scholarly journals Pars Plana Lensectomy and Iris-Claw Artisan Intraocular Lens Implantation in Patients with Marfan Syndrome

2021 ◽  
Author(s):  
Saeed Karimi ◽  
Zahra Karjou ◽  
Mohadeseh Yaghoobi ◽  
Homayoun Nikkhah ◽  
Sare Safi
Keyword(s):  
Visual Acuity ◽  
Marfan Syndrome ◽  
Crystalline Lens ◽  
Safe Procedure ◽  
Iol Implantation ◽  
Lens Subluxation ◽  
Pars Plana Lensectomy ◽  
Pars Plana ◽  
The Mean ◽  
Iris Claw

Abstract Purpose: To evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw artisan intra-ocular lens (IOL) implantation in the patients with subluxated crystalline lens secondary to Marfan syndrome.Methods: In this retrospective case series, we evaluate the records of all patients with Marfan syndrome and moderate to severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw artisan IOL at referral hospital from September 2015 to October 2019.Results: Twenty-one eyes of fifteen patients (10 males and 5 females) with the mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P <0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder -0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment two months after surgery.Conclusion: Pars plana lensectomy and iris-claw artisan IOL implantation seem to be a useful, impressive and safe procedure with a low rate of complications in Marfan patients with moderate to severe crystalline lens subluxation. Visual acuity was significantly improved with the acceptable anatomical and refractive outcomes.

scholarly journals Mommy, why can’t I see clearly?

2020 ◽  
Vol 2 (3) ◽  
pp. 244-250
Author(s):  
Nurulhuda Md Amin ◽  
Safiyah Jameelah Mohd Yusof ◽  
Nor Fadzillah Abd Jalil ◽  
Raja Norliza Raja Omar ◽  
Mushawiahti Mustapha
Keyword(s):  
Visual Acuity ◽  
Marfan Syndrome ◽  
Crystalline Lens ◽  
Visual Axis ◽  
Ectopia Lentis ◽  
Lens Subluxation ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity ◽  
Iris Claw

Ectopia lentis or crystalline lens subluxation is one of the major criteria to diagnose Marfan syndrome. It may vary from mild lens subluxation to lens dislocation. Herewith is a case report of a 4-year-old autistic boy who had never been diagnosed with Marfan syndrome. He presented to the clinic after his parents noticed he had difficulty focusing on near objects. His bilateral best-corrected visual acuity was 6/60. On examination, there was bilateral lens subluxation superotemporally and lens equator blocking his visual axis. He was sent to the paediatric team and further Marfan workout showed dilated aortic root. He was then diagnosed with Marfan syndrome. He underwent bilateral lens aspiration, anterior vitrectomy, and iris-claw lens implantation. His postoperative bilateral visual acuity on day 1 was 6/30 and his best-corrected visual acuity 3 months after surgery was 6/9 for both eyes. In conclusion, ophthalmologists play an important role in diagnosing and managing Marfan syndrome. Early diagnosis is important to help preserve vision and improve quality of life.

scholarly journals Secondary Sulcus-Fixed Foldable IOL Implantation with 25-G Infusion in Patients with Previous PPV after Open-Globe Injury

2017 ◽  
Vol 27 (6) ◽  
pp. 786-790
Author(s):  
Tiangeng He ◽  
Caiyun You ◽  
Song Chen ◽  
Xiangda Meng ◽  
Yuanyuan Liu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Open Globe Injury ◽  
Corneal Incision ◽  
Iol Implantation ◽  
Clear Corneal Incision ◽  
Secondary Iol Implantation ◽  
Open Globe ◽  
Uncorrected Visual Acuity ◽  
Pars Plana ◽  
The Mean

