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Hu X, Qi J, Cheng K, He W, Zhang K, Zhao C, Lu Y, Zhu X. Effectiveness of prophylactic capsular tension ring implantation during cataract surgery in highly myopic eyes. J Cataract Refract Surg 2024; 50:1030-1036. [PMID: 39313860 DOI: 10.1097/j.jcrs.0000000000001495] [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: 01/26/2024] [Accepted: 05/19/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE To assess the effectiveness of prophylactic capsular tension ring (CTR) implantation during cataract surgery in highly myopic eyes. SETTING Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China. DESIGN Prospective cohort study. METHODS Consecutive highly myopic patients treated with cataract surgery were recruited and randomized to undergo CTR implantation or not. The outcomes compared between the 2 groups included axial lens position (ALP), intraocular lens (IOL) decentration and tilt, area of anterior capsule opening, severity of anterior capsular opacification (ACO), and posterior capsular opacification (PCO) at 1 year postoperatively. RESULTS A total of 55 highly myopic eyes with CTRs implanted and 55 without were included in the analysis. At 1 year postoperatively, no significant differences were detected between the CTR and non-CTR groups for the mean ALP, IOL decentration, or tilt (all P > .05). However, the CTR group had a significantly larger area of anterior capsule opening (23.62 ± 3.30 mm2 vs 21.85 ± 2.30 mm2, P = .003), and less severe ACO (P = .033) and PCO (PCO-3 mm: 0.06 ± 0.13 vs 0.13 ± 0.20, P = .038; PCO-C: 0.15 ± 0.18 vs 0.25 ± 0.26, P = .026) than the non-CTR group. The corrected distance visual acuity, prediction error, and higher-order aberrations did not differ between the 2 groups (all P > .05). CONCLUSIONS In highly myopic eyes, although prophylactic CTR implantation can reduce the severity of capsular contraction and opacification, it does not significantly affect postoperative IOL stability or visual outcomes.
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Affiliation(s)
- Xiaoxin Hu
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China (Hu, Qi, Cheng, He, Zhang, Zhao, Lu, Zhu); NHC Key laboratory of Myopia and Related Eye Diseases; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China (Hu, Qi, Cheng, He, Zhang, Zhao, Lu, Zhu); Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China (Hu, Qi, Cheng, He, Zhang, Zhao, Lu, Zhu)
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Iwasaki K, Komori R, Arimura S, Takamura Y, Inatani M. Intraocular Pressure-Lowering Effect of Intraocular Lens Refixation in Patients with Elevated Intraocular Pressure Due to Intraocular Lens Subluxation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1440. [PMID: 39336482 PMCID: PMC11434365 DOI: 10.3390/medicina60091440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/24/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: To evaluate the surgical outcomes of intraocular lens (IOL) refixation with vitrectomy in patients with elevated intraocular pressure (IOP) due to IOL subluxation. Materials and Methods: Patients with elevated IOP due to IOL subluxation who had undergone IOL refixation with vitrectomy between 1 June 2013 and 31 December 2023 were retrospectively evaluated. The primary outcome measure was surgical success or failure. Surgical success was defined as a reduction of ≥20% in the preoperative IOP or IOP ≤ 21 mmHg (criterion A), IOP ≤ 18 mmHg (criterion B), or IOP ≤ 15 mmHg (criterion C). Reoperation, loss of light perception, and hypotony were considered as surgical failure. The IOP, number of glaucoma medications used, postoperative complications, and visual acuity were evaluated as the secondary outcomes. The surgical outcomes were compared between the glaucoma and ocular hypertension (OH) groups. Results: At 12 months postoperatively, the probability of success was 72.5%, 54.1%, and 28.4% using criterion A, B, and C, respectively, and the mean IOP and mean number of glaucoma medications used had decreased significantly (p < 0.01 and p = 0.03, respectively). Furthermore, the cumulative success rate was significantly higher in the OH group than in the glaucoma (100% vs. 47.4%; p < 0.01) when using criterion A. Additional glaucoma surgery was required only in the glaucoma group. Conclusions: IOL refixation surgery significantly decreases the IOP and number of glaucoma medications required in patients with elevated IOP due to IOL subluxation. Thus, IOL refixation surgery alone without glaucoma surgery might be effective as the primary procedure in such patients.
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Affiliation(s)
| | | | | | | | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui 910-1193, Japan; (K.I.); (R.K.); (S.A.); (Y.T.)
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Linaburg TJ, Cui QN, Armenti S. EVALUATION AND MANAGEMENT OF POST-OPERATIVE COMPLICATIONS FOLLOWING CATARACT EXTRACTION AND INTRAOCULAR LENS PLACEMENT. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2024; 9:133-151. [PMID: 39247851 PMCID: PMC11378954 DOI: 10.1016/j.yaoo.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
THIS REVIEW EXPLORES POST-OPERATIVE CHALLENGES ARISING FROM CATARACT SURGERY, INCLUDING INTRAOCULAR LENS (IOL) DECENTRATION OR DISLOCATION, REFRACTIVE SURPRISES, DYSPHOTOPSIAS, AND IOL OPACIFICATIONS. IOL DECENTRATION OR DISLOCATION IS RARE, HIGHLIGHTING THE NEED FOR CAREFUL MANAGEMENT WITH MONITORING, SURGICAL REPOSITIONING OR LENS EXCHANGE TO ACHIEVE OPTIMAL VISUAL OUTCOMES. REFRACTIVE SURPRISES, ATTRIBUTED TO ERRORS IN IOL CALCULATION AND SELECTION, MAY BE MANAGED CONSERVATIVELY OR SURGICALLY, WITH THE MOST ACCURATE RESULTS ACHIEVED BY LASER VISION CORRECTION. POSITIVE AND NEGATIVE DYSPHOTOPSIAS MAY CONTINUE TO BE INTOLERABLE FOR PATIENTS, AND MAY REQUIRE LENS EXCHANGE AS WELL. IOL OPACIFICATIONS VARY BY IOL MATERIAL AND MAY BE VISUALLY SIGNIFICANT, REQUIRING LENS EXCHANGE. WE UNDERSCORE THE IMPORTANCE OF NUANCED MANAGEMENT AND PROVIDING OPTIMAL PATIENT CARE IN THE ABOVE POST-CATARACT SURGERY AND IOL IMPLANTATION COMPLICATIONS.
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Affiliation(s)
- Taylor J Linaburg
- DEPARTMENT OF OPHTHALMOLOGY, SCHEIE EYE INSTITUTE, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA
| | - Qi N Cui
- DEPARTMENT OF OPHTHALMOLOGY, SCHEIE EYE INSTITUTE, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA
| | - Stephen Armenti
- DEPARTMENT OF OPHTHALMOLOGY, SCHEIE EYE INSTITUTE, UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA
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Medin H, Kure ISH, Dalby M, Kristianslund O, Drolsum L. Inflammatory reaction in eyes with late in-the-bag intraocular lens dislocation. Acta Ophthalmol 2024; 102:306-311. [PMID: 37303305 DOI: 10.1111/aos.15720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE To investigate the inflammatory reaction in eyes with late in-the-bag intraocular lens (IOL) dislocation. METHODS This prospective clinical study with fellow-eye comparison consists of 76 of the patients (76 eyes) with late in-the-bag IOL dislocation enrolled in the LION trial. The main outcome measure was anterior chamber flare before surgery measured with a laser flare meter in photon counts per millisecond (pc/ms). The dislocation was graded as 1 (small: optic still covering the visual axis), 2 (optic equator close to the visual axis) or 3 (optic decentred beyond the visual axis, but the IOL-capsule complex partly visible in the pupillary area). The secondary aim was to compare intraocular pressure (IOP) before surgery. RESULTS Flare levels before surgery were significantly higher in the dislocation eyes than in the fellow eyes with a median flare of 21.5 (range 5.4-135.7) pc/ms versus 14.1 (2.0-42.9) pc/ms, respectively (p ˂ 0.001). A regression analysis of log-transformed flare values showed that the dislocation eyes had a non-significant tendency towards higher flare in dislocation grade 1 with a median flare of 24.6 (5.4-135.7) pc/ms compared to grade 2; 19.6 (6.5-41.5) pc/ms (p = 0.06), and no significant difference compared to grade 3; 19.4 (10.2-53.5) pc/ms (p = 0.47). The IOP was significantly higher in the dislocation eyes than in the fellow eyes (p ˂ 0.001). CONCLUSIONS Eyes with late in-the-bag IOL dislocation had increased flare levels compared to their fellow eyes. This suggests that inflammation is part of the clinical picture of late in-the-bag IOL dislocation.
