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Lachovská S, Kristian P. INCIDENCE OF PSEUDOEXFOLIATION SYNDROME AND GLAUCOMA IN A SET OF MORE THAN 14,000 EYES OF PATIENTS OPERATED FOR A CATARACT. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2022; 78:56-62. [PMID: 35477245 DOI: 10.31348/2022/8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Evaluation of the incidence of pseudoexfoliation (PEX) syndrome and glaucoma in cataract patients operated at our Clinic, with an analysis of possible complications. METHODOLOGY Retrospective evaluation of medical records of PEX syndrome patients who have undergone cataract surgery at the Gemini Eye Clinic Ostrava-Hrusov was undertaken. The study period was from November 2016 to April 2021. The evaluated parameters were the incidence of PEX syndrome, age and gender of patients, intraocular pressure (IOP) before the surgery, pre-existing therapy of previously diagnosed secondary glaucoma and the occurrence of perioperative complications. RESULTS In the study period of 4.5 years, out of the total number of 14 167 operated eyes with cataracts there were 852 eyes of 689 patients with PEX syndrome diagnosed at our Clinic, i.e. 6.0 %. The mean age was 76.9 years, the median 77 years, range 54-100 years. The observed pathology was more common in women at a ratio of 1.84: 1 (552: 300). Elevation of IOP above 21 mmHg was recorded in 118 eyes, in 14 of them IOP reached values over 30 mmHg. Diagnosed and long-term treated secondary glaucoma was confirmed by 153 patients (204 eyes), out of which 22 eyes have undergone antiglaucoma laser (19 eyes) and / or surgery (5 eyes) in the anamnesis. Perioperatively, we recorded the following pathological findings accompanying the occurrence of PEX syndrome in 231 eyes. Most often it was poor artificial mydriasis (189 eyes), then subluxation of the lens (31 eyes) or zonular fragility (17 eyes). To reduce the risk of perioperative and postoperative complications, implantation of a capsular tension ring was indicated in 20 eyes. Complications during the procedure occurred in 11 eyes, of which 8 eyes were diagnosed with advanced cataract. CONCLUSION PEX syndrome and glaucoma are relatively common diseases that can complicate the lives of patients and eye surgeons. The incidence of PEX syndrome in our cataract patients was 6 %. Proper diagnosis of this disease is important not only for the possible occurrence of numerous complications during and after cataract surgery, but also for the possible presence of secondary glaucoma. It also serves to detect possible involvement of the contralateral eye. In addition, due to the involvement of practically all tissues in the body, the patient is endangered by numerous, especially vascular comorbidities. For these reasons, we find it appropriate that these patients are observed by other healthcare specialists. In our experience, early indication of cataract surgery is important to achieve a lower degree of zonular fragility and a softer lens core. In addition, lower levels of proinflammatory pseudoexfoliation material occur in the anterior segment of the eye in the early stages, which may have a beneficial effect on the postoperative healing.
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Haripriya A, Ramulu PY, Schehlein EM, Shekhar M, Chandrashekharan S, Narendran K, Venkatesh R, Sithiq M, Ramakrishnan R, Ravindran RD, Robin AL. The Aravind Pseudoexfoliation Study: 5-Year Postoperative Results. The Effect of Intraocular Lens Choice and Capsular Tension Rings. Am J Ophthalmol 2020; 219:253-260. [PMID: 32621898 DOI: 10.1016/j.ajo.2020.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We compared rates of intraocular lens (IOL) decentration, neodymium-doped yttrium aluminum garnet capsulotomy for posterior capsule opacification (PCO), and visual acuity (VA) in eyes with and without pseudoexfoliation (PEX) 5 years after undergoing cataract surgery. DESIGN Prospective comparative interventional study. METHODS This multicenter study population included 1 eye of both 930 cataract patients with and 470 cataract patients without uncomplicated PEX (no small pupils or phacodonesis) all undergoing phacoemulsification by experienced Aravind Eye Care System surgeons. Eyes were randomized to either 1- or 3-piece intraocular lenses (IOLs). PEX eyes were also randomized to either receive or not receive a capsule tension ring. The main outcome measures included IOL decentration and PCO. Secondary outcomes included postoperative best-corrected VA. RESULTS Follow-up was 86.2% in the PEX group and 86.7% in the control group at 5 years. The PEX group was older (P < .001) and had more men (P = .01). IOL decentration at 5 years was equally prevalent in PEX and control eyes (1.0% vs 1.1%, respectively, P = .8). Neodymium-doped yttrium aluminum garnet posterior capsulotomy rates for PCO were similar in the PEX group when compared with control subejcts (5.3% compared with 3.2%, respectively, P = .07). Best corrected VA was better at baseline and years 2 and 3 in the control group (P = .0001, P = .0005, and P = .02); however, there was no difference in BCVA at years 1, 4, and 5 between the PEX and control groups (P = .09, P = .29, and P = .5). CONCLUSION In a large-scale, long-term, prospective comparative study of cataract surgery in eyes with uncomplicated PEX, the risks of IOL decentration and PCO were low and comparable to that in control subjects. When approaching cataract surgery in eyes with relatively uncomplicated PEX, neither IOL choice (1- vs 3-piece acrylic IOL) nor the presence/absence of a capsule tension ring affects outcomes at 5 years.
