Enlargement of Phimotic Capsulorhexis Using Plasma Energy: A Case Series

Purpose: to evaluate the effectiveness and safety of the plasma ablation technique of Fugo blade system to enlarge phimotic capsulotomies in the management of anterior capsule contraction syndrome.Patients and methods. Results of the enlargement of phimotic capsulotomies using the plasma ablation technique in 17 patients with anterior capsule contraction syndrome (10 men and 7 women, 18 eyes; average age — 73.8 ± 9.6 years) were retrospectively analyzed. Surgically, after pupil dilation, the anterior chamber was irrigated with a viscoelastic device (1.4 % solution of hyaluronic acid), and the tip of the Fugo blade was inserted through a 2.0–2.2 mm wide corneal incision. After slightly touching the anterior capsule, the apparatus was activated, and its tip was moved in a concentric manner, excising the required size of the fibrosed anterior capsule in a resistance-free fashion. Finally, the viscoelastic material was aspirated, and the incisions were hydrated.Results. Phimotic capsulotomies were enlarged in all cases. Except for three cases where the bimanual technique was required to ablate the anterior capsule, all other cases were managed single-handedly. The use of cohesive viscoelastic device (1.4 % solution of hyaluronic acid) made it possible to perform this procedure with minimum trauma and under visual control. No serious complications were encountered during surgery or in the early postoperative period. Patients were discharged 1–2 days after surgery. Corneal edema, which was observed in six eyes, resolved within 3–4 days. Visual acuity improved in all cases, except for 2 patients with complete glaucomatous optic atrophy. IOP remained under control in all cases. No negative effect on the hypotensive results of previous glaucoma surgeries was observed.Conclusion. The plasma-generating Fugo blade system is an effective and safe tool to enlarge phimotic capsulorhexis in a resistance-free fashion. It is easy to use, mastering of new surgical skills is not required, surgical trauma is minimal, the surgical time is reduced, and the patient’s rehabilitation period is significantly shortened.

Comparison of Diathermic high-frequency capsulorhexis and Femtosecond laser-assisted capsulorrhexis in white cataract surgery

Aim: To compare the integrity, roundness and diameter of the capsulotomy in the white cataract between femtosecond laser assisted capsulotomy and high-frequency capsulorhexis.Methods: The prospective study included 32 patients with white-nuclear cataracts, 16 of whom underwent femtosecond capsulorhexis and another 16 underwent diathermic high-frequency capsulorhexis. The integrity roundness and diameter of the capsulorhexis post-operation were compared.Results: Femtosecond group obtained 6 cases(37.5%)of complete capsular. No anterior capsule tear occurred. Diathermy high-frequency achieved continuous complete capsulor in 3 eyes(18.75%) and anterior capsule was teared in 13 eyes(81.25%). The femtosecond group has a mean capsular diameter of 5.4 mm, and the diathermic high-frequency group has an average capsular diameter of 6 mm. No posterior capsule tear occurred in both surgical procedures. Conclusions: Femtosecond laser-assisted cataract surgery can achieve high capsulor integrity and stable capsulorhexis diameter. Compared with the diathermic high-frequency capsulorhexis, the frequency of injecting the viscoelastic agent was reduced, and the tear of the capsule was less likely to occur. The continuous complete capsular(CCC) by femtosecond laser is more round, more complete ,more controllable and smoother than diathermy high-frequency(DHC).

Lens-induced hypopyon uveitis as the presenting manifestation of posterior lens nucleus dislocation following pars-plana vitrectomy: case report

A 57-year-old otherwise healthy male presented to our department seven days following uneventful pars-plana vitrectomy with gas tamponade for a superior bullous retinal detachment in the left eye. Ophthalmic examination revealed anterior segment inflammation with hypopyon and fibrinous exudate. Intra-ocular pressure was 28 mmHg. Posterior segment evaluation was difficult to assess due to the presence of anterior capsule opacification and gas bubble. A Toxic Anterior Segment Syndrome was suspected, and the patient was treated with topical and oral corticosteroid medication in combination with anti-glaucomatous therapy. On follow-up, anterior segment inflammation and ocular hypertension improved. On day ten post-operatively, ocular ultrasonography demonstrated lens material inferiorly with attached retina. The final diagnosis of posterior lens nucleus dislocation with lens-induced uveitis was retained. The patient underwent an uneventful second vitrectomy with aspiration of the dislocated lens nucleus and sulcus three piece-lens implantation. On last follow-up, visual acuity was 20/50 with no relapsing of ocular inflammation and the retina remained reattached.

Open reduction of an old and unreduced posterior elbow dislocation

The old unreduced elbow dislocation is not very frequent, but when it is found, it is a challenge for every surgeon. We present a case of 65 years old man who came to the hospital with a dislocated elbow. After the first attempt to reduce, the elbow was mobilized in sling for 2 weeks, but during a small effort, the joint dislocated again. Another two orthopedic reduction were tried, followed by cast immobilization, but the elbow dislocated again. The patient presented in our service after two months from the injury with stiff joint in a vicious position. On imagistic examinations (Rx, CT, MRI), it was found comminuted fracture of coronoid process, posterior dislocation of olecranon and both collateral ligaments were torn. An open reduction was performed during which the joint surface was cleaned up, the anterior capsule was reattached to the coronoid process with an anchor, and then, collateral ligament was restored with the help of autograft, a gracilis muscle (bone fixed with two anchors). Postoperatively, the patient slowly began to mobilize the elbow with splint protection. After a year, the patient returned for follow-up; the function was completely restored and he had no pain.

