scholarly journals Management of Dislocated Intraocular Lenses with Iris Suture

2016 ◽  
Vol 27 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Mun Y. Faria ◽  
Nuno P. Ferreira ◽  
Mario Canastro

Purpose Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. Methods In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. Results A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of logMAR units. The mean visual acuity improvement was 4.08 ± 5.33 lines on the logMAR scale. In this study, every IOL was stable at the last follow-up. As late complications, macular edema occurred in 1 patient and retinal detachment occurred in 2 patients. There were no cases of endophthalmitis. Conclusions Iris suture fixation of subluxated IOL is a good treatment option for eyes with dislocated IOLs, leading to long-term stability of the IOL. The advantage of this procedure is using the same IOL in a closed eye surgery. No astigmatic difference is expected as no large corneal incision is needed.

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Zhi-Xiang Hu ◽  
HaiShuang Lin ◽  
Lingying Ye ◽  
Zhong Lin ◽  
Tianyu Chen ◽  
...  

Purpose. To report a new technique for sutureless intrascleral fixation of three-piece foldable intraocular lenses (IOLs) using 25-gauge trocars. Methods. We performed this technique on patients with insufficient posterior capsule support. Seventeen eyes from 15 patients with aphakia, dislocated IOL, or subluxated crystalline lens undergoing posterior chamber sutureless implantation of an IOL were studied. The haptics of the IOL were externalized using two 25-gauge forceps. The haptics were bended back (hook-like) into the vitreous cavity through a scleral incision made by using a 25-gauge trocar. And, IOL tilt was determined by using a slit lamp and UBM, and complications were recorded. Results. The IOLs were fixed with exact centration and axial stability. No wound leakage was reported even without the use of sutures. The mean best-corrected visual acuity (BCVA) was 0.82 logarithm of the minimum angle of resolution (logMAR) units preoperatively, and the mean BCVA was 0.44 logMAR units at the 6-month follow-up visit. No postoperative retinal detachment, endophthalmitis, IOL tilt or dislocation, or vitreous hemorrhage was noted. Conclusion. Sutureless intrascleral haptic-hook posterior chamber IOL implantation using 25-gauge trocars provides good IOL fixation with reliable wound closure without the use of sutures. This trial is registered with ChiCTR1800017436.


2016 ◽  
Vol 27 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Gabriel Katz ◽  
Elad Moisseiev ◽  
Dafna Goldenberg ◽  
Joseph Moisseiev ◽  
Yosef Lomnicky ◽  
...  

Purpose To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). Methods This was a retrospective study of patients with DME initially treated with bevacizumab and switched to ranibizumab. Visual acuity (VA) and central retinal thickness (CRT) were retrieved at fixed timepoints prior to and after the switch. Results Forty eyes of 32 patients were included in the study. The difference in VA between any of these fixed timepoints was not statistically significant. A significant gain in VA was found in eyes that lost more than 0.1 logMAR during treatment with the last 3 bevacizumab injections. The mean CRT was significantly lower after the first 3 ranibizumab injections and at the final follow-up (p<0.001), a 67 ± 14 μm and 78 ± 18 μm reduction in thickness, respectively. Conclusions Switching to ranibizumab resulted in a significant decrease in the CRT of eyes with DME, and should be considered when there is a lack of response or deterioration while on bevacizumab injections. A significant gain in VA was observed in a subgroup of eyes that lost more than one line while receiving the last 3 bevacizumab injections prior to the switch.


2021 ◽  
Vol 14 (1) ◽  
pp. 61-64
Author(s):  
G. V. Sorokoletov ◽  
E. R. Tumanyan ◽  
A. N. Bessarabov ◽  
M. A. Soboleva

