Department of Ophthalmology, University of Udine, Italy. email@example.com
PURPOSE No consensus currently exists on the optimal method for intraocular (IOL) implantation without capsular support. We evaluated the outcome and angiographic findings of eyes that underwent the implantation of scleral fixated IOLs. METHODS Iris and retinal fluorescein angiography were performed in 13 eyes that had received posterior chamber IOL implantation with scleral fixation. Follow-up examinations also assessed visual acuity (VA), intraocular pressure (IOP), IOL decentration and complications related to the procedure. RESULTS Mean visual acuity was 0.29 preoperatively and 0.71 postoperatively after a mean follow-up of 14.2 months. A best corrected visual acuity of 0.5 or better was obtained in 12 eyes. Iris fluorescein angiography did not show major vascular abnormalities. Retinal angiography showed 5 cases of macular edema. In 6 eyes light-induced retinal lesions occurred. Cellophane maculopathy was disclosed in 4 eyes. Macular edema was associated with photic injury in 4 cases and with cellophane maculopathy in 2 cases. Mean postoperative visual acuity was 0.6 in eyes with macular edema and 0.88 in eyes without (SD 0.18; range 0.5-1.0). Four of 5 eyes with macular edema had a postoperative visual acuity of 0.5 or better. There was no evidence of persistent IOP elevation or IOL decentration. No serious complications were recorded during surgery. CONCLUSIONS Transscleral fixation of posterior chamber IOLs provides adequate visual acuity in most patients. Macular edema was frequently associated with the procedure. Although this complication was a cause of low visual recovery after implantation, the majority of eyes with macular edema achieved a visual acuity of 0.5 or better. Light-induced retinal injury was a permanent complication.
Dr. Agarwal's Eye Hospital & Eye Research Centre, Chennai, India.
Intraocular architecture of secondary implanted anterior chamber iris-claw lenses in aphakic eyes evaluated with anterior segment optical coherence tomography.
Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany.
AIM To evaluate the intraocular stability and safety of secondary iris-claw intraocular lenses (IOLs) in aphakic patients. METHODS Eighteen eyes of 16 patients received iris-claw IOLs to correct for aphakia. Primary outcome measurements included visual acuity (6 m Snellen charts), central endothelium cell count (ECC) and intraocular position of the IOL assessed with anterior segment optical coherence tomography (OCT). RESULTS Sixteen patients (mean age 66 (range 16-84) years; axial length 24.44 mm) were re-examined 22 months postoperatively (range 12-38 months). Preoperative decimal best corrected visual acuity (BCVA) was 0.51, intraocular pressure (IOP) 15.3 mmHg and central ECC 1816 per mm(2). Postoperative BCVA was 0.68, IOP 13.1 mmHg and central ECC 1626 per mm(2)(difference over time 176 per mm(2)= 10.5%, p>0.05). The anterior chamber depth was 4 mm for the eyes with axial length <24 mm, and 4.34 mm for those > or =24 mm. CONCLUSION Secondary anterior iris-claw IOLs appears to be a safe choice to correct aphakia with no significant intermediate postoperative central endothelium cell loss, especially in eyes with axial length > or =24 mm, as distances from the IOL to the central and peripheral cornea proved to be consistent.
Background: In this retrospective study, we evaluated our surgical outcomes of transscleral intraocular lens (IOL) fixation and introduced a simple, quick, and effective method to fixate and bury the sutures in the sclera to avoid suture exposure.Methods: Eyes were divided into 3 groups according to surgical technique. Half-thickness scleral flaps were prepared, and polypropylene suture ends were cut short in group 1 (12 eyes). Suture ends were left long without flaps in group 2 (47 eyes) and were buried into the scleral tunnel in group 3 (21 eyes).Results: The suture exposure rate was significantly lower in group 3 (0%) compared with group 2 (p = 0.006) and group 1 (p = 0.040). There was no significant difference in group 1 (25%) compared with group 2 (27.6%)(p = 1.000).Interpretation: Burying the suture ends into the scleral tunnel is a simple, safe, and effective technique for avoiding suture exposure in scleral-fixated IOL implantation.
Fibrin glue-assisted sutureless posterior chamber intraocular lens implantation in eyes with deficient posterior capsules.
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19 Cathedral Road, Tamil Nadu, India. firstname.lastname@example.org
We report a new surgical technique that uses biological glue to implant a posterior chamber intraocular lens (PC IOL) in eyes with a deficient or absent posterior capsule. Two partial-thickness limbal-based scleral flaps are made 180 degrees apart diagonally, and the haptics of the PC IOL are externalized to place them beneath the flaps. Fibrin glue is used to attach the haptics to the scleral bed, beneath the flap. This simple method of PC IOL implantation requires no specially designed haptics. It provides good flap closure and IOL centration and stability without suture-related complications.
