Incidence of rhegmatogenous retinal detachment after bag-in-the-lens intraocular lens implantation

Incidence of rhegmatogenous retinal detachment after bag-in-the-lens IOL implantation: extended follow-up in a larger cohort of patients

PURPOSE

To report the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique.

SETTING

Department of Ophthalmology, Antwerp University Hospital, Belgium.

DESIGN

Prospective cohort study.

METHODS

All consecutive BIL IOL surgeries performed between January 2001 and December 2010 were included, with the exclusion of combined procedures and IOL exchanges. The incidence of RRD was reported first in the total cohort, then in a subgroup of patients with 1 year to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors, except gender. Risk factors associated with RRD were examined using multiple Cox regression analysis with a random intercept.

RESULTS

Rhegmatogenous RD was diagnosed in 36 eyes (1.06%) of 3385 BIL cases, with a mean follow-up of 48.28 ± 40.05 months (range 0 to 195 months). The 2-year cumulative RRD incidence rate was 0.66% (17 cases in 1024 eyes; 0.00% in patients without risk factors). The 5-year cumulative RRD incidence rate was 1.17% (26 cases in 931 eyes; 0.15% without risk factors). Five risk factors were confirmed: male sex, age less than 60 years at the time of surgery, axial length 25.0 mm or greater, a history of contralateral RD, and intraoperative surgical complications.

CONCLUSIONS

The incidence of RRD after BIL IOL implantation is comparable with that of lens-in-the-bag (LIB) implantation. This larger study provided a longer follow-up and suggested that RRD incidence is even lower than that previously reported. This study also confirmed intraoperative surgical complications as an additional risk factor for RRD development, as already described with LIB implantation.

Bag-in-the-lens implantation helps avoid posterior synechiae of the iris after phacovitrectomy

PURPOSE

To compare the rate of posterior synechiae of the iris (PSI) occurrence after phacovitrectomy between a group with lens-in-the-bag (LIB) implantation, that is, implantation in the capsular bag, and a group with bag-in-the-lens (BIL) implantation.

SETTING

CHU de Caen, Department of Ophthalmology, Caen, France.

DESIGN

Comparative retrospective study.

METHODS

One hundred consecutive cases of phacovitrectomies conducted between May 2013 and July 2016 were included. A retrospective analysis of the occurrence rate of PSI in the LIB group and in the BIL group was performed, using multivariate analysis including multiple risk factors such as preoperative synechiae, proliferative diabetic retinopathy, use of 20-gauge vitrectomy, use of gas or silicone tamponade, and use of endophotocoagulation.

RESULTS

One hundred eyes of 92 patients were included in this study (55 eyes in the LIB group and 45 in the BIL group). The occurrence of PSI was significantly lower in the BIL group with 1 case (2%) versus 22 cases (40%) in the LIB group (P < .001). Among the risk factors studied, preoperative synechiae and the use of retinal endophotocoagulation were almost significantly associated with the occurrence of PSI (P = .068 and P = .087, respectively). In the LIB group, these PSI led to 1 case of acute elevation of intraocular pressure by pupillary seclusion and the use of laser iridotomy in 8 cases.

CONCLUSION

The use of BIL rather than LIB implantation in phacovitrectomy practically eliminates PSI.

Transzonular capsulo-hyaloidal hydroseparation with optional triamcinolone enhancement: A technique to detect or induce anterior hyaloid membrane detachment for primary posterior laser capsulotomy

Primary posterior laser capsulotomy (PPLC) requires adequate visualization and spacing of the posterior lens capsule (PLC) and anterior hyaloid membrane (AHM). After intraocular lens implantation and watertight incision hydration, the laser is redocked for optical coherence tomography reimaging. If the PLC and AHM are not imaged or interspaced adequately, transzonular capsulo-hyaloidal hydroseparation is attempted by rinsing the zonular fibers with fluid. If the PLC or AHM are still not detected or discernable, an attempt follows to mark the Berger space using diluted triamcinolone acetate. Before hydroseparation, the AHM or PLC are often invisible or variably attached. If structures cannot be defined, triamcinolone-added hydroseparation is often effective in defining the AHM and Berger space. Transzonular capsulo-hyaloidal hydroseparation with an optional triamcinolone acetate addition can initiate or complete AHM detachment and improve visibility and patency of Berger space for augmenting control and feasibility of PPLC.