Comparison of Gene Expression of Inflammation- and Fibrosis-Related Factors Between the Anterior and Posterior Capsule in Patients With Rotator Cuff Tear and Shoulder Stiffness

Background: Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release. Purpose: This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear. Study Design: Descriptive laboratory study. Methods: Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor–β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor–α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test. Results: The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness ( P = .010 for both) and the control ( P = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule ( P = .013, .003, and .006, respectively) and the control ( P = .014, .003, and .005, respectively). Conclusion: Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness. Clinical Relevance: Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.

UBM indicators in anterior capsular contraction syndrome

The article presents the results of UBM studies of patients with anterior capsular contraction syndrome (CS). Purpose. Тo use the UBM method to study the state of the ciliary body (CB) and the capsular bag of the lens in patients with CS. Material and methods. The study included 42 patients with capsular CS. The UBM HI-scan ultrasound biomicroscope (Optikon, Italy) was used. Results. The reduction of the capsule bag of the lens was accompanied by a significant decrease in the diameter of the anterior capsulotomy opening, IOL decentration and its displacement towards the posterior pole of the eye, stretching or damage to the zonula ciliaris, and an increase in the CB thickness. In 2 cases, ruptures of the CB and its separation from the place of attachment to the radix iridis were recorded. Conclusion. UBM is an effective assessment method for CS, which allows us to study the state of the capsule bag of the lens and CB, evaluate the effectiveness of laser treatment and predict the risks associated with a high probability of complications. Key words: capsular contraction syndrome, anterior capsule, lens, laser, UBM, ciliary body.

Intralenticular metallic foreign body ‘locked-in’ the posterior capsule and the utility of multimodal imaging

Intraocular foreign bodies (FBs) are common ocular injuries reporting to the emergency services all over the world. The authors highlight the findings and surgical management of a case of intralenticular metallic FB following an injury while using chisel and hammer. The ocular path of the FB (2 mm) could be traced from a self-sealed corneal perforation, extending through the anterior capsule rupture, terminating at the posterior capsule, forming a posterior capsule tent with a part embedded in clear lens. Preoperative ultrasound biomicroscopy gave clues on posterior capsule integrity and the exact site of FB, and helped prognosticate and plan the surgical management of the case. The ‘locked-in’ FB was extracted after clear lens aspiration and posterior capsulorrhexis. The posterior capsule acted as a natural barrier between anterior and posterior segment, where the FB was found embedded.

Modified capsulorhexis for fluid-filled mature cataracts

Background: The aim of this study was to develop a modified capsulorhexis technique featuring a new maneuver for the removal of subcortical fluid in fluid-filled mature cataracts to avoid high intralenticular pressure. Methods: This prospective interventional study included 33 eyes with mature cataracts and evidence of subcapsular fluid spaces by slit lamp examination. For each patient, 20% mannitol was administered intravenously according to the bodyweight 1 h preoperatively. Under peribulbar anesthesia, a 2.2-mm main incision was made, and the anterior chamber was filled with a dispersive ophthalmic viscosurgical device. Using a bent-tip cystotome, a 2-mm curved incision was made in the center of the anterior capsule, which released subcortical fluid and was drained through compression of the posterior lip of the main incision using a spatula. Then, fine gentle milking in all quadrants around the puncture on the anterior lens capsule from the periphery toward the site of puncture using the blunt-edged spatula further assists drainage of subcortical fluid and breaks fine septa inside the lens to remove fluid from intralenticular fluid pocket collections. Results: The study included 15 (45.5%) men and 18 (54.5%) women with a mean ± standard deviation (SD) of age of 63.2 ± 5.33 and 64.4 ± 6.21 years, respectively. The modified capsulorhexis technique was performed for 33 intumescent cataracts. Capsulorhexis was completed in all cases; capsulorhexis was easy in 31 (94%) eyes and difficult in 2 (6%) eyes. In the two difficult cases, radial extension occurred in one eye, and it was retrieved using the Little technique; the other case with radial tear was completed successfully using a retinal micro scissor from the other edge of the capsulorhexis until reaching an oval, continuous capsulorhexis. Conclusions: This modified capsulorhexis technique with compression on the posterior lip of the main incision and capsule milking allowed for a safe, continuous curvilinear capsulorhexis. Further comparative studies are necessary to confirm our preliminary results. How to cite this article: Ghoneim EM. Modified capsulorhexis for fluid-filled mature cataracts. Med Hypothesis Discov Innov Ophthalmol. 2021 Summer; 10(2): 17-24. https://doi.org/10.51329/mehdioptometry1422

Bacillus endophthalmitis after cataract removal surgery following initial ocular trauma: a case report

Infectious endophthalmitis is an ocular infection caused by bacterial or fungal organisms involving intraocular tissues, aqueous, and vitreous humour. Bacillus sp. is an uncommon microorganism causing endophthalmitis. We describe a teenager who presented with a self-sealed corneal laceration, cataractous lens, and evidence of a breach in the anterior capsule. The eye was initially quiet and stable. The event started 1 day after uncomplicated cataract surgery. The patient developed fulminant postoperative endophthalmitis with a fatal final visual outcome. A high index of suspicion is mandatory, and more aggressive treatment may be able to improve the final outcome.