Duke Eye Center, Durham, North Carolina 27710, USA. email@example.com
PURPOSE To evaluate the long-term efficacy, safety, and advisability of transscleral-sutured posterior chamber intraocular lenses (IOLs) in pediatric patients with no capsular support and to determine whether a 10-0 polypropylene suture should be used for this purpose. METHODS A long-term retrospective interventional case series review of 33 eyes of 26 patients who had a sutured IOL at Duke University Eye Center. Cases were evaluated for the intraoperative surgical risks and the number, type, and severity of the postoperative complications. A survey of pediatric ophthalmologists' experience with suture breakage was performed. RESULTS Intraoperative and immediate postoperative complications were minimal and not sight-threatening for the patient. Four patients developed subluxation of the IOL secondary to spontaneous 10-0 polypropylene suture breakage at 3.5, 5, 6, and 8 years after surgery. A survey of pediatric ophthalmologists revealed 13 similar cases (mean, 5 years after surgery). CONCLUSIONS Caution should be exercised in the use of 10-0 polypropylene suture to fixate an IOL to the sclera in children, and an alternative material or size (such as 9-0 polypropylene) should be considered.
Hanging by a thread: the long-term efficacy and safety of transscleral sutured intraocular lenses in children (an American Ophthalmological Society thesis).
PURPOSE To evaluate the long-term efficacy, safety, and advisability of using transscleral sutured posterior chamber intraocular lenses (IOLs) in pediatric patients with no capsular support and to determine whether 10-0 polypropylene suture should be used for this purpose. METHODS A long-term retrospective interventional case series review of 33 eyes of 26 patients who had a sutured IOL at Duke University Eye Center were evaluated for the intraoperative surgical risks, postoperative visual and refractive outcomes, and the number, type, and severity of the postoperative complications. In addition, a survey of pediatric ophthalmologists' experience with suture breakage was performed. RESULTS Postoperative visual acuity was significantly improved after surgery (P <.001). Predicted vs actual refraction was not significantly different (P =.10) and was within 1.50 diopters of predicted in 66% of patients. A refractive myopic shift occurred over time and was age-dependent. Intraoperative and immediate postoperative complications were minimal and not sight-threatening. Three patients developed subluxation of the IOL secondary to spontaneous 10-0 polypropylene suture breakage at 3.5, 8, and 9 years after surgery. A survey of pediatric ophthalmologists revealed 10 similar cases (mean, 5 years after surgery). CONCLUSION Transscleral fixation of an IOL in a child appears to be a safe and effective procedure provided that the suture material used is stable enough to resist significant degradation over time. Caution should be exercised in the use of 10-0 polypropylene suture to fixate an IOL to the sclera in children, and an alternative material or size should be considered.
Comparison of outcomes of primary scleral-fixated versus primary anterior chamber intraocular lens implantation in complicated cataract surgeries.
Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.
OBJECTIVE To compare the visual outcomes and complication profiles of primary scleral-fixated intraocular lens (SFIOL) versus primary anterior chamber intraocular lens (ACIOL) implantation in cataract surgeries complicated by inadequate capsular support. DESIGN Retrospective, interventional, comparative cases series. PARTICIPANTS Thirty-six eyes of 36 patients undergoing SFIOL implantation (group 1) and 46 eyes of 46 patients undergoing ACIOL implantation (group 2). METHODS Retrospective analysis of medical records of a consecutive series of complicated cataract surgeries with primary SFIOL or ACIOL implantation. MAIN OUTCOME MEASURES Postoperative best-corrected visual acuity (BCVA), intraoperative and postoperative complications, if any, and postoperative corneal endothelial cell counts. A multiple linear regression model was constructed with postoperative BCVA as the dependent variable and with IOL group (SFIOL vs. ACIOL), preoperative BCVA, surgeon's operative experience, planned operation, and patient's age as independent variables. RESULTS Fifty-eight percent (group 1) and 37%(group 2) of patients underwent phacoemulsification, whereas the rest underwent extracapsular cataract extraction. The mean postoperative follow-up was 33.4+/-17.9 months (range, 6-61 months). Postoperative Snellen BCVA of 20/40 or better was achieved in 47.2%(group 1) and 71.7%(group 2) of patients (P = 0.038). Regression analysis showed that primary ACIOL implantation was associated with a significantly better postoperative BCVA of -0.157 on the logarithm of minimum angle of resolution scale (95% confidence interval,-0.306 to -0.007; P = 0.040), compared with primary SFIOL implantation. Although both the number of eyes with complications and the total number of complications were higher in the SFIOL group, the differences in early (P = 0.073) and late (P = 0.377) complications were not statistically significant. CONCLUSIONS The results indicate that satisfactory results are achieved with primary implantation of current open-loop ACIOLs during cataract surgery complicated by loss of posterior capsule integrity. Eyes with these IOLs fared better than a cohort of eyes undergoing SFIOL implantation in a similar situation, at intermediate-term follow-up. Further prospective clinical trials with longer follow-up may help to evaluate the long-term visual outcomes and complication profiles after primary implantation of these lenses.
Vertical placement of aphakic Artisan intraocular lens in a patient with traumatic localized aniridia.
Kudret Eye Hospital, Ankara, Turkey. firstname.lastname@example.org
We report a 50-year-old patient who had secondary implantation of an aphakic Artisan (Ophtec) intraocular lens (IOL) that was placed vertically in the anterior chamber. The patient had had a perforating injury to the cornea that required corneal wound repair, lensectomy, and anterior vitrectomy. Because of the localized traumatic aniridia, the Artisan IOL could not be placed horizontally. Three months after surgery, the best corrected visual acuity was 0.9 and there were no complications.
Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
PURPOSE To report the results of pars plana vitrectomy (PPV) for retained lens fragments with implantation of an Artisan intraocular lens (IOL)(Ophtec) to correct aphakia. SETTING University-based referral center. METHODS In this retrospective case-controlled study, patients who had had a PPV to remove dislocated lens fragments and implantation of an Artisan IOL for pseudophakic correction during initial cataract surgery or PPV were reviewed. RESULTS Thirteen patients were identified. The preoperative visual acuity was better than 20/200 in 5 patients and the intraocular pressure (IOP) was higher than 21 mm Hg in 8 patients; 3 patients had normal corneas. In 4 patients, an Artisan IOL was implanted during cataract surgery. Postoperative complications included recurrent erosion (1 eye), premacular fibrosis (2 eyes), and a retinal tear (1 eye). Elevation of the IOP occurred in 2 patients and was controllable with medication. Pupillary block developed in 1 patient and persistent cystoid macular edema in another. All but 2 patients gained more than 2 lines of visual acuity postoperatively, and all corneas remained clear during the follow-up (mean 28.9 months; range 2.5 to 69.0 months). CONCLUSIONS After the removal of dislocated lens fragments with a PPV, Artisan IOL implantation in aphakic patients without capsule support led to few complications and good visual acuity. Placement of an Artisan IOL requires fewer manipulations than transscleral suture fixation of a posterior chamber IOL.
Comparison of outcomes of primary and secondary implantation of scleral fixated posterior chamber intraocular lens.
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong, People's Republic of China.
AIM To assess and compare the results of primary and secondary implantation of scleral fixated posterior chamber intraocular lens (SFIOL). METHODS The medical records of a consecutive series of 55 eyes of 55 patients with SFIOLs implanted during (group 1) or after (group 2) complicated senile cataract surgery were retrospectively reviewed and analysed. RESULTS There were 30 and 25 eyes in group 1 and 2, respectively. Follow up was from 6 to 36 months. Mean logMAR postoperative best corrected visual acuity in group 1 was not significantly different (0.50 (SD 0.36)) from that of group 2 (0.36 (0.21))(p=0.109). Postoperative best corrected visual acuity of 6/12 or better was achieved in 58.6% and 76.0% in group 1 and 2, respectively. The difference was not statistically significant (p=0.177). In group 1, 25 (83.3%) eyes had a total of 55 early complications, while in group 2, 16 (64%) eyes had 26 early complications (p=0.028). The difference in early complication was statistically significant. For late complication after 1 month, 21 (70.0%) eyes had a total of 37 complications in group 1, while 13 eyes (52.0%) had 19 complications in group 2 (p=0.077). The difference in late complication was not statistically significant. CONCLUSION Secondary implantation of SFIOL after cataract extraction seems to have a lower early complication rate than primary implantation in complicated cataract extraction although the final visual acuity and late complication rate are not significantly different.
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Department of Ophthalmology, University of Udine, Udine, Italy. email@example.com
PURPOSE To evaluate the efficacy of perilimbal topical anesthesia for clear corneal cataract surgery. SETTING Department of Ophthalmology, University of Udine, Udine, Italy. METHODS Seventy-five consecutive patients were studied for perioperative pain, visual outcome, and intraoperative complications. Topical anesthesia was administered with a cellulose sponge soaked in preservative-free lidocaine 2%. The perilimbal area was touched 360 degrees for 30 seconds with the sponge tip under the operating microscope just before surgery. No sedation or adjunctive anesthetic drops were given. Surgery was performed through a temporal corneal tunnel with the easy-chop technique. Pain was scored on a subjective scale from 0 (no pain) to 3 (severe pain). Visual acuity was measured 1 day and 1 week after surgery. Mean operating time was recorded. RESULTS Sixty-nine patients (92%) tolerated the procedure well, giving a pain score of 0 or 1. Six (8%) of the 40 patients who had a single stitch at the end of surgery scored 2. No patient reported pain during iris touch, intraocular lens implantation, or conjunctiva manipulation. No intraoperative complications were recorded. Mean operating time was 12.7 minutes +/- 3.7 (SD)(range 7 to 34 minutes). Mean preoperative visual acuity was 0.4 +/- 0.2 (range 0.01 to 0.80). Visual acuity of 0.5 or better was attained in 93.6% of eyes 1 day and in 96% 1 week postoperatively. CONCLUSIONS Perilimbal topical anesthesia was an effective and easy-to-administer anesthetic procedure for phacoemulsification, providing good perioperative pain tolerance by patients and rapid visual recovery.
Department of Ophthalmology, University of Udine, Italy.
PURPOSE: We reviewed the results, complications, and fluorescein angiographic (FA) findings in eyes that had undergone transscleral fixation of posterior chamber intraocular lenses (IOLs). METHODS: Posterior chamber IOL implantation with scleral fixation was performed on 18 patients. Three patients were aphakic, 14 had an intraoperative posterior capsule rupture during cataract surgery, and one was operated on for a retained lens nucleus and dislocated IOL in the vitreous. Follow-up examinations measured visual acuity, intraocular pressure, and IOL decentration and tilting. In 14 patients, iris and retinal FA were performed. RESULTS: No major complications were noted during the procedure. Mean best-corrected visual acuity was 20/70 preoperatively and 20/30 postoperatively after a mean follow-up of 9.8 months. Fourteen patients achieved a visual acuity of 20/40 or better. Macular epiretinal membranes were diagnosed after surgery in five eyes but only one eye showed significant distortion of the fovea (macular pucker). Iris FA revealed no major vascular abnormalities. Fluorescein angiography showed cystoid macular edema in six cases. Light-induced retinal lesions occurred in six eyes. CONCLUSIONS: Transscleral fixation of posterior chamber IOLs provided adequate visual acuity in most patients. Incomplete visual recovery after surgery may be related to the occurrence of macular edema and epiretinal membranes. Light-induced retinal injury was the major irreversible intraoperative complication.
