Novel technique of explantation of rigid phakic iris-claw lens and cataract extraction by sutureless manual small-incision surgery

A 38-year-old patient presented to us with complaints of blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/400, improving to 20/60 with pinhole. The patient underwent phakic iris-claw lens surgery 15 years ago for high myopia. On examination, there was anterior chamber rigid phakic iris-claw lens along with complicated cataract. We planned for sutureless self-sealing 6.5 mm sclerocorneal tunnel for explantation of rigid phakic iris-claw lens along with cataract extraction with irrigating vectis. There was postoperative reduction in astigmatism due to incision planned on steep axis, and visual acuity improved to 20/30 uncorrected. This technique provides significant advantages from the previously described techniques in terms of decreased postop astigmatism, no need for sutures, no issues of chamber instability and iris trauma and without the need for phacoemulsification.

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Persistently poor vision in dim illumination after implantation of XtraFocus small-aperture IOL (Morcher)

BMJ Case Reports ◽

10.1136/bcr-2019-232473 ◽

2019 ◽

Vol 12 (11) ◽

pp. e232473 ◽

Cited By ~ 3

Author(s):

Prateek Agarwal ◽

Samuel Edward Navon ◽

Praveen Subudhi ◽

Neha Mithal

Keyword(s):

Visual Acuity ◽

Cataract Extraction ◽

Hand Movements ◽

Blurred Vision ◽

Small Aperture ◽

Poor Vision ◽

Uncorrected Visual Acuity ◽

The Face ◽

History Of ◽

Near Visual Acuity

A 21-year-old patient presents to us with complaints of blurred vision and photophobia in the left eye, with an uncorrected visual acuity of 20/100 improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction, with residual irregular astigmatism and traumatic mydriasis. XtraFocus Pinhole intraocular lens (Morcher) was implanted in the left eye. One week postoperatively, the left eye uncorrected visual acuity improved to 20/30, uncorrected intermediate visual acuity improved to 20/40, and uncorrected near visual acuity improved to J4. The glare and photophobia resolved completely. Surprisingly, the patient complained of severely poor vision in dim illumination. His vision was limited to bare perception of objects and hand movements close to the face. He started facing difficulties in major activities such as driving at night and in dark ambient surroundings such as movie theatres, which persisted to the extent of necessitating explantation of the implant.

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Persistent troublesome floaters necessitating the explantation of XtraFocus Pinhole IOL (Morcher)

BMJ Case Reports ◽

10.1136/bcr-2018-229057 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229057 ◽

Cited By ~ 1

Author(s):

Prateek Agarwal ◽

Samuel Edward Navon

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Cataract Extraction ◽

Blurred Vision ◽

Uncorrected Visual Acuity ◽

History Of ◽

Irregular Astigmatism

A 41-year-old patient presented with blurred vision and photophobia in the left eye with an uncorrected visual acuity of 20/150, improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction with residual irregular astigmatism and traumatic mydriasis. XtraFocus Pinhole intraocular lens (Morcher) was implanted in the left eye and the vision improved to 20/40. Postoperatively, the patient experienced significant floaters which persisted to the extent of necessitating explantation of implant.

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Comparison of visual outcomes in patients undergoing small incision cataract surgery versus phacoemulsification at Divisional Headquarters Hospital, New Mirpur, Azad Kashmir.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3749 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1365-1369 ◽

Cited By ~ 1

Author(s):