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Affiliation(s)
- Helle Medin
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Slørdahl Hjort Kure
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marius Dalby
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Drammen, Norway
- Lovisenberg Diaconal University College, Oslo, Oslo, Norway
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Arimatsu M, Akagi T, Suetake A, Sakaue Y, Iikawa R, Igarashi R, Togano T, Ando T, Yoshida H, Terashima H, Fukuchi T. Intrascleral intraocular lens fixation with ab interno trabeculotomy in patients with exfoliation glaucoma with lens subluxation. Jpn J Ophthalmol 2024; 68:200-205. [PMID: 38587787 DOI: 10.1007/s10384-024-01059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/21/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To evaluate the surgical outcomes of intrascleral intraocular lens (IOL) fixation using ab interno trabeculotomy (LOT) in patients with exfoliation glaucoma with lens subluxation. STUDY DESIGN Retrospective case series. METHODS Twenty eyes of 18 patients with exfoliation glaucoma and lens or IOL subluxations were included. Three success criteria were based on postoperative intraocular pressure (IOP) (A, ≤15 mmHg; B, ≤18 mmHg; C, ≤21 mmHg). The IOP, number of glaucoma medications, and visual acuity were compared before and after surgery. Success probability was analyzed using Kaplan-Meier survival curves. Cox proportional hazards' regression models were used to examine prognostic factors for surgical failure. RESULTS The mean follow-up period was 23.4 ± 7.8 months. The mean IOP significantly decreased from 23.2 ± 6.8 mmHg preoperatively to 14.0 ± 4.4 mmHg at 1 year postoperative (P<0.001). Postoperative hyphema and vitreous hemorrhage were observed in seven and 15 eyes, respectively, and washout in the anterior chamber or vitreous cavity was performed in four eyes. Postoperative IOP spikes and hypotony were observed in four eyes each. Glaucoma reoperation was performed in two eyes. The success rates at 12 months were 65%, 85%, and 90% using criteria A, B, and C, respectively. The IOP at 1 month after surgery was a significant prognostic factor for surgical failure according to criterion A (hazard ratio: 1.08; P=0.034). CONCLUSION Intrascleral IOL fixation combined with microhook LOT is a promising option in cases of exfoliation glaucoma with subluxated lens/IOL; however, the high rate of postoperative hyphema and vitreous hemorrhage should be noted.
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Affiliation(s)
- Mao Arimatsu
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Tadamichi Akagi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Aki Suetake
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuta Sakaue
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Ryu Iikawa
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Ryoko Igarashi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Tetsuya Togano
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takumi Ando
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiromitsu Yoshida
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiroko Terashima
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takeo Fukuchi
- Division of Ophthalmology and Visual Science, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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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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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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Armonaite L, Behndig A. Repositioning of in-the-bag Dislocated Intraocular Lenses: A Randomized Clinical Trial Comparing Two Surgical Methods. Ophthalmic Res 2023; 66:590-598. [PMID: 36739865 DOI: 10.1159/000529506] [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: 05/04/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate intraocular lens (IOL) tilt, IOL-induced astigmatism (IIA), refractive change, and impact of capsular fibrosis on IOL position after scleral fixation of dislocated IOL using two methods: ab externo scleral suture loop fixation (group A) and a modification, embracing the continuous curvilinear capsulorhexis (group B). METHODS In this prospective randomized clinical trial conducted at St. Erik Eye Hospital, 117 patients with dislocated IOL were randomized to group A (n = 61) or B (n = 56). Patients with ordinary pseudophakia (n = 60) served as controls. IOL tilt was measured three-dimensionally with anterior segment optical coherence tomography (AS-OCT). RESULTS The median IOL tilt was similar with both methods (A: 7.8°; B: 8.3°; p = 0.51) but higher than in ordinary pseudophakia (5.4°; p < 0.001). Both groups showed a myopic shift, p < 0.001. In cases without capsular fibrosis, the median IOL tilt was 15.5° in group A (n = 7) and 7.0° in group B (n = 5), p = 0.19. For each degree of IOL tilt, IIA increased by 0.075 D (p < 0.001). IOL position could be measured with AS-OCT in all patients given that the IOL was visible in the pupil. CONCLUSION After IOL fixation surgery, IOL tilt is higher than in normal pseudophakia. A study involving more patients without capsular fibrosis could clarify whether IOL position is better with method B in this subgroup. IAA is low, but myopic shift is common. AS-OCT is useful for IOL tilt assessment after IOL fixation surgery.
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Affiliation(s)
- Laura Armonaite
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Behndig
- Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå University, Umeå, Sweden
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Early Lensectomy in Patients With Pseudoexfoliation: Long-Term Effectiveness and Safety Outcomes. J Glaucoma 2023; 32:93-100. [PMID: 36696356 DOI: 10.1097/ijg.0000000000002158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/21/2022] [Indexed: 01/26/2023]
Abstract
PRCIS Early lensectomy in patients presenting pseudoexfoliation (PXF) in an asymmetric clinical stage resulted in effective, safe, and predictable long-term results. Good intraocular pressure (IOP) was found, thus it might be considered as a possible surgical approach in these patients. PURPOSE The purpose of this study is to assess the long-term effectiveness, predictability, and safety of cataract surgery performed in patients with capsular PXF at an early stage of the disease. MATERIALS AND METHODS This retrospective, comparative study included PXF patients who underwent phacoemulsification with hydrophobic acrylic intraocular lens implantation in both eyes with a postoperative follow-up ≥5 years. Patients were classified in 2 groups: symmetric PXF (n=102) and asymmetric PXF (n=59). Preoperative and postoperative uncorrected and corrected distance visual acuity, manifest refraction, IOP, number of hypotensive drugs, visual field mean deviation, and the incidence of complications were registered. RESULTS The mean follow-up time was 8.5±2.8 years. Six months after cataract surgery, monocular uncorrected and corrected distance visual acuity were 0.3±0.4 and 0.1±0.3 logMAR, respectively, for the symmetric PXF, and 0.2±0.2 and 0.1±0.2 logMAR, respectively, for the asymmetric group. Total 95% and 96% of eyes were within ±1.00D in symmetric and asymmetric groups, respectively. At the final follow-up, IOP decreased only in the asymmetric group (P=0.004), with a reduction in the number of medications in both eyes (P<0.001). Mean deviation changed from -8.8 to -11.6 dB in the symmetric group (P<0.001), and from -5.0±6.2 to -7.9±10.6 dB (P=0.42) in the asymmetric group. Intraoperative complications were only registered in the symmetric group: 7 (3.4%; P=0.04). Ten cases (4.9%) of late intraocular lens dislocation were found, all from the symmetric group (P=0.03). CONCLUSIONS Early lensectomy in patients with PXF before its symmetric presentation resulted in effective, safe, and predictable long-term results.
