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

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.

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Prognostic Factors for Low Visual Acuity after Cataract Surgery with Vitreous Loss

Journal of Ophthalmology ◽

10.1155/2021/6691904 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Michael Mimouni ◽

Michal Schaap-Fogler ◽

Philip Polkinghorne ◽

Gilad Rabina ◽

Rita Ehrlich

Keyword(s):

Visual Acuity ◽

Prognostic Factors ◽

Cataract Surgery ◽

Intraocular Lens ◽

Axial Length ◽

Visual Outcome ◽

Multivariable Logistic Regression Analysis ◽

Iol Implantation ◽

Secondary Iol Implantation ◽

Vitreous Loss

Purpose. The purpose of this study is to find prognostic factors associated with low visual acuity in patients experiencing vitreous loss during cataract surgery. Methods. A retrospective, noncomparative, interventional, case study of patients experiencing vitreous loss during cataract surgery. Data collected included demographics, best corrected visual acuity (BCVA), axial length (AL), presence of ocular comorbidity affecting central vision, timing of intraocular lens (IOL) implantation, position of the implanted lens, and the presence of corneal sutures. Low visual outcome was defined as BCVA < 20/40. Results. Overall, 179 patients (60.3% males) with a mean age of 73 ± 12 years and axial length of 23.5 ± 1.3 mm with a mean follow-up of 12 ± 13 months were included. In multivariable logistic regression analysis, low visual outcome was independently associated with persisting postoperative complications (OR 6.25, 95% CI 1.378–30.9), preexisting ocular comorbidities (OR 4.45, 95% CI 1.1–18.00), and secondary intraocular lens (IOL) implant (OR 10.36, 95% CI 1.8–60.00). Conversely, pars plana vitrectomy (PPV) for dislocated fragments of lens material, age > 70 years, gender, axial length, degree of surgeon, corneal suturing, and anterior chamber lens implantation were not found to have significant associations with low visual outcomes ( P > 0.05 ). Conclusions. Low visual outcome after vitreous loss during cataract surgery was associated with ocular comorbidities, secondary IOL implantation, development of cystoid macular edema, and additional surgical complications.

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Primary and Secondary Intraocular Lens Implantation in Congenital Cataract Surgery: A Retrospective Comparative Study of the Visual Outcomes

Journal of Ophthalmology & Clinical Research ◽

10.33140/jocr/01/01/00004 ◽

2017 ◽

Vol 1 (1) ◽

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Cataract Surgery ◽

Intraocular Lens ◽

Congenital Cataract ◽

Iol Implantation ◽

Visual Outcomes ◽

Secondary Iol Implantation ◽

Myopic Shift ◽

Congenital Cataract Surgery

Objectives: To compare visual outcomes, principally myopic shift, visual acuity, intraocular pressure and strabismus between primary and secondary intraocular lens (IOL) implantation following congenital cataract surgery. Methods: A retrospective study of the long-term ocular outcomes in primary versus secondary IOL implantation (IOL-I) following congenital cataract surgery was conducted. We analyzed the files of all children with congenital cataract who underwent unilateral or bilateral lensectomy, posterior capsulotomy and anterior vitrectomy followed by primary or secondary IOL-I between 2000 to 2012, at King Abdulaziz University Hospital, Jeddah. Preoperative and postoperative assessment of each operated eye in terms of axial length, refractive errors, strabismus as well as (post IOL-I) intraocular pressure (IOP) and best corrected visual acuity (BC-VA) were collected and analyzed. Results: Data of 26 eyes of 14 patients (9 males, 6 females) was analyzed: 16 (61.5%) eyes underwent lensectomty and anterior vasectomy with primary IOL-I and 10 (38.5%) eyes underwent lumpectomy and anterior vasectomy with secondary IOL-I. Mean age at cataract surgery was 67.53 (± 48.70) months in the group of primary IOL-I versus 5.90 (± 3.72) months in the group of secondary IOL-I; and patients were followed up for 49.33 (± 26.23) versus 86.50 (± 23.36) months, respectively (p=.051). In the secondary IOL-I group, the mean of time from primary lensectomy to IOL-I was 50.44 (± 18.41) months. Last BC-VA showed better outcomes in primary IOL-I group as 10 eyes (83.3%) with good VA versus only 2 eyes (20%) in the secondary IOL-I, (p=0.009). Myopic shift was greater in secondary IOL group 10.86 (± 11.62) versus 0.19 (± 2.38) diopters (D) in primary IOL (p=0.046*); while no significant difference was observed in IOP (p=0.697). No case of isotropic was detected in primary versus 6 cases in the secondary IOL group. Conclusion: Visual outcomes, including visual acuity, strabismus and myopic shift were better in the group of children who underwent primary IOL implantation at age of >2 years, when compared to those with secondary IOL implantation at the age of <2 years, following congenital cataract surgery. However, poor visual acuity in the secondary IOL group was mainly explained by the relatively higher prevalence of eye complications in this group.

