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Magyar M, Szentmáry N, Ujváry L, Sándor GL, Schirra F, Nagy ZZ, Tóth G. Indications and Outcomes of Intraocular Lens Explantation in a Tertiary Eyecare Center in Hungary between 2006 and 2020. J Ophthalmol 2024; 2024:6653621. [PMID: 38827421 PMCID: PMC11142860 DOI: 10.1155/2024/6653621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Purpose Our study aimed to evaluate the indications and outcomes of intraocular lens (IOL) explantation surgeries in a tertiary eyecare center in Hungary. Materials and Methods This retrospective study included all IOL explantation surgeries performed between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University, Budapest, Hungary. There were no exclusion criteria for this study. For each patient, the demographics, clinical history, preoperative status, indications for IOL explantation, and operative and postoperative details were reviewed. Primary outcomes included explantation indications and the type of secondary implanted IOL. Results A total of 161 eyes from 153 patients were included (96 males; 62.7%); age at the time of the IOL explantation was 65.0 ± 17.4 years. The mean time between primary cataract surgery and IOL explantation was 8.5 ± 7.7 years. In total, 139 (86.3%) PCIOLs and 22 (13.7%) ACIOLs were explanted. The main indications for IOL explantation were dislocation (n = 133; 95.7%) and refractive cause (n = 2; 1.4%) in the PCIOL group. Among ACIOL explantations, the main reasons were pseudophakic bullous keratopathy (n = 14; 63.6%), dislocation (n = 4; 18.2%), and refractive cause (n = 2; 9.1%). In the PCIOL group, 115 (82.7%) primary IOLs were implanted in the capsular bag, 16 (11.5%) were sulcus fixated, and 8 (5.8%) were scleral fixated. The most frequent ocular comorbidities were previous vitrectomy (n = 50, 31.1%), previous ocular trauma (n = 45, 28.0%), glaucoma (n = 16, 9.9%), pseudoexfoliation syndrome (n = 15, 9.3%), and high axial myopia (n = 14, 8.7%). The most commonly used secondary IOL implant was the prepupillary iris-claw IOL (n = 115, 73.7%), followed by the retropupillary iris-claw IOL (n = 32, 20.5%). Uncorrected visual acuity (UCVA) was significantly better following IOL exchange in the entire sample (1.57 ± 0.61 (range: 2.40-0.05) vs. 0.77 ± 0.56 (range: 2.40-0.00); p < 0.001). Best-corrected visual acuity (BCVA) was maintained or improved in 80.7% of cases after IOL explantation. Conclusions The most common indication for IOL explantation at a tertiary eyecare center in Hungary is IOL dislocation, followed by pseudophakic bullous keratopathy. Prepupillary and retropupillary iris-claw IOL are the most frequently used secondary implants and their use resulted in a significant UCVA improvement following IOL exchange.
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Affiliation(s)
- Márton Magyar
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Nóra Szentmáry
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Kirrberger Str. 100 66424, Homburg, Saar, Germany
| | - László Ujváry
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Gábor László Sándor
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Frank Schirra
- Argos Augenzentrum, Faktoreistraße 4 66111, Saarbrücken, Germany
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
| | - Gábor Tóth
- Department of Ophthalmology, Semmelweis University, Maria Utca 39 1085, Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Kirrberger Str. 100 66424, Homburg, Saar, Germany
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Noguchi S, Nakakura S, Tabuchi H, Noguchi A. Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps. J Clin Med 2024; 13:2938. [PMID: 38792480 PMCID: PMC11122020 DOI: 10.3390/jcm13102938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.
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Affiliation(s)
- Santaro Noguchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan; (S.N.); (H.T.)
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan; (S.N.); (H.T.)
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan; (S.N.); (H.T.)
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Son HS, Chang DF, Li C, Liu L, Zafar S, Lum F, Woreta FA. Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2024; 131:403-411. [PMID: 37858872 DOI: 10.1016/j.ophtha.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN Retrospective cohort study. PARTICIPANTS Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES Visual outcomes and postoperative complications after lens exchange. RESULTS A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | | | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Lynn Liu
- American Academy of Ophthalmology, San Francisco, California
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Silva M, Orguel S, Becker M, Freiberg FJ. Indications, Complications, and Early Postoperative Course of Recovery of Intraocular Lens Exchange Surgery: a Single-Center Retrospective Study. Klin Monbl Augenheilkd 2023; 240:415-420. [PMID: 37164400 DOI: 10.1055/a-2004-5147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery. MATERIAL AND METHODS Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed. RESULTS One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%). CONCLUSION The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.
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Affiliation(s)
- Marcio Silva
- Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
- Ophthalmology, Eye Center Wil, Wil, Switzerland
| | - Selim Orguel
- Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
- Ophthalmology, University of Basel, Basel, Switzerland
| | - Matthias Becker
- Ophthalmology, City Hospital Waid and Triemli, Zurich, Switzerland
- Ophthalmology, Heidelberg University, Heidelberg, Germany
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Jafarinasab M, Kalantarion M, Hooshmandi S, Hassanpour K, Najdi D, Kheiri B, Sabbaghi H. Indications and outcomes of intraocular Lens Exchange among pseudophakic eyes in a Tertiary Referral Center. BMC Ophthalmol 2023; 23:127. [PMID: 36978043 PMCID: PMC10053672 DOI: 10.1186/s12886-023-02871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To determine the indications and surgical outcomes of intraocular lens (IOL) exchange in pseudophakic patients at Labbafinejad Tertiary Referral Center between 2014 and 2019. METHODS In this retrospective interventional case series, the medical records of 193 patients with a history of IOL exchange were reviewed. Preoperative data, including clinical characteristics, indications of the first and second IOL implantation, intra- and postoperative complications due to IOL exchange, and the pre-and postoperative refractive error and best-corrected visual acuity (BCVA) were considered the outcome measures in this study. All postoperative data were analyzed at least six months after follow-up. RESULTS The mean age of our participants was 59.13 ± 20.97 years old at the time of the IOL exchange, with a male percentage of 63.2%. The mean follow-up after the IOL exchange was 15.72 ± 16.28 months. The main indications of IOL exchange were IOL decentration (50.3%), corneal decompensation (30.6%), and residual refractive errors (8.3%). 57.10% of patients with the postoperative spherical equivalent at -2.00 diopter (D) to + 2.00D. The mean best-corrected visual acuity was 0.82 ± 0.76 LogMAR before the IOL exchange and was improved to 0.73 ± 0.79 LogMAR after the surgery. Corneal decompensation (6.2%), glaucoma (4.7%), retinal detachment (4.1%), cystoid macular edema (2.1%), and uveitis (1%) were found as the postoperative complications. There was only one case with suprachoroidal hemorrhage during IOL exchange. CONCLUSIONS IOL decentration followed by corneal decompensation was the most common indication of IOL exchange. After IOL exchange, the most complications during follow-up were corneal decompensation, glaucoma, retinal detachment, and cystoid macular edema.