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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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Intraocular lens dislocation: manifestation, ocular and systemic risk factors. Int Ophthalmol 2022; 43:1317-1324. [PMID: 36149618 PMCID: PMC10113310 DOI: 10.1007/s10792-022-02529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to evaluate ocular and systemic risk factors for posterior chamber intraocular lens dislocation, as well as forms of manifestation. METHODS A retrospective case-control study were all patients presented in the period 2012-2016 having intraocular lens dislocation and being treated with implantation of an iris-fixated intraocular lens was conducted at the University Hospital Mainz. As controls, pseudophakic patients presenting for other reasons were included. RESULTS 150 eyes of 150 patients (mean age 72.7 ± 12.4 years, range 24-93 years) with IOL dislocation and 150 eyes of 103 controls were included in this study. The average time between primary implantation and IOL luxation was 86 months (iQR: 39.25-127 months) for all dislocations. Previous pars plana vitrectomy (PPV) (crudeOR = 2.14 (95% CI 1.23, 3.72), p = 0.011) and PEX (crudeOR = 11.6 (4.79, 28.12), p < 0.001) was linked with a higher risk of IOL luxation. Luxation occurs also earlier in patients with previous PPV and PEX than in eyes with neither PEX nor previous PPV (82.2 vs. 127 months). Rhegmatogenous retinal detachment was the major pathology that required a previous PPV for eyes with an IOL dislocation (57%). The average time between PPV and IOL dislocation was 74.67 months (range 0-186 months). CONCLUSION Patients with a coexistence of both: PEX and a previous PPV had an elevated risk of IOL dislocation, and also had a shorter time interval between primary IOL implantation and IOL dislocation followed by eyes with PEX only and eyes with only a previous PPV.
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Femtosecond Laser Combined with Double-Flange Polypropylene Suture Capsular Tension Ring Suspension for the Treatment of Subluxation of Lens in Marfan Syndrome. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9348311. [PMID: 35991146 PMCID: PMC9385373 DOI: 10.1155/2022/9348311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the use of femtosecond laser combined with double-flange polypropylene suture capsular tension ring (CTR) suspension to treat subluxation of lens in Marfan syndrome. The objective is to provide safer and more effective surgical procedures for patients. Setting. Eye Hospital, Aier Eye Hospital of Wuhan University, Wuhan, China Methods In this retrospective study, we observed sixteen patients (16 eyes) with Marfan syndrome who had undergone this operation. Femtosecond laser incision was performed on the anterior capsule with the lens as the center. The suspending CTR was clipped to anterior capsule to support it, which was secured to the sclera with a double-flange polypropylene suture. Uncorrected visual acuity (UCVA), intraocular pressure (IOP), tilt, and decentration of the intraocular lens (IOL) and postoperative complications were evaluated. Results All 16 patients were successfully implanted with suspended CTR and IOL after femtosecond laser assisted surgery. Visual acuity improved significantly after surgery (p < 0.01). At 1 month, 3 months and 6 months postoperatively, the tilt of the IOL was 2.70 ± 0.934, 2.65 ± 0.897, and 2.66 ± 0.781, and the decentration of the IOL was 0.30 ± 0.770, 0.30 ± 0.682, and 0.29 ± 0.737; both had no statistically significant difference between the three groups. After the operation, 4 patients had hyphema and 2 patients experienced a temporary postoperative IOP increase. Only one flange was exposed one month after operation and recovered right after secondary adjustment. Conclusion Femtosecond laser combined with double-flange polypropylene suture CTR suspension was effective in fixing the lens capsule to the scleral wall in cases of subluxation of lens seen in Marfan syndrome during our short-term observation. The long-term efficacy of this operation needs further observation and follow-up.
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Medin H, Dalby M, Kure ISH, Karabeg M, Drolsum L, Kristianslund O. Intraocular Inflammation in Eyes Operated for Late In-the-bag intraOcular lens dislocatioN (LION): A Randomized Clinical Trial. Am J Ophthalmol 2022; 238:66-74. [PMID: 34995522 DOI: 10.1016/j.ajo.2021.12.019] [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: 11/01/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the intraocular inflammation after 2 surgical approaches for late in-the-bag intraocular lens (IOL) dislocation. DESIGN Prospective, randomized, parallel-group clinical trial. METHODS We randomly assigned 100 patients (100 eyes) referred to Oslo University Hospital (tertiary referral center) with late in-the-bag IOL dislocation into IOL repositioning by scleral suturing (n=49) or IOL exchange with retropupillary fixation of an iris-claw lens (n=51). Patients were examined before surgery and 2 weeks, 6 weeks, and 6 months after surgery. The main outcome measure was anterior chamber laser flare, measured with a laser flare meter as photon counts per millisecond (pc/ms). RESULTS Two weeks following surgery, median flare values were 28.9 pc/ms (range, 7.9-140) in the repositioning group and 31.6 pc/ms (range, 9.8-92.3) in the exchange group (P = .83). Flare levels were still elevated after 6 weeks with no difference between the groups (P = .93), whereas it decreased to baseline levels after 6 months. Six weeks following surgery, the central retinal thickness was similar (P = .97); cystoid macular edema (CME) was found in 4 and 5 patients, respectively (P = .85); and the mean best corrected visual acuity was 0.17 (95% CI 0.09, 0.25) and 0.21 (95% CI 0.09, 0.32) logarithm of the minimum angle of resolution, respectively (P = .61). CONCLUSIONS This study revealed similar levels of intraocular inflammation following IOL repositioning and IOL exchange. There was no significant difference regarding risk of CME and visual outcome. The prolonged elevation in postoperative flare indicates a possible requirement for an extended anti-inflammatory treatment period after these operations.
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Affiliation(s)
- Helle Medin
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway.
| | - Marius Dalby
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.)
| | | | - Mia Karabeg
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
| | - Liv Drolsum
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
| | - Olav Kristianslund
- From the Department of Ophthalmology, Oslo University Hospital (H.M., M.D., I.S.H.K., M.K., L.D., O.K.); Institute of Clinical Medicine, University of Oslo (H.M., M.K., L.D., O.K.), Oslo, Norway
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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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Schuknecht A, Wachtl J, Fleischhauer J, Kniestedt C. Intraocular Pressure in Eyes with Intraocular Lens Dislocation and Pseudoexfoliation Syndrome. Klin Monbl Augenheilkd 2022; 239:424-428. [PMID: 35472783 DOI: 10.1055/a-1766-7153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate intraocular pressure in eyes with intraocular lens subluxation and pseudoexfoliation syndrome. METHODS In this retrospective study conducted at one eye centre (tazz) in Zurich, Switzerland, we reviewed 85 eyes with intraocular lens subluxation and pseudoexfoliation syndrome. Intraocular lens exchange was carried out by two surgeons between 03/2016 and 12/2019 (45 months). Information on baseline characteristics and diagnosis of glaucoma was recorded. Intraocular pressure and best-corrected visual acuity were analysed preoperatively and at five time points up to 12 months after lens exchange. Data on antiglaucomatous medication was collected before surgery and at two different time points after surgery. Postoperative pressure lowering procedures and complications were further analysed. RESULTS This study includes 85 pseudoexfoliation eyes with intraocular lens subluxation. The mean interval between cataract surgery and lens exchange was 8.9 ± 5.2 years. Intraocular pressure elevation in the event of intraocular lens subluxation was found in 54% (46/85) of eyes. Mean intraocular pressure decreased from 22.9 ± 9.4 mmHg preoperatively to 15.2 ± 3.4 mmHg at follow-up 12 months after lens exchange (p < 0.001). Postoperative topical antiglaucomatous drug requirements were comparable to preoperative levels (p = 0.520). Less systemic acetazolamide was required 12 months postoperatively (p = 0.018). A pressure lowering procedure was required in seven (8%) eyes in the postoperative period due to persistence of high intraocular pressure. Intermittent increase or persistence of high intraocular pressure occurred in 13 (15%) eyes. CONCLUSION This study emphasises the connection between acute pressure elevation and intraocular lens subluxation in patients with pseudoexfoliation syndrome. Intraocular pressure decreases after lens exchange and decrease sustains for a postoperative period of 12 months. Postoperative pressure lowering procedures were not required in the majority of eyes. We therefore conclude that intraocular lens exchange is efficient in the management of lens subluxation and pressure elevation in patients with pseudoexfoliation syndrome.