Khawaja Abdul Hamid ◽

Shaista Habibullah

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Cataract Extraction ◽

Extracapsular Cataract Extraction ◽

Small Incision Cataract Surgery ◽

Visual Outcomes ◽

Small Incision ◽

Department Of Ophthalmology ◽

Significant Difference ◽

Uncorrected Visual Acuity

Cataract extraction is one of the commonest surgical procedures in Ophthalmology globally. Extracapsular cataract extraction ECCE), through a small incision (SICS), with insertion of an intraocular lens has been the most widely used method from 1990s until recently. Technological advances have led to the increasing use of phacoemulsification (PE) to emulsify and remove the lens. The technique requires a smaller incision, but requires substantial capital investment in theatre equipment. In this we compared the visual outcomes of patients undergoing both surgical techniques at a public sector hospital in Mirpur. Study Design: Single-center retrospective cohort study. Setting: Department of Ophthalmology, Divisional Headquarters Hospital, New Mirpur, AJK. Period: Cataract surgery cases from January 2018 to February 2019. Materials and Methods: 196 patients with age related cataract were included in the SICS group and 115 in the phacoemulsification group. The main comparative outcome was uncorrected visual acuity 4 weeks after surgery. Results: In this study, it was found that the primary post-operative visual outcome for small incision cataract surgery and phacoemulsification was comparable in terms of uncorrected visual acuity. No statistically significant difference was found in the proportions of SICS and phacoemulsification groups when compared for UCVA of 6/9 or better, 6/60 or better and 6/60 and worse.

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Technique of re-enclavation of post-traumatic disenclaved haptic of posterior iris claw lens in a vitrectomised eye

BMJ Case Reports ◽

10.1136/bcr-2021-245570 ◽

2021 ◽

Vol 14 (9) ◽

pp. e245570

Author(s):

Sudarshan Khokhar ◽

Saumya Kumar ◽

Deeksha Rani ◽

Aayush Majumdar

Keyword(s):

Visual Acuity ◽

Ultrasound Biomicroscopy ◽

Sudden Onset ◽

Invasive Technique ◽

Uncorrected Visual Acuity ◽

Nasal Side ◽

History Of ◽

23 Gauge ◽

Iris Claw Lens ◽

Iris Claw

A 58-year-old woman presented to us with sudden onset diminution of vision for 10 days following trauma while using mobile phone. Patient had a history of posterior iris claw implantation 3 years ago. On examination, the patient was aphakic and intraocular lens (IOL) was seen enclaved on nasal side and disenclaved on temporal side on ultrasound biomicroscopy. Patient underwent surgery for re-enclavation of temporal haptic by lifting the IOL using 23-gauge pars plana trocar. Patient had a postoperative uncorrected visual acuity of 6/9 and best-corrected visual acuity of 6/6 with refraction. Re-enclavation of partially disenclaved posterior iris claw lens is a minimally invasive technique to restore visual acuity in such cases.

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First Postoperative Day Visual Outcome Following 6 mm Manual Small Incision Cataract Surgery Using Intratunnel Phacofracture Technique

US Ophthalmic Review ◽

10.17925/usor.2014.07.01.26 ◽

2014 ◽

Vol 07 (01) ◽

pp. 26 ◽

Cited By ~ 1

Author(s):

Sudhir Singh ◽

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Low Cost ◽

Visual Outcome ◽

Cataract Extraction ◽

Research Centre ◽

Small Incision Cataract Surgery ◽

Small Incision ◽

Uncorrected Visual Acuity ◽

Cataract Patients

Object:To study first postoperative day visual outcome following 6 mm manual small incision cataract surgery (MSICS) using intratunnel phacofracture technique.Design:Retrospective design.Setting:Tertiary eye care centre.Participants:A total of 216 patients who underwent MSICS performed by a single surgeon at the JW Global Hospital & Research Centre, Mount Abu, India from April 2012 to March 2013. Cataract patients with any other ocular comorbidity were not included. One hundred and thirty-six cataract patients (72 male/64 female) with a mean age of 59.75 years (range 40–80 years) were included in the study. All surgeries were performed by a single surgeon using the 6 mm MSICS intratunnel phacofracture technique.Outcome measures:The first postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and rates and types of complications were recorded.Results:A total of 136 surgeries were performed using the 6 mm MSICS intratunnel phacofracture technique. All the surgeries were performed by a single experienced surgeon. The mean UCVA and mean BCVA at first postoperative day were 0.367 (Snellen equivalent 20/46) and 0.226 (Snellen equivalent 20/33) log MAR units, respectively. No serious peri- and postoperative complications were encountered.Conclusions:The 6 mm MSICS is a safe, fast, and low-cost cataract extraction technique. It is an effective alternate to costly phacoemulsification.

