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Błagun N, Krix-Jachym K, Rękas M. Comparison of Safety and Efficacy of Four-Point Scleral Intraocular Lens Fixation and the Yamane Technique. Ophthalmol Ther 2024; 13:1955-1966. [PMID: 38771460 PMCID: PMC11178701 DOI: 10.1007/s40123-024-00962-7] [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: 02/04/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION The purpose of our study was to compare the safety and efficacy of two scleral fixation intraocular lens (IOL) methods of four-point scleral fixation (Akreos AO60) and the Yamane technique (AcrySof MA60AC). METHODS This prospective, randomized study was conducted at the Military Institute of Medicine-National Research Institute in Warsaw between 2021 and 2023. We compared both groups for cause of aphakia, ocular history, refractive status, and complication. RESULTS Our study included 50 eyes from 47 patients. Four-point fixation was performed in 25 eyes (group 1), and the Yamane technique was used in 25 eyes (group 2). Surgical time was 24.1 min ± 8.9 in group 1 and 25.1 min ± 9.9 in group 2 (p > 0.05). The postoperative BCVA (best-corrected visual acuity) for group 1 and group 2 at 1 year's observation was 0.10 ± 0.15 and 0.09 ± 0.17 logMAR, respectively (p > 0.05). Postoperative total refractive error (RE) was - 0.06 ± 0.71 diopters (D) for four-point scleral fixation and 0.83 ± 0.70 D for Yamane technique (p < 0.05). Endothelial cell density (ECD) loss was 0.9% in group 1 and 3.5% in group 2 (p > 0.05). Bleeding into the anterior chamber and vitreous body was more frequent in the group of patients operated on with the use of the Yamane technique (10 cases, 20%, p = 0.01). IOL displacement was found in one case (2%) in group 2. CONCLUSIONS Both analyzed techniques are well tolerated and ensure good refractive results (extremely predictable in four-point scleral fixation) and have a similar safety profile. Four-point scleral fixation of IOL would appear to be safe, effective and beneficial for young, active patients, especially after trauma or recurrent subluxation. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT06389643.
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Affiliation(s)
- Natalia Błagun
- Ophthalmology Department, Military Institute of Medicine - National Research Institute, Szaserów Street 128, 04-141, Warsaw, Poland.
| | - Karolina Krix-Jachym
- Ophthalmology Department, Military Institute of Medicine - National Research Institute, Szaserów Street 128, 04-141, Warsaw, Poland
| | - Marek Rękas
- Ophthalmology Department, Military Institute of Medicine - National Research Institute, Szaserów Street 128, 04-141, Warsaw, Poland
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Guerin PL, Guerin GM, Pastore MR, Gouigoux S, Tognetto D. Long-term functional outcome between Yamane technique and retropupillary iris-claw technique in a large study cohort. J Cataract Refract Surg 2024; 50:605-610. [PMID: 38350232 PMCID: PMC11146187 DOI: 10.1097/j.jcrs.0000000000001421] [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: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To evaluate which secondary intraocular lens (IOL) implantation technique was more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw IOL (ICIOL) and flanged intrascleral IOL (FIIOL) fixation with the Yamane technique. SETTING Eye Clinic of the University of Trieste, Trieste, Italy. DESIGN Retrospective observational study. METHODS 116 eyes of 110 patients who underwent ICIOL or FIIOL were analyzed. Patients with follow-up shorter than 6 months or with incomplete clinical data were excluded. Collected data included demographics, ocular comorbidity, indication of surgery, intraocular pressure, early (≤1 month) and late (>1 month) postoperative complications, corrected distance visual acuity (CDVA), and manifest refraction at the last follow-up visit. RESULTS 50% (n = 58) of eyes underwent FIIOL and 50% (n = 58) ICIOL implantation for aphakia (n = 44, 38%) and IOL dislocation (n = 72, 62%). No statistically significant differences in demographics, comorbidity, follow-up duration, postoperative complications, and surgical indications were found. The refractive prediction error (RPE) was 0.69 ± 0.94 diopter (D) in the FIIOL group and 0.21 ± 0.75 D in the ICIOL group ( P = .03), indicating residual hyperopia after both techniques. RPE, mean absolute error, and median absolute error were higher in the FIIOL group ( P = .003). ICIOL implantation was more successful in obtaining a RPE between -0.50 D and +0.50 D (52% of ICIOL, n = 30, and 31% of FIIOL, n = 18). CONCLUSIONS Both techniques were effective in increasing preoperative CDVA with no statistical difference between them. Although complication rates did not significantly differ, the FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-piece IOL, as performed in ciliary sulcus implantation, to prevent myopic shift, is not recommended.
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Affiliation(s)
- Pier Luigi Guerin
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Gian Marco Guerin
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Marco Rocco Pastore
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Stefano Gouigoux
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
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Halkiadakis I, Ntravalias T, Kollia E, Chatzistefanou K, Kandarakis SA, Patsea E. Screening for multifocal intraocular lens implantation in cataract patients in a public hospital. Int Ophthalmol 2024; 44:151. [PMID: 38507136 DOI: 10.1007/s10792-024-03088-8] [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: 09/30/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To identify the rate and characteristics of cataract surgery candidates suitable for multifocal intraocular lens implantation among patients undergoing preoperative evaluation in a public hospital. MATERIALS AND METHODS Screening was performed based on the patient's medical records, comprehensive ophthalmic examination, optical biometry (Zeiss, IOL Master 700) and optical coherence tomography (OCT) (Heidelberg, OCT Spectralis) in accordance with the relevant indications and contraindications mentioned in the pertinent literature. Patients were included in the present study if they were eligible for bilateral cataract surgery. The exclusion criteria were the presence of central nervous system or motility issues, prior refractive surgery, the presence of astigmatism greater than 1 dioptre and/or the presence of important ocular comorbidities in either eye. RESULTS The study evaluated 1200 consecutive patients. Four hundred thirty-two patients (36%) were not eligible for bilateral surgery and were excluded from the study. Of the 768 patients included in the present study, 346 (45.1%) were considered suitable candidates. Four hundred twenty-two patients (54.9%) were excluded for one or both eyes. Among them, 121 (28.7%) were excluded because of retinal disease, 120 (28.4%) because of regular astigmatism (> 1.0 D of corneal astigmatism), 32 (7.5%) because of pseudoexfoliation or zonular instability, and 30 (7.1%) because of glaucoma or ocular hypertension; in addition, 90 (21.3%) patients were excluded for multiple reasons. Suitable candidates were significantly younger (70 and 75 years, respectively) (p < 0.001). After being informed about the potential risks and benefits of MOIL implantation, 212 of 346 (83.8%) eligible patients provided consent. CONCLUSION Close to half of cataract patients in a public hospital were eligible for MOIL implantation, and the majority of patients would proceed to surgery. The most prevalent contraindication was macular disease.
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Affiliation(s)
- Ioannis Halkiadakis
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece.
| | - Thomas Ntravalias
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece
| | - Elpida Kollia
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece
| | - Klio Chatzistefanou
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Stylianos A Kandarakis
- First Department of Ophthalmology, National and Kapodistrian University of Athens, General Hospital "G. Gennimatas", Athens, Greece
| | - Eleni Patsea
- Ophthalmiatrion Athinon, Athens Eye Hospital, Sarantaporou 7 Agios Stephanos, 145 65, Athens, Greece
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Au Eong JTW, Tsai JHJ, Au Eong KG. Severe astigmatism secondary to large intraocular lens pantoscopic tilt because of a malpositioned haptic following cataract surgery. J Surg Case Rep 2024; 2024:rjae134. [PMID: 38469204 PMCID: PMC10927352 DOI: 10.1093/jscr/rjae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
An 80-year-old woman presented with painless blurring of vision and monocular diplopia in her left eye following routine phacoemulsification and monofocal intraocular lens (IOL) implantation 5 weeks earlier. Her uncorrected visual acuity (VA) was 6/60 correctable with pinhole to 6/21. Her best-corrected VA was 6/15 with a subjective refraction of -0.50DS/-5.25DCx37. Her corneal astigmatism was -1.25DCx74. Ophthalmic examination disclosed a severely tilted single-piece posterior chamber IOL in the capsular bag. The inferior portion of the optic was tilted posteriorly because of a twisted and malpositioned haptic. The patient underwent remedial surgery to untwist and reposition the IOL haptic which led to immediate improvement of the IOL position. Her uncorrected VA improved to 6/12-2 correctable with pinhole to 12+1 with an autorefraction of +0.25DS/-2.00DCx74 on the first postoperative day. One month postoperatively, her best-corrected VA was 6/12 with a refraction of +0.50DS/-2.50DCx82. Her final vision was limited by myopic macular degeneration.
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Affiliation(s)
- Jonathan T W Au Eong
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Jarryl H J Tsai
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
| | - Kah-Guan Au Eong
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, 308232, Singapore
- International Eye Cataract Retina Centre, Mount Elizabeth Medical Centre and Farrer Park Medical Centre, 1 Farrer Park Station Road #14-07/08, Connexion, 217562, Singapore
- Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore
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Lin X, Ma D, Yang J. Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches. Front Med (Lausanne) 2024; 11:1366576. [PMID: 38439904 PMCID: PMC10911763 DOI: 10.3389/fmed.2024.1366576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.
