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Shoshany TN, Torjani A, Zhang Q, Syed ZA. Management and Outcomes of Traumatic Cataract During Open Globe Repair. Am J Ophthalmol 2024; 266:248-254. [PMID: 38801873 DOI: 10.1016/j.ajo.2024.05.017] [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: 02/24/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To compare outcomes of primary lensectomy (PL) versus no lensectomy (NL) during repair of zone I (involving cornea and limbus) and II (up to 5mm posterior to the limbus) open globe injuries (OGIs) with lens involvement. DESIGN Retrospective clinical cohort study. METHODS 107 patients with OGIs involving both blunt and penetrating injury to the lens who presented to Wills Eye Hospital between April 1, 2017 and August 31, 2022 were included. Data from presenting visit was collected including demographic information, time from injury to surgery, visual acuity (VA), intraocular pressure (IOP), injury characteristics, and years since residency graduation of surgeon. VA, IOP, retinal detachment (RD) rate, and endophthalmitis incidence were compared between PL and NL groups at postoperative week 1 (POW1) and postoperative month 1 (POM1). VA, peak IOP, need for further surgeries, and types of additional surgery were compared between the two groups at the final visit. RESULTS 19 (17.8%) patients underwent PL. Age, sex, and initial VA were similar between groups (all p≥0.05). The PL group had surgery later from the time of injury (6.1±14.6 days vs. 1.3±1.9 days; p=0.010), higher IOP at presentation (12.9±11.6 mmHg vs. 7.7±11.3 mmHg; p=0.046), shorter wounds (2.3±1.4mm vs. 4.7±3.2mm; p=0.003), more frequent lens capsule violation (89.5% vs. 50%; p=0.010), increased likelihood of intraocular foreign bodies (52.6% vs. 17.0%; p=0.004), and were more likely to be operated on by surgeons with ≥ 5 years of experience post-residency (68.4% vs. 28.4%; p<0.001). At POW1, the PL group had significantly better logMAR VA (1.2±0.9 vs. 2.0±1.0; p=0.002), and this continued at POM1 (1.0±0.8 vs. 1.6±1.1; p=0.031) and the final visit (0.4±0.7 vs. 1.0±1.1; p=0.010). The PL group had lower IOP at POW1 (12.4±3.0 mmHg vs. 17.3±8.2 mmHg; p=0.005) than the NL group. There was no difference in RD or endophthalmitis rates between the two groups at POW1 or POM1 (p>0.05 for all). The NL group was more likely to require additional surgery by final follow-up (77.3% vs. 47.4%; p<0.001). In the multivariable analysis, PL had better final VA and decreased need for further surgery (both p<0.05). CONCLUSIONS In the appropriate circumstance, PL during lens-involving anterior OGI repair may lead to improved patient outcomes.
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Affiliation(s)
- Talia N Shoshany
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Ava Torjani
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Department of Ophthalmology, Keck School of Medicine, USC Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Qiang Zhang
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA
| | - Zeba A Syed
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA.
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Li C, Chen X, Ke X, Cheng Y, Zhang Q, Liao X, Xia H, Shi T, Jin C, Huang Y, Chen H. Comparison of the effectiveness of different corneal curvature measurement methods for IOL implantation in traumatic aphakic eyes with corneal injury. Int Ophthalmol 2024; 44:248. [PMID: 38907133 DOI: 10.1007/s10792-024-03172-z] [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: 09/26/2023] [Accepted: 06/15/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND/AIM To assess the refractive outcomes of secondary intraocular lenses (IOL) in patients with traumatic aphakic eyes with corneal penetrating injury and compare different corneal curvature measurement methods. METHODS Patients with unilateral penetrating eye injuries underwent corneal wound repair and cataract extraction, followed by secondary IOL implantation. Corneal curvature measurements were taken on the contralateral healthy eye (Group A), from the affected eye before removing corneal sutures (Group B), or after suture removal (Group C). The refractive outcomes were compared among the three groups. RESULTS The study included 261 eyes. The Mean Absolute Error (MAE) in Group C (0.99 ± 0.85 D) was significantly smaller than that in Group A (1.87 ± 1.71 D) and Group B (1.37 ± 1.20 D) (both P < 0.001). Moreover, the percentage of eyes with IOL prediction errors within ± 0.50 D in Group C (40%) was higher than that in group A (21.7%) (OR = 2.364, 95%CI: 1.272-4.392, P = 0.006) and group B (28.0%) (OR = 1.714, 95%CI: 0.948-3.099, P = 0.073), and the percentage of eyes with IOL prediction errors within ± 1.0 D in Group C (90.9%) was higher than that in group A (67.9%) (OR = 4.758, 95%CI: 2.131-10.626, P < 0.001) and group B (75.0%) (OR = 3.370, 95%CI: 1.483-7.660, P = 0.003) as well. CONCLUSIONS In traumatic aphakic eyes with corneal sutures, IOL power calculation based on the corneal curvature of the injured eye after removing the corneal sutures yields the best refractive outcomes.
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Affiliation(s)
- Cuilian Li
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Xiaolin Chen
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Xixuan Ke
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Yinglin Cheng
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Qi Zhang
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Xulong Liao
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Honghe Xia
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Tingkun Shi
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Chuang Jin
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Yuqiang Huang
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University & The Chinese University of Hong Kong, North Dongxia Road, Shantou, 515041, China.
