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Pesoa Y, Palevski D, Tiosano A, Erlich R, Schaap Fogler M, Hadayer A, Levy I, Dotan A. Posterior synechia formation after phacovitrectomy - Predicting factors and the role of short-acting mydriatics. Acta Ophthalmol 2024; 102:e352-e357. [PMID: 37681397 DOI: 10.1111/aos.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/03/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE To evaluate the influence of topical short-acting mydriatics on the formation of posterior synechia after phacovitrectomy surgery of pars plana vitrectomy and phacoemulsification with intraocular lens implantation. METHODS A prospective randomised controlled trial. Fifty-seven adult (>18 years old) patients (57 eyes) who underwent phacovitrectomy surgery at a single tertiary hospital, were randomly divided into two groups. The control group (29 eyes) received standard postoperative treatment (topical antibiotics and steroids). The study group (28 eyes) received short-acting mydriatics together with standard therapy. Patients were followed until 24 months after surgery. The primary outcome measure was the formation of posterior synechia during the follow-up period. RESULTS A total of 7 patients developed posterior synechia during the follow-up period (12%), 3 in the study group (11%) and 4 in the control group (14%). There was no statistical difference between the groups. Significant associations for the development of posterior synechia were surgery for retinal detachment, longer surgery duration (>93 min) and the use of tamponade, in particular silicone oil. CONCLUSIONS The use of topical short-acting mydriatic drops after phacovitrectomy surgery, in addition to standard post-operative treatment, did not reduce the formation of posterior synechia. However, we identified several factors that may influence or act as predictors for the development of posterior synechia: surgery for retinal detachment, using silicone oil tamponade and a longer surgery duration. Our findings may aid in the standardisation of post-phacovitrectomy surgery treatment and define potential at-risk patients who should be monitored more closely.
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Affiliation(s)
- Yair Pesoa
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dahlia Palevski
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Tiosano
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rita Erlich
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Schaap Fogler
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Hadayer
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Issac Levy
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Dotan
- Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mogil RS, Ferenchak K, Starr MR. GORE-TEX SUTURE-ASSOCIATED ENDOPHTHALMITIS IN A SCLERAL-SUTURED INTRAOCULAR LENS. Retin Cases Brief Rep 2024; 18:293-295. [PMID: 36603161 DOI: 10.1097/icb.0000000000001400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To describe a unique case of Gore-Tex (Gore Medical, AZ) suture-associated delayed-onset endophthalmitis in a patient with a history of scleromalacia, pathologic myopia, multiple prior vitrectomies in the setting of a scleral-sutured intraocular lens (IOL). METHODS A 69-year-old man complained of blurry vision and eye pain 21 months after implantation of a scleral-sutured IOL and was found to have an exposed Gore-Tex suture with scleromalacia, vision loss to hand motion, a hypopyon, and vitritis. He was diagnosed with culture-positive endophthalmitis. He had a previous history of a rhegmatogenous retinal detachment repair and subsequent dislocated IOL in this eye treated with a scleral-sutured IOL. A vitreous tap and injection of broad-spectrum antibiotics and suture removal at the slit lamp were performed at the time of presentation. One week later, he underwent pars plana vitrectomy and removal of the IOL. RESULTS After the tap and inject and subsequent lens removal, his vision has returned to his preoperative vision of 20/100 with refraction. DISCUSSION Gore-Tex suture is a nonabsorbable and flexible option with great tensile strength that has emerged as a favored alternative to polypropylene for the use in transscleral fixated IOLs. Although endophthalmitis and suture erosion are known complications of this procedure, this report describes one of the first cases of Gore-Tex suture-associated endophthalmitis.
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Affiliation(s)
- Rachel S Mogil
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Tello A, Galvis V. Determination of progressive endothelial cell loss after posterior chamber phakic intraocular lens implantation. Int Ophthalmol 2024; 44:195. [PMID: 38658386 DOI: 10.1007/s10792-024-03124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Comments about endothelial cell loss after posterior chamber phakic intraocular lens are provided, with a particular emphasis on the importance of determining progressive postoperative cell density reduction, excluding that related to surgical trauma.
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Affiliation(s)
- Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Centro Medico Carlos Ardila Lulle, Floor 3, Module 7. Urbanización El Bosque, Floridablanca, Santander, Colombia.
- Ophthalmology Department, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia.
- Ophthalmology Department, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia.
- Surgery Department, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
| | - Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Centro Medico Carlos Ardila Lulle, Floor 3, Module 7. Urbanización El Bosque, Floridablanca, Santander, Colombia
- Ophthalmology Department, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Ophthalmology Department, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
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de Paula A, Gattazzo I, Savini G, Schiano Lomoriello D, Corsi A. An analysis of the factors involved in IOL decentration after phacoemulsification using CASIA 2 anterior segment optical coherence tomography. Int Ophthalmol 2024; 44:194. [PMID: 38656707 DOI: 10.1007/s10792-024-03126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the magnitude of IOL transversal shift (ITS) after phacoemulsification and to analyse the factors contributing to IOL decentration and ITS. METHODS 94 consecutive patients who underwent cataract surgery and IOL implantation was enrolled. Each patient underwent anterior segment optical coherence tomography with CASIA 2 (Tomey, Nagoya, Japan) to assess crystalline lens decentration, thickness and diameter seven days preoperatively and at one and sixty days postoperatively. Univariate and multivariate linear regression analysis were performed to evaluate the determinants of ITS and final decentration. RESULTS The preoperative crystalline lens diameter was associated with the ITS and with the IOL final decentration. A positive association between the final IOL decentration and the first post-surgical day decentration was found (p < 0.0001). CONCLUSION Greater crystalline lens diameter was associated with greater decentration and with greater ITS. Day-one IOL decentration seems to be the main determinant of final IOL decentration.
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Affiliation(s)
- Alessandro de Paula
- Ophthalmology Unit, Policlinico Casilino, Via Casilina, 1049, 00169, Rome, Italy.
| | - Irene Gattazzo
- Ophthalmology Unit, NESMOS Department, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Andrea Corsi
- Ophthalmology Unit, Policlinico Casilino, Via Casilina, 1049, 00169, Rome, Italy
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Son HS, Chang DF, Li C, Liu L, Zafar S, Lum F, Woreta FA. Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2024; 131:403-411. [PMID: 37858872 DOI: 10.1016/j.ophtha.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN Retrospective cohort study. PARTICIPANTS Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES Visual outcomes and postoperative complications after lens exchange. RESULTS A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | | | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Lynn Liu
- American Academy of Ophthalmology, San Francisco, California
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ortega-Usobiaga J, Bilbao-Calabuig R, González-López F, Beltrán-Sanz J, Wang Y, Llovet-Osuna F, Figueroa MS. Phacoemulsification with implantation of a trifocal intraocular lens in eyes with asteroid hyalosis and synchysis scintillans. J Fr Ophtalmol 2024; 47:104105. [PMID: 38428321 DOI: 10.1016/j.jfo.2024.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 03/03/2024]
Abstract
PURPOSE To compare the visual outcomes in both eyes of patients who undergo phacoemulsification and trifocal intraocular lens (IOL) implantation and have asteroid hyalosis (AH) or synchysis scintillans (SS) in only one eye. METHODS A retrospective comparative case series was performed. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction after implantation of the same model of trifocal IOL in both eyes (PhysIOL FineVision Pod-F and Micro-F and Rayner RayOne Trifocal). RESULTS A total of 164 eyes of 82 patients (41 females, 50%) met the inclusion criteria. There were no statistically significant differences in sphere, cylinder, spherical equivalent, UDVA, UIVA, or UNVA between the groups. Postoperative CDVA was slightly better in the control group (logMAR 0.03) than in the AH/SS group (logMAR 0.04) (P: 0.014). There were no statistically significant differences in predictability, safety index, or efficacy index between the groups. Overall subjective satisfaction was good (98.2%). CONCLUSIONS Visual outcomes and satisfaction are good after implantation of trifocal IOLs in eyes with AH or SS. Therefore, trifocal IOLs should not be ruled out in these patients when no other vitreoretinal disorder is present.
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Affiliation(s)
- Julio Ortega-Usobiaga
- Department of Cataract and Refractive Surgery, Clínica Baviera (Aier Eye Hospital Group), 9. 48009 Bilbao, Spain.
| | - Rafael Bilbao-Calabuig
- Department of Cataract and Refractive Surgery, Clínica Baviera (Aier Eye Hospital Group), Madrid, Spain
| | | | - Jaime Beltrán-Sanz
- Department of Research and Development, Clínica Baviera (Aier Eye Hospital Group), Valencia, Spain
| | - Yong Wang
- Aier Eye Hospital Affiliated to Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Fernando Llovet-Osuna
- Department of Cataract and Refractive Surgery, Clínica Baviera (Aier Eye Hospital Group), Madrid, Spain
| | - Marta S Figueroa
- Department of Retina, Clínica Baviera, Madrid, Spain; Department of Opththalmology, Ramon y Cajal Hospital, University of Alcala de Henares, Madrid, Spain
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Zou Q, Zhao S, Cheng L, Song C, Yuan P, Zhu R. Effects of crystalline lens rise and anterior chamber parameters on vault after implantable collamer lens placement. PLoS One 2024; 19:e0296811. [PMID: 38512912 PMCID: PMC10956874 DOI: 10.1371/journal.pone.0296811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/19/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND To analyze vault effects of crystalline lens rise (CLR) and anterior chamber parameters (recorded by Pentacam) in highly myopic patients receiving implantable collamer lenses (ICLs), which may avoid subsequent complications such as glaucoma and cataract caused by the abnormal vault. METHODS We collected clinical data of 137 patients with highly myopic vision, who were all subsequent recipients of V4c ICLs between June 2020 and January 2021. Horizontal ciliary sulcus-to-sulcus diameter (hSTS) and CLR were measured by ultrasonic biomicroscopy (UBM), and a Pentacam anterior segment analyzer was used to measure horizontal white-to-white diameter (hWTW), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), CLR, and postoperative vault (Year 1 and Month 1). The lens thickness (LT) was determined by optical biometry (IOL Master instrument). The predictive model was generated through multiple linear regression analyses of influential factors, such as hSTS, CLR, hWTW, ACD, ACA, ACV, ICL size, and LT. The predictive performance of the multivariate model on vault after ICL was assessed using the receiver operating characteristic (ROC) curve with area under the curve (AUC) as well as the point of tangency. RESULTS Average CLR assessed by UBM was lower than the average value obtained by Pentacam (0.561 vs. 0.683). Bland-Altman analysis showed a good consistency in the two measurement methods and substantial correlation (r = 0.316; P = 0.000). The ROC curve of Model 1 (postoperative Year 1) displayed an AUC of 0.847 (95% confidence interval [CI]: 74.19-95.27), with optimal threshold of 0.581 (sensitivity, 0.857; specificity, 0.724). In addition, respective values for Model 2 (postoperative Month 1) were 0.783 (95% CI: 64.94-91.64) and 0.522 (sensitivity, 0.917; specificity, 0.605). CONCLUSION CLR and anterior chamber parameters are important determinants of postoperative vault after ICL placement. The multivariate regression model we constructed may serve in large part as a predictive gauge, effectively avoid postoperative complication.
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Affiliation(s)
- Quan Zou
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Sen Zhao
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Lei Cheng
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Chao Song
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Ping Yuan
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Ran Zhu
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
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Aljindan M, Albalawi N, Alzaher F, Hariri J, Bin Helayel H, Alsubaie MF, Khan O, Aloqab A, Alarfaj G, Sulaimani NM. Retinal complications post posterior chamber phakic intraocular lens implantation at a tertiary eye hospital in the Eastern Province of Saudi Arabia. Int Ophthalmol 2024; 44:141. [PMID: 38492122 DOI: 10.1007/s10792-024-03076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Phakic intraocular lenses treat higher degrees of myopia not possible previously with conventional refractive surgery. The aim of this study is to report the incidence and risk factors of retinal complications after posterior chamber PIOL implantation and assess the differences in biometric parameters between patients who developed such complications versus those who did not. METHODS This retrospective study recruited 514 patients who underwent ICL implantation to correct myopia at a tertiary eye hospital center in the Eastern province of Saudi Arabia. Follow up period was at least one year. Medical records of the patients were reviewed to obtain the required data. Associations between respondents' characteristics and retinal complications were evaluated using the Chi-squared test. RESULTS The mean (SD) age was 27.7 (± 6.5) years ranging from 18 to 47. Laser treatment was performed in 14 cases (2.7%). Retinal complications occurred in six cases (1.2%). The risk of retinal complication was significantly higher among patients with high axial length (OR = 1.3, 95% CI 1.2, 1.4) and patients with high pre-spherical equivalent before ICL (OR = 1.09, 95% CI 1.03, 1.4). CONCLUSION Patients with higher axial length and higher pre-spherical equivalent before ICL implantation are at high risk of retinal complications.
