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Kaplan AT, Yalçın SÖ, Oral AY. Primary versus secondary intraocular lens implantation following removal of congenital/de al of congenital/developmental catar elopmental cataracts: outcomes after acts: outcomes after at least 4 years. Turk J Med Sci 2023; 53:77-87. [PMID: 36945931 PMCID: PMC10388037 DOI: 10.55730/1300-0144.5560] [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: 11/15/2022] [Accepted: 02/11/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The aim of this study is to evaluate the long-term outcomes of primary and secondary intraocular lens (IOL) implantation following removal of congenital/developmental cataracts. METHODS One hundred and forty-four patients aged under 16 years who were followed up between 2003 and 2021 were analyzed retrospectively. The long-term results of children who underwent surgery before 2 years of age for congenital or developmental cataracts and underwent secondary IOL implantation after 2 years of age and those who underwent cataract surgery with primary IOL implantation after 2 years of age were compared. Patients with traumatic, secondary cataracts and cataracts due to ocular anomalies were not included in the study. RESULTS We evaluated 64 patients (mean age 9.5 ± 4.5 years) with secondary IOL implantation and 80 patients (mean age 12.8 ± 4.1 years) with primary IOL implantation in the study. Distance and near best-corrected visual acuities were significantly better in the primary IOL group than the secondary IOL group (p < 0.001). Incidence of strabismus after primary IOL surgery was significantly lower and presence of binocular vision was more often than the secondary IOL group (p = 0.002). There was no significant difference between the two groups in terms of refraction and myopic shift (p = 0.242, p = 0.172, respectively). Mean refractive changes were significant in unilateral cases of secondary IOL group and primary IOL group (p = 0.013, p = 0.049, respectively) and myopic shift was also greater in both groups of unilateral cases than the fellow eyes (p = 0.023, p = 0.012, respectively). DISCUSSION Visual outcomes and binocular vision were better, and the incidence of strabismus was also much less in the primary IOL group.
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Affiliation(s)
- Ayşin Tuba Kaplan
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, İstanbul,Turkey
| | - Sibel Öskan Yalçın
- Department of Ophthalmology, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Sciences, İstanbul,Turkey
| | - Ayşe Yeşim Oral
- Department of Ophthalmology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Lewin GA, Dixon CJ. Post-operative outcomes in canine eyes receiving a rhexis-fixated prosthetic intra-ocular lens: 30 cases (2014-2020). J Small Anim Pract 2021; 63:211-219. [PMID: 34796972 DOI: 10.1111/jsap.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 07/21/2021] [Accepted: 09/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the outcomes following the insertion of a rhexis-fixated prosthetic intraocular lens (IOL) in dogs undergoing lens removal. MATERIALS AND METHODS The results are from 30 eyes of 28 dogs, undergoing lendectomy, in which the lens capsule could not accommodate a conventional prosthetic endo-capsular IOL. The reported cases had sustained either spontaneous or traumatic lens capsule rupture, or accidental intra-operative iatrogenic lens capsule disruption, or had required a planned, large, anterior or posterior continuous curvilinear capsulorhexis, all of which precluded insertion of a prosthetic IOL within the lens capsule. An acrylic IOL (XVET; Medicontur) was modified and positioned across the anterior and/or posterior capsulorhexes. RESULTS Other than haptic luxation in three cases, no complications were seen that were directly attributable to the rhexis-fixated lens. Over a follow-up period from three to 76 months (mean 20.7 months) 26/30 eyes remained visual. Blindness developed in three eyes due to retinal detachment and one eye was enucleated due to regrowth of a ciliary body adenoma. CLINICAL SIGNIFICANCE Rhexis fixation provided an alternative method to implant a prosthetic IOL when the lens capsule was unable to accommodate a conventional endo-capsular IOL.