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Outcomes and Complications of Concurrent Pars Plana Vitrectomy and Scleral-Fixated Intraocular Lens Placement Using Gore-Tex Suture

Journal of VitreoRetinal Diseases ◽

10.1177/2474126419895691 ◽

2019 ◽

Vol 4 (2) ◽

pp. 119-124

Author(s):

H. Russell Day ◽

Alia K. Durrani ◽

Stephen J. Kim ◽

Shriji Patel

Keyword(s):

Visual Acuity ◽

Postoperative Complications ◽

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Vitreous Hemorrhage ◽

Posterior Chamber ◽

Pars Plana ◽

The Mean ◽

Scleral Fixated Intraocular Lens

Purpose: The authors aim to describe the visual outcomes and postoperative complications of concurrent pars plana vitrectomy and scleral-fixated intraocular lens (IOL) placement using Gore-Tex suture. Methods: A retrospective review of medical records was performed on 27 eyes of 27 patients undergoing concurrent pars plana vitrectomy and scleral-fixated IOL with Gore-Tex suture. Outcome measures were change in preoperative and postoperative visual acuity, final manifest refraction, and incidence of intraoperative and postoperative complications. Results: The mean age was 69.2 ± 11.3 years; there were 16 male patients (59%). The duration of follow-up ranged from 33 to 576 days with a mean of 200 ± 143 days. All patients received Bausch + Lomb Akreos AO60 IOL. The overall mean best-corrected visual acuity in Snellen equivalent improved from 20/276 preoperatively to 20/44 postoperatively ( P < .001). The mean postoperative manifest spherical equivalent refraction was –0.35 ± 1.34 diopters (D). Seventy-five percent of eyes were ± 1.0 D of target refraction. Postoperative complications included corneal edema (26.0%), ocular hypertension (25.9%), hypotony (7.4%), cystoid macular edema (7.4%), vitreous hemorrhage (7.4%), and hyphema (3.7%). No cases of suture breakage, IOL dislocation, retinal detachment, or uveitis–glaucoma–hyphema syndrome were identified. Conclusions: The use of Gore-Tex suture for posterior chamber IOL fixation resulted in favorable outcomes. No suture-related complications occurred during the follow-up period. Final refraction in this setting is typically within ± 1.0 D of target.

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Postoperative Endophthalmitis Caused by Cutibacterium (Formerly Propionibacterium) Acnes: Case Series and Review

Case Reports in Ophthalmology ◽

10.1159/000510208 ◽

2021 ◽

pp. 1-10

Author(s):

Benjamin J. Fowler ◽

Darlene Miller ◽

Xiaohe Yan ◽

Nicolas A. Yannuzzi ◽

Harry W. Flynn Jr.

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Clinical Features ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Postoperative Endophthalmitis ◽