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Affiliation(s)
- Xuanqiao Lin
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Dongmei Ma
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Key NHC Laboratory of Myopia, Fudan University, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Iranipour BJ, Rosander JH, Zetterberg M. Visual Improvement and Lowered Intraocular Pressure After Surgical Management of In-The-Bag Intraocular Lens Dislocation and Aphakia Correction; Retrospective Analysis of Scleral Suturing versus Retropupillary Fixated Iris-Claw Intraocular Lens During a 5-Year Period. Clin Ophthalmol 2024; 18:315-324. [PMID: 38332906 PMCID: PMC10849897 DOI: 10.2147/opth.s445244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose We compare and evaluate the visual outcome and complication rate of two different techniques of surgical management of in-the-bag intraocular lens (IOL) dislocation or aphakia correction. In addition, we evaluate possible risk factors for IOL dislocation or aphakia. Patients and Methods This retrospective case series reviewed medical records for all patients who had undergone surgery for IOL dislocation or aphakia during a 5-year period at a single ophthalmic center in Sweden. The two most common procedures, scleral suturing of dislocated in-the-bag IOL and retropupillary fixation of iris-claw IOL, were further analyzed. Main outcome measures were best-corrected visual acuity (BCVA), reoperations, and complications. Results The study comprised 110 eyes, including scleral suturing procedures (n=35) and retropupillary iris-claw IOL (n=75). There was a significantly higher rate of dense cataract (p=0.030) and posterior capsular rupture (PCR), (p=0.016) among iris-claw cases at the primary cataract extraction with pseudoexfoliations in about two-thirds of patients in both groups. All eyes in the scleral suturing group had an IOL dislocation. In the iris-claw group, 23 eyes (30.7%) were aphakic following complicated cataract surgery with PCR. No intraoperative complications occurred in any eyes during the secondary IOL procedure. Both groups showed significant improvement in BCVA, yet there was no significant difference between groups in postoperative BCVA (p=0.263). However, the scleral suturing group experienced a significantly larger improvement in BCVA due to worse BCVA preoperatively (p=0.005). Intraocular pressure decreased significantly after both repositioning and exchange surgery (p=0.002 and 0.010 respectively), but improvement between groups was not significantly different (p=0.264). Conclusion Both surgical methods resulted in significantly improved BCVA and lowering of IOP and can be considered safe with limited complications. The outcome was similar between groups. Pseudoexfoliation prevalence was high in both groups indicating that it may be a risk factor for either aphakia or late IOL dislocation.
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Affiliation(s)
| | - Jonas H Rosander
- Department of Ophthalmology, The NU Hospital Group, Region Västra Götaland, Uddevalla, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience/Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Nayman T, Milad D, Sebag M. Long-term outcomes of iris-sutured subluxated intraocular lenses. Indian J Ophthalmol 2024; 72:S218-S223. [PMID: 38271417 DOI: 10.4103/ijo.ijo_3397_22] [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: 12/30/2022] [Accepted: 07/21/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing. SETTINGS AND DESIGN Retrospective chart review. METHODS Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure. RESULTS A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 ± 7.0 years. The mean follow-up duration was 46.8 ± 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 ± 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 ± 0.59 vs. 0.21 ± 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved. CONCLUSIONS The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.
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Affiliation(s)
- Taylor Nayman
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Daniel Milad
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Mikael Sebag
- Department of Ophthalmology, Université de Montréal, Montreal, Quebec, Canada
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Wang Y, Zhou L, Bao X, Peng T, Lei R, Ortega-Usobiaga J. Four-Point Flange Intrascleral Fixation With Double Suture Through the Dislocated Plate-Haptic Trifocal Intraocular Lens. Am J Ophthalmol 2023; 255:68-73. [PMID: 37354926 DOI: 10.1016/j.ajo.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To describe a technique for the replacement of dislocation of plate-haptic trifocal intraocular lens (IOL) through double-suture 4-point flange intrascleral fixation. DESIGN Retrospective, interventional, noncomparative, case series. METHODS A total of 7 eyes of 7 patients with a dislocated plate-haptic trifocal IOL were enrolled for 4-point flange intrascleral fixation with double 7-0 polypropylene suture. Preoperative and postoperative visual acuity, operating time, refractive results, postoperative IOL tilt and decentration, and intraoperative and postoperative complications were recorded. RESULTS The mean postoperative uncorrected distance visual acuity (UDVA) was 0.05 ± 0.06 logarithm of the minimum angle of resolution (logMAR). The mean postoperative uncorrected intermediate visual acuity (UIVA) at 80 cm was 0.09 ± 0.06 logMAR and the mean postoperative uncorrected near visual acuity (UNVA) at 40 cm was 0.06 ± 0.07 logMAR. The mean postoperative residual spherical equivalent values were -0.27 ± 0.39 diopters. The visual function index-14 questionnaire showed that no difficulty was found in >80% of subjects for all tasks. The mean surgical time was 16.23 ± 5.64 min. The mean tilt of IOL was 3.74° ± 1.31° and the mean decentration of the IOL was 0.18 ± 0.09 mm. No important complications appeared. CONCLUSION We have described the technique of 4-point flange intrascleral fixation for plate-haptic trifocal IOL.
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Affiliation(s)
- Yong Wang
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Li Zhou
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Xianyi Bao
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Tingting Peng
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Rong Lei
- From the Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hospital), (Y.W., L.Z., X.B., T.P., R.L.) Wuhan, Hubei Province, China
| | - Julio Ortega-Usobiaga
- Department of Cataract and Refractive Surgery (J.O-U.), Clínica Baviera (Aier Eye Hospital Group), Bilbao, Spain
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Thakur A, Bansal M, Challa D, Malhotra C, Jain AK. Dead bag syndrome-in the capsular bag subluxated intraocular lens centration and refixation: A new technique. Indian J Ophthalmol 2023; 71:3412-3414. [PMID: 37787245 PMCID: PMC10683701 DOI: 10.4103/ijo.ijo_1061_23] [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: 04/24/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 10/04/2023] Open
Abstract
We describe a technique of scleral IOL fixation and optic centration of in the capsular bag subluxated IOL in a patient of "dead bag syndrome." A 29-year-old male diagnosed case of thalassemia presented with painless progressive diminution of vision in the left eye following uncomplicated sequential phacoemulsification in both eyes 15 years back. The right eye revealed completely centered IOL with significant amount of anterior capsular opacification (ACO), while the left eye revealed inferior subluxation of the IOL within capsular bag. The capsular bag was dilated, diaphanous with clear anterior and posterior capsule without any evidence of capsular fibrosis or opacification. Thus, a diagnosis of "dead bag syndrome" was made. The haptics were sutured to sclera (Hoffman's pockets) using two loops of 9-0 polypropylene, passed anterior and posterior to IOL haptics within the capsular bag. Postoperatively, the patient had a vision of 20/40 with a centered intraocular lens.
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Affiliation(s)
- Anchal Thakur
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muskaan Bansal
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Challa
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chintan Malhotra
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun K Jain
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Khoramnia R, Baur ID, Auffarth GU. Aetiology and Management of IOL Dislocations. Klin Monbl Augenheilkd 2023; 240:971-980. [PMID: 37494272 DOI: 10.1055/a-2074-9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Early (< 3 months) intraocular lens (IOL) dislocation occurs due to insufficient fixation in the capsular bag, while late dislocation (≥ 3 months) is due to increasing insufficiency of the zonular apparatus. Iris-fixated IOL (IFIOL) and suture- or sutureless-fixated scleral IOL (SFIOL) are currently the most commonly used methods when IOL exchange is indicated. Different methods of scleral fixation with or without sutures have been described. The most important techniques are summarised in this paper. IFIOL and SFIOL allow comparable visual outcomes but differ in their risk profile. The decision of which method to use should be made case by case and in accordance with the surgeon's preference.
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Affiliation(s)
- Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Isabella Diana Baur
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC) und David J Apple International Laboratory for Ocular Pathology, Universitäts-Augenklinik Heidelberg, Deutschland
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Czajka MP, Frajdenberg A, Johansson B. Technique for Sutured Scleral Fixation of One-Piece Hydrophobic Acrylic Intraocular Lenses Dislocated Into the Vitreous. Retina 2023; 43:1413-1416. [PMID: 33149099 DOI: 10.1097/iae.0000000000003008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To present a suturing technique for safe refixation of posteriorly dislocated one-piece hydrophobic acrylic intraocular lenses (IOLs). METHOD Retrospective data analysis of a series of 12 cases operated with vitrectomy, followed by IOL relocation to the retropupillary area, after which polypropylene sutures are passed through the optic-haptic junctions of the dislocated IOL and subsequently secured to the sclera. RESULTS In all cases, the IOL remained centered throughout the follow-up period (mean 10.5 months, range 3 weeks-36 months). One case was complicated by vitreous hemorrhage the first postoperative day and later cystoid macular edema. Visual acuity was not compromised at the end of follow-up. CONCLUSION The presented technique is safe and provides long-term stable refixation in cases of late posterior dislocation of a one-piece hydrophobic acrylic IOL. The risk that sutures looped around haptics will slip off the haptic is thereby avoided.
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Affiliation(s)
- Marcin P Czajka
- Departments of Ophthalmology, and
- Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Agata Frajdenberg
- Departments of Ophthalmology, and
- Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Björn Johansson
- Departments of Ophthalmology, and
- Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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12
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Zhang Y, Zong Y, Zhu X, Lu Y, Jiang C. Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment of dislocated intraocular lenses. BMC Ophthalmol 2023; 23:271. [PMID: 37312094 DOI: 10.1186/s12886-023-03020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND To compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL). METHODS Thirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed. RESULTS The major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was - 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01). CONCLUSION All three IOL repositioning techniques resulted in favorable ocular prognosis.