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Affiliation(s)
- G A Lewin
- Veterinary Vision, Signal House, Gillan Way, Penrith, Cumbria, CA11 9BP, UK
| | - C J Dixon
- Veterinary Vision, Signal House, Gillan Way, Penrith, Cumbria, CA11 9BP, UK
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Chougule P, Kekunnaya R. Intraocular lens implantation in infants and toddlers in 2020. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1794822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Pratik Chougule
- The David Brown Children’s Eye Care Center, Child Sight Institute, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Ramesh Kekunnaya
- Jasti V Ramanamma Children’s Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
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Chen J, Chen Y, Zhong Y, Li J. Comparison of visual acuity and complications between primary IOL implantation and aphakia in patients with congenital cataract younger than 2 years: a meta-analysis. J Cataract Refract Surg 2020; 46:465-473. [PMID: 32142042 DOI: 10.1097/j.jcrs.0000000000000015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To analyze the visual acuity and complications between primary intraocular lens (IOL) implantation and contact lens wearing, this literature search was performed with data on patients with congenital cataract younger than 2 years published in March 2019. Seven identified studies enrolling 675 eyes were selected for analysis. Patients with primary IOL implantation owned better visual acuity than those with aphakia who wore the contact lens (weighted mean difference = 0.161; 95% CI, 0.108-0.214). For visual axis opacification (VAO), primary IOL implantation increases the incidence of VAO compared with contact lens wearing (relative risk = 0.23; 95% CI, 0.13-0.42). No statistically significant difference was found between the 2 groups about the prevalence of glaucoma and strabismus. Primary IOL implantation achieved better visual outcomes after cataract extraction in patients younger than 2 years. In addition, no higher risk for complications among primary IOL implantation compared with contact lens wearing was noted. Therefore, implanting a primary IOL during congenital cataract surgery is a better therapy for children younger than 2 years than wearing a contact lens.
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Affiliation(s)
- Jiabao Chen
- From the Department of Ophthalmology, Peking University Shenzhen Hospital (J. Chen, Y. Chen, Li), Guangdong, Department of Ophthalmology, Shantou University Medical College (J. Chen), Guangdong, and Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University (Zhong), Hangzhou, Zhejiang, China
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Vasavada AR, Vasavada V, Shah SK, Trivedi RH, Vasavada VA, Vasavada SA, Srivastava S, Sudhalkar A. Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery. J Cataract Refract Surg 2019; 43:1177-1183. [PMID: 28991614 DOI: 10.1016/j.jcrs.2017.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare complications in children up to 4 years old having cataract surgery with intraocular lens (IOL) implantation using 2 techniques: in-the-bag IOL with anterior vitrectomy or optic capture of IOL with no anterior vitrectomy. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN Prospective randomized control clinical trial. METHODS The study included children having cataract surgery with IOL implantation. Patients were randomized to Group 1 (in-the-bag 3-piece hydrophobic acrylic IOL [Acrysof MA60AC] with anterior vitrectomy) or Group 2 (optic capture of the same IOL without anterior vitrectomy). Intraoperative complications were documented. Postoperative visual axis obscuration (VAO), glaucoma, cell deposits on the IOL, and posterior synechiae were compared at 1, 3, 6, and 12 months. RESULTS The study comprised 61 children (61 eyes). The mean ages were 14.8 months ±11.47 (SD) in Group 1 (n = 30) and 18.2 ± 11.47 months in Group 2 (n = 31). Overall, only 1 eye in Group 1 developed a VAO requiring membranectomy 4 months postoperatively, and 2 eyes in Group 1 developed glaucoma over 12 months (P = .49). Intraocular lens cell deposits and posterior synechiae were comparable between groups. The IOL could not be captured in 5 eyes (16.1%); no complications occurred in these eyes. CONCLUSIONS Optic capture of 3-piece hydrophobic acrylic IOLs could be achieved in most eyes. The VAO, glaucoma, and inflammation were comparable 12 months postoperatively. Thus, optic capture of an IOL is an alternative surgical technique that can be used to avoid vitrectomy, even in children younger than 4 years.