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Affiliation(s)
- Mohanna Aljindan
- Ophthalmology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Nada Albalawi
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
- Ophthalmology Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Fatimah Alzaher
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Jumana Hariri
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Halah Bin Helayel
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Majed Fehaid Alsubaie
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Omar Khan
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
- Ophthalmology Department, Ohud Hospital, Ministry of Health, Madinah, Saudi Arabia
| | - Aysha Aloqab
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia.
- Ophthalmology Department, Bahrain Defence Force Hospital, Riffa, Bahrain.
| | - Ghufran Alarfaj
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
| | - Naif M Sulaimani
- Ophthalmology Department, Dhahran-Eye-Specialist-Hospital, Al Jamiah, Dhahran, Saudi Arabia
- Dr. Sulaiman Al Habib Hospital, Khobar, Saudi Arabia
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Passo RM, Thanos A. MEMBRANOUS ENCAPSULATION OF AN AKREOS INTRAOCULAR LENS FOLLOWING SCLERAL FIXATION MASQUERADING AS OPACIFICATION. Retin Cases Brief Rep 2024; 18:259-262. [PMID: 36730821 DOI: 10.1097/icb.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 10/25/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To report a case of membranous encapsulation of a scleral-fixated Akreos intraocular lens (IOL) that was successfully treated with vitrectomy and membranectomy without IOL exchange or removal. METHODS Case report. RESULTS A 58-year-old woman with a history of bilateral chronic anterior and intermediate uveitis underwent scleral fixation of Akreos IOL for dislocated 3-piece IOL in the vitreous cavity. She presented one year later with progressively worsening vision (decreased to 20/200) and was found to have a complete encapsulation of the IOL. The patient underwent successful vitrectomy and membranectomy with return of vision to 20/25 within three months of surgery. CONCLUSION There are numerous case reports of opacification after scleral fixation of Akreos IOL. To our knowledge, this is the first report of complete encapsulation of the IOL with a membrane of this type and character. The etiology for this patient's presentation is unclear, but was presumed to be related to her history of chronic intraocular inflammation.
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Affiliation(s)
- Ross M Passo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; and
| | - Aristomenis Thanos
- Department of Vitreo-Retina and Ocular Oncology, Devers Eye Institute, Portland, Oregon
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Reinstein DZ, MacGregor C, Archer TJ, Gupta R, Potter JG. A review of posterior chamber phakic intraocular lenses. Curr Opin Ophthalmol 2024; 35:138-146. [PMID: 38059758 DOI: 10.1097/icu.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Posterior chamber phakic intraocular lenses (pIOLs) are increasing in popularity as a viable alternative to laser refractive surgery. The purpose of this review is to evaluate the recent updates to pIOLs and to assess the advancements and safety of the procedure. RECENT FINDINGS Accurate lens sizing is the key determinant to suitable vault prediction, advancements to sizing formulae including the use of very high frequency (VHF) digital ultrasound and the application of artificial intelligence and machine learning has led to improved vault prediction and safety. The introduction of the central aquaport has been shown to reduce the formation of cataract and is now adopted in most myopic pIOLs. Recently published studies have demonstrated that pIOLs have an excellent safety profile with no increased risk of retinal detachment or endothelial cell loss. Advancements have led to the introduction of extended depth of focus pIOLs for the correction of presbyopia, further research is required to evaluate the efficacy of new lens designs. SUMMARY pIOL surgery is experiencing traction with improved lens design and increased lenses choices such as larger optical zone and presbyopic options. Accuracy of implantable collamer lens sizing is paramount to the safety and clinical outcomes, greater predictability is likely to encourage more posterior chamber pIOL users due to fewer sizing related complications.
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Affiliation(s)
- Dan Z Reinstein
- Reinstein Vision
- London Vision Clinic, EuroEyes Group, London, UK
- Columbia University Medical Center, New York, USA
- Sorbonne Université, Paris, France
- Biomedical Science Research Institute, Ulster University, Coleraine, UK
| | | | - Timothy J Archer
- Reinstein Vision
- London Vision Clinic, EuroEyes Group, London, UK
| | - Ruchi Gupta
- Reinstein Vision
- London Vision Clinic, EuroEyes Group, London, UK
| | - Joseph G Potter
- Reinstein Vision
- London Vision Clinic, EuroEyes Group, London, UK
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Tsui JC, Brucker AJ, Kolomeyer AM. RHEGMATOGENOUS RETINAL DETACHMENT WITH CONCURRENT CHOROIDAL DETACHMENT AND MACULAR HOLE FORMATION AFTER UNCOMPLICATED CATARACT EXTRACTION AND INTRAOCULAR LENS IMPLANTATION: A CASE REPORT AND REVIEW OF LITERATURE. Retin Cases Brief Rep 2024; 18:168-172. [PMID: 36731017 DOI: 10.1097/icb.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe a case of concurrent rhegmatogenous retinal detachment, choroidal detachment, and macular hole (RRD-CD-MH) formation in a patient after uncomplicated cataract extraction and intraocular lens implantation (CEIOL). In addition, we summarize the previously reported cases of RRD-CD-MH in the literature. METHODS Interventional case report and literature review. RESULTS A 71-year-old white man without relevant medical or ocular history underwent an uncomplicated CEIOL. He presented with counting fingers vision and intraocular pressure of 5 mmHg after 3 weeks. On dilated fundus examination, multiple superior tears and total RRD with a serous CD was evident. Intraoperatively, a full-thickness MH was identified. The patient underwent routine RRD and MH repair, with instillation of 1,000 centistoke silicone oil (SiO). The retina successfully re-attached, the CD resolved, and the intraocular pressure normalized; however, the MH did not initially close. The SiO was removed approximately 4 months later and, while the MH remained open, the patient's vision improved to 20/80. Approximately three years after the surgical repair, the MH closed spontaneously, and the vision remained at 20/80. CONCLUSION Our patient developed an RRD-CD-MH after uncomplicated CEIOL. The MH displayed delayed closure. The vision improved after surgical repair, and remained stable in the long term.
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Affiliation(s)
- Jonathan C Tsui
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander J Brucker
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anton M Kolomeyer
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
- NJ Retina (PRISM Vision Group), New Providence, New Jersey
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12
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Pollmann AS, Nguyen MTD, Keyeutat M, Danis É, Durr GM, Agoumi Y, Jabbour S. Refractive outcomes of immediately sequential bilateral cataract surgery in eyes with long and short axial lengths. BMC Ophthalmol 2024; 24:77. [PMID: 38378504 PMCID: PMC10877801 DOI: 10.1186/s12886-024-03347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/22/2024] Open
Abstract
PURPOSE To report the refractive outcomes of long (≥25.00 mm) and short (≤22.00 mm) axial length (AL) eyes undergoing immediately sequential bilateral cataract surgery (ISBCS). METHODS In this retrospective cohort study, patients who underwent ISBCS were identified and eyes of patients with bilateral long and short ALs were included. Pre- and postoperative biometry, autorefraction, and ocular comorbidities or complications were recorded. The primary outcome was the mean refractive prediction error. RESULTS Thirty-seven patients (74 eyes) with long ALs and 18 patients (36 eyes) with short ALs were included. The means ± standard deviations of the ALs were 26.40 ± 1.38 mm and 21.44 ± 0.46 mm in the long and short AL groups, respectively. In long AL eyes, the mean absolute error from the biometry-predicted refraction was - 0.16 ± 0.46 D, corresponding to 74% of eyes achieving a refraction within ±0.50 D of the predicted value. In short AL eyes, the mean absolute error was - 0.63 ± 0.73 D, corresponding to 44% of eyes achieving a refraction within ±0.50 D of the predicted value. Eight (44.4%) patients with short AL eyes had a myopic deviation greater than ±0.50 D from the predicted result in both eyes. CONCLUSIONS Compared to patients with long AL eyes, ISBCS in patients with short ALs had a wider variance in refractive outcome and a lower rate of achieving a postoperative refraction within ±0.50 D of the predicted target.
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Affiliation(s)
- André S Pollmann
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada.
| | - Michael Trong Duc Nguyen
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Milime Keyeutat
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Éliane Danis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Georges M Durr
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Younes Agoumi
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
| | - Samir Jabbour
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 Sanguinet St, Montréal, Quebec, H2X 3E4, Canada
- Department of Ophthalmology, McGill University, Montréal, Canada
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Lee S, Lee G, Park CY. Late spontaneous posterior capsule rupture with single-piece hydrophobic acrylic intraocular lens dislocation. Sci Rep 2024; 14:3368. [PMID: 38336847 PMCID: PMC10858262 DOI: 10.1038/s41598-024-53934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
In this study, we described and discussed the late onset spontaneous posterior capsule rupture with intraocular lens (IOL) dislocation years after uncomplicated cataract surgery and implantation of hydrophobic acrylic IOLs. Eight patients presented with spontaneous posterior capsule rupture and IOL dislocation 5-20 years after uncomplicated phacoemulsification and IOL (AcrySof, Alcon, US) implantation. None of the patients had undergone posterior capsulotomy in the past. Four of the patients admitted habitual eye rubbing. An intact and well-centered continuous curvilinear capsulotomy edge was observed in all cases. IOLs were dislocated or displaced behind the anterior capsulotomy with a significant decrease in vision. A large rupture with a curled edge of the broken posterior capsule was visible. Dislocated IOLs were removed, and a three-piece IOL was inserted in the sulcus in six cases and suture fixated to the sclera in two cases. Improved vision was achieved in all cases. Although the mechanism underlying this late complication is unclear, habitual eye rubbing or IOL design may play a role. Further investigation is needed to prevent this complication in the future.
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Affiliation(s)
- Soomin Lee
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, 410-773, Gyunggido, South Korea
| | - Gahye Lee
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, 410-773, Gyunggido, South Korea
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University, Ilsan Hospital, 814, Siksadong, Ilsan-dong-gu, Goyang, 410-773, Gyunggido, South Korea.
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Du YH, Liang XF, Hirooka K, Xia HK, Jia ZY. A potential role for inflammatory cytokines in a rare late-onset capsular block syndrome: a case report. BMC Ophthalmol 2024; 24:53. [PMID: 38308223 PMCID: PMC10835890 DOI: 10.1186/s12886-024-03320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/22/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Late-onset capsule block syndrome (CBS) is a rare complication of cataract phacoemulsification and the implantation of a posterior chamber intraocular lens (PCIOL), which manifests six months to years after surgery. The hallmark of CBS is the formation of an opaque liquid substance between the implanted intraocular lens (IOL) and the posterior capsule. However, its pathogenesis remains unclear. CASE PRESENTATION A 64-year-old female patient with chronic angle-closure glaucoma (axis length < 21 mm) underwent trabeculectomy surgery combined with phacoemulsification and PCIOL. After a 4-year follow-up, a decline in visual acuity occurred in her right eye due to the location of opaque fluid in the visual axis and distension of the capsular bag. The initial course of action was to release the trapped fluid. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy could not be employed due to her non-dilating pupil and high extension of the posterior capsule. Subsequently, anterior capsule peeling and anterior segment vitrectomy surgery were performed. The depth of the anterior chamber (ACD), the distance between the face of the retro-IOL and the posterior capsule, the best-corrected visual acuity (BCVA), and the visual quality (VQ) were measured both before and after surgery. Inflammatory cytokine levels in the opaque substances (OS) trapped between the PCIOL and the posterior capsule were assessed using a flow cytometer and compared to normal statistical data in aqueous humor. After surgery, the patient experienced a significant improvement in BCVA and VQ. The distance between the face of the retro-IOL and the posterior capsule was on the verge of disappearing. However, ACD did not differ between pre- and post-operatively. Interleukin-8 (IL-8) and basic fibroblast growth factor (BFGF) concentrations were higher in the OS than in aqueous humor, especially in the former. However, the concentration of vascular cell adhesion molecule (VCAM) in the OS was lower than in aqueous humor. CONCLUSIONS Anterior segment vitrectomy surgery proved to be a successful treatment for late-onset CBS, presenting a challenging case. In the human lens, inflammatory cytokines originating from the opaque substances may contribute to abnormal metabolism in the sealed area, a consequence of late-onset CBS.
