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Guerin PL, Guerin GM, Pastore MR, Gouigoux S, Tognetto D. Long-term functional outcome between Yamane technique and retropupillary iris-claw technique in a large study cohort. J Cataract Refract Surg 2024; 50:605-610. [PMID: 38350232 PMCID: PMC11146187 DOI: 10.1097/j.jcrs.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To evaluate which secondary intraocular lens (IOL) implantation technique was more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw IOL (ICIOL) and flanged intrascleral IOL (FIIOL) fixation with the Yamane technique. SETTING Eye Clinic of the University of Trieste, Trieste, Italy. DESIGN Retrospective observational study. METHODS 116 eyes of 110 patients who underwent ICIOL or FIIOL were analyzed. Patients with follow-up shorter than 6 months or with incomplete clinical data were excluded. Collected data included demographics, ocular comorbidity, indication of surgery, intraocular pressure, early (≤1 month) and late (>1 month) postoperative complications, corrected distance visual acuity (CDVA), and manifest refraction at the last follow-up visit. RESULTS 50% (n = 58) of eyes underwent FIIOL and 50% (n = 58) ICIOL implantation for aphakia (n = 44, 38%) and IOL dislocation (n = 72, 62%). No statistically significant differences in demographics, comorbidity, follow-up duration, postoperative complications, and surgical indications were found. The refractive prediction error (RPE) was 0.69 ± 0.94 diopter (D) in the FIIOL group and 0.21 ± 0.75 D in the ICIOL group ( P = .03), indicating residual hyperopia after both techniques. RPE, mean absolute error, and median absolute error were higher in the FIIOL group ( P = .003). ICIOL implantation was more successful in obtaining a RPE between -0.50 D and +0.50 D (52% of ICIOL, n = 30, and 31% of FIIOL, n = 18). CONCLUSIONS Both techniques were effective in increasing preoperative CDVA with no statistical difference between them. Although complication rates did not significantly differ, the FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-piece IOL, as performed in ciliary sulcus implantation, to prevent myopic shift, is not recommended.
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Affiliation(s)
- Pier Luigi Guerin
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Gian Marco Guerin
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Marco Rocco Pastore
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Stefano Gouigoux
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- From the Eye Clinic, Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
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Chen FF, Jiang F, Zhang WW, Liu YJ, He ZF, Xie ZG. Six-point scleral fixation of a three-looped haptics one-piece posterior chamber intraocular lens by a single suture. Indian J Ophthalmol 2024; 72:S319-S322. [PMID: 38271430 DOI: 10.4103/ijo.ijo_1093_23] [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: 04/26/2023] [Accepted: 08/07/2023] [Indexed: 01/27/2024] Open
Abstract
To evaluate a novel technique for six-point scleral fixation of a three-looped haptics posterior chamber intraocular lens (PCIOL) by a single suture. Nine eyes of nine patients were studied from September 2021 to March 2023. All patients had undergone vitrectomy. Only a single 9-0 polypropylene suture was used for scleral fixation. The three looped haptics were fixed at 12, 4, and 8 o'clock with six-point scleral fixation. The entire procedure took about 30 min. Among the nine patients, eight (88.8%) eyes had a significant improvement in best-corrected visual acuity, whereas one (11.2%) eye showed no change. No intraoperative or postoperative complications were observed. By ultrasonic biomicroscopy examination, intraocular lenses were well positioned and stable with no tilt in the horizontal and vertical axis. The method of six-point scleral fixation of a three-looped haptics PCIOL by a single suture is safe and effective.
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Affiliation(s)
- Fei-Fei Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing, Jiangsu Province, China
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Bin Helayel H, Balbaid NT, Fairaq R, Bin Dakhil TA, Al-Blowi M, Al-Swailem SA, Khandekar R, AlMutlak M. Assessment of refractive outcomes in eyes that underwent intraocular lens implantation in the posterior chamber but not "in-the-capsular bag:" A comparative retrospective study. Saudi J Ophthalmol 2024; 38:71-77. [PMID: 38628420 PMCID: PMC11017000 DOI: 10.4103/sjopt.sjopt_186_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The purpose of this study was to report visual and refractive outcomes in eyes that underwent intraocular lens (IOL) fixation in the absence of capsular support. METHODS This was a retrospective chart review of cases undergoing posterior chamber iris-fixated IOL (IFIOL) and scleral-fixated IOL (SFIOL) implants from June 2014 to March 2020 with more than 3 months of follow-up and having a preoperative best-corrected visual acuity of 20/80 and more. RESULTS Records of 120 eyes of 112 patients were reviewed. The mean age of the patients was 46.9 ± 22.3 (14.4-98.0) years, and 62% (n = 70) of participants were male. Most of the eyes (102: 85%) were aphakic at the time of surgery. The mean follow-up was 22.95 ± 17.1 months. The efficacy index of sutured IFIOL and glued SFIOL outperformed sutured SFIOL at 3 months and final visits postoperatively (P < 0.001). All techniques studied here resulted in a similar safety index at 3 months (P = 0.4). The mean predictive error (postoperative spherical equivalent refraction minus intended target refraction) was +0.07 ± 1.5 D and -0.12 ± 1.4 D at 3 months and the final postoperative visit, respectively. CONCLUSION The studied techniques have relatively good visual and refractive outcomes in this series. In addition, techniques involving a small corneal incision with foldable IOL fixation to the iris or scleral tissue have superior efficacy and safety indices compared to creating large corneoscleral wounds for rigid IOL fixation techniques.