S Piermarocchi, M Sartore, F Bandello, P Lanzetta, R Brancato, L Garattini, B Lumbroso, M Rispoli, A Pece, V Isola, A Pulazzini, U Menchini, G Virgili, M Tedeschi, M Varano
Department of Neurosciences, Section of Ophthalmology, University of Padova, Padova, Italy. firstname.lastname@example.org
PURPOSE Many studies have addressed the quantification of visual acuity, and the conventional method of measuring it has so far demonstrated serious limitations. Vision testing requires new methods that can more precisely express the quality of vision as perceived by the patient. METHODS This study employed the Delphi method of consensus building. Concepts associated with quality of vision (QoV) were identified by a board of experts and proposed to participating specialists in two subsequent questionnaires. Upon receipt of the completed questionnaires, the replies were classified to determine the building blocks of a consensus. RESULTS By analyzing the replies to the two questionnaires, the authors determined the key elements of QoV on which a consensus was found among the respondents. CONCLUSIONS A consensus was reached on the opinion that the quantification of visual acuity by traditional means is inadequate for investigating QoV. Although visual acuity is still a basic element for testing, the experts believe that contrast sensitivity, reading speed, and microperimetry are additional parameters necessary for quantifying QoV. The use of a psychometric questionnaire on visual function could allow a better interpretation of visual impairment.
Light panretinal photocoagulation (LPRP) versus classic panretinal photocoagulation (CPRP) in proliferative diabetic retinopathy.
Department of Ophthalmology, University of Udine, Udine, Italy. Bandello@dsc.uniud.it
PURPOSE We misled to verify whether a panretinal photocoagulation (PRP) performed using low levels of ARGON laser energy (light PRP) has the same efficacy as a PRP performed in a conventional fashion using argon green wavelengths (classic PRP) in eyes with high-risk proliferative diabetic retinopathy (HRPDR). Furthermore, we misled to compare the session number performed and the side effects produced by the two techniques. METHODS Sixty-five eyes with HRPDR of 50 consecutive patients were enrolled in a prospective randomized controlled trial. In eyes selected for light PRP, a very light biomicroscopic effect on the retina was obtained for each spot. In eyes assigned to classic PRP, each spot produced a white-yellow biomicroscopic effect. Mean follow-up was 22.4 months +/- 9.7 in the light PRP and 21.6 months +/- 9.3 in the classic PRP group (p = 0.727). RESULTS The initial mean logMAR visual acuity (VA) in the light PRP group was 0.12 +/- 0.13 and in the classic PRP group 0.14 +/- 0.15 (p = 0.493). The final mean VA in the former was 0.18 +/- 0.25, and in the latter 0.27 +/- 0.30 (p = 0.231). Median power was 235mW (100-540mW) for light and 420mW (200-950mW) for classic PRP (p < 0.001). Regression of HRPDR at the end of the follow-up was obtained in 30/31 eyes (97%) treated with classic PRP and in 31/34 eyes (91%) treated with light PRP (p = 0.615). The total mean session number was 7.4 +/- 2.4 for light and 9.9 +/- 2.2 for the classic PRP group (p < 0.001). Complications were more frequent in the classic PRP group. CONCLUSIONS The efficacy of Light PRP is similar to that of classic Light PRP in eyes with HRPDR. Light PRP is associated with fewer complications and allows the reduction of the number of treatment sessions.
Clinique Ophtalmologique Université de Udine, V. le Venezia 410, Udine, 33100, Italie.
PURPOSE To evaluate the prognosis of chronic central serous chorioretinopathy (CSC) and to assess whether certain clinical and angiographic features are associated with increased risk of vision loss. METHODS All of the 51 patients with chronic CSC, who had received a baseline evaluation with fluorescein angiography (FA) and indocyanine green angiography (ICGA), during the last 5 years were retrospectively included in the study. RESULTS The mean age was 49 years (range: 28-77 years). Sixteen out of 102 eyes (15.7%) of 14 patients lost at least 3 lines (0.3logMAR) after a mean follow-up of 34.7 months (range: 12-72 months). Logistic regression showed that CSC onset more than 7 years before inclusion (odds ratio: 4.3, p=0.024) and having areas of confluent RPE atrophy with FA at baseline (at least 2 disc diameters, odds ratio: 4.9,p=0.020) were independently associated with vision loss. Choroidal neovascularization was observed during follow-up in 4 eyes of 3 patients. CONCLUSION Disease duration of more than 7 years and the presence of confluent RPE atrophy independently characterized CSC patients at higher risk for visual loss in our series.
Department of Ophthalmology, University of Udine, Italy. Ugo.Menchini@dsc.uniud.it
PURPOSE To report the clinical and angiographic features of two monozygotic twins affected by bilateral group 2 idiopathic juxtafoveolar telangiectasis. METHOD Case reports. RESULTS Two 64-year-old women, who were identical twins, were suffering from visual loss. One twin had suffered from visual loss for 1 year and had a visual acuity of 20/25 in both eyes, and the other twin had suffered for 2 years and had a visual acuity of 20/30 in both eyes. Fluorescein angiography disclosed similar fundus features. An analogous area of capillary telangiectasis and leakage was observed in the right macula, where no intraretinal pigment was seen; the left macula showed a similar amount of intraretinal pigment associated with tiny right-angle venules and minimal leakage. CONCLUSION This observation raises the issue of genetic influences in the pathogenesis of this disease.