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Affiliation(s)
- Ying-Hua Du
- Department of Ophthalmology, Beijing TianTan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China.
| | - Xiao-Fang Liang
- Department of Ophthalmology, Beijing TianTan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, 100070, Beijing, China
| | - Kazuyuki Hirooka
- Department of Ophthalmology, Hiroshima University Hospital (Medical), Hiroshima, Japan
| | - Hui-Ka Xia
- Department of Ophthalmology, Hebei General Hospital, 050051, Shijiazhuang, China
| | - Zhi-Yang Jia
- Department of Ophthalmology, Hebei General Hospital, 050051, Shijiazhuang, China
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Álvarez-García MT, Rivera-Ruiz E, Alió JL, Piñero DP. Long-term Prevalence of Opacification of a Hydrophylic Acrylic Rotationally Asymmetric Refractive Multifocal Intraocular Lens. J Refract Surg 2024; 40:e98-e107. [PMID: 38346118 DOI: 10.3928/1081597x-20240115-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE To determine the prevalence of opacification of a hydrophylic intraocular lens (IOL) with hydrophobic coverage and the percentage of explantations required, determining possible risk factors associated with these opacifications. METHODS This ambispective study enrolled 575 eyes of 296 patients (age 36 to 87 years) that underwent cataract surgery between 2010 and 2017 with implantation of different models of Lentis Mplus IOLs: LS-312-MF30, LS-313-MF15, LS-313-MF30, LU-313-MF30, and LU-313-MF30T (Oculentis GmbH). Visual, refractive, and slit-lamp biomicroscopic changes were evaluated in a long-term follow-up. The percentage of cases with IOL opacification and the percentage of cases in which IOL explantation was required due to such opacifications were calculated at each visit. Five of the explanted IOLs from this series could be analyzed by scanning electron microscopy (SEM-EDX). RESULTS IOL opacification developed in 63 eyes (11.0%). With 95% confidence, the prevalence of IOL opacification was between 842 and 1,401 cases per 10,000 eyes. The time elapsed between surgery and the presence of IOL opacification ranged between 0 and 9.3 years (mean: 4.7 ± 2.2 years). No significant differences in terms of IOL opacification rate were found according to gender (P = .378). No significant differences were found in arterial hypertension, diabetes, hypothyroidism, or hyperthyroidism rates between eyes with or without IOL opacification (P ≥ .053). IOL explantation was needed in 9 eyes (1.57%). SEM-EDX analysis confirmed the presence of rough areas on the IOL surface containing different components, such as calcium, phosphorous, copper, or nitrogen. CONCLUSIONS The prevalence of opacification with time in Lentis Mplus IOLs is high, with no systemic risk factors associated with this complication, suggesting that it may be attributable to the material and/or the manufacturing process. [J Refract Surg. 2024;40(2):e98-e107.].
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Hu JY, Ti SE, Chee SP. Risk factors affecting visual outcomes following dropped nucleus after cataract surgery. Eye (Lond) 2024; 38:253-258. [PMID: 37542173 PMCID: PMC10810779 DOI: 10.1038/s41433-023-02668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/03/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND/ AIMS To describe the visual outcomes in eyes with dropped nucleus during phacoemulsification surgery. SETTING Singapore National Eye Centre (SNEC). DESIGN Retrospective chart review of prospectively reported cases of dropped nucleus. METHODS The clinical charts of all cases of dropped nucleus (Jan 2001 to Dec 2016) were retrospectively reviewed for patient demographics, surgeon type, stage of surgery, timing of pars plana vitrectomy (PPV), and complications. Visual success was defined as best corrected visual acuity (BCVA) ≥ 20/40 at last review. Final risk factors affecting visual success were identified using multivariate logistic regression analysis. RESULTS Incidence of dropped nucleus following cataract surgery was 0.17% (n = 292). Duration of follow-up was 25.5 months (mean), 18.5 months (median). There was a statistically significant difference in dropped nucleus rate between Residents (0.3%) and Faculty (0.14%) (x2 = 38.2, P < 0.001), but ensuing major complications rates were similar. PPV was performed in 251 eyes (87.2%). At final examination, 202 cases (85.2%) achieved BCVA 20/40 or better, after excluding patients with co-existing ocular pathology. Timing of vitrectomy (delayed vs same-day) did not influence the final visual success (x2 = 0.969, p = 0.51). Risk factors for poor visual outcomes included age >70 years, absence of intraocular lens (IOL) implant, and presence of major complications. CONCLUSION Overall incidence of dropped nucleus in SNEC was 0.17%, with BCVA of 20/40 or better in 85.2% cases. Visual prognosis was influenced by patient's age, presence of IOL implant or additional major complications.
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Affiliation(s)
- Jeremy Youwei Hu
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent Singapore, 119260, Singapore, Singapore
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, 11 Mandalay Rd, Singapore, 308232, Singapore
| | - Seng-Ei Ti
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent Singapore, 119260, Singapore, Singapore
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Soon-Phaik Chee
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Kent Ridge Crescent Singapore, 119260, Singapore, Singapore.
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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Ben Addou Idrissi S, Bengebara O, Filali Sadouk M, Himmich M, Lahlou L, El Ouazzani Taybi H, Moutei H, Bennis A, Chraibi F, Abdellaoui M, Benatiya Andaloussi I. Comparison of pars plana vitrectomy and combined pars plana vitrectomy with phacoemulsification for proliferative diabetic retinopathy: A retrospective study about 120 eyes. Indian J Ophthalmol 2024; 72:S287-S292. [PMID: 38271425 DOI: 10.4103/ijo.ijo_1976_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To compare the outcomes of pars plana vitrectomy (PPV) and combined PPV with phacoemulsification (PPVCE) surgeries for proliferative diabetic retinopathy (PDR) and cataract treatment. METHODS Retrospective analysis of 120 diabetic patients who underwent PPV or PPVCE. RESULTS The key outcome indicators were best-corrected visual acuity (BCVA) and post-operative complications. The PPVCE group had an average age of 53 years, with 50% females and 50% males. The initial visual acuity (VA) was 1.84 log MAR. In this group, BCVA remained stable or increased in 61 eyes (74%). Regarding the PPV group, the average age was 43 years; 65% were men while 34% were women. The initial VA was 1.83 log MAR; in this group, the VA increased or remained stable in 28 eyes (73%). The evolution of the VA was rather symmetric in the two groups without a significant difference (P = 0.9). Similarly, the occurrence of postoperative complications was comparable for the main complications studied, namely the inflammatory reaction (P = 0.809), ocular hypertension (P = 0.344), corneal edema (P = 0.07), and neovascular glaucoma (P = 0.413). However, there was a decrease in BCVA (three lines) in the PPV group after 6 months of follow-up (P = 0.05) in patients with a clear lens preoperatively and who developed a clinically evident cataract. CONCLUSION According to this study, for diabetic patients with severe cataracts and vitreoretinal disease requiring vitrectomy, combining vitrectomy with phacoemulsification as a single surgical intervention may be a suitable therapeutic choice. This approach does not significantly increase the risk of visual impairment or retinopathy development.
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Affiliation(s)
- Sara Ben Addou Idrissi
- Department of Ophthalmology, Omar Drissi Hospital, Faculty of Medicine, Pharmacy and Dental Medicine, FEZ, Morocco
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Holland E, Karpecki P, Fingeret M, Schaeffer J, Gupta P, Fram N, Smits G, Ignacio T, Lindstrom R. Efficacy and Safety of CSF-1 (0.4% Pilocarpine Hydrochloride) in Presbyopia: Pooled Results of the NEAR Phase 3 Randomized, Clinical Trials. Clin Ther 2024; 46:104-113. [PMID: 38216351 DOI: 10.1016/j.clinthera.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE This study was undertaken to evaluate the safety and efficacy of CSF-1 (0.4% pilocarpine hydrochloride ophthalmic solution) for use in individuals with presbyopia. METHODS Two Phase 3 multicenter, randomized, double-masked, vehicle-controlled, parallel-group clinical trials were conducted in 35 private ophthalmology clinics in the United States from October 2020 to February 2022. Key inclusion criteria were the following: (1) age 45-64 years, (2) distance-corrected near visual acuity (DCNVA) at 40 cm ≥0.40 and ≤0.90 logarithm of the minimum angle of resolution (logMAR, approximately 20/50-20/160 Snellen) in at least 1 eye, (3) manifest refraction (MR) between -4.50 and +2.00 diopter (D) sphere in each eye with ≤2.00D difference between eyes, (4) <2.00D of cylinder MR in each eye, (5) ≤0.04 logMAR (20/20-2 or better) corrected distance visual acuity (CDVA) at 4 m in each eye. Key exclusion criteria were the following: (1) >0.14 logMAR (7 letters) improvement in post-vehicle treatment in monocular DCNVA in either eye at visit 1, (2) introcular pressure (IOP) <9 or >22 mm Hg, (3) average dark-adapted pupillometry <3.5 mm in either eye, (4) prior refractive surgery or intraocular lens (IOL) implantation. Participants applied CSF-1 or vehicle twice per day for 2 weeks. Efficacy and safety assessments were performed at several times on days 1, 8, and 15. Response was defined as ≥3-line gain in DCNVA without loss of ≥1-line in CDVA in the study eye under mesopic room lighting conditions. The primary efficacy endpoint was measured 1 hour post-dose 1 on day 8. Key secondary endpoints were 2 hours post-dose 1, and 1 and 2 hours post-dose 2, also on day 8. Safety endpoints were ocular and non-ocular treatment-related adverse events (TRAE), conjunctival redness, drop comfort, slit-lamp biomicroscopy, intraocular pressure, indirect fundoscopy, and CDVA at 4 m. FINDINGS Six hundred thirteen participants were randomized to CSF-1 (n = 309) or vehicle (n = 304). Participants were predominantly White (80.8%) and female (62.0%), with mean age (standard deviation) of 54.7 (4.8). CSF-1 met the primary and key secondary endpoints. At the primary endpoint, 40.1% of the CSF-1 group achieved response versus 19.1% of the vehicle group (P < 0.0001). The percentage of responders was significantly greater in CSF-1 compared with vehicle at all tested times. Changes from baseline in all safety endpoints were comparable between groups. Most adverse events (AEs) were mild and transient. Neither serious nor severe AEs were reported with CSF-1. IMPLICATIONS CSF-1, a low-dose pilocarpine ophthalmic solution, demonstrated superiority to vehicle in improving near vision in individuals with presbyopia without compromising distance vision. CSF-1 demonstrated a favorable safety profile. CLINICALTRIALS gov identifier: NCT04599933 (NEAR-1), NCT04599972 (NEAR-2).
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Affiliation(s)
| | - Paul Karpecki
- The Kentucky College of Optometry, University of Pikeville, KY
| | - Murray Fingeret
- Department of Veterans Administration New York Harbor Health Care System, New York, NY
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Abstract
PURPOSE The purpose of this study was to describe two cases of traumatic lens subluxation resulting from pickleball injury. METHODS This is a case series. RESULTS A 77-year-old man presented with worsening vision and was noted to have subluxation of his intraocular lens 10 days after being struck in the eye with a pickleball. The patient underwent a lens exchange with scleral fixation. A 76-year-old woman presented with blurry vision on the same day as her injury and was noted to have subluxation of her crystalline lens. She also underwent a lens insertion with scleral fixation. However, she experienced additional complications of postoperative cystoid macular edema and traumatic glaucoma. CONCLUSION We recommend increased use of eye protection in pickleball.
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Affiliation(s)
- Harrison Huang
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Lee Y, Kim JS, Kim BG, Hwang JH, Kang MJ, Lee JH. Comparison of the Incidence of Nd:YAG Laser Capsulotomy Based on the Type of Intraocular Lens. Medicina (Kaunas) 2023; 59:2173. [PMID: 38138276 PMCID: PMC10744545 DOI: 10.3390/medicina59122173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Posterior capsular opacification (PCO) is the most common long-term complication of successful cataract surgery and can cause visual impairment. We aimed to investigate the effects of intraocular lens (IOL) characteristics on PCO by comparing the incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for different types of intraocular lenses. Materials and Methods: A retrospective analysis was performed on 2866 eyes that underwent cataract surgery between January 2010 and December 2017, with at least 5 years of follow-up. The IOLs used for surgery were the hydrophobic lenses SN60WF (Alcon, Fort Worth, TX, USA), ZCB00 (Johnson & Johnson Vision, Santa Ana, CA, USA), and MX60 (Bausch & Lomb, Rochester, NY, USA), and the hydrophilic lens MI60 (Bausch & Lomb, Rochester, NY, USA). We analyzed the incidence of Nd:YAG laser capsulotomy according to the type of IOL used. Results: The incidence of Nd:YAG laser capsulotomy was significantly higher with MI60 lenses (31.70%, 175/552 eyes) compared to SN60WF (7.90%, 113/1431 eyes), ZCB00 (10.06%, 64/636 eyes), and MX60 (10.57%, 13/123 eyes; p < 0.001) lenses. The incidence of Nd:YAG laser capsulotomy was significantly lower with the hydrophobic IOLs (8.68%, 190/2190 eyes) than with the hydrophilic IOL (31.70%, 175/552 eyes; p < 0.001). Over time, the rate of increase in the cumulative number of Nd:YAG laser capsulotomy cases was the highest with MI60. The cumulative rate of Nd:YAG laser capsulotomy during the first 3 years was 4.90% with SN60WF (70/1431 eyes), 6.76% with ZCB00 (43/636 eyes), 8.94% with MX60 (11/123 eyes), and 26.10% with MI60 (144/552 eyes) lenses. Conclusions: The incidence of PCO is influenced by the material of the IOLs. The hydrophilic IOL was associated with a higher rate of Nd:YAG laser capsulotomy than the hydrophobic IOLs, with a shorter time to Nd:YAG laser capsulotomy.
