Features of Surgical Correction of Spontaneous Luxation of the Complex “IOL Posterior Chamber – Capsular Bag”

Luxation of intraocular lens in capsular bag several years after cataract surgery leads to a decrease in visual function and requires surgical treatment.Aim: to determine effectiveness of various types of surgical treatment of late spontaneous dislocations of IOL in capsular bag.Methods. Analysis of 123 case histories of patients with late IOL dislocation, operated in 2013–2015, was made. First group included patients with replaced IOLs dislocated into pupillary lens. Second group consisted of patients who underwent reposition and suture of IOL to iris. Examination was made before operation and 6–12 months after operation. Results. The average term from moment of IOL implantation to its luxation was 8.78 ± 4.85 years. II degree of dislocation was detected in 74 % of patients, III degree of dislocation – in 10 %, and IV degree – in 16 % of patients.Uncorrected visual acuity was reduced to 0.15 ± 0.16; best corrected visual acuity to 0.31 ± 0.26. In 83.7 % of patients a pseudoexfoliation syndrome was detected. In 62.6 % of patients IOL luxation was accompanied byhydrodynamic disturbances. Best corrected visual acuity in period from 6 to 12 months after surgery was 0.40 ± 0.24, and after IOL reposition – 0.49 ± 0.22. In addition, after IOL replacement a significant increase in postoperative astigmatism was noted from –0.44 ± 0.84 to –1.96 ± 1.60 D (p < 0.001).Conclusion. As a result of surgical treatment of late spontaneous IOL dislocations in both groups increase in distance uncorrected and best corrected visual acuity was noted. Insufficient visual functions after surgical treatment were caused by concomitant pathology as well as increased postoperative astigmatism.

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27-gauge trocar-assisted transconjunctival sutureless intraocular lens scleral fixation

European Journal of Ophthalmology ◽

10.1177/1120672120919068 ◽

2020 ◽

pp. 112067212091906

Author(s):

David Vladimir Diamint ◽

Juan Martin Giambruni

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Intraocular Lens ◽

Posterior Chamber ◽

Surgery Complications ◽

Scleral Fixation ◽

Sutureless Technique ◽

Corrected Visual Acuity ◽

Cataract Surgery Complications ◽

Best Corrected Visual Acuity

Objective To present the surgical outcome of posterior chamber intraocular lens scleral fixation using a 27-gauge trocar-assisted transconjunctival sutureless technique in aphakic patients due to cataract surgery complications with inadequate capsular support. Methods Six consecutive patients with aphakia due to cataract surgery complications with inadequate capsular bag support were operated by two surgeons. Intraocular lens scleral fixation was performed with a 27-gauge trocar-assisted transconjunctival sutureless technique. Patients were followed-up for 12 months. Preoperative and postoperative best-corrected visual acuities were assessed with Early Treatment Diabetic Retinopathy Study charts and expressed in decimals. Results All patients showed statistically significant best-corrected visual acuity improvement and excellent anatomic results. Mean preoperative best-corrected visual acuity was 0.17 (range of 0.1–0.2). Mean postoperative best-corrected visual acuity was 0.84 (range of 0.63–1.00). Mean initial spherical equivalent refractive error was +11.85 (range of +9.00 to +15.00). Mean final spherical equivalent refractive error was –0.25 (range of –1.25 to +2.25). There were no postoperative complications during the whole follow-up. Conclusion Fixation of a posterior chamber intraocular lens using a 27-gauge trocar-assisted transconjunctival sutureless intrascleral technique is an excellent option for aphakic patients secondary to cataract surgery complications with inadequate capsular support.