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Comparison of astigmatism following manual small incision cataract surgery: superior versus temporal approach

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v4i1.5851 ◽

1970 ◽

Vol 4 (1) ◽

pp. 54-58 ◽

Cited By ~ 10

Author(s):

VK Malik ◽

S Kumar ◽

R Kamboj ◽

C Jain ◽

K Jain ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Cataract Extraction ◽

P Value ◽

Small Incision Cataract Surgery ◽

Small Incision ◽

Uncorrected Visual Acuity ◽

Standard Value ◽

Group 2 ◽

Superior Approach

Introduction: Now-a-days, all techniques of cataract extraction are meant for giving the best uncorrected visual acuity and early post-operative rehabilitation. Purpose: To compare astigmatism induced by the superior and temporal section in manual small incision cataract surgery (SICS) in the Indian population. Materials and methods: One hundred and ten eyes were taken. Eyes having a steeper vertical keratometry reading were assigned to the superior SICS group whereas eyes with a steeper horizontal keratometry reading were assigned to the temporal SICS group. Eyes with no astigmatism were randomly assigned to either of the two groups. Both the groups had 54 eyes each. Eyes in Group 1 underwent manual SICS with a superior tunnel and eyes in Group 2 underwent manual SICS with a temporal tunnel. The patients were examined on postoperative Day1, 1 week, 45 days, and 3 months. Uncorrected and best-corrected visual acuity was recorded, slit-lamp examination, auto-refracto-meter and keratometry examinations were done. Statistics: All calculations were performed using surgically-induced astigmatism (SIA) Calculator version 1.0, a free software program. Results: In Group 2, only 35 eyes out of 54 completed the follow-up of 90 days. The mean SIA in Group1 was found to be 1.45 ± 0.7387 and in Group 2 it was 0.75± 0.4067. The z score applied was found to be 5.7143. This value was more than the standard value, i.e.2.58. The p value accordingly was < 0.001, which is highly significant. The SIA induced by the superior incision was 48.28 % more than by the temporal incision. Conclusion: SICS with the temporal approach provides a better stabilization of the refraction with a significantly less SIA than superior approach. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5851 NEPJOPH 2012; 4(1): 54-58

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Comparison of the Outcomes of Manual Small Incision Cataract Surgery (MSICS) and Phacoemulsification (PHACO) in Ghana

Annals of African Surgery ◽

10.4314/aas.v18i3.4 ◽

2021 ◽

Vol 18 (3) ◽

pp. 143-149

Author(s):

Samuel Kyei ◽

Ebenezer Zaabaar ◽

Frank Assiamah ◽

Michael Agyemang Kwarteng ◽

Kofi Asiedu

Keyword(s):

Visual Acuity ◽

Postoperative Complications ◽

Cataract Surgery ◽

Medical Records ◽

Cross Sectional Study ◽

Small Incision Cataract Surgery ◽

Cross Sectional ◽

Small Incision ◽

Uncorrected Visual Acuity

Background: The growing middle-class population of Ghana has seen more people being employed in visually demanding occupations and hence there is an increased desire for quality post-cataract surgical visual outcomes. This study aimed at comparing the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification (PHACO) among Ghanaians. Methods: This was a retrospective cross-sectional study in which records of patients who underwent MSCIS or phacoemulsification by the same surgeon were reviewed. Results: Medical records of 248 eyes were reviewed, out of which 132 underwent PHACO and 116 had MSICS. A significant number of the PHACO group had good (6/6–6/18) uncorrected visual acuity (UCVA) compared to the MSICS group at 1–2 weeks follow-up (p = 0.003) and 4–6 weeks follow-up (p = 0.002). MSICS resulted in a higher total astigmatic change compared to PHACO (p < 0.001). The PHACO grouphad a higher number of postoperative complications compared with the MSICS group (p <0.001). Postoperative borderline and poor uncorrected visual acuity were associated with age, total astigmatic change, and postoperative complications. Conclusion: The postoperative UCVA outcomes at 4–6 weeks’ follow-up indicates that PHACO resulted in noticeably less spectacle dependency when compared to MSICS.