Quantitation of lanosterol in the vitreous humor of rabbits after ocular administration of lanosterol/thermogel formulation by ultra high performance liquid chromatography-tandem mass spectrometry with the electrospray ionization mode

Cataracts are the most common cause of blindness worldwide affecting tens of millions of people. Here, we report a simple, rapid, sensitive and specific method by ultra performance liquid chromatography-tandem mass spectrometry with the electrospray ionization mode (UPLC-ESI-MS/MS) for quantitation of lanosterol, a possible effective drug for cataracts, in the vitreous humor of rabbits after ocular administration. The injected lanosterol was prepared by dispersing lanosterol molecules into the poly-(dl-lactic acid-co-glycolic acid)-poly(ethylene glycol)-poly-(dl-lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) thermogel solution. The analyte and internal standard (IS, panaxadiol) were extracted by the simple protein precipitation with methanol. The chromatographic separation used an Agilent RRHD SB-C₁₈ column with a methanol mobile phase containing 50mM of ammonium acetate aqueous solution (with 0.1% formic acid) (95:5, v/v). The protonated analyte was quantitated in positive ionization by multiple reaction monitoring (MRM) with a mass spectrometer. The mass transitions m/z 443.5→235 and m/z 461→127 were used to measure the analyte and IS, respectively. The assay exhibited a linear dynamic range of 1-1250ngmL^-1 for lanosterol in vitreous samples. The lower limit of quantitation (LLOQ) was 1ngmL^-1 with a relative standard deviation (RSD) of less than 15%. Acceptable precision and accuracy were obtained for concentrations over the standard curve ranges. A run time of 5min per sample offered a throughput of more than 200 samples per day. This validated method was used to analyze vitreous samples of New Zealand white rabbits for pharmacokinetic studies. The results provided useful information on pharmacological action mechanism of lanosterol and were meaningful for cataract treatment among the elderly population.

[Multifocal intraocular lens (MIOL) surgery in young non-presbyopic ametropes : Reasonable and safe?]

BACKGROUND

Refractive lens exchange and implantation of a multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses.

OBJECTIVES

This retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible.

MATERIALS AND METHODS

This retrospective case series comprised consecutively treated 32 eyes of 16 patients (5 myopic, 11 hyperopic patients; mean age 31 ± 6 years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed.

RESULTS

Related to distance corrected near visual acuity myopic eyes had a median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (P = 0.415). For intermediate vision, in both groups a lower EI (<0.5; P = 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up.

CONCLUSIONS

When neither laser refractive surgery nor implantation of a phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.

Effects of histone acetylation on superoxide dismutase 1 gene expression in the pathogenesis of senile cataract

Histone acetylation plays key roles in gene expression, but its effects on superoxide dismutase 1 (SOD1) expression in senile cataract remains unknown. To address this problem, the study was to investigate the influence of histone acetylation on SOD1 expression and its effects in the pathogenesis of senile cataract. Senile cataract was classified into three types—nuclear cataract (NC), cortical cataract (CC), and posterior subcapsular cataract (SC)—using the Lens Opacities Classification System III. In senile cataracts, SOD1 expression decreased significantly. Both H3 and H4 were deacetylated at −600 bp of the SOD1 promoter of cataract lenses, and hypoacetylated at −1500, −1200, and −900 bp. In hypoacetylated histones, the hypoacetylation pattern differed among the cataracts. In vitro, anacardic acid (AA) significantly reduced H3 and H4 acetylation at the SOD1 promoter, decreased protein expression, and induced cataract formation in rabbits. AA also inhibited HLEC viability and increased cell apoptosis. In contrast, trichostatin A (TSA) was able to efficaciously stop AA’s effects on both rabbit lenses and HLECs. Decreased histone acetylation at the SOD1 promoter is associated with declined SOD1 expression in senile cataracts. Histone acetylation plays an essential role in the regulation of SOD1 expression and in the pathogenesis of senile cataracts.