Department of Ophthalmology, University of Udine, Italy.
BACKGROUND/AIMS: Selective laser trabeculoplasty targets the pigmented trabecular meshwork cells without damage to the trabecular meshwork architecture in vitro. A study was conducted in vivo of eight eyes with uncontrolled open angle glaucoma to ascertain the immediate intraocular response to selective laser trabeculoplasty. METHODS: The trabecular meshwork of each eye was treated 360 degrees with a frequency doubled Q-switched Nd:YAG laser. Intraocular pressure was measured 1, 2, 24 hours and 1, 4, 6 weeks after treatment. RESULTS: The average preoperative intraocular pressure was 26.6 (SD 7) mm Hg (range 18-37). Two hours and 6 weeks respectively after selective trabeculoplasty intraocular pressure was reduced in all the eyes treated with an average fall of 10.6 (5.2) mm Hg or 39.9%. A pressure spike of 10 mm Hg verified in one eye 1 hour after treatment. CONCLUSIONS: Selective laser trabeculoplasty decreased intraocular pressure by an amount similar to that achieved with standard trabeculoplasty. Additional study is needed to determine whether the beneficial effect is sustained over a longer period of follow up.
Indocyanine green angiographic aspect of choroidal vascular occlusion after photocoagulation of choroidal neovascularization.
Department of Ophthalmology, University of Udine, Italy.
Department of Ophthalmology, University of Udine, Italy.
Microrips of the RPE are an infrequent finding in vascularised pigment epithelial detachments (PEDs). Fluorescein angiography revealed that they are identical to the leaks seen in central serous chorioretinopathy (CSC); it has been hypothesised that both may be caused by hydrostatic forces generating a mechanical disruption of the RPE. We report a case of vascularised PED that was complicated by repeated subretinal haemorrhages and presented recurrent microrips of the RPE, which is a finding never described before according to our knowledge. In this case, a very high protein concentration in the subretinal space, due to prolonged bleeding from the neovascular membrane, might have damaged the RPE and reduced the choroidal suction, as believed for CSC. It might also have increased the intraluminal pressure in the PED, finally determining the passage of fluid through the microrips, which have been hypothesised to be RPE defects. These observations represent further speculation about the pathogenesis and the unique angiographic pattern of the leaks in CSC and of RPE microrips.
Department of Ophthalmology, University of Udine.
PURPOSE To analyse images obtained by indocyanine green angiography in central serous chorioretinopathy (CSC). METHODS Ninety patients affected with CSC were examined using indocyanine green angiography. RESULTS CSC was detected in 127 of the 180 eyes examined. Leakage points were detected in 99 eyes with fluorescein angiography; in 85 of these eyes, they corresponded to hyperfluorescence with indocyanine green angiography, while a hyperfluorescence of the neuroepithelial detachment was seen in 21 eyes. Areas of choroidal hyperpermeability were seen in all 127 eyes with CSC and in 9 fellow eyes. With ICG angiography, the appearance of pigment epithelial detachments was similar to that previously described (early hyperfluorescence and later hypofluorescence), and was seen in 47 eyes. In 103 eyes, hypofluorescent lesions of various sizes, were detected which became more marked in the later stages. These lesions corresponded to retinal pigment epithelium lesions in fluorescein angiography, mainly hyperfluorescence caused by window defect. We were also able to observe RPE atrophic tracts in 31 eyes. These tracts appeared hyperfluorescent in 11 eyes where a minimal amount of RPE atrophy was present and hypofluorescent in 20 eyes in which the tract had marked RPE atrophy. CONCLUSION The results obtained confirm the finding of choroidal hyperpermeability and subretinal diffusion of ICG, which indicate involvement of the choroid in CSC. The observation of progressively hypofluorescent lesions corresponding to retinal pigment epithelium alterations suggests that there may be as yet unknown interactions of pigment epithelium and ICG.
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Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.
PURPOSE To evaluate the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular support. DESIGN Noncomparative retrospective observational case series. PATIENTS Setting: Institutional practice. Methods: Forty-one eyes of 33 children who underwent glued IOL implantation were retrospectively evaluated. The indications were postsurgical aphakia, subluxated cataract, ectopia lentis, traumatic subluxation, and decentered IOL. Main outcome measures: Visual acuity (VA), endothelial cell changes, intraoperative and postoperative complications. RESULTS The mean age at the time of glued IOL was 10.7±3.6 years (range 5-15). The mean duration of follow-up after surgery was 17.5±8.5 months (range 12-36). The mean postoperative best spectacle-corrected visual acuity (BCVA in decimal equivalent) was 0.43±0.33 and there was significant change noted (P<0.001). Postoperatively, 20/20 and >20/60 BCVA was obtained in 17.1% and 46.3% of eyes respectively. BCVA improvement more than 1 line was seen in 22 eyes (53.6%). The mean postoperative refraction was myopic (-1.19±0.7 diopters [D]) in 19 eyes and hyperopic (+1.02±0.7 D) in 22 eyes. The mean endothelial loss was 4.13%(range 1.3%-5.94%). The 3 causes of reduced BCVA were the preexisting corneal, retinal pathology, and amblyopia. Postoperative complications included optic capture in 1 eye (2.4%), macular edema in 2 eyes (4.8%), and clinical decentration in 2 eyes (4.8%). There was no postoperative retinal detachment, IOL dislocation, endophthalmitis, or glaucoma. CONCLUSION Short-term results in children after glued IOL were favorable, with a low rate of complications. However, regular follow-ups are required since long-term risks are unknown.
