Severe Intraocular Pressure Fluctuation following Hemodialysis after Cataract Surgery in a Patient with Chronic Renal Failure

Purpose: To report a case of severe intraocular pressure fluctuation following hemodialysis after cataract surgery in a patient with chronic renal failure.Case summary: A 51-year-old female patient on hemodialysis for chronic renal failure, who was seen regularly by our retina clinic for proliferative diabetic retinopathy and right eye cataract, presented with decreased visual acuity in her right eye. During phacoemulsification under the diagnosis of right eye cataract, zonular dialysis and posterior capsule rupture occurred and intraocular lens ciliary sulcus insertion was performed. Following hemodialysis 3 days after the surgery, the patient complained of headache and right eye pain. The intraocular pressure of the right eye had increased to 44 mmHg. Mild inflammation in the anterior chamber was found with remnant lens material present at the inferior anterior angle. The use of glaucoma eye drops, anterior chamber paracentesis, and anterior chamber irrigation reduced the intraocular pressure and improved the patient’s symptoms. However, a severe increase in intraocular pressure recurred with the above symptoms, again following hemodialysis. Intraocular pressure fluctuation was repetitively present after serial hemodialysis treatments for 1 month, at which point cataract and glaucoma surgeries were considered. However, the intraocular pressure stabilized afterwards; thus, the patient remained under observation and was treated with glaucoma eye drops.Conclusions: Inflammation and a decrease in the aqueous outflow facility due to remnant lens material and the use of an ophthalmic viscoelastic device in cataract surgery may cause severe intraocular pressure fluctuations in patients undergoing hemodialysis for chronic renal failure.

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.

Silicone Oil Adhesion to Hydrophobic Acrylic Intraocular Lenses: A Comparative Laboratory Study of a New versus an Established Hydrophobic Acrylic Intraocular Lens Material

Background. In vitro assessment of silicone oil adhesion to a new hydrophobic acrylic intraocular lens (IOL) material, the Clareon model CNA0T0, compared with the established AcrySof model SN60WF was carried out. Methods. Silicone oil adhesion was assessed for two types of IOLs, Clareon CNA0T0 (n = 10) and AcrySof SN60WF (n = 10). Lenses were immersed in an aqueous sodium chloride solution for 12 hours and then incubated at room temperature in silicone oil for 12 hours. The lenses were washed with distilled water and photographed at 25x magnification using a microscope. The percent coverage was calculated by dividing the area of oil coverage by the total surface area of the lens. Results. Silicone oil adhesion to the surface of the CNA0T0 lens ranged from 4% to 22%, with a mean ± SD coverage of 8% ± 4%. Silicone oil adhesion to the surface of the SN60WF lens ranged from 1% to 17%, with a mean coverage of 9% ± 4%. The silicone oil adhesion of CNA0T0 was equivalent to that of SN60WF ( P > 0.05 ). Conclusions. The new Clareon model CNA0T0 IOL has silicone oil adhesion and interaction that are equivalent to the established AcrySof IOL.

Polyhedral Oligomeric Silsesquioxane Based Silicone Ophthalmic Contact Lens Material Containing Neodymium Nanoparticles

This research was conducted to analyze the compatibility of used monomers and produce the high functional POSS-based ophthalmic polymer containing silicone monomers and neodymium nanoparticle. Synthesized silicone polymer (SiD), trimethylsilylmethacrylate (TSMA), N-vinyl-2-pyrrolidone (NVP) and neodymium nanoparticles were used as additives for the basic combination of polyhedral oligomeric silsesquioxane (POSS), and methyl methacrylate (DMA). And also, the materials were copolymerized with ethylene glycol dimethacrylate (EGDMA) as the cross-linking agent, azobisisobutyronitrile (AIBN) as the initiator. It is judged that the POSS-co-NVP polymer is optically good and thus have good compatibility. Especially copolymerization with TSMA showed high oxygen permeability, but with SID considered to be more stable judging by lens shape. Physical properties shows that the neodymium nanoparticle increases the wettability while maintaining water content. These materials are considered to make synergy effect each other, so it can be used in functional hydrogel ophthalmic lenses.

Study on Dispersant and Surface Analysis of Ophthalmic Lens Materials Containing Carbon Nanotubes

In this study, two types of carbon nanotubes were used as ophthalmic material, and hydrogel contact lenses were polymerized by adding two types of dispersants to effectively exert the functions of carbon nanotubes. The physical properties and surfaces of the ophthalmic hydrogel lenses prepared to confirm the functionality as a dispersant were compared and analyzed to find the utility as an ophthalmic lens material. For the polymerization, single-walled carbon nanotubes (SWCNTs), single-walled carbon nanotubes carboxylic acid functionalized (SWCCNTs), 2-hydroxyethyl methacrylate (HEMA), ethylene glycol dimethacrylate (EGDMA, a crosslinking agent), and azobisisobutyronitrile (AIBN, an initiator) was used. In addition, as a dispersant, PVP (polyvinylpyrrolidone) and BYK-111 were copolymerized. As a result of this study, PVP increased the water content and decreased refractive index regardless of the type of carbon, whereas BYK-111 did not show a significant difference in basic properties. Also, PVP gradually decreased breaking strength, while BYK-111 gradually increased breaking strength. BYK-111 effectively exerted the function of carbon nanotubes, and it was confirmed whether it was dispersed through TEM. Therefore, if carbon nanotubes are used as ophthalmic materials by utilizing BYK-111, it considered to be used as functional ophthalmic lens materials.

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 mm Hg. 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 steroid medication associated 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-material antigenic 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.