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Affiliation(s)
| | | | | | | | | | - Jee Hye Lee
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea; (Y.L.); (J.S.K.); (B.G.K.); (J.H.H.); (M.J.K.)
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Oshika T, Endo T, Kurosaka D, Matsuki N, Miyagi M, Mori T, Nagamoto T, Negishi K, Nishina S, Nomura K, Unoki N, Yoshida S. Long-term surgical outcomes of pediatric cataract-multivariate analysis of prognostic factors. Sci Rep 2023; 13:21645. [PMID: 38062153 PMCID: PMC10703864 DOI: 10.1038/s41598-023-49166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
We assessed the 10-year postoperative outcomes of pediatric cataract patients who underwent surgery at the age of 6 years or younger. A retrospective review of medical charts was conducted for 457 eyes of 277 patients, with the age at surgery averaging 1.3 ± 1.5 years (mean ± SD) and the follow-up duration averaging 12.8 ± 2.4 years (ranging from 10 to 17 years). The cohort included 250 eyes of 125 cases with bilateral aphakia (age at surgery 0.5 ± 0.8 years), 110 eyes of 55 cases with bilateral pseudophakia (1.9 ± 1.6 years), 42 cases with unilateral aphakia (1.1 ± 1.3 years), and 55 cases with unilateral pseudophakia (2.6 ± 1.7). A forward stepwise multiple regression analysis revealed that the best-corrected visual acuity at the final visit was significantly associated with laterality of cataract (with bilateral cases showing better results compared to unilateral cases), presence of systemic comorbidities, presence of ocular comorbidities, development of glaucoma, and phakic status (with better results in the pseudophakia group than the aphakia group). The age at surgery did not significantly affect visual acuity outcomes. A multiple logistic regression analysis demonstrated that the incidence of secondary glaucoma was significantly linked to younger age at surgery, phakic status (higher in aphakic than pseudophakic eyes), and presence of systemic comorbidities. In conclusion, after pediatric cataract surgery, final visual acuity was better in patients with bilateral cataracts, those treated with an intraocular lens, and cases without systemic or ocular comorbidities and secondary glaucoma. The development of secondary glaucoma was linked to younger age at surgery, aphakic status, and presence of systemic comorbidities.
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Affiliation(s)
- Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Takao Endo
- Osaka Women's and Children's Hospital, Osaka, Japan
| | - Daijiro Kurosaka
- Department of Ophthalmology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Naoko Matsuki
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mai Miyagi
- Aichi Children's Health and Medical Center, Aichi, Japan
| | - Takafumi Mori
- Department of Ophthalmology, Fukushima Medical University, Fukushima, Japan
| | | | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Sachiko Nishina
- National Center for Child Health and Development, Tokyo, Japan
| | - Koji Nomura
- Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | | | - Shigeo Yoshida
- Department of Ophthalmology, Kurume University School of Medicine, Fukuoka, Japan
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Cornée C, Weber M, Clément M. [Opacification of the FIL-SSF Carlevale intraocular lens: Report of two cases]. J Fr Ophtalmol 2023; 46:e350-e351. [PMID: 37652790 DOI: 10.1016/j.jfo.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 02/18/2023] [Accepted: 03/04/2023] [Indexed: 09/02/2023]
Affiliation(s)
- C Cornée
- Service d'ophtalmologie, centre hospitalier Loire Vendée Océan, 20, boulevard Guérin, 85300 Challans, France; Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - M Weber
- Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - M Clément
- Service d'ophtalmologie, centre hospitalier Loire Vendée Océan, 20, boulevard Guérin, 85300 Challans, France; Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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23
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Xie X, Zhang J, Han X, Chen X, Qiu X, Huang R, Huang Y, Ye J, Wen L, Tan X, Luo L, Liu Y. Is Astigmatism Correction Necessary for Patients With Cataract Who Have Corneal Astigmatism of Less Than 0.75 D? J Refract Surg 2023; 39:850-855. [PMID: 38063827 DOI: 10.3928/1081597x-20231106-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE To investigate the proportion of patients with predicted refractive astigmatism (PRA) of 0.75 diopters (D) or greater and associated risk factors among cataract surgery candidates with low corneal astigmatism. METHODS A retrospective cross-sectional study was conducted in Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract who had preoperative simulated keratometric astigmatism of less than 0.75 D were recruited. The PRA was calculated by Barrett toric calculator using posterior corneal astigmatism (PCA) measured by the IOLMaster 700 (Carl Zeiss Meditec AG) and corneal surgically induced astigmatism (SIA). Two corneal incision locations (temporal [0°/180°], 135° incision) and varying magnitudes (0.10 to 0.60 D) were considered for SIA. Multiple logistic regression analysis was used to explore risk factors associated with PRA of 0.75 D or greater and build predictive model. Sensitivity analysis was performed using PRA threshold of 0.50 D. RESULTS A total of 1,750 eyes from 1,750 patients were included (mean age: 60.14 ± 13.24 years, 42.91% male, 1,010 right eyes and 740 left eyes). The 135° incision (odds ratio [OR]: 17.86) and against-the-rule (ATR) astigmatism (OR: 37.55) are the major risk factors for PRA of 0.75 D or greater. Higher simulated keratometric astigmatism (OR: 2.03), larger PCA (OR: 1.64), and surgically induced astigmatism (OR: 1.29) also significantly increased the risk of PRA of 0.75 D or greater. Nomogram model were constructed with an area under curve of 0.90. CONCLUSIONS For patients with corneal astigmatism of less than 0.75 D, temporal incision and measured PCA is preferred. Those patients with ATR astigmatism should be considered for astigmatism correction when using a 135° incision. [J Refract Surg. 2023;39(12):850-855.].
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Jevnikar K, Počkar S, Umek L, Rothova A, Valentincic NV. Prognostic factors of cataract surgery in patients with uveitis. Int Ophthalmol 2023; 43:4605-4612. [PMID: 37697081 PMCID: PMC10724088 DOI: 10.1007/s10792-023-02860-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/20/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To evaluate the long-term visual outcomes of patients with uveitis undergoing cataract surgery and to identify possible factors influencing the visual prognosis and the development of postoperative complications. METHODS Retrospective study of all patients with uveitis who underwent cataract surgery between January 2015 and February 2020 in our tertiary referral center. RESULTS A total of 78 eyes from 78 patients were included in the study. The best-corrected visual acuity (BCVA) improved in 86% of patients, and a BCVA of 0.5 or better was achieved in 57 (73%) patients. A significant correlation was shown between the preoperative and postoperative BCVA (Spearman r = 0.521, p < 0.01). Final BCVA differed between diverse anatomical uveitis entities (p = 0.047), and anterior uveitis demonstrated the best outcomes. Chronic uveitis resulted in a worse final BCVA than acute recurrent uveitis (p = 0.001). The presence of CME any time before the surgery and intermediate uveitis were associated with worse visual prognosis, while systemic therapy for uveitis before surgery and iris manipulation during surgery were not related to visual outcomes. Postoperative development of cystoid macular edema (CME) was closely associated with preexisting CME (p < 0.001) and intermediate uveitis (p = 0.01). CONCLUSIONS Visual results of cataract surgery in patients with uveitis were beneficial, but limited visual outcomes were more frequently observed in patients with chronic uveitis and intermediate uveitis with a history of CME. In consequence, prevention, or adequate treatment of CME, especially in patients with intermediate uveitis, might result in better visual results of their cataract surgery.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Saša Počkar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lan Umek
- Faculty of Public Administration, University of Ljubljana, Ljubljana, Slovenia
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasa Vidovic Valentincic
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Hložánek M, Cilečková L, Alió JL, Autrata R, Zelenayová N, Komínek M, Cendelín J, Mahelková G. Risk of visual axis opacification in infants with and without primary IOL implantation after congenital cataract surgery performed during the first 4 months of age. Graefes Arch Clin Exp Ophthalmol 2023; 261:3643-3649. [PMID: 37329362 PMCID: PMC10667373 DOI: 10.1007/s00417-023-06143-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE The study evaluates the rate of postoperative formation of a pupillary membrane (PM) and posterior visual axis opacification (PVAO) in infants with and without primary IOL implantation during the first 4 months of infancy. METHODS Medical records for 144 eyes (101 infants) operated between 2005 and 2014 were evaluated. A posterior capsulectomy and anterior vitrectomy were performed. Primary IOL implantation was performed in 68 eyes, while 76 eyes were left aphakic. There were 16 bilateral cases in the pseudophakic group and 27 in the aphakic group. The follow-up period was 54.3 ± 21.05 months and 49.1 ± 18.60 months, respectively. Fisher's exact test was used for statistical analysis. The two-sample t-test with equal variance was used to compare surgery age, follow-up period and time intervals of complications. RESULTS The mean age of surgery was 2.1 ± 0.85 months in the pseudophakic and 2.2 ± 1.01 months in the aphakic group. PM was diagnosed in 40% pseudophakic and 7% aphakic eyes. A second surgery for PVAO was performed in 72% pseudophakic and 16% aphakic eyes. Both were significantly higher in the pseudophakic group. In the pseudophakic group, the number of PVAO was significantly higher in infants operated before 8 weeks of age compared to surgery age 9-16 weeks. The frequency of PM was not age-dependent. CONCLUSION Although it remains feasible to implant an IOL during the primary surgery, even in very young infants, there should always be solid arguments for this decision since it puts the child at higher risk of repeated surgeries under general anaesthesia.
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Affiliation(s)
- Martin Hložánek
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic.
| | - Lenka Cilečková
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic
| | - Jorge L Alió
- Department of Pathology and Surgery (Ophthalmology), Faculty of Medicine, University Miguel Hernandez, Avenida de la Universidad, s/n, 03202 Elche, Alicante, Spain
- Vissum Miranza Instituto Oftalmologico de Alicante, C/Cabañal, 1, 03016, Alicante, Spain
| | - Rudolf Autrata
- Department of Paediatric Ophthalmology, Faculty of Medicine, Masaryk University and University Hospital Brno, Černopolní 9, 62500, Brno, Czech Republic
| | - Nina Zelenayová
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic
| | - Martin Komínek
- Department of Paediatric Ophthalmology, Faculty of Medicine, Masaryk University and University Hospital Brno, Černopolní 9, 62500, Brno, Czech Republic
| | - Jiří Cendelín
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic
| | - Gabriela Mahelková
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic
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Zheng H, Tan Q, Zhou S, Luo W, Ortega-Usobiaga J, Wang L, Wang Y. The tolerance of refractive errors of extended depth of focus intraocular lens in patients with previous corneal refractive surgery. Int Ophthalmol 2023; 43:3989-3997. [PMID: 37458945 DOI: 10.1007/s10792-023-02802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/23/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To evaluate the tolerance for refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia. METHODS Patients from Aier Eye Hospital of Wuhan University with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed. RESULTS At the final visit, UDVA, CDVA, UIVA, and UNVA (LogMAR) were 0.06 ± 0.09, 0.01 ± 0.06, 0.11 ± 0.08, 0.20 ± 0.10, respectively. The mean spherical equivalent (SE) was - 0.57 ± 0.58D, sphere and cylinder were - 0.24 ± 0.60D, - 0.70 ± 0.58D respectively. No statistical difference in UDVA between eyes with SE in ± 0.50 D and in ± 1.0 D (p > 0.05). Corneal astigmatism > 1.00D has no significant effect on postoperative visual acuity (p > 0.05). The defocus curve showed that visual acuity could reach 0.2 in the refractive range of + 0.50D ~ - 1.50D. SR and MTF values were all higher than before the surgery. In bilateral implantation patients, the VF-14-CN questionnaire score and visual quality were quite excellent. CONCLUSION The EDOF IOL have a certain tolerance for refractive errors and corneal astigmatism, and it's recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.
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Affiliation(s)
- Hansong Zheng
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hostital)), Wuhan, People's Republic of China
| | - Qian Tan
- Aier School of Ophthalmology, Central South University, Changsha, People's Republic of China
| | - Suowang Zhou
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hostital)), Wuhan, People's Republic of China
| | - Wenjing Luo
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hostital)), Wuhan, People's Republic of China
| | - Julio Ortega-Usobiaga
- Clinica Baviera, (AIER Eye Hospital Group), Calle Ibañez de Bilbao, 9, Bilbao, Spain
| | - Li Wang
- The Department of Ophthalmology, Baylor College of Medicine, Cullen Eye Institute, Texas Medical Center, Houston, TX, USA
| | - Yong Wang
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hostital)), Wuhan, People's Republic of China.