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Affiliation(s)
- Mohammadreza Jafarinasab
- Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Masomeh Kalantarion
- Department of Medical Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadid Hooshmandi
- Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Danial Najdi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Bahareh Kheiri
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave, Tehran, 16666, Iran
| | - Hamideh Sabbaghi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, 23 Paidar Fard, Bostan 9, Pasdaran Ave, Tehran, 16666, Iran.
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Al-Shymali O, Alió del Barrio JL, McAlinden C, Canto M, Primavera L, Alio JL. Multifocal intraocular lens exchange to monofocal for the management of neuroadaptation failure. EYE AND VISION (LONDON, ENGLAND) 2022; 9:40. [PMID: 36316701 PMCID: PMC9623973 DOI: 10.1186/s40662-022-00311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/07/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of this study was to evaluate visual, refractive, quality of vision, visual function and satisfaction of multifocal intraocular lens (MF-IOL) exchange with a monofocal IOL (MNF-IOL) in dissatisfied patients following MF-IOL implantation. METHODS This was a retrospective case series. Bilateral IOL exchange (MF-IOL to MNF-IOL) was performed in 13 patients (26 eyes) with neuroadaptation failure. Questionnaires including the Quality of Vision (QoV), Visual Function Index (VF-14 and Rasch-revised VF-8R version), and a satisfaction questionnaire were used. RESULTS The mean time for IOL exchange was 15 months. The corrected distance visual acuity (CDVA) improved from 20/26 to 20/23 (P = 0.028). The uncorrected near visual acuity (UNVA) worsened after exchange from 20/47 to 20/62 (P = 0.024). QoV scores improved significantly across all three subscales after exchange. Visual function for far distance improved with a change in VF-14 score from 74.2 ± 24.8 to 90.9 ± 9.1 (P = 0.03). The VF-8R score showed worsening although not statistically significant. Near vision spectacle independence was totally or partially lost in all cases. Ten patients (77%) reported they would not repeat the lens exchange. Safety and efficacy indices changed from 1.23 to 0.85, respectively, at three months to 1.24 (P = 0.871) and 0.89 (P = 0.568), respectively, at one year. CONCLUSION IOL exchange (multifocal to monofocal) to solve neuroadaptation failure in this case series resulted in significant improvements in dysphotopsia and improved distance visual function. However, UNVA worsened and patient satisfaction after exchange remained suboptimal with 77% claiming they would not repeat the lens exchange, suggesting the value of near vision spectacle independence for these patients.
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Affiliation(s)
- Olena Al-Shymali
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L. Alió del Barrio
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Colm McAlinden
- grid.461312.30000 0000 9616 5600Department of Ophthalmology, Royal Gwent Hospital, Newport, UK
| | - Mario Canto
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Laura Primavera
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
| | - Jorge L. Alio
- grid.419256.dCornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Vissum Miranza Alicante, Universidad Miguel Hernandez, Calle Cabañal 1, 03016 Alicante, Spain
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Dragnea DC, Tru Latin Small Letter T With Comma Below A RN, Goemaere J, Tassignon MJ, Dhubhghaill SN. Intraocular Bag-in-the-Lens Exchange: Indications, Outcomes and Complications. J Cataract Refract Surg 2021; 48:568-575. [PMID: 34417783 DOI: 10.1097/j.jcrs.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the indications, outcomes, and complications regarding the Bag-in-the-lens (BIL) intraocular lens (IOL) exchanges over a period of 13 years in a tertiary ophthalmologic centre. SETTING Department of Ophthalmology of the University Hospital of Antwerp (UZA). DESIGN Observational retrospective study. PATIENTS AND METHODS Between 2003 and 2020, 12 176 patients were operated using the BIL technique. We included adult patients who underwent an intraocular BIL exchange and recorded the demographics, indications, outcomes, and complications. RESULTS Fifty-nine eyes of 59 patients who underwent a BIL exchange between 2007 and 2020 were included (0.48%). The mean age was 61.15 ±13.53 years. The mean time between primary surgery and IOL exchange was 25.73 ± 41.88 months. The main indication for explantation was refractive surprise mostly related to the patients' risk factors e.g. preoperative corneal and refractive surgery. The mean preoperative uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were 0.36 ± 0.24 and 0.79 ± 0.24 respectively. The postoperative 1 month-UDVA and CDVA were 0.66 ± 0.28 and 0.86 ± 0.19 respectively. The improvement in UDVA was statistically significant (<0.0001). The most common peroperative complication was damage to the anterior hyaloid in 9 eyes (15%), which did not prohibit reimplantation of a secondary BIL. CONCLUSIONS BIL to BIL exchange is an viable and successful technique that provides good refractive results with few, manageable complications. Because of the tertiary profile of our centre with referral of complex cases, BIL was our preferred IOL in patients at risk of postoperative refractive surprise.
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Affiliation(s)
- Diana Carmen Dragnea
- Department of Ophthalmology, Antwerp University Hospital, Wilrijk, Belgium Department of Medicine, University of Antwerp, Wilrijk, Belgium University of Medicine and Pharmacy, Târgu Mure[Latin Small Letter s with comma below], Romania
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Kandemir Besek N, Erdogan G, Gumus G, Kepez Yildiz B, Aygit E, Yildirim Y, Agca A. Comparative evaluation of re-use or replacement of dislocated 3-piece intraocular lenses with a scleral fixation technique. J Fr Ophtalmol 2020; 43:139-144. [DOI: 10.1016/j.jfo.2019.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/24/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022]
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Brunin G, Sajjad A, Kim EJ, Montes de Oca I, Weikert MP, Wang L, Koch DD, Al-Mohtaseb Z. Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg 2019; 43:369-376. [PMID: 28410720 DOI: 10.1016/j.jcrs.2016.12.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/09/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. SETTING Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN Retrospective case series. METHODS All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. RESULTS The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. CONCLUSIONS When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.
