical intervention.
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Affiliation(s)
- Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Junxiong Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Bing Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Aiming Chen
- Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | | | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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