<p>Big Bag IOL Implantation with Scleral Fixation Technique in IOL/Crystalline Lens Subluxation/Luxation Cases and High Myopia</p>

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.

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

European Journal of Ophthalmology ◽

10.1177/1120672121992950 ◽

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.

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Removal of the Crystalline Lens in Sixty-three Cases of High Myopia

The American Journal of the Medical Sciences ◽

10.1097/00000441-190409000-00063 ◽

1904 ◽

Vol 128 (3) ◽

pp. 556

Author(s):

&NA;

Keyword(s):

High Myopia ◽

Crystalline Lens

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Comparison of the Techniques of Secondary Intraocular Lens Implantation after Penetrating Keratoplasty

Journal of Ophthalmology ◽

10.1155/2018/3271017 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Katarzyna Krysik ◽

Dariusz Dobrowolski ◽

Ewa Wroblewska-Czajka ◽

Anita Lyssek-Boron ◽

Edward Wylegala

Keyword(s):

Surgical Techniques ◽

Vitreous Body ◽

Iol Implantation ◽

Scleral Fixation ◽

Lens Extraction ◽

Secondary Iol Implantation ◽

Secondary Implantation ◽

Significant Difference ◽

Corrected Distance Visual Acuity ◽

Secondary Intraocular Lens Implantation

Aim. To conduct a retrospective analysis of secondary IOL implantation in patients who underwent PK with no simultaneous IOL implantation. Materials and Methods. The retrospective study of the secondary implantation of IOLs was conducted in 46 eyes that underwent a primary operation with PK and cataract/lens extraction with no IOL implantation due to capsule rupture or combining corneal or intraocular complications. The minimum period from PK was 12 months. All secondary IOL implantations were performed from January 2011 to August 2017. Aphakic postkeratoplasty patients were treated using one of the surgical techniques for secondary IOL implantation. In-the-bag IOL implantation was possible if the posterior capsule was complete. If the lens capsule remnants were sufficient to provide secure IOL support, an in-the-sulcus IOL implantation was performed. Scleral fixation was offered in eyes with extensive capsular deficiency or the presence of the vitreous body in anterior chamber. BCVA and expected and achieved refraction were evaluated; we included using two biometry devices, and results were compared. Results. The corrected distance visual acuity (CDVA) before surgery ranged from 0.1 to 0.8 (mean 0.54 ± 0.17). After secondary IOL implantation, CDVA ranged from 0.2 to 0.8 (mean 0.43 ± 0.14) at postoperative 1 month and from 0.3 to 0.9 (mean 0.55 ± 0.15) at postoperative 6 months (p<0.05). Comparison of the final refraction using two methods of biometry showed no statistically significant difference in the group that underwent scleral fixation of the IOL, similar to the findings for the in-the-bag and in-the-sulcus IOL implantation groups. In the scleral-fixation group, p=0.55 for the USG biometry technique and p=0.22 for the OB technique. p values for the IOL-implantation group were p=0.49 and p=0.44, respectively. Conclusion. Both implantation methods are safe for the patients. Final refraction is depending on the technique and indication to keratoplasty. Both biometry techniques deliver precise data for IOL choice.

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Bilateral Isolated Spherophakia with Lens Subluxation, High Myopia and Secondary Angle Closure: A Case Report

10.21203/rs.2.118/v1 ◽

2018 ◽

Author(s):

Ye Zhang ◽

Ravi Thomas ◽

Cong Wang ◽

Xiangyu Shi

Keyword(s):