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Affiliation(s)
- Abhay R Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Vaishali Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sajani K Shah
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rupal H Trivedi
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Viraj A Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shail A Vasavada
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Samaresh Srivastava
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aditya Sudhalkar
- From the Iladevi Cataract & IOL Research Centre (A.B. Vasavada, V. Vasavada, Shah, V.A. Vasavada, S.A. Vasavada, Srivastava, Sudhalkar), Ahmedabad, India; Storm Eye Institute (Trivedi), Medical University of South Carolina, Charleston, South Carolina, USA
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Xie YB, Ren MY, Wang Q, Wang LH. Intraocular lens optic capture in pediatric cataract surgery. Int J Ophthalmol 2018; 11:1403-1410. [PMID: 30140648 DOI: 10.18240/ijo.2018.08.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 12/28/2022] Open
Abstract
Posterior capsule opacification (PCO) remains the most common complication of pediatric cataract surgery despite continuous efforts to reduce its incidence. For this reason, pediatric cataract surgeons have expended considerable effort into preventing and mitigating PCO. The intraocular lens (IOL) optic capture technique has been used for the prevention of PCO after pediatric cataract surgery for more than 20y, but there is still no professional consensus. However, recent research has shown encouraging results. The IOL optic capture technique can be performed without anterior vitrectomy to prevent PCO, even in younger children. The type and characteristics of IOLs used for optic capture technique, the location of IOL and the complications of IOL optic capture in children are here reviewed.
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Affiliation(s)
- Ying-Bin Xie
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Mei-Yu Ren
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Qi Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Li-Hua Wang
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
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Lotfy A, Abdelrahman A. Trypan blue-assisted posterior capsulorhexis in pediatric cataract surgery. Clin Ophthalmol 2017; 11:219-222. [PMID: 28182152 PMCID: PMC5279846 DOI: 10.2147/opth.s123150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of staining the posterior capsule with trypan blue during capsulorhexis in pediatric cataract surgery. PATIENTS AND METHODS This was a prospective randomized comparative study carried out at Alpha Vision Center, Zagazig, Egypt. This study included 2 groups of children with pediatric cataract randomly allocated to undergo irrigation and aspiration. In the trypan group, which included 11 eyes, trypan blue was used to stain the posterior capsule during posterior capsulorhexis. In the control group, which included 10 eyes, no staining was performed. All surgeries were performed by the same surgeon. The 2 groups were compared for criteria such as completion of capsulorhexis, disruption of vitreous face and in-the-bag intraocular lens implantation. RESULTS This study included 21 eyes of 16 patients (age range: 6 months-4 years). A statistically significant difference was observed for the following parameters between the 2 groups: capsulorhexis completion (P=0.04), vitreous face disruption (P=0.01) and in-the-bag intraocular lens implantation (P=0.022). CONCLUSION This study suggests that staining of the posterior capsule during capsulorhexis in pediatric cataract operation gives better results than capsulorhexis without staining. The stain changes the capsule texture making capsulorhexis easier with fewer complications.
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Affiliation(s)
- Ayman Lotfy
- Ophthalmology Department, Zagazig University Hospital
- Alpha Vision Center, Zagazig, Egypt
| | - Ayman Abdelrahman
- Ophthalmology Department, Zagazig University Hospital
- Alpha Vision Center, Zagazig, Egypt
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Abstract
Cataract is a significant cause of visual disability in the pediatric population worldwide and can significantly impact the neurobiological development of a child. Early diagnosis and prompt surgical intervention is critical to prevent irreversible amblyopia. Thorough ocular evaluation, including the onset, duration, and morphology of a cataract, is essential to determine the timing for surgical intervention. Detailed assessment of the general health of the child, preferably in conjunction with a pediatrician, is helpful to rule out any associated systemic condition. Although pediatric cataracts have a diverse etiology, with the majority being idiopathic, genetic counseling and molecular testing should be undertaken with the help of a genetic counselor and/or geneticist in cases of hereditary cataracts. Advancement in surgical techniques and methods of optical rehabilitation has substantially improved the functional and anatomic outcomes of pediatric cataract surgeries in recent years. However, the phenomenon of refractive growth and the process of emmetropization have continued to puzzle pediatric ophthalmologists and highlight the need for future prospective studies. Posterior capsule opacification and secondary glaucoma are still the major postoperative complications necessitating long-term surveillance in children undergoing cataract surgery early in life. Successful management of pediatric cataracts depends on individualized care and experienced teamwork. We reviewed the etiology, preoperative evaluation including biometry, choice of intraocular lens, surgical techniques, and recent developments in the field of childhood cataract.