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Garg A, Lau THA, Popovic MM, Kertes PJ, Muni RH. Sutured Scleral-Fixated Versus Anterior Chamber Intraocular Lens Implantation: A Meta-Analysis. Ophthalmic Surg Lasers Imaging Retina 2022; 53:12-21. [PMID: 34982000 DOI: 10.3928/23258160-20211213-01] [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: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE No consensus exists on the comparative efficacy and safety of sutured scleral-fixated (SSF) and anterior chamber (AC) intraocular lens (IOL) implantation. We aim to compare outcomes of these two techniques. PATIENTS AND METHODS A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was conducted (2005 to 2020). Studies comparing SSFIOLs with ACIOLs were included. Outcomes included corrected distance visual acuity and complications. A meta-analysis was conducted with a random effects model. Weighted mean differences and risk ratios with 95% CIs were computed. RESULTS Seven hundred eighty-three eyes from nine studies were included. SSFIOLs had a significantly higher absolute postoperative spherical equivalent (weighted mean difference, 0.32; 95% CI, 0.03 to 0.60; P = .03; low certainty) and incidence of IOL decentration/subluxation (risk ratio, 2.69; 95% CI, 1.03 to 7.01; P = .04; moderate certainty) than ACIOLs. There was no difference in final corrected distance visual acuity (P = .26). CONCLUSIONS SSFIOLs have a higher absolute postoperative spherical equivalent and incidence of IOL decentration/subluxation than ACIOLs. Future prospective studies are needed to confirm these findings. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:12-21.].
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Scleral fixation of subluxated or dislocated multifocal and multifocal toric intraocular lenses. Graefes Arch Clin Exp Ophthalmol 2021; 260:1195-1203. [PMID: 34817677 DOI: 10.1007/s00417-021-05498-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the feasibility of scleral fixation of subluxated or dislocated multifocal/multifocal toric intraocular lenses (IOLs) to rescue the IOL and restore both near and far vision. METHOD A total of 18 eyes of 17 patients who underwent transscleral or intrascleral fixation of subluxated or dislocated multifocal or multifocal toric IOLs at 2.5 mm posterior to the limbus were enrolled. Preoperative uncorrected distance visual acuity (UDVA) and postoperative UDVA values were compared in this retrospective cross-sectional study. The postoperative corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at 40 cm, residual sphere, cylinder, spherical equivalent, and IOL centration were evaluated. RESULTS The mean follow-up period was 4.0 ± 5.0 months. The mean preoperative UDVA was 0.73 ± 0.71 logMAR and the postoperative UDVA was 0.05 ± 0.10 logMAR, which was significantly improved relative to the preoperative UDVA. The mean postoperative CDVA was 0.00 ± 0.00 logMAR and the mean postoperative UNVA at 40 cm was 0.05 ± 0.07 logMAR. The mean postoperative residual sphere, cylinder, and spherical equivalent values were - 0.21 ± 0.41 D, - 0.29 ± 0.26 CD, and - 0.33 ± 0.39 D, respectively. Postoperative anterior segment photographs showed good centration of optics in all cases of single-piece foldable multifocal IOLs but a slight inferior decentration in one case of a three-piece multifocal IOL. CONCLUSION Scleral fixation of subluxated or dislocated multifocal and multifocal toric IOLs could be one of the treatment options to rescue subluxated or dislocated multifocal IOLs and restore both near and far vision.
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Outcomes of flanged IOL fixation combined with microhook trabeculotomy. Int Ophthalmol 2021; 42:799-804. [PMID: 34652544 DOI: 10.1007/s10792-021-02045-z] [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: 03/12/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of flanged intraocular lens fixation combined with microhook trabeculotomy. PATIENTS AND METHODS This study was a retrospective case series and included nine eyes of nine exfoliation glaucoma patients with subluxated lens or intraocular lens who underwent flanged intraocular lens fixation combined with microhook trabeculotomy between May 2019 and February 2020 at the Kochi University Hospital. The mean best-corrected visual acuity, intraocular pressure, and number of antiglaucoma medications were compared before and after surgery. RESULTS The mean follow-up period was 5.67 ± 2.50 months. The mean best-corrected visual acuity improved significantly from 0.83 ± 0.72 preoperatively to 0.22 ± 0.34 at the last visit (p = 0.015). The mean intraocular pressure had significantly reduced from 27.1 ± 8.12 mmHg preoperatively to 13.2 ± 3.73 at the last visit (p = 0.008). The mean number of antiglaucoma medications decreased significantly from 4.56 ± 1.88 to 2.0 ± 1.0 at the last visit (p = 0.008). Postoperative intraocular pressure control to 21 mmHg or lower was achieved or maintained in all patients. Postoperative vitreous hemorrhage was observed in six eyes (66.7%), two of which needed reoperation. CONCLUSIONS This study showed that flanged intraocular lens fixation combined with microhook trabeculotomy might be effective for exfoliation glaucoma with subluxated lens or intraocular lens.
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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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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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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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May consultation #2. J Cataract Refract Surg 2021; 47:678-679. [PMID: 33908395 DOI: 10.1097/01.j.jcrs.0000751768.18790.cf] [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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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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Vaiciuliene R, Jasinskas V. Corneal endothelial status in different grades of late spontaneous in-the-bag IOL dislocation. Int Ophthalmol 2021; 41:1625-1634. [PMID: 33606154 DOI: 10.1007/s10792-021-01702-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate corneal endothelial cell density (ECD) in the eyes with different grades of late spontaneous in-the-bag intraocular lens (IOL) dislocation. METHODS A prospective study included seventy-eight patients who applied for IOL dislocation. Overall 80 eyes were divided into four grades based on the in-the-bag IOL dislocation classification. All eyes underwent a complete ophthalmological examination. ECD was evaluated using in vivo corneal confocal microscopy. RESULTS Median corneal ECD was 1929 (1022-2958) cells/mm2 of all the patients. The lowest number of ECD was in grade 2 (grade 1 median ECD 1990.33 (1182-2425.33) cells/mm2, grade 2-1577.0 (1022-2958) cells/mm2, grade 3-2205.84 (1259-2807.67) cells/mm2 and grade 4-2072.17 (1045-2581.0) cells/mm2). A statistically significant difference was observed between the median of ECD of grade 2nd and 3rd (p = 0.023). By grouping cases into those with and without glaucoma, we found that corneal ECD was significantly lower in eyes with glaucoma compared with eyes without glaucoma in grades 3 and 4 (p < 0.05), while in other grades, the difference did not reach the significance level. We divided the corneal ECD of all eyes into two categories ≤ 1500 cells/mm2 and > 1500 cells/mm2. Logistic regression demonstrated that the odds of having corneal ECD less than 1500 cells/mm2 increased by 3.5-fold if patients with IOL dislocation had been diagnosed with glaucoma previously. CONCLUSION Late spontaneous in-the-bag IOL dislocation reduced corneal ECD. Previously diagnosed glaucoma was the most common comorbidity. This condition has a significant impact on corneal ECD for patients with IOL dislocation.