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Dericioğlu V, Sevik MO, Bağatur Vurgun E, Çerman E. Predictive Factors of Complications and Visual Outcomes after Pediatric Cataract Surgery: A Single Referral Center Study from Türkiye. Turk J Ophthalmol 2023; 53:267-274. [PMID: 37867431 PMCID: PMC10599340 DOI: 10.4274/tjo.galenos.2023.50951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/26/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To evaluate the predictive factors of complications and visual acuity outcomes in pediatric cataract patients. Materials and Methods This retrospective, observational clinical study included 80 eyes of 50 patients treated for pediatric cataracts between 2010 and 2020. The eyes were divided into Group I (congenital cataracts, n=38) and Group II (developmental cataracts, n=42). Group II was also divided into Group IIA (aphakic, n=21) and Group IIB (pseudophakic, n=21). The effects of the age, laterality, cataract morphology, intraocular lens implantation, preoperative nystagmus/strabismus, and intraoperative anterior hyaloid rupture on complications and final best-corrected visual acuity (BCVA; logMAR) were evaluated. Results The median (interquartile range) age and follow-up time were 28 (5-79) months and 60 (29-84) months, respectively. There was a significant difference in mean final BCVA between Group I (0.79±0.46) and Group II (0.57±0.51) (p=0.047); however, no difference was observed between Group IIA and Group IIB (p=0.541). Having congenital cataract (p=0.045), preoperative nystagmus/strabismus (p=0.042), total/mature cataract (p<0.001), and postoperative complications (p=0.07) were significantly associated with final BCVA. However, in multivariate analysis, only total/mature cataract (β: 0.52, p<0.001) and having any complication (β: 0.24, p=0.018) were associated with final BCVA. Congenital cataract and intraoperative anterior hyaloid rupture were the only significant risk factors of postoperative complications on univariate (p=0.027 and p=0.003, respectively) and binary logistic regression analysis (odds ratio [OR]: 2.95 [95% confidence interval: 1.07-8.15], p=0.036 and OR: 4.28 [95% confidence interval: 1.55-11.77], p=0.005, respectively). Conclusion Total/mature cataract and the presence of any postoperative complication adversely affected the final BCVA. Having a congenital cataract and intraoperative anterior hyaloid membrane rupture increased the risk of complications.
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Affiliation(s)
- Volkan Dericioğlu
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Mehmet Orkun Sevik
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Elif Bağatur Vurgun
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
| | - Eren Çerman
- Marmara University Faculty of Medicine, Department of Ophthalmology, İstanbul, Türkiye
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Huang H, Yan J, Li B, Huang M, Guo S, Fan A, Liu W. Tear Film Stability Affects Visual Acuity After Implantations of Monofocal and Multifocal Intraocular Lenses: An Evaluation by Objective Scatter Index. Transl Vis Sci Technol 2023; 12:15. [PMID: 37847201 PMCID: PMC10584023 DOI: 10.1167/tvst.12.10.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
Purpose To assess the impact of tear film on postoperative visual acuity after cataract surgery to implant an intraocular lens (IOL). Methods Tear break-up time (TBUT), Schirmer I test, objective scatter index (OSI), and uncorrected distance visual acuity (UCDVA), intermediate visual acuity (UCIVA), and near visual acuity (UCNVA) were collected 6 months after cataract surgery. Results Fifteen eyes with monofocal (Mo-) IOLs and 15 eyes with multifocal (Mu-) IOLs from 30 subjects were included. The Mu-IOL group exhibited higher baseline OSI (1.92 ± 0.69, P < 0.001). Negative correlations-both groups: tear film-related OSI (TF-OSI) and TBUT/Schirmer I test; Mo-IOL: TBUT and logMAR UCDVA-and positive correlations-both groups: TF-OSI and baseline OSI, baseline OSI/TF-OSI and logMAR UCDVA; Mu-IOL: baseline OSI/TF-OSI and logMAR UCIVA/UCNVA-were found. Linear regression showed associations between TF-OSI and TBUT (Mo-IOL: R2 = 0.455, P = 0.006; Mu-IOL: R2 = 0.454, P = 0.006)/Schirmer I test (Mo-IOL: R2 = 0.527, P = 0.002; Mu-IOL: R2 = 0.266, P = 0.049). Multiple regression showed associations between baseline OSI (Mo-IOL: R2 = 0.309, P = 0.032; Mu-IOL: R2 = 0.305, P = 0.033)/TF-OSI (Mo-IOL: R2 = 0.332, P = 0.025; Mu-IOL: R2 = 0.523, P = 0.002)/TBUT (Mo-IOL only: R2 = 0.315, P = 0.029) and logMAR UCDVA. Conclusions TF-OSI reflects the UCDVA performance in eyes with IOLs and facilitates a better understanding of the effects of the tear film. Translational Relevance TF-OSI offers a developmental and objective approach to assessing the changing visual performance caused by tear film after cataract surgery and IOL implantation in clinical practices.
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Affiliation(s)
- Hao Huang
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
- 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
| | - Jianjun Yan
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
| | - Bowen Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, China
| | - Mansha Huang
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, China
| | - Shuanglin Guo
- 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
| | - Aifang Fan
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
| | - Wei Liu
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, China
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Borkenstein AF, Borkenstein EM. Clinical Performance of New Enhanced Monofocal Intraocular Lenses: Comparison of Hydrophobic C-loop and Hydrophilic Plate-Haptic Platform. Adv Ther 2023; 40:4561-4573. [PMID: 37584899 PMCID: PMC10499736 DOI: 10.1007/s12325-023-02635-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Enhanced monofocal intraocular lenses (IOLs) represent a new type of lens, which should lead to a very good distance vision similar to monofocal IOLs and an improved intermediate vision without increasing the risk for photic phenomena. METHODS The aim of this clinical observation/registry study was to directly compare two different IOL platforms (hydrophilic acrylic L-333 (group A) vs hydrophobic acrylic AN6Q (group B)) with the same enhanced monofocal optic principle but different material and haptic design in clinical routine. A total of 102 cataract cases (51:51) were included in the study. Groups A and B were similar regarding demographics, age (71.6 ± 9 years for L-333 and 73.6 ± 8 years for AN6Q) and their calculated IOL power (20.9 ± 2.0 D for L-333 and 21.5 ± 3.4 D for AN6Q). Spherical equivalent (SE), (un)corrected distance, intermediate visual acuity, the surgeons' experience and patient feedback were assessed postoperatively. RESULTS SE improved significantly in the AN6Q group, while the L-333 group showed a slightly smaller standard deviation postoperatively. In group A the uncorrected distance visual acuity (UDVA) improved from pre-op (0.43 ± 0.16 logMAR) to 1 month post-op (0.06 ± 0.04 logMAR) significantly and in group B from pre-op (0.54 ± 0.19 logMAR) to (0.05 ± 0.06 logMAR) postoperatively. Both groups showed excellent outcomes for distance without negative side effects. On testing uncorrected intermediate vision (80 cm) with Radner charts, 80% reached line 5 (0.0 logRAD) with fewer than one mistake and 10% reached line 4 (- 0.1 logRAD) in group A; 74% reached line 5 with fewer than one mistake and 4% reached line 4 in group B. CONCLUSION Both IOL models (groups A and B) provided satisfying results regarding implantation behaviour, refractive error, visual acuity and overall patient satisfaction. The haptic design might influence the outcome of refractive error. Long-term follow-up data should be considered in multicentre studies to further characterize both platforms and to optimize IOL power calculation (constants, surgeon factor). It was shown that the enhanced monofocal optic can provide good visual acuity for far distance and improve intermediate distance. This type of new monofocal optic design, which however must be strictly separated from typical refractive/diffractive multifocal, presbyopia-correcting lenses, could be a good option in standard cataract care.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein & Borkenstein Private Practice, Privatklinik Der Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria.
| | - Eva-Maria Borkenstein
- Borkenstein & Borkenstein Private Practice, Privatklinik Der Kreuzschwestern Graz, Kreuzgasse 35, 8010, Graz, Austria
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Christopher KL, Patnaik JL, Penland KJ, Pantcheva MB, Lynch AM, Ifantides C. Outcomes and Risk Factors for Complications in Cataract Patients with Hepatitis C Virus Infection. Ophthalmic Epidemiol 2023; 30:492-498. [PMID: 36196031 DOI: 10.1080/09286586.2022.2131836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE To describe outcomes of patients with hepatitis C virus (HCV) seropositivity undergoing cataract surgery, as well as investigate risk factors for surgical complications. METHODS This is a retrospective cohort study of all consecutive patients who underwent cataract surgery at a tertiary care hospital in the United States between 2014 and 2019. The exposure of interest was HCV seropositivity and outcomes included surgical complications and associated risk factors, visual acuity, and post-operative complications. RESULTS A total of 11,276 eyes of 6,858 patients were included in the study, of which 122 patients (1.78%) and 210 eyes (1.86%) were HCV positive. Average age at surgery was 63.4 (8.4) years for HCV positive patients and 69.1 (10.6) years for HCV negative patients. Patients with HCV were more likely to suffer a complication during cataract surgery, 2.9% versus 1.2% (OR 2.27, 95% CI 1.03 to 5.01, p = .0415). Postoperative best corrected visual acuity was excellent: median and range 0.00 (-0.13, 3.00) logMAR for HCV positive eyes versus 0.00 (-0.30, 3.00) logMAR for HCV negative eyes. Among HCV positive patients, elevated alanine transaminase (>52 U/L) was associated with a higher intraoperative complication rate (10.0% vs 1.8%, OR 5.53, 95% CI 1.05 to 29.2, p = .044). CONCLUSION While patients with HCV are more likely to have complications during cataract surgery, final best corrected visual acuity was excellent regardless of HCV status. Patients with HCV are more likely to undergo cataract surgery at a younger age, and those with elevated alanine transaminase are at highest risk for complications.
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Affiliation(s)
- Karen L Christopher
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, United States
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, United States
| | - Kylie J Penland
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, United States
| | - Mina B Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, United States
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, United States
| | - Cristos Ifantides
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, United States
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Rodríguez-Calvo-de-Mora M, Rocha-de-Lossada C, Rodríguez-Vallejo M, Zamora-de-la-Cruz D, Fernández J. Retinal detachment after refractive lens exchange: A narrative review. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:507-520. [PMID: 37364678 DOI: 10.1016/j.oftale.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
Refractive lens exchange (RLE) allows to correct ametropias and presbyopia by replacing the crystalline lens with an extended depth of focus or multifocal intraocular lens (IOL). Retinal detachment (RD) is one of the most serious adverse events after RLE. This study aimed to review the evidence related to the risk of RD after RLE and clinical outcomes. A search using PubMed and a snowball search approach was conducted to identify articles and case reports. According to the literature, the risks of RD should be considered in patients <60 years old with axial lengths >23 mm. Only nine articles reported visual acuity (VA) after RD in RLE, and only 25% of eyes had a VA > 20/40. Considering that the decrease in VA might be uniform for all types of IOLs after RD, surgeons should focus on selecting the patient to prevent RD rather than on a particular IOL optical design based on the potential risk of DR.
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Affiliation(s)
- M Rodríguez-Calvo-de-Mora
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain; Departamento de Oftalmología, VITHAS Málaga, Málaga, Spain; Departamento de Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain.
| | - C Rocha-de-Lossada
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain; Departamento de Oftalmología, VITHAS Málaga, Málaga, Spain; Departamento de Oftalmología, Hospital Regional Universitario Málaga, Málaga, Spain; Departamento de Cirugía, Área de Oftalmología, Universidad de Sevilla, Sevilla, Spain
| | - M Rodríguez-Vallejo
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain
| | - D Zamora-de-la-Cruz
- Departamento de Segmento Anterior, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico; Departamento de Segmento Anterior, Hospital Mexiquense de Salud Visual, ISEM, Naucalpan de Juárez, Mexico
| | - J Fernández
- Qvision, Departamento de Oftalmología, VITHAS Almería Hospital, Almería, Spain
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32
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Giannaccare G, Nadeem S, Vaccaro S, Scorcia V. Spontaneous intraocular lens extrusion through Gundersen conjunctival graft after multiple failed keratoplasties: A report of two cases. Eur J Ophthalmol 2023; 33:NP79-NP82. [PMID: 36305034 DOI: 10.1177/11206721221136433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To report the occurrence and the outcomes of 2 cases of spontaneous extrusion of 3-piece intraocular lens (IOL) through a Gundersen conjunctival flap performed for tectonic purposes after multiple failed penetrating keratoplasties (PKs). METHODS A 70-year-old woman (Patient #1) with severe dry eye disease who had undergone cataract surgery with posterior chamber 3-piece IOL implantation, multiple PKs and Gundersen conjunctival flap in her left eye presented with partial extrusion of the optic and the inferior haptic of the IOL through the conjunctival flap. Inferior symblepharon and keratinization of the entire ocular surface were also present. A 64-year-old diabetic man (Patient #2) with history of cataract surgery with a posterior chamber IOL implantation, multiple PKs for keratoconus and Gunderson conjunctival flap in his right eye presented with partial extrusion of IOL optic through the conjunctival flap. RESULTS Patient #1 refused a further surgery and IOL was removed at the slit lamp. Currently, 3 months after IOL extrusion, corneal perforation self-sealed, visual acuity of light perception is maintained, and the patient does not complain any symptoms of ocular discomfort or pain. In Patient #2, tectonic PK combined with IOL removal and anterior vitrectomy was performed. Currently, 1 month postoperatively corneal graft is clear, intraocular pressure is normal, and patient's vision is counting fingers. CONCLUSIONS In both cases, IOL extrusion occurred spontaneously through a Gunderson conjunctival flap. Including the underlying Tenon's capsule in the conjunctival graft could increase its tectonic support, potentially avoiding this complication.