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Affiliation(s)
- Anagha Medsinge
- Pediatric Ophthalmology, Strabismus, and Adult Motility, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, (UPMC), Pittsburgh, PA, USA ; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ken K Nischal
- Pediatric Ophthalmology, Strabismus, and Adult Motility, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, (UPMC), Pittsburgh, PA, USA ; University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Posterior capsule management in congenital cataract surgery. J Cataract Refract Surg 2011; 37:173-93. [PMID: 21183112 DOI: 10.1016/j.jcrs.2010.10.036] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 06/17/2010] [Accepted: 06/26/2010] [Indexed: 11/20/2022]
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Tassignon MJ, Gobin L, De Veuster I, Godts D. [Advantages of the bag-in-the-lens intraocular lens in pediatric cataract surgery]. J Fr Ophtalmol 2009; 32:481-7. [PMID: 19717210 DOI: 10.1016/j.jfo.2009.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 06/26/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the advantages of the bag-in-the-lens intraocular lens in children undergoing cataract surgery. PATIENTS AND METHODS This prospective study included 54 eyes of 37 children and babies (age, 2 months to 14 years), consecutively operated on between December 1999 and January 2008 for unilateral or bilateral cataract using the "bag-in-the-lens" intraocular lens. Slit-lamp examination, intraocular pressure, visual acuity, and refraction were followed to the best possible degree over time. RESULTS The mean age of the 37 children at the last consultation visit was 8.3+/-4.9 years. The mean visual acuity improved from 0.2+/-0.1 to 0.8+/-0.3. On the other hand, visual acuity improvement in children presenting hyperplastic persistence of the vitreous was less favorable with a postoperative average visual acuity of 0.14+/-0.18. The mean postoperative refraction in 13 children (26 eyes) operated on for bilateral cataract was 0.5+/-1.5 D for eyes showing axial lengths with substantial variation. The refraction was stable over time in children over 2 years of age. Once the implant was positioned correctly, the remaining epithelial cells of the lens did not migrate toward the visual axis, which was the case in 93.8% of all eyes and in 100% of children over 1 year of age. CONCLUSIONS The "bag-in-the-lens" implant is particularly indicated in children in whom posterior rhexis and optic capture have been recommended since 1994. The implantation minimizes the use of anterior vitrectomy in pediatric cataract surgery, limiting it to those eyes presenting a proliferative hyperplastic vitreous.
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Affiliation(s)
- M-J Tassignon
- Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium.
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Cavallini GM, Masini C, Chiesi C, Campi L, Rivasi F, Ferrari P. Cataract development in a young patient with lathosterolosis: a clinicopathologic case report. Eur J Ophthalmol 2009; 19:139-42. [PMID: 19123163 DOI: 10.1177/112067210901900122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a unique case of cataract in a young patient with lathosterolosis, a singular defect of cholesterol biosynthesis, and to report the clinical results and histopathologic findings after cataract surgery. METHODS A 7-year-old patient with lathosterolosis, a rare defect of cholesterol biosynthesis, presented with a complex phenotype, including severe mental retardation, liver disease, multiple congenital anomalies, and bilateral posterior subcapsular cataracts. After a severe metabolic decompensation, a worsening in the lens opacity of the left eye occurred. The authors thus performed cataract surgery and made a histopathologic analysis of aspirated lenticular samples. The following examinations were performed at 1 day, 1 week, 3 months, 6 months, 12 months, and 24 months: refraction, biomicroscopy, and fundus evaluation. Visual acuity was not assessable due to lack of patient collaboration. The postoperative follow-up period was 24 months. RESULTS Histopathologic findings on lenticular fragments revealed the presence of fibers disposed in a honeycomb, samples with homogeneous eosinophilic lens fibers, and other fragments characterized by bulgy elements referable to cortical fibers with degenerative characteristics. After surgery, biomicroscopic evaluation revealed no significant inflammation and good intraocular lens centration at the various control visits. No intraoperative or postoperative complications occurred. No posterior capsule opacification occurred 2 years after surgery. CONCLUSIONS Lathosterolosis may lead to dysmetabolic cataract development; this unique case of cataract in such a patient has been successfully managed with surgery. Clinical results were excellent, and no complications occurred either intra- or postoperatively.