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Affiliation(s)
- Halah Bin Helayel
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Rafah Fairaq
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Turki A. Bin Dakhil
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Al-Blowi
- Department of Optometry, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar A. Al-Swailem
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mohammed AlMutlak
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Wu K, Shi J, Zong Y, Xu G, Zhu H, Jiang C. Outcomes of Secondary Intracapsular Intraocular Lens Implantation in Patients following Rhegmatogenous Retinal Detachment. J Clin Med 2023; 12:7749. [PMID: 38137820 PMCID: PMC10743941 DOI: 10.3390/jcm12247749] [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: 11/02/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
This study reports the outcomes of a secondary IOL implantation technique in patients that suffered from rhegmatogenous retinal detachment combined with a cataract, which included reopening the capsular bag, enabling secondary intracapsular intraocular lens (IOL) implantation. We included consecutive cases with rhegmatogenous retinal detachment (RRD) treated with vitrectomy and silicone oil tamponade, and subsequent secondary IOL implantation during silicone oil removal between September 2019 and June 2022. Demographics, pre- and postoperative clinical data, and complications were collected. Visual and refractive outcomes and IOL position were evaluated. Thirty eyes were included and followed up for a mean of 24.2 ± 5.06 months. Compared with the preoperative values, no significant changes were observed in the intraocular pressure (p = 0.170) and endothelial cell density (p = 0.336); however, the best-corrected visual acuity (Snellen: 20/83 vs. 20/38; logMAR: 0.66 ± 0.23 vs. 0.37 ± 0.32; p < 0.001) and spherical equivalent (p < 0.001) improved significantly. The mean prediction error (ME) was -0.45 ± 0.68 D (-1.9-0.54 D), and the mean absolute prediction error (MAE) was 0.62 ± 0.52 D (0.01-1.9 D). The macula-on subgroup demonstrated significantly better refractive outcomes than the macula-off subgroup (ME, p = 0.046; MAE, p = 0.008). The IOL was well positioned, with a mean horizontal and vertical tilt and decentration of 0.53 ± 0.49° and 0.21 ± 0.16 mm, and 0.54 ± 0.45° and 0.22 ± 0.16 mm, respectively. Secondary intracapsular IOL implantation provided a good and stable IOL position and satisfactory refractive outcomes, and is a feasible treatment option for patients with RRD.
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Affiliation(s)
- Kaicheng Wu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Jiemei Shi
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Yuan Zong
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Gezhi Xu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
| | - Haohao Zhu
- Department of Ophthalmology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China
| | - Chunhui Jiang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, Shanghai 200031, China; (K.W.); (J.S.); (Y.Z.); (G.X.)
- Key Laboratory of Myopia of the State Health Ministry, Shanghai 200031, China
- Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai 200031, China
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Zhang J, Han X, Chen X, Liu Z, Zhang Y, Qiu X, Tan X, Luo L, Liu Y. Choice of intraocular lens calculation formula for cataract patients with prior pars plana vitrectomy. J Cataract Refract Surg 2023; 49:956-963. [PMID: 37440441 DOI: 10.1097/j.jcrs.0000000000001253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE To determine the optimal intraocular lens (IOL) calculation formula for vitrectomized eyes with diverse surgical and biometric characteristics. SETTING Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN Retrospective consecutive case series study. METHODS This study included 974 vitrectomized eyes (974 patients) scheduled for phacoemulsification with IOL implantation. 11 formulas were evaluated: Barrett Universal II (BUII), Emmetropia Verifying Optical, Hoffer-QST, Kane, Ladas Super Formula, Pearl-DGS, Radial Basis Function (RBF), Haigis, HofferQ, Holladay1, and SRK/T. Risk factors for prediction error (PE) exceeding 1 diopter (D) were determined using multiple logistic regression. Subgroup analyses were performed based on surgical history and biometric parameters. RESULTS The risk of hyperopic PE (>1 D) was higher in patients with silicone oil tamponade (odds ratio [OR], 1.82) and longer axial length (AL) (OR, 1.55), while patients with previous scleral buckling (OR, 2.43) or ciliary sulcus IOL implantation (OR, 6.65) were more susceptible to myopic PE (<-1 D). The Kane formula had the highest overall prediction accuracy, and also the best in silicone oil-filled eyes and the flat cornea subgroup. The BUII and RBF displayed the optimal performance in eyes with previous scleral buckle and steep cornea, respectively. In eyes with an AL ≥ 26 mm, the Holladay1 with the nonlinear version of the Wang-Koch AL adjustment (Holladay1-WKn) showed the lowest absolute PE and highest percentage within ± 1.0 D of PE. CONCLUSIONS The Kane achieved the highest overall prediction accuracy in vitrectomized eyes. The optimal formula for eyes with previous scleral buckle, steep cornea, or long AL was BUII, RBF, and Holladay1-WKn, respectively.
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Affiliation(s)
- Jiaqing Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China (J. Zhang, Han, Chen, Z. Liu, Y. Zhang, Qiu, Tan, Luo, Y. Liu); Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China (J. Zhang, Han, Chen, Z. Liu, Y. Zhang, Qiu, Tan, Luo, Y. Liu)
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Fossati G, Vallejo-Garcia JL, Raimondi R, Santoru F, Buzzi M, Ferraro V, Feo A, Rosetta P, Vinciguerra P, Vinciguerra R. Camellens FIL622-1 IOL Implantation in the Ciliary Sulcus: Refractive Outcomes and Optimization of A-constant. J Refract Surg 2022; 38:806-811. [PMID: 36476301 DOI: 10.3928/1081597x-20221026-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the refractive outcomes of patients who had sulcus implantation of the Camellens FIL622-1 intraocular lens (IOL) (Soleko) after posterior capsular rupture, and to optimize the A-constant suggested by the manufacturer. METHODS This study included patients who underwent secondary Camellens FIL622-1 IOL implantation in the ciliary sulcus after complicated cataract surgery with posterior capsular rupture. IOL power was calculated by the SRK/T formula, using the recommended A-constant (118.8) for ciliary sulcus implantation. A new optimized A-constant was obtained and used to evaluate the refractive outcomes. The main outcome measures were mean prediction error (PE), median absolute error (MedAE), mean absolute error (MAE), and percentage of eyes with a PE within ±0.50, ±1.00, and ±2.00 diopters (D). RESULTS Forty patients (40 eyes) were included in the study. The new optimized A-constant was 117.5, and the mean PE, MedAE, and MAE was -0.02 ± 0.73, 0.34, and 0.54, respectively. The percentage of eyes with a PE within ±0.50, ±1.00, and ±2.00 D was 65%, 87.5%, and 100%, respectively. CONCLUSIONS The Camellens FIL622-1 IOL represents a valid option as sulcus implantation after posterior capsular rupture and it would guarantee the surgeon an on-label option with a more accurate biometric calculation, at the time of surgical implantation, with the new optimized A-constant. [J Refract Surg. 2022;38(12):806-811.].