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Affiliation(s)
| | - Sana Nadeem
- Department of Ophthalmology, Foundation University Medical College & Fauji Foundation Hospital, Islamabad, Pakistan
| | - Sabrina Vaccaro
- Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy
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33
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Ma M, Xiao Q, Wang A, Zheng Z. A posterior chamber phakic refractive lens dislocated into the vitreous. Eur J Ophthalmol 2023; 33:NP21-NP24. [PMID: 36314418 DOI: 10.1177/11206721221135911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
SIGNIFICANCE We present a unique cause for zonular dehiscence, which provides a pathway for subsequent dislocation of an implanted phakic refractive lens (PRL) into the vitreous cavity. PURPOSE To determine the cause of zonular dehiscence and to avoid similar complications after PRL implantation in the future. CASE REPORT A 37-year-old highly myopic patient with refraction of -24.0 DS in both eyes received PRL implantation in both eyes. In the 14-month postoperative follow-up, it was found that the PRL dislocated into the vitreous cavity. The patient then underwent phacoemulsification and vitrectomy. The patient was treated successfully. No ocular complication was found. The visual acuity of the left eye was 20/40, two weeks after surgery. CONCLUSIONS We report a unique cause for zonular dehiscence, and the clarification of its detailed characteristics may contribute to prevention of such a complication in the future.
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Affiliation(s)
- Mingming Ma
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
| | - Qirui Xiao
- Shanghai Bright Eye Hospital, Shanghai, China
| | - Aijun Wang
- Shanghai Bright Eye Hospital, Shanghai, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai engineering center for precise diagnosis and treatment of eye diseases, Shanghai, China
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34
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Coco G, Ferrara M, Borgia A, Romano D, Romano V. Carlevale intraocular lens opacification after Descemet stripping automated endothelial keratoplasty. Eur J Ophthalmol 2023; 33:NP60-NP62. [PMID: 36163691 DOI: 10.1177/11206721221128669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case of sutureless scleral-fixated (SSF) Carlevale intraocular lens (IOL) opacification following Descemet stripping automated endothelial keratoplasty (DSAEK) surgery. METHODS An 82-year-old man underwent combined SSF Carlevale IOL implant and DSAEK surgery for aphakic endothelial decompensation. Surgery was uneventful, while the postoperative period was complicated by multiple graft detachments requiring re-bubbling. After four re-bubbling procedures, the corneal graft attached and cleared over time. RESULTS 29 months after combined SSF IOL implant and DSAEK surgery, the patient presented with decreased vision due to IOL opacification affecting the visual axis. CONCLUSION Although combined SSF IOL and DSAEK surgery is an overall safe and effective procedure for aphakic endothelial decompensation, risk of IOL opacification due to anterior chamber air injection is higher when using hydrophilic IOLs and in cases requiring multiple re-bubbling, therefore, intraocular lens material should be chosen after considering the risks and benefits.
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Affiliation(s)
- Giulia Coco
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mariantonia Ferrara
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | - Alfredo Borgia
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Davide Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
| | - Vito Romano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic, University of Brescia, Viale Europa 15, 25123 Brescia, Italy
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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35
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Yen KG, Repka MX, Sutherland DR, Haider KM, Hatt SR, Kraker RT, Galvin JA, Li Z, Cotter SA, Holmes JM. Complications Occurring Through 5 Years Following Primary Intraocular Lens Implantation for Pediatric Cataract. JAMA Ophthalmol 2023; 141:705-714. [PMID: 37347490 PMCID: PMC10288374 DOI: 10.1001/jamaophthalmol.2023.2335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/20/2023] [Indexed: 06/23/2023]
Abstract
Importance Lensectomy with primary intraocular lens (IOL) implantation is often used in the management of nontraumatic pediatric cataract, but long-term data evaluating the association of age and IOL location with the incidence of complications are limited. Objective To describe the incidence of complications and additional eye surgeries through 5 years following pediatric lensectomy with primary IOL implantation and association with age at surgery and IOL location. Design, Setting, and Participants This prospective cohort study used Pediatric Eye Disease Investigator Group cataract registry data from 61 institution- and community-based practices over 3 years (June 2012 to July 2015). Participants were children younger than 13 years without baseline glaucoma who had primary IOL implantation (345 bilateral and 264 unilateral) for nontraumatic cataract. Data analysis was performed between September 2021 and January 2023. Exposures Lensectomy with primary IOL implantation. Main Outcome and Measures Five-year cumulative incidence of complications by age at surgery (<2 years, 2 to <4 years, 4 to <7 years, and 7 to <13 years) and by IOL location (sulcus vs capsular bag) were estimated using Cox proportional hazards models. Results The cohort included 609 eyes from 491 children (mean [SD] age, 5.6 [3.3] years; 261 [53%] male and 230 [47%] female). Following cataract extraction with primary IOL implantation, a frequent complication was surgery for visual axis opacification (VAO) (cumulative incidence, 32%; 95% CI, 27%-36%). Cumulative incidence was lower with anterior vitrectomy at the time of IOL placement (12%; 95% CI, 8%-16%) vs without (58%; 95% CI, 50%-65%), and the risk of undergoing surgery for VAO was associated with not performing anterior vitrectomy (hazard ratio [HR], 6.19; 95% CI, 3.70-10.34; P < .001). After adjusting for anterior vitrectomy at lens surgery, there were no differences in incidence of surgery for VAO by age at surgery (<2 years, HR, 1.35 [95% CI, 0.63-2.87], 2 to <4 years, HR, 0.86 [95% CI, 0.44-1.68], 4 to <7 years, HR, 1.06 [95% CI, 0.72-1.56]; P = .74) or by capsular bag vs sulcus IOL fixation (HR, 1.22; 95% CI, 0.36-4.17; P = .75). Cumulative incidence of glaucoma plus glaucoma suspect by 5 years was 7% (95% CI, 4%-9%), which did not differ by age after controlling for IOL location and laterality. Conclusions and Relevance In this cohort study, a frequent complication following pediatric lensectomy with primary IOL was surgery for VAO, which was associated with primary anterior vitrectomy not being performed but was not associated with age at surgery or IOL location. The risk of glaucoma development across all ages at surgery suggests a need for long-term monitoring.
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Affiliation(s)
| | | | | | | | | | | | - Jennifer A. Galvin
- Eye Physicians & Surgeons, Milford, Connecticut
- Yale School of Medicine, New Haven, Connecticut
| | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | - Susan A. Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, Fullerton
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Zhang D, Liu Z, Cai H, Wang H, Chen X, Zhang C. Rotating the Intraocular Lens to Prevent Posterior Capsular Opacification in Cataract Surgeries. J Vis Exp 2023. [PMID: 37486122 DOI: 10.3791/65419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Posterior capsule opacification (PCO) is a common postoperative complication of extracapsular cataract surgery, which is caused by the proliferation and migration of lens epithelial cells and can affect long-term visual outcomes significantly. The most effective treatment for PCO is neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy; however, this treatment is associated with posterior segment complication and can break the stability of capsular bag, affecting the position and function of trifocal or toric intraocular lenses (IOLs). Advances in surgical procedures, IOL design, and pharmacy have reduced the rate of PCO in recent years, concentrating on the inhibition of proliferative lens epithelial cells (LECs). This protocol aimed to clear LECs more thoroughly during phacoemulsification and IOL implantation. The first several steps, including clear corneal incision, continuous circular capsulorhexis, hydrodissection, hydrodelineation, and phacoemulsification, were completed as conventional procedures. After placing the IOL into the capsular bag, rotation of the IOL by at least 360° was performed using an irrigation/aspiration tip or a hook, with slight stress on the posterior capsule. Some residuals occurred in the originally transparent capsular bag after rotation of the IOLs. Then, these materials and the viscoelastic were cleared completely using an irrigation/aspiration system. A clear posterior capsule was observed after the surgery in patients undergoing this method. This method of rotating IOLs is a simple, effective, and safe way to prevent PCO by clearing residual LECs and can be carried out without extra tools or skills.
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Affiliation(s)
- Di Zhang
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital
| | - Ziyuan Liu
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital
| | - Hongyuan Cai
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital
| | - Haikun Wang
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital
| | - Xiaoyong Chen
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital;
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital; Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital
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Nuijts RM, Bhatt U, Nanavaty MA, Roberts TV, Peterson R, Teus MA. Three-year multinational clinical study on an aspheric hydrophobic acrylic intraocular lens. J Cataract Refract Surg 2023; 49:672-678. [PMID: 36848238 PMCID: PMC10284131 DOI: 10.1097/j.jcrs.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/23/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To present the results of a study investigating the 3-year effectiveness and safety of the Clareon single-piece intraocular lens (IOL). SETTING 19 multinational sites. DESIGN Prospective multicenter single-arm study. METHODS Patients were bilaterally implanted with Clareon IOLs. Assessments included uncorrected distance visual acuity, corrected distance visual acuity (CDVA), manifest refraction, tilt, decentration, applanation tonometry, and fundus examination, including glistenings and posterior capsule opacification (PCO) evaluation. The primary outcomes for effectiveness and safety were evaluated at 1 year and compared with ISO historical safety and performance endpoint (SPE) rates. Patients were followed for up to 3 years after implantation. RESULTS 424 eyes of 215 patients were implanted (n = 215 first eye, n = 209 second eye), and 183 patients completed the trial at 3 years (with 364 binocular and 1 monocular patient). At 1 year, the cumulative and persistent adverse event rates were below SPE targets, and 99.5% of eyes achieved a monocular CDVA of ≤0.3 logMAR (vs the SPE target of 92.5%). At 3 years, the mean monocular CDVA was -0.032, with 93.4% (341/365) of eyes achieving a CDVA of 0.1 logMAR or better, 100% of eyes presented with grade 0 glistenings ≤25 MV/mm 2 , and 92.9% of eyes (394/424) had either no PCO or clinically nonsignificant PCO. CONCLUSIONS This study supports the long-term safety and effectiveness of the Clareon IOL. The visual outcomes were excellent and stable over the 3-year study period, PCO rates were very low, and 100% of IOLs had grade 0 glistenings.
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Affiliation(s)
- Rudy M.M.A. Nuijts
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Uday Bhatt
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Mayank A. Nanavaty
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Timothy V. Roberts
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Rachael Peterson
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
| | - Miguel A. Teus
- From the University Eye Clinic, Maastricht University Medical Center, Maastricht, the Netherlands (Nuijts); Vision Eye Institute, Melbourne, Victoria, Australia (Bhatt); Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom (Nanavaty); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (Roberts); Vision Eye Institute, Sydney, New South Wales, Australia (Roberts); Alcon Laboratories LLC, Fort Worth, Texas (Peterson); Hospital Universitario Principe de Asturias, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain (Teus)
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Donachie PHJ, Barnes BL, Olaitan M, Sparrow JM, Buchan JC. The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 9, Risk factors for posterior capsule opacification. Eye (Lond) 2023; 37:1633-1639. [PMID: 36002508 PMCID: PMC10219961 DOI: 10.1038/s41433-022-02204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Posterior Capsule Opacification (PCO) is the most common long-term post-operative adverse occurrence after cataract surgery often requiring treatment with YAG laser posterior capsulotomy. This study aimed to identify potential risk factors, known at the time of cataract surgery, that influence the development of PCO. SUBJECT/METHODS A retrospective study of publicly funded cataract surgery from The Royal College of Ophthalmologists' National Ophthalmology Database. Eligible for analysis were 500,872 cataract operations performed in 41 participating centres. RESULTS The 500,872 operations were performed on 243,167 (48.5%) left eyes and 257,705 (51.5%) right eyes from 373,579 patients by 2196 surgeons. Post-cataract PCO was recorded for 61,778 (12.3%) eyes and the six month, one, three, five and nine year observed rates of PCO were 2.3%, 4.4%, 19.7%, 34.0% and 46.9% respectively. Different PCO profiles were observed between IOL materials and the identified risk factors that increased the risk of developing PCO included hydrophilic IOL material, axial length >26 mm, the presence of high myopia and implantation of lower IOL powers and previous vitrectomy surgery, along with younger age and female gender. CONCLUSIONS Many factors influence the development of PCO relating to the patient, the eye, the lens and the surgery. Some factors are modifiable such as IOL material, therefore the opportunity exists to attempt to reduce PCO rates, benefitting patients and the UK NHS.