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Affiliation(s)
- G M Cavallini
- Department of Ophthalmology, University of Modena and Reggio Emilia, Italy.
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Luo Y, Lu Y, Lu G, Wang M. Primary posterior capsulorhexis with anterior vitrectomy in preventing posterior capsule opacification in pediatric cataract microsurgery. Microsurgery 2008; 28:113-6. [PMID: 18220313 DOI: 10.1002/micr.20460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our study was performed to investigate the operative effects of pediatric cataract surgery with anterior vitrectomy. The study comprised of 38 pediatric patients aged 2-5 years and involved a total of 60 eyes with congenital cataracts. The study was done between March 2004 and December 2005. Posterior capsulorhexis with anterior vitrectomy was performed on 34 eyes of 20 children, and cataract extraction was performed on 26 eyes of 18 children. The percentages of various complications and rate of neodymium YAG (Nd:YAG) laser capsulotomy were followed up for 12-36 months. There were significant differences in the percentages of posterior capsule opacification (PCO) and rate of neodymium YAG (Nd:YAG) capsulotomy between the anterior vitrectomy group and cataract extraction group (P < 0.01). The anterior vitrectomy group was associated with less posterior capsular opacification (11.8%) than the cataract extraction group (76.9%). The YAG capsulotomy rate was 2.9% for the anterior vitrectomy group, and 57.7% for the cataract extraction group. After operation the fibrous exudates in anterior chamber and the intraocular lens subluxation or capture were 5.9% and 2.9% for the anterior vitrectomy group while for the cataract extraction group they were 23.1% and 15.4%; the difference was statistically significant (P < 0.05). The results suggest that primary posterior capsulorhexis with anterior vitrectomy in pediatric cataract surgery who are between 2 and 5 years old is necessary and effective procedure with low PCO rate.
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Affiliation(s)
- Yi Luo
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
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Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases. Graefes Arch Clin Exp Ophthalmol 2008; 246:787-801. [PMID: 18425525 PMCID: PMC2367393 DOI: 10.1007/s00417-008-0779-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Revised: 01/20/2008] [Accepted: 01/24/2008] [Indexed: 11/05/2022] Open
Abstract
Background Current after-cataract prevention relies on optimizing the natural barrier effect of the optic rim against lens epithelial cell (LEC) migration. However, deficiencies in circumferential capsular bag closure caused by the intraocular lens (IOL) haptic or delayed secondary re-division of the fused capsules by Soemmering´s ring formation lead to primary or secondary barrier failure. Consequently, surprisingly high posterior laser capsulotomy rates have been reported long-term, even with optimal capsular surgery and the most widespread hydrophobic acrylic IOLs, considered to be the most advanced. Intraoperative removal of the central posterior capsule has been shown to be effective in further reducing LEC immigration. However, efficacy has turned out to be limited because of the propensity of LECs to use the posterior optic surface as an alternative scaffold. Material and methods Technique: in pediatric cataract surgery, buttoning-in of the optic into an adequately-centered posterior capsulorhexis opening has been described previously. This technique was further elaborated and applied as the standard technique in a large series of adult eyes. In general, the diameter aimed at was 5–6 mm for the anterior, and 4–5 mm for the posterior capsulorhexis. Between September 2004 and June 2007, 1000 consecutive cases have thus been performed and systematically evaluated. One hundred and fifty eyes additionally underwent extensive anterior LEC abrasion. Another sub-series investigated the option of further reducing capsular fibrosis by creating an anterior capsulorhexis larger than the optic. Evaluation: special scrutiny was applied to detect postoperative vitreous entrapment. Regeneratory and fibrotic after-cataract formation were both meticulously followed-up. Postoperative pressure course, anterior segment inflammation, macular thickness and morphology, as well as axial optic stability and optic centration, were evaluated in intraindividual comparison studies.