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Luo WJ, Hu SQ, Wang Y, Zheng HS, Zhou SW, Ortega-Usobiaga J. Comparison of the actual diameter of capsulotomy and predicted diameter of capsulotomy after femtosecond laser-assisted capsulotomy. J Cataract Refract Surg 2022; 48:1264-1269. [PMID: 35545817 DOI: 10.1097/j.jcrs.0000000000000970] [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: 03/22/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the consistency between the actual diameter of capsulotomy (ADC) and the predicted diameter of capsulotomy (PDC) in femtosecond laser-assisted cataract surgery (FLACS) and analyze the factors that influence the deviation of the diameter of capsulotomy (DDC) between the actual and predicted. SETTING Aier Eye Hospital of Wuhan University, China. DESIGN Retrospective observational case series. METHODS Patients who underwent FLACS from March 2020 to March 2021 were reviewed. The ADC in FLACS was measured and compared with the PDC. The effects of age, sex, and biometrics on DDC were analyzed. RESULTS 412 eyes of 336 patients were included. The mean age was 53.0 ± 0.91 years (range 3 to 91 years). When the PDC was set to 4.50 mm, the results showed that the ADC was 5.21 ± 0.21 mm with a significant difference between them ( P &lt; .05). However, when the PDC was set to 5.2 mm, the ADC was 5.10 ± 0.38 mm without a significant difference between them ( P &gt; .05). No correlation ( P &gt; .05) was found between the DDC and the axial length, the DDC and the anterior chamber depth (ACD), and the DDC and the mean keratometry (Km), but a negative correlation was found between the DDC and the lens thickness (LT) ( r = -0.21; P &lt; .05) and the DDC with age ( r = -0.70; P &lt; .05). Using curvilinear regression analysis, a development of an age-depending correction formula was predicted: ADC = PDC + 1.23 - 0.30 ln (x) (x = age ≥3) ( R2 = 0.65; F = 752.39; P = .00). CONCLUSIONS The consistency of the ADC and PDC was influenced by age and LT. For patients aged 40 years or younger, the younger the patient, the wider the DDC; for patients older than 40 years, the DDC was small. The thicker the LT, the smaller the DDC.
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Affiliation(s)
- Wen Jing Luo
- From the Aier Eye Hospital Affiliated to Wuhan University, Wuhan, Hubei Province, China (Luo, Hu, Wang, Zheng, Zhou); Department of Cataract and Refractive Surgery, Clínica Baviera, Aier Eye Hospital, Bilbao, Biscay, Spain (Ortega-Usobiaga)
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Dubinsky-Pertzov B, Mahler OS, Hecht I, Shemer A, Or L, Gazit I, Pras E, Einan-Lifshitz A. Accuracy of Intraocular Lens Calculation Formulas for the Four-Flanged Fixation Technique in Eyes With No Capsular Support. J Refract Surg 2022; 38:668-673. [DOI: 10.3928/1081597x-20220919-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tokuhisa T, Watanabe T, Watanabe A, Nakano T. Refractive error induced by intraocular lens tilt after intrascleral intraocular lens fixation. Int Ophthalmol 2022; 42:1213-1220. [PMID: 35064856 DOI: 10.1007/s10792-021-02106-3] [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: 01/31/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the spherical shift of intraocular lens (IOL) tilt after intrascleral fixation. METHODS We retrospectively reviewed the medical records of patients who underwent flanged intrascleral IOL fixation with transconjunctival 25- or 27-gauge pars plana vitrectomy at the Department of Ophthalmology of the Jikei University Hospital. The minimum follow-up duration was 3 months. Second-generation anterior segment optical coherence tomography (CASIA2; TOMEY) was used to obtain the values of tilt and decentration of the intrasclerally fixated IOL and postoperative anterior chamber depth. We investigated the relationship between refractive error and various parameters, such as IOL tilt and decentration, axial length, and keratometry. In addition to our clinical investigation, we conducted optical simulations using Zemax to evaluate the spherical shift of the IOL tilt by means of the through-focus response and change in spherical equivalent power. RESULTS The study involved 72 eyes of 67 patients. The degree of IOL tilt was correlated with the amount of refractive error (Spearman's rank correlation coefficient [CC] = - 0.32; P = 0.006). In particular, a tilt angle greater than 10° strongly affected the refractive error. The postoperative anterior chamber depth also correlated with the refractive error (CC = 0.50; P < 0.001), as opposed to decentration (CC = - 0.17; P = 0.15), axial length (CC = - 0.08; P = 0.49), and keratometry (CC = - 0.06; P = 0.64). Optical simulations also revealed a myopic shift that exponentially increased as the tilt became greater. CONCLUSION IOL tilts that are greater than 10° induce refractive error.