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Affiliation(s)
- Paul H J Donachie
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK
| | - Beth L Barnes
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK
| | - Martina Olaitan
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK
| | - John M Sparrow
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK
| | - John C Buchan
- The Royal College of Ophthalmologists' National Ophthalmology Audit, 18 Stephenson Way, London, NW1 2HD, UK.
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
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39
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Hecht I, Kanclerz P, Achiron A, Elbaz U, Tuuminen R. The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Glaucoma. J Glaucoma 2023; 32:451-457. [PMID: 37054398 DOI: 10.1097/ijg.0000000000002220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023]
Abstract
PRCIS Among patients who underwent uneventful cataract surgery, an advantage was seen to blue-light filtering (BLF) intraocular lenses (IOLs) in terms of glaucoma-free survival and glaucoma procedure-free survival. Among patients with preexisting glaucoma, no advantage was seen. PURPOSE To assess the effect of BLF IOLs on the development and progression of glaucoma after cataract surgery. PATIENTS AND METHODS A retrospective cohort study of patients who underwent uneventful cataract surgery between 2007 and 2018 at Kymenlaakso Central Hospital, Finland. Survival analyses for the overall risk of developing glaucoma or undergoing glaucoma procedures were assessed between patients who received a BLF IOL (SN60WF) and a non-BLF IOL (ZA9003 and ZCB00). A separate analysis was performed on patients with preexisting glaucoma. RESULTS Included 11,028 eyes of 11,028 patients with a mean age of 75 ± 9 years (62% females). The BLF IOL was used in 5188 eyes (47%) and the non-BLF IOL in 5840 eyes (53%). During the follow-up (mean: 55 ± 34 mo), 316 cases of glaucoma were diagnosed. Glaucoma-free survival rates showed an advantage to the BLF IOL ( P = 0.036). In a Cox regression analysis controlling for age and sex the use of a BLF IOL was again associated with a lower ratio of glaucoma development (hazard ratio:0.778; 95% CI: 0.621-0.975). Furthermore, glaucoma procedure-free survival analysis revealed an advantage to the BLF IOL (hazard ratio:0.616; 95% CI: 0.406-0.935). Among 662 cases, which already had glaucoma at the time of surgery, no significant differences were seen in any outcome. CONCLUSIONS Among a large cohort of patients who underwent cataract surgery, the use of BLF IOLs was associated with favorable glaucoma outcomes compared with the use of non-BLF IOLs. Among patients with preexisting glaucoma, no significant advantage was seen.
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Affiliation(s)
- Idan Hecht
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Sackler School of Medicine, Tel Aviv University
- Department of Ophthalmology, Shamir Medical Center
| | - Piotr Kanclerz
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Hygeia Clinic, Gdańsk, Poland
| | - Asaf Achiron
- Sackler School of Medicine, Tel Aviv University
- Tel Aviv Sourasky Medical Center, Tel Aviv
| | - Uri Elbaz
- Sackler School of Medicine, Tel Aviv University
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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Funarunart P, Treesit I. Pseudophakic pupillary block after reverse sulcus intraocular lens implantation: A case report. Medicine (Baltimore) 2023; 102:e33496. [PMID: 37058055 PMCID: PMC10101256 DOI: 10.1097/md.0000000000033496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Reverse sulcus intraocular lens (IOL) implantation can cause serious ophthalmic complications. Even routine ocular examinations can provoke significant consequences. Herein, we present a case of recurrent pupillary capture and pseudophakic pupillary block related to reverse sulcus IOL implantation. CASE REPORT A 44-year-old man developed a pseudophakic pupillary block after pupil dilation aimed at relieving pupillary capture in an undetected reverse position of the sulcus IOL. The pupillary block was successfully treated with 2% pilocarpine and laser peripheral iridotomywas performed to prevent recurrence. The patient experienced recurrent pupillary capture with decreased vision in the affected eye. IOL exchange was the definite treatment resulting in improved vision and proper positioning of the IOL. CONCLUSIONS AND IMPORTANCE When the reverse position of sulcus IOL is detected postoperatively, prophylactic laser peripheral iridotomy should be considered to prevent pupillary block particularly when pupillary capture is present. Pharmacologic pupillary dilation should be performed cautiously. Recurrent pupillary capture is possible and IOL repositioning should be considered to prevent further complications.
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Affiliation(s)
- Panrapee Funarunart
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Isaraporn Treesit
- Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
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Eggermont RL, Witteman AM, van Erkelens JA, Vermeulen K, Vunderink L, Reus NJ. Nd:YAG laser capsulotomy rates in the Netherlands: practice variation and association with physician practice styles. J Cataract Refract Surg 2023; 49:373-377. [PMID: 36729037 DOI: 10.1097/j.jcrs.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/06/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine the practice variation in the rate of Nd:YAG laser capsulotomy within 1 year after cataract surgery and to identify possible associations with physician practice styles. SETTING All hospitals and private clinics in the Netherlands. DESIGN Retrospective observational study. METHODS In the national medical claims database, we identified all laser capsulotomies performed in the Netherlands within a year after cataract surgery in the years 2016 and 2017. Centers with the lowest and highest percentages of Nd:YAG laser capsulotomies were interviewed on their physician practice styles related to the development of posterior capsule opacification. RESULTS The incidence of Nd:YAG laser capsulotomy varied between 1.2% and 26.0% in 2016 (median 5.0%) and between 0.9% and 22.7% in 2017 (median 5.0%). The rate of capsulotomy was highly consistent over time for each center (Pearson correlation coefficient, 0.89, P < .001). In general, ophthalmology centers with a high rate of Nd:YAG laser capsulotomy more often did not (routinely) polish the posterior lens capsule, performed cortex removal with coaxial irrigation/aspiration (I/A, instead of bimanual), and more often used hydrophilic intraocular lenses (IOLs) (compared with only using hydrophobic IOLs). CONCLUSIONS We found a significant practice variation in performing Nd:YAG laser capsulotomy within 1 year after cataract surgery in the Netherlands. Routinely polishing the posterior capsule, using bimanual I/A, and the use of hydrophobic IOLs are associated with a lower incidence in Nd:YAG laser capsulotomy. Incorporating these practice styles may lower the practice variation and thus prevent added medical burden for the patient and decrease costs.
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Affiliation(s)
- Rogier L Eggermont
- From the Department of Ophthalmology, Amphia Hospital, Breda, the Netherlands (Eggermont, Reus); Department of Ophthalmology, The Rotterdam Eye Hospital, Rotterdam, the Netherlands (Eggermont); Department of Medical Advice, VGZ Health Insurance Company, Eindhoven, the Netherlands (Witteman); Vektis, Zeist, the Netherlands (van Erkelens); Department of Innovation and Advice, CZ, Health Insurance Company, Tilburg, the Netherlands (Vermeulen); Zorgverzekeraars Nederland, Zeist, the Netherlands (Vunderink)
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Arrevola-Velasco L, Beltrán J, Rumbo A, Nieto R, Druchkiv V, Martínez de la Casa JM, Ruiz-Moreno JM. Ten-year prevalence of rhegmatogenous retinal detachment in myopic eyes after posterior chamber phakic implantable collamer lens. J Cataract Refract Surg 2023; 49:272-277. [PMID: 36730449 DOI: 10.1097/j.jcrs.0000000000001099] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/13/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine and compare the prevalence of rhegmatogenous retinal detachment (RRD) in myopic eyes operated of posterior chamber phakic implantable collamer lens (ICL) with a control group of nonoperated myopic eyes over 10 years of follow-up. SETTING Clinica Baviera, Madrid, Spain. DESIGN Retrospective cohort study. METHODS There were 2 study cohorts: one with patients operated with ICL and a control group of nonoperated patients. The primary outcome of RRD was measured retrospectively, first through chart review of ICL-operated patients with at least 10 years of follow-up, then secondarily through telephone questionnaires and specialist verification for those with incomplete follow-up. Prevalence and incidence were calculated and compared, as well as their possible association with other risk factors. RESULTS 58 operated patients completed follow-up in our clinic. A survey of 3849 more patients was conducted for a total of 252 operated with a mean spherical equivalent (SEQ) of -12.6 diopters (D) and 221 nonoperated with a mean SEQ of -10.5 D. 7 eyes developed an RRD in the operated vs 5 eyes among the nonoperated (prevalence 1.71% vs 1.25%, respectively, P = .773). The equivalence tests, the two one-sided test and the null hypothesis test between groups, were within the 0.02 limits, confirming the null hypothesis, and compared survival curves did not show significant differences ( P = .59). CONCLUSIONS ICL implantation surgery for high myopia did not affect the prevalence of RRD in operated eyes compared with similar nonoperated eyes, in this long-term study.
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Affiliation(s)
- Luis Arrevola-Velasco
- From the Clínica Baviera, Madrid, Spain (Arrevola-Velasco); Clínica Baviera, Valencia, Spain (Beltrán, Rumbo, Nieto, Druchkiv); Hospital Universitario Clínico San Carlos, Madrid, Spain (Martínez de la Casa); Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain (Ruiz-Moreno)
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Kim TY, Moon IH, Park SE, Ji YW, Lee HK. Long-Term Follow-Up of Corneal Endothelial Cell Changes After Iris-Fixated Phakic Intraocular Lens Explantation. Cornea 2023; 42:150-155. [PMID: 35120351 DOI: 10.1097/ico.0000000000003001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/28/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate long-term corneal endothelial cell changes and visual outcomes after iris-fixated phakic intraocular lens (pIOL) explantation in patients with endothelial damage and to investigate potential predictors of endothelial injury. METHODS Consecutive patients undergoing pIOL explantation with corneal endothelial cell density (ECD) <2000 cells/mm 2 at the time of the procedure were retrospectively reviewed in a single tertiary center. All patients were treated between April 2016 and October 2020 at a high-volume referral-based tertiary hospital. The primary outcome was the change in corneal endothelial parameters, including ECD, over long-term follow-up. Secondary outcomes included changes in corrected distance visual acuity and analysis of prognostic factors. RESULTS This study included 44 eyes from 28 patients with an average age of 42.5 ± 7.8 years (range: 27-63). Mean ECD before explantation was 1375.4 ± 468.2 cells/mm 2 (range: 622-1996), and the average duration of follow-up after explantation was 20.5 months (6-58.2). Two years after explantation, ECD had significantly decreased by more than 25% to 1019.6 ± 368.6 (608-1689; P < 0.01). However, there was no significant change in corrected distance visual acuity (20/23-20/22, P = 0.59). Longer operation duration (odds ratio, 1.004; P = 0.04) was the only significant factor weakly associated with postoperative decreases in ECD. CONCLUSIONS Although ECD continuously decreased despite pIOL explantation on a long-term follow-up, patients did not experience any discomfort or showed decreases in visual acuity. Therefore, a careful follow-up is required for possible endothelial injury after pIOL explantation.
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Affiliation(s)
- Tae Young Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Hee Moon
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Eun Park
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Woo Ji
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea; and
| | - Hyung Keun Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- College of Pharmacy, Yonsei University, Incheon, Korea
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Barcala X, Zaytouny A, Rego-Lorca D, Sanchez-Quiros J, Sanchez-Jean R, Martinez-de-la-Casa JM, Dorronsoro C, Marcos S. Visual simulations of presbyopic corrections through cataract opacification. J Cataract Refract Surg 2023; 49:34-43. [PMID: 35971215 PMCID: PMC9794132 DOI: 10.1097/j.jcrs.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To study the viability of visual simulation of presbyopic correction in patients with cataract and the effect and impact of the cataract on the perceived visual quality of the different simulated presbyopic corrections preoperatively and postoperatively. SETTING San Carlos Clinical Hospital, Madrid, Spain. DESIGN Observational, noninterventional, pilot study, early feasibility of the device being studied. METHODS Cataract patients were tested preoperatively (n = 24) and postoperatively (n = 15) after bilateral implantation of monofocal intraocular lenses (IOLs). The degree of cataract was evaluated objectively with the objective scatter index (OSI). Visual acuity (VA) and perceived visual quality of natural scene images (Multifocal Acceptance Score) were measured before and after cataract surgery at far (4 m), intermediate (64 cm) and near distance (40 cm) with 4 binocular presbyopic corrections (single vision, bifocal, monovision and modified-monovision) simulated with a binocular Simultaneous Vision simulator based on temporal multiplexing. RESULTS VA was significantly correlated with OSI ( r = -0.71, P < .0005), although the visual degradation at far for each correction was constant and not correlated with OSI. The visual benefit at near distance provided by the presbyopic correction was noticeable (23.3% ± 27.6% across corrections) for OSI <5. The individual perceptual scores were highly correlated preoperatively vs postoperatively ( r = 0.64, P < .0005) for all corrections and distances. CONCLUSIONS Visual simulations of IOLs are an excellent tool to explore prospective postoperative vision. The high correlation in the perceptual scores pre- and post-cataract surgery demonstrates that SimVis Gekko can be used in cataractous patients to guide the selection of the optimal correction for a patient.