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Affiliation(s)
- Greg Brunin
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ahmar Sajjad
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Kim
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ildamaris Montes de Oca
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Mitchell P Weikert
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Douglas D Koch
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Zaina Al-Mohtaseb
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
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de Rojas MV, Viña S, Gestoso A, Simón P, Álvarez M. Intraocular lens explantation in Spain: indications and outcomes at a tertiary referral center from 2010 to 2018. Int Ophthalmol 2019; 40:313-323. [PMID: 31565759 DOI: 10.1007/s10792-019-01181-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/22/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the causes of IOL explantation, techniques for secondary IOL implantation, visual outcomes and complications. METHODS Setting: Department of Ophthalmology Complexo Hospitalario Universitario A Coruña, Spain. DESIGN Retrospective study. All explanted IOLs from January 2010 to June 2018 were included. Medical records were reviewed to determine the surgical indication for IOL explantation, type of IOL implanted, time between surgeries, visual outcomes and surgical complications. RESULTS One hundred forty-one IOLs were explanted (134 patients). Mean time from original surgery to IOL explantation was 7.89 ± 5.81 years. Causes of IOL explantation were IOL dislocation (81.56%)-in-the-bag IOL dislocation (71.63%), out-of-the-bag IOL dislocation (9.9%)-corneal decompensation (12.05%), refractive surprise (3.5%), uveitis-glaucoma-hyphema syndrome (1.4%), IOL opacification (1.4%). Procedures for secondary IOL implantation were retropupillar iris-claw IOL (63.8%), flanged scleral fixated IOL (9.2%), three-piece IOL in ciliary sulcus (8.5%), angle-supported anterior chamber IOL (7.1%), in-the-bag IOL (3.5%), scleral fixated IOL with sutures (0.7%). Ten cases (7.1%) were left aphakic. Mean preoperative and postoperative logMAR CDVA were 1.34 ± 0.87 and 0.63 ± 0.69, respectively (p = 0.000). Mean preoperative IOP and postoperative IOP were 16.78 ± 4.49 and 15.53 ± 3.476 mmHg, respectively (p = 0.005). Complications include cystoid macular edema (7.8%), glaucoma (7.1%), IOL luxation (2.1%), retinal detachment (1.4%), trophic ulcer and leucoma (1.4%), corneal decompensation (1.4%). CONCLUSIONS In-the-bag IOL dislocation was the most frequent indication for IOL explantation, followed by pseudophakic bullous keratopathy. Simultaneous IOL exchange for a retropupillar iris-claw IOL was the most frequent procedure for secondary IOL implantation. Mean CDVA improved significantly and IOP decreased significantly after IOL explantation. The most frequent postoperative complication was cystoid macular edema.
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Affiliation(s)
- Mª Victoria de Rojas
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain.
| | - Sara Viña
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
| | - Antía Gestoso
- Department of Ophthalmology, Hospital Povisa, Vigo, Spain
| | - Patricia Simón
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
| | - Marcelino Álvarez
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
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Patel NA, Gangasani N, Yannuzzi NA, Melo G, Flynn HW, Smiddy WE. Indications and Outcomes for the Removal of Intraocular Lens Implants in a Retinal Surgery Practice. Ophthalmic Surg Lasers Imaging Retina 2019; 50:504-508. [PMID: 31415697 DOI: 10.3928/23258160-20190806-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the reasons for and clinical outcomes of intraocular lens (IOL) removal, with or without exchange, in the setting of retina surgery. PATIENTS AND METHODS This is a retrospective, noncomparative, consecutive, interventional case series of patients undergoing IOL removal at an academic referral center performed by a single surgeon between 2002 and 2013. Data collected included baseline patient characteristics, visual acuity (VA), type of IOL, reason for IOL removal, and postoperative complications. RESULTS The study cohort included 63 eyes with IOL removal. Of these, 51 (81%) were left aphakic. For cases of IOL opacification or dislocated IOL (56), the decision to remove was made for 35 (63%) during concurrent retinal surgery due to obstruction in visualization. Overall, the most common reason for removal of the IOL was IOL opacities in 42 eyes (67%), followed by nonspecific nature of opacities (n = 19; 45%), oil artifact (n = 17; 40%), opaque nonvascular membranes (n = 4; 10%), and fibrovascular proliferation (n = 2; 5%). Other causes for removal were IOL dislocation (n = 14; 22%), endophthalmitis (n = 7; 11%), and broken IOL haptic (n = 1; 2%). The composition of the 42 IOLs with opacification included 19 (45%) silicone, 14 (33%) unspecified, five (12%) polymethyl methacrylate, and four acrylic (10%). From the 17 IOLs removed due to oil opacification, 15 (83%) were silicone, and two (17%) were unspecified. Postoperative complications included recurrent retinal detachment (n = 13; 21%), hypotony (n = 8; 13%), phthisis bulbi (n = 8; 13%), corneal edema (n = 7; 11%), cystoid macular edema (n = 5; 8%), elevated intraocular pressure (n = 3; 5%), vitreous hemorrhage (n = 3; 5%), hyphema (1; 2%), anterior synechiae (1; 2%), and subretinal hemorrhage (1; 2%) The mean (SD) immediate, 3 months, and final best-corrected VA in logMAR were 2.18 (0.47), 1.85 (0.82), and 1.97 (0.85). CONCLUSION The vitreoretinal surgeon must be prepared for IOL removal, especially if IOL opacification and dislocation compromise the view or capability to achieve primary retinal reattachment objectives. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:504-508.].
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Affiliation(s)
- Jeewan S Titiyal
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manpreet Kaur
- Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Ludlow J, Nguyen J, Aliancy J, Masino B, Ha L, Werner L, Mamalis N. Long-term uveal and capsular biocompatibility of a novel modular intraocular lens system. Acta Ophthalmol 2018; 96:e427-e433. [PMID: 29369535 DOI: 10.1111/aos.13674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the long-term biocompatibility and safety of a new modular posterior chamber intraocular lens (IOL) system in rabbit eyes. METHODS Seven New Zealand rabbits underwent bilateral phacoemulsification with placement of the modular IOL in OD and a control IOL (SA60AT) in OS. Slit-lamp examinations were performed at postoperative weeks 1, 2, 3, 4, 6 and 8 and months 3 and 6. All rabbits were then sacrificed and eyes enucleated. The eyes were examined grossly from the Miyake-Apple view. Selected IOLs were explanted and underwent surface staining for implant cytology. All globes were then sectioned and processed for histopathological examination. RESULTS The modular IOL remained stable in all seven rabbits through the entire follow-up period. Biocompatibility was better than the control lens at six months postoperatively, on account of less extensive synechiae formation as assessed by slit-lamp examination. At the six-week examination, posterior capsule opacification (PCO) was significantly better in the test group (scored as 1.71 ± 0.8 versus 3.28 ± 0.48 in the control group, p = 0.0008). On gross examination with the Miyake-Apple view, Soemmering's ring formation was significantly better in the test group, (5.14 ± 1.57 versus 10.85 ± 1.95 in the control group, p = 0.002). CONCLUSION Previous studies showed that explantation/exchange of the modular system optic was safer and easier than with a standard IOL. The new modular IOL system has demonstrated better long-term biocompatibility compared to the control lens at six months postoperatively in the rabbit model.
