Ocular Manifestations of Acute Secondary Angle Closure Associated With Lens Subluxation

Purpose:To evaluate the clinical characteristics and ocular features of patients with acute secondary angle closure, associated with lens subluxation (ASAC-LS).Methods:We performed a retrospective study at the EENT Hospital of Fudan University, Shanghai, China. A total of 41 affected eyes from 41 patients were enrolled in this study. Furthermore, 20 affected eyes were part of the ASAC-LS cohort and 21 affected eyes were included in the acute primary angle closure (APAC) cohort. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), minimum corneal curvature (K1), maximum corneal curvature (K2), and anterior chamber depth (ACD) were measured and compared between the 2 cohorts. In addition, inter-eye (intraindividual) comparison was performed.Results:The ASAC-LS cohort exhibited younger ages, more frequent trauma history (35%), lower IOP (27.43 ± 13.86 mmHg vs. 41.27 ± 10.36 mmHg), longer AL (23.96 ± 2.60 vs. 22.49 ± 0.77 mm), shallower ACD (1.28 ± 0.38 vs. 1.58 ± 0.23 mm), and bigger ACD differences (0.99 ± 0.52 vs. 0.15 ± 0.19 mm), as compared with the APAC cohort (all p < 0.05). Moreover, eyes from the lens subluxation cohort experienced worse BCVA, higher IOP, and shallower ACD than their matched unaffected eyes (all p < 0.05). Although longer AL, shallower ACD, and bigger ACD differences were strongly correlated with lens subluxation in a univariate logistic regression analysis, only the ACD difference remained significant in the multivariate model (p = 0.004, OR = 1,510.50). Additionally, according to the receiver operating characteristic (ROC) curve analysis, both ACD and ACD differences had greater value in the differential diagnosis of ASAC-LS and APAC, with a cut-off value of 1.4 and 0.63 mm, respectively.Conclusions:Shallower ACD and larger ACD differences provide the promising diagnostic potential for patients with ASAC-LS.

Primary scleral-fixated posterior chamber intraocular lenses in patients with congenital lens subluxation

Objective We investigated the long-term visual outcomes and ocular complications of primary scleral-fixated posterior chamber intraocular lenses (SF-PC-IOLs) in patients with congenital lens subluxation. Methods We enrolled 53 patients (77 eyes) with congenital lens subluxation caused by ectopia lentis, Marfan syndrome, and Weill–Marchesani syndrome who underwent primary implantation of a SF-PC-IOL. All patients underwent a complete ophthalmic examination include visual acuity (VA), intraocular pressure (IOP), intraocular lenses (IOL) position, intraoperative complications and postoperative complications. Cox regression analysis and survival analysis were used to evaluate the risk factors for postoperative complications. Results Seventy seven eyes from 53 patients were included. Mean age at surgery was 23 ± 20 years (5 to 67 years), with a mean follow-up of 39 ± 27 months (12 to 130 months). The best-corrected VA improved from 0.84 ± 0.55 to 0.26 ± 0.43 logarithms of the minimum angle of resolution (p < 0.001). Best-corrected VA improved postoperatively in 73 eyes (94%). The main causes of reduced vision after surgery were retinal pathologies and amblyopia. Complications included transient intraocular haemorrhage (2 eyes, 2.6%), early vitreous incarceration (2 eyes, 2.6%), retinal detachment (6 eyes, 7.8%) and IOL dislocation (3 eyes, 3.9%). Cox regression showed that postoperative eye trauma was a risk factor for long-term postoperative complications. Conclusion SF-PC-IOLs provide good visual outcomes in patients with congenital lens subluxation. The SF-PC-IOLs showed good stability, except in patients suffering from postsurgical eye trauma.