To date, the operation of choice in young patients with high myopia, is the implantation of posterior chamber phakic intraocular lenses (PIOL), provided that there are contraindications to keratorefractive interventions, However, in the late postoperative period, cataracts may occur, which requires the development of surgical tactics for lens explantation with simultaneous phacoemulsification of cataract (FEC) implementation.The purpose is to develop and analyze a method for removing a PIOL through a 2 mm corneal incision in subcapsular cataract cases.Material and methods. Posterior chamber domestic models of PIOL type RSK-1(3) and RSK-3 in 22 patients (37 eyes), implanted in the S.N. FEDOROV “EYE MICROSURGERY” clinic in 1994 – 2001 had to be removed due to the development of secondary cataracts. PIOL stayed in the eye 2 to 26 years (averagely 14.30 ± 1.30 yrs). In all cases, the P IOL was removed followed by FEC with implantation of a posterior chamber IOL. The optical power of the IOL was calculated mainly in such a way that the residual myopic refraction was 2.0–3.0 D.Results. The intraoperative condition of the anterior chamber was stable, the volume of irrigation fluid consumed was within 90–120 ml. No complications were detected in the early and late postoperative periods. The results of dynamic ophthalmological follow up of patients showed that visual acuity without correction and with correction after surgery averaged 0.2 ± 0.1 and 0.60 ± 0.15, respectively.Conclusion. The proposed method of explantation of domestic lenses of S.N. FEDOROV NMRC MNTK “EYE MICROSURGERY” shows that it enables a safe, simple removal of PIOL in the event of secondary subcapsular cataract, which allows achieving high clinical and functional results without overspending the irrigation solution.


2021 ◽  
Author(s):  
Dan Liu ◽  
Cong Fan ◽  
Chunyan Li ◽  
Jian Jiang

Abstract Background: Multifocal intraocular lenses (IOLs) is very intolerant to residual corneal astigmatism and patients with more than 1.0 D of residual corneal astigmatism are not suitable candidates for implantation of multifocal IOLs. The purpose of this study was to evaluate the efficacy of a single clear corneal incision (CCI) or an opposite clear corneal incision (OCCI) made on a steep meridian for correction of low to moderate corneal astigmatism during implantation of multifocal IOLs.Methods: This is a retrospective cohort study. A total of 50 patients with pre-operative total corneal astigmatism, ranging between 0.5 and 2.0 diopters (D), who underwent cataract surgery and received multifocal IOLs were included. Correction of corneal astigmatism was done via single CCIs on steep meridians in patients with 0.5–1.2 D total corneal astigmatisms, and OCCIs in patients with 1.3–2.0 D total corneal astigmatisms. Visual acuity, corneal astigmatism, ocular aberrations, corneal aberrations, and subjective vision quality were evaluated after surgery.Results: At 12-weeks post-surgery, the mean uncorrected distance vision (UCDV) was 0.06±0.09 logarithm of the minimum angle of resolution (logMAR) and 0.03±0.09 logMAR, and the mean uncorrected near vision (UCNV) was 0.08±0.11 logMAR and 0.09±0.09 logMAR in the CCI and OCCI groups, respectively. The change in corneal astigmatism was 0.52 ± 0.22D and 1.06 ± 0.23D in the CCI and OCCI groups, respectively (P<0.001). Total corneal higher-order aberrations (HOAs) and trefoil increased in both groups (P<0.05); however, there was no difference in the change in total corneal HOAs between the two groups (P>0.05). Conclusions: CCI and OCCI made on a steep axis could be an option for correction of mild-to-moderate astigmatism during cataract surgery with multifocal IOL implantation.


2021 ◽  
Vol 62 (7) ◽  
pp. 931-938
Author(s):  
Ji Hyun Yoon ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim

Purpose: The long-term clinical outcomes of cataract surgery in patients with retinitis pigmentosa (RP) were evaluated. Methods: A retrospective analysis of medical records was performed for patients who were diagnosed with RP and underwent cataract surgery. Preoperative best-corrected visual acuity (BCVA) was compared with BCVA at 1 month postoperatively and at the final visit. The proportion of patients with cystoid macular edema development or aggravation after surgery was evaluated, as was the proportion of patients with intraocular lens subluxation/dislocation. For patients who underwent optical coherence tomography, factors associated with a BCVA of 0.5 or better at 1 month were analyzed. Results: In total, 133 eyes were included and the mean follow-up period was 58.7 months. The mean logarithm of minimal angle of resolution BCVA was 0.69 ± 0.65 at diagnosis. The BCVA was significantly improved to 0.51 ± 0.47 at 1 month postoperatively (p < 0.001). However, the BCVA at the final visit (0.70 ± 0.81) was similar to the baseline value (p = 1.000). Cystoid macular edema development or aggravation was noted in 8 eyes (6.0%) and intraocular lens subluxation/dislocation was noted in 4 eyes (3.0%). A subgroup analysis involving 108 eyes revealed that preoperative BCVA (p < 0.001) and ellipsoid zone status (p = 0.001) were associated with postoperative visual acuity. Conclusions: Short-term outcomes of cataract surgery in patients with RP were comparatively good. However, long-term visual deterioration was noted with disease progression. Preoperative BCVA and ellipsoid zone status are useful markers for predicting short-term visual outcomes.