Cutibacterium Acnes ◽

Pars Plana ◽

Microbiologic Diagnosis

We report the clinical features, treatment strategies and outcomes in a series of patients with infectious endophthalmitis after cataract surgery caused by Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes). This retrospective case series includes six eyes of six patients with chronic postoperative endophthalmitis caused by culture-proven C. acnesfrom December 2010 to July 2019 at a University referral center. All patients underwent prior cataract extraction with intraocular lens (CE/IOL) implantation. The mean time between cataract surgery and the microbiologic diagnosis of endophthalmitis was 7.4 ± 5.2 months (range 1.5–17 months). The average time from obtaining the specimen to culture positivity was 7.7 ± 4.4 days (range 3–15 days). Three eyes (50%) presented with hypopyon and three eyes (50%) presented with prominent keratic precipitates without hypopyon. Presenting visual acuity ranged from 20/25 to 2/200. Initial treatments included intravitreal antibiotics alone (n = 2), pars plana vitrectomy (PPV) with partial capsulectomy and intravitreal antibiotics (n = 3), and pars plana vitrectomy with IOL removal and intravitreal antibiotics (n = 1). Follow-up treatments included IOL removal (n = 2), intravitreal antibiotics (n = 1), and topical antibiotics (n = 1). The best-corrected visual acuity at last follow-up was 20/70 or better in all patients. In a literature review, the clinical features and treatment outcomes for all case series of delayed-onset postoperative endophthalmitis caused by C. acnes(n = 120) are listed. A definitive cure (the absence of recurrent inflammation) was achieved in 100% of patients that underwent IOL removal, in 77% of those that underwent PPV/partial capsulectomy and intravitreal antibiotics, and in 18% of cases treated with intravitreal antibiotics alone. Endophthalmitis after CE/IOL caused by C. acnesis characterized by slowly progressive intraocular inflammation and has a protracted course from surgery to microbiologic diagnosis. Visual outcomes are generally favorable, but IOL explantation may be necessary for definitive cure.

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Recurrent Intraocular Lens Dislocation in a Patient with Familial Ectopia Lentis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094545 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4545

Author(s):

Tomasz K. Wilczyński ◽

Alfred Niewiem ◽

Rafał Leszczyński ◽

Katarzyna Michalska-Małecka

Keyword(s):

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Vision Loss ◽

Silicone Oil ◽

Single Case ◽

Recurrent Dislocation ◽

Ectopia Lentis ◽

Pars Plana ◽

The Right

A 36-year-old patient presented to the hospital with recurrent dislocation of the intraocular lens (IOL). The patient with the diagnosis of familial ectopia lentis was first operated on for crystalline lens subluxation in the left eye in 2007 and in the right eye in 2009. In both eyes, lens extraction with anterior vitrectomy and transscleral fixation of a rigid IOL was performed. In 2011, the IOL in the right eye luxated into the vitreous cavity due to ocular trauma. The patient underwent a pars plana vitrectomy with the IOL resuturation to the sclera. Seven years later, a spontaneous vision loss in the right eye was caused by a retinal detachment. The pars plana vitrectomy with silicone oil tamponade and a consequential oil removal three months later were performed in 2018. The follow-up examination revealed recurrent IOL dislocation in the same eye. Due to a history of previous suture-related complications a decision was made to remove the subluxated rigid polymethyl-methacrylate (PMMA) IOL and fixate to sclera a sutureless SOLEKO FIL SSF Carlevale lens. The purpose of this report is to present a single case of a 36-year-old patient who was presented to the hospital with recurrent dislocation of the intraocular lens. In a three-month follow-up period, a good anatomical and functional outcome was finally obtained with transscleral sutureless intraocular lens. This lens is an option worth considering especially in a young patient with a long life expectancy and physically active.

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Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

BMC Ophthalmology ◽

10.1186/s12886-021-01872-z ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Pars Plana ◽

Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

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Cataract Surgery and Uveitis

Annals of King Edward Medical University ◽

10.21649/akemu.v9i3.1332 ◽

2016 ◽

Vol 9 (3) ◽

Author(s):

Mumtaz Hussain ◽

Muhammad Moin ◽

Nazir Ahmad Aasi ◽

Muhammad Waqas ◽

Jawaid Mughal

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

General Hospital ◽

Cataract Extraction ◽

Extracapsular Cataract Extraction ◽

Iol Implantation ◽

Corrected Visual Acuity ◽

Best Corrected Visual Acuity

The study of 30 patients was performed at Lahore General Hospital, and Institute Of Ophthalmology Mayo Hospital, Lahore from June 1989 to June 2003 for 14 years. Total number of eyes were 34 where 2 patients had both eyes. Age ranged from 12-65 years. Males were 11 and females were 19. all the patients had planned extracapsular cataract extraction with IOL implantation. Total follow up period ranged from 1-5 years and best corrected visual acuity in these patients after surgery was 6/12 to 6/6. Post operatively, eyes had vitreous membranes and glaucomatous reaction.