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Affiliation(s)
- Teruaki Tokuhisa
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan.
| | - Tomoyuki Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
| | - Akira Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minatoku, Tokyo, 105-0003, Japan
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Vingopoulos F, Nair A, See CW, Iyengar N, Haberman I, Sperber L, Lazzaro DR, Singh R, Ho A, Gupta O, Sharma S, Modi Y. POSITION OF IN-THE-BAG POSTERIOR CHAMBER INTRAOCULAR LENSES RELATIVE TO THE LIMBUS: Applications to Scleral-Sutured Lenses. Retina 2021; 41:1533-1540. [PMID: 33239547 DOI: 10.1097/iae.0000000000003044] [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: 11/26/2022]
Abstract
PURPOSE To characterize the true position of in-the-bag intraocular lenses (IOLs) relative to the limbus using ultrasound biomicroscopy and estimate scleral-sutured IOL positioning. METHODS This prospective single-center study included 70 eyes of 41 patients with in-the-bag posterior chamber IOLs. Four vertical ultrasound biomicroscopy captures were performed in each eye in the superior, inferior, nasal, and temporal quadrants. Postoperative biometric data were collected. The primary outcome was the vertical distance of the in-the-bag IOL from the sclerocorneal limbus. Secondary outcomes included anterior shift and refractive change of a theoretical scleral-sutured IOL using sclerotomies at 2.5 mm and 3 mm posterior to the limbus. RESULTS A total of 265 ultrasound biomicroscopy images were analyzed, including 64 superior, 69 inferior, 66 nasal, and 66 temporal. The true in-the-bag IOL position measured as distance posterior to the sclerocorneal limbus was 4.23 ± 0.56 mm superiorly, 4.22 ± 0.46 mm inferiorly, 3.95 ± 0.48 mm nasally, and 3.86 ± 0.52 mm temporally. The anterior shift of a theoretical scleral-sutured IOL was 0.60 mm for a 3-mm sclerotomy and 0.93 mm for a 2.5-mm sclerotomy, resulting in a theoretical myopic shift of 0.45 diopter (D) and 0.79 D, respectively, assuming a 15-D IOL. Larger biometric measurements correlated with a more posterior in-the-bag position. CONCLUSION True in-the-bag IOL position was found to be more posterior than estimates of scleral-sutured IOLs. Additional corrections in scleral-sutured IOL calculations may improve refractive outcomes.
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Affiliation(s)
- Filippos Vingopoulos
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
| | - Archana Nair
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
| | - Craig W See
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Nishanth Iyengar
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
| | - Ilyse Haberman
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
| | - Laurence Sperber
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
| | - Douglas R Lazzaro
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
| | - Rishi Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Allen Ho
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Omesh Gupta
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sumit Sharma
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Yasha Modi
- Department of Ophthalmology, NYU Langone Health, New York University, New York, New York
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Shuaib AM, Elhusseiny AM, Hassanein DH, Zedan RH, Elhilali HM. Predictive Value of Intraocular Lens Power Calculation Formulae in Children. Clin Ophthalmol 2021; 15:2527-2536. [PMID: 34168426 PMCID: PMC8216728 DOI: 10.2147/opth.s316697] [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: 04/23/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To compare the accuracy of IOL power calculation formulae in a large cohort of children who underwent IOL implantation. Setting Cairo University Children Hospital. Design Retrospective, case series. Methods A retrospective chart review of all children <14 years, who underwent primary or secondary IOL implantation in Cairo University Children Hospital from January 2016 to December 2019, was performed. Absolute prediction error (APE) was calculated for SRKII, SRK/T, Holladay I and Hoffer-Q formulae using the patients' AL, keratometric (K) readings, implanted IOL power and refraction done two months postoperatively. Results The study included 308 eyes of 255 patients with a mean age of 4.74 ± 3.19 years at the time of surgery. The mean K-reading was 43.42 ± 3.57 diopters (D) and mean AL was 22.01 ± 1.93 mm. The percentage of eyes with APE within 0.5D was 27.7% (85 eyes), 32.2% (99 eyes), 30.6% (94 eyes) and 25.4% (78 eyes) with SRK II, SRK/T, Holladay I and Hoffer-Q formulae, respectively. APE was significantly lower with the SRK/T formula (P≤0.004) and significantly higher with the Hoffer-Q formula (P≤ 0.002). There was a negative correlation between the age of the patient and the APE of the SRK II formula (P=0.02). Moreover, the SRK/T, Holladay and Hoffer-Q formulae APEs were affected by the average k-readings (P=0.019, 0.005 and 0.035) respectively. Conclusion The SRK/T and Holladay I formulae were the most predictable formulae in IOL power calculation in pediatric eyes.
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Lenglinger M, Bertelmann E. Iris and Lens Trauma - Iris Reconstruction. Klin Monbl Augenheilkd 2020; 237:1079-1086. [PMID: 32967032 DOI: 10.1055/a-1217-1199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Iris and lens injuries entail a large spectrum and occur in closed and open globe injuries. Depending on accompanying ocular trauma (e.g. corneal involvement) as well as on the extend of the injuries several different surgical options are available ranging from suturing techniques to special individualized implants. The aim of this article is to present and discuss current treatment options for lens and iris trauma in regards to typical cases.
