Clinical outcomes in post-epikeratophakic eyes after removal of epikeratoplasty lenticule

Background Assessment of the optical outcome and adverse events in post-epikeratopathic eyes after removal of the epikeratoplasty lenticule (EKPL). Methods This was a retrospective case-series study of patients who underwent EKPL removal between 2002 and 2020. Ten eyes were included in the analysis. We compared the clinical characteristics of the patients before surgery, 6 months after surgery, before lenticular removal, and after removal, and reported optical or ocular surface complications. Results We removed EKPL due to the lenticular opacity in five eyes (50%), intraocular lens (IOL) insertion (n = 4, 40%) after cataract surgery (n = 3) or in aphakic eyes (n = 1), and lenticule-induced irregular astigmatism in one eye (10%). After EKPL removal, the mean refractive power of the cornea (Km) revealed a tendency to increase. Out of nine cases, six cases showed corneal steepening and three cases revealed corneal flattening. When the keratometric readings of pre-epikeratoplasty and post-lenticular removal were compared within the same case, the average difference was 5.1 D ± 4.0 (n = 8). Complications were observed in 3 of 10 cases (excessive corneal flatness, ectatic change, and abnormal epithelial cell ingrowth) after removal. Conclusions The surgeon should expect the corneal refractive power to steepen or flatten in some cases with abnormal astigmatism and irregularity. Epikeratophakic eyes may exhibit serious ectatic changes, and abnormal epithelial cell ingrowth after removal of epikeratophakic lenticules.

Trans-optic Suture Fixation of Subluxated Intraocular Lenses

PurposeTo report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens materialMethodsCases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit lamp examination.ResultsFourteen cases were included in this series. In 9 cases the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In 5 cases this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases the lenses remained centered and stable at the end of follow up, and no post-operative complications occurred.ConclusionTrans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.

Risk Factors for Band Keratopathy in Aphakic Eyes With Silicone Oil Tamponade for Open-Globe Injuries: A Multicenter Case-Control Study

Band keratopathy (BK) is a common complication in aphakic eyes with silicone oil tamponade for open-globe injury (OGI), characterized by the grayish-white opacities in the cornea, resulting in a significantly decreased vision when extending to the visual axis. To identify the risk factors for BK in aphakic eyes following vitreoretinal surgical treatment with silicone oil tamponade for OGIs, we performed a multicenter case-control study. The incidence of BK was 28% (28/100 eyes). The multivariate binary logistic regression revealed the silicone oil retention time (SORT) ≥6 months and zone III injury were significant risk factors for BK. From the hierarchical interaction, SORT ≥6 months had a significant risk for BK in eyes with rupture, aniridia, and zone III injury, while zone III injury had a significant risk for BK in eyes with rupture, incomplete/complete iris, and SORT ≥6 months. By using restricted cubic splines with three knots at the 25th, 50th, and 75th centiles to model the association of SORT with BK, we also found a marked increase in the risk for BK at ≥10 months and a slow increase after 6 months, but almost stable within 4–6 months.

Cataract Surgery with or without Intraocular Lens Implantation in Pediatric Uveitis: A Systematic Review with Meta-Analyses

Purpose. To systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without intraocular lens (IOL) implantation and to perform comparative meta-analyses to compare visual acuity outcomes and complication rates. Methods. On 12 November 2020, we systematically searched the Cochrane Central, PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and all affiliated databases of the Web of Science. Two authors independently reviewed studies and extracted data. Studies were reviewed qualitatively in text and quantitatively with meta-analyses. Outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA), inflammation control, and rates of postoperative complications. Results. Ten studies of 288 eyes were eligible for review of which the majority were eyes with juvenile idiopathic arthritis-associated uveitis. Summary estimates revealed that the BCVA was better in pseudophakic eyes vs. aphakic eyes (1-year postoperative: −0.23 logMAR, 95% CI: −0.43 to −0.03 logMAR, P = 0.027 ; 5-year postoperative: −0.35 logMAR, 95% CI: −0.51 to −0.18 logMAR, P = 0.000036 ). Pseudophakic eyes had more visual axis opacification (OR 6.76, 95% CI: 2.73 to 16.8, P = 0.000036 ) and less hypotony (OR 0.19, 95% CI: 0.04 to 0.95, P = 0.044 ). Conclusions. In modern era cataract surgery on eyes with pediatric uveitis with IOL implantation leads to satisfactory and superior visual outcomes and no differences in complication rates apart from an increased prevalence of visual axis opacification and a decreased prevalence of hypotony when compared to aphakia. However, limitations of the retrospective design and the presence of selection bias necessitate a careful interpretation.

Changes in corneal thickness after vitrectomy—Implications for glaucoma practice

Purpose To evaluate changes in central corneal thickness (CCT) following vitrectomy. Methods All consecutive old and new patients referred to glaucoma services for possible secondary glaucoma after vitrectomy and who had undergone corneal pachymetry between July 2013 to June 2020, were included. The eye that developed elevated intraocular pressure (IOP) and was diagnosed clinically as glaucoma after vitrectomy, was labelled as the “affected” eye. The contralateral eye of the patient with normal IOP and no history of vitrectomy was labelled as the “control” eye. The difference in CCT in the affected eye and the contralateral control eye (ΔCCT) and CCT were compared between different age groups. Correlation of CCT in the affected eye with age, diagnosis, type of surgery done, lens status and pre-existing glaucoma was done using multivariate regression analysis. Results Of 127 eyes of 120 patients (M:F = 85:35), the average CCT in the affected eye was significantly higher than the unaffected contralateral control eye (p<0.0001). The ΔCCT in eyes presenting at an age <25 years was higher (median 582, 497–840) than those that presented later (median 518, 384–755), p <0.0001, with maximum ΔCCT seen in eyes that had undergone vitrectomy at age<12 years. The CCT in the affected eye was significantly higher in aphakic eyes (588±81.6 microns) than in pseudophakic eyes (552±79.03 microns), p = 0.03. On multivariate analysis, age<25 years remained as a significant influencer of CCT in the affected eye (β = -1.7, p<0.001, R2 = 28.3%). Conclusions Young age group<25 years are more prone to corneal remodelling and CCT changes after vitrectomy.