2020 ◽  
Vol 7 (4) ◽  
pp. 110-117
Author(s):  
Dr. Priyanka S. Kanekar ◽  
Dr. Smita Patare ◽  
Dr. Roopa Naik

Background: The modern cataract surgery involves implantation of posterior chamber intraocular lens (PCIOL) when the posterior capsule is intact. However, in case of weak or no capsular support, PCIOL implantation is not possible. In such situations, implantation of secondary Iris claw lens (ICIOL) or Scleral fixated IOL(SFIOL) remains as treatment options. The aim of this study was to compare the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications in aphakic patients. Methods: This prospective randomized study was done from January 2019 to December 2019. Forty aphakic patients fulfilling inclusion criteria, who attended the ophthalmology outpatient department of VVPF’s Medical college and hospital, Ahmednagar were included in this study. These patients were randomly divided into two groups such as Group 1 included 20 patients who underwent ICIOL implantation and Group 2 included 20 patients who underwent SFIOL implantation. The preoperative and postoperative evaluation was done with visual acuity, slit-lamp examination, IOP, fundus examination for the follow up period of 6 months. Results were analysed with Chi square test and t-test using SPSS software. Results: 85% ICIOL and 80% of SFIOL patients had final Best Corrected Visual Acuity (BCVA) of 6/18-6/6. Surgical time in ICIOL was significantly less than SFIOL group (p=0.00). Suture related complications were significantly more in SFIOL group. However, oval pupil and pigment dispersion were seen more in ICIOL group but were harmless. One patient in SFIOL group developed Cystoid Macular Edema (CME) which persisted till final follow up and 1 haptic of ICIOL was disenclavated which was re-enclavated. Conclusion: Comparable final visual outcome was found between ICIOL group and SFIOL group. However, Implantation of ICIOL required less surgical time with fewer complications and hence is a better alternative to SFIOL implantation in correction of aphakia.


2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Filipe Mira ◽  
Manuel Paulo ◽  
Filipe Henriques ◽  
João Figueira

Purpose. The aim was to evaluate the efficacy of aflibercept in patients with diabetic macular edema (DME) unresponsive to prior anti-VEGF therapy. Methods. Retrospective review of DME unresponsive to previous anti-VEGF switched to aflibercept with 3 months of follow-up. Changes in best correct visual acuity (BCVA), central retinal thickness (CRT), and frequency of injections were analyzed. The percentage of subjects who had ≥20/40 (logMAR equivalent 0.3) and ≤20/200 (logMAR equivalent 1) was evaluated. Results. A total of 32 eyes from 26 patients were included. Mean age was 65 ± 10 years old. The mean number of previous anti-VEGF injections was 5.34 ± 2.38, and the mean number of aflibercept injections at the end of the study was 2.00 ± 0.00. The CRT at baseline was 501.47 ± 150.51 μm and 367.97 ± 124.61 μm at 3 months of follow-up (P<0.001). The logMAR BCVA at baseline was 0.71 ± 0.36 and 0.65 ± 0.33 at the end of the follow-up (P=0.037). At baseline, 12.5% of patients had ≥20/40 compared with 25% at the end of follow-up. At baseline, 28.13% of patients had 20/200 or inferior vision compared with 15.63% at the end of the follow-up. Conclusions. DME patients unresponsive to previous multiple ranibizumab injections demonstrate a significant anatomical and functional improvement with the switch to aflibercept.


