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Osher RH. Comment on: Anterior vitreous detachment and retrolental material during cataract surgery: incidence and risk factors, with pathological evidence. J Cataract Refract Surg 2023; 49:1290. [PMID: 37801565 DOI: 10.1097/j.jcrs.0000000000001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Robert H Osher
- From the Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio (Osher); Cincinnati Eye Institute, Cincinnati, Ohio (Osher)
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Incidence and Risk Factors for Berger's Space Development after Uneventful Cataract Surgery: Evidence from Swept-Source Optical Coherence Tomography. J Clin Med 2022; 11:jcm11133580. [PMID: 35806863 PMCID: PMC9267354 DOI: 10.3390/jcm11133580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Background: This study investigates the incidence and risk factors for the development of Berger’s space (BS) after uneventful phacoemulsification based on swept-source optical coherence tomography (SS-OCT). Methods: Cataractous eyes captured using qualified SS-OCT images before and after uneventful phacoemulsification cataract surgery were included. Six high-resolution cross-sectional anterior segment SS-OCT images at 30° intervals were used for BS data measurements. BS width was measured at three points on each scanned meridian line: the central point line aligned with the cornea vertex and two point lines at the pupil’s margins. Results: A total of 223 eyes that underwent uneventful cataract surgery were evaluated. Preoperatively, only two eyes (2/223, 0.9%) were observed to have consistent BS in all six scanning directions. BS was observed postoperatively in 44 eyes (44/223, 19.7%). A total of 13 eyes (13/223, 5.8%) with insufficient image quality, pupil dilation, or lack of preoperative image data were excluded from the study. A total of 31 postoperative eyes with BS and 31 matched eyes without BS were included in the final data analysis. The smallest postoperative BS width was in the upper quadrant of the vertical meridian line (90°), with a mean value of 280 μm. The largest BS width was observed in the opposite area of the main clear corneal incision, with a mean value >500 μm. Conclusions: Uneven-width BS is observable after uneventful phacoemulsification. Locations with a much wider BS (indirect manifestation of Wieger zonular detachment) are predominantly located in the opposite direction to the main corneal incisions.
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Ullrich M, Ruiss M, Hienert J, Pilwachs C, Fisus AD, Georgiev S, Hirnschall N, Findl O. Anterior chamber depth variability between 2 hydrophobic acrylic 1-piece intraocular lenses: randomized trial. J Cataract Refract Surg 2021; 47:1460-1465. [PMID: 33929807 DOI: 10.1097/j.jcrs.0000000000000668] [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: 02/19/2021] [Accepted: 03/27/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the difference in anterior chamber depth (ACD) after uneventful cataract surgery between 2 hydrophobic acrylic 1-piece intraocular lenses (IOLs) with different material properties. SETTING Hanusch Hospital, Vienna, Austria. DESIGN Single-center, bilateral randomized paired-eye controlled study. METHODS Patients scheduled for bilateral cataract surgery were randomized to receive the Clareon IOL in 1 eye and the AcrySof IQ IOL (both Alcon Laboratories, Inc.) in the contralateral eye. Preoperatively, a slitlamp examination, optical biometry (IOLMaster 700, Carl Zeiss Meditec AG), refraction, and visual acuity measurements were performed. ACD was assessed 1 hour and 1 week postoperatively and with additional measurement of uncorrected (UDVA) and corrected distance visual acuity (CDVA) 6 months postoperatively. RESULTS 80 eyes of 40 patients were analyzed in this study. ACD at the 6-month follow-up was 3.94 ± 0.30 mm for the Clareon IOL and 3.91 ± 0.32 mm for the AcrySof IQ IOL (P = .08). Statistically significant differences in the ACD shift between both IOLs were detected between 1 week and 6 months (P = .04) and 1 hour and 6 months (P = .04). There were no statistically significant differences between both IOLs in UDVA (P = .78), CDVA (P = .59), and spherical equivalent (SE, P = .39) at the 6-month visit. The mean absolute error between the measured and the aimed SE was not significant (P = .97). CONCLUSIONS There was no clinically relevant difference in ACD between the Clareon IOL and the AcrySof IQ IOL in patients after uneventful cataract surgery. Both IOLs yielded good refraction and visual acuity outcomes.
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Affiliation(s)
- Marlies Ullrich
- From the VIROS-Vienna Institute for Research in Ocular Surgery, a Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
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Park HY, Kim JH. Three Cases of Intraoperative Acute Fluid Misdirection Syndrome during Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.8.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We report the management of three cases of intraoperative acute fluid misdirection syndrome during cataract surgery.Case summary: Cataract surgery was performed in one eye of an 82-year-old woman with pseudoexfoliation syndrome, one eye of an 80-year-old man with end-stage glaucoma, and both eyes of a 72-year-old man with pseudoexfoliation syndrome. In the first two cases, the capsular bag space decreased during cortex aspiration and after removal of the cortex, respectively. After intravenous mannitol and intake of oral acetazolamide, the intraocular lens was successfully inserted in the first two cases on the same day. In the third case, after first removing the nucleus and cortex of the right eye, the capsular bag space decreased and an intraocular lens was carefully inserted. No intraoperative complications were seen during the left eye operation. One month after the operation, the best-corrected visual acuity had improved and the intraocular pressure was within normal limits for all three cases.Conclusions: A relatively shallow chamber, pseudoexfoliation, zonular laxity, and use of high molecular weight ophthalmic viscosurgical devices may cause acute fluid misdirection syndrome during cataract surgery. Pars plana vitrectomy may be required. However, intravenous high osmotic agent treatment should be attempted first, followed by intraocular lens insertion on the same day.