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Visual outcome of conventional extracapsular cataract extraction with posterior chamber intraocular lens implantation versus manual small-incision cataract surgery

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v1i1.3668 ◽

1970 ◽

Vol 1 (1) ◽

pp. 13-19 ◽

Cited By ~ 4

Author(s):

A Gurung ◽

DB Karki ◽

S Shrestha ◽

AP Rijal

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Postoperative Period ◽

Cataract Extraction ◽

Posterior Chamber ◽

P Value ◽

Extracapsular Cataract Extraction ◽

Small Incision Cataract Surgery ◽

Small Incision ◽

Posterior Chamber Intraocular Lens

Background: An effective method for cataract surgery should be identified to combat cataract blindness. Aim: To study the surgical outcome of conventional extracapsular cataract extraction versus manual small-incision cataract surgery. Materials and methods: A randomized clinical trial was carried out including one hundred eyes (88 patients) which were divided into two groups using systematic randomization: groups of conventional extracapsular cataract extraction with posterior chamber intraocular lens (ECCE with PCIOL) implantation and manual small-incision cataract surgery (MSICS). The postoperative parameters/variables studied were the unaided and best-corrected visual acuity and astigmatism. Statistics: Epi info 2000 version statistical software was used for data analysis and calculation of relative risk, 95% CI and p value. The p value of less than 0.05 was considered as significant. Results: In the immediate postoperative period, unaided visual acuity of =/> 6/18 was achieved in 24 subjects in MSICS group versus 7 in ECCE with PCIOL group (RR=2.05, 95% CI=1.44 - 2.94, p = 0.0002), whereas the same at 6 - 8 weeks postoperatively was found in 28 and 22 subjects in those groups respectively (RR=1.27, 95% CI=0.86-1.89, p=0.23). The astigmatism of =/> 2 at 6 - 8 weeks was found in 35 and 17 subjects from the conventional and MSICS groups respectively ( R=2.28, 95% CI = 1.39-3.73, p=0.0002). Conclusion: Both MSICS and conventional ECCE with PCIOL are safe and effective techniques for treatment of cataract patients. A more rapid recovery of good vision can be achieved with MSICS than with conventional ECCE with PCIOL in the immediate postoperative period. Key words: ECCE; MSICS; visual acuity; astigmatism DOI: 10.3126/nepjoph.v1i1.3668 Nep J Oph 2009;1(1):13-19

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Novel technique of fixing intracorneal rings segments after migration

BMJ Case Reports ◽

10.1136/bcr-2019-233312 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233312

Author(s):

Prateek Agarwal ◽

Praveen Subudhi ◽

Neha Mithal

Keyword(s):

Visual Acuity ◽

Corneal Stroma ◽

Stable Position ◽

Novel Technique ◽

Nylon Suture ◽

Uncorrected Visual Acuity ◽

History Of ◽

And Migration

A 38-year-old patient with a history of non-progressive keratoconus in the left eye presented to us with an uncorrected visual acuity of 20/400, which improved to 20/60 with pinhole. We planned for intracorneal rings segment in the left eye. Postoperatively uncorrected visual acuity improved to 20/30. The patient presented 2 weeks later with severely decreased vision to 20/100 and migration of intracorneal rings were noted with both the rings riding side by side. The patient gave history of vigorous eye rubbing. The rings were repositioned with the help of Sinskey hooks and superior ring was anchored with 10-nylon suture passed through the ring hole to the corneal stroma. Two more sutures were placed radial to the circumference of inferior ring to prevent its migration. The sutures were removed after 1 month and the patient was followed up with stable position of the rings for the next 6 months . The uncorrected visual acuity improved to 20/40.

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Refractive surprise: twice the SMILE

BMJ Case Reports ◽

10.1136/bcr-2019-231233 ◽

2019 ◽

Vol 12 (9) ◽

pp. e231233

Author(s):

Garvit Bhutani ◽

Somasheila I Murthy ◽

Jagadesh C Reddy ◽

Pravin K Vaddavalli

Keyword(s):

Visual Acuity ◽

Refractive Error ◽

Small Incision Lenticule Extraction ◽

Small Incision ◽

Uncorrected Visual Acuity ◽

Lenticule Extraction ◽

Refractive Surprise

A 35-year-old man presented with decreased vision in his left eye following small incision lenticule extraction (SMILE) surgery. The refractive error after surgery was nearly twice his preoperative refractive error in the left eye. The patient was diagnosed as having a retained lenticule after SMILE surgery, which was folded on itself and was successfully managed by conversion to a flap. Postoperatively, the patient maintained good uncorrected visual acuity and a low refractive error, with the best spectacle corrected acuity of 20/20.

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