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Affiliation(s)
- Renata Vaiciuliene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu st. 2, LT-50161, Kaunas, Lithuania.
| | - Vytautas Jasinskas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu st. 2, LT-50161, Kaunas, Lithuania
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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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Yang S, Jiang H, Nie K, Feng L, Fan W. Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules. BMC Ophthalmol 2021; 21:19. [PMID: 33413210 PMCID: PMC7792360 DOI: 10.1186/s12886-020-01772-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia. METHODS A total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia. RESULTS Surgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed. CONCLUSION CTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-INR-17011217 , date of registration April 22, 2017, prospectively registered.
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Affiliation(s)
- Shangfei Yang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Kailai Nie
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Liwen Feng
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
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A NOVEL TECHNIQUE FOR EXTRACTION OF DROPPED BROKEN HAPTICS OF HARD POSTERIOR CHAMBER INTRAOCULAR LENS. Retin Cases Brief Rep 2021; 15:22-23. [PMID: 29557850 DOI: 10.1097/icb.0000000000000730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To report a novel technique for extraction of dropped haptics of hard posterior chamber intraocular lens. METHODS A 58-year-old woman had undergone cataract extraction, and while implanting the posterior chamber intraocular lens it was dislocated in the anterior vitreous, and the cataract surgeon, tried to remove it by the anterior approach, but he succeeded to remove the optic part only, leaving the haptics dropped, then he referred the case after giving topical and systemic medications to control intraocular inflammation and, the case was prepared for pars plana vitrectomy, then injection of perfluorodecaline to keep the haptics away from the posterior pole then by 23 G vitrectomy probe and, the use of vacuum only, the haptics were removed and the perfluorodecaline was removed. RESULTS After extraction of both haptics by 23 G vitrectomy probe, the case was implanted by a hard polymethylmethacrylate posterior chamber intraocular lens on the sulcus, and postoperatively, the inflammatory signs were subsided and her visual acuity was improved, without any posterior segment complications. CONCLUSION Dropped haptic of hard posterior chamber intraocular lens can be removed successfully with 23 G vitrectomy probe.
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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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Hostovsky A, Mandelcorn M, Mandelcorn ED. Secondary Posterior Chamber Intraocular Lens Fixation Using Flanged Prolene Sutures as an Alternative to an Anterior Chamber Intraocular Lens Implantation. Clin Ophthalmol 2020; 14:3481-3486. [PMID: 33122884 PMCID: PMC7591231 DOI: 10.2147/opth.s276707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose To describe and evaluate the clinical outcomes of the Flanged Prolene Suture intraocular lens fixation (PIF) technique and compare it to anterior chamber IOL (ACIOL) implantation. Design A retrospective comparative review. Methods A retrospective comparative review of consecutive patients undergoing secondary IOL implantation was performed. A comparison between patients that had ACIOL and PIF technique was conducted. The main outcome measures were changes in best-corrected visual acuity (VA), IOL position and complications. Results In the study period, fourteen eyes had ACIOL implantation and ten eyes had PIF surgery. VA acuity for both groups combined improved from 1.27 ± 0.65 logMAR preoperatively to 0.84 ± 0.65 logMAR (P<0.0001). Seventeen patients had VA measurements in the year before the IOL dislocation. In those seventeen patients, VA changed from a baseline of 0.90 ± 0.68 to 0.97 ± 0.61 logMAR in the PIF group (p=0.334) and from 0.54 ± 0.27 to 0.85 ± 0.65 logMAR in the ACIOL group (p=0.145). No intraoperative or early postoperative complications were documented in either group. Two (20%) patients in the PIF group developed CME and one patient developed corneal edema. In the ACIOL group, one patient developed significant CME and two patients developed visual significant corneal edema. Conclusion The PIF technique seems to offer a simple, fast and safe way to fixate an IOL posteriorly. In our experience, the learning curve of the technique is short with a low complication rate and good visual outcomes. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/cw9BUcheaVk
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Affiliation(s)
- Avner Hostovsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, The University Health Network, Toronto, Ontario, Canada
| | - Mark Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, The University Health Network, Toronto, Ontario, Canada
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Ophthalmology, Toronto Western Hospital, The University Health Network, Toronto, Ontario, Canada
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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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Ansah DO, Li X, Gehlbach PL, Jun AS, Soiberman US. Prediction error in iris suture fixated intraocular lenses and long‐term stability. Clin Exp Ophthalmol 2020; 48:1175-1182. [DOI: 10.1111/ceo.13851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Derick O. Ansah
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Ximin Li
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Peter L. Gehlbach
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Albert S. Jun
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Uri S. Soiberman
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
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Sella S, Rubowitz A, Sheen-Ophir S, Ferencz JR, Assia EI, Ton Y. Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach. Int Ophthalmol 2020; 41:221-229. [PMID: 32915391 DOI: 10.1007/s10792-020-01570-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/17/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). METHODS A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. RESULTS Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5 years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. CONCLUSION Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.