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Affiliation(s)
- Yinglei Zhang
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yuan Zong
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Xiangjia Zhu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Yi Lu
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
| | - Chunhui Jiang
- Eye Institute, Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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Jin H, Zhang Q. Flapless Intrascleral Knotting Technique for Suture Fixation of Intraocular Implants. Retina 2023; 43:1031-1034. [PMID: 32568983 DOI: 10.1097/iae.0000000000002895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We will describe a flapless/grooveless/pocketless and minimally invasive technique for scleral suture fixation of intraocular implants. METHODS After introducing the suture into the eye, the two ends of the suture were left exterior to the globe, the free end and the end connected to a curved needle (the needle side). A back-and-forth intrascleral suture passage was performed with the aid of a curved needle. The suture was thus supported by adequate scleral tissue. The suture was fixated to the sclera by knotting it into the sclerotomy. The ends of the suture were finally anchored intrasclerally with the aid of a 30-gauge needle. RESULTS The technique was used in 15 eyes of 15 patients. The mean postoperative follow-up period was 9.1 ± 4.6 months. Postoperatively, the intraoperative lenses of all the eyes remained well-positioned and stable. The postoperative visual acuities for all of the eyes were also improved. No suture erosion, suture loosening, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. CONCLUSION The present technique provides minimal surgical invasion for the scleral suture fixation of intraocular implants.
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Affiliation(s)
- Haiying Jin
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated to Shanghai Tongji University, School of Medicine, Shanghai, China; and
| | - Qi Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Canabrava S, Carvalho MS. Double-flanged polypropylene technique: 5-year results. J Cataract Refract Surg 2023; 49:565-570. [PMID: 36745851 DOI: 10.1097/j.jcrs.0000000000001154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the long-term (5-year) results and complications of the double-flanged polypropylene technique in patients with capsular tension segment fixation, nonfoldable intraocular lens (IOL) scleral fixation, and foldable IOL scleral fixation. SETTING Santa Casa de Belo Horizonte and Centro Oftalmológico de Minas Gerais. DESIGN Prospective case series. METHODS Eyes that underwent treatment using the double-flanged polypropylene technique between September 2016 to September 2021 were included. LogMAR visual acuity was recorded, as well as complications such as long-term polypropylene resistance, conjunctival erosion, conjunctival inflammation, flange exposure, internalization, endophthalmitis, retinal detachment, and cystoid macular edema. RESULTS 71 eyes of 61 patients were evaluated. The mean follow-up period for these eyes was 28.2 ± 14.3 (min: 4; max: 60; median: 26) months. 173 flanges were performed. 13 cases with sub-Tenon flanges (7.5%) were observed. 5 exposed flanges (2.89%), presented after a mean of 1.8 weeks postoperatively, were observed. 1 patient with large flanges presented with conjunctival inflammation and hyperemia. 2 late internalized flanges (1.1%) and 2 recently internalized flanges (1.1%) were observed. 3 eyes (4.22%) had retinal detachment. Moreover, cystoid macular edema was detected in 3 eyes (4.22%). No cases of endophthalmitis were observed. CONCLUSIONS The double-flanged technique was proven to be stable when the correct technical procedure was followed. However, complications can be observed, especially with short scleral tunnels and in eyes where the flanges were not buried inside the sclera.
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Khojasteh H, Riazi-Esfahani H, Mirghorbani M, Khalili Pour E, Mahmoudi A, Mahdizad Z, Akhavanrezayat A, Ghoraba H, Do DV, Nguyen QD. Cataract surgery in patients with retinitis pigmentosa: systematic review. J Cataract Refract Surg 2023; 49:312-320. [PMID: 36730350 PMCID: PMC9981325 DOI: 10.1097/j.jcrs.0000000000001101] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 02/03/2023]
Abstract
Retinitis pigmentosa (RP) is an inherited bilateral retinal degenerative disease with an incidence of 1 in 4000 people. RP affects more than 1 million individuals worldwide. Although night blindness and restricted visual field are the most typical symptoms of these individuals, generalized vision loss due to cataracts can be expected in the latter stages of the disease. It has been demonstrated that posterior subcapsular cataract is the most prevalent cataract in younger individuals with RP, as opposed to age-related cataracts. Although most ophthalmologists may have a negative view of cataract surgery in patients with RP, it appears that it can play an important role in the visual restoration of patients with RP. However, there are concerns about performing cataract surgery for patients with RP. Herein, a systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses on databases of MEDLINE and Scopus.
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Affiliation(s)
- Hassan Khojasteh
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Hamid Riazi-Esfahani
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Masoud Mirghorbani
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Elias Khalili Pour
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Alireza Mahmoudi
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Zahra Mahdizad
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Amir Akhavanrezayat
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Hashem Ghoraba
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Diana V. Do
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
| | - Quan Dong Nguyen
- From the Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California (Khojasteh, Akhavanrezayat, Ghoraba, Do, Nguyen); Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (Khojasteh, Riazi-Esfahani, Mirghorbani, Pour, Mahmoudi, Mahdizad)
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Darian-Smith E, Safran SG, Coroneo MT. Zonular and capsular bag disorders: a hypothetical perspective based on recent pathophysiological insights. J Cataract Refract Surg 2023; 49:207-212. [PMID: 36700888 DOI: 10.1097/j.jcrs.0000000000001098] [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: 09/07/2022] [Accepted: 11/13/2022] [Indexed: 01/27/2023]
Abstract
The purpose of this article was to look at the pathophysiology behind and devise a classification system for the causes of zonular apparatus-capsular bag (ZACB) insufficiency. Also discussed is dystrophic bag syndrome, including clinical cases and addressing where it lies on the ZACB spectrum. There has been interest in the emergence of in-the-bag intraocular lens (IOL) subluxation, the prevalence of which is increasing. There has also been a recent report of dead bag syndrome, which the authors believe is part of the same disease spectrum. The authors put these phenomena into perspective and provide a classification system based on the possible causes of what they have termed ZACB insufficiency. The basic aspects of capsular bag-IOL ocular pathophysiology are summarized with a focus on functional aspects and the consequences for IOL fastening. Within this framework, dystrophic bag syndrome is a form of primary capsular ZACB insufficiency. The contribution of factors such as intraocular drugs may suggest a reconsideration of agents used and their mode of application.
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Affiliation(s)
- Erica Darian-Smith
- From the Department of Ophthalmology, Prince of Wales Hospital at University of New South Wales, Sydney, Australia (Darian-Smith, Safran, Coroneo); Sydney University Medical School, Sydney, Australia (Darian-Smith); Capital Health System, New Jersey Surgery Centre, Pennington, New Jersey
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Mayer-Xanthaki CF, Hirnschall N, Pregartner G, Gabriel M, Falb T, Sommer M, Haas A. Capsular tension ring as protective measure against in-the-bag dislocations after cataract surgery. J Cataract Refract Surg 2023; 49:154-158. [PMID: 36100162 DOI: 10.1097/j.jcrs.0000000000001060] [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: 06/30/2022] [Accepted: 09/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the influence of capsular tension ring (CTR) implantation on the development of in-the-bag (ITB) dislocations after cataract surgery. SETTING Department of Ophthalmology Graz, Graz, Austria. DESIGN Single-center, retrospective cohort study. METHODS The medical records of patients who underwent cataract operation between 1996 and 2017 were analyzed. Cox proportional hazards regression analysis was used to assess the influence of CTR implantation and other predisposing factors (pseudoexfoliation [PEX], age, retinitis pigmentosa, sex, zonular weakness, uveitis, high myopia, and intraocular lens design and material) on ITB dislocations. RESULTS ITB dislocations were found in 111 (0.16%) of 68199 eyes (46 632 patients). In the multivariate analysis adjusted for other predisposing risk factors, a CTR implantation was associated with a lower risk of an ITB dislocation (hazard ratio [HR], 0.29; 95% CI, 0.11-0.80; P = .017). In eyes with PEX, a CTR implantation was associated with an HR of 0.16 (95% CI, 0.04-0.70; P = .015), whereas eyes without PEX had an HR of 0.80 (95% CI, 0.14-4.41; P = .793). A CTR implantation in eyes with zonular weakness resulted in a potentially lower risk (HR, 0.37; 95% CI, 0.12-1.12; P = .078). CONCLUSIONS According to the dataset, implantation of a CTR was a protective measure against an ITB dislocation. Especially in patients with zonular weakness and PEX, the CTR implantation was association with a lower risk of ITB dislocations. In patients without PEX, no association was established.
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Affiliation(s)
- Christoph F Mayer-Xanthaki
- From the Department of Ophthalmology, Medical University of Graz, Graz, Austria (Mayer-Xanthaki, Gabriel, Falb, Sommer, Haas); Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Linz, Austria (Hirnschall); Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria (Pregartner)
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Intrascleral fixation of capsular bag and intraocular lens in cases with large zonular dialysis. Int Ophthalmol 2023; 43:131-140. [PMID: 35794404 DOI: 10.1007/s10792-022-02395-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of sutureless capsular bag and intraocular lens (IOL) fixation with flattened, flanged intrascleral fixation technique in patients with large zonular dialysis. METHODS Fifty-five eyes of 51 patients who underwent flattened flanged intrascleral capsular bag and IOL fixation and optic capture for traumatic cataract, subluxated cataract, and pseudoexfoliation syndrome (PEX) with zonular dialysis greater than 180° were included in the study. The main difference of this technique from the Yamane technique is that it has a flattened flange with sharp borders at the haptic tip. Uncorrected visual acuity, corrected distance visual acuity (CDVA), astigmatism, endothelial cell loss, IOL tilt, and intraoperative and postoperative complications were evaluated. RESULTS The mean age of the patients was 57.4 ± 15.1 years (range 18-83). Of the patients, 28 (55%) were male and 23 (45%) were female. The mean duration of follow-up after surgery was 19.3 ± 6.5 months (range 12-36). The mean preoperative and postoperative CDVA were 0.71 ± 0.16 logMAR and 0.13 ± 0.20 logMAR, respectively (p < 0.001). The mean preoperative and postoperative astigmatism were 2.0 ± 1.4 D and 1.0 ± 0.7 D, respectively (p < 0.001). The mean IOL tilt was 5.7° ± 5.2°. The mean endothelial cell loss was 9% (range 0.9-19.5). Anterior capsular phimosis was developed in 2 eyes (4%). CONCLUSION The flattened flanged intrascleral technique of the capsular bag combined with optic capture provides good visual outcomes, robust capsular bag-IOL fixation, and minimal adverse events. However, further studies with more patients are needed for long-term results.