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Visual outcome following scleral fixated intraocular lens implantation

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v16i2.18478 ◽

2017 ◽

Vol 16 (2) ◽

pp. 63-68

Author(s):

Chunu Shrestha ◽

Sabina Shrestha ◽

Aparajita Manoranjan

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Visual Outcome ◽

Posterior Chamber ◽

Visual Rehabilitation ◽

Post Surgery ◽

Corrected Visual Acuity ◽

The Common ◽

Best Corrected Visual Acuity ◽

Scleral Fixated Intraocular Lens

Introduction: Scleral fixated intraocular lens(SFIOL) implantation to correct aphakia offers superior visual rehabilitation in comparison to aphakic spectacles or contact lens. This study was done to evaluate a simplified technique of scleral fixation of posterior chamber intra-ocular lens (IOL) in terms of visual outcome and complications.Methods: This was a prospective study enrolling 23 eyes of 23 patients who underwent anterior vitrectomy followed by ab-externo sclera fixation of posterior chamber IOL using 10.0 polypropylene sutures from January 2016 to February 2017 in Nepal Eye Hospital.Scleral flap was made at 3 and 9'o clock meridian to cover the knots which prevent erosion of the knots through conjunctiva. Main outcome measures were post-operative best corrected visual acuity and post-operative complications.Result: Best corrected visual acuity were 6/6 - 6/18 in 86.9% (n=20), 6/24 - 6/60 in 8.7% (n=2) and worse than 6/60 in 4.3% (n=1)at six months followup. The mean spherical equivalent before surgery was +10.60 diopter and -1.14 diopter post-surgery. The common indicationsfor scleral fixated intraocular lens weretrauma in 60.86% (n=14), surgical aphakia in21.73% (n=5), spontaneous posterior dislocation of lens in 13.0% (n=3) and subluxated intraocular lens in 4.34% (n=1). The common complications were astigmatism in 91.30% (n=21), decentered IOL in 4.34% (n=1) and uveitis in 4.35% (n=1).Conclusion: Ab-externosclerated fixated intraocular lens is a safe and effective method for visual rehabilitation with low post-operative risk.

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

The Open Ophthalmology Journal ◽

10.2174/1874364101509010033 ◽

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.

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Changes in macular thickness post uncomplicated MSICS & phacoemulsification surgery

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.124 ◽

2022 ◽

Vol 7 (4) ◽

pp. 619-623

Author(s):

Kartika Anand ◽

Ashutosh Dokania

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Macular Thickness ◽

Posterior Chamber ◽

Prospective Clinical Study ◽

Small Incision Cataract Surgery ◽

Corrected Visual Acuity ◽

Clinically Significant ◽

Clinically Significant Macular Oedema ◽

Best Corrected Visual Acuity

To evaluate changes in macular thickness via-a-vis visual acuity post uncomplicated manual small incision cataract surgery (MSICS) & phacoemulsification surgery Prospective clinical study on 160 patients of uncomplicated immature senile cataract, aged 40-70yrs, patients were randomised into two groups, MSICS & phacoemulsification, by simple 1:1 randomization, who underwent uncomplicated cataract surgery with posterior chamber intraocular lens (PCIOL). Post-operatively, the patients were evaluated for best corrected visual acuity (BCVA) and changes in macular thickness by optical coherence tomography (OCT) at post-op Day 1, 7, 21, 48, and 12 weeks. Paired t-test was used for comparison across follow up. : At 12 weeks post-operative, mean logMAR BCVA was 0.01±0.02 for MSICS group and 0±0.02 for Phacoemulsification group. Macular thickness was not statistically significant (p=0.342) between MSICS group (219.19±17.88µm) and Phacoemlusification group (215.61±16.21µm), at the end of 12 weeks post-operative. Clinically significant macular oedema was not diagnosed in any of the patients at the follow-ups.: Both procedures achieved good post-operative Best Corrected visual acuity without significant differences in BCVA between both the groups at the end of 12 weeks.