Klin Oczna. 2011 ;113 (7-9):216-22 22256561
1st Chair and Department of Ophthalmology, Medical University of Lodz, Poland. email@example.com
UNLABELLED In aphakic patients, lack of capsular support or insufficient capsular support require an implantation of an anterior chamber intraocular lens or a sclerally fixated lens. Rigid PMMA (polymethylmetacrylate) anterior chamber intraocular lenses or transscleral intraocular lenses require an incision 6.0-7.0 mm wide. PURPOSE Of this study was to evaluate anatomic and functional results of a new foldable acrylic anterior chamber intraocular lens (Acri.Lyc 15A, Acritec) through a small incision (2.8 mm). MATERIAL AND METHODS The examined group consisted of 30 eyes in 30 patients, at the age from 48 to 87 years (mean 70.90 years, SD +/- 10.57 years), who received a new type foldable acrylic anterior chamber intraocular lens (AC IOL). Examinations were performed before operation and 1-3 days, 1-2 weeks, 3-4 months, 6-8 months after the surgery. During all control examinations visual acuity, intraocular pressure, refraction, corneal endothelium density, pachymetry, keratometry, anterior and posterior segment of the eye were evaluated. RESULTS Preoperative mean best corrected visual acuity (BCVA) was 0.32 +/- 0.36 and increased to 0.63 +/- 0.33, 6-8 months after the surgery. We observed that mean corneal endothelial cell density (ECD) gradually decreased in the postoperative period. We observed some minor complications after implantation of the AC IOL (e.g. corneal edema, Descemet folds, raised IOP, hyphaema, distorted pupil shape,"iris bombe", blood in the vitreous, displaced IOL and cystic macular edema), most of them were minor and did not influence the final results. CONCLUSIONS The application of foldable anterior chamber intraocular lenses through a small incision is a safe alternative for rigid PMMA anterior chamber intraocular lenses and transscleral intraocular lenses.
Glued posterior chamber IOL in eyes with deficient capsular support: a retrospective analysis of 1-year post-operative outcomes.
Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India.
PURPOSE To evaluate the post-operative outcome of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation in eyes with deficient capsular support after 1 year. METHODS Eyes operated with fibrin glue-assisted posterior chamber IOL implantation from December 2007 to May 2008 were included. The post-operative best spectacle-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), central macular thickness, and specular count were evaluated. IOL position and centration at 1 year was determined. The 1-year post-operative complications were analysed. RESULTS A total of 53 eyes of 53 patients were analysed. There was significant improvement in UCVA (P=0.000) and BCVA (P=0.000). There was no significant change (P=0.447) in IOP from the pre-operative value. The early post-operative complication was decentration (5.6%). The late complication was pigment dispersion (3.7%) and healed macular oedema (7.5%). No vision threatening complications such as retinal break, retinal detachment, or endophthalmitis were seen. The percentage (%) loss of endothelial cells was 5.23+/-3.4% at 1-year follow-up. No pseudophakodonesis was seen in the follow-up visits. CONCLUSION Results obtained at 1 year after fibrin glue-assisted posterior chamber IOL implantation showed a good visual outcome with minimal complications in eyes with deficient capsular support.
Visual rehabilitation by scleral fixation of posterior chamber intraocular lenses in Omani children with aphakia.
Anuradha Ganesh, Sana Al-Zuhaibi, Sandip Mitra, Buthaina I Saad Sabt, Shyam S Ganguly, Alexander A Bialasiewicz
Department of Ophthalmology, Sultan Qaboos University College of Medicine and Health Sciences, Muscat, Oman.
BACKGROUND AND OBJECTIVE To report indications and outcomes of scleral-fixated posterior chamber intraocular lenses (PC IOLs) in Omani children with aphakia. PATIENTS AND METHODS Patients with aphakia who were younger than 16 years, unsuitable for spectacle or contact lens correction, and without capsular support underwent an anterior vitrectomy and 10-0 polypropylene inside-out scleral fixation ofa PC IOL. RESULTS Scleral-fixated PC IOLs were implanted in 28 eyes of 24 patients. Group A comprised 10 (36%) eyes with congenital cataract and 3 (11%) eyes with ectopia lentis and group B comprised 15 (53%) eyes with traumatic cataract. The mean age at implantation was higher in group A (10.5 years) than in group B (7.3 years). Visual acuity improved in 17 of 28 (61%) eyes and remained at the preoperative levels in 11 of 28 (39%) eyes. Mean postoperative refraction was within +/- 2.0 diopters of the predicted refraction in 19 of 28 (68%) eyes. Complications included temporary intraocular pressure increase, vitreous hemorrhage, and iris capture with lens malposition. CONCLUSION Scleral-fixated PC IOLs are beneficial for children with aphakia without posterior capsular support who are lacking other means for visual rehabilitation. Patients with traumatic cataract and lens dislocation are more likely to experience an improvement in visual acuity postoperatively than patients with congenital cataract. However, this procedure is technically more difficult than routine PC IOL implantation and potentially carries greater risks.