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Yusef YN, Yusef SN, Ivanov MN, Vvedenskiy AS, Fokina ND, Alkharki L, Shkolyarenko NY. [Evolution of IOL exchange. Part 2. Modern problems of IOL exchange]. Vestn Oftalmol 2020; 136:254-259. [PMID: 33063974 DOI: 10.17116/oftalma2020136052254] [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 discusses modern problems of intraocular lens (IOL) exchange. Making an adequate choice between IOL reposition and IOL exchange in pseudophakic patients with problems of lens fixation remains a largely unsolved issue. The literature data shows a noticeable increase in the number of supporters of retropupillary fixation of an iris-claw lens during the exchange procedure.
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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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Gabriel de Figueiredo C, Bordin de Figueiredo G, de Figueiredo J. Aspiration of anterior lens epithelium cells to prevent capsule contraction syndrome in pseudoexfoliation syndrome. J Cataract Refract Surg 2019; 45:523-524. [PMID: 30947855 DOI: 10.1016/j.jcrs.2018.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 10/27/2022]
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Guo L, Wang C, Yang X. A novel technique for the surgical management of intraocular lens-capsular bag-capsular tension ring complex dislocation. Exp Ther Med 2019; 17:2785-2788. [PMID: 30936957 DOI: 10.3892/etm.2019.7224] [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: 07/04/2016] [Accepted: 11/04/2018] [Indexed: 11/05/2022] Open
Abstract
The present study describes a surgical technique for the management of complex dislocation and subluxation of the intraocular lens (IOL)-capsular bag (CB)-capsular tension ring (CTR) complex. During the procedure, one double-curved suture was inserted through the sclera into the posterior chamber, passing through the anterior capsules and then into the anterior chamber. The suture lines were pulled out from above and below the IOL-CB-CTR complex and a knot was tied 1 mm away from the corneoscleral incision. The IOL-CB-CTR complex was repositioned by adjusting the suture length. This novel method does not require explanting of the original IOL, allowing the IOL-CB-CTR complex to be immobilized in a simple and effective way.