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Kong CF, Lee B, Downie J, Francis IC. Successful surgical management of interlenticular membrane by vitreoretinal interlenticular membranectomy (VIM). BMJ Case Rep 2021; 14:14/7/e242201. [PMID: 34281940 DOI: 10.1136/bcr-2021-242201] [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: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Cheng Fei Kong
- Ophthalmology Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Brendon Lee
- Ophthalmology Department, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - John Downie
- Ophthalmology Department, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Ian C Francis
- Ophthalmology Department, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
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Hirnschall N, Farrokhi S, Amir-Asgari S, Hienert J, Findl O. Intraoperative optical coherence tomography measurements of aphakic eyes to predict postoperative position of 2 intraocular lens designs. J Cataract Refract Surg 2018; 44:1310-1316. [PMID: 30219261 DOI: 10.1016/j.jcrs.2018.07.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate intraoperative anterior chamber depth (ACD) measurements of the aphakic eye to predict the postoperative ACD and compare 2 intraocular lens (IOL) designs. SETTING Hanusch Hospital, Vienna, Austria. DESIGN Prospective study. METHODS In this prospective study, patients scheduled for cataract surgery received a plate-haptic IOL (Asphina, Carl Zeiss Meditec AG) or an open-loop haptic IOL (ZCB00, Johnson & Johnson). Preoperatively, optical biometry (IOLMaster 700, CZM, or Lenstar, Haag-Streit) was performed. Intraoperatively, a prototype setup was used to perform time-domain OCT scans of the anterior eye segment (Visante connected to OPMI Lumera 200, both CZM). The intraoperative ACD was measured and used to predict the postoperative IOL position. Optical biometry and subjective refraction and autorefraction (RM 8800, Topcon) were performed 2 months postoperatively. RESULTS The study comprised 203 eyes of 203 patients. A partial least-square regression model for ACD generated 2 months postoperatively showed that the predictive power of the intraoperative ACD (0.48) was highest followed by the axial eye length (0.45) and then the preoperatively measured ACD (0.30). These findings were confirmed in a bootstrapping model. Regression models combining the preoperative ACD and intraoperative ACD resulted in further significant improvement. CONCLUSIONS Intraoperative ACD measurements predicted the postoperative position of open-loop IOLs and plate-haptic IOLs better than preoperative ACD measurements. Combining preoperative and intraoperative ACD measurements further improved the prediction.
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Affiliation(s)
- Nino Hirnschall
- From the Vienna Institute for Research in Ocular Surgery (Hirnschall, Farrokhi, Amir-Asgari, Hienert, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria; Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Sanaz Farrokhi
- From the Vienna Institute for Research in Ocular Surgery (Hirnschall, Farrokhi, Amir-Asgari, Hienert, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria; Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Sahand Amir-Asgari
- From the Vienna Institute for Research in Ocular Surgery (Hirnschall, Farrokhi, Amir-Asgari, Hienert, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria; Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Julius Hienert
- From the Vienna Institute for Research in Ocular Surgery (Hirnschall, Farrokhi, Amir-Asgari, Hienert, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria; Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom
| | - Oliver Findl
- From the Vienna Institute for Research in Ocular Surgery (Hirnschall, Farrokhi, Amir-Asgari, Hienert, Findl), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria; Moorfields Eye Hospital NHS Foundation Trust (Findl), London, United Kingdom.
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Kam AW, Chen TS, Wang SB, Jain NS, Goh AY, Douglas CP, McKelvie PA, Agar A, Osher RH, Francis IC. Materials in the vitreous demonstrated under the operating microscope during cataract surgery and confirmed histologically. Clin Exp Ophthalmol 2016; 45:206-207. [PMID: 27507551 DOI: 10.1111/ceo.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew W Kam
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | - Tony S Chen
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Neeranjali S Jain
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | - Aaron Yj Goh
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Penny A McKelvie
- The University of Melbourne, Melbourne, Australia.,St Vincent's Hospital, Melbourne, Australia
| | - Ashish Agar
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia
| | | | - Ian C Francis
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia.,The University of New South Wales, Sydney, Australia.,Chatswood Grove Eye Clinic, Ophthalmic Surgery Centre, Chatswood, Australia
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Grzybowski A, Kanclerz P. Materials in the vitreous during standard cataract surgery: concept not verified yet. Clin Exp Ophthalmol 2016; 45:205-206. [PMID: 27507293 DOI: 10.1111/ceo.12817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 07/19/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznan City Hospital, Poznan, Poland.,Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
| | - Piotr Kanclerz
- Department of Ophthalmology, Medical University of Gdańsk, Gdansk, Poland
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