2003 ◽  
Vol 13 (2) ◽  
pp. 221-222 ◽  
Author(s):  
M. Jäger ◽  
J.B. Jonas

Purpose To describe the occurrence of cystoid macular edema in a pseudophakic vitrectomized patient following use of latanoprost (0.005%). Methods A 58-year-old patient underwent routine cataract surgery with posterior chamber lens implantation complicated by rhegmatogenous retinal detachment three months later. A pars plana vitrectomy was performed with silicone oil endotamponade which was removed six months later. Five months after oil removal, the patient presented with secondary open-angle glaucoma treated with latanoprost 0.005% eye drops once daily. Results Two weeks after initiation of latanoprost treatment, visual acuity dropped from 0.8 to 0.3 due to cystoid macular edema confirmed by fluorescein angiography. After discontinuing latanoprost therapy and with topical corticosteroid treatment, cystoid macular edema slowly resolved, and within 6 months, visual acuity improved to 0.8. Conclusions Despite its marked ocular hypotensive effect, latanoprost should be carefully used in patients after uncomplicated cataract surgery if the vitreous body was removed by pars piana vitrectomy.


2021 ◽  
Vol 4 (2) ◽  
pp. 127
Author(s):  
Nasrin Y ◽  
Sharma Ajay ◽  
Sharmila Yalakala

Introduction: Current study aimed to evaluate efficacy of intravitreal Bevacizumab in Diabetic macular edema, and to identify their ocular and systemic complications if any. Method: It is a prospective, interventional study with 68 patients in 82 eyes with Diabetic macular edema. All treated by 3 injection of intravitreal bevacizumab with 1 month interval. Visual acuity, macular edema, and complications evaluated at every month upto 6th months. Ranibizumab was offered if the patient is a non-respondent to Bevacizumab. Results: Majority age group of 61-70 years with a mean age of 59 ± 6.72 years. The mean duration of diabetes was 11.68 ± 7.2 years. The mean baseline BCVA and CRT are 0.64 ± 0.28 Log MAR units and 436.99 ± 135.10 μm. After 3 injections, BCVA values are 0.48±0.27 (p< 0.01)), 0.36±0.24 (p<0.01)), and 0.27±0.24 (p<0.01), 0.23±0.27 Log MAR (p<0.01)) at 1month, 2 months, and 3 months, and 6 months follow-up respectively. CMT levels are 315.79±124.60 μ at 1 month, after 3rd IVA and this significant change (p<0.01) followed with subsequent follow-up with mean CRT of 296.04±122.97 μ (p< 0.01) at 6th month. The BCVA improved ≥ 2 Snellen lines in 69.5% and 78% cases, resolution of CMT in 56% and 69.5% cases at 3 months and 6 months respectively. At the end of the 3rd month, 46 eyes macular edema completely resolved with 3 injections of IVA, 23 eyes persistent macular edema present, 13 eyes refractory to bevacizumab injections. Persistent & Refractory macular edema eyes (36) switched to Ranibizumab injections.In persistent macular edema, significant resolution (p≤0.01) of macular thickness (370.52 ± 71.43 µm vs. 341.08 ± 122.75 µm) without (p=0.09) improvement in visual acuity (0.45 ± 0.20 vs. 0.34 ± 0.23) was observed post Ranibizumab injections.  In Refractory macular edema, thickness of cases no significant (497.76 ± 161.07µm vs 407.84 ± 169.64 µm) improvement seen after Ranibizumab injections(p=0.1). Recurrence of macular edema seen in 10.9%. Subconjunctival haemorrhage seen in 10.9%-12.1% cases, raised IOP in 2.4%-3.6% cases at post injection day 1. No other ocular and systemic complications were observed during follow-up. Conclusions: Intravitreal bevacizumab is effective in treatment of diabetic macular edema but therapeutic effect is temporary and repeat treatment is needed. It does not show any potential drug related ocular and systemic side effects, hence it is safe and economical therapeutic agent


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fathy Fawzy Morkos ◽  
Nader F. Fawzy ◽  
Mohamed El Bahrawy ◽  
Nada Fathy ◽  
Rania Serag Elkitkat

Abstract Background Myopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort. Methods This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed. Results The study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was − 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity “CDVA” (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow-up visits had a mean ± SD of 14.67 months ±16.56 (range of 1 to 54 months). The results showed a refractive stability, with statistically insignificant improvements in the patients’ visual acuity and refractive status on evaluating the enrolled pediatrics during the follow-up visits compared to the first postoperative visits. No postoperative complications were encountered. Worthy of mention is that there was a significant (80%) non-compliance with the prescribed postoperative occlusion therapy. Conclusions The present study, with the longest reported follow-up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting myopic anisometropic amblyopia in pediatrics. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases with failed conventional therapy to guard against anisometropic amblyopia.


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