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Shetty PA, Natarajan R, Bhalerao SA, Vuyyuru S, Thigale UY, Tara D. Prognostic factors for visual outcome after surgical repair of limbal corneal laceration at a tertiary eye care center in South India. Indian J Ophthalmol 2023; 71:3198-3202. [PMID: 37602608 PMCID: PMC10565948 DOI: 10.4103/ijo.ijo_156_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/01/2023] [Accepted: 06/03/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow-up of one year were included. Postoperative best-corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow-up were noted. Results Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow-up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis.
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Affiliation(s)
- Prerana A Shetty
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Ramya Natarajan
- Department of Ophthalmic Biophysics, KAR Campus, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sushank A Bhalerao
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Sowjanya Vuyyuru
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Uma Yogesh Thigale
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
| | - Divya Tara
- Shantilal Shanghvi Cornea Institute (SSCI), KVC Campus, L. V. Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
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Pólit Huerta F, Pólit Hoyos AF, Pólit Hoyos J, Molano-González N. Difference between both eyes in the calculation of the dioptre power of the intraocular lens in a series of 7994 patients. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:124-132. [PMID: 35248393 DOI: 10.1016/j.oftale.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/13/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE To analyse the distribution of the difference between both eyes in the calculation of the dioptric power of the intraocular lens in a series of 7994 patients and the biometric variables that determine it. METHODS The data of patients between 3 and 99 years old, residents of the city of Guayaquil and neighbouring sites, who received ocular biometry by partial optical coherence interferometry between 2004 and 2020 were reviewed. Ocular biometrics, including axial length (AL), anterior chamber depth (ACD), and the mean corneal dioptre power (CD), were measured by partial coherence interferometry. Refraction without or with cycloplegia was recorded in spherical equivalent (SE). The Haigis formula from the IOL Master instrument was used to calculate the dioptric power of the intraocular lens in both eyes. RESULTS Data from the bilateral optical biometry of 7994 patients were analysed. The mean and standard deviation of AL, CD, ACD and dioptre power of the IOL were 23.66 ± 1.25, 43.70 ± 1.49, 3.34 ± 0.40 and +20.46 ± 3.84, respectively. 2538 (31.7%) patients had equal dioptre power of the IOL between both eyes. 3243 (40.6%) patients had a 0.50 D difference; 1162 (14.5%), 1.0 D; 425 (5.3%), 1.5 D. 626 patients (7.8%) had a difference in IOL dioptre of 2 D or more, with a maximum of 24 D. The asymmetry of AL between OU was ≥0.4 mm in 10.49%, while that of CD reached ≥1 D in 1.9%. CONCLUSIONS 92.16% of patients had a difference within 1.5 D between both eyes in the calculation of the dioptre power of the intraocular lens. In case an eye is programmed in which it is impossible to perform a reliable biometry, either due to trauma or due to white or brunescent cataract, the calculation of the intraocular lens could be done taking as a reference the biometry of the contralateral eye.
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Affiliation(s)
- F Pólit Huerta
- Oftalmología, Hospital Clínica Kennedy, Guayaquil, Ecuador; Oftalmología, Clínica Internacional de la Visión de Ecuador, Guayaquil, Ecuador
| | - A F Pólit Hoyos
- Oftalmología, Hospital Clínica Kennedy, Guayaquil, Ecuador; Oftalmología, Clínica Internacional de la Visión de Ecuador, Guayaquil, Ecuador.
| | - J Pólit Hoyos
- Oftalmología, Hospital Clínica Kennedy, Guayaquil, Ecuador; Oftalmología, Clínica Internacional de la Visión de Ecuador, Guayaquil, Ecuador
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Besek NK, Nacaroglu SA, Er MO, Kirgiz A, Yilmaz FO, Yildiz BK, Ocal MC. The Effect of Secondary Intraocular Lens Implantation Time on Visual Prognosis in Aphakia Cases After Open Globe Injury. ACTA ACUST UNITED AC 2021; 35:368-375. [PMID: 34344135 PMCID: PMC8521333 DOI: 10.3341/kjo.2020.0004] [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: 11/16/2020] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Purpose We investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury. Methods The study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012-2019. Demographic characteristics, trauma zone, ocular trauma score (OTS), type of injury, time of secondary IOL implantation, final best corrected visual acuity (BCVA), and complications were recorded for each patient. Results The mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40±0.86 LogMAR, while the postoperative final BCVA was found to be 0.53±0.70 LogMAR (p<0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r= 0.140, p=0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA LogMAR (r=0.895, p<0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p= 0.007). Conclusion Although time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.
