A clinical case of replacing an opacified intraocular lens in avitreal eye

2021 ◽  
pp. 110-113
Author(s):  
E.A. Lomukhina ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Visual Acuity ◽  
Surgical Treatment ◽  
Anterior Chamber ◽  
Silicone Oil ◽  
Vitreous Cavity ◽  
Aspheric Iol ◽  
Replacement Technique ◽  
The Right ◽  
Two Stages

Purpose. Using a clinical example, to analyze the possible causes of opacity of the Hydro-4 Aspheric IOL (Rumex, Great Britain). Materials and methods. Patient K., 32 years old, underwent the surgery for tractional retinal detachment in both eyes, which arose against the background of proliferative diabetic retinopathy of the retina. A history of type 1 diabetes mellitus from the age of 9. The visual acuity of both eyes before surgery was 0.03 n/k. Microinvasive (25G) vitrectomy with silicone oil tamponade of the vitreous cavity was performed. The second stage of surgical treatment is the removal of silicone oil from the vitreous cavity and phacoemulsification of cataract with partial excision of the posterior lens capsule with IOL implantation into the capsule bag of both eyes. A Hydro-4 Aspheric IOL (Rumex, UK) was implanted in the right eye, and Aspira-aAy (HumanOptic AG, Germany) – in the left one. After 3 months, on examination, attention was drawn to the diffuse opacity of the IOL of the right eye. The visual acuity was 0.01 n/k. The IOL replacement technique was as follows. Viscoelastic was injected into the anterior chamber and into the capsule bag through corneal paracentesis at 10 and 2 o'clock. The lens was dislocated into the anterior chamber and cut in half with vitreal scissors. The cut parts of the IOL were removed through a 2.2 mm tunnel at 12 o'clock. The Tecnis lens (AMO, USA) was chosen for implantation. Results and discussion. There was an increase in uncorrected visual acuity up to 0.4. There were no intra- and postoperative complications such as hemorrhagic, inflammatory, and also any from the cornea. The question remains open why, with the same tactics of the first two stages of surgical treatment of both eyes and implantation of lenses made of hydrophilic acrylic, only one IOL became cloudy. Accounting for the materials from which the IOL is made, which lens model is better to prefer to this day remains an urgent and unresolved problem for ophthalmic surgeons. Conclusion. The presence of a concomitant diabetes mellitus in the patient could influence the development of opacification of the hydrophilic acrylic IOL. Key words: IOL opacity, hydrophilic acrylic, IOL explantation, avitria.

Methods of correction of aphakia in silicone tamponade of the vitreous cavity

2021 ◽  
pp. 68-72
Author(s):  
G.O. Karpov ◽  
◽  
R.R. Fayzrakhmanov ◽  
O.A. Pavlovsky ◽  
A.V. Sukhanova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Comparative Analysis ◽  
Anterior Chamber ◽  
Intraocular Lens ◽  
Silicone Oil ◽  
Vitreous Cavity ◽  
Intraocular Lenses ◽  
Silicon Oil ◽  
Group 2 ◽  
Iol Fixation

The purpose of this study is to conduct a comparative analysis of the correction of aphakia by various models of intraocular lenses using silicon oil tamponade (SO) of the vitreous cavity. Materials and methods. The studies were conducted on 16 eyes of patients aged from 56 to 75 years (65.5±12 years) with aphakia and pathology of the vitreal cavity. The duration of the silicone tamponade was 2-3 months. Depending on the use of the type of IOL, all patients were divided into 2 groups. Results. When using an anterior chamber intraocular lens (IOL), the presence of ophthalmic hypertension was revealed in 75% of cases, which is 2.02 times higher than when using transcleral IOL fixation. In 37.5% of cases, the SO output to the anterior chamber is determined, in contrast to the group where IOL hemming was used. A higher percentage of SO migration to the anterior chamber of the eye in group 2 patients is due to a violation of the anatomy of the anterior chamber barrier and the vitreal cavity. Conclusion. Thus, in patients who underwent transcleral IOL fixation, visual acuity is 2.1 times higher than in patients who were implanted with an anterior chamber IOL. Transcleral fixation of the IOL can form the necessary barrier between the anterior and posterior chambers of the eye, and is also the closest IOL position to the physiological one. Key words: intraocular lens, silicone oil, transcleral fixation.