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Bhaskaran J, Narayanan S, Balamurali R. Three-piece intraocular lens in the sulcus with optic capture in patients with mild to moderate zonular weakness in exfoliation. Indian J Ophthalmol 2022; 70:4312-4318. [PMID: 36453336 PMCID: PMC9940506 DOI: 10.4103/ijo.ijo_1415_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To study the use of sulcus placement of a 3-piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Methods Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3-piece IOL implanted in the sulcus with optic capture over a 5-year period between January 2017 and January 2022 were included in this retrospective case series. Results The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil-expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of "in the bag" posterior chamber IOL or major complications. There was a significant improvement in visual acuity. Conclusion The sulcus placement of 3-piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of "in the bag" IOL.
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Affiliation(s)
| | - Smita Narayanan
- Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala, India,Correspondence to: Dr. Smita Narayanan, Regional Institute of Ophthalmology, Thiruvananthapuram, Kerala, India. E-mail:
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Carlà MM, Boselli F, Giannuzzi F, Caporossi T, Gambini G, Mosca L, Savastano A, Rizzo S. Sutureless scleral fixation Carlevale IOL: a review on the novel designed lens. Int Ophthalmol 2022; 43:2129-2138. [DOI: 10.1007/s10792-022-02579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/12/2022] [Indexed: 11/27/2022]
Abstract
AbstractBackground: Complicated cataract surgery is the main cause of secondary lens implantation surgery. Several approaches have been introduced to face those circumstances. As it concerns scleral-fixated IOLs for the posterior chamber, many types of IOL can be implanted. The aim of article is to review the single piece sutureless scleral fixation Carlevale lens; Methods: Narrative review; Results: Several works described as safe the IOL implantation utilizing the handshake approach, without tactile manipulation, which allows for self-centration and lens firm fixation in uncomplicated surgery. This allows to reduce high order aberration such as astigmatism and coma, with a very good postoperative BCVA Conclusions: Carlevale lens is one of the best option to manage insufficient capsular support.
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Yee Chau Sim A, Meng Hsien Y, Seng Fai T, Mustapha M, Wan Abdul Halim WH. Bilateral Sequential Spontaneous Anterior Dislocated Intraocular Lens in a Patient With Retinitis Pigmentosa. Cureus 2022; 14:e26986. [PMID: 35989805 PMCID: PMC9385266 DOI: 10.7759/cureus.26986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Retinitis pigmentosa is one of the risk factors for intraocular lens dislocation post cataract surgery which can lead to many complications. A 64-year-old Chinese female with bilateral pseudophakia and retinitis pigmentosa was referred for the continuation of care in 2009 with baseline visual acuity of hand movement bilaterally due to the retinitis pigmentosa. The cataract surgeries with posterior chamber intraocular lens (PCIOL) implantation in her early 50s were uneventful. In 2011, her right eye PCIOL dislocated anteriorly into the anterior chamber spontaneously and touched the cornea. It was complicated with bullous keratopathy and corneal decompensation. Intraocular pressure (IOP) was normal. PCIOL explantation, anterior vitrectomy and surgical peripheral iridotomy were performed. However, the cornea remained decompensated postoperatively. Her left eye was stable until 2019 when she developed acute angle closure secondary to complete anterior dislocation of PCIOL with pupillary block glaucoma. She underwent left eye PCIOL explantation, anterior vitrectomy and surgical peripheral iridotomy when IOP was optimised medically. Finally, both eyes were left aphakic due to poor prognosis with light perception (PL) vision, IOP was stable on single topical antiglaucoma and bilateral decompensated corneas were maintained with topical hypertonic saline. This case highlights the different serious sequelae of bilateral eyes in an unfortunate retinitis pigmentosa patient.
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Lee DW, Kim SJ, Chung I, Yoo WS. The Utility of Peripheral Vitrectomy Featuring Scleral Indentation during Scleral Fixation of Intraocular Lenses. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.3341/jkos.2022.63.7.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: We evaluated the utility of peripheral vitrectomy featuring scleral indentation; we compared a group who underwent peripheral vitrectomy to a control group for whom vitrectomy was combined with scleral fixation of intraocular lenses (IOLs) in patients exhibiting IOL dislocations.Methods: From January 2018 to December 2020, 20 eyes of patients evidencing IOL dislocations that underwent total vitrectomy, IOL removal, and IOL scleral fixation were evaluated; peripheral vitrectomy with scleral indentation was performed in 10 patients. All operations were performed by the same surgeon. We excluded patients with follow-up periods less than 6 months, those with a history of retinal and/or glaucoma surgery, and patients with retinal abnormalities or glaucoma that might significantly compromise visual acuity. The postoperative best-corrected visual acuity, intraocular pressure, astigmatism changes, and complications were retrieved from the medical records.Results: Six months after surgery, the best corrected visual acuity was 0.95 (the Snellen measure) in the group who underwent peripheral vitrectomy featuring scleral indentation, and 0.60 in the control group (p = 0.029). The total astigmatism values were 0.48 diopter in the former and 2.80 diopter in the latter group; the difference was significant (p < 0.001).Conclusions: In patients with IOL dislocations who underwent vitrectomy combined with IOL scleral fixation, improvements in visual acuity were further enhanced when peripheral vitrectomy was combined with scleral indentation. Complete removal of the peripheral vitreous may stabilize IOL positioning by the remnant vitreous.
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Kim Y, Choi EY, Lee CS, Kim SS, Byeon SH. Clinical Characteristics of recurrent intraocular lens dislocation after scleral-fixated sutured intraocular lens and long-term outcomes of intraocular lens re-fixation. Graefes Arch Clin Exp Ophthalmol 2022; 260:3267-3273. [PMID: 35588329 DOI: 10.1007/s00417-022-05692-9] [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: 01/07/2022] [Revised: 04/08/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to investigate the clinical characteristics of patients with recurrent intraocular lens (IOL) dislocation after scleral-fixated sutured IOL implantation and evaluate the long-term outcomes of scleral re-fixation of IOL. METHODS The medical records of patients who underwent surgery for IOL dislocation between January 2011 and January 2021 were reviewed. The study included 164 patients (male: 131, female: 33) (176 eyes). Patient demographics, preoperative, intraoperative and postoperative data, and the ocular and systemic conditions associated with IOL re-dislocation were analyzed. RESULTS The study included 176 consecutive cases of scleral-fixated sutured IOL. Twenty-six eyes (14.8%) showed re-dislocation of IOL after the initial IOL scleral fixation and underwent reoperation (mean 75.5 ± 62.5 months after the first surgery); three (11.5%) of them required a third surgery. Younger adults (aged less than 40 years), and patients who underwent IOL scleral fixation in complicated cataract surgery or aphakic state had a higher risk of re-dislocation. Diabetes mellitus (DM) was the only statistically significantly higher risk factor in the re-dislocated group (p = 0.041). The complication rate with scleral re-fixation was higher than that in the non-re-dislocated group. No statistically significant differences were observed, except for vitreous hemorrhage (p = 0.024). CONCLUSIONS Caution should be exercised when performing sutured scleral fixation of IOL in younger patients, cases of complicated cataract surgery and aphakia, and patients with DM to prevent IOL re-dislocation. Scleral-fixated sutured IOL in eyes with recurrent IOL dislocation seems to be a safe and effective procedure with a relatively low complication rate.
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Affiliation(s)
- Yeji Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, Republic of Korea.
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The dead bag syndrome. J Cataract Refract Surg 2022; 48:517-518. [PMID: 35703837 DOI: 10.1097/j.jcrs.0000000000000930] [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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Schuknecht A, Wachtl J, Fleischhauer J, Kniestedt C. Two Surgical Approaches for Intraocular Lens Dislocation: Pars Plana Vitrectomy Versus Core Vitrectomy with Lens Exchange. Klin Monbl Augenheilkd 2022; 239:484-489. [PMID: 35472791 DOI: 10.1055/a-1788-3967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the efficacy and safety of core vitrectomy and pars plana vitrectomy for lens exchange in patients with intraocular lens dislocation. METHODS This is a retrospective study conducted at one eye center in Zurich, Switzerland. We reviewed 124 eyes with dislocated intraocular lens undergoing lens exchange carried out by two surgeons between 03/2016 and 12/2019 (45 months). Intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were analyzed preoperatively and at 5 time points up to 12 months after lens exchange. Data on postoperative complications were collected. RESULTS There were 124 eyes with intraocular lens dislocation that were referred for lens exchange. Of these eyes, 59 (48%) received core vitrectomy and 65 (52%) received pars plana vitrectomy with lens exchange. Glaucoma was more frequent in the core vitrectomy group (78%) than in the pars plana vitrectomy group (32%; p < 0.001). In the core vitrectomy group, 19 (32%) eyes presented with visual impairment, 17 (29%) eyes presented with high IOP alone, and 23 (39%) eyes presented with both at the same time prior to surgery. Mean preoperative IOP in the core vitrectomy group decreased from 22.4 ± 9.2 mmHg to 14.7 ± 3.1 mmHg 12 months after surgery (p < 0.001). Mean BCVA changed from 0.40 ± 0.41 logMAR preoperatively to 0.32 ± 0.37 logMAR at 12 months postoperatively (p = 0.598) in the core vitrectomy group. In the pars plana vitrectomy group, 44 (68%) eyes presented with a change in vision, 7 (11%) eyes presented with high IOP alone, and 14 (22%) eyes presented with pressure elevation and visual impairment at the visit prior to surgery. Mean preoperative IOP in the pars plana vitrectomy group decreased from 20.9 ± 8.3 mmHg to 15.1 ± 3.5 mmHg at 12 months after lens exchange (p < 0.001). Mean BCVA in the pars plana vitrectomy group was 0.57 ± 0.62 logMAR preoperatively and 0.22 ± 0.35 logMAR 12 months postoperatively (p < 0.001). Postoperative pressure decompensation occurred more frequently in the core vitrectomy group (20%) than in the pars plana vitrectomy group (6%; p = 0.018). There was no statistically significant difference for postoperative cystoid macular edema (p = 0.055), anisometropia (p = 0.986), and high astigmatism (p = 0.362). CONCLUSION Core vitrectomy and pars plana vitrectomy with lens exchange are equally efficient and safe in the management of intraocular lens dislocation.