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Affiliation(s)
- Nilay Kandemir Besek
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Senay Asik Nacaroglu
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Onur Er
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kirgiz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Fevziye Ondes Yilmaz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Burçin Kepez Yildiz
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
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Secondary Sulcus-Fixed Foldable IOL Implantation with 25-G Infusion in Patients with Previous PPV after Open-Globe Injury. Eur J Ophthalmol 2018; 27:786-790. [PMID: 28525682 PMCID: PMC6380094 DOI: 10.5301/ejo.5000963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of secondary sulcus-fixed foldable intraocular lens (IOL) implantation through a clear corneal incision with 25-G infusion in patients with previous pars plana vitrectomy (PPV) after open-globe injury, and to analyze postoperative outcomes and prognostic factors of treatment. METHODS Clinical data of 89 eyes of 89 patients with open-globe injury who underwent secondary sulcus-fixed foldable IOL implantation through a clear corneal incision with 25-G infusion after vitrectomy in our hospital between January 2008 and June 2015 were retrospectively analyzed. The examinations before IOL implantation mainly included visual acuity, slit-lamp examination, direct and indirect ophthalmoscope, visual electrophysiology, corneal endothelium, B scan, ultrasound biomicroscope, and intraocular pressure. Five eyes underwent suturing of peripheral iris and 7 eyes underwent suturing of iris laceration simultaneously. The mean follow-up was 18 months with a range from 6 months to 8 years. RESULTS The mean interval between secondary sulcus-fixed foldable IOL implantation and vitrectomy was 2.8 months with a range from 2 to 6 months. The uncorrected visual acuity improved in all patients with a well-centered IOL ranging from 0.1 to 0.8 with the best-corrected visual acuity from 0.1 to 1.0 after secondary IOL implantation. The postoperative complications mainly included mild anterior chamber exudates in 10 eyes (11%), temporary IOP elevation in 12 eyes (13%), and recurrent retinal detachment in 5 eyes (6%), which were subsequently managed by surgery. CONCLUSIONS The interval of 2.8 months between vitrectomy and secondary IOL implantation is an appropriate and safe option to correct aphakia in patients receiving vitrectomy for open-globe injury.
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Sen P, Shah C, Sen A, Jain E, Mohan A. Primary versus secondary intraocular lens implantation in traumatic cataract after open-globe injury in pediatric patients. J Cataract Refract Surg 2018; 44:1446-1453. [DOI: 10.1016/j.jcrs.2018.07.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 11/25/2022]
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Arora K, Arora P, Ganesh S, Gupta S, Das RR. Visual and Refractive Outcomes of Children After Early Secondary Cataract Extraction Following Wound Repair for Penetrating Ocular Trauma. J Pediatr Ophthalmol Strabismus 2018; 55:122-127. [PMID: 29131915 DOI: 10.3928/01913913-20170703-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/07/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the visual and refractive outcomes in children 8 years of age or younger with corneal laceration and cataract following penetrating ocular injuries who underwent primary corneal tear repair followed within 1 to 8 weeks by early secondary cataract extraction. METHODS This retrospective, non-comparative case series reviewed the admission and operative charts of children 8 years of age or younger (range: 3 to 8 years) who underwent corneal wound repair as the primary surgical procedure followed within 1 to 8 weeks by cataract extraction with intraocular lens implantation, with a minimum follow-up period of 6 months. The main outcome measures were best corrected visual acuity (BCVA) and refractive error as the spherical equivalent at the final follow-up visit. RESULTS A total of 47 children (33 boys, 14 girls) were included. The mean age at the time of injury was 5.9 ± 2.2 years (range: 3 to 8 years). Follow-up periods ranged from 6 months to 3 years (median: 18 months). The mean time gap between the wound repair and cataract extraction was 5 weeks (range: 1 to 8 weeks). Approximately 36 (77%) eyes obtained BCVA better than 6/18. All but one eye achieved BCVA better than 6/60. The deviation from emmetropia was less than 1.00 diopter (D) in 23 (54%) eyes, 1.00 to 3.00 D in 15 (35%) eyes, and more than 3.00 D in 5 (12%) eyes. CONCLUSIONS Early removal of cataract with intraocular lens implantation 1 to 8 weeks after the primary wound repair in young children with penetrating corneal injuries can result in excellent visual and refractive outcomes with early intervention and aggressive amblyopia treatment. [J Pediatr Ophthalmol Strabismus. 2018;55(2):122-127.].
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Smith MP, Colyer MH, Weichel ED, Stutzman RD. Traumatic cataracts secondary to combat ocular trauma. J Cataract Refract Surg 2015; 41:1693-8. [DOI: 10.1016/j.jcrs.2014.12.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 12/01/2022]
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Rogers G, Mustak H, Hann M, Steven D, Cook C. Sutured posterior chamber intraocular lenses for traumatic cataract in Africa. J Cataract Refract Surg 2014; 40:1097-101. [PMID: 24874771 DOI: 10.1016/j.jcrs.2014.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/26/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the outcomes of sutured scleral fixation of posterior chamber intraocular lenses (PC IOLs) after trauma in an African population. SETTING State hospital and affiliated district hospital, Cape Town, South Africa. DESIGN Case series. METHODS A retrospective review was performed of the medical records of patients in whom a sutured PC IOL had been implanted for traumatic aphakia in the preceding 5 years. RESULTS Eighty-five percent of the 59 patients had a significant improvement in uncorrected distance visual acuity (UDVA) at the final visit. Two-thirds of patients achieved an UDVA of 6/18 or better. Those not improving had severe preexisting macular or corneal pathology. A significant number of patients (28%) with angle recession developed ocular hypertension during the postoperative period. CONCLUSION After careful preoperative selection, sutured PC IOLs were effective in the visual rehabilitation of eyes with traumatic subluxated cataract in which the capsular bag could not be retained. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Graeme Rogers
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa.