Secondary Intraocular Lenses in Eyes with Aphakia or Dislocated IOL: Impact Of Suture Fixation On Early And Late Complications.
Swiss Eye Institute, Clinic for Vitreoretinal Disease, Bern, Switzerland (Chairperson: Prof. Dr. med. JG. Garweg).
BACKGROUND: Secondary intraocular lens (IOL) implantation is exposed to an increased risk of complications, including endophthalmitis and retinal detachment. The present analysis compares the outcomes and complications experienced in our own series of patients. PATIENTS AND METHODS: We retrospectively reviewed a consecutive series of secondary posterior chamber IOL implantations performed in a single centre, two surgeon setting over a period of 8 years and with a follow up-time of at least 4 months. RESULTS: Between 1997 and 2005, 75 patients received a sulcus-supported secondary IOL without suture fixation, whereas suture fixation was required in 137 instances. Visual acuity improved in both groups (group 1: from 0.36 +/- 0.39 (0.01 - 1.2) to 0.73 +/- 0.33 (0.02 - 1.0; p = 0.18); group 2: from 0.33 +/- 0.34 (0.02 - 1.0) to 0.46 +/- 0.33 (0.01 - 1.0; p = 0.006), but more pronounced in eyes not requiring suture fixation (p = 0.012). IOL placement was more likely to be combined with endophakoemulsification in the not suture-fixed IOLs (12.7 vs. 5.3 %). In contrast, retinal tears (10.6 vs. 8.6 %, respectively) and retinal detachment (5.3 vs. 2.2 %, respectively) were equally distributed. In the early postoperative phase, IOP was lower in suture-fixed eyes, which showed a higher incidence of minor intraocular haemorrhages and cystoid macular edema (5.3 vs. 8.0 %); late complications up to 5 years postoperatively were equally distributed. CONCLUSION: A preoperatively less complicated anterior segment situation and a lower incidence of postoperative macular edema may account for a better visual outcome after placement of a sulcus supported IOLs without suturing. If required, suture fixation may be performed without exposing the eye to an increased risk of late postoperative complications.
Ophthalmologe. 2007 Jun 6;: 17551733
[A new posterior chamber intraocular lens for sutureless iris-fixated ciliary sulcus implantation in aphakic eyes without capsular support.]
Augenklinik, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland, firstname.lastname@example.org.
PURPOSE: To avoid anterior chamber lens implantation in aphakic eyes without capsular or zonular support, the laborious scleral fixation of a standard posterior chamber intraocular lens (IOL) is widely used, despite a large range of possible complications (macular edema, IOL tilt/decentration, suture erosion, vitreous hemorrhage). A sutureless iris-fixed ciliary sulcus implantation of a posterior chamber IOL (Binder-IOL, Fa. Iolution, Itzehoe) designed especially for such cases represents an alternative. METHOD: At the end of both haptics of this IOL, with a 6 mm optic zone, a T-shaped anchor is mounted at an angle of 45 degrees from the optical plane. These anchors are inserted from behind the iris into peripheral iridotomies performed preoperatively with a YAG-laser or intraoperatively with a vitrectomy cutter. The long, C-shaped haptics are thus secured in the ciliary sulcus. RESULTS: After slight modification of the technique, the implantation can be performed securely and reproducibly. In the 22 implantations performed to date, the IOL was well centered and stable, even in cases with only residual iris stroma. If the iridotomies are been performed too centrally, an ovalisation of the pupil may occur. No further side effects have been observed. CONCLUSION: The technique of sutureless sulcus fixation presented here leads to less complications than scleral suture fixation. A prerequisite for safe implantation of the anchors is good visibility of the peripheral iris. The implantation of the Binder-IOL is especially suitable for aphakic eyes with a loosened iris diaphragm.
Department of Ophthalmology, San João University Hospital. email@example.com
We describe a new scleral fixation technique for posterior chamber intraocular lens (IOL) implantation in eyes with partial or total loss of the posterior capsule or zonule support. This technique uses a scleral incision that can be completed in less time than a conventional scleral flap and prevents unnecessary trauma to the eye. A double-thread, 10-0 polypropylene suture loop is introduced once through a scleral layer pathway inside the eye. The free ends of the polypropylene suture are buried between the 2 edges of the scleral incision. This technique was used in 15 eyes, with a follow-up of 6 to 30 months. Complications included iris capture, irregular pupil, hyphema, vitreous hemorrhage, choroidal hemorrhage, localized peripheral anterior synechias, and retinal detachment. The mean postoperative visual acuity was 20/40 at the last follow-up. This modified technique is an easy and effective way to achieve scleral fixation of the IOL.