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Affiliation(s)
- Sara Sella
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
| | - Alexander Rubowitz
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Shira Sheen-Ophir
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Joseph R Ferencz
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel.,Ein-Tal Eye Center, Tel Aviv, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center (affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel), 59 Tchernichovsky St., 44281, Kfar Saba, Israel
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Abela-Formanek C, Reumüller A. Sekundäre Linsenimplantation: chirurgische Techniken und Ergebnisse. SPEKTRUM DER AUGENHEILKUNDE 2020. [DOI: 10.1007/s00717-020-00462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEs stehen verschiedene alternative chirurgische Optionen zur Verfügung, um eine sekundäre Intraokularlinse (IOL) in Augen mit unzureichender Kapselunterstützung zu implantieren. Erfolgreiche Techniken umfassen die Implantation einer irisfixierten IOL (IFIOL), einer kammerwinkelgestützten Vorderkammerlinse (ACIOL) oder verschiedene Variationen zur Sklerafixierung (SFIOL). Jede dieser Methoden hat sich als sicher und effektiv erwiesen, weist jedoch verfahrensspezifische Einschränkungen auf. Jüngste Studien zeigen, dass die Entwicklung neuer chirurgischer Techniken diesen Patienten weiterhin sichere und reproduzierbare Behandlungsmöglichkeiten bietet. Obwohl die Implantation von sekundären IOLs ohne Kapselunterstützung von vielen Faktoren, einschließlich der Präferenz des Chirurgen, abhängt, sind nahtlose sklerafixierende Techniken für die chirurgische Gemeinschaft von wachsendem Interesse. Das Bestreben nach kürzeren und weniger traumatischen Operationen sowie nach reproduzierbaren und funktionell guten Ergebnissen, fördert dabei die Entwicklung von neuen Operationstechniken, Intraokularlinsen und Instrumenten. Diese Übersichtsarbeit gibt einen Einblick in alte und neue Behandlungsmethoden zur Korrektur von Aphakie mit sekundären Intraokularlinsen
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Tran THC, Zaier D, Proença J, Rouland JF. Posterior segment Intra-Ocular Implant (IOL) dislocation: Predisposing factors, surgical management, outcome analysis. J Fr Ophtalmol 2020; 43:1062-1068. [PMID: 32811657 DOI: 10.1016/j.jfo.2020.01.018] [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: 07/18/2019] [Revised: 11/17/2019] [Accepted: 01/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the predisposing factors, management and visual prognosis of intraocular Lens (IOL) dislocation into the posterior segment. METHODS The cases of posterior IOL dislocation from January 2012 to May 2017 at 2 centers were reviewed. Only eyes with dislocations requiring IOL explantation or repositioning were included. Predisposing factors, interval between cataract surgery and IOL dislocation, circumstances of onset, management, and postoperative complications are reported. RESULTS 72 eyes of 72 patients were included. The mean age was 67.6 years. 47 patients (68%) were men. The mean time interval from cataract surgery to IOL dislocation was significantly shorter in the out-of-the bag group than the in-the-bag IOL dislocation group (3.8 months vs 132 months, P=0.002). Predisposing factors for out-of-the-bag IOL dislocation were mainly capsular rupture and/or zonular dehiscence (83%) after complicated cataract surgery. The predisposing factors for in-the-bag IOL dislocation were high myopia (40%), pseudoexfoliation syndrome (40%), previous vitrectomy (38%), or Marfan syndrome (3%) with uneventful cataract surgery. The type of luxated implant was mainly a 3-piece foldable IOL (50%), followed by foldable one-piece IOL (28%) and a rigid one-piece IOL (17%). Most cases of posterior chamber IOL dislocation occurred spontaneously (80%) without a trigger event. Management consisted of a posterior approach in 24 cases (33%) or an anterior approach in 48 cases (67%), associated with IOL repositioning in 20 eyes (28%), and IOL replacement in 34 eyes (47%). Finally, 18 eyes (25%) were left aphakic. Postoperative complications occurred in 7 cases (9.7%). CONCLUSIONS Predisposing factors and time from cataract surgery to IOL dislocation were different for out-of-the bag versus in-the-bag IOL dislocation. Management of IOL dislocation varied considerably, depending on surgeon preference and experience. Surgery for IOL dislocation significantly improved best corrected visual acuity and was associated with a low complication rate.
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Affiliation(s)
- T H C Tran
- Ophthalmology department, Lille Catholic hospitals, Lille Catholic university, Lille, France.
| | - D Zaier
- Ophthalmology department, Lille Catholic hospitals, Lille Catholic university, Lille, France
| | - J Proença
- Ophthalmology department, Claude-Huriez hospital, Lille II university, Lille, France
| | - J F Rouland
- Ophthalmology department, Claude-Huriez hospital, Lille II university, Lille, France
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Durr GM, Ahmed IIK. Intraocular Lens Complications: Decentration, Uveitis-Glaucoma-Hyphema Syndrome, Opacification, and Refractive Surprises. Ophthalmology 2020; 128:e186-e194. [PMID: 32652203 DOI: 10.1016/j.ophtha.2020.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review was to report the incidence, diagnosis, and management of IOL decentrations, uveitis-glaucoma-hyphema (UGH) syndrome, IOL opacifications, and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Controlled Trial Database and the reference lists of original studies as well as reviews. Intraocular lens decentrations and dislocations can appear at any time, particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery, or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. Intraocular lens opacifications such as glistenings rarely require intervention, but others, such as subsurface nanoglistenings, calcifications, or discolorations, may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. Intraocular lens complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize patient outcomes.
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Affiliation(s)
- Georges M Durr
- Department of Ophthalmology, Université de Montréal, Montréal, Canada; Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
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Taskin I, Altinbay D, Ozdemir VN. A different surgical approach to cases with zonular weakness or dialysis: sutureless transscleral fixated intraocular lens implantation and stabilization of lens capsule. Int Ophthalmol 2020; 40:2315-2323. [PMID: 32419104 DOI: 10.1007/s10792-020-01416-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of sutureless transscleral fixated intraocular lens (IOL) implantation and capsule stabilization of IOL optics on postoperative visual outcomes in cases with zonular dialysis in excess of 70°. METHODS Fifteen eyes of thirteen patients with > 70° zonular dialysis and endothelial cell counts higher than 1500 cells/mm2 who had been followed for at least 6 months were included. A modified surgical approach was applied to these eyes with sutureless transscleral fixated IOL implantation and the IOL was secured to the capsulorhexis to stabilize the lens capsule (optic capture). RESULTS The mean best-corrected visual acuity (BCVA) was 0.21 ± 0.2 on the first day, 0.45 ± 0.33 on the first week, 0.60 ± 0.32 on the first month, 0.80 ± 0.26 on the third month, and 0.82 ± 0.27 on the sixth month. When preoperative BCVA and postoperative BCVA were compared, a statistically significant increase was observed in postoperative BCVA beginning from the seventh postoperative day. There was a statistically significant (p = 0.038) decrease in endothelial cell count at postoperative third and sixth months (1895 ± 65, 1872 ± 376, respectively) compared to preoperative values. CONCLUSIONS The use of this new surgical modification that utilizes capsular tension rings combined with a procedure that secures the sutureless scleral IOL fixation to the capsulorhexis for the treatment of eyes with zonular dialysis in excess of 70° was found to be very successful in the 6 months of follow-up. More cases and longer follow-up periods are required to provide an idea as to whether different complications will develop in such patients.
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Affiliation(s)
- Ibrahim Taskin
- Private Niveye Center, Ophthalmology Clinic, Adana, Turkey
| | - Deniz Altinbay
- Private Niveye Center, Ophthalmology Clinic, Adana, Turkey.
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Czajka MP, Frajdenberg A, Stopa M, Pabin T, Johansson B, Jakobsson G. Sutureless intrascleral fixation using different three-piece posterior chamber intraocular lenses: a literature review of surgical techniques in cases of insufficient capsular support and a retrospective multicentre study. Acta Ophthalmol 2020; 98:224-236. [PMID: 31788964 DOI: 10.1111/aos.14307] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023]
Abstract
We present a literature review of surgical techniques of intraocular lens placement in eyes with insufficient capsular support, focusing on the most recent publications, together with a retrospective multicentre consecutive case series analysis of 103 eyes undergoing pars plana vitrectomy and sutureless intrascleral (SIS) fixation of a standard three-piece PCIOL. Many different approaches appear in the literature without any specific procedure achieving superior outcomes. Advantages and disadvantages vary between techniques. Common complications related to IOL fixation techniques were as follow: anterior chamber IOL: transient/permanent corneal oedema (9-66.6%), uveitis (1.1-39.3%); iris-fixated IOL: pupil ovalization (16-47.7%); and sutured scleral-fixated IOL: suture breakage/exposure (6.1-11%), vitreous haemorrhage: (5.5-16.6%). In our retrospective case series, indications for surgery were postoperative aphakia in 50 eyes (49%), IOL dislocation in 38 eyes (37%) and natural lens dislocation in 15 eyes (14%). Scleral tunnels for haptic fixation were created with (28 eyes, 27.2%) or without (75 eyes, 72.8%) 25 gauge trocar cannulas. Complications included transient hypotony (n = 20; 19.4%), corneal decompensation (n = 7; 6.7%), IOL dislocation (n = 6; 5.8%), cystoid macular oedema (n = 5; 4.8%), vitreous haemorrhage (n = 4; 3.8%) and retinal detachment (n = 4; 3.8%). Mean best corrected visual acuity improved from logMAR 0.65 to 0.36 at the final visit (p = 0.001). In conclusion, SIS fixation provides good anatomical and functional outcomes; however, complications can occur. The number of surgical approaches for IOL dislocation described in the literature indicates that optimal treatment remains to be found.