Results A low rate of vitreous complications was found, which can be avoided by appropriate surgery. Vitreous entanglement occurred in six eyes, and vitreous herniation after PPCCC over-sizing in two. In three, anterior vitrectomy was performed. There was only one single case of retinal detachment—supposedly unrelated to the technique itself—and no case of cystoid macular edema. Retro-optical regenerate formation was completely abolished, while fibrosis was drastically reduced by the posterior capsule sandwiched in between the anterior LEC layer on the backside of the anterior capsule and the anterior optic surface, thereby blocking contact-mediated myofibroblastic LEC transdifferentiation. Additional capsular polishing further reduced residual fibrosis emerging from the anterior capsule contacting the optic adjacent to the haptic junction, as well as regeneratory LEC re-proliferation on the posterior capsule overlying the optic. Postoperative pressure course was almost identical to that found after standard in-the-bag implantation of the IOL, as was flare, and macular thickness and morphology. As opposed to bag-fixated IOLs, no axial movement of the optic was detected. IOL optics always perfectly centered even when the capsular opening was not optimally centered. Due to the exquisite stretchability and elasticity of the posterior capsule, the 6-mm IOL optic could safely be buttoned-in in a posterior capsulorhexis of 4 mm and smaller. Conclusions Posterior optic buttonholing (POBH) is a safe and effective technique which not only excludes retro-optical opacification, but also withholds capsular fibrosis by obviating direct contact between the anterior capsular leaf and the optic surface. Anterior LEC abrasion significantly reduced both the residual fibrosis and regeneratory LEC proliferation. Apart from pediatric cataract, POBH is currently recommended for eyes with pseudoexfoliation syndrome, high axial myopia, peripheral retinal disease, and multifocal IOL implantation. Toric IOLs and magnet-driven accommodative IOL systems are other potential applications. Generally, POBH holds promise for becoming a routine alternative to standard in-the-bag IOL implantation in the future.
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Verbruggen KHM, Rozema JJ, Gobin L, Coeckelbergh T, De Groot V, Tassignon MJ. Intraocular lens centration and visual outcomes after bag-in-the-lens implantation. J Cataract Refract Surg 2007; 33:1267-72. [PMID: 17586385 DOI: 10.1016/j.jcrs.2007.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 03/04/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the centration and visual outcomes after cataract surgery using the bag-in-the-lens (BIL) implantation technique. SETTING University Hospital Antwerp, Department of Ophthalmology, Edegem, Belgium. METHODS This study comprised 180 eyes of 125 patients who had cataract surgery with implantation of the BIL intraocular lens (IOL) between March 2002 and September 2005. Postoperative data at 5 weeks, 6 months, and 1 year were evaluated. The geometric center of the IOL, measured on a red reflex slitlamp photograph, was compared with the geometric center of the pupil and the limbus. RESULTS The mean decentration compared with the limbus was 0.304 mm+/-0.17 (SD) at a mean angle of -24.9+/-113.3 degrees. Compared with the dilated pupil, the mean deviation was 0.256+/-0.15 mm at a mean angle of -5.2+/-119.0 degrees. The amount of decentration was stable during the postoperative follow-up period. There was no correlation between the amount of decentration and the visual outcomes (pupil: r=-0.07, P=.494; limbus: r=0.11, P=.304). CONCLUSIONS Surgeon-controlled BIL centration was predictable 5 weeks and unchanged 6 months and 1 year postoperatively. It can therefore be concluded that capsular bag healing has no influence on BIL IOL centration over time.