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Affiliation(s)
- Lin Guo
- Department of Ophthalmology, Shaanxi Ophthalmic Medical Center, Xi'an No. 4 Hospital, Affiliated GuangRen Hospital, School of Medicine, Xi'an Jiao Tong University, Xi'an, Shaanxi 710004, P.R. China
| | - Congyi Wang
- Department of Ophthalmology, Shaanxi Ophthalmic Medical Center, Xi'an No. 4 Hospital, Affiliated GuangRen Hospital, School of Medicine, Xi'an Jiao Tong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xinguang Yang
- Department of Ophthalmology, Shaanxi Ophthalmic Medical Center, Xi'an No. 4 Hospital, Affiliated GuangRen Hospital, School of Medicine, Xi'an Jiao Tong University, Xi'an, Shaanxi 710004, P.R. China
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Management of subluxated capsular bag-fixated intraocular lenses using a capsular anchor. J Cataract Refract Surg 2018; 42:653-8. [PMID: 27255239 DOI: 10.1016/j.jcrs.2016.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED We describe the use of the capsular anchor (AssiAnchor) to manage a subluxated intraocular lens (IOL) in the capsular bag. The anchor comprises 2 prongs that hold the anterior lens capsule and a central rod that is sutured to the scleral wall, enabling centration of the IOL-capsular bag complex. Six pseudophakic patients presenting with subluxated posterior chamber IOLs in the capsular bag were operated on using the device. The anchor was used successfully in all cases, although in 2 cases only 1 prong was placed under the capsulorhexis edge. In 1 eye, 2 anchors were used 1 month apart following repeated traumatic zonular injury. The capsular bag holding the IOL remained centered and stable throughout the follow-up period. The anchoring device, which was originally designed to preserve the lens capsule and stabilize subluxated crystalline lenses, can also be used to treat subluxation of a capsular bag-fixated IOL. FINANCIAL DISCLOSURE Dr. Assia is the inventor of the AssiAnchor, has a licensed patent of the anchor, and is consultant to Hanita Lenses. Dr. Lapid-Gortzak is a consultant to and speaker for Alcon Surgical, Inc., Hanita Lenses, Orca Surgical, and Sanoculis Ltd.; a speaker for Santen; and a consultant to Icon. Drs. Ton and Naftali have no financial or proprietary interest in any material or method mentioned.
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Huerva V, Ascaso FJ, Caral I, Grzybowski A. Calculation of iris-claw IOL power for correction of late in-the-bag IOL complex dislocation. BMC Ophthalmol 2017; 17:122. [PMID: 28693457 PMCID: PMC5504750 DOI: 10.1186/s12886-017-0516-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023] Open
Abstract
Background To assess the constants and formula for aphakia correction with iris-claw IOLs to achieve the best refractive status in cases of late in-the-bag IOL complex dislocation. Methods A literature search was performed. The following data were obtained: Iris-claw IOL model, Iridal or retroiridal enclavation, A-constant, ultrasound or optical biometry, formula employed and refractive outcomes. Acceptable emmetropia was considered if the resulting spherical equivalent (SE) was within ±1.00 D. Results The majority of the studies used SRK/T formula (66.6%). The 88.9% of the reports obtained a SE within ±1.00 D. Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, the emmetropia (±1.00 D) of SE, was able to get near 100% of reported cases over the pupil implantation. However, the emmetropia decreased to 80% when the enclavation is retropupilar using the same formula. The A-constant can vary from 116.7 to 117.5 for retropupilar enclavation. Conclusions Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, ±1.00 D of SE, is able to get near 100% of cases. Nevertheless, ±1.00 D of SE decreased to 80% of the cases when the enclavation is retropupilar.
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Affiliation(s)
- Valentín Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198, Lleida, Spain. .,IRB Lleida, Lleida, Spain.
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain
| | - Isabel Caral
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198, Lleida, Spain.,IRB Lleida, Lleida, Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, Poznań, Poland.,University of Warmia and Mazury, Olsztyn, Poland
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Koçak Altıntaş AG, Omay AE, Çelik S. Spontaneous Late Intraocular Lens and Capsule Tension Ring Dislocation. Turk J Ophthalmol 2017; 47:106-109. [PMID: 28405485 PMCID: PMC5384115 DOI: 10.4274/tjo.79836] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 07/27/2015] [Indexed: 12/01/2022] Open
Abstract
In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.