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Inferior Removal of Dislocated Polymethyl Methacrylate Intraocular Lens and Scleral Refixation in Glaucomatous Eyes. Ophthalmol Ther 2022; 11:881-886. [PMID: 35190966 PMCID: PMC8927515 DOI: 10.1007/s40123-022-00477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/01/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction The aim of this study was to report a technique for the removal of dislocated polymethyl methacrylate (PMMA) intraocular lenses (IOLs) in glaucomatous eyes. Methods Dislocated PMMA IOLs were removed from the inferior sclerocorneal incision, and sutureless intrascleral fixation of each IOL was performed to preserve the intact superior conjunctiva and sclera for future trabeculectomy or to maintain a functional filtering bleb of trabeculectomy.
Results In two cases, the condition of the bleb did not change, while the intraocular pressure improved or did not change after the procedures. IOL fixation was stable with no complications, such as tilt, decentration, or extrication of the IOL haptics. Conclusion This procedure of preserving the superior conjunctiva and sclera can maintain the function of the bleb, superior cornea and sclera and may contribute to the success of future trabeculectomy. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00477-z.
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He M, Wu T, Zhang L, Ye W, Ma J, Zhao C, Liu J, Zhou J. Correlation between neutrophil-to-lymphocyte ratio and clinical manifestations and complications of retinitis pigmentosa. Acta Ophthalmol 2022; 100:e278-e287. [PMID: 34080305 DOI: 10.1111/aos.14880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/04/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The role of inflammation in retinitis pigmentosa (RP) has been receiving additional attention. However, the association between inflammation and the clinical manifestations and complications of RP is still unclear. This study aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR) of RP complicated with cataract and explore the correlations between the NLR and specific clinical features of RP. METHODS This retrospective study included 79 RP patients complicated with cataract (125 eyes) and 63 age- and sex-matched patients (63 eyes) with age-related cataract (ARC). Patients' ocular examination results were collected and complete blood count results were used to calculate NLRs. The correlations between the NLR of RP patients and the parameters of ocular examinations were analysed. RESULTS The NLRs of RP patients with cataracts were significantly higher than those of ARC (1.93 ± 0.83 versus 1.65 ± 0.59, p = 0.029). The NLRs increased with the severity of posterior subcapsular cataract (PSC), zonular deficiency, poor preoperative best-corrected visual acuity (LogMAR>1), and visual field defects. Analysis of receiver operating characteristic curves suggested that NLR > 1.36 could predict higher degrees (PSC area >3%, >P1) of PSC (p = 0.002, 95% CI, 0.672-0.934), and that NLR > 2.12 could predict zonular weakness (p = 0.002, 95% CI, 0.665-0.928) in RP. CONCLUSION The NLRs in RP patients with cataract are not only higher but also associated with several clinical manifestations of RP. The NLR can be a predictive biomarker of higher degrees of PSC (>P1) and zonular weakness in RP before cataract surgery. These results suggest that systemic inflammation may play a role in the pathogenesis of RP.
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Affiliation(s)
- Mengmei He
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Tong Wu
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Luning Zhang
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Wei Ye
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Jiyuan Ma
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Chao Zhao
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Jiahua Liu
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
| | - Jian Zhou
- Department of Ophthalmology Xijing Hospital Eye Institute of Chinese PLA Fourth Military Medical University Xi’an China
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Kato M, Namba M, Shimoyama S, Inoue M, Ouchi C, Shimizu T. Intrascleral Intraocular Lens Fixation Preserving the Lens Capsule in Cases of Cataract with Insufficient Zonular Support. Clin Ophthalmol 2022; 16:93-100. [PMID: 35046634 PMCID: PMC8761028 DOI: 10.2147/opth.s344523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To report our modified simple technique for optic capture and the clinical results of intrascleral IOL fixation preserving the lens capsule, without vitrectomy, in cases of cataract with insufficient zonular support to stabilize the intraocular lens (IOL). Patients and Methods In 37 eyes of 25 patients with phacodonesis and two or more risk factors for progressive zonular insufficiency, we inserted a CTR to support the capsule and zonules during cataract surgery and IOL fixation; an optic was inserted into the lens capsule, and a haptic was fixed in the scleral tunnel without vitrectomy. In all cases, anterior or total vitrectomy was not needed. Results The postoperative mean (± standard deviation) tilt and decentration of the implanted IOL did not change from 6 to 12 months (6.77 ± 3.15° to 6.33 ± 3.38° and 0.60 ± 0.30 to 0.61 ± 0.35 mm, respectively). We encountered no late IOL dislocation and no retinal complications, including retinal breaks or cystoid macular oedema, postoperatively (follow-up = 21.1 ± 5.2 months). Conclusion Our modified techniques preclude the need for vitrectomy. If the lens capsule can be preserved using a CTR, our modified technique can be used to stabilize IOL.
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Affiliation(s)
- Mutsuko Kato
- Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, Japan
| | - Michie Namba
- Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, Japan
| | - Sachika Shimoyama
- Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, Japan
| | - Mayumi Inoue
- Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, Japan
| | - Chihiro Ouchi
- Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, Japan
| | - Takehiro Shimizu
- Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, Japan
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Cruz S, Valenzuela F, Stoppel J, Maul E, Gibbons A. Comparison of Horizontal Corneal Diameter Measurements Using Orbscan IIz, OPD Scan III, and IOLMaster 700. Eye Contact Lens 2021; 47:533-538. [PMID: 33900214 DOI: 10.1097/icl.0000000000000786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare three automated devices for measuring the horizontal corneal diameter (white to white [WTW]). METHODS In 65 eyes of 38 patients, the WTW distance was measured independently by three examiners using the following techniques: Orbscan IIz tomography system (Bausch & Lomb), IOLMaster 700 (Carl Zeiss Meditec), and OPD Scan III (NIDEK). We tested for systematic differences in measurements and estimated the limits of agreement (LoA) using linear mixed-effects models. RESULTS The mean WTW distance was 11.8±0.40 mm with Orbscan IIz, 12.1±0.5 mm with IOLMaster 700 and 12.0±0.4 mm with OPD Scan III. The mean difference between IOLMaster 700 and Orbscan IIz was 0.33 (95% CI, 0.28 to 0.38; P<0.001), between OPD Scan III and Orbscan IIz was 0.24 mm (95% CI, 0.21 to 0.28; P<0.001), and between IOL Master 700 and OPD Scan III was 0.09 (95% CI, 0.05 to 0.12; P<0.001). The 95% LoA for Orbscan IIz versus IOLMaster 700 was -0.69 to 0.03 mm, Orbscan IIz versus OPD Scan III was -0.52 to -0.03 mm, and OPD versus IOLMaster 700 was -0.39 to 0.22 mm. CONCLUSIONS The data suggest that these devices are not interchangeable for usual clinical practice. Adjustments based on mean differences were not enough to compensate for interinstrument discrepancy in WTW measurements.
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Affiliation(s)
- Sebastian Cruz
- Fundación Oftalmológica Los Andes (S.C., F.V., J.S., E.M.), Department of Ophthalmology, Universidad de los Andes, Santiago, Chile ; Department of Ophthalmology (F.V.), Clinica Universidad de Los Andes, Santiago, Chile; and Bascom Palmer Eye Institute (A.G.), University of Miami, Miller School of Medicine, Miami, FL
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The influence of intraocular lens dislocation surgical correction method on corneal endothelium. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov59305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND:Intraocular lens (IOL) dislocation is a rare but serious complication of surgical treatment of patients with cataract. Among the factors contributing to its development, the main ones are pseudoexfoliation syndrome (PEX), high axial myopia, chronic uveitis, history of eye injury and age. There is no universal IOL dislocation correction technique.
PURPOSE:To evaluate the impact on corneal endothelium of two different methods of IOL dislocation correction: IOL repositioning with transscleral suture fixation or IOL exchange to iris-claw one.
MATERIALS AND METHODS:Within the study, 78 patients were examined and operated. All patients were divided into two groups: in the first group, IOL was repositioned with transscleral suture fixation, and in the second group IOL was exchanged to iris-claw IOL. Groups were equal by gender and age. Key estimated indicators were endothelial cell density and coefficient of variation reflecting the degree of polymegatism.