Central corneal thickness measurements in phakic, pseudophakic, and aphakic children with ultrasound pachymetry and different non-contact devices

Aims: Evidence for choosing a satisfactory device for central corneal thickness (CCT) measurement in children particularly pseudophakic and aphakic ones is insufficient. The aim of this study is to compare four differently-measured CCTs obtained using ultrasound pachymetry (UP), Pentacam, partial coherence interferometry (PCI), and specular microscopy (SM) in phakic, pseudophakic, and aphakic children and assess the agreement between the six pairs of the methods. Methods: Children with history of cataract surgery at age six or younger and phakic children were recruited into this study. CCT was measured using UP (Optikon 2000, Rome, Italy), Pentacam (Oculus Inc, Wetzlar, Germany), PCI (IOLMaster 700, Carl Zeiss Meditec AG, Jena, Germany), and SM (Topcon SP-3000P; Topcon Corporation, Japan).Results: One-hundred two eyes (53 phakic, 29 pseudophakic, and 20 aphakic eyes) were included. The mean ages (±SD) of phakic, pseudophakic, and aphakic cases were 9.75 (±3.3), 9.9 (±2.3), and 8.2 (±2.8) years respectively. The mean CCTs (±SE) for phakic children using Pentacam, PCI, UP, and SM were 549.7 (±5.0), 546.5 (±4.5), 565.9 (±5.5), and 506.2 (±4.4) mm respectively, for pseudophakic cases were 570.1 (±6.4), 565.0 (±6.1), 571.9 (±6.3), and 524.3 (±6.3) mm respectively, and for aphakic participants were 635.3 (±14.2), 635.4 (±14.5), 649.0 (±13.5), and 589.1 (±13.3) mm respectively. Conclusion: Compared to Pentacam and PCI, SM underestimated CCT particularly in phakic and pseudophakic children, whereas UP slightly overestimated CCT especially in phakic and aphakic children. Furthermore, Pentacam and PCI had the closest agreement. By contrast, SM had the poorest agreement with the other three methods.

Ahmed Glaucoma Valve Implantation with the Tube Placement in the Ciliary Sulcus: Short Term Results

Purpose: To evaluate the clinical outcomes of pseudophakic/aphakic eyes with uncontrolled glaucoma that underwent Ahmed glaucoma valve implantation with the tube placement in the ciliary sulcus.Methods: Medical records of the patients who underwent Ahmed glaucoma valve implantation through the ciliary sulcus, between December 2017 and June 2019, were reviewed retrospectively. Patients’ age, gender, glaucoma diagnosis, visual acuity, intraocular pressure levels and complications were recorded. Results: Forty-seven eyes of 43 patients with glaucoma were enrolled. The mean age was 54.5 ± 19.9 years (range, 7 - 88 years) at the time of surgery and the mean postoperative follow-up period was 7.9 ± 3.4 months (range, 3 -16 months). The mean preoperative intraocular pressure level was 35.2 ±6.8 mmHg (range, 25-55 mmHg) and it was found as 15.6 ± 5.4 mmHg (range, 9-33 mmHg) at last follow-up visit. Decrease in intraocular pressure level was statistically significant (P < 0.001). At last follow-up visit success was achieved in 41 eyes (87.2 %). Hyphema was the most common postoperative complication and developed in 11 eyes (23.4%) and resolved spontaneously in all of them within one month.Conclusion: In pseudophakic or aphakic eyes with uncontrolled glaucoma, placement of Ahmed glaucoma valve tube in the ciliary sulcus is a safe and effective procedure. Ciliary sulcus can be considered as a potential space during tube shunt surgery in eyes with high risk of tube-corneal touch or corneal decompensation.

Intrascleral Suture Anchoring: A Flapless/Grooveless Four-Point Intraocular Lens Fixation Technique

Purpose. We describe a minimally invasive suture fixation technique for four-point fixation of intraocular lenses (IOLs) in the treatment of aphakic eyes, namely, the intrascleral suture anchoring technique. Neither scleral flaps nor large conjunctival dissections are required. Methods. This study included 11 eyes (11 patients). After looping the eyelets on the IOL haptics and externalizing the threads, the curved needle attached to the externalized thread was started with two sequential intrascleral passes from the first fixation point to reach the second fixation point. The same procedure was performed for the other side of the IOL. A fixation knot was created in the sclerotomy by the two ends of the thread to close the suture loop for IOL fixation. Another knot was created about 2 to 3 mm from the exiting point and was intrasclerally anchored by the aid of the attached curved needle. Results. The mean postoperative follow-up period was 9.7 ± 5.8 months (range 5–15 months). The IOLs of all eyes remained well positioned and stable postoperatively. The postoperative visual acuities were improved. No suture erosion, suture loosening, hypotony, scleral atrophy, chronic inflammation, retinal tear, and/or detachment were observed within the follow-up period. Conclusion. The present technique is an alternative, flapless method for the four-point suture fixation of IOLs. It provides both minimal surgical trauma and reliable stability.