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Unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia

European Journal of Ophthalmology ◽

10.1177/1120672119877159 ◽

2019 ◽

pp. 112067211987715

Author(s):

Pablo Sanjuán ◽

Borja Salvador-Culla ◽

Maria Isabel Canut ◽

Rafael I Barraquer

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

High Myopia ◽

Anterior Segment ◽

Cataract Extraction ◽

Posterior Chamber ◽

Visual Axis ◽

Filtering Bleb ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

Purpose: To report a case of a unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia. Clinical case: A 33-year-old woman with high myopia (–18 D) presented with discomfort in the left eye. Ocular history included pars plana vitrectomy and cataract extraction and posterior chamber intraocular lens implantation in the left eye. Best-corrected visual acuity was 0.65 and intraocular pressure was 20 mmHg. Slit-lamp examination showed a filtering bleb in the upper-temporal quadrant, which extended and dissected the proximal cornea without affecting the visual axis. The morphology and content of the bleb was studied with anterior segment optical coherence tomography, which ruled out a corneal-scleral fistulization into the subconjunctival space. The spontaneous filtering bleb was resected surgically. Due to her high myopia, two strips of fascia lata were used to strengthen the area. In the postoperative period, a complete resection of the bleb was confirmed, without apparent leaking points and with a well-vascularized conjunctiva. No complications were noted. The patient maintained the same best-corrected visual acuity and intraocular pressure than before surgery. Conclusion: The formation of a spontaneous filtering bleb is a rare entity in patients with high myopia, whose risk increases due to their thinned sclerae. The risk is even greater if they have undergone ocular surgeries. Resection of the filtering bleb in our case halted the progression of the corneal dissection, therefore respecting the transparency of the visual axis and preserving visual acuity.

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Analysis of the surgical treatment of posterior lenticonus associated with congenital cataract

Russian Pediatric Ophthalmology ◽

10.18821/1993-1859-2016-11-3-138-143 ◽

2016 ◽

Vol 11 (3) ◽

pp. 138-143

Author(s):

K. B Pershin ◽

N. F Pashinova ◽

Alina Vasil’evna Cherkashina ◽

A. Yu Tsygankov

Keyword(s):

Visual Acuity ◽

Surgical Treatment ◽

Intraocular Lens ◽

Congenital Cataract ◽

Intraocular Lenses ◽

Entire Group ◽

Intraocular Lens Implantation ◽

Corrected Visual Acuity ◽

Lens Implantation ◽

Best Corrected Visual Acuity

Aim. The objective of the present study was to analyze the results of the surgical treatment of the children presenting with posterior lenticonus associated with congenital cataract. Materials and methods. The total of 8 children (8 eyes) with posterior lenticonus enrolled in this study accounted for 6.5% of all cases of congenital cataract treated at the “Excimer” Eye Center during the period from 2003 to 2015. The age of the patients varied from 0.2 to 15 (mean 8.1±3.8) years. Preoperatively, the uncorrected visual acuity was estimated to be 0.11±0.1 (0.01 - 0.3), with the best corrected visual acuity being 0.15±0.13 (range: 0.01 - 0.4). Lensectomy was performed under general anesthesia by means of the incision technology (1.8 and 2.2 mm) with the use of the Millenium, Stellaris microsurgical system (Bausch and Lomb, USA) and the Infinity system (Alcon, USA). In all the cases, different IOL models (Alcon, USA) were implanted; in four cases, the toric intraocular lenses were used. Results. In all the patients with posterior lenticonus and congenital cataract, the “dry” aspiration of the lens was performed. The distinctive features of posterior capsulorhexis included the use of two viscoelastic materials, viz. heavy Healon GV applied over the intraocular lens and ProVisc applied under the intraocular lens in the form of a “layer cake”. Thereafter, posterior capsulorhexis and vitrectomy were done. The lens was implanted into the capsular bag (n = 6) and into the ciliary sulcus (n = 2) with the anterior and posterior “optic capture”; the edges of the optical hole were placed behind the capsulorhexis hole. In the cases of the initial posterior capsular defect (n = 3), we performed vitreorhexis and vitrectomy followed by intraocular lens implantation. The best corrected visual acuity increased from 0.15 before the operation to 0.72 after surgery, with astigmatism being reduced from 2.3±0.9 to 1.6±065 diopters (overall astigmatism for the entire group) and from 1.81±0.46 to 0.56±0.56 diopters for the subgroup treated by means of toric IOL implantation. The patients remained under the observation during the follow-up period of more than 36 months. Conclusion. Lensectomy followed by intraocular lens implantation used for the treatment of the children presenting with posterior lenticonus and congenital cataract is the efficient method for the management of this combined pathology. Such features of the surgical technique as “dry” aspiration of the lens mass, posterior capsulorhexis, anterior vitrectomy, and optical capture taken together make it possible to achieve the favourable and stable functional outcome of the treatment.