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Affiliation(s)
- Jason Ludlow
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
| | - Jason Nguyen
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
| | - Joah Aliancy
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
| | - Bryan Masino
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
| | - Larry Ha
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
| | - Liliana Werner
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
| | - Nick Mamalis
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City UT USA
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Bothun ED, Cavalcante LC, Hodge DO, Patel SV. Population-based Incidence of Intraocular Lens Exchange in Olmsted County, Minnesota. Am J Ophthalmol 2018; 187:80-86. [PMID: 29305312 DOI: 10.1016/j.ajo.2017.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/09/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the population-based incidence of pseudophakic intraocular lens exchange in Olmsted County, Minnesota. DESIGN Retrospective review of a population-based cohort. METHODS Patients undergoing pseudophakic intraocular lens exchange in Olmsted County, Minnesota, between January 1, 1986 and December 31, 2016 were identified from the Rochester Epidemiology Project medical record linkage system. Indications and outcomes were determined, and the incidence rate was calculated as cases per 1 000 000 person-years. Poisson regression analysis was used to assess changes in incidence over time, and the cumulative probability of needing a lens exchange was estimated by Kaplan-Meier analysis. RESULTS Eighty cases of intraocular lens exchange were identified, yielding an overall age- and sex-adjusted incidence rate of 28.4 per million (confidence interval [CI], 22.1-34.7), which increased over the study period (P = .04). The 30-year cumulative probability of intraocular lens exchange among patients undergoing cataract surgery was 1.5% (CI, 0.6%-2.4%), increasing at a relatively constant rate. Dislocated lenses accounted for 72.5% of lens exchanges. Unplanned refractive outcome of primary cataract surgery and uveitis-glaucoma-hyphema syndrome from squared-edged haptics emerged as newer indications for intraocular lens exchange. CONCLUSIONS The population-based incidence of pseudophakic intraocular lens exchange has increased over the last 30 years, and can be explained by the increase in incidence rate of cataract surgery over the same period. Surgeons should be aware of emerging indications of intraocular lens exchange, which reflect changes in lens design and increasing expectations of refractive outcomes.
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Szigiato AA, Schlenker MB, Ahmed IIK. Population-based analysis of intraocular lens exchange and repositioning. J Cataract Refract Surg 2017; 43:754-760. [DOI: 10.1016/j.jcrs.2017.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/07/2016] [Accepted: 03/21/2017] [Indexed: 12/01/2022]
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Chai F, Ma B, Yang XG, Li J, Chu MF. A pilot study of intraocular lens explantation in 69 eyes in Chinese patients. Int J Ophthalmol 2017; 10:579-585. [PMID: 28503431 DOI: 10.18240/ijo.2017.04.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 02/06/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To study the effects of intraocular lens (IOL) explantation and demographic characteristics. METHODS Retrospective non-comparative case series. Clinical data recorded from patient charts included the following: demographic, preoperative and postoperative characteristics; complications; surgical methods, and changes in visual acuity. RESULTS A total of 69 eyes in 67 Chinese patients who received IOL explants were studied. The patients' mean age at the time of explantation was 46.1 years old [SD 22.5 (6-85)], and 37 patients were female (55.2%). Regarding employment, 47.8% were farmers, 23.9% were retired, 16.4% were students, 4.5% were unemployed, 3% were workers, and 4.5% were other (including staff members, teachers and officers). The main reasons for explantation were dislocation/decentration in 41 cases (59.4%) and retinal detachment in 10 cases (14.5%). The third most prevalent cause was incorrect lens power in 7 eyes (10.1%). The remaining reasons were endophthalmitis in 6 cases (8.7%), posterior capsular opacity in 3 eyes (4.3%), and impacting retinal surgery operation in 2 cases (2.9%). The main comorbidities were high myopia in 18 eyes (26.1%), trauma in 8 eyes (11.6%), retinal detachment in 6 eyes (8.7%), congenital cataracts in 8 eyes (11.6%), and Marfan's syndrome in 2 eyes (2.9%). The mean time from implantation to explantation was 4.0y [SD 4.2 (0.005-15)]. Treatment after explantation included posterior chamber IOL implantation in 44 eyes (63.8%) and aphakia in 25 eyes (36.2%). After surgery, the best corrected visual ability (BCVA) was improved in 50 cases (72.5%), including 28 patients (40.6%) in whom visual ability was improved by more than two lines. CONCLUSION Dislocation/decentration is the main cause for explantation, and high myopia is a main risk factor. Posterior chamber IOL implantation remains the most elected treatment after explantation.
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Affiliation(s)
- Fang Chai
- Xi'an No.4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Bo Ma
- Xi'an No.4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Xin-Guang Yang
- Xi'an No.4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Juan Li
- Xi'an No.4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Mei-Fang Chu
- Xi'an No.4 Hospital, Shaanxi Ophthalmic Medical Center, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
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Koçak Altıntaş AG, Omay AE, Çelik S. Spontaneous Late Intraocular Lens and Capsule Tension Ring Dislocation. Turk J Ophthalmol 2017; 47:106-109. [PMID: 28405485 PMCID: PMC5384115 DOI: 10.4274/tjo.79836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 07/27/2015] [Indexed: 12/01/2022] Open
Abstract
In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.
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Affiliation(s)
| | - Aslıhan Esra Omay
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Selda Çelik
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
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18
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Rho CR, Kim MJ, Joo CK. Influence of across-pupil sutures on the optical quality of intraocular lenses. Int Ophthalmol 2017; 38:909-915. [PMID: 28161802 DOI: 10.1007/s10792-016-0441-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE In cases of pupillary capture after previous transscleral fixation of an intraocular lens (IOL), an across-pupil suture technique is sometimes used to stabilize the IOL. We investigated the optical effects of 10-0 polypropylene sutures placed across the pupil. METHODS Optical performance was evaluated using the optical bench metrology system, and a single-piece IOL was used in an optical bench system consisting of a model eye, a high-resolution Hartmann-Shack wave front sensor, and an image capturing device with 2.0, 3.0, 4.0, and 4.5 mm apertures with distance focus. To simulate across-pupil sutures, two 10-0 polypropylene sutures were placed 2 mm apart across the pupil. The focus image, spherical aberration, and image quality were measured and compared with and without sutures. RESULTS When pupil size increased, spherical aberration increased, irrespective of sutures. No difference was found in spherical aberration with and without sutures, and image qualities at 17.6 and 35.2 cycles per degree were not affected by the across-pupil sutures. CONCLUSIONS The differences in optical quality using across-pupil 10-0 polypropylene sutures were clinically negligible.
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Affiliation(s)
- Chang Rae Rho
- Department of Ophthalmology and Visual Science, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Ophthalmology and Visual Science, Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Ji Kim
- Department of Ophthalmology and Visual Science, Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea.
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Kavuncu S, Omay AE, Tırhış MH, Yılmazbaş P. Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital. Turk J Ophthalmol 2017; 46:156-160. [PMID: 28058149 PMCID: PMC5200819 DOI: 10.4274/tjo.69379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/24/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL) in a tertiary referral eye hospital. Materials and Methods: Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease. Results: The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX) was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively. Conclusion: IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery.
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Affiliation(s)
- Sevim Kavuncu
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | | | - Pelin Yılmazbaş
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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20
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Roelofs K, Rudnisky C. In-the-bag intraocular lens exchange 13 years after refractive lens extraction. Can J Ophthalmol 2016; 51:e161-e163. [PMID: 27938971 DOI: 10.1016/j.jcjo.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/19/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Kelsey Roelofs
- Department of Ophthalmology, University of Alberta, Edmonton, Alta
| | - Chris Rudnisky
- Department of Ophthalmology, University of Alberta, Edmonton, Alta.