Treatment of the сomplications of long-term silicone oil tamponade in a patient with retinopathy of prematurity and recurrent retinal detachment

2021 ◽  
pp. 367-374
Author(s):  
A. Kolesnik ◽  
◽  
B. Malyugin ◽  
E. Pedanova ◽  
I. Gorshkov ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Retinopathy Of Prematurity ◽  
Silicone Oil ◽  
Combined Treatment ◽  
Corneal Thickness ◽  
Functional Results ◽  
Vitreous Cavity ◽  
Silicone Oil Tamponade ◽  
The Right

Objective. To present the clinical and functional results of combined treatment of the complications of long-term silicone oil tamponade in a patient with retinopathy of premature. Materials and methods. A 24-year-old patient diagnosed with stage 4b retinopathy of premature in a single seeing right eye. Between 2011 and 2020 underwent 5 microinvasive revisions of the vitreous cavity with replacement of silicone oil and median duration of silicone oil tamponade of 19+25.5 months over this entire period. Because of the constant migration of emulsified silicone oil to anterior chamber due to weakness of iridolenticular ligaments, band keratopathy developed in the right eye, opacity of the IOL due to the adhesion of precipitates on its anterior and posterior surfaces, pupillary membrane, and aggravation of the proliferative membrane on the ocular surface. UCVA was proectio incerta and IOP was 17 mmHg. The median thickness of the cornea was 853 μm, the average thickness of the corneal calcifications is 57 μm. The patient underwent revision of the vitreous cavity with removal of the pupillary membrane, the next steps were to install bandage sutures in the anterior chamber parallel to iris in two mutually perpendicular surfaces to create additional barriers to silicone oil migration. Then we used 27 mg of K3-EDTA to produce 0.1% chelating solution and to remove corneal calcium deposits. Final stage was YAG – laser discision of precipitates from the IOL surfaces. Results. Postoperatively UCVA of the right eye in 1-month was 0.05, IOP was 17 mmHg and endothelial cell density was 1200 cells / mm2. According to OCT data the median corneal thickness was 640 μm, the thickness of the epithelial layer was 39 μm. Biomicroscopically, cornea was transparent, a single silicone oil vesicle in the lower segment of anterior chamver, the bandage sutures are consistent, the IOL is centered with a transparent optical zone, silicone oil visualized on the fundus, epi- and subretinal proliferates were delimited by laser coagulates, epiretinal membrane was in the macular region. Key words: retinopathy of prematurity, silicone oil, emulsification, ribbon-like keratopathy, bandage threads, EDTA.

Extrascleral Filling Using Endoillumination the First Experiencethe

2020 ◽  
pp. 43-49
Author(s):  
V.Y. Markevich ◽  
◽  
T.A. Imshenetskaya ◽  
O.A. Yarmak ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Silicone Oil ◽  
Subretinal Fluid ◽  
Crystalline Lens ◽  
Vitreous Cavity ◽  
Macular Area ◽  
General Group ◽  
Anatomical Outcome

Purpose. To study the effectiveness of extrascleral filling (ESF) using endoillumination in the surgical treatment of patients with primary rhegmatogenous retinal detachment (RRD). Material and methods. The material for the study was the data of a comprehensive clinical examination and surgical treatment by ESF method using endoillumination in 17 patients (17 eyes) with RRD. In 7 cases (41%), the macular area was involved in the detachment process. In 5 cases (29.4%), local scleral filling was performed. In the remaining 12 cases (70.6%), the local ESF was supplemented with a circling silicone element. Surgical intervention was supplemented by transscleral drainage of subretinal fluid (SRF) in 10 cases (59%) and pneumatic retinopexy with SF6 gas 50% in 8 cases (48%). Results. In the general group of patients, best corrected visual acuity (BCVA) increased from 0.35 to 0.46. In the subgroup of patients with a detached macular area, the positive dynamics is more pronounced, BCVA increased from 0.1 to 0.28. The progression of proliferative vitreoretinopathy caused the recurrence of retinal detachment in two patients (11.8%). Recurrences were diagnosed after 3 and 5 months, respectively. In both cases, a vitrectomy with tamponade of the vitreous cavity with silicone oil 5000 Cst was performed. The percentage of successful anatomical outcome after the first operation in our study was 82%. The percentage of successful achievement of the final anatomical result was 94%. In two cases, additional injection of SF6 gas into the vitreous cavity was required. Conclusion. This type of surgical treatment is an effective method of surgical treatment of patients with RRD. In our study, the successful anatomical outcome after the first operation was recorded in 82% of patients, which correlates with the data of the authors who also used this method (83–92%). Surgeons who performed surgical treatment using this technique in our study note improved workplace ergonomics when visualizing the fundus using an operating microscope and endoillumination compared with indirect ophthalmoscopy. Other teams of authors came to this conclusion as well. In our study, there were no complications associated with the introduction of a light pipe into the vitreous cavity (iatrogenic crystalline lens injury, endophthalmitis), which indicates the safety of this type of surgical treatment.