Visual Outcome of Combined Descemet Stripping Endothelial Keratoplasty and Sutured Scleral Fixated Intraocular Lens in Endothelial Decompensation with Coexistent Aphakia or Intra Ocular Lens Subluxation

Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

Comparative analysis of ultrasound biomicroscopy between femto-assisted and ultrasound cataract removal in case of lens subluxation

Purpose of the study to carry out a comparative analysis of the state of the zonular fibers before and after surgery on UBM between femtolaser assisted and classical ultrasound cataract removal. Material and methods. 19 patients (38 eyes) with age-related cataracts. 22 eyes were with pseudo-exfoliative syndrome. All patients were examined with grade 1 lens subluxation. The first group of 19 eyes underwent cataract femto-phacoemulsification. The second group included 19 eyes without using a femtolaser. The state of the fibers was determined on the UBM on the fifth day after the operation at the end of antibiotic therapy. Results. The data showed the presence of a statistically significant difference between the group with femto-assistance and the group without it. In the first group, UBM analysis showed that the state of the zonular fibers remained in the same state in 16 of 19 eyes. In the second group, 11 of 19 eyes required ring implantation with suturing to the sclera and 3 required IOL implantation with seamless fixation to the sclera and vitrectomy. Conclusions. The appropriate path to surgery depends on the most accurate objective assessment of the condition of the lens ligaments, since the position of the IOL is one of the main factors for a good result expected by the patient after surgery. Reducing the «trauma» of the eye with lens surgery has been a key success factor and femtolaser guidance provides valuable assistance in obtaining it. Key words: lens subluxation, femtosecond laser, UBM.

Effective treatment for secondary angle-closure glaucoma caused by traumatic lens subluxation: phacoemulsification with capsular-tension-ring implantation combined with ophthalmic endoscope-controlled goniosynechialysis

AIM: To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis (Phaco-CTR-IOL-OE-GSL) for treating secondary angle-closure glaucoma induced by traumatic lens subluxation. METHODS: A retrospective and descriptive study was performed on patients with lens subluxation, angle closure, goniosynechia, and evaluated intraocular pressure (IOP) that cannot be controlled with medication, who underwent Phaco-CTR-IOL-OE-GSL. The postoperative best-corrected visual acuity (BCVA), IOP, range of goniosynechia and complications were retrospectively observed. RESULTS: Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included. The follow-up period was 51.1±8.6mo. The preoperative range of zonule rupture was 158.2°±33.0°, and the range of goniosynechia was 220.0°±92.5°. The baseline BCVA was 0.9±1.0 logMAR, IOP was 30.7±17.3 mm Hg, and number of anti-glaucoma medication was 3.2±1.1. Mild intraoperative hyphaemia with 8 eyes (88.8%) in the anterior chamber, and was absorbed two days postoperatively. One eye (11.1%) had postoperative ciliary body detachment and was recovered after five days of topical drug treatment. BCVA was 0.2±0.2 logMAR at 3mo postoperatively. The average IOP at the last follow-up was 16.7±2.0 mm Hg, and no anti-glaucoma medications were used. The average range of recurrent goniosynechia was 54.9°±33° at the final postoperative gonioscopic examination. CONCLUSION: Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation. The use of an endoscope provides a more direct and clear examination for GSL, and 360° dissection is easily achieved.

Pars Plana Lensectomy and Iris-Claw Artisan Intraocular Lens Implantation in Patients with Marfan Syndrome

Purpose: To evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw artisan intra-ocular lens (IOL) implantation in the patients with subluxated crystalline lens secondary to Marfan syndrome.Methods: In this retrospective case series, we evaluate the records of all patients with Marfan syndrome and moderate to severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw artisan IOL at referral hospital from September 2015 to October 2019.Results: Twenty-one eyes of fifteen patients (10 males and 5 females) with the mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P <0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder -0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment two months after surgery.Conclusion: Pars plana lensectomy and iris-claw artisan IOL implantation seem to be a useful, impressive and safe procedure with a low rate of complications in Marfan patients with moderate to severe crystalline lens subluxation. Visual acuity was significantly improved with the acceptable anatomical and refractive outcomes.