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21
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Narváez J, Nam E. Iris fixation of unstable anterior chamber intraocular lenses. J Cataract Refract Surg 2016; 42:961-4. [PMID: 27492092 DOI: 10.1016/j.jcrs.2016.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/07/2016] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED Cataract surgeons are sometimes challenged with a patient who has an unstable anterior chamber intraocular lens (AC IOL). Over time, an unstable AC IOL can lead to significant complications. This problem is most often addressed with an IOL exchange using an appropriately sized AC IOL or a posterior chamber IOL with iris or scleral fixation. We present a technique of 2-point iris fixation of unstable AC IOLs as a simpler and less traumatic alternative. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Julio Narváez
- From the Department of Ophthalmology (Narváez, Nam), Loma Linda University, Loma Linda, and the Delta Eye Medical Group (Narváez), Stockton, California, USA.
| | - Enoch Nam
- From the Department of Ophthalmology (Narváez, Nam), Loma Linda University, Loma Linda, and the Delta Eye Medical Group (Narváez), Stockton, California, USA
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22
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Lee MH, Webster DL. Intraocular lens exchange-removing the optic intact. Int J Ophthalmol 2016; 9:925-8. [PMID: 27366699 DOI: 10.18240/ijo.2016.06.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 07/09/2015] [Indexed: 11/23/2022] Open
Abstract
Current practice for intraocular lens (IOL) exchange is to cut the optic of the posterior chamber intraocular lens (PCIOL) prior to removing it. Great care must be taken during this maneuver to avoid a posterior capsular tear. Removing the haptics from the fibrosed capsule can also be hazardous, as it may result in zonular stress and dehiscence. A technique is described for performing foldable (one-piece acrylic) IOL removal without cutting the optic. Careful visco-dissection of the haptics with a low viscosity ophthalmic viscosurgical device (OVD) in the fibrosed peripheral capsular tunnel avoids zonular or capsular stress. Internal wound enlargement permits foldable IOL removal in one piece, whilst preserving a self-sealing sutureless corneal wound. This technique may enhance the safety and efficacy of foldable IOL exchange.
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Affiliation(s)
- Matthew Hao Lee
- Department of Ophthalmology, Alfred Hospital, Melbourne, VIC 3004, Australia
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23
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Liu J, Liu W, Jia Y, Al-Mohtaseb ZN, Wang L. Repositioning a decentered intraocular lens with 4 haptics. J Cataract Refract Surg 2016; 42:353-7. [PMID: 27006325 DOI: 10.1016/j.jcrs.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022]
Abstract
We describe a technique to reposition a decentered 4-haptic intraocular lens (IOL). Using an ophthalmic viscosurgical device, the haptic with the worst distortion is dissected from the capsular bag and pulled outside the bag. The opposite haptic (180 degrees away) is also dissected and placed in front of the anterior capsule. The remaining 2 haptics are left in the capsular bag. With this repositioning, the 2 haptics in the bag limit the IOL movement, the 2 haptics outside the bag are no longer distorted, and the IOL is centered. We present 2 cases in which this technique was used to reposition decentered 4-haptic IOLs.
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Affiliation(s)
- Jiewei Liu
- From Shanxi Eye Hospital (J. Liu, W. Liu, Jia, Wang), Taiyuan, China, and Cullen Eye Institute (Al-Mohtaseb, Wang), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
| | - Wenjie Liu
- From Shanxi Eye Hospital (J. Liu, W. Liu, Jia, Wang), Taiyuan, China, and Cullen Eye Institute (Al-Mohtaseb, Wang), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Yading Jia
- From Shanxi Eye Hospital (J. Liu, W. Liu, Jia, Wang), Taiyuan, China, and Cullen Eye Institute (Al-Mohtaseb, Wang), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Zaina N Al-Mohtaseb
- From Shanxi Eye Hospital (J. Liu, W. Liu, Jia, Wang), Taiyuan, China, and Cullen Eye Institute (Al-Mohtaseb, Wang), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- From Shanxi Eye Hospital (J. Liu, W. Liu, Jia, Wang), Taiyuan, China, and Cullen Eye Institute (Al-Mohtaseb, Wang), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
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Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature. J Ophthalmol 2015; 2015:805706. [PMID: 26798506 PMCID: PMC4698990 DOI: 10.1155/2015/805706] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.
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MacLean KD, Werner L, Kramer GD, Farukhi MA, Gardiner GL, Kahook MY, Mamalis N. Evaluation of stability and capsular bag opacification of a new foldable adjustable intraocular lens. Clin Exp Ophthalmol 2015; 43:648-54. [DOI: 10.1111/ceo.12526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Kyle D MacLean
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City Utah
| | - Liliana Werner
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City Utah
| | - Gregory D Kramer
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City Utah
| | - M Aabid Farukhi
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City Utah
| | - Gareth L Gardiner
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City Utah
| | - Malik Y Kahook
- Department of Ophthalmology; University of Colorado School of Medicine; Aurora Colorado USA
| | - Nick Mamalis
- Department of Ophthalmology and Visual Sciences; John A. Moran Eye Center; University of Utah; Salt Lake City Utah
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Narang P, Steinert R, Little B, Agarwal A. Intraocular lens scaffold to facilitate intraocular lens exchange. J Cataract Refract Surg 2014; 40:1403-7. [DOI: 10.1016/j.jcrs.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/28/2014] [Accepted: 01/31/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Priya Narang
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom
| | - Roger Steinert
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom
| | - Brian Little
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom
| | - Amar Agarwal
- From the Narang Eye Care and Laser Centre (Narang), Ahmedabad and Dr. Agarwal's Eye Hospital and Eye Research Centre (Agarwal), Chennai, India; Gavin Herbert Eye Institute (Steinert), Department of Ophthalmology, University of California, Irvine, California, USA; Moorfields Eye Hospital (Little), London, United Kingdom.
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Tassignon MJ, Bartholomeeusen E, Rozema JJ, Jongenelen S, Mathysen DGP. Feasibility of multifocal intra-ocular lens exchange and conversion to the bag-in-the-lens implantation. Acta Ophthalmol 2014; 92:265-9. [PMID: 23648070 DOI: 10.1111/aos.12093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Our purpose was to evaluate the surgical outcome after intra-ocular lens exchange in patients who presented impairing visual complaints after primary multifocal intra-ocular lens (MIOL) implantation. In particular, the study was undertaken to look at the number of eyes that could be equipped with the bag-in-the-lens (BIL) IOL after MIOL exchange. METHODS This series consisted of 30 eyes of 21 consecutive patients scheduled for MIOL exchange. In 15 out of the 30 eyes, IOL misalignment was measured on slit lamp anterior segment photo's after defining the mathematical centres of the IOL optic, pupil and limbus. RESULTS Diffractive MIOL was more frequently explanted (25; 83%) when compared with refractive MIOL (4; 13%) and progressive optic IOL (1; 4%). In 21 out of the 30 eyes (70%) a bag-in-the-lens could be implanted. In 7 out of the 30 eyes (23%), the capsule was not considered sufficiently stable to accommodate an IOL. An iris-fixated IOL or a sulcus-fixated IOL was then implanted. In 2 out of the 30 eyes (6%) the remaining capsular bag could accommodate a traditional lens-in-the-bag only. Eyes that underwent Nd:YAG laser capsulotomy prior to the MIOL exchange needed anterior vitrectomy peroperatively (11 eyes; 37%). Visual acuity improved postoperatively in 13 out of the 30 eyes and remained stable in 17 out of the 30 eyes. CONCLUSIONS Since the BIL technique requires a very well-preserved capsular bag for the purpose of the IOL implantation, the success rate of BIL implantation after MIOL is a good indicator to evaluate the degree of difficulty to exchange MIOL.