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A Female Case of X-Linked Retinoschisis with Macular Hole Bilaterally

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/8824995 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

A. Altun

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Surgical Experience ◽

Flap Technique ◽

Macular Holes ◽

Female Case ◽

Pars Plana

Purpose. We aimed at reminding that X-linked retinoschisis may also be seen in female patients and share our vitreoretinal surgical experience. Methods. The patient underwent pars plana vitrectomy including the closure of the macular holes with inverted ILM flap technique bilaterally. Lens extractions were performed by phacoemulsification during the removal of silicone oil endotamponade. Patient. An 18-year-old girl with X-linked retinoschisis and large macular holes in both eyes presented to the clinic of ophthalmology. It was confirmed that the patient had RS1 mutation Results. Nine-month-follow-up was uneventful for retinal findings. Significant improvement in visual acuity was achieved, and macular holes were remained closed. Conclusion. In cases with large macular holes due to XLR, an inverted ILM flap technique might be safe and effective. Four-month-silicone-endotamponade might be sufficient.

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Deep Anterior Lamellar Keratoplasty followed by Toric Lens Implantation for the Treatment of Concomitant Anterior Stromal Diseases and Cataract

Ophthalmology Point of Care ◽

10.5301/oapoc.0000008 ◽

2017 ◽

Vol 1 (1) ◽

pp. oapoc.0000008 ◽

Cited By ~ 1

Author(s):

Vincenzo Scorcia ◽

Andrea Lucisano ◽

Vincenzo Savoca Corona ◽

Valentina De Luca ◽

Adriano Carnevali ◽

...

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Cataract Surgery ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Toric Iol ◽

Iol Implantation ◽

Anterior Lamellar Keratoplasty ◽

Topographic Astigmatism

Purpose To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) followed by phacoemulsification and toric intraocular lens (IOL) implantation for the treatment of concomitant stromal disease and cataract. Methods In this retrospective non-comparative interventional case series, ten eyes affected by stromal disease and cataract underwent DALK followed by phacoemulsification with toric IOL implantation after a minimum period of 5 months from complete suture removal. In each case, topographic astigmatism, refraction, visual acuity, and endothelial cell density were recorded before DALK and 1, 6, and 12 months after cataract surgery. In addition, IOL rotation was evaluated using anterior segment optical coherence tomography. Results Big-bubble DALK was performed in all eyes but one that received manual dissection. Topographic astigmatism averaged 5.6 ± 2.2 diopters (D) after suture removal; refractive astigmatism decreased to 0.55 ± 0.61 D as early as one month after cataract surgery and did not change substantially throughout the follow-up period. In all patients, one month after phacoemulsification uncorrected and best spectacle-corrected visual acuity were, respectively, ≥20/40 and ≥20/25 with a residual spherical equivalent of 0.00 ± 0.84 D. At the latest follow-up visit, in all cases the IOL rotation was ≤5 degrees from the intended position and the endothelial cell loss within 8.5%. No complications were recorded. Conclusions DALK followed by phacoemulsification with toric IOL implantation optimizes visual and refractive outcomes in patients with concomitant stromal disease and cataract. In comparison with a combined procedure, the sequential approach offers better predictability of the postoperative refraction in the absence of an increased risk of complications.

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Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series

10.21203/rs.3.rs-37812/v3 ◽

2020 ◽

Author(s):

Takahiko Hayashi ◽

Yasutsugu Ida ◽

Toshiki Shimizu ◽

Tsubasa Kuroki ◽

Yuji Kobashigawa ◽

...

Keyword(s):

Graft Survival ◽

Intraocular Lens ◽

Pars Plana Vitrectomy ◽

Penetrating Keratoplasty ◽

Case Series ◽

Glaucoma Surgery ◽

Bullous Keratopathy ◽

Spherical Equivalent ◽

Iol Implantation ◽

Pars Plana

Abstract Background The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes.Methods In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. Results This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively.Conclusion The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.

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