Anterior Chamber ◽

High Myopia ◽

Rare Condition ◽

Spherical Shape ◽

Angle Closure ◽

Lens Subluxation ◽

Pars Plana Lensectomy ◽

Shallow Anterior Chamber ◽

One Year ◽

The Right

Abstract Background: Spherophakia is a rare condition and compared to its occurrence with familial and systemic disorders, isolated spherophakia is even more uncommon. This rare case of isolated spherophakia will raise the alertness of physicians when dealing with a high myopia patient with shallow anterior chamber and relatively normal fundus. Case presentation: We report a case of a 17-year-old male who experienced painless decrease of vision in both eyes (OU) for 11 years, with progression of visual impairment and occasional ocular pain for one year. Examination revealed high myopia, increased intraocular pressures (IOP, 28 mmHg in the right eye (OD) and 33 mmHg in the left (OS)), shallow central anterior chambers, lenses of a spherical shape with superior subluxation, occludable angles without peripheral anterior synechiae, and healthy optic discs OU. A diagnosis of bilateral isolated spherophakia, lens subluxation, high myopia and secondary angle closure (AC) was made. Pars plana lensectomy with anterior vitrectomy and scleral suturing of an intraocular lens was performed. On postoperative follow-up at 19 days OD and 63 days OS, the visual acuity was 6/6 and the IOP was normal without any medication OU. Conclusions: A presentation with high myopia, shallow anterior chamber with a normal retina should alert the clinician to the possibility of spherophakia, as compared to high myopia caused by elongated axial length. Surgery should be considered in cases of spherophakia with AC where the IOP cannot be controlled by noninvasive means.

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Refractive Stability of LASIK with the VISX 20/20 Excimer Laser vs ZB5M Phakic IOL Implantation in Patients with High Myopia (>−10.00 D): A 10-Year Retrospective Study

Journal of Refractive Surgery ◽

10.3928/1081597x-20100707-02 ◽

2010 ◽

Cited By ~ 3

Author(s):

Mohamad Rosman ◽

Jorge L. Alió ◽

Dolores Ortiz ◽

Juan J. Pérez-Santonja

Keyword(s):

Retrospective Study ◽

Excimer Laser ◽

High Myopia ◽

Iol Implantation ◽

Phakic Iol

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Contralateral Posterior Chamber Phakic Intraocular Lens Implantation as Rehabilitation of Refractive Lens Exchange with a Monofocal Intraocular Lens in a Young, Nonpresbyopic, Bilateral Highly-Myopic Patient

Case Reports in Ophthalmological Medicine ◽

10.1155/2019/8791071 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kepa Balparda ◽

Claudia Marcela Vanegas-Ramírez ◽

Laura Segura-Muñoz ◽

Manuela Gómez-Londoño

Keyword(s):

Intraocular Lens ◽

Crystalline Lens ◽

Posterior Chamber ◽

Phakic Intraocular Lens ◽

Short Term ◽

Corneal Surgery ◽

Iol Implantation ◽

Refractive Lens Exchange ◽

Patient’S Satisfaction ◽

Refractive Lens

Background. Refractive errors are widespread in the human population; nowadays, numerous surgical options allow for efficient and safe correction them. One of the main elements to ensure success in this kind of intervention will depend on the careful patient and surgical approach selection. Excimer laser corneal surgery is considered by most for low to moderate ametropias. Another option, which has been suggested may be safer, is to cut a small corneal lenticule with femtosecond laser, and then extracting it through a small incision. Nevertheless, in some specific cases, such as patients with high refractive error or those with some corneal abnormality, laser corneal ablations are considered unsafe from either a biomechanical or refractive standpoint. In this kind of particular cases, Phakic Intraocular Lens (P-IOL) implantation constitutes attractive, highly predictable and safe option. Objective. The authors want to show the case of a young high-myopic woman, already pseudophakic in one eye, where the P-IOL implantation in the fellow eye yielded excellent short-term visual results, and high patient’s satisfaction, is presented. Materials. The authors present the case of a 32-years-old, highly myopic female patient underwent a Refractive Lens Exchange (RLE) with a monofocal Intraocular Lens (IOL) implantation in her left eye elsewhere, and developed severe visual issues, especially regarding near-work. Symptoms resolved through the implantation of a posterior chamber P-IOL in the contralateral eye. Results. The postoperative course was unremarkable, inflammation was mild, and visual recovery was quick. There was no need to perform any procedure on her left eye or to use any reading glasses, as unilateral effective near vision through her right eye was enough for all her daily tasks. Conclusions. RLE in young pre-presbyopic highly myopic patients may not be an advisable alternative in most cases, because of the high risks of retinal complications observed. In addition, eliminating accommodation will cause significant limitations, and multifocal IOLs currently available are far from the quality of vision that a young human crystalline lens yields. On the other hand, implantation of a P-IOL is a good option if eye conditions are optimal, as it preserves natural accommodation. In this case an EyeCryl Phakic Toric® IOL showed excellent short-term refractive predictability and safety.

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