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Affiliation(s)
- Marie-José Tassignon
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Antwerp, BelgiumDepartment of Ophthalmology, University of Antwerp, Antwerp, Belgium
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Indications and outcomes of intraocular lens exchange during a recent 5-year period. Am J Ophthalmol 2014; 157:154-162.e1. [PMID: 24182744 DOI: 10.1016/j.ajo.2013.08.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze and classify the indications, clinical presentations, and surgical outcomes of intraocular lens (IOL) exchange performed in a recent 5-year period. DESIGN Retrospective, interventional case series. METHODS setting: Private clinical practice. study population: Chart records of 57 eyes of 53 consecutive patients who had undergone IOL exchange between May 2007 and December 2011 were reviewed. observation procedures and main outcome measures: The preoperative clinical characteristics, treatment parameters, intraoperative and postoperative complications, and pre- and postoperative logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) were recorded and analyzed. RESULTS IOL dislocation (46%), incorrect IOL power (23%), patient dissatisfaction (21%), and optic opacification (7%) were the most common indications for IOL exchange. In the IOL dislocation group, posterior capsule opening presented in 57% of eyes (8/14) with in-the-bag dislocation. Of the dissatisfaction patients, 42% (5/11) had undesired visual acuity without symptoms of glare/optical aberrations. Surface calcification of silicone lenses associated with asteroid hyalosis accounted for the most cases (3/4) of optic opacification. Overall, the mean logMAR BCVA improved significantly (P < .001) and 88% of all eyes were 20/40 or better, including 73% in the IOL dislocation group and 100% in all other groups. No vision-threatening complications occurred in this series. CONCLUSIONS The request for IOL exchange owing to patient dissatisfaction is increasing, especially for those with undesired visual acuity in the absence of photic symptoms. Surface calcification of silicone lenses suggests that this type of lens is not appropriate in the presence of asteroid hyalosis. Optimal visual results with a low rate of complications can be achieved in each category of indication. The findings of the study may stimulate discussion of a question: Does in-the-bag IOL dislocation occur only in eyes with an intact posterior capsule?
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Lee JS, Kim YH, Park JY, Kim SI. A Case of Corrected Residual Refractive Error after Cataract Surgery with the Sulcoflex Piggyback IOL. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.12.1890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | | | - Jung Yul Park
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Sung Il Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Intraocular lens exchange for pseudophakic refractive surprise due to incorrectly labeled intraocular lens. J Cataract Refract Surg 2012. [PMID: 23195259 DOI: 10.1016/j.jcrs.2012.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zarei-Ghanavati S. January consultation #7. J Cataract Refract Surg 2012. [DOI: 10.1016/j.jcrs.2011.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pueringer SL, Hodge DO, Erie JC. Risk of late intraocular lens dislocation after cataract surgery, 1980-2009: a population-based study. Am J Ophthalmol 2011; 152:618-23. [PMID: 21683329 DOI: 10.1016/j.ajo.2011.03.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/05/2011] [Accepted: 03/07/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the long-term cumulative risk of late posterior chamber intraocular lens (IOL) dislocation after cataract extraction in a population-based cohort. DESIGN Retrospective cohort study and nested case-control study. METHODS The records of all residents of Olmsted County, Minnesota, who underwent cataract extraction from January 1, 1980, through May 31, 2009, (14 471 cases in 9577 residents) and who were diagnosed with late posterior chamber IOL dislocation in the same period were reviewed. Cases were identified through the Rochester Epidemiology Project. Three controls chosen from the cataract surgery cohort were matched to each IOL dislocation case by age, gender, and duration of follow-up. Records were reviewed to confirm case status and to ascertain risk factor information. The cumulative risk of IOL dislocation was estimated by using the Kaplan-Meier method. Logistic regression models assessed differences between cases and controls. RESULTS We identified 16 cases of late posterior chamber IOL dislocation, 9 with in-the-bag dislocations and 7 with out-of-the-bag dislocations. At 5, 10, 15, 20, and 25 years after cataract extraction, the cumulative risk of IOL dislocation was 0.1%, 0.1%, 0.2%, 0.7%, and 1.7%, respectively. There was no significant difference in the risk of late IOL dislocation after extracapsular cataract extraction when compared with phacoemulsification (P = .21) or between different decades of surgery (P = .92). Pseudoexfoliation and zonular laxity at surgery were associated significantly with late IOL dislocation (P = .01). CONCLUSIONS The long-term cumulative risk of late IOL dislocation after cataract extraction was low and did not significantly change over our nearly 30-year study period.
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Affiliation(s)
- Sam L Pueringer
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Fintelmann RE, Kim SK, Hwang DG. Upside-down lens syndrome: ocular complications secondary to inverted implantation of the Kelman Multiflex anterior chamber intraocular lens. Am J Ophthalmol 2011; 152:122-125.e2. [PMID: 21570051 DOI: 10.1016/j.ajo.2011.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe ocular complications resulting from inverted insertion of a Kelman Multiflex anterior chamber intraocular lens (ACIOL). DESIGN Retrospective observational case series. METHODS We describe the outcomes of 4 cases of complicated cataract surgery in which a flexible open-loop polymethylmethacrylate (PMMA) ACIOL (Kelman Multiflex type) was placed in an inverted configuration, all of which were referred to a single institution. RESULTS In all 4 cases, the placement of an inverted ACIOL resulted in ocular complications including chronic iritis, cystoid macular edema, pupil capture, iris adhesions, and corneal decompensation. CONCLUSIONS Inadvertent inverted placement of the Kelman Multiflex anterior chamber intraocular lenses can lead to a constellation of severe ocular complications. When inserting such lenses, the surgeon should ensure that the lens is correctly oriented such that the optic vaults anteriorly and not posteriorly.