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Cataract surgery in camp patients: a study on visual outcomes

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v3i2.5270 ◽

1970 ◽

Vol 3 (2) ◽

pp. 159-164

Author(s):

SG Pai ◽

SJ Kamath ◽

V Kedia ◽

K Shruthi ◽

A Pai

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Visual Outcome ◽

Posterior Chamber ◽

Small Incision Cataract Surgery ◽

Evaluation Team ◽

Visual Outcomes ◽

Corrected Visual Acuity ◽

Operative Complications ◽

Best Corrected Visual Acuity

Aim: To assess the complications and visual outcomes associated with cataract surgery in camp patients operated at a tertiary centre. Materials and methods: In a retrospective study, 206 outreach camp patients had undergone cataract surgeries with posterior chamber intraocular lens implantation under peribulbar anesthesia over a period of 6 months. Post-operative complications on Day 1 were graded as per Oxford Cataract Treatment and Evaluation Team (OCTET) definitions. One month postoperative complications, best corrected visual acuity and refractive errors were assessed. Results: 206 eyes underwent cataract extraction with PCIOL implantation. Small incision cataract surgery (SICS) was the commonest method (78.6%) used. The most common first post-operative day complication was mild iridocyclitis (26.2%). The complications were based on OCTET definitions, and showed that 33 % had Grade I and 3.4 % had Grade II complications. The major post-operative complication after 4 weeks of surgery was posterior capsular opacity. 89.8 % of the eyes had a 4 week-post-operative best corrected visual acuity of e” 6/24. The commonest refractive error was myopia with against the rule astigmatism, seen in 86 out of 150 cases. Conclusion: High quality cataract surgery with a low rate of intra-operative complications and good visual outcome can be attained in camp patients operated in the base hospitals, thus justifying more similar screening camps to clear the vast cataract backlog. Key words: cataract surgery, eye camp, visual outcomes DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5270 Nepal J Ophthalmol 2011; 3(2): 159-164

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Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Eye and Vision ◽

10.1186/s40662-020-00219-x ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Jiahui Chen ◽

Lina Lan ◽

Yating Tang ◽

Yi Lu ◽

Yongxiang Jiang

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Postoperative Complications ◽

Capsular Tension Ring ◽

Corrected Visual Acuity ◽

Pressure Spike ◽

Cleft Closure ◽

Best Corrected Visual Acuity ◽

Capsular Bag ◽

Cyclodialysis Cleft

Abstract Background To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis. Methods A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis. Outcome measures included intraocular pressure, best-corrected visual acuity, and postoperative complications. Results Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years. The cyclodialysis cleft extended over 2.9 clock hours (range 0.5–6.5). The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes. At the last follow-up, the cyclodialysis cleft was closed in 16/20 (80.0%) eyes. The intraocular lens was stable in all patients postoperatively. Best-corrected visual acuity, in terms of the logarithm of the minimal angle of resolution, improved from 1.3 ± 0.8 before surgery to 0.4 ± 0.3 after surgery (P < 0.001). Intraocular pressure increased significantly from 10.6 ± 3.2 mmHg before surgery to 13.0 ± 4.8 mmHg after surgery (P = 0.040). Postoperative complications included a painful reversible intraocular pressure spike in four patients (20.0%). Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of ≥ 10 mmHg. Conclusions The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe, successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

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New surgical approach for sutureless scleral fixation

European Journal of Ophthalmology ◽

10.1177/1120672120902020 ◽

2020 ◽

Vol 30 (3) ◽

pp. 612-615 ◽

Cited By ~ 10

Author(s):

Chiara Veronese ◽

Chiara Maiolo ◽

Grayson W Armstrong ◽

Laura Primavera ◽

Carlo Torrazza ◽

...