| | - Hamzah Mustak
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - Mignon Hann
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - David Steven
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - Colin Cook
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
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Kim SI, Byon IS, Lee JE. Clinical Outcomes of Secondary Intraocular Lens Implantation in Vitrectomized Aphakic Eyes Due to Ocular Trauma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.10.1581] [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)
- Sung Il Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | - Ik Soo Byon
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Abstract
PURPOSE To review the changes in the surgical techniques used for cataract removal in the setting of trauma and their postoperative outcome. RECENT FINDINGS Primary cataract removal with intraocular lens (IOL) implantation is the commonly followed procedure for penetrating injuries with cataract. IOL implantation has evolved through various techniques namely 'in the bag', 'in the sulcus', epilenticular implantation, anterior chamber IOL, scleral fixated IOL and recently glued IOL. SUMMARY Certain lacerating injuries of the anterior segment are particularly amenable to cataract extraction and IOL implantation at the time of primary laceration repair. This approach obviates additional operative and anesthetic risks, while affording timelier visual rehabilitation. Secondary lens removal may also be indicated in cases of severe corneal injury and marked edema, which may interfere with intraocular visualization.
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Affiliation(s)
- Ankoor S Shah
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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Assi A, Chacra CB, Cherfan G. Combined lensectomy, vitrectomy, and primary intraocular lens implantation in patients with traumatic eye injury. Int Ophthalmol 2007; 28:387-94. [PMID: 17962909 DOI: 10.1007/s10792-007-9151-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 09/25/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE To analyse the postoperative anatomic and functional outcomes in addition to complications after combined lensectomy, vitrectomy, and primary intraocular lens (IOL) implantation in patients with traumatic eye injury. METHODS Retrospective review of patients with traumatic cataract and posterior segment injury who underwent combined lensectomy, vitrectomy, and primary IOL implantation with a minimum follow up (FU) of 3 months. RESULTS Thirteen consecutive patients (all male) with a mean age of 42.8 years (range 17-82 years) underwent combined lensectomy, vitrectomy, and primary IOL implantation from February 2000 to January 2006. Postoperative FU ranged from 3 to 54 months (mean 17.6 months). Best corrected visual acuity (BCVA) at presentation ranged from 20/30 to hand movement and was worse than 20/200 in eight patients (61%). Four patients (31%) had blunt trauma with no globe rupture. Of the nine patients (69%) with a penetrating eye injury (PEI), eight had an intraocular foreign body (IOFB) with one retinal detachment at presentation. Four patients had primary closure at the time of the vitrectomy. All eight IOFBs were removed. Seven patients had additional scleral buckling and four intravitreal gas injection. BCVA at last FU ranged from 20/20 to 20/300 and was 20/40 or better in eight eyes (62%). All patients had an attached retina at last FU. One eye had further surgery for epiretinal membrane proliferation and ptosis. CONCLUSIONS These results suggest that combined vitrectomy, lensectomy and primary intraocular implantation can offer good visual rehabilitation in patients with traumatic cataract and posterior segment injury.
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Affiliation(s)
- Alexandre Assi
- Beirut Eye Clinic, Badaro Trade Centre, Sami Solh Ave, Beirut, 2058-8203, Lebanon.
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Yang CQ, Tong JP, Lou DH. Surgical results of pars plana vitrectomy combined with phacoemulsification. J Zhejiang Univ Sci B 2006; 7:129-32. [PMID: 16421968 PMCID: PMC1363756 DOI: 10.1631/jzus.2006.b0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the technical feasibility, safety, outcome, and incidence of complications after combined clear corneal phacoemulsification (PEA) with intraocular lens (IOL) implantation and vitreoretinal surgery. METHODS Combined operations of PEA and PPV were performed on 52 eyes of 52 patients with cataract and vitreoretinal diseases. RESULTS The mean follow-up time was (10.3+/-2.8) months. Postoperatively, visual acuity improved in 46 eyes (88.5%); was unchanged in 6 eyes (11.5%). The best-corrected visual acuities (BCVAs) were the following: 20/40 or better (9 eyes), 20/50 to 20/100 (24 eyes), 20/200 (5 eyes), 20/400 (10 eyes), and fingers counting (FC) to light perception (LP) (4 eyes). In 38 eyes BCVA was 20/200 or better, and in 9 eyes it was 20/40 or better postoperatively. Postoperative complications included posterior capsual opacification (7 eyes); secondary glaucoma (1 eye); and retinal detachment (2 eyes). CONCLUSION Although further studies are indicated, our study suggests that the combined operation of PPV, PEA and IOL implantation is safe and effective for patients. The visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.