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Affiliation(s)
| | - Aslıhan Esra Omay
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Selda Çelik
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey
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Liu E, Cole S, Werner L, Hengerer F, Mamalis N, Kohnen T. Pathologic evidence of pseudoexfoliation in cases of in-the-bag intraocular lens subluxation or dislocation. J Cataract Refract Surg 2015; 41:929-35. [DOI: 10.1016/j.jcrs.2014.08.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
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Investigation of phacoemulsification on exfoliation syndrome combined cataract with different nuclear hardness. Eur J Ophthalmol 2015; 25:416-21. [PMID: 25684159 DOI: 10.5301/ejo.5000574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated the clinical staging and management of cataracts to decrease the incidence of complications of phacoemulsification and improve the postoperative visual function of patients with exfoliation syndrome (XFS) with cataract. METHODS Cataracts with XFS were divided into early, middle, and late stages using the Emery-Little lens opacities classification system. Phacoemulsification and intraocular lens (IOL) implantation were performed in all eyes. The incidences of intraoperative and early postoperative complications of phacoemulsification were compared, and differences in the outcomes of phacoemulsification were evaluated. RESULTS There were 23, 31, and 34 eyes with early-, middle- and late-stage XFS, respectively. The mean ultrasound time, cumulative dissipated energy, and incidence of moderate to severe corneal edema and wound burn in the late-stage group were significantly higher than in the early- and middle-stage groups (p<0.05). The incidence of zonular dehiscence, capsular rupture, vitreous loss, and iritis were not significant among the 3 groups (p>0.05). Intraocular pressure rise in the early postoperative period and the level of optic atrophy in the late-stage group were significantly higher than in the other 2 groups (p<0.05). The gain in visual acuity in the early- and middle-stage groups after surgery was better than in the late-stage group of XFS, and the difference was statistically significant (p<0.05). CONCLUSIONS The clinical staging of cataract with XFS contributed to the choice of operation time and its management. Phacoemulsification and IOL implantation in early- and middle-stage XFS induced fewer complications and led to better recovery of visual function after surgery.
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Research on calculation of the IOL tilt and decentration based on surface fitting. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:572530. [PMID: 23935701 PMCID: PMC3725812 DOI: 10.1155/2013/572530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 06/02/2013] [Indexed: 11/22/2022]
Abstract
The tilt and decentration of intraocular lens (IOL) result in defocussing, astigmatism, and wavefront aberration after operation. The objective is to give a method to estimate the tilt and decentration of IOL more accurately. Based on AS-OCT images of twelve eyes from eight cases with subluxation lens after operation, we fitted spherical equation to the data obtained from the images of the anterior and posterior surfaces of the IOL. By the established relationship between IOL tilt (decentration) and the scanned angle, at which a piece of AS-OCT image was taken by the instrument, the IOL tilt and decentration were calculated. IOL tilt angle and decentration of each subject were given. Moreover, the horizontal and vertical tilt was also obtained. Accordingly, the possible errors of IOL tilt and decentration existed in the method employed by AS-OCT instrument. Based on 6–12 pieces of AS-OCT images at different directions, the tilt angle and decentration values were shown, respectively. The method of the surface fitting to the IOL surface can accurately analyze the IOL's location, and six pieces of AS-OCT images at three pairs symmetrical directions are enough to get tilt angle and decentration value of IOL more precisely.
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Shingleton BJ, Yang Y, O’Donoghue MW. Management and outcomes of intraocular lens dislocation in patients with pseudoexfoliation. J Cataract Refract Surg 2013; 39:984-93. [DOI: 10.1016/j.jcrs.2013.01.044] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 12/01/2022]
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Werner L, Zaugg B, Neuhann T, Burrow M, Tetz M. In-the-Bag Capsular Tension Ring and Intraocular Lens Subluxation or Dislocation. Ophthalmology 2012; 119:266-71. [DOI: 10.1016/j.ophtha.2011.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 11/26/2022] Open
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Oetting TA, Tsui JYM, Szeto AT. Sliding internal knot technique for late in-the-bag intraocular lens decentration. J Cataract Refract Surg 2011; 37:810-3. [PMID: 21511149 DOI: 10.1016/j.jcrs.2011.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 01/19/2011] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
We describe a technique that uses a sliding (Siepser) internal knot to secure the intraocular lens (IOL) and capsular bag complex to the sclera. The technique is helpful in cases of late dislocation of the IOL-capsular bag complex, which seems to be particularly common in patients with pseudoexfoliation. The technique, which borrows from earlier techniques, has the advantages of an external approach of the suture needle and a sliding knot with an internal tie that does not require a knot to be covered or rotated.
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Affiliation(s)
- Thomas A Oetting
- University of Iowa Hospital and Clinics and the Veterans Administration Medical Center, Iowa City, Iowa 52242, USA.