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Affiliation(s)
- Robert E Fintelmann
- Cornea Service, Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143-0730, USA
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Whole Population Trends in Complications of Cataract Surgery over 22 Years in Western Australia. Ophthalmology 2011; 118:1055-61. [DOI: 10.1016/j.ophtha.2010.11.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 10/31/2010] [Accepted: 11/04/2010] [Indexed: 11/20/2022] Open
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Mönestam EI. Incidence of dislocation of intraocular lenses and pseudophakodonesis 10 years after cataract surgery. Ophthalmology 2009; 116:2315-20. [PMID: 19815277 DOI: 10.1016/j.ophtha.2009.05.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 05/11/2009] [Accepted: 05/12/2009] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To estimate the incidence of early and late intraocular lens (IOL) dislocation and the frequency of pseudophakodonesis in a population-based cohort of cataract surgery cases. The patients were followed up from before to 10 years after surgery. DESIGN Cohort study. PARTICIPANTS Eight hundred ten cataract surgery patients. METHODS A prospective population-based cohort of 810 cataract surgery patients with presenile or senile cataracts was examined before surgery. Ten years later, 289 (73%) of 395 survivors agreed to participate in an eye examination. In addition to a routine eye examination of the anterior and posterior segment, all eyes were assessed for pseudophakodonesis and significant dislocation of the IOL. The medical records were studied and information concerning previous postoperative surgical interventions such as IOL exchange or repositioning was noted. This information was also obtained from the records of the deceased patients and those unable or unwilling to participate. The material was analyzed statistically. MAIN OUTCOME MEASURES Previous IOL exchange or repositioning surgery, significant IOL dislocation, and degree of pseudophakodonesis. RESULTS Most patients (n = 795/810; 98%) underwent sutureless clear corneal phacoemulsification surgery with a 3.2-mm temporal incision. A foldable IOL was implanted, 95% of which were an Alcon MA60BM AcrySof (Alcon Inc, Fort Worth, TX). Approximately 40% of the patients had pseudoexfoliations (PEX). After a 10-year follow-up, 5 (0.6%) of the 800 patients at risk required surgery for a dislocated IOL. All of these patients were male, and in all cases, the dislocation was late and within the capsular bag. The cumulative incidence over 10 years was 1%. At the examination 10 years after surgery, 2 (0.7%) of 287 patients at risk had pronounced pseudophakodonesis and 4 (1.4%) had moderate pseudophakodonesis. CONCLUSIONS The 10-year cumulative incidence of dislocated IOLs needing surgical attention was low in this population-based cohort with a high frequency of PEX. Early dislocation did not occur in any of the patients. The risk of this complication in an individual patient seems to be low. Because of the large number of people with previous cataract surgery, dislocated IOLs may cause a relatively large public health care burden.
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Affiliation(s)
- Eva I Mönestam
- Department of Clinical Sciences/Ophthalmology, Norrlands University Hospital, Umeå, Sweden.
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Leysen I, Bartholomeeusen E, Coeckelbergh T, Tassignon MJB. Surgical outcomes of intraocular lens exchange. J Cataract Refract Surg 2009; 35:1013-8. [DOI: 10.1016/j.jcrs.2009.01.024] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 01/26/2009] [Accepted: 01/27/2009] [Indexed: 10/20/2022]
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Chang SW, Yu CY, Chen DP. Comparison of intraocular lens power calculation by the IOLMaster in phakic and eyes with hydrophobic acrylic lenses. Ophthalmology 2009; 116:1336-42. [PMID: 19427697 DOI: 10.1016/j.ophtha.2009.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 01/07/2009] [Accepted: 01/23/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the optical biometry measurements and intraocular lens (IOL) power estimation using the IOLMaster (Carl Zeiss Meditec, Dublin, CA) in phakic eyes and eyes with hydrophobic acrylic lenses. DESIGN Observational cross-sectional study. PARTICIPANTS A total of 156 patients (226 eyes). METHODS The IOLMaster measurements (IOLM-1) were performed before phacoemulsification and reexamined 3 months postoperatively (IOLM-2). One of the foldable acrylic IOLs (AcrySof SA60AT, SN60WF, or SN60D3, Alcon Laboratories Inc., Dallas, TX) was implanted. MAIN OUTCOME MEASURES The expected refraction and estimation error calculated from IOLM-1 using the SRK II, SRK/T, and Haigis formulae were compared with the residual refraction 3 months postoperatively. The power of the implanted IOL and IOLM-2 measurement data were used to re-estimate the postoperative expected refraction in pseudophakic eyes. The difference in expected refraction and estimation error between phakic and pseudophakic eyes was studied. Differences in the anterior chamber depth and axial length measured by IOLM-1 and IOLM-2 were analyzed and correlated with the estimation error. RESULTS The IOLMaster measured an axial length 0.10+/-0.15 mm shorter in pseudophakic eyes (P<0.001). Calculations from IOLM-2 gave a significantly more hyperopic expected refraction than IOLM-1, with an averaged 0.20+/-0.46 diopters (D), 0.18+/-0.45 D, and 0.65+/-0.59 D calculated by the SRK II, SRK/T, and Haigis formulae, respectively. There was no significant difference among the 3 IOLs. The difference in estimation error correlated with the difference in axial length and anterior chamber depth (P<0.001 for the SRK II, SRK/T, and Haigis formulae). However, the correlation was strongest when the Haigis formula was used for the calculation. CONCLUSIONS The expected refraction in pseudophakic eyes differed significantly from that in phakic eyes by the IOLMaster depending on the IOL formulae used for the calculation rather than the type of IOL. An adjustment of target refraction by 0.20 to 0.65 D toward the hyperopic side of the desired refraction could be considered when using optical biometry data in pseudophakic eyes to achieve postoperative emmetropia.
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Affiliation(s)
- Shu-Wen Chang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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Kim SM, Choi S. Clinical efficacy and complications of intraocular lens exchange for opacified intraocular lenses. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 22:228-35. [PMID: 19096239 PMCID: PMC2629912 DOI: 10.3341/kjo.2008.22.4.228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy and complications of intraocular lens (IOL) exchange. METHODS A review of medical records was performed for 52 eyes that had undergone an IOL exchange due to IOL opacification. Surgical complications and their incidences were analyzed. The mean best corrected visual acuity (BCVA) after the IOL exchange was compared with the mean pre-exchange BCVA and with the mean BCVA after the initial IOL implantation. Prediction error of refraction and biometric data obtained for the IOL exchange were, if available, compared with those obtained for the initial IOL implantation. The prediction error for the IOL exchange, calculated from the biometric data obtained before the IOL exchange, was compared with that calculated from the measurements obtained before the initial IOL implantation. RESULTS The overall complication rates were low and no serious complications were found. The mean BCVA improved significantly after the IOL exchange and was not significantly different from that obtained after the initial IOL implantation. However, the refractive prediction for the IOL exchange was not as good as it was for the initial IOL implantation, which was thought to be related with difficulties in axial length (AL) measurements. Biometric data taken before the initial IOL implantation was associated with a significantly better refractive prediction than those taken before the IOL exchange. CONCLUSIONS IOL exchange was both efficacious and safe for visual recovery. However, IOL exchange was related with increased difficulty of predicting postoperative refraction; difficulties in AL measurements are the suggested cause.