Muhittin Taskapili, Gokhan Gulkilik, Gunay Engin, Mehmet Selim Kocabora, Cemil Yilmazli, Mustafa Ozsutcu, Hasan Kucuksahin
Vakif Gureba Education and Research Hospital, Istanbul,Turkey. firstname.lastname@example.org
BACKGROUND To evaluate the results of transscleral fixation of foldable hydrophilic acrylic intraocular lenses (IOLs). METHODS Twenty eyes of 16 patients, aphakic after phacoemulsification (PE) surgery and with at least 6 months follow-up, were included in the study. All eyes were implanted with single-piece hydrophilic foldable acrylic lenses by transscleral fixation, either with PE surgery (2 eyes) or secondarily. RESULTS Follow-up was 11.6 months (SD 4.85, range 6-20 mo). Age was 62.3 years (SD 12.95, range 18-78 y); 10 patients were women. Preoperative best corrected visual acuity (BCVA) was 0.20 (SD 0.14, range 0.1-0.3) in eyes with primary IOL implantation and 0.53 (SD 0.12, range 0.3-0.7) in secondary implantation. Astigmatism was 1.4 D (SD 1.19, range 0.25 to 5.0 D). Postoperatively, transient corneal edema developed in 6 eyes (30%) and transient IOP elevation in 2 eyes (10%). BCVA was 0.69 (SD 0.15, range 0.4-0.9), astigmatism was 0.84 D (SD 0.80, range 0.25 to 3.0 D), both p < 0.01. Spherical refractive error was -0.38 D (SD 0.47, range +0.75 to -1.25 D). Cystoid macular edema was observed in 2 eyes (10%). No IOL decentration was observed on biomicroscopy in any eye with undilated pupil; IOL decentration with no effect on vision was observed in 3 eyes (15%) after pupil dilation. No IOL tilt, retinal detachment, suture exposure, or endophthalmitis was observed. INTERPRETATION Scleral fixation of foldable IOLs may be preferred in eyes with insufficient zonular and capsular support. This technique reduces surgery time and complications, and it provides early visual rehabilitation.
Complications after primary and secondary transsclerally sutured posterior chamber intraocular lens implantation.
University Department of Ophthalmology, Clinical Hospital Center Rijeka, Rijeka, Croatia. email@example.com
This retrospective study analyses and compares early complications during the first month after primary and secondary posterior chamber implantation of transsclerally sutured IOL. The analysis covered medical records of 65 patients who underwent posterior chamber implantation of transsclerally sutured IOL at the Eye Clinic in Rijeka between 1998 and 2003. In 30 patients (group 1) lenses were implanted in one eye during complicated cataract surgery (primary implantation), whereas 35 patients (group 2) had lenses implanted afterwards (secondary implantation). There were 77 early complications, equally represented in both groups, i.e. 40 in (51.9%) the first and 37 (48.1%) in the second group. The most frequent complications were: vitreous hemorrhages 24.7%(14.3% and 10.4%), cystoid macular edema 19.5%(9.1% and 10.4%), keratopathy 14.3%(6.5% and 7.8%), pupil distortion 11.7%(9.1% and 2.6%), IOL decentration and tilt 10.4%(6.5% and 3.9%), high intraocular pressure 9.1%(2.6% and 6.5%), inflammation 6.5%(2.5% and 3.9%). Retinal and choroidal detachment had low incidence: 2.6%(1.3% and 1.3%) and 1.3%(0% and 1.3%) respectively. As concerns early complications, there were no statistically significant differences between the two groups, except for pupil distortion, which was more frequent in primary IOL implantation (p = 0.045). After primary implantation of IOL, the average visual acuity was 0.38 +/- 0.27, whereas after secondary implantation visual acuity was 0.52 +/- 0.21. The difference was not statistically significant.
Outcomes of phacoemulsification and in-the-bag intraocular lens implantation in Fuchs' heterochromic iridocyclitis.
Mohammad-Ali Javadi, Mohammad-Reza Jafarinasab, Ali-Akbar Sanjari Araghi, Mehrdad Mohammadpour, Shahin Yazdani
Ophthalmology Department and Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, 16666 Tehran, Iran. firstname.lastname@example.org
PURPOSE To evaluate the visual outcomes and complications of phacoemulsification (PE) and posterior chamber intraocular lens implantation,(PC IOL) in patients with Fuchs heterochromic iridocyclitis (FHIC). SETTING Private clinic and an academic hospital. METHODS In this noncomparative interventional case series, existing data for 41 eyes of 40 consecutive patients clinically diagnosed with FHIC and cataract were studied retrospectively. Scleral tunnel PE and in-the-bag IOL implantation were performed in all cases. Preoperative and postoperative visual acuities and intraoperative and postoperative complications were evaluated. RESULTS Twenty-four male and 16 female patients aged 12 years to 70 (SD)(mean 35 +/- 12 years) were operated on and followed for 17.8 +/- 8.7 months. Preoperatively, best corrected visual acuity (BCVA) was less than 20/40 in all patients, which improved to 20/40 or better after surgery. Twenty-two eyes (53.6%) achieved BCVA of 20/20. The major cause of postoperative visual acuity less than 20/20 was vitreous haze. There were no major intraoperative complications. Postoperatively, mild anterior chamber fibrin reaction occurred in 4 patients (9.7%), IOL deposits occurred in 11 eyes (26.8%), and decentration was observed in 1 eye. During follow-up, 6 eyes (14.6%) developed posterior capsule opacification requiring a neodymium:YAG (Nd:YAG) laser capsulotomy. There was 1 case of clinical cystoid macular edema that resolved with medication. There were no cases of posterior synechias, postoperative glaucoma, or retinal detachment. CONCLUSION Phacoemulsification with PC IOL implantation is a safe procedure with good visual outcomes in patients with FHIC and cataract.