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Choi SK, Jo MH, Park SH, Lee JJ, Byon IS, Lee JE, Park SW. Comparison of refractive deviations after phacovitrectomy according to the intraocular lens insertion method. Jpn J Ophthalmol 2020; 64:462-467. [PMID: 32857267 DOI: 10.1007/s10384-020-00761-0] [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: 01/20/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to compare refractive deviations between in-the-bag insertion, trans-scleral ciliary sulcus fixation, ciliary sulcus insertion, and ciliary sulcus insertion with optic capture after phacovitrectomy. STUDY DESIGN Single-unit, single-surgeon, retrospective study. METHODS Consecutive patients who underwent phacovitrectomy and intraocular lens (IOL) out-of-the-bag insertion simultaneously were retrospectively reviewed. Patients who underwent phacovitrectomy with IOL in-the-bag insertion were also included for comparison with those who underwent phacovitrectomy with out-of-the-bag insertion. Patients were classified into four groups based on the IOL insertion method. The average difference from the target spherical equivalent (SE) to postoperative SE was defined as the refractive deviation. Refractive deviations of the groups were compared. RESULTS The refractive deviation for the in-the-bag insertion (43 eyes) was -0.18 ± 0.50 Df, -0.84 ± 0.81 D for the trans-scleral ciliary sulcus fixation (43 eyes), -0.93 ± 0.68 D for the ciliary sulcus insertion (25 eyes), and -0.27 ± 0.50 D for the ciliary sulcus insertion with optic capture group (24 eyes). The trans-scleral ciliary sulcus fixation and ciliary sulcus insertion groups had significantly different deviations than the in-the-bag group (p < 0.001). There was no significant difference between the ciliary sulcus insertion with optic capture and the in-the-bag insertion groups (p = 0.100). CONCLUSION Refractive deviation was significantly different between the eyes that underwent trans-scleral ciliary sulcus fixation or ciliary sulcus insertion and the eyes that underwent in-the-bag insertion. However, there was no significant deviation among the eyes that underwent ciliary sulcus insertion with optic capture.
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Affiliation(s)
- Seung Kwon Choi
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Myung Ho Jo
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sun Ho Park
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jae Jung Lee
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung Who Park
- Department of Ophthalmology, Pusan National University College of Medicine, 179, Gudeok-ro, Seo-gu, Busan, 49241, South Korea. .,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
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14
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Qu Y, Duan P, Huo S, Li F, Li J. Sutured Intrascleral Posterior Chamber Intraocular Lens Fixation with Ciliary Sulcus Location Guided by Ultrasonic Biological Microscopy: A Retrospective Analysis of Anatomical and Refractive Outcome. J Ophthalmol 2020; 2020:5843410. [PMID: 32587761 PMCID: PMC7293751 DOI: 10.1155/2020/5843410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report the outcome of sutured intrascleral posterior chamber intraocular lens (PC IOL) fixation with ciliary sulcus location guided by ultrasonic biological microscopy (UBM). METHODS Patients who underwent a sutured intrascleral PC IOL fixation were reviewed and divided into four groups. In group 1, the traditional sulcus fixation (2 mm from limbus) of IOL was performed. In groups 2, 3, and 4, UBM was performed before surgery to locate the position of the ciliary sulcus as the haptics insertion position. IOL power was selected by decreasing the calculated value of the IOL power by 1.0 D, 1.0 D, 0.5 D, and 0.0 D, respectively. RESULTS Sixty-one patients (63 eyes) were included in the four groups. After 4.1 ± 3.0 months' follow-up, the postsurgery spherical equivalent (SE) was 0.73 ± 1.86, 0.71 ± 0.84, 1.14 ± 0.45, and 0.07 ± 0.89 diopters (D), respectively. Statistical significance was reached for the postsurgery SE with target refraction between group 1 (p = 0.027, <0.05), group 2 (p = 0.003, <0.01), and group 3 (p = 0.017, <0.05). No significant difference existed for the postsurgery SE with target refraction in group 4 (p = 0.779, >0.05), and the postsurgery SE in group 4 was the nearest to target refraction. CONCLUSION Intrascleral PC IOL fixation guided by UBM is helpful for locating the ciliary sulcus and satisfactory visual outcomes with a predictable IOL power calculation.
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Affiliation(s)
- Ya Qu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), 30th Gaotanyan Street, Shapingba, Chongqing 400038, China
| | - Ping Duan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), 30th Gaotanyan Street, Shapingba, Chongqing 400038, China
| | - Shujia Huo
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), 30th Gaotanyan Street, Shapingba, Chongqing 400038, China
| | - Fuliang Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), 30th Gaotanyan Street, Shapingba, Chongqing 400038, China
| | - Jiawen Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), 30th Gaotanyan Street, Shapingba, Chongqing 400038, China
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15
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Koçluk Y, Kasım B. Descemet membrane endothelial keratoplasty and intraocular lens implantation in cases of aphakic bullous keratopathy. Semin Ophthalmol 2020; 35:86-93. [PMID: 32105503 DOI: 10.1080/08820538.2020.1733031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To present the results of a modified sutured transcleral or sutureless intrascleral three-piece foldable intraocular lens (IOL) implantation with Descemet membrane endothelial keratoplasty (DMEK) in cases of aphakic bullous keratopathy (ABK) with inadequate capsular support.Methods: Twenty-one eyes of 21 patients with ABK and inadequate capsular support who underwent DMEK with three-piece foldable IOL implantation from September 2015 to June 2018 were analyzed, retrospectively. Two techniques were used in IOL implantation; sutureless intrascleral fixation of the IOL (ISF-IOL) and sutured transscleral-fixated IOL (TSF-IOL) implantation.Results: Rebubblings due to the graft detachment were needed in 9 (43%) of 21 eyes in the early postoperative period. At the last follow-up visit, 18 (85.7%) of DM grafts were attached. Any complication related to IOL implantation was not observed in the ISF-IOL cases. Exposure of the fixation suture in 1 (25%) of 4 TSF-IOL cases was seen, postoperatively. The increase in the mean best-corrected visual acuity (BCVA) at the last follow-up visit was statistically significant when compared to the mean preoperative BCVA (p < .001). The mean preoperative central corneal thickness was decreased from 883.3 ± 111.8 (700-1150) μm to 582.3 ± 118.2 (490-990) μm at the last follow-up visit (p < .001).Conclusion: DMEK combined with sutureless/sutured three-piece foldable IOL implantation appears to be a feasible method for the management in ABK without adequate capsular support. A faster visual recovery can be obtained with the techniques presented.