Keyword(s):

Visual Acuity ◽

Surgical Technique ◽

Intraocular Lens ◽

Posterior Chamber ◽

Scleral Fixation ◽

Refractive Outcomes ◽

Corrected Visual Acuity ◽

Change In The Mean ◽

Intraocular Lens Decentration ◽

Best Corrected Visual Acuity

Purpose: The aim of this article is to describe a novel surgical technique for sutureless scleral fixation of an intraocular lens using the newly developed FIL SSF Carlevale IOL (Soleko, Italy). Methods: Four eyes of four patients with poor capsular support were recruited to our study, three resulting from intraocular lens subluxation and one case resulting from traumatic cataract. A novel sutureless sclera-fixated intraocular lens was implanted into the posterior chamber of each eye with sclerocorneal plugs fixating the lens to the wall of the eye. Results: Mean age of patients was 52 ± 16 years, ranging from 35 to 70 years. Mean follow-up was 6.50 ± 1.29 months (range: 5–7 months). Mean preoperative best-corrected visual acuity was 0.50 ± 0.33 logMAR (range: 1–0.3 logMAR). Postoperative best-corrected visual acuity improved to 0.08 ± 0.08 logMAR (range: 0.2–0 logMAR). There was no significant change in the mean intraocular pressure and there were no postoperative complications, such as iatrogenic distortion or breakage of the intraocular lens haptic, intraocular lens decentration, endophthalmitis, or retinal detachment. Discussion: To the best of our knowledge, this is the first report of outcomes using the novel sutureless sclera-fixated FIL SSF Carlevale IOL. This new surgical technique offers a simplified and effective approach for sutureless scleral intraocular lens fixation with good refractive outcomes.

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Outcome of surgery for traumatic cataract in children in a child eye health tertiary facility, Ibadan, Nigeria

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211005308 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110053

Author(s):

Mary Ogbenyi Ugalahi ◽

Bolutife Ayokunnu Olusanya ◽

Olanipekun Olalekan Aremu ◽

Aderonke Mojisola Baiyeroju

Keyword(s):

Visual Acuity ◽

Traumatic Cataract ◽

Eye Health ◽

Corrected Visual Acuity ◽

Surgical Methods ◽

Outcome Of Surgery ◽

Best Corrected Visual Acuity ◽

Capsular Bag ◽

Childhood Cataract ◽

Ibadan Nigeria

Objective: The objective of this study was to describe the outcome of surgery for traumatic cataract and associated factors in children aged 16 years and below operated in a tertiary facility. Methods: This was a retrospective review of records of children who had surgery for traumatic cataract between August 2015 and August 2019. Information on biodata, preoperative visual acuity, surgical methods, complications, and postoperative visual acuity were retrieved. Data were analyzed using IBM SPSS Statistics 20.0. Results: Traumatic cataract accounted for 87 (14.7%) of 593 eyes operated for childhood cataract during the period. Of these, a total of 79 records were available for review. There were 56 (70.9%) males with a mean age of 10.11 (±3.39) years. All injuries were unilateral; closed globe injuries accounted for 70 (88.8%) of the cataracts and the left eye was affected in 42 (53.2%) patients. Fifty-two (67.09%) eyes had other ocular injuries apart from cataracts. The morphology of the cataract was membranous in 44 (55.7%) eyes, and 76 (96.2%) eyes had cataract surgery with intraocular lens (IOL) implantation; 39 (51.3%) of these IOLs were implanted within the capsular bag. The preoperative best corrected visual acuity was worse than 6/18 in all 79 (100%) eyes and improved to 6/18 or better in 32 (40.5%) eyes at 3 months postoperatively. Conclusion: Traumatic cataract accounted for less than a quarter of all childhood cataracts in our center. Majority of the eyes had successful IOLs implantation during surgery, and the best corrected visual acuity improved in a moderate proportion of these patients.

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