Postoperative endophthalmitis

2021 ◽  
pp. 185-187
Author(s):  
I.A. Frolychev ◽  
◽  
N.A. Pozdeyeva ◽  
◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Silicone Oil ◽  
Angiogenesis Inhibitor ◽  
Cataract Extraction ◽  
State Institution ◽  
Federal State ◽  
Postoperative Endophthalmitis ◽  
Ophthalmic Surgery ◽  
Corrected Visual Acuity

Surgical treatment of postoperative endophthalmitis is an urgent problem of ophthalmic surgery. Purpose.The aim of the study was to analyze the results of treatment of patients with postoperative endophthalmitis using perfluorodecalin and antibiotic solutions for vitreal cavity tamponade. Materials and methods. For the period 2016-2020, 35 patients (35 eyes) were operated in the Cheboksary branch of the S. Fyodorov Eye Microsurgery Federal State Institution. In 26 patients, this complication occurred after cataract extraction, in 7 after vitreoretinal operations, in 2 after intravitreal administration of an angiogenesis inhibitor. Visual acuity before treatment of endophthalmitis in 3 patients was to 0.02– 0.08, in 16 – counting of fingers in the face, in 13 – pr.l.certa, in 3-pr. l. incerta. All patients underwent vitrectomy with perfluorodecalin tamponade of the vitreal cavity for up to 14 days and intravitreal administration of vancomycin 1 mg and ceftazidime 2.25 mg at the end of the operation. On day 2-3, all patients underwent additional intravitreal administration of antibiotics, depending on the detected pathogen. Further, in 22 patients, the removal of perfluorodecalin and the remaining preretinal and peripherally located exudate was performed, in 13 patients - tamponade of the vitreal cavity with silicone oil. Results. As a result of the treatment according to the developed method, it was possible to preserve visual functions in 32 patients (91%) out of 35. At discharge, the corrected visual acuity was from 0.1 to 0.7 (0.28±0.2). After 6 months, the corrected visual acuity in 32 patients was from 0.1 to 0.9 (0.36±0.2). Visual acuity (above 0.3) was achieved in 26 cases (74.3%). Conclusion. Clinical results demonstrate the effectiveness of the developed method of surgical treatment of endophthalmitis. Key words: postoperative endophthalmitis, perfluorodecalin, intravitreal administration of vancomycin and ceftazidime.

scholarly journals Exophiala Endophthalmitis after Cataract Surgery

2021 ◽  
Vol 62 (10) ◽  
pp. 1435-1439
Author(s):  
Tae Hwan Kim ◽  
Moon Kyung Shin ◽  
Yoon Hyung Kwon
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Anterior Chamber ◽  
Intraocular Lens ◽  
Early Stage ◽  
Vitreous Body ◽  
Complete Removal ◽  
Eye Drops ◽  
Second Surgery ◽  
The Right

Purpose: To report a case of Exophiala endophthalmitis after cataract surgery, which has not been reported previously in Korea.Case summary: A 70-year-old woman visited the hospital 7 days after cataract surgery in her right eye with unilateral vision impairment. At the time of the visit, visual acuity of the right eye was hand motion, and the fundus was not clearly observed due to numerous inflammatory cells with hypopyon in the anterior chamber. With an initial diagnosis of suspected bacterial endophthalmitis, vitrectomy was performed immediately with intravitreal injection of antibiotics and steroid. On day 14 after vitrectomy, inflammation in the anterior chamber and vitreous opacity worsened, and complete vitrectomy, including of the vitreous base, and removal of the intraocular lens and capsule was performed. Exophiala was detected in the biopsy specimen on day 6 after the second surgery, and the patient was discharged with a prescription for voriconazole eye drops. On day 23 after the second surgery, the best-corrected visual acuity in the right eye had improved to 1.0, and there was no evidence of endophthalmitis recurrence and no observed additional abnormal findings of the fundus until 6 months after second surgery.Conclusions: In a case of fungal endophthalmitis that occurred after cataract surgery, good results were obtained by vitrectomy involving complete removal of the peripheral vitreous body, including the intraocular lens and lens capsule, which was the basis for growth of the fungus in the early stage of endophthalmitis.

scholarly journals Outcomes of a Foldable Capsular Vitreous Body Implantation: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiangzhong Xu ◽  
Huimin Ge ◽  
Jiajun Li ◽  
Weihong Shang ◽  
Yuke Ji ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Ocular Trauma ◽  
Silicone Oil ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Vitreous Body ◽  
Fundus Photography ◽  
Clinical Value