Purpose To evaluate the safety and efficacy of secondary sulcus-fixed foldable intraocular lens (IOL) implantation through a clear corneal incision with 25-G infusion in patients with previous pars plana vitrectomy (PPV) after open-globe injury, and to analyze postoperative outcomes and prognostic factors of treatment. Methods Clinical data of 89 eyes of 89 patients with open-globe injury who underwent secondary sulcus-fixed foldable IOL implantation through a clear corneal incision with 25-G infusion after vitrectomy in our hospital between January 2008 and June 2015 were retrospectively analyzed. The examinations before IOL implantation mainly included visual acuity, slit-lamp examination, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope, and intraocular pressure. Five eyes underwent suturing of peripheral iris and 7 eyes underwent suturing of iris laceration simultaneously. The mean follow-up was 18 months with a range from 6 months to 8 years. Results The mean interval between secondary sulcus-fixed foldable IOL implantation and vitrectomy was 2.8 months with a range from 2 to 6 months. The uncorrected visual acuity improved in all patients with a well-centered IOL ranging from 0.1 to 0.8 with the best-corrected visual acuity from 0.1 to 1.0 after secondary IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 10 eyes (11%), temporary IOP elevation in 12 eyes (13%), and recurrent retinal detachment in 5 eyes (6%), which were subsequently managed by surgery. Conclusions The interval of 2.8 months between vitrectomy and secondary IOL implantation is an appropriate and safe option to correct aphakia in patients receiving vitrectomy for open-globe injury.

Outcomes of three surgical approaches for managing ectopia lentis in Marfan syndrome

2021 ◽  
pp. 112067212199295
Author(s):  
Gurkan Erdogan ◽  
Nilay Kandemir Besek ◽  
Betul Onal Gunay ◽  
Alper Agca
Keyword(s):  
Marfan Syndrome ◽  
Crystalline Lens ◽  
Surgical Approaches ◽  
Posterior Chamber ◽  
Ectopia Lentis ◽  
Iol Implantation ◽  
Capsular Tension Ring ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To investigate the clinical outcomes of three surgical approaches for ectopia lentis in Marfan syndrome (MS) patients who had undergone crystalline lens removal with posterior chamber intraocular lens (IOL) implantation techniques comprising the intrascleral fixation of IOL, sutured scleral fixation of IOL, and IOL implantation with the use of a Cionni capsular tension ring (CTR). Methods: This is a retrospective comparative study, including 35 eyes of 21 patients who underwent the intrascleral fixation of IOL (group 1), scleral IOL fixation with the Z-suture (group 2), and IOL implantation with the use of a Cionni CTR (group 3) following crystalline lens removal. The surgical indications were as follows: no improvement in visual function after eyeglasses or contact lens application due to excessive irregular astigmatism and advanced crystalline lens decentration in which the edge of the crystalline lens came up to the optical axis, or dislocation of the crystalline lens resulting in aphakia and secondary glaucoma due to lens dislocation. The surgical outcomes and complications due to surgery were compared between the groups. Results: The mean age of the patients in the study was 12.3 ± 8.7 years (5–32 years). There were 10 eyes in group 1, 13 eyes in group 2, and 12 eyes in group 3. Visual acuity improved significantly in each group after surgery. Ocular residual astigmatism did not differ significantly between the groups ( p = 0.51). Conclusion: There were no significant differences between the three surgical approaches in the current study in terms of the postoperative results and complications.

scholarly journals Delayed diagnosis of homocystinuria presenting as bilateral congenital lens subluxation

2017 ◽  
Vol 145 (9-10) ◽  
pp. 513-515
Author(s):  
Marija Jelic-Vukovic ◽  
Suzana Matic ◽  
Josip Barac ◽  
Tomislav Novinscak ◽  
Mirna Belovari ◽  
...  
Keyword(s):  
Intraocular Lens ◽  
Delayed Diagnosis ◽  
Vitreoretinal Surgery ◽  
Ectopia Lentis ◽  
Lens Subluxation ◽  
Ocular Manifestations ◽  
Methionine Restriction ◽  
Sulcus Fixation ◽  
Pars Plana Lensectomy ◽  
Pars Plana

Introduction. Homocystinuria is an autosomal recessively inherited defect leading to hyperhomocysteinemia and associated with ocular manifestations, mainly myopia and ectopia lentis. Case outline. A 26-year-old male with secondary glaucoma due to bilateral lens subluxation was admitted to the Department of vitreoretinal surgery. Horizontal nystagmus, bilateral lens subluxation, and bilateral amblyopia were first discovered at the age of three years. Preoperative laboratory workup revealed elevated levels of homocysteine. Bilateral pars plana lensectomy and vitrectomy followed by a sulcus fixation of the intraocular lens (ALCON MA60 Acrysof IOL) were performed. The patient was prescribed folic acid, methionine, and pyridoxine, and was urged to maintain a methionine-low diet. After a bilateral lensectomy and sulcus fixation of the intraocular lens and a methionine restriction therapy combined with vitamin B6, B9, and B12 supplementation, his condition improved greatly. Conclusion. In this report of a rare case we emphasize the importance of examining differential diagnoses of lens subluxation, since early intervention can prevent serious complications.