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Affiliation(s)
- Marcin Piotr Czajka
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Agata Frajdenberg
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Marcin Stopa
- Department of Ophthalmology Chair of Ophthalmology and Optometry Heliodor Swiecicki University Hospital Poznan University of Medical Sciences Poznan Poland
| | - Tomasz Pabin
- Department of Ophthalmology Chair of Ophthalmology and Optometry Heliodor Swiecicki University Hospital Poznan University of Medical Sciences Poznan Poland
| | - Björn Johansson
- Department of Ophthalmology and Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - Gunnar Jakobsson
- Department of Ophthalmology Sahlgrenska University Hospital Gothenburg Sweden
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Clinical Characteristics of Intraocular Lens Dislocation in Chinese Han Populations. J Ophthalmol 2020; 2020:8053941. [PMID: 32411436 PMCID: PMC7201720 DOI: 10.1155/2020/8053941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/07/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the clinical characteristics of patients with intraocular lens (IOL) dislocation after IOL implantation in Chinese Han populations. Methods The medical records of patients with IOL dislocation were retrospectively reviewed from January 2007 to December 2017, and a total of 312 patients (male: 231, female: 97) (328 eyes) were included in this study. The axial length (AL), IOL power, and the time interval between cataract surgery and IOL dislocation as well as the ocular conditions associated with IOL dislocation were recorded. The IOL dislocation was classified and graded based on its relationship with the capsule and the position of the dislocated IOL. Results The mean time between original cataract surgery and IOL dislocation was 5.63 ± 5.13 years; IOL dislocation occurred in up to 56.1% (184 eyes) of the eyes within 5 years. Trauma was found in 136 eyes (41.5%); pars plana vitrectomies were performed in 61 eyes (18.6%), and high myopia was detected in 108 eyes (32.9%). A total of 243 eyes (74.1%) had out-of-the-bag IOL dislocations, while 85 eyes (25.9%) had in-the-bag IOL dislocations. There was a statistically significant difference in the constituent ratio of trauma between in-the-bag dislocation and out-of-the-bag dislocation (Pearson's chi2 = 33.3992, P < 0.001); ocular blunt traumas were significantly higher in in-the-bag dislocations, while open-globe injuries were significantly higher in out-of-the-bag dislocations. A statistically significant difference was found for the ratio of patients with AL longer than 30 mm between in-the-bag dislocation and out-of-the-bag dislocation (Pearson's chi2 = 9.7355, P < 0.002). Conclusions In Chinese Han populations, the most common IOL dislocation is out-of-the-bag dislocation; the most common risk factors were trauma, long axial length, and eyes undergoing pars plana vitrectomy; a minimum follow-up of 5 years is suggested for IOL dislocation-predisposed eyes undergoing cataract surgery.
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Castanos MV, Najac T, Dauhajre J, Buxton DF. Late intraocular Lens dislocation following scleral depression: a case report. BMC Ophthalmol 2020; 20:39. [PMID: 32000720 PMCID: PMC6990508 DOI: 10.1186/s12886-020-1327-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background The case describes a rare entity. Most cases of IOL dislocation are associated with surgical trauma or preexisting zonulopathy. This patient presents IOL dislocation following routine exam, suggesting the need of careful evaluation of zonular integrity on pseudopahkic patients. Methods Patient is a 65 year old who presented with sudden loss of vision and pain following retinal examination using scleral depression. Patient was diagnosed with late intraocular lens dislocation, which was subsequently for proper repositioning of IOL. Conclusion Pseduophakic eyes should be approached with caution when scleral indentation is attempted due to the possibility of zonular dehiscence and subsequent intraocular lens dislocation.
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Affiliation(s)
- Maria V Castanos
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA.
| | - Tyler Najac
- Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Jacqueline Dauhajre
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
| | - Douglas F Buxton
- New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th St, New York, NY, 10003, USA
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Brunin G, Sajjad A, Kim EJ, Montes de Oca I, Weikert MP, Wang L, Koch DD, Al-Mohtaseb Z. Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes. J Cataract Refract Surg 2019; 43:369-376. [PMID: 28410720 DOI: 10.1016/j.jcrs.2016.12.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/09/2016] [Accepted: 12/19/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. SETTING Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN Retrospective case series. METHODS All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. RESULTS The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. CONCLUSIONS When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.
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Affiliation(s)
- Greg Brunin
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ahmar Sajjad
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Eric J Kim
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Ildamaris Montes de Oca
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Mitchell P Weikert
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Li Wang
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Douglas D Koch
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Zaina Al-Mohtaseb
- From the Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
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Kristianslund O, Dalby M, Moe MC, Drolsum L. Cost-effectiveness analysis in a randomized trial of late in-the-bag intraocular lens dislocation surgery: repositioning versus exchange. Acta Ophthalmol 2019; 97:771-777. [PMID: 30968572 DOI: 10.1111/aos.14108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/14/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the cost-effectiveness of two operation methods for late in-the-bag intraocular lens (IOL) dislocation. METHODS In this randomized clinical trial, 104 patients were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillary iris-claw lens (n = 50). A cost-effectiveness analysis (CEA) was performed in conjunction with previously published 6-month efficacy and safety results. An incremental cost-effectiveness ratio was calculated as the cost difference between the operation groups relative to their difference in postoperative corrected distance visual acuity (CDVA) (mean and 95% confidence interval: minimum and maximum), reported as the cost difference in United States Dollars ($) per logMAR difference. RESULTS Exchange surgery was $281.20 ± 17.66 more expensive than repositioning, mainly explained by the new IOL and the frequent use of anterior vitrectomy. A previous trial publication revealed no significant difference in the 6-month postoperative CDVA between the groups. In the CEA, the mean group difference yielded an incremental cost-effectiveness ratio of -$281.20 per -0.11 logMAR (-$1108/QALY) in favour of repositioning, ranging from -$281.20 per -0.29 logMAR (-$406/QALY) in favour of repositioning to +$281.20 per -0.08 logMAR (+$1522/QALY) in favour of exchange. The CEA did not include the mean 9.5 min shorter operation time for exchange. CONCLUSION Repositioning tended to be more cost-effective than exchange; however, this is modified if also considering the operation time. Overall, it seems the cost-effectiveness is not alone sufficiently different to recommend one of the operation methods over the other for late in-the-bag IOL dislocation.