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Chuang LH, Lai CC. Secondary intraocular lens implantation of traumatic cataract in open-globe injury. Can J Ophthalmol 2005; 40:454-9. [PMID: 16116509 DOI: 10.1016/s0008-4182(05)80005-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine the visual outcome and accuracy of biometry in traumatic cataract in open-globe injury. METHODS A clinical retrospective study of 30 consecutive patients treated for ocular penetrating trauma was conducted. Patient demographics, causes of injury, wound categories, timing and procedures of the primary repair, interval of subsequent intraocular lens (IOL) implantation, follow-up, and postoperative complications were recorded. Additionally, binocular biometry was documented. Twenty-six eyes (86.7%) were open-globe injuries occurring in the workplace. All patients received cataract extraction with primary repair of the penetrating wound, 18 eyes (60%) underwent trans pars plana vitrectomy with lensectomy and 12 eyes (40%) underwent lens aspiration or extracapsular cataract extraction. Simultaneously, 16 eyes (53.3%) underwent intraocular foreign body removal. RESULTS The mean visual improvement after secondary IOL implantation was statistically significant (p = 0.002). Seventeen eyes (56.7%) achieved final best-corrected visual acuity of 20/40 or better. The mean deviation of final refraction and target refraction was -0.69 +/- 0.56 diopter, and 23 eyes (76.7%) were within 1 diopter based on biometry of the traumatic eye. In 18 eyes (60%), the difference was within 1 diopter according to biometry of the fellow eye. In 5 cases (16.7%), there was no improvement of vision because of central corneal scar, secondary glaucoma, macular pucker, or recurrent retinal detachment. INTERPRETATION The vision of patients with traumatic cataract in open-globe injury was improved after prompt surgical intervention and subsequent IOL implantation. A minority of patients experienced no change in vision or a deterioration of vision due to irregular astigmatism caused by a corneal wound or variable damage to the posterior segment. Using biometry of the injured eye after primary repair was more accurate than using biometry of the fellow eye to determine the power of the lens for IOL implantation in variable open-globe injury.
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Affiliation(s)
- Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
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18
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Weinand F, Plag M, Pavlovic S. [Primary implantation of posterior chamber lenses after traumatic cataract peneration]. Ophthalmologe 2004; 100:843-6. [PMID: 14618359 DOI: 10.1007/s00347-003-0840-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To analyze the postoperative outcome and complication rate after phacoemulsification, lens aspiration or lensectomy with primary intraocular lens (IOL) implantation after traumatic cataract penetration. METHODS We retrospectively reviewed the data of 15 patients who were admitted to our hospital from 1997 to 2001 because of traumatic cataract with corneal laceration with and without intraocular foreign body (IOFB). In all patients phacoemulsification, lens aspiration or lensectomy and primary IOL implantation were performed. Removal of IOFB was performed in 6 patients. RESULTS The mean follow-up was 19.6 months, 8 eyes (53%) achieved a final visual acuity of 20/40 or better and 12 eyes achieved 20/100 or better final visual acuity. One patient (final visual acuity=1/40) had an additional macular pathology. Due to irregular astigmatism two patients achieved a final vision of less than 20/100. Major causes of limited visual acuity were central corneal scars and in one patient a photopic maculopathy. Four eyes (25%) developed secondary cataract and underwent YAG laser capsulotomy. In one patient PVR retinal detachment had to be treated by pars-plana vitrectomy with silicone oil tamponade. CONCLUSIONS Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with a favourable visual outcome and a low rate of postoperative complications.
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Affiliation(s)
- F Weinand
- Zentrum für Augenheilkunde der Universität Giessen, Giessen.
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19
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Jacobi PC, Dietlein TS, Lueke C, Jacobi FK. Multifocal intraocular lens implantation in patients with traumatic cataract. Ophthalmology 2003; 110:531-8. [PMID: 12623816 DOI: 10.1016/s0161-6420(02)01774-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the postoperative outcome and complication rate of cataract extraction with implantation of a zonal-progressive multifocal intraocular lens (IOL) for traumatic cataract. DESIGN Prospective, nonrandomized, comparative trial. PARTICIPANTS Fifty-one eyes of 51 subjects with traumatic cataract caused by nonpenetrating, penetrating, and perforating ocular trauma at two university institutions with more than 12 months follow-up. INTERVENTIONS Temporal clear corneal phacoemulsification with foldable IOL implantation was performed in all eyes. In 29 subjects, a zonal-progressive optic multifocal IOL (Array SA40-N Allergan, Irvine, CA) was implanted, whereas 22 subjects received a monofocal IOL and served as controls. RESULTS Preoperative subjects demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar in the two groups. Subjects with a multifocal IOL achieved a significantly better uncorrected near visual acuity than subjects with monofocal IOL (0.24 vs. 0.40; P = 0.0001). With distance correction only, mean near visual acuity was 0.21 vs. 0.43 (P = 0.0001). Best-corrected near visual acuity was 0.17 for both groups (P = 0.91), with +1.24 diopters (D) for the multifocal group and +2.45 D for the monofocal group (P = 0.0001). Spectacle dependency differed significantly between the two groups, with 18 (81%) subjects of the monofocal group commonly requiring an additional plus add for near tasks compared with 5 (17%) subjects in the multifocal group (P = 0.001). Stereopsis was superior in the multifocal group (P < 0.001), with 20 (69%) and 16 (55%) patients with a multifocal IOL responding positively to the Lang and Titmus tests, respectively. In the monofocal group, only eight (36%) and five (22%) subjects gave correct answers. CONCLUSIONS Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in subjects with traumatic cataract.
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Affiliation(s)
- Philipp C Jacobi
- Department of Ophthalmology, University Eye Hospital of Cologne, Joseph-Stelzmannstrasse 9, 50931 Cologne, Germany.