scholarly journals Effect of Bevacizumab Injection before Vitrectomy on Intravitreal Hemorrhage in Pseudophakic Patients with Proliferative Diabetic Retinopathy

2013 ◽  
Vol 5 ◽  
pp. OED.S12352 ◽  
Author(s):  
Mehmet Demir ◽  
Ersin Oba ◽  
Efe Can ◽  
Orhan Kara ◽  
Sonmez Cinar
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Pars Plana Vitrectomy ◽  
Intravitreal Bevacizumab ◽  
Central Macular Thickness ◽  
Intraoperative Bleeding ◽  
Corrected Visual Acuity ◽  
Pars Plana ◽  
The Mean

We evaluated the effect of intravitreal bevacizumab (IVB) injection before pars plana vitrectomy (PPV) on intravitreal hemorrhage (VH) during and after vitrectomy for postoperative the first day and the first month in pseudophakic patients with proliferative diabetic retinopathy (PDR). This retrospective study was performed on 44 eyes of 44 patients who underwent vitrectomy for PDR. Patients were divided into PPV (n = 22 eyes) and PPV + IVB (n = 22 eyes) groups. Injection of bevacizumab (1.25 mg/0.05 mL) was performed 3 days before vitrectomy. Outcomes of visual acuity as well as intraoperative and postoperative VH were compared between the two groups. One month after surgery, visual acuity improved in PPV and PPV + IVB groups ( P = 0.005, P = 0.006), respectively. There was no difference between the two groups in best corrected visual acuity at baseline and after vitrectomy ( P = 0.71). Intraoperative bleeding into the vitreous was recorded in 14 (63.6%) cases in the PPV group and in 7 (31.8%) cases in the PPV + IVB group. The first month, intravitreal hemorrhage was recorded in six patients in the PPV group and in two patients in the PPV + IVB group ( P = 0.03). The mean pre-postoperative central macular thickness was similar in both groups. Intravitreal injection of IVB before vitrectomy decreased the rate of VH at the time of surgery and at the first postoperative month in patients with PDR.

scholarly journals Pediatric Traumatic Cataracts : 10 Year-experience of a Tertiary Referral Center 

2021 ◽  
Author(s):  
Nesrin Tutas Gunaydın ◽  
Ayse Aydın Oral
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Final Visual Acuity ◽  
Close Monitoring ◽  
Iol Implantation ◽  
Tertiary Referral Center ◽  
Corrected Distance Visual Acuity ◽  
The Mean ◽  
Visual Results ◽  
Trauma Type

Abstract Background: To evaluate the factors influencing final visual acuity in pediatric traumatic cataracts. Methods: Data of patients who presented with traumatic cataracts were reviewed retrospectively. We evaluated sex; age at trauma; trauma type, cause, and zone; duration between the time of trauma and cataract surgery; surgical method used; time, location, and type of intraocular lens (IOL) implantation; initial and final corrected distance visual acuity (CDVA); amblyopia rate and complications. Results: In all, 61 eyes of 59 patients with cataracts after trauma, under 16 years of age, were included. The mean age of the children was 7.2 ± 3.9 years. Primary IOL implantation was performed in 70.9% of eyes. The CDVA was 0.7 LogMAR or better in 16.3% of the 49 eyes where the visual acuity could be measured at the time of trauma and in 69.1% of 55 eyes in which it could be measured after treatment. The evaluation of factors potentially influencing the final visual acuity revealed that eyes that had undergone posterior capsulotomy (PC) and anterior vitrectomy (AV) during cataract surgery had significantly better final vision compared to eyes that did not undergo these procedures. Conclusion: Good visual results can be obtained in children with traumatic cataracts using PC and AV together with lens aspiration and IOL implantation, followed by effective amblyopia treatment and close monitoring.

scholarly journals Nucleus Drop or Intraocular Lens Drop Underwent Pars Plana Vitrectomy due to Complication of Cataract Surgery