RESULTS:Endothelial cell density was significantly lower both before surgery and at any term after it, in the group with IOL exchange, and coefficient of variation was significantly higher in the group with IOL exchange throughout this study.
CONCLUSION:The choice of technique for IOL dislocation correction is the basis of success in surgical treatment. Certain preoperative examination data should be definitely considered, including the degree of dislocation, IOL type, IOP level, endothelial cell density and presence of concomitant ocular conditions.
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Lee SY, Cho YK. The Effect of Scleral Sutured Intraocular Lens with Optic-haptic Junction Fixation in the Capsular Bag. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.9.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare the stability of intraocular lens (IOL) insertion methods of sutured haptics in the bag with scleral fixation to those of in the bag insertion and scleral sulcus fixation. Methods: In group of only phacodonesis, two IOL insertion methods, in the bag insertion and sutured haptics in the bag with scleral fixation were compared. In group of phacodonesis with less than 90° zonulysis, two IOL insertion methods, sutured haptics in the bag with scleral fixation and scleral sulcus fixation were compared. Postoperative 2 months and 12 months refraction were compared with target refraction and the refractive change between postoperative 2 and 12 months were compared in each group. The change of anterior chamber depth (ACD) at postoperative 2 and 12 months were compared with preoperative ACD, and the change of ACD between postoperative 2 and 12 months were compared in each group. Results: In group of only phacodonesis, the typical in the bag insertion group showed significant ACD change between postoperative 2 and 12 months (<i>p</i> = 0.010), but the group of sutured haptics in the bag with scleral fixation didn’t show the significant ACD change (<i>p</i> = 0.515). In group of phacodonesis with less than 90° zonulysis, the sulcus scleral fixation method showed significant ACD change and significant refractive change (<i>p</i> = 0.015, <i>p</i> = 0.004), but the group of sutured haptics in the bag with scleral fixation method didn’t show the significant ACD nor refractive change (<i>p</i> = 0.713, <i>p</i> = 0.106) between postoperative 2 and 12 months. Conclusions: In eyes with zonular instability, sutured haptics in the bag with scleral fixation method can promote the postoperative stability of IOL.
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Incidence and Characteristics of Intraocular Lens Dislocation after Phacoemulsification: An Eight-Year, Nationwide, Population-Based Study. J Clin Med 2021; 10:jcm10173830. [PMID: 34501279 PMCID: PMC8432084 DOI: 10.3390/jcm10173830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We investigate the incidence and characteristics of IOL dislocation among the pseudophakic population after phacoemulsification. METHODS National data were collected from the health claims recorded with the Health Insurance Review and Assessment Service of South Korea from 2009 to 2016. Pseudophakic patients aged 40 years or older were included. The incidence estimates of phacoemulsification and IOL dislocation were analyzed, and the cumulative probabilities of IOL dislocation among the pseudophakic population and general population were calculated as a proportion. RESULTS Of 51,307,821 total subjects, 25,271,917 of whom were aged 40 years or older, 3,906,071 cataract cases in 2,650,104 pseudophakic patients were identified, and 72,309 patients experienced IOL dislocation. The cumulative probability was 2.73% per person and 1.85% per surgery among patients 40 years of age or older. The eight-year incidence rate for IOL dislocation in the pseudophakic population aged 40 years or older was 7671 per 1,000,000 person-years (95% CI: 7616-7727), including 10,341 cases in men and 5814 in women. Incidence peaked in the seventh decade of life for cataract surgery but in the fifth decade of life for IOL dislocation. The cumulative probability of IOL dislocation after phacoemulsification was approximately 2%, and the incidence rate was about 7000 per 1,000,000 pseudophakic patients. CONCLUSIONS There was a significantly higher incidence of IOL dislocation among young males, even though the higher incidence of cataract surgery was observed among older females. These estimates of the nationwide, population-based incidence of IOL dislocation can help increase understanding of the population vulnerable to IOL dislocation.
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Chen YC, Liu YC, Lee WJ. A Man With Right Ocular Pain. Ann Emerg Med 2021; 78:452-464. [PMID: 34420557 DOI: 10.1016/j.annemergmed.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Yi-Chieh Chen
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Chang Liu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Jing Lee
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
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Kim H, Jeon S. Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions. Clin Ophthalmol 2021; 15:3379-3389. [PMID: 34413626 PMCID: PMC8370492 DOI: 10.2147/opth.s324983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate refractive outcomes after retropupillary iris-claw intraocular lens (IOL) implantation and to compare postoperative astigmatism from (1) a conventional 5.5-mm sclerocorneal incision, (2) an L-shaped scleral tunnel incision, and (3) a frown scleral tunnel incision. Methods This was a retrospective study of eyes undergoing dislocated IOL exchange for a retropupillary iris-claw IOL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and postoperative complications were evaluated until postoperative months 24. The refractive outcomes and the surgically induced astigmatism (SIA) vector were compared between groups. Results The medical records of 107 eyes from 107 patients with mean age of 65.31 ± 12.15 years were reviewed. Eyes with a frown incision showed the best UDVA, followed by those with L-shaped and conventional incisions (P = 0.003). Eyes with an L-shaped incision or frown incision had a lower SIA than that of the conventional incision group at postoperative 6 months (mean ± standard deviation [SD] SIA, 0.86 ± 0.85 D, 0.63 ± 0.37 D, and 1.70 ± 1.27 D for frown incision, L-shaped incision, and conventional incisions, respectively; P = 0.004). Conclusion The frown incision and L-shaped incision induced a significantly smaller SIA than the conventional incisions, which was associated with better UDVA postoperatively.
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Affiliation(s)
- Hyungil Kim
- Gyeongju St. Mary's Eye Clinic, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea
| | - Sohee Jeon
- Keye Eye Center, Seoul, Republic of Korea
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Mahler OS, Biron R, Hecht I, Pras E, Einan-Lifshitz A. Intrascleral 4-flanged technique for in-the-bag intraocular lens subluxation. J Cataract Refract Surg 2021; 47:476-481. [PMID: 33149040 DOI: 10.1097/j.jcrs.0000000000000474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a series of cases in which the 4-flanged technique was used in the management of in-the-bag intraocular lens (IOL) subluxation. SETTING Shamir Medical Center, Israel. DESIGN Retrospective cohort analysis. METHODS Included were consecutive cases with secondary IOL subluxation that underwent scleral fixation with the 4-flanged technique using 6-0 polypropylene and low temperature cautery. Surgeries were performed during September 2019 to April 2020. Postoperative IOL angle tilt was evaluated using high-resolution ocular coherence tomography. RESULTS Eleven eyes of 11 patients were included. The mean age was 82.7 ± 5.5 years, and 60% were men. Pseudoexfoliation was noted in 82% of patients, and only 1 case was related to trauma. The mean corrected distance visual acuity (CDVA) postoperatively was within 1 line of the original presubluxation CDVA (0.55 ± 0.41 vs 0.54 ± 0.6 logMAR, P = .965). The mean postoperative IOL tilt was 5.78 ± 3.85 degrees. Surgery duration decreased from 70 ± 14 minutes to 39 ± 15 minutes (first to last operations). No intraoperative complications were reported. Postoperatively, transient intraocular pressure elevation, which resolved at 1 week, was recorded in 45% of cases. Cystoid macular edema, which resolved within a few months under topical treatment, was seen in 2 patients. CONCLUSIONS Among a cohort of patients with secondary in-the-bag IOL subluxation, the 4-flanged technique was safe and resulted in satisfactory visual outcomes and a stable IOL position, with a short learning curve.
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Affiliation(s)
- Ori S Mahler
- From the Department of Ophthalmology, Shamir Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Knot-free suture scleral fixation of dislocated intraocular lenses: clinical results of a novel surgical technique. J Cataract Refract Surg 2021; 47:898-901. [PMID: 33315738 DOI: 10.1097/j.jcrs.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe and report surgical outcomes of a novel, knot-free technique to manage dislocated intraocular lenses (IOLs). SETTING Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. DESIGN Retrospective observational clinical study. METHODS The files of 47 patients were retrospectively reviewed, and the patients who had a follow-up time of 6 months or more were included in this study. The surgery of every case was watched for the surgical complications and calculation of the surgical time. The postoperative complications and success rate were specifically tabulated. RESULTS Thirty-five eyes of 35 patients were included in this study (23 men, 12 women; mean age 63.1 ± 19.2 years). The mean follow-up time was 22.5 ± 9.9 months. The mean surgical time was 28.2 ± 6.8 minutes. Corrected distance visual acuity improved significantly after surgery (P = .001). Anatomic success rate was 97.1% after a single surgery. Most common complications included transient intraocular pressure (IOP) elevation (n = 2), persistent IOP elevation (n = 1), mild IOL tilt (n = 1), mild IOL decentration (n = 1), secondary IOL dislocation requiring intervention (n = 1), transient corneal edema (n = 1), and bullous keratopathy (n = 1). DISCUSSION Knot-free suture scleral fixation of dislocated IOLs was a minimally invasive approach for the management of dislocated IOLs and required only two 20-gauge corneal incisions without the need for scleral flaps or incisions. This technique had a low complication rate and delivered successful results in most cases.