Background. The vitreous body is an important part of the ocular body fluid. A foldable capsular vitreous body (FCVB) is designed to treat chronic adverse complications in severe ocular trauma and silicone oil-dependent eyes. This study is aimed at investigating a method for implanting an FCVB, its postoperative efficacy, and clinical value. Methods. A retrospective analysis was performed on data from 18 patients who underwent vitrectomy and FCVB implantation for severe ocular trauma and silicone oil-dependent eyes between March 2019 and May 2020. All treated eyes underwent clinical examinations involving the best-corrected visual acuity, intraocular pressure, FCVB position, anterior segment photography, and wide-angle fundus photography regularly after surgery. Results. Eighteen eyes from 18 patients were enrolled in this study. A total of 2.00–4.20 ( 3.46 ± 0.78 ) ml of silicone oil were injected into the FCVB during surgery. The patients were followed up at 1, 2, and 4 weeks and 3, 6, and 12 months after surgery. Twelve months after surgery, visual acuity improved in 7 (38.89%) eyes. In contrast, 10 (55.56%) eyes showed no obvious improvement, and 1 (5.56%) eye had decreased vision. Intraocular pressure at 12 months was 10.13 ± 3.52  mmHg, which was comparable to that before the surgery ( t = 0.38 , P = 0.71 ). The anterior chamber depth examined by slit lamp was 2.00–3.00 cornea thickness (CT) in 7 eyes, 1.00–2.00 CT in 2 eyes, and <1.00 CT in one eye. The anterior chamber disappeared in eight eyes. There were eight eyes with clear cornea, four eyes with localized opacity, and two eyes with obvious gray-white opacity. There was no case of severe FCVB deflection, rupture, or exposure during the observation period. Conclusion. FCVB implantation is an effective and safe treatment for eyes with severe ocular trauma and silicone oil-dependent eyes. It may support retinal reattachment, slow down eyeball atrophy, reduce the risk of chronic adverse complications such as corneal endothelial decompensation, and maintain intraocular pressure and preoperative visual function.

scholarly journals LETTER TO THE EDITOR Excision of Congenital Bilateral Persistent Pupillary Membrane in a Child with Exotropia

2015 ◽  
Vol 9 (1) ◽  
pp. 33-35
Author(s):  
Michiko Iida ◽  
Tatsuya Mimura ◽  
Mari Goto ◽  
Yuko Kamei ◽  
Aki Kondo ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Surgical Treatment ◽  
Histopathological Examination ◽  
Crystalline Lens ◽  
Ocular Tissues ◽  
Corrected Visual Acuity ◽  
The Right ◽  
Best Corrected Visual Acuity ◽  
High Hyperopia

Purpose : To report the clinical and histopathological findings of a patient who had bilateral persistent pupillary membrane with exotropia and high hyperopia. Methods : Case Report: A 7-year-old boy presented with a persistent pupillary membrane in both eyes. His best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/32 in the left eye with exotropia of 18 prism diopters. He underwent surgical resection of both membranes. At 5 months postoperatively, BCVA was 20/20 with final bilateral refraction of +6.5 D in both eyes. Exotropia and photophobia showed improvement immediately after surgery. Histopathological examination revealed typical features of normal iris tissue in the excised membranes. Conclusion : Bilateral persistent pupillary membranes were excised successfully without injury to other ocular tissues, including the crystalline lens. Surgical treatment may be required for the management of persistent pupillary membrane associated with visual impairment such as exotropia or photophobia.

scholarly journals Outcomes of Application Two-Piece Microkeratome-Assisted Mushroom Keratoplasty

2021 ◽  
Vol 18 (1) ◽  
pp. 70-76
Author(s):  
S. V. Trufanov ◽  
E. A. Budnikova ◽  
V. N. Rozinova
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Surgical Treatment ◽  
Anterior Chamber ◽  
Cell Density ◽  
Endothelial Cell Density ◽  
Corneal Astigmatism ◽  
Descemet Membrane ◽  
Donor Material ◽  
Specific Complication