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Affiliation(s)
- Seung Mo Kim
- Department of Ophthalmology, Seoul Veterans Hospital, Seoul, Korea
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Moon HJ, Jeong TS, You IC, Yang KJ, Yoon KC. Surgical Outcomes following Exchange of Opacified Hydrophilic Acrylic Intraocualr Lenses. Chonnam Med J 2008. [DOI: 10.4068/cmj.2008.44.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyung-Jin Moon
- Department of Ophthalmology, Chonnam National University and Hospital, Korea
| | - Tae-Sun Jeong
- Department of Ophthalmology, Chonnam National University and Hospital, Korea
| | - In-Cheon You
- Department of Ophthalmology, Chonnam National University and Hospital, Korea
| | - Kun-Jin Yang
- Best Eye Clinic, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea
| | - Kyung-Chul Yoon
- Department of Ophthalmology, Chonnam National University and Hospital, Korea
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Marques FF, Marques DMV, Osher RH, Freitas LL. Longitudinal study of intraocular lens exchange. J Cataract Refract Surg 2007; 33:254-7. [PMID: 17276266 DOI: 10.1016/j.jcrs.2006.10.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 10/01/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze the indications for intraocular lens (IOL) exchange, interval between the first IOL implantation and the exchange, type and mix of IOLs used, effect on vision, and frequency of complications. SETTING Cincinnati Eye Institute-Cincinnati-Ohio-USA. METHODS This retrospective study comprised 49 eyes of 49 adult patients who had IOL exchange between 1986 and 2002 performed by the same surgeon. The mean age was 70 years old, and 55% were women. The mean interval between surgeries was 53.8 months and the mean follow-up, 35.6 months. The patients were divided into 2 groups according to the type of IOL originally implanted: anterior chamber (AC) or posterior chamber (PC). RESULTS There were 15 eyes with an AC IOL and 34 eyes with a PC IOL. The difference in mean age and follow-up were not statistically significant between groups. The mean interval between the primary surgery and IOL explantation was 82.3 months in the AC IOL group and 37.9 months in the PC IOL group. The main reason for IOL exchange was inflammation (53.34%) and dislocation/decentration (85.30%), respectively. The preoperative best corrected visual acuity was similar in both groups, and visual acuity was maintained or improved in 80%. Vitreous prolapse was the main intraoperative complication. CONCLUSIONS The primary indication for IOL exchange was intraocular inflammation in patients with an AC IOL and IOL malposition in patients with a PC IOL. The results confirm the safety and positive visual outcome in this complex group of patients.
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Affiliation(s)
- Frederico F Marques
- Cataract Sectors, Complexo Hospitalar Padre Bento de Guarulhos and Centro de Estudo do Hospital Monumento, São Paulo, Brazil.
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Jin GJC, Crandall AS, Jones JJ. Intraocular lens exchange due to incorrect lens power. Ophthalmology 2006; 114:417-24. [PMID: 17123608 DOI: 10.1016/j.ophtha.2006.07.041] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 07/03/2006] [Accepted: 07/04/2006] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate patients who had intraocular lens (IOL) exchange for unexpected postoperative refractive errors, determine the sources associated with the errors, and derive an empiric approach to estimating the power for IOL exchange. DESIGN Retrospective review of interventional case series. PARTICIPANTS Twenty-two eyes that underwent IOL exchange for correcting unexpected refractive errors after cataract surgery with IOL implantation were reviewed. INTERVENTION All the IOLs for IOL exchange were placed in-the-bag. The same type of IOLs was used for original IOL implantation and IOL exchange in 91% (20/22) of eyes. MAIN OUTCOME MEASURES Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), refraction, and reasons for IOL exchange. The equation derived from refractive change and change in IOL power was developed to calculate IOL power for exchange. RESULTS Of the 22 cases, the identified reasons were keratometry errors in 5 (23%) and incorrect axial length (AL) determination in 3 (14%). In 3 other cases, a wrong IOL was implanted. After IOL exchange, 82% (18/22) of eyes were within +/-0.50 diopters (D) and 86% (19/22) within +/-1.00 D of emmetropia. Uncorrected visual acuity was 20/40 or better in 82% of eyes, and BSCVA was 20/40 or better in 95% (21/22) of eyes. The correlation between change of refraction and IOL power was significant (P<0.002). CONCLUSIONS Among the identified causes, incorrect corneal power determination was the most frequent reason for incorrect IOL power implantation, followed by error in AL measurement and inserting a wrong IOL. The pre-exchange refraction can be used theoretically to calculate the IOL power for exchange.
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Altaie R, Loane E, O'Sullivan K, Beatty S. Surgical and visual outcomes following exchange of opacified Hydroview intraocular lenses. Br J Ophthalmol 2006; 91:299-302. [PMID: 17077119 PMCID: PMC1857646 DOI: 10.1136/bjo.2006.095414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To report the clinical and surgical outcomes following exchange of opacified Hydroview intraocular lenses (IOLs), and to relate the final visual and anatomic results to clinical and surgical variables. METHODS This is a prospective study of seventy-three eyes that underwent exchange of opacified Hydroview IOLs in Waterford Regional Hospital, Ireland. Preoperative, intraoperative and postoperative details were recorded. RESULTS This study comprised 73 eyes of 71 consecutive patients undergoing IOL exchange, performed at mean (+/-SD) intervals of 36.64 (+/-9.9) months following the primary cataract surgery. The mean (+/-SE) follow-up following the exchange procedure was 13 (+/-1) months (range: 1-45 months). The secondary IOL was placed in the capsular bag, in the sulcus, and in the anterior chamber in 22 (30.1%), 24 (32.9%) and 27 (37%) cases, respectively. The IOL exchange procedure was uneventful in 36 eyes (49.3%), whereas intraoperative events such as posterior capsule rupture, vitreous loss and zonular dehiscence were seen in the remainder (50.7%). Following the IOL exchange procedure, a significant improvement in best corrected visual acuity (BCVA) was noted at one and at three months, and at the final visit (Wilcoxon signed ranks test: p<0.001, p = 0.006, and p<0.001, respectively). Following exclusion of eyes with visually consequential ocular comorbidity, a better final BCVA was noted among those eyes where the secondary IOL was placed in the capsular bag or in the sulcus when compared with placement of the secondary IOL in the anterior chamber (IOL in the bag or sulcus: 26 eyes (35.6%), median (IQR) final BCVA: 0.2 (0.10-0.40); IOL in the anterior chamber: 19 eyes (26.02%), median (IQR) final BCVA: 0.5 (0.20-0.60); Mann Whitney U Test: p = 0.004). CONCLUSION IOL exchange is a technically challenging, but visually rewarding procedure. However, placement of the secondary IOL in the anterior chamber is associated with a poorer visual outcome when compared with placement of the secondary IOL in the sulcus or in the capsular bag.
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Affiliation(s)
- Rasha Altaie
- Department of Ophthalmology, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland.
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