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20
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Affiliation(s)
- Shahzad I Mian
- Cornea Service, Massachusetts Eye and Ear Infirmary, Boston, 02114, USA
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21
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Baykara M, Dogru M, Ozçetin H, Ertürk H. Primary repair and intraocular lens implantation after perforating eye injury. J Cataract Refract Surg 2002; 28:1832-5. [PMID: 12388037 DOI: 10.1016/s0886-3350(02)01274-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the clinical outcome after primary treatment of lens injuries with corneal or corneoscleral trauma. METHODS Ten eyes of 10 patients were retrospectively evaluated. There were no foreign bodies in any eye. After primary repair, an anterior chamber maintainer (ACM) was introduced through the inferotemporal corneal quadrant. Sodium hyaluronate 1.4% (Healon GV(R)) was injected, and the anterior capsule was stained with trypan blue 0.1% vital stain (Vision Blue) under the viscoelastic substance. After a capsulorhexis was created, the lens material was aspirated. The nucleus was delivered from the scleral tunnel, which was opened from the superior/superotemporal corneal quadrant. A conventional 21.0 diopter poly(methyl methacrylate) intraocular lens (IOL) with a 5.5 mm optic and overall diameter of 12.5 mm (Dr. Schmidth(R), Hannan Kibbutz) was implanted through the scleral tunnel. The scleral tunnel was not sutured, and the corneal entry sites were closed with stromal hydration. RESULTS The final best spectacle-corrected visual acuity (BSCVA) was better than 20/100 in all patients, and 6 patients had a BSCVA of 20/20. The IOL was in the capsular bag in all patients at the last follow-up. The mean follow-up was 12.3 months (range 7 to 25 months). The main visually limiting factors were corneal scar, irregular astigmatism, and traumatic maculopathy. CONCLUSIONS Primary IOL implantation in carefully selected patients with penetrating corneoscleral lens injury may yield visually rewarding results. The use of a vital stain to increase the visibility of the injured anterior capsule and of a closed scleral tunnel system with an ACM increased the surgical safety.
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Affiliation(s)
- Mehmet Baykara
- Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey.
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22
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Cohen KL. Inaccuracy of intraocular lens power calculation after traumatic corneal laceration and cataract. J Cataract Refract Surg 2001; 27:1519-22. [PMID: 11566543 DOI: 10.1016/s0886-3350(01)00872-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A 53-year-old man sustained a perforating, central corneal injury with a nail in his right eye. After primary repair of the laceration, a traumatic cataract was removed and a Multiflex-style intraocular lens (IOL) was inserted. A 4.00 diopter surprise resulted, probably due to calculation of the IOL power using measurements from the contralateral normal eye. Inability to wear a contact lens for visual correction resulted in IOL exchange surgery in which a sulcus-sutured IOL was implanted. The IOL power was calculated using simulated keratometry from videokeratoscopy and axial length measurements of the injured eye. This resulted in an IOL power closer to emmetropia, allowing for a best spectacle-corrected visual acuity of 20/20 and comfortable wearing of spectacles.
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Affiliation(s)
- K L Cohen
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7040, USA
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Moisseiev J, Segev F, Harizman N, Arazi T, Rotenstreich Y, Assia EI. Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma. Ophthalmology 2001; 108:1099-103. [PMID: 11382636 DOI: 10.1016/s0161-6420(01)00575-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To analyze the postoperative outcome and complication rate after cataract extraction or lensectomy with primary intraocular lens (IOL) implantation for penetrating traumatic cataract. DESIGN Retrospective, nonconsecutive, noncomparative case series. METHODS We retrospectively reviewed the files of 21 patients who were admitted to our departments because of traumatic cataract with corneal or scleral laceration caused by penetrating trauma with or without intraocular foreign body (IOFB) from 1992 through 1997. Lens aspiration or manual extracapsular cataract extraction with primary IOL implantation was performed in all patients. Removal of an IOFB was performed in eight patients. MAIN OUTCOME MEASURES Final visual acuity and deviation of actual refraction from emmetropia and from expected postoperative refraction. RESULTS The mean follow-up was 20.4 months. Fourteen eyes (67%) achieved final visual acuity of 20/40 or better, 95% obtained 20/60 or better final visual acuity, and all eyes achieved 20/100 or better final visual acuity. Major causes of limited visual acuity were central corneal scar and central retinal injury. Eleven eyes (57%) experienced secondary cataract and underwent neodymium:yytrium-aluminum-garnet capsulotomy. CONCLUSIONS Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with favorable visual outcome and a low rate of postoperative complications.
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Affiliation(s)
- J Moisseiev
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
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24
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Cheema RA, Lukaris AD. Visual recovery in unilateral traumatic pediatric cataracts treated with posterior chamber intraocular lens and anterior vitrectomy in Pakistan. Int Ophthalmol 2001; 23:85-9. [PMID: 11196125 DOI: 10.1023/a:1026503413950] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate visual recovery in unilateral traumatic cataracts in children treated with posterior chamber intraocular lens implantation and anterior vitrectomy. METHODS Sixteen children with unilateral traumatic cataract between ages 3-10 years (mean, 5 years 8 months) were treated with posterior chamber intraocular lens implantation and anterior vitrectomy. Surgery was performed between 2 weeks and 7 months (mean, 7.75 weeks) after injury. Follow up was between 9 and 29 months (mean, 17.9 months). RESULTS The most common postoperative complication was fibrinous uveitis, which developed in 4 children (25%). All eyes had a clear visual axis postoperatively; none required capsulotomy. The mean postoperative refraction was +0.9 diopters (range, +3.50 to -2.75 diopters). Three eyes (18.75%) had visual acuity of 6/9, 8 eyes (50%) had visual acuity of 6/12 or better, and 11 eyes (68.75%) had visual acuity of 6/18 or better. The cause of poor visual acuity was cystoid macular edema in one eye, macular scars in two eyes, and amblyopia in one eye. CONCLUSIONS Unilateral traumatic cataracts in children in whom aphakia is corrected with posterior chamber lens implantation combined with anterior vitrectomy result in good visual outcome, and we recommend this treatment modality in traumatic cataract in children.