Purpose: to evaluate outcomes and to expose possible specific complications of two-piece mushroom keratoplasty.Patients and methods. A total of 9 patients (9 eyes) with corneal perforations and deep stromal opacities involving the Descemet membrane were undergone surgery. In all cases, preserved hypothermic corneoscleral buttons (in Borzenok– Moroz medium) for up to 5 days were used as donor material. The two-piece mushroom keratoplasty was performed using a microkeratome and vacuum trephines set in the variant proposed by M. Busin.Results. Success survival was obtained in 78 % of patients (7 out of 9 cases). Best spectaclecorrected visual acuity (BSCVA) 1 year after surgery averaged 0.54 ± 0.20. The average of corneal astigmatism was 3.41 ± 1.89 D. Endothelial cell density in 6 months after surgery was on average 2364 ± 236/mm2, and in 1 year — 2082 ± 228/mm2. A false chamber formation between separate parts of the graft as a specific complication was detected in 2 patients on 1 day after surgery. In one case it was eliminated by air re-injecting into the ocular anterior chamber. The second patient underwent conventional PKP due to the lack of graft adaptation. In addition, 1 patient also underwent conventional PKP as a result of postoperative crystalline infectious keratopathy, which is the non-specific complication of mushroom keratoplasty.Conclusion. The two-piece microkeratome-assisted mushroom keratoplasty is an effective method of surgical treatment of corneal perforations and deep stromal opacities involving the Descemet membrane.

scholarly journals EXPERIENCE OF SURGICAL TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY

2016 ◽  
Vol 1 (6) ◽  
pp. 118-121
Author(s):  
Казеннов ◽  
Aleksey Kazennov ◽  
Канюков ◽  
Vladimir Kanyukov ◽  
Трубина ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Visual Function ◽  
Silicone Oil ◽  
Antihypertensive Drugs ◽  
Direct Action ◽  
Blood Clot ◽  
Vitreous Cavity ◽  
Transscleral Cyclophotocoagulation

The study included 48vitreoretinal surgeries performed during 2014-2015 in 39patients with advanced fibrovascular stage of proliferative diabetic retinopathy. Visual acuity before the surgery averaged from pr. l. certae to 0.01. In 7cases patients underwent intravitreal injection of Lucentis 2–3weeks before the surgery. The surgery was performed according to the standard 3-port 25G vitrectomy. In some cases, short-term tamponade of vitreous cavity by fluid perfluororganic compounds (PFOS) was performed for 2–3days. This was due to prolonged bleeding during the surgery. In these cases, fibrinolytic of direct action (hemasa) was injected directly to the blood clot. In 4 cases circular retinotomy was needed. In 35cases tamponade was made by silicone oil 5700cSt, in 13 – by air-gas mixture. In cases of air-gas tamponade 3 patients had a relapse. After vitreous cavity revision it was plugged with silicone oil 5700cSt. In 17cases visual function remained unchanged, in 18 cases the changes were imperceptible, in 9cases visual acuity improved to 0.2, in 3cases – visual function increased to 0.4 and in 1patient – to 0.7. In postoperative period IOP increased in 7 cases. In 5 of these cases compensation was achieved with antihypertensive drugs. In one case the patient was implanted leukosapphire drainage, and in one more case transscleral cyclophotocoagulation about terminal aching glaucoma was performed. The silicone oil was removed in 6patients at the period of 6 months up to 2years.

scholarly journals Spontaneous levitation of dropped nucleus on first post-operative day

2017 ◽  
Vol 5 ◽  
pp. 2050313X1770871
Author(s):  
Mayuresh P Naik ◽  
Harindersingh Sethi ◽  
Anuj Mehta ◽  
Abhinav Bhalla ◽  
Komal Saluja
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Posterior Segment ◽  
Vitreous Cavity ◽  
Fundus Examination ◽  
Anterior Vitrectomy ◽  
Retinal Tear ◽  
Corrected Visual Acuity ◽  
Grade Iii ◽  
Best Corrected Visual Acuity

A 60-year-old male patient presenting with gradual painless progressive diminution of vision was diagnosed with nuclear sclerosis grade III (LOCS). Intra-operatively, there was a nuclear drop into the vitreous cavity. The patient was left aphakic and was deferred for further vitreoretinal procedure the next day. On first post-op day, the nucleus fragment (of roughly the same size that had dropped into the vitreous) was seen in the anterior chamber. A gentle ultrasonography B-Scan done for posterior segment evaluation was anechoic. Incision was enlarged and viscoexpression of the nucleus fragment was done followed by thorough anterior vitrectomy. Post-operatively, dilated full fundus examination showed clear vitreous cavity without any evidence of retinal tear or detachment. This was later confirmed by an anechoic ultrasonography B-Scan. After 2 weeks, three-piece foldable IOL was placed in the sulcus with posterior optic capture and the patient attained a best-corrected visual acuity of 6/9P.

Sign in / Sign up

Export Citation Format

Share Document