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Affiliation(s)
- Xoana Barcala
- From the Institute of Optics, Spanish National Research Council, IO-CSIC, Madrid, Spain (Barcala, Zaytouny, Dorronsoro, Marcos); 2EyesVision SL, Madrid, Spain (Barcala, Dorronsoro); Servicio de Oftalmología, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Spain (Rego-Lorca, Sanchez-Quiros, Sanchez-Jean, Martinez-de-la-Casa); Center for Visual Science, The Institute of Optics, Flaum Eye Institute, University of Rochester, Rochester, New York (Marcos)
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Popov I, Juhas J, Kopálová K, Krásnik V. CHANGE OF SURGICALLY INDUCED CORNEAL ASTIGMATISM AND POSITION OF ARTIFICIAL INTRAOCULAR LENS OVER TIME. Cesk Slov Oftalmol 2023; 79:88-93. [PMID: 37072256 DOI: 10.31348/2023/14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
AIMS To analyze changes in surgically induced corneal astigmatism and articial intraocular lens (IOL) stability over time following cataract surgery. To compare the interchangeability of measurements between an automatic keratorefractometer (AKRM) and a biometer. MATERIAL AND METHODS In this prospective observational study, the above-mentioned parameters were collected from 25 eyes (25 subjects) on the first day, first week, first and third month after uncomplicated cataract surgery. We used IOL-induced astigmatism (difference between refractometry and keratometry) as an indirect indicator of IOL stability change. We used the Blant-Altman method to analyze consistency between devices. RESULTS At the above time points, surgically induced astigmatism (SIA) decreased as follows: 0.65 D; 0.62 D; 0.60 D and 0.41 D (in the first day, week, month and third month respectively). Astigmatism induced by changes of the position of the IOL varied as follows: 0.88 D; 0.59 D; 0.44 D and 0.49 D. Changes in both parameters were statistically significant (p0.05). CONCLUSION Both surgically induced astigmatism and astigmatism induced by IOL decreased over time, in which both changes were statistically significant. The decrease in SIA was most pronounced between the first and third month after surgery. For IOL-induced astigmatism, the greatest decrease was within the first month after surgery. The differences in measurement between the biometer and AKRM were statistically insignificant, but the clinical interchangeability between the given methods is questionable, especially with regard to measurement of the astigmatism angle.
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Meng B, Li S, Wang K, Huang Y, Wang Y, Zhao L. Systematic review of the efficacy and safety of stage I or II IOL implantation in patients with diabetic retinopathy. Medicine (Baltimore) 2022; 101:e32406. [PMID: 36595831 PMCID: PMC9794241 DOI: 10.1097/md.0000000000032406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intraocular lens (IOL) implantation is required after vitrectomy combined with cataract surgery in diabetic retinopathy patients. However, the question of whether an IOL should be implanted in stage I after vitrectomy or stage II during silicone oil filling has been controversial, and there has been no systematic review of this clinical issue. METHODS WanFang, SinoMed CNKI, VIP, PubMed, Embase, and Cochrane Library databases were systematically searched for relevant studies. The deadline was May 8, 2021. All studies of stage I or II IOL implantation in patients with diabetes who underwent vitrectomy were included. Revman 5.3 software was used for the meta-analysis. RESULTS Four studies, involving 253 eyes, were included. This study analyzed the literature with a common outcome index by meta-analysis and systematically evaluated the literature without a common outcome index. Four studies compared the efficacy and safety of the 2 sequential surgical methods in patients with diabetic retinopathy. The results of the meta-analysis showed that there was no significant difference in the efficacy and safety of stage II IOL implantation when compared with stage I IOL implantation (P > .05). One study showed that stage II cataract surgery with oil extraction resulted in better postoperative visual acuity and fewer complications than stage I cataract surgery with vitrectomy. One study showed that stage II IOL implantation during oil extraction had better postoperative visual acuity than stage I IOL implantation during vitrectomy without increasing surgical complications. CONCLUSION Vitrectomy combined with stage II IOL implantation is safer and more effective than stage I in patients with diabetic retinopathy; however, more clinical studies are needed to verify this.
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Affiliation(s)
- Bo Meng
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuang Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kang Wang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yingxiang Huang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanling Wang
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lu Zhao
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
- * Correspondence: Lu Zhao, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing 100050, China (e-mail: )
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Yee C, Joye AS, Nanji AA, Chamberlain WD. Cyclodialysis Cleft After Secondary Intraocular Lens Placement With Yamane Technique. Cornea 2022; 41:1455-1457. [PMID: 36219215 PMCID: PMC9554359 DOI: 10.1097/ico.0000000000003059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report a rare case of cyclodialysis cleft after secondary intraocular lens (IOL) placement using the Yamane flanged intrascleral haptic fixation technique. METHODS This study is an observational case report. RESULTS A 74-year-old man with an ocular history of spontaneously dislocated IOL and subsequent anterior chamber IOL (ACIOL) placement presented with monocular diplopia secondary to ACIOL subluxation. The patient underwent explantation of the subluxed ACIOL and placement of a scleral-fixated IOL using the Yamane technique. The postoperative course was complicated by persistent hypotony, prompting ultrasound biomicroscopy, which revealed a cyclodialysis cleft adjacent to one of the externalized IOL haptics. The haptic was discovered in the involved supraciliary space while performing direct cyclopexy. The cyclodialysis cleft closed with return to physiologic intraocular pressure. CONCLUSIONS Cyclodialysis cleft formation is a possible complication of scleral IOL fixation and should be suspected in cases of prolonged postoperative hypotony. Extended longitudinal tracking of the needle and haptic through the supraciliary space may be one mechanism for cyclodialysis cleft formation in the Yamane technique.
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Affiliation(s)
- Claudine Yee
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
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Zhang H, Gong R, Zhang X, Deng Y. Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation. Int Ophthalmol 2022; 42:3625-3641. [PMID: 35731355 PMCID: PMC9587946 DOI: 10.1007/s10792-022-02355-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/18/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To introduce a modified procedure of ICL implantation, to summarize the perioperative problems and their corresponding treatment after myopia correction with Implantable Collamer Lens (ICL), and to compare the difference of complications between the no-hole ICL and hole ICL. METHODS We searched all articles on ICL-related perioperative problems and their corresponding treatment in Scopus, Embase, PubMed and Web of Science databases for the last 22 years. RESULTS ICL implantation is safe, effective, stable and predictable in the correction of myopia, hyperopia and astigmatism, but can also cause a series of perioperative problems, including intraoperative and postoperative complications. CONCLUSION There are many kinds of complications related to ICL, but the common intraoperative and postoperative complications mainly include abnormality of arch height, abnormal position of ICL, loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma, cataract and night vision symptoms. Compared with ICL without central pore, the incidence of complications such as loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma and cataract was relatively lower in central hole ICL, while postoperative complications such as night vision symptoms were obvious.
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Affiliation(s)
- Hao Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, No.37, Guoxue Xiang, Chengdu, 610041 Sichuan China
| | - Rui Gong
- Department of Ophthalmology, West China Hospital, Sichuan University, No.37, Guoxue Xiang, Chengdu, 610041 Sichuan China
| | - Xiaolan Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, No.37, Guoxue Xiang, Chengdu, 610041 Sichuan China
| | - Yingping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, No.37, Guoxue Xiang, Chengdu, 610041 Sichuan China
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Sankarananthan R, Prasad S, Shekhar M, Narendran S, Balakrishnan L, Rathinam SR. Outcomes of cataract surgery in patients with Human Immunodeficiency Virus infection in a developing country. Int Ophthalmol 2022; 43:1601-1609. [PMID: 36273361 DOI: 10.1007/s10792-022-02559-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the outcomes of cataract surgery in patients with Human Immunodeficiency Virus (HIV) infection. Setting Tertiary care ophthalmic hospital DESIGN: Retrospective study METHODS: This study included all eyes of patients with known HIV infection undergoing cataract surgery with a minimum follow-up of 6 months between January 2017 and December 2020. Patients who underwent combined surgeries and pediatric patients were excluded from analysis. Data were retrieved from electronic medical records and we documented demographics, history, detailed anterior and posterior segment examination, pre-operative grade and type of cataract, type of surgery done, its complication and post-operative course. All these parameters were recorded at the baseline visit and at 1 month and 6 months postoperatively. RESULTS One hundred and twenty nine eyes of 107 HIV infected patients that underwent cataract surgery were evaluated. Mature cataract was seen in 31% of the eyes. Features of HIV related uveitis/retinitis were seen in 21 (16.2%) eyes. Phacoemulsification was performed in 44 (34.1%) eyes while manual small incision cataract surgery (MSICS) was done in 85 (65.9%) eyes. Intra-operative complications were encountered in 4 (3.1%) eyes. At the final follow-up, there was a significant improvement in median corrected distance visual acuity (CDVA) from LogMAR 1.08 (5/60) at baseline to LogMAR 0 (6/6) at 6 months follow-up. CONCLUSION Patients with HIV infection usually present early and with advanced cataracts. Visual outcomes after cataract surgery are generally good but affected by presence of prior HIV related uveitis or retinitis.
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Affiliation(s)
- R Sankarananthan
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Senthil Prasad
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
| | - Madhu Shekhar
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India.
| | - Siddharth Narendran
- Department of Intraocular Lens and Cataract Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, India
| | | | - S R Rathinam
- Department of Uvea Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, India
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Qu J, Tian Z, Li X, Zhang Y. Anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification and trabeculectomy in treatment of medically uncontrolled acute primary angle-closure glaucoma: A retrospective study. Medicine (Baltimore) 2022; 101:e30946. [PMID: 36221410 PMCID: PMC9542570 DOI: 10.1097/md.0000000000030946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To explore the clinical efficacy of quadruple surgery (anterior segment pars plana vitrectomy + phacoemulsification + posterior capsulorhexis + intraocular lens (IOL) implantation + trabeculectomy) and dual surgery (phacoemulsification + IOL implantation + trabeculectomy) to treat medically uncontrolled acute primary angle-closure glaucoma (APACG). The clinical data of 44 patients (45 eyes) with APACG treated in the Department of Ophthalmology of Taihe Hospital were retrospectively analyzed. They were divided into 2 groups based on quadruple surgery and dual surgery. There were 20 patients (20 eyes) underwent quadruple surgery in group A. And there were 24 patients (25 eyes) dual surgery in group B. The changes in intraocular pressure (IOP), visual improvement, and complications were observed between the 2 groups preoperatively and 1 month, 3 months, and 6 months postoperatively. Preoperative best corrected visual acuity (BCVA) was the influencing factor of postoperative BCVA at 1 month, 3 months and 6 months. Before surgery, the mean IOP of group A was significantly higher than that of group B (P < .001), and no significant difference was found in the BCVA, age, gender, eyes, axial length (AL), anterior chamber depth (ACD) (PBCVA = 0.12, Page = 0.76, Peyes = 0.20, Pgender = 0.37, PAL = 0.94, PACD = 0.08). On comparison at postoperative 1week, there was no significant difference in the IOP and BCVA between the 2 groups (PIOP = 0.64, PBCVA = 0.66). The mean IOP of group A was significantly lower than that of group B 1 month, 3 months, and 6 months postoperatively (P1month = 0.002, P3months < 0.001, P6months < 0.001). The degree of visual acuity recovery was significantly higher in group A at 1 month, 3 months, and 6 months postoperatively (P1month = 0.03, P3months = 0.02, P6months = 0.02). During treatment, the incidence of complications in group B was significantly higher than that in group A (P < .01). The clinical efficacy of anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification, and trabeculectomy elicits clinical safety in treating medically uncontrolled APACG. It has remarkable effects and leads to a significant decrease in the occurrence of complications.
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Affiliation(s)
- Jie Qu
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
- Jinzhou Medical University
| | - Zhen Tian
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
| | - Xin Li
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
| | - Yong Zhang
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
- Jinzhou Medical University
- *Correspondence: Yong Zhang, Master Supervisor of Hubei University of Medicine, Chief Physician of Taihe Hospital in Shiyan City of Hubei Province in China (e-mail: )
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