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MESH Headings
- Capsulorhexis/methods
- Cataract/etiology
- Child
- Child, Preschool
- Eye Injuries/complications
- Eye Injuries/epidemiology
- Eye Injuries/surgery
- Eye Injuries, Penetrating/complications
- Eye Injuries, Penetrating/epidemiology
- Eye Injuries, Penetrating/surgery
- Female
- Humans
- Incidence
- Lens Implantation, Intraocular/methods
- Lens, Crystalline/injuries
- Lens, Crystalline/surgery
- Male
- Pakistan/epidemiology
- Prospective Studies
- Recovery of Function
- Visual Acuity
- Vitrectomy/methods
- Wounds, Nonpenetrating/complications
- Wounds, Nonpenetrating/epidemiology
- Wounds, Nonpenetrating/surgery
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Affiliation(s)
- R A Cheema
- King Edward Medical College, Lahore Pakistan.
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25
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Abstract
Over the past quarter century, advances in our understanding of corneal anatomy, physiology, and wound healing have all played an integral role in the management of corneal trauma. As the etiologies of corneal trauma have changed, so has our understanding of the impact of injury on corneal function as it relates to visual rehabilitation. Numerous new classes of antibiotics, antiinflammatory agents, and tissue adhesives have emerged. Occlusive therapy has advanced from simple pressure patching bandage soft contact lenses and collagen shields. Surgical instrumentation, operating microscopes, viscoelastic substances, and suture materials have all improved the outcomes of corneal trauma repair. Improved understanding of the refractive properties of the cornea through topography and alternative suture techniques has helped us restore the natural corneal curvature and visual outcomes. Consequently, in the last quarter of this century our therapeutic approaches to cornea trauma, both medical and surgical, have improved.
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Affiliation(s)
- M S Macsai
- Division of Ophthalmology, Evanston Northwestern Healthcare, Northwestern University Medical School, Illinois, USA
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26
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Batman C, Cekiç O, Totan Y, Ozkan SS, Zilelioglu O. Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation. J Cataract Refract Surg 2000; 26:254-9. [PMID: 10683794 DOI: 10.1016/s0886-3350(99)00368-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.
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Affiliation(s)
- C Batman
- SSK Eye Hospital, Ankara, Turkey
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27
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Pandey SK, Ram J, Werner L, Brar GS, Jain AK, Gupta A, Apple DJ. Visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses in children with traumatic cataracts. J Cataract Refract Surg 1999; 25:1576-84. [PMID: 10609199 DOI: 10.1016/s0886-3350(99)00297-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the visual results and postoperative complications of capsular bag and ciliary sulcus fixation of posterior chamber intraocular lenses (IOLs) for traumatic cataracts in children. SETTING Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS Twenty children (20 eyes) with traumatic cataracts had extracapsular cataract extraction (ECCE) and posterior chamber IOL implantation. They were randomly divided into 2 groups. Capsular bag fixation was performed in 10 children (Group A) and ciliary sulcus fixation in the other 10 (Group B). Traumatic cataracts associated with large corneal lacerations (10.0 mm or more), hyphema, angle recession, or posterior segment involvement were excluded. The best corrected visual acuity (BCVA) as well as early and delayed postoperative complications were prospectively evaluated in both groups. RESULTS The BCVA was 6/12 or better in 9 eyes (90%) in Group A and 8 eyes (80%) in Group B at the end of the mean follow-up (24.6 months +/- 10.6 [SD]). Amblyopia (1 eye in Group A) and corneal scar and commotio retinae (1 eye each in Group B) accounted for a visual acuity of worse than 6/12. The residual refractive error did not exceed 3.50 diopters in either group. The incidences of fibrinous anterior uveitis and pupillary capture were significantly higher in Group B (P < .05, Fisher exact test). CONCLUSION Capsular bag fixation of posterior chamber IOLs provided visual results similar to those with ciliary sulcus fixation but was associated with fewer postoperative complications, particularly uveitis and pupillary capture. This represents another important reason to attempt in-the-bag fixation in cases of traumatic cataract.
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Affiliation(s)
- S K Pandey
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, MUSC, Charleston, USA
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28
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Tyagi AK, Kheterpal S, Callear AB, Kirkby GR, Price NJ. Simultaneous posterior chamber intraocular lens implant combined with vitreoretinal surgery for intraocular foreign body injuries. Eye (Lond) 1998; 12 ( Pt 2):230-3. [PMID: 9683945 DOI: 10.1038/eye.1998.55] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED To evaluate the safety of simultaneous posterior chamber intraocular lens (IOL) implant combined with complex vitreoretinal surgery for ocular trauma due to intraocular foreign body (IOFB). METHODS We undertook a retrospective analysis of 10 patients who had undergone simultaneous cataract extraction, vitreoretinal surgery, removal of IOFB and posterior chamber IOL implant, for ocular trauma due to IOFB. The visual outcome and complications were noted. The surgical procedure is described. RESULTS Ten young, male patients were followed for 5-30 months post-operatively. The post-operative visual acuity in the operated eye remained the same or improved as compared with their pre-operative vision. Eight patients had a visual acuity of 6/9 or better. One patient developed post-operative infective endophthalmitis. Three patients had retinal detachment post-operatively. The IOL was stable in all patients. CONCLUSIONS Simultaneous posterior chamber IOL implant with vitreoretinal surgery is safe in selected cases of severe ocular trauma due to IOFB. It allows early visual rehabilitation of young, working patients.