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Affiliation(s)
- Yusuf Koçluk
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | - Burcu Kasım
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
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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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17
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Kemer Atik B, Altan C, Agca A, Kirmaci A, Yildirim Y, Genc S, Taskapili M. The effect of intraocular lens tilt on visual outcomes in scleral-fixated intraocular lens implantation. Int Ophthalmol 2019; 40:717-724. [PMID: 31760546 DOI: 10.1007/s10792-019-01233-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/16/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the effect of scleral-fixated intraocular lens (IOL) tilt on visual outcomes. METHODS Ninety-four eyes of consecutive 94 patients who underwent scleral-fixated IOL implantation with Z-suture technique were included in this prospective study. The values of pre- and postoperative 12th month uncorrected visual acuity (UCVA), cylindrical refractive error, best-corrected visual acuity (BCVA) and corneal and lenticular astigmatism were recorded. The position of the implanted IOL was evaluated with anterior segment optical coherence tomography (AS-OCT). The relationships between the AS-OCT measurements and the visual acuity or refractive errors were investigated. RESULTS The IOL position was evaluated as tilted in 68 (72.3%) patients: 29 (30.8%) in both vertical + horizontal axes, 30 (31.9%) in the horizontal axis and 9 (9.6%) in the vertical axis. There were no significant differences between patients with and without tilt IOL position in terms of the UCVA, BCVA, cylindrical refractive error and lenticular astigmatism (p > 0.05, for each). The mean BCVA was significantly higher in the no-tilt group than in the both horizontal + vertical tilt and the vertical tilt groups (p = 0.03, p = 0.04, respectively). The mean lenticular astigmatism was significantly higher in the vertical tilt group than the other groups (p = 0.04). CONCLUSION Tilting in IOL position occurs commonly; however, IOLs with tilting on any of the axes do not have significantly worse outcomes when compared with IOLs with no tilt, in terms of visual results and refractive errors. On the other hand, tilting on the vertical axis is observed less commonly, yet is more effective on visual results and refractive errors, when compared with tilting on the horizontal axis.
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Affiliation(s)
- Burcu Kemer Atik
- Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Alper Agca
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asli Kirmaci
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yusuf Yildirim
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selim Genc
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Muhittin Taskapili
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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18
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Su D, Stephens JD, Obeid A, Borkar D, Storey PP, Khan MA, Hsu J, Garg SJ, Gupta O. Refractive Outcomes after Pars Plana Vitrectomy and Scleral Fixated Intraocular Lens with Gore-Tex Suture. Ophthalmol Retina 2019; 3:548-552. [PMID: 31277795 DOI: 10.1016/j.oret.2019.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/08/2019] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate refractive outcomes after combined pars plana vitrectomy (PPV) and scleral fixation of an intraocular lens (IOL) using Gore-Tex suture. DESIGN Retrospective cohort study. PARTICIPANTS Fifty-five eyes from 53 patients who underwent PPV with a Gore-Tex sutured IOL from June 2013 through December 2017. METHODS Patients who underwent combined PPV and scleral fixation of an IOL with Gore-Tex suture were identified. All eyes underwent scleral fixation of either an Akreos A060 or enVista MX60 IOL and were fixated either 2 mm or 3 mm posterior to the limbus. Postoperative manifest refractions were performed at least 3 months after surgery and were compared with preoperative predicted target refraction based on in-the-bag IOL calculations. Subgroup analyses based on sclerotomy placement and IOL models were performed. MAIN OUTCOME MEASURES Postoperative manifest refraction and difference with sclerotomy placement and IOL model. RESULTS The mean postoperative spherical equivalent (SEQ) was -0.99±1.00 diopters (D). The mean difference in SEQ (ΔSEQ) from preoperative predicted target was -0.64±1.00 D. The IOL was fixated 2 mm posterior to the limbus in 14 eyes and 3 mm in 41 eyes. Within these 2 subgroups, the mean postoperative SEQ was -1.53±1.35 D for fixation 2 mm posterior to the limbus and -0.82±0.83 D for fixation 3 mm posterior to the limbus (P = 0.09). The mean ΔSEQ was -0.43±0.71 D for fixation 3 mm posterior to the limbus and -1.35±1.32 D for fixation 2 mm posterior to the limbus (P = 0.03). The mean amount of surgically induced astigmatism in the overall cohort was 0.77±0.65 D. The mean ΔSEQ and induced astigmatism were similar between IOL models. CONCLUSIONS After combined PPV and Gore-Tex-sutured IOL implantation, mean postoperative refractive outcomes were more myopic when the IOL was fixated 2 mm from the limbus compared with 3 mm from the limbus. No significant difference was found between IOL models. Based on these results, future implant power calculations may be adjusted to approximate preoperative target refraction more accurately.