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Noviana Kurniasari Vivin ◽  
Ari Djatikusumo ◽  
Elvioza Elvioza ◽  
Gitalisa Andayani ◽  
Anggun Rama Yudantha ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Intraocular Lens ◽  
Pars Plana Vitrectomy ◽  
Iol Implantation ◽  
Secondary Iol Implantation ◽  
Choice Of Procedure ◽  
Department Of Ophthalmology ◽  
Pars Plana

Abstract Background: The incidence of nucleus drop or intraocular lens (IOL) drop as the complication of phacoemulsification increases due to the increased frequency of phacoemulsification. Pars plana vitrectomy (PPV) followed by endofragmentation and secondary IOL implantation is the choice of procedure for management. This study aims to determine the frequency, outcomes, and complication of PPV in the case of nucleus drop or IOL drop in the Department of Ophthalmology, Fakultas Kedokteran Universitas Indonesia – Rumah Sakit Cipto Mangunkusumo (FKUI-RSCM) Methods: This study is a retrospective descriptive study conducted in the Vitreoretinal Division of the Department of Ophthalmology, FKUI - RSCM. Research data was taken from the medical records of all nucleus drop or IOL drop patients underwent PPV in January 2017-December 2017. Results: There were 19 cases studied. The incidence of nucleus drop occurred in phacoemulsification surgery techniques (94.7%) and ECCE techniques (5.3%). Vitrectomy surgery was performed ≤2 weeks in 31.6% and >2 weeks in 68.4% after the patient first arrived at the vitreoretinal clinic. Most pre-PPV visual acuity was 1/60-6/60 (47.1%). In the final follow-up, visual acuity improved from 6/45 to 6/6 occurred in 42.2% of cases. Complication after PPV and secondary IOL implantation include elevated IOP (10.5%), IOL decentration (5.3%), corneal decompensation (5.3%), macular edema (5.3%), and retinal detachment (5.3%). Conclusion: Nucleus drop or IOL drop generally occurs in phacoemulsification cataract surgery techniques. Improved visual acuity was achieved after PPV and secondary IOL implantation at the end of the follow-up period. Most common post-PPV complication is elevated IOP.  

scholarly journals Posterior Segment Retained Intraocular Foreign Body: A Study from Western Nepal

2021 ◽  
Vol 13 (1) ◽  
pp. 22-30
Author(s):  
Bikram Bahadur Thapa ◽  
Sweta Singh ◽  
Gyanendra Lamichhane ◽  
Shanti Gurung ◽  
Saurav Piya
Keyword(s):  
Visual Acuity ◽  
Foreign Body ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Large Diameter ◽  
Visual Outcome ◽  
Posterior Segment ◽  
Intraocular Foreign Body ◽  
Pars Plana ◽  
The Mean

Introduction: Posterior segment retained Intraocular foreign body (IOFB) management is challenging. Facility of pars plana vitrectomy (PPV) and availability of well trained vitreo retina surgeons are the basic need to accomplish this work.  Encircling band provide permanent 360° support to close the anterior retinal break and prevent traction on the retina. The objective of this study is to analyse the clinical characteristics and predictors of the final visual outcome and survival of the globe in cases of retained IOFB in the posterior eye segment. Materials and methods: A hospital based retrospective observational study was conducted. All the patients of retained IOFB in the posterior segment presented from January 2016 to June 2019 were enrolled. Patients presented with visual acuity of NPL were excluded. Statistical analysis was performed using a variety of tests using SPSS version 21.   Results: Forty eyes of 40 patients were included. The mean age was 27.08±10.68 years (range 5-66). 95% of our patients were male. Most of them (52.5%) worked on the farm. 26(65%) of 40 eyes had Zone I injury. The median time spent before presentation was 13.5 day. Retinal detachment, vitreous hemorrhage, and endophthalmitis were present in 15, 23 and 5 eyes, respectively, before IOFB removal. The mean LogMAR visual acuity was improved significantly from 2.50±0.87 to 1.33± 1.01 (p=0.003). Poor presenting visual acuity, retinal detachment and large diameter of IOFB were found as the predictor of poor final visual acuity. Conclusion:  Pars plana vitrectomy by a vitreo retinal surgeon can give encouraging results in the cases of retained posterior segment IOFB. Poor presenting visual acuity, large diameter of IOFB and RD before IOFB removal are predictors of poor visual outcome.

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