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Affiliation(s)
- A K Tyagi
- Birmingham and Midland Eye Centre, UK
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29
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Abstract
PURPOSE To evaluate the presentation, mode of management, and clinical outcome of traumatic cataract in children. SETTING L.V. Prasad Eye Institute, Hyderabad, India. METHODS One hundred thirty-seven children (< 16 years) who developed traumatic cataract, seen between January 1988 and December 1993, were retrospectively analyzed. Nature of injury, type of cataract, management, and outcome were evaluated. RESULTS The study group comprised 110 boys and 27 girls. Average follow-up was 11.7 months (range 1 week to 60 months). Most injuries (54.7%) were caused by a stick or a bow and arrow. Most (53.2%) of the cataracts were total. Corneal scarring (60.5%) and iris-related problems (49.6%) were the most common associated findings. Extracapsular cataract extraction with intraocular lens (IOL) implantation was performed in 65.67% of patients. Visual acuity improved form 20/200 or worse in 97.7% of patients preoperatively to 20/60 or better in 74.1% or patients postoperatively. Seventeen patients had associated posterior segment insult; most failed to recover satisfactory vision. Posterior capsule opacification (PCO) was noted in 42.9% of patients. CONCLUSIONS Extracapsular cataract extraction with IOL implantation provides satisfactory results in children with traumatic cataract. Associated posterior segment complications and development of PCO are the major obstacles to visual rehabilitation.
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Affiliation(s)
- M Krishnamachary
- Sight Savers Cornea Training Centre, L.V. Prasad Eye Institute, Hyderabad, India
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30
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McElvanney AM, Talbot EM. Posterior chamber lens implantation combined with pars plana vitrectomy. J Cataract Refract Surg 1997; 23:106-10. [PMID: 9100116 DOI: 10.1016/s0886-3350(97)80159-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the outcome of cataract extraction and posterior chamber intraocular lens (IOL) implantation combined with pars plana vitrectomy. SETTING Ophthalmic ward in a district general hospital. METHODS This study evaluated seven consecutive patients who had cataract extraction, IOL implantation, and pars plana vitrectomy in one procedure. Four patients were diabetic, and three had perforating eye injuries with cataract formation and intraocular foreign bodies. RESULTS No significant postoperative complications occurred, and the posterior chamber lenses were well tolerated. In all cases, good subjective visual improvement was achieved and visualization of the posterior pole was excellent. CONCLUSION Combining cataract extraction with posterior chamber IOL implantation and vitrectomy in one procedure may be indicated, especially if there is traumatic rupture of the lens capsule.
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31
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Rubsamen PE, Irvin WD, McCuen BW, Smiddy WE, Bowman CB. Primary intraocular lens implantation in the setting of penetrating ocular trauma. Ophthalmology 1995; 102:101-7. [PMID: 7831023 DOI: 10.1016/s0161-6420(95)31073-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate the clinical outcome of patients who underwent lensectomy and intraocular lens (IOL) implantation at the time of primary repair of a penetrating ocular injury. METHODS A review of 14 patients who sustained cataracts and lens rupture in the setting of a corneal laceration to determine anatomic and visual outcome, in addition to complications related to the primary IOL. RESULTS The IOL remained anatomically stable in all 14 patients with no complications encountered at implantation or after surgery. Final visual acuity in 9 of the 14 patients was 20/40 or better. Six patients underwent pars plana vitrectomy for removal of an intraocular foreign body. CONCLUSION Intraocular lens implantation at the time of lensectomy and primary repair of a corneal laceration allows good visual rehabilitation with restoration of binocular function and serves as an alternative to contact lens correction in select patients.
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Affiliation(s)
- P E Rubsamen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine
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32
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Affiliation(s)
- R F Beatty
- Department of Ophthalmology, Porter Memorial Hospital, Denver, CO, USA
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33
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Chan TK, Mackintosh G, Yeoh R, Lim AS. Primary posterior chamber IOL implantation in penetrating ocular trauma. Int Ophthalmol 1993; 17:137-41. [PMID: 8262712 DOI: 10.1007/bf00942927] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This paper describes the experience of primary cataract extraction and posterior chamber IOL implantation in 11 eyes with penetrating ocular trauma. The primary surgical procedure consisted of repair of corneoscleral laceration, cataract extraction, posterior chamber IOL implantation and in certain cases, removal of intraocular foreign body and vitrectomy. 10 out of 11 cases had a post operative visual acuity of 6/18 or better, with 9 out of 11 having a post operative visual acuity of 6/12 or better. One case initially had a visual acuity of 6/24 but later developed retinal detachment with a visual acuity of 'hand movements'. Another patient developed a small localised retinal detachment during the tenth postoperative month but with successful surgery, attained a visual acuity of 6/6. The encouraging results suggest that this procedure may be recommended in carefully selected cases, under the management of an experienced surgeon.
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Affiliation(s)
- T K Chan
- Department of Ophthalmology, National University Hospital, Singapore
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