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Affiliation(s)
- Daniel Su
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - John D Stephens
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Anthony Obeid
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Durga Borkar
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Philip P Storey
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - M Ali Khan
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania; Retina Division, Doheny and Stein Eye Institutes, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason Hsu
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sunir J Garg
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Omesh Gupta
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
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19
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Alfonso JF, Lisa C, Alfonso-Bartolozzi B, Fernández-Vega-Cueto L, Montés-Micó R. Implantable Collamer Lens
®
for Management of Pseudophakic Ametropia in Eyes With a Spectrum of Previous Corneal Surgery. J Refract Surg 2018; 34:654-663. [DOI: 10.3928/1081597x-20180815-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/13/2018] [Indexed: 11/20/2022]
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Chantarasorn Y, Techalertsuwan S, Siripanthong P, Tamerug A. Reinforced scleral fixation of foldable intraocular lens by double sutures: comparison with intrascleral intraocular lens fixation. Jpn J Ophthalmol 2018; 62:365-372. [PMID: 29464488 DOI: 10.1007/s10384-018-0579-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 01/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study is to describe a new technique for small-incision scleral fixation of intraocular lens (IOL) using double 10-0 polypropylene sutures, and to report the outcomes of IOL position compared with intrascleral IOL fixation at 12-month follow-up. STUDY DESIGN A retrospective comparative study. METHOD This new technique, called double sutured scleral fixated-IOL (DSF-IOL), was created to help with long-term knots strengthening by applying double sutures to each IOL haptic using an augmented Clove-hitch knot instead of the conventional knots tied by single suture. The tilt and decenter of IOL were measured by Scheimpflug camera and other refractive outcomes were compared between two groups at 12-month follow-up. RESULTS This study consisted of 26 eyes (54.2%) from the DSF-IOL group, and 22 eyes (45.8%) from the intrascleral fixated IOL (ISF-IOL) group. No significant differences of mean absolute degree of IOL tilt (2.90 ± 0.77 vs 2.82 ± 0.72; p = 0.633) and IOL decenter (151.90 ± 59.80 vs 175.0 ± 73.14 microns; p = 0.265) were found between the two groups. Post-operative LogMAR visual acuity was not statistically different between the two groups (0.32 ± 0.17 vs 0.41 ± 0.19, p = 0.089). Early post-operative hypotony was only present in the ISF-IOL group (13.6%). CONCLUSION This study shows that DSF-IOL is as effective as ISF-IOL. This technique can be a simpler approach to optimize small-incision scleral fixation of IOL without the complications associated with intrascleral IOL fixation.
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Affiliation(s)
- Yodpong Chantarasorn
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Dusit, Bangkok, 10300, Thailand.
| | - Settapong Techalertsuwan
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| | - Pongsavit Siripanthong
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
| | - Anurak Tamerug
- School of medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Street, Bangkok, 10300, Thailand
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Stem MS, Todorich B, Woodward MA, Hsu J, Wolfe JD. Scleral-Fixated Intraocular Lenses: Past and Present. ACTA ACUST UNITED AC 2017; 1:144-152. [PMID: 29104957 DOI: 10.1177/2474126417690650] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan's syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement in the anterior chamber (ACIOLs), fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the pre-operative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.
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Affiliation(s)
- Maxwell S Stem
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | - Bozho Todorich
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | - Jason Hsu
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jeremy D Wolfe
- Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, MI
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22
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Eom Y, Hwang HS, Hwang JY, Song JS, Kim HM. Posterior Vault Distance of Ciliary Sulcus-Implanted Three-piece Intraocular Lenses According to Ciliary Sulcus Diameter. Am J Ophthalmol 2017; 175:52-59. [PMID: 27939559 DOI: 10.1016/j.ajo.2016.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 11/25/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the correlation among preoperative biometry data, postoperative ciliary sulcus diameter, posterior vault distance, and effective lens position of ciliary sulcus-implanted intraocular lenses (IOLs). DESIGN Retrospective interventional case series. METHODS Twenty-six eyes of 26 patients underwent phacoemulsification with implantation of a ZA9003 IOL (Abbott Medical Optics Inc, Santa Ana, California, USA) in the ciliary sulcus. We analyzed correlations among preoperative biometry data and ultrasound biomicroscopy measurements, ciliary sulcus diameter, posterior vault distance, and effective lens position. Regression analyses were performed to identify which combination of preoperative biometry data, average corneal power (keratometry [K]), anterior chamber depth (ACD), and axial length (AL) was best for predicting effective lens position. RESULTS The sulcus diameter was shorter in eyes that had a steep cornea and shorter AL. The posterior vault distance was negatively correlated with sulcus diameter in subjects who had shorter postoperative time intervals (≤24 months) (R2 = 0.336 and P = .038). The posterior vault distance decreased with each passing postoperative month (R2 = 0.158 and P = .045). The R2 value for predicting the effective lens positions of sulcus-implanted IOLs based on the entire average K, ACD, and AL was higher than those based on parts of these values. CONCLUSIONS The effective lens position of sulcus-implanted IOLs can be affected by sulcus diameter, and lens position can change, especially in the early postoperative period. We recommend using the entire average K, ACD, and AL to predict the effective position of sulcus-implanted IOLs.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Jin Young Hwang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.