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Affiliation(s)
- Olav Kristianslund
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Marius Dalby
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Morten C. Moe
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Liv Drolsum
- Department of Ophthalmology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Dalby M, Kristianslund O, Drolsum L. Long-Term Outcomes after Surgery for Late In-The-Bag Intraocular Lens Dislocation: A Randomized Clinical Trial. Am J Ophthalmol 2019; 207:184-194. [PMID: 31194950 DOI: 10.1016/j.ajo.2019.05.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the long-term efficacy and safety of 2 operation methods for late in-the-bag intraocular lens (IOL) dislocation. DESIGN Prospective, randomized, parallel group surgical clinical trial. METHODS During a 3-year period, 104 patients (104 eyes) were assigned one group for IOL repositioning by scleral suturing (n = 54) or one group for IOL exchange by retropupillary fixation of an iris claw IOL (n = 50). A single surgeon performed all operations using an anterior approach. Patients were examined before surgery and at 6 months and 1 and 2 years after surgery. The present study included the 66 patients (63%) who completed the 2-year follow-up, and the main outcaome measurement was corrected distance visual acuity (CDVA) 2 years after surgery. RESULTS After 2 years, the mean CDVA was 0.20 ± 0.29 logarithm of the minimum angle of resolution (logMAR) units (range, -0.18 to 1.10) in the repositioning group and 0.22 ± 0.30 logMAR (range, -0.10 to 1.22) in the exchange group (P = .69). A CDVA of 20/40 or better was achieved by 76% of all patients. Four eyes (12%) had cystoid macular edema in the repositioning group compared with 5 eyes (15%) in the exchange group. Two eyes underwent redislocation (1 in each group). There were no cases of endophthalmitis or retinal detachment. CONCLUSIONS There were no significant differences between the visual acuity using IOL repositioning and that using IOL exchange 2 years after surgery. The two methods were equally efficient and safe from a long-term perspective and are both considered acceptable treatments.
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de Rojas MV, Viña S, Gestoso A, Simón P, Álvarez M. Intraocular lens explantation in Spain: indications and outcomes at a tertiary referral center from 2010 to 2018. Int Ophthalmol 2019; 40:313-323. [PMID: 31565759 DOI: 10.1007/s10792-019-01181-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/22/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the causes of IOL explantation, techniques for secondary IOL implantation, visual outcomes and complications. METHODS Setting: Department of Ophthalmology Complexo Hospitalario Universitario A Coruña, Spain. DESIGN Retrospective study. All explanted IOLs from January 2010 to June 2018 were included. Medical records were reviewed to determine the surgical indication for IOL explantation, type of IOL implanted, time between surgeries, visual outcomes and surgical complications. RESULTS One hundred forty-one IOLs were explanted (134 patients). Mean time from original surgery to IOL explantation was 7.89 ± 5.81 years. Causes of IOL explantation were IOL dislocation (81.56%)-in-the-bag IOL dislocation (71.63%), out-of-the-bag IOL dislocation (9.9%)-corneal decompensation (12.05%), refractive surprise (3.5%), uveitis-glaucoma-hyphema syndrome (1.4%), IOL opacification (1.4%). Procedures for secondary IOL implantation were retropupillar iris-claw IOL (63.8%), flanged scleral fixated IOL (9.2%), three-piece IOL in ciliary sulcus (8.5%), angle-supported anterior chamber IOL (7.1%), in-the-bag IOL (3.5%), scleral fixated IOL with sutures (0.7%). Ten cases (7.1%) were left aphakic. Mean preoperative and postoperative logMAR CDVA were 1.34 ± 0.87 and 0.63 ± 0.69, respectively (p = 0.000). Mean preoperative IOP and postoperative IOP were 16.78 ± 4.49 and 15.53 ± 3.476 mmHg, respectively (p = 0.005). Complications include cystoid macular edema (7.8%), glaucoma (7.1%), IOL luxation (2.1%), retinal detachment (1.4%), trophic ulcer and leucoma (1.4%), corneal decompensation (1.4%). CONCLUSIONS In-the-bag IOL dislocation was the most frequent indication for IOL explantation, followed by pseudophakic bullous keratopathy. Simultaneous IOL exchange for a retropupillar iris-claw IOL was the most frequent procedure for secondary IOL implantation. Mean CDVA improved significantly and IOP decreased significantly after IOL explantation. The most frequent postoperative complication was cystoid macular edema.
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Affiliation(s)
- Mª Victoria de Rojas
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain.
| | - Sara Viña
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
| | - Antía Gestoso
- Department of Ophthalmology, Hospital Povisa, Vigo, Spain
| | - Patricia Simón
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
| | - Marcelino Álvarez
- Department of Ophthalmology Hospital Abente y Lago, Complexo Hospitalario Universitario A Coruña, Plaza del Parrote s/n, 15006, A Coruña, Spain
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Lee YH, Kim YC. In-the-bag dislocation of polyfocal full-optics accommodative intraocular lens: A case report. Indian J Ophthalmol 2019; 67:1200-1202. [PMID: 31238464 PMCID: PMC6611258 DOI: 10.4103/ijo.ijo_1552_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Herein, we report a case of in-the-bag dislocation of a WIOL-CF® polyfocal full-optics intraocular lens (IOL), without a history of trauma. A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye. He had undergone uneventful phacoemulsification with WIOL-CF® IOL implantation in the left eye at the local clinic 7 years prior. In fundus examination, IOL-capsular bag complex dislocated into the posterior vitreous was observed. We believe this is the first report of in-the-bag dislocation of a WIOL-CF® IOL that has been subluxated or dislocated in a characteristic pattern, not an in-the-bag pattern.
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Affiliation(s)
- You Hyun Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea
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Belin PJ, Raouf S, Lieberman RM. Innovations in Secondary Intraocular Lens Placement. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2019; 4:177-191. [DOI: 10.1016/j.yaoo.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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High intraocular pressure in eyes with late in-the-bag intraocular lens dislocation. J Cataract Refract Surg 2019; 45:1043-1044. [DOI: 10.1016/j.jcrs.2019.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/27/2019] [Indexed: 11/18/2022]
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Subasi S, Yuksel N, Karabas VL, Yilmaz Tugan B. Late in-the-bag spontaneous IOL dislocation: risk factors and surgical outcomes. Int J Ophthalmol 2019; 12:954-960. [PMID: 31236352 DOI: 10.18240/ijo.2019.06.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the possible predisposing risk factors for late in-the-bag spontaneous IOL dislocations and to study the early surgical and visual outcomes of repositioning and exchange surgeries. METHODS Medical and surgical records of 39 eyes of 39 patients who underwent IOL repositioning or exchange surgery for dislocation between 2010 and 2018 were reviewed. Possible predisposing risk factors and some characteristics of late in-the-bag spontaneous IOL dislocations; outcomes of IOL repositioning and exchange surgeries, including visual acuity, refractive status before and after surgery and postoperative complications were evaluated. RESULTS The predisposing factors for late in-the-bag spontaneous IOL dislocations were pseudoexfoliation [PEX; 12/39 (30.8%)], previous vitreoretinal surgery [7/39 (17.9%)], axial myopia [3/39 (7.7%)], both PEX and axial myopia [1/39 (2.6%)], both previous vitreoretinal surgery and axial myopia [2/39 (5.1%)] and uveitis [1/39 (2.6%)]. The mean interval between cataract and dislocation surgery was 7.23y, greater in PEX positive group (8.63y). The mean best corrected visual acuity (BCVA) improved significantly after dislocation surgery (P<0.001) and also improved significantly after exchange surgery (P=0.001). The mean value of spherical equivalant decreased significantly after dislocation surgery (P=0.011), whereas corneal astigmatism increased but this difference was not significant after dislocation surgery and exchange surgery (P=0.191, P=0.074, respectively). CONCLUSION The most prevelant risk factors for late in-the-bag spontaneous IOL dislocations are PEX, previous vitreoretinal surgery and axial myopia. In the management of IOL dislocations, exchange surgery with small corneal incision seemed effective with improved BCVA and safety with low postoperative complications.
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Affiliation(s)
- Sevgi Subasi
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli 41380, Turkey
| | - Nursen Yuksel
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli 41380, Turkey
| | - V Levent Karabas
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli 41380, Turkey
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Srinivasan S. In-the-bag intraocular lens dislocation: A ticking time bomb. J Cataract Refract Surg 2019; 45:259-260. [DOI: 10.1016/j.jcrs.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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