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Clinical and histopathological findings in the Dead Bag Syndrome. J Cataract Refract Surg 2021; 48:177-184. [PMID: 34261985 DOI: 10.1097/j.jcrs.0000000000000742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE A "dead bag syndrome" has been recently described, in which the capsular bag appears to be clear many years after surgery, becoming diaphanous and floppy, and unable to support the intraocular lens (IOL) within it. The aim of this study was to describe findings of this syndrome. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Case series with clinicopathological correlation. METHODS Out of 10 cases suspected to be from dead bag syndrome, 8 IOLs/7 capsular bags were removed due to subluxation/dislocation. The seven capsular bags available for analysis were fixed in formalin and submitted to histopathological examination (hematoxylin/eosin and Masson's trichrome stains). The associated explanted IOLs in 5 cases were also examined microscopically. RESULTS Histopathologic examination of the seven capsular bags showed capsular thinning and/or splitting. Lens epithelial cells (LECs) were completely absent on two specimens while the other five specimens had rare LECs on the inner surface of the capsule. Explanted IOLs were three-piece silicone lenses or single-piece hydrophobic acrylic lenses. One IOL optic showed a small amount of granular pigment deposition, but the optics of the other four lenses were unremarkable. CONCLUSIONS In this syndrome, there appears to be an absence of secondary proliferation of LECs, as well as fibrotic changes. The capsule shows some signs of degradation, such as thinning and/or splitting. Weakness of zonular attachments appears to be an associated finding, with subsequent in-the-bag IOL dislocation. Further studies are necessary to ascertain the etiology of this condition.
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Kristianslund O, Dalby M, Drolsum L. Late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2021; 47:942-954. [PMID: 33750091 DOI: 10.1097/j.jcrs.0000000000000605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/05/2021] [Indexed: 12/21/2022]
Abstract
This review aimed to evaluate the cumulative incidence, patient characteristics, predisposing conditions, and treatment outcomes for late in-the-bag intraocular lens (IOL) dislocation. Literature searches in PubMed (MEDLINE), Embase, and Cochrane Library Central database identified 1 randomized clinical trial, 1 prospective case series, 2 prospective cohort studies, and 36 retrospective studies of this condition, which showed that the cumulative incidence was 0.5% to 3%, it occurred on average 6 to 12 years after cataract surgery, and mean patient age was 65 to 85 years. Pseudoexfoliation syndrome, myopia, and previous vitreoretinal surgery were the most common predisposing conditions. Studies indicated that IOL repositioning and IOL exchange provided similar visual outcomes and were equally safe. The long-term visual outcome seemed satisfactory. However, the quality of evidence regarding treatment was in general quite low. More studies of late in-the-bag IOL dislocation are needed, and in particular, different surgical techniques should be included in high-quality clinical trials.
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Affiliation(s)
- Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital, Oslo Norway (Kristianslund, Dalby, Drolsum); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Kristianslund, Dalby, Drolsum)
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A Review and Update on Surgical Management of Intraocular Lens Dislocation. Int Ophthalmol Clin 2021; 61:15-28. [PMID: 33337791 DOI: 10.1097/iio.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Weight of Different Intraocular Lenses: Evaluation of Toricity, Focality, Design, and Material. J Ophthalmol 2021; 2021:6686700. [PMID: 33968444 PMCID: PMC8081614 DOI: 10.1155/2021/6686700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the weight of intraocular lenses (IOLs) depending on their material, dioptric power, toricity, focality, and haptic design. Methods Twenty-eight different IOL models from nine different medical companies (a total of 38 IOLs) and 1 capsular tension ring (CTR) were evaluated. IOLs were weighed using a precision scale, in hydrated conditions, as an approximation to their intraocular status. Results Hydrophilic IOLs were heavier than hydrophobic lenses (p < 0.001). Regarding toricity, no statistical differences were found comparing toric to non-toric models (p=0.1). Likewise, no differences were found between multifocal IOLs and monofocal IOLs (p=0.19). Dioptric power did not affect IOL weight: IOLs of <15DP had similar weights to those of ≥15D and IOLs of ≥24D had similar weights to those of <24 D (p=0.86 and p=0.59, respectively). Plate-design IOLs were significantly heavier than 1-piece C-loop (p < 0.001), 3-piece C-loop (p < 0.001), and 4-haptic lenses (p=0.001). Conclusions Of the characteristics analyzed that might influence IOL weight, lenses with hydrophilic material and plate-haptic design were found to be heavier. Toricity, focality, and dioptric power had no influence on IOL weight.
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Axisymmetric Finite Element Modelling of the Human Lens Complex under Cataract Surgery. Symmetry (Basel) 2021. [DOI: 10.3390/sym13040696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cataract is a disease opacifying the crystalline, leading to a blurred vision and ultimately to blindness. With an aging population, the incidence of cataract is increasing, as well as the number of treatments. The solution available is its complete removal, followed by an implant of an intraocular lens (IOL). Although the post-operative complications on cataract surgeries have been decreasing in general, the bag-IOL complex dislocation is still an issue, probably being the most serious complication under this procedure. In this work, an axisymmetric Finite Element (FE) modelling strategy of the crystalline complex during the process of accommodation under cataract surgery is proposed. The goal was to understand the influence of biomechanical alterations promoted by the IOL on bag-IOL dislocation after surgery. An increase of force and stress in the zonules was verified in the pseudophakic eye compared to the complete eye, which could explain why zonules break years after surgery, leading to the bag-IOL dislocation. The axisymmetric FE model proposed in this work is innovative in this field, which still lacks detailed research, and can be an important complement for the clinical and biomechanical work on the crystalline complex.
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Pineda-Fernández A, Chen Y, Rodriguez L. Transfixion of Foldable Intraocular Lens With Polytetrafluoroethylene Suture for Scleral Fixation. J Refract Surg 2021; 37:180-185. [PMID: 34038296 DOI: 10.3928/1081597x-20201222-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a new scleral fixation technique potentially usable for every acrylic foldable intraocular lens (IOL) available in the market, regardless of whether it is a three-piece, single-piece, or haptic shape. METHODS Before surgery, the authors performed the transfixion of the IOL optic in four points with the polytetrafluoroethylene suture under a surgical microscope. Four sclerotomy sites were marked 2 mm from the limbus, and two scleral grooves were created in between. The IOL was introduced into the posterior chamber. The four ends of the needleless polytetrafluoroethylene sutures were externalized through the sclerotomies, tightened for optimum IOL centration, and tied. The exposed sutures were placed within the scleral grooves, and the knots were buried within the sclerotomies. This technique was performed uneventfully in 7 cases. RESULTS The foldable IOL was stable in all eyes 6 months after surgery, with no signs of IOL subluxation, dislocation, tilt, or suture-related complications, such as erosion or infection. CONCLUSIONS The transfixion of the foldable posterior chamber IOL for stable four-point scleral fixation using a polytetrafluoroethylene suture provides excellent stability and prevents IOL tilt and decentration. This technique can immensely benefit patients requiring secondary foldable posterior chamber IOL implantation in the absence of capsular support. [J Refract Surg. 2021;37(3):180-185.).
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Ohta K, Sato A, Fukui E. Late Dislocation of In-the-Bag Intraocular Lens in Three Patients with Multiple Chorioretinal Atrophy Associated with Sarcoidosis. Int Med Case Rep J 2021; 14:95-100. [PMID: 33628063 PMCID: PMC7897715 DOI: 10.2147/imcrj.s288270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose A late dislocation of an in-the-bag intraocular lens (IOL) is strongly associated with pseudoexfoliation and less with retinitis pigmentosa, prior vitreoretinal surgery, and uveitis. We present our findings of late in-the-bag IOL dislocation in three patients with multiple chorioretinal atrophy associated with sarcoidosis. Methods Observational study of three elderly female Japanese patients with a history of uveitis from sarcoidosis who presented with a late dislocation of an in-the-bag IOL. Results The late in-the-bag IOL dislocation occurred in the convalescent/quiescent stage of the sarcoidosis. Peripheral multifocal chorioretinal atrophy was the main manifestation in all patients who were diagnosed with definite or presumed sarcoidosis. The dislocated IOLs were successfully removed and new IOLs were implanted with scleral suture fixation followed by no remarkable active uveitis. Conclusion Clinicians should be aware that patients with peripheral multifocal chorioretinal atrophy associated with sarcoidosis can have a late in-the-bag IOL dislocation.
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Affiliation(s)
- Kouichi Ohta
- Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - Atsuko Sato
- Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, Japan
| | - Emi Fukui
- Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, Japan
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Fan Q, Han X, Luo J, Cai L, Qiu X, Lu Y, Yang J. Risk factors of intraocular lens dislocation following routine cataract surgery: a case-control study. Clin Exp Optom 2021; 104:510-517. [PMID: 33689608 DOI: 10.1080/08164622.2021.1878829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: Intraocular lens dislocation usually causes severe visual symptoms and even blindness in patients. It is important for eye care practitioners to be able to identify patients susceptible to intraocular lens dislocation.Background: To investigate the risk factors of intraocular lens dislocation following routine cataract surgery.Methods: This retrospective case-control study included patients diagnosed with intraocular lens dislocation between January 2007 and March 2018. Controls matched to the cases by age and time of routine cataract surgery in a ratio of 3:1 were randomly selected from patients without intraocular lens dislocation. The medical records of the patients were reviewed and analysed. Independent t-test, chi-square test, and logistic regression analysis were employed to identify risk factors of intraocular lens dislocation.Results: In total, 127 cases (with intraocular lens dislocation) and 381 controls (without intraocular lens dislocation) were evaluated. Among cases, the proportion of men was significantly higher than that of women (p = 0.012). High myopia was significantly associated with all types of intraocular lens dislocation; it was also a risk factor for in-the-bag intraocular lens dislocation. Lens subluxation was significantly associated with the in-the-bag and late intraocular lens dislocations. Intraoperative and post-operative vitrectomy, rather than pre-operative vitrectomy, were associated with intraocular lens dislocation. Post-operative trauma was significantly associated with in-the-bag intraocular lens dislocation; pre-operative and post-operative trauma were significantly associated with out-of-the-bag intraocular lens dislocation. Male sex (odds ratio (OR) = 2.996, p = 0.006), pre-operative trauma (OR = 7.861, p = 0.014), high myopia (OR = 11.268, p < 0.001), and lens subluxation (OR = 13.431, p = 0.018) were the risk factors of intraocular lens dislocation.Conclusion: Male sex, pre-operative trauma, high myopia, and lens subluxation were the main predisposing factors for intraocular lens dislocation in Chinese Han population.