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Occurrence of capsular delamination in the dislocated in-the-bag intraocular lens. Graefes Arch Clin Exp Ophthalmol 2011; 249:1409-15. [DOI: 10.1007/s00417-010-1605-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 11/15/2010] [Accepted: 12/15/2010] [Indexed: 11/26/2022] Open
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Gatzioufas Z, Kopsidas K, Gyongyossy B, Moschos M, Seitz B. Late-onset anterior dislocation of a posterior chamber intraocular lens in a patient with pseudoexfoliation syndrome. Case Rep Ophthalmol 2011; 2:1-4. [PMID: 21532993 PMCID: PMC3082490 DOI: 10.1159/000323861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Here, we report on a patient with pseudoexfoliation syndrome who developed acute angle-closure glaucoma with a marked myopic shift due to anterior dislocation of the posterior chamber intraocular lens almost 16 months after an uneventful phacoemulsification. Examination with a Scheimpflug camera was extremely useful in confirming the diagnosis. This is the fist case of late-onset angle-closure glaucoma with a significant myopic shift due to anterior dislocation of the posterior chamber intraocular lens, which resulted in a permanent alteration of the postoperative target refraction.
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Affiliation(s)
- Zisis Gatzioufas
- Department of Ophthalmology, University of Saarland, Homburg/Saar, Germany
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Jakobsson G, Zetterberg M, Lundström M, Stenevi U, Grenmark R, Sundelin K. Late dislocation of in-the-bag and out-of-the bag intraocular lenses: Ocular and surgical characteristics and time to lens repositioning. J Cataract Refract Surg 2010; 36:1637-44. [DOI: 10.1016/j.jcrs.2010.04.042] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/04/2010] [Accepted: 04/15/2010] [Indexed: 11/30/2022]
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Management of late spontaneous in-the-bag intraocular lens dislocation: Retrospective analysis of 45 cases. J Cataract Refract Surg 2010; 36:1270-82. [DOI: 10.1016/j.jcrs.2010.01.035] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 01/18/2010] [Accepted: 01/27/2010] [Indexed: 11/22/2022]
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Baykara M, Yalçinbayir O, Ozçetin H. Replacement of the Lens and its Capsule that Dislocated to the Anterior Chamber by the Posterior Iris Claw Lens. Ophthalmic Surg Lasers Imaging Retina 2010; 41:1-2. [PMID: 20337343 DOI: 10.3928/15428877-20100215-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2008] [Indexed: 05/29/2023]
Abstract
In a case with retinitis pigmentosa, the intraocular lens that dislocated to the anterior chamber 20 tears after the cataract surgery has been removed via scleral tunnel incision. Then, the iris claw lens was placed behind the iris again by the scleral tunnel. This case was reported as an example for both its existing and rehabilitation method.
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Davis D, Brubaker J, Espandar L, Stringham J, Crandall A, Werner L, Mamalis N. Late In-the-Bag Spontaneous Intraocular Lens Dislocation. Ophthalmology 2009; 116:664-70. [DOI: 10.1016/j.ophtha.2008.11.018] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/14/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022] Open
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Sergienko NM, Kondratenko YN, Yakimov AK. Capsule fixation device for cataract surgery. Eur J Ophthalmol 2009; 19:143-6. [PMID: 19123164 DOI: 10.1177/112067210901900123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The authors present a patient with Marfan syndrome who underwent cataract surgery using a novel device for fixation of capsular bag. METHODS The capsule fixation device (CFD) is poly(methyl methacrylate) arch with double-armed bent hook that can be introduced into the anterior chamber through the clear corneal incision, placed with a rest on the capsule equator, and sutured to the sclera without injury of the capsular bag. A 16-year-old patient with Marfan syndrome underwent consecutive phacoemulsification with in-the-bag intraocular lens and CFD implantation on both eyes. RESULTS During the surgery handling the CFD was technically simple with good visualization. The preoperative best-corrected visual acuity was 0.3 and 0.1 and postoperatively 0.6 and 0.8 in the right and left eyes, respectively. The postoperative follow-up was over 9 months. CONCLUSIONS Use of the CFD was successful in a case of lens subluxation with no complications observed during the period of follow-up.