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23
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Eom Y, Song JS, Kim HM. Spectacle plane add power of multifocal intraocular lenses according to effective lens position. Can J Ophthalmol 2017; 52:54-60. [DOI: 10.1016/j.jcjo.2016.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/01/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
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24
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Choo HG, Lee JH, Kim SW. Clinical Outcome of Ciliary Sulcus-Implanted Single-Piece Foldable Acrylic Intraocular Lens. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.5.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hun Gu Choo
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong Hyuck Lee
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
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Modified Haigis Formula Effective Lens Position Equation for Ciliary Sulcus-Implanted Intraocular Lenses. Am J Ophthalmol 2016; 161:142-49.e1-2. [PMID: 26456253 DOI: 10.1016/j.ajo.2015.09.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the effect of a modified Haigis formula effective lens position equation on improving refractive outcomes in eyes with ciliary sulcus-implanted intraocular lenses (IOLs). DESIGN Retrospective cross-sectional study. METHODS One hundred thirty-two eyes of 132 consecutive patients who underwent phacoemulsification with implantation of a ZA9003 (Abbott Medical Optics Inc, Santa Ana, California, USA; 69 eyes) or AR40e (Abbott Medical Optics Inc; 63 eyes) IOL in the ciliary sulcus were enrolled. The modified effective lens position (ELP) equation based on the corneal radius (CR) (ELP - β0 - β1 × CR, where β0 and β1 are parameters in the linear regression analysis) was obtained using linear regression analysis in each IOL group, and was applied to the other IOL group in order to evaluate its effect on refractive outcomes in an independent data set. The median absolute error (MedAE) was predicted using the modified effective lens position equation and was compared with that predicted using the adjusted IOL power. RESULTS The modified effective lens position equation was ELP + 11.662 - 1.6225 × CR in the ZA9003 group and ELP + 10.606 - 1.4817 × CR in the AR40e group. The MedAE that was predicted using the modified effective lens position equation (0.34 diopter [D] in the ZA9003 group and 0.42 D in the AR40e group) was significantly smaller than that predicted using the adjusted IOL power (0.47 D in the ZA9003 group and 0.66 D in the AR40e group) (P < .001 and P = .005, respectively). CONCLUSIONS IOL power calculation using the modified Haigis formula effective lens position equation improved refractive outcomes in eyes with sulcus-implanted IOLs.
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Packer M, Teuma EV, Glasser A, Bott S. Defining the ideal femtosecond laser capsulotomy. Br J Ophthalmol 2015; 99:1137-42. [PMID: 25829488 PMCID: PMC4518749 DOI: 10.1136/bjophthalmol-2014-306065] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/09/2015] [Indexed: 11/23/2022]
Abstract
Purpose We define the ideal anterior capsulotomy through consideration of capsular histology and biomechanics. Desirable qualities include preventing posterior capsular opacification (PCO), maintaining effective lens position (ELP) and optimising capsular strength. Methods Laboratory study of capsular biomechanics and literature review of histology and published clinical results. Results Parameters of ideal capsulotomy construction include complete overlap of the intraocular lens to prevent PCO, centration on the clinical approximation of the optical axis of the lens to ensure concentricity with the capsule equator, and maximal capsular thickness at the capsulotomy edge to maintain integrity. Conclusions Constructing the capsulotomy centred on the clinical approximation of the optical axis of the lens with diameter 5.25 mm optimises prevention of PCO, consistency of ELP and capsular strength.
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Affiliation(s)
- Mark Packer
- Oregon Health & Science University, Eugene, Oregon, USA
| | | | - Adrian Glasser
- College of Optometry, University of Houston, Houston, USA
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Serna-Ojeda JC, Cordova-Cervantes J, Lopez-Salas M, Abdala-Figuerola AC, Jimenez-Corona A, Matiz-Moreno H, Chavez-Mondragon E. Management of traumatic cataract in adults at a reference center in Mexico City. Int Ophthalmol 2014; 35:451-8. [PMID: 25028216 DOI: 10.1007/s10792-014-9968-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 07/01/2014] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to determine the clinical presentation, mode of injury, surgical, and postoperative outcomes in adult patients with traumatic cataract. This is a clinical, observational, and retrospective study with review of records of patients in the period 2010-2012. Eighty patients were included, of whom 67 (83.75 %) were male. The mean age at presentation was 46 years (range 18-82 years). Sixty-four patients (80 %) had a closed-globe blunt ocular trauma and 16 (20 %) had an open-globe penetrating trauma. Seventy-seven (96.25 %) patients underwent phacoemulsification; 13.7 % (n = 11) required placement of capsular tension rings and 22.5 % (n = 18) automated anterior vitrectomy. In 53 % of the cases the intraocular lens (IOL) was placed in the capsular bag. Forty-seven patients (58.75 %) achieved a best-corrected visual acuity of 20/40 or better. In 57 (71.25 %) the final refraction was obtained, with a mean spherical equivalent of -0.56D (range -3.50D to +2.00 D). The improvement in visual acuity was significantly higher when the IOL was placed in the capsular bag compared to when it was placed in the sulcus (average difference of 0.667, p = 0.001). The most common mechanism of trauma is closed globe. Phacoemulsification was the procedure most common performed, with the IOL placed most commonly in the capsular bag. The final best-corrected visual acuity in most patients was 20/40 or better. Placing the IOL in the capsular bag represented an improvement in visual acuity compared to placement in the sulcus.
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Affiliation(s)
- Juan Carlos Serna-Ojeda
- Anterior Segment Department, Instituto de Oftalmologia "Conde de Valenciana", Chimalpopoca 14, 06800, Mexico, DF, Mexico,
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Abstract
Implantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.
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Affiliation(s)
- S Schulze
- Universitäts-Augenklinik Marburg, Philipps-Universität Marburg & Universitätsklinikum Gießen und Marburg GmbH, Baldingerstr., 35043, Marburg, Deutschland,
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Comparison of cornea endothelial cell counts after combined phacovitrectomy versus pars plana vitrectomy with fragmentation. Graefes Arch Clin Exp Ophthalmol 2013; 251:2187-93. [DOI: 10.1007/s00417-013-2440-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022] Open
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Millar ER, Allen D, Steel DH. Effect of anterior capsulorhexis optic capture of a sulcus-fixated intraocular lens on refractive outcomes. J Cataract Refract Surg 2013; 39:841-4. [DOI: 10.1016/j.jcrs.2012.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 11/26/2012] [Accepted: 12/21/2012] [Indexed: 10/27/2022]
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Carifi G, Zuberbuhler B, Teggihalli BC, Theoulakis P. Ciliary sulcus lens power. Ophthalmology 2012; 119:2416-7; author reply 2417. [PMID: 23122469 DOI: 10.1016/j.ophtha.2012.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/06/2012] [Indexed: 11/18/2022] Open
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