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Affiliation(s)
- Qi Fan
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiaoyan Han
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Lei Cai
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiaodi Qiu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jin Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Jujo T, Kogo J, Sasaki H, Sekine R, Sato K, Ebisutani S, Toyoda Y, Kitaoka Y, Takagi H. 27-gauge trocar-assisted sutureless intraocular lens fixation. BMC Ophthalmol 2021; 21:8. [PMID: 33407262 PMCID: PMC7789339 DOI: 10.1186/s12886-020-01758-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/04/2020] [Indexed: 01/19/2023] Open
Abstract
Backgrounds However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar. Methods Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications. Results The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was − 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred. Conclusions IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.
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Affiliation(s)
- Tatsuya Jujo
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Jiro Kogo
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan.
| | - Hiroki Sasaki
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Reio Sekine
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Keiji Sato
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Sakura Ebisutani
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Yasuhiro Toyoda
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Yasushi Kitaoka
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Hitoshi Takagi
- Department of Ophthalmology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
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Surgical Outcome of Refixation versus Exchange of Dislocated Intraocular Lens: A Retrospective Cohort Study. J Clin Med 2020; 9:jcm9123868. [PMID: 33260686 PMCID: PMC7760674 DOI: 10.3390/jcm9123868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/28/2022] Open
Abstract
We compared the surgical outcomes and complications of refixation vs. exchange of dislocated intraocular lenses (IOLs) in patients who underwent transscleral suture fixation combined with pars plana vitrectomy for the treatment of IOL dislocation. A total of 83 eyes (n = 83 patients) with postoperative follow-up of ≥6 months were evaluated: 40 received refixation of dislocated IOL (refixation group) while 43 received IOL exchange (exchange group) treatment. Treatment outcomes, including best-corrected visual acuity (BCVA), spherical equivalent, corneal cylinder, intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial cell density (ECD), and postoperative complications were retrospectively reviewed. BCVA improvement at 6 months after surgery was comparable between the groups. Postoperative decrease in corneal ECD was significantly greater in the exchange group than in the refixation group, but no significant differences were found in spherical equivalent, corneal cylinder, IOP, or CMT changes. The exchange group experienced significantly more frequent postoperative vitreoretinal complications, such as retinal detachment, choroidal effusion, cystoid macular edema, and secondary epiretinal membrane, than the refixation group. Without any reason to extract the dislocated IOL, reuse of the dislocated IOL would be a better surgical option for transscleral suture fixation to protect corneal endothelial cells and prevent postoperative vitreoretinal complications.
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Long-term myofibroblast persistence in the capsular bag contributes to the late spontaneous in-the-bag intraocular lens dislocation. Sci Rep 2020; 10:20532. [PMID: 33239706 PMCID: PMC7689492 DOI: 10.1038/s41598-020-77207-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Late spontaneous in-the-bag intraocular lens (IOL) dislocation is a complication presenting 6 months or later after cataract surgery. We aimed to characterize the cells in the lens capsules (LCs) of 18 patients with spontaneous late in-the-bag IOL dislocation. Patients' average age was 82.6 ± 1.5 years (range 72-98), and most of them had pseudoexfoliation syndrome (PEX). Cells from the LCs were positive for myofibroblast (αSMA), proliferation (Ki-67, PCNA), early lens development/lens progenitor (SOX2, PAX6), chemokine receptor (CXCR4), and transmembrane (N-cadherin) markers, while negative for epithelial (E-cadherin) marker. Moreover, the cells produced abundant fibronectin, type I and type V collagen in the nearby extracellular matrix (ECM). During ex vivo cultivation of dislocated IOL-LCs in toto, the cells proliferated and likely migrated onto the IOL's anterior side. EdU proliferation assay confirmed the proliferation potential of the myofibroblasts (MFBs) in dislocated IOL-LCs. Primary cultured lens epithelial cells/MFBs isolated from the LC of dislocated IOLs could induce collagen matrix contraction and continuously proliferated, migrated, and induced ECM remodeling. Taken together, this indicates that long-lived MFBs of dislocated IOLs might contribute to the pathogenic mechanisms in late in-the-bag IOL dislocation.
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D'Agostino I, Parrulli S, De Angelis S, Invernizzi A, Bottoni F, Staurenghi G, Cereda MG. Sutureless scleral fixation: comparison between 3-piece IOL and new single-piece foldable IOL. Graefes Arch Clin Exp Ophthalmol 2020; 259:1365-1373. [PMID: 33090281 DOI: 10.1007/s00417-020-04980-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Comparing two different sutureless scleral fixation techniques. METHODS A retrospective study of patients who underwent sutureless scleral fixation IOL from October 2013 to May 2018 at "Luigi Sacco Hospital", University of Milan. Comparison between two groups: Group 1 implanted with a 3-piece ALCON-MA60AC and group 2 implanted with a newly developed single-piece foldable IOL SOLEKO FIL-SSF. Patients underwent a complete preoperative ophthalmic assessment and post-operative evaluation at 1, 3, and 6 months. Vitrectomy was performed in all cases. The two groups were compared for age, axial length, and lens status at baseline. Visual acuity, refractive results, surgical time, and post-operative complications were recorded. RESULTS Thirty-one eyes were included: group 1, 15 eyes of 15 patients, and group 2, 16 eyes of 14 patients. No difference was found in visual acuity. Mean refractive error was 1D in both groups (group 1 1.01D, group 2 1.09D), but spherical equivalent was more often moved toward negative values and induced astigmatism was greater in the 3-piece group (group 1 1.91D [SD ± 2.07], group 2 0.67D [SD ± 0.88] P = 0.04). Surgical procedure was faster in group 2 (mean time difference 21', P = 0.01*). New displacement occurred in 5 cases (33%) of group 1 and in no cases of group 2 (P = 0.01*). Post-operative bleeding was registered only in group 1 (20%), but the difference was not statistically significant. CONCLUSIONS The group 2 IOL gives in our sample better results due to less post-operative astigmatism and reducing dislocation and bleeding during follow-up. Surgical technique appeared easier and faster: the specifically designed IOL seems to be a feasible solution for sutureless scleral fixation.
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Affiliation(s)
- Isabella D'Agostino
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefano De Angelis
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Ferdinando Bottoni
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Matteo Giuseppe Cereda
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
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Yusef YN, Yusef SN, Ivanov MN, Vvedenskiy AS, Fokina ND, Alkharki L, Shashorina SA. [Evolution of IOL exchange. Part 1. Development of methods for IOL exchange]. Vestn Oftalmol 2020; 136:248-253. [PMID: 33063973 DOI: 10.17116/oftalma2020136052248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review presents the history of development and improvement of methods for intraocular lens (IOL) exchange. Existing techniques of IOL exchange are comparatively analyzed.
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Affiliation(s)
- Yu N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - S N Yusef
- Research Institute of Eye Diseases, Moscow, Russia
| | - M N Ivanov
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - N D Fokina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - L Alkharki
- Research Institute of Eye Diseases, Moscow, Russia
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Mayer-Xanthaki CF, Pregartner G, Hirnschall N, Falb T, Sommer M, Findl O, Wedrich A. Impact of intraocular lens characteristics on intraocular lens dislocation after cataract surgery. Br J Ophthalmol 2020; 105:1510-1514. [DOI: 10.1136/bjophthalmol-2020-317124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/22/2020] [Accepted: 09/03/2020] [Indexed: 11/04/2022]
Abstract
BackgroundTo assess the influence of intraocular lens (IOL) characteristics on IOL dislocations after cataract surgery.MethodsPatients who underwent cataract surgery at the Department of Ophthalmology Graz, Austria, between 1996 and 2017 were included and medical records were reviewed. Cox proportional-hazard regression models were used to assess the influence of IOL characteristics on IOL dislocation.ResultsFrom 68 199 eyes out of 46 632 patients (60.2% women, mean age: 73.71 SD±10.82 years), 111 (0.16%) had an in-the-bag (ITB) disloaction and 35 (0.05%) had an out-of-the-bag (OTB) dislocation. The HRs adjusted for predisposing factors significantly associated with a higher risk for an ITB dislocation were 2.35 (95% CI, 1.45 to 3.8) for hydrophilic IOLs, 2.01 for quadripode IOLs (95% CI, 1.04 to 3.86) and 1.61 (95% CI, 1.04 to 2.48) for haptic angulation. A lower risk was observed for three-piece IOLs (HR=0.58, 95% CI, 0.34 to 0.98) and larger overall IOL diameter (HR=0.79, 95% CI, 0.66 to 0.95). For an OTB dislocation, the HR associated with a higher risk was 18.81 (95% CI, 5.84 to 60.58) for silicone IOLs and 2.12 (95% CI, 0.62 to 7.29) for hydrophilic IOLs. Larger overall IOL diameter (HR 0.40, 95% CI; 0.25 to 0.63) showed a lower risk.ConclusionHydrophilic IOLs, quadripode IOLs and haptic angulation were associated with a higher risk for an ITB dislocation, whereas three-piece IOLs and a larger overall diameter were associated with a lower risk. Risk factors for OTB dislocation were silicone IOLs, hydrophilic IOLs and a smaller overall IOL diameter.
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