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Tassignon MJ, De Veuster I, Godts D, Kosec D, Van den Dooren K, Gobin L. Bag-in-the-lens intraocular lens implantation in the pediatric eye. J Cataract Refract Surg 2007; 33:611-7. [PMID: 17397732 DOI: 10.1016/j.jcrs.2006.12.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 12/19/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the efficacy, safety, and feasibility of implantation of a bag-in-the-lens intraocular lens (IOL) in children and babies. SETTING Departments of Ophthalmology, University Hospital, Antwerp, Belgium, and the University Hospital, Ljubljana, Slovenia, and a private ophthalmology practice, Oudenaarde, Belgium. METHODS Thirty-four eyes of 22 children had implantation of a bag-in-the-lens IOL. The ages ranged from 2 months to 14 years. Congenital cataract was present in 26 eyes, and persistent fetal vasculature (PFV) was concomitantly present in 4 eyes. Fifteen patients had bilateral cataract, and 6 had unilateral cataract. RESULTS In 3 eyes, the IOL could not be properly implanted. In these cases, secondary intervention was necessary because of early posterior capsule opacification. The mean postoperative follow-up was 17.45 months +/- 17.12 (SD) (range 4 to 68 months). None of the children except those presenting with PFV had anterior vitrectomy during surgery. The optical axis remained clear during the follow-up in all patients who had successful IOL implantation. CONCLUSIONS The bag-in-the-lens implantation technique in children and babies was safe and kept the visual axis clear after cataract surgery. In the near future, 4.0 or 4.5 mm IOLs will be available that may improve the success rate of IOL implantation in the small eyes of babies.
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Menapace R. [After-cataract following intraocular lens implantation. Part II: prevention with alternative implants and techniques]. Ophthalmologe 2007; 104:345-53; quiz 354-5. [PMID: 17372739 DOI: 10.1007/s00347-007-1505-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The introduction of sharp-edged optics has drastically reduced, but not fully eradicated, retro-optical after-cataract formation. The effectiveness of capsular bending rings or primary posterior capsulorhexis is also limited, and these have not become widespread because of the demanding surgical technique and the costs associated with an additional implant. Anterior capsule polishing has been found to even increase the need for laser capsulotomy, and rinsing the sealed capsular bag with cell-toxic agents has not yet gained clinical application. Routine posterior optic buttonholing through a well-centered posterior capsulorhexis opening is a promising alternative because it precludes access of lens epithelial cells behind the optic while at the same time counteracting fibrosis of the anterior capsule. Because this effect is independent of optic rim design and lens material, future efforts in lens refinement may concentrate on reducing the reflectivity of the optic rim and optimizing the biocompatibility of the lens material.
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Affiliation(s)
- R Menapace
- Universitätsklinik für Augenheilkunde und Optometrie, AKH-Wien, Wien, Osterreich.
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Menapace R. Routine posterior optic buttonholing for eradication of posterior capsule opacification in adults: report of 500 consecutive cases. J Cataract Refract Surg 2006; 32:929-43. [PMID: 16814050 DOI: 10.1016/j.jcrs.2006.02.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2005] [Accepted: 04/16/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the efficacy of posterior optic buttonholing (POBH) through a primary posterior capsulorhexis (PPCCC) to preserve full capsular transparency, and its potential as a routine alternative to standard in-the-bag implantation of sharp-edged optic intraocular lenses (IOLs). SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS After standard cataract removal, a PPCCC 4.0 to 5.0 mm in diameter was performed and the optic of a 3-piece IOL buttonholed posteriorly. One third of the eyes additionally had extensive anterior capsule polishing. All surgeries were performed under topical anesthesia. RESULTS The first 500 consecutive surgeries were evaluated. In 11 eyes, POBH was not performed as planned. In 4 cases, anterior capsulorhexis fixation of the optic was used as an alternative. In the early series, vitreous entanglement was seen in 5 eyes, of which 1 case prompted translimbal anterior vitrectomy. No case of cystoid macula edema was observed. One case of peripheral retinal detachment in a highly-myopic eye 4 months postoperatively appeared to be unrelated to the surgery. All lenses were well-centered without tilt, and both capsule leaves remained clear especially after additional polishing. CONCLUSION Posterior optic buttonholing precludes lens epithelial cells from accessing the retrolental space. The sandwiched posterior capsule blocks optic contact and thus fibrosis of the anterior capsule. Posterior optic buttonholing avoids after-cataract independent of optic edge design. Anterior capsule polishing adds to its efficacy by excluding any residual fibrosis. Surgery under topical anesthesia was well-controlled and safe. Posterior optic buttonholing may become a routine alternative to standard in-the-bag IOL implantation when supported by a longer follow-up.
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Affiliation(s)
- Rupert Menapace
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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