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Affiliation(s)
- N M Sergienko
- Department of Ophthalmology, National Medical Academy of Postgraduate Education, Kiev, Ukraine
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22
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Kranemann C. February Consultation #2. J Cataract Refract Surg 2008. [DOI: 10.1016/j.jcrs.2007.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kumar A, Freeman M, Kumar V, Ramanathan US. In the bag IOL dislocation following uncomplicated phacoemulsification. Cont Lens Anterior Eye 2007; 31:103-6. [PMID: 18061517 DOI: 10.1016/j.clae.2007.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 10/01/2007] [Accepted: 10/04/2007] [Indexed: 11/25/2022]
Abstract
We present two cases of early post-operative, in the bag intraocular lens (IOL) dislocation following uncomplicated phacoemulsification. Dislocation occurred in the presence of capsular fibrosis and anterior capsular phimosis. One patient was a known diabetic, the other diagnosed with pseudoexfoliation syndrome. These are recognised risk factors for capsular fibrosis. Surgical management included enlargement of the anterior capsular opening using intraocular micro-scissors and vitreous cutter to facilitate the removal of the dislocated IOL from the capsular bag. Both patients achieved a satisfactory visual outcome following IOL exchange with a rigid, sulcus fixated posterior chamber IOL (PCIOL). We discuss the risk factors for capsular fibrosis and propose preventative strategies to reduce the incidence of in the bag IOL dislocation.
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Affiliation(s)
- Anupma Kumar
- Guys & St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.
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Drolsum L, Ringvold A, Nicolaissen B. Cataract and glaucoma surgery in pseudoexfoliation syndrome: a review. ACTA ACUST UNITED AC 2007; 85:810-21. [PMID: 17376188 DOI: 10.1111/j.1600-0420.2007.00903.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pseudoexfoliation syndrome is a risk factor in cataract surgery because of the increased weakness of zonular apparatus and reduced pupillary dilatation. The surgical outcome of using phacoemulsification in the central zone, inducing minimal stress on the zonules, inserting a capsular tension ring in selected cases, and stretching the pupil mechanically in eyes with miotic pupils, may turn out to be uneventful in most cases. Postoperative fibrosis with subsequent shrinkage of the capsule is increased in these eyes, and these centripetal forces will further loosen the zonular fibres. Late in-the-bag intraocular lens dislocation is therefore anticipated to become a growing problem in the future. Despite the dysfunctioning of the blood-aqueous barrier in eyes with pseudoexfoliation syndrome, the frequency of postoperative inflammatory reaction is low due to the improvements made in surgical technique and equipment in recent years. Glaucoma frequently occurs in eyes with pseudoexfoliation syndrome. Compared with primary open-angle glaucoma, optic damage is more pronounced in these eyes at the time of diagnosis and response to medical therapy is poorer. Although responses to argon laser therapy and filtering surgery are roughly similar between the two types of glaucoma, there are indications that primary laser trabeculoplasty has a higher success rate in pseudoexfoliation glaucoma than in primary open-angle glaucoma.
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Affiliation(s)
- Liv Drolsum
- Department of Ophthalmology, Centre for Eye Research, Ullevål University Hospital, University of Oslo, Oslo, Norway.
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Ahmed IIK, Abadir A. Spontaneous IOL-CTR dislocation. J Cataract Refract Surg 2007; 33:176; author reply 176. [PMID: 17276241 DOI: 10.1016/j.jcrs.2006.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 09/17/2006] [Indexed: 11/29/2022]
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Goldman JM, Karp CL. Adjunct devices for managing challenging cases in cataract surgery: pupil expansion and stabilization of the capsular bag. Curr Opin Ophthalmol 2007; 18:44-51. [PMID: 17159447 DOI: 10.1097/icu.0b013e3280121b09] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients anticipate favorable surgical outcomes when having cataract surgery. The modern-day cataract surgeon should employ all necessary means to achieve this result. A working knowledge of adjunct devices for pupil expansion and capsular-bag stabilization can significantly improve surgical outcomes. RECENT FINDINGS Adjunct devices for pupil expansion include the Beehler pupil dilator, nylon iris hooks, and pupillary rings, including the Perfect Pupil, the Graether 2000, and the Morcher pupil dilator. Capsular-bag stabilization can be accomplished with capsular tension rings, capsular tension segments or iris hooks. The recent literature on these devices is reviewed. SUMMARY Impaired visualization through a small pupil and poor tissue stabilization increases the chance of tissue damage, retained nuclear material, and vitreous loss. Fortunately, inadequate mydriasis and instability of the capsular bag can be managed safely with the use of adjunct tools. Preoperative planning, familiarity with available tools, and accessibility of these devices in the operative setting is necessary.
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