1
|
Liu YJ, Zhang WW, Chen FF, He ZF, Xie ZG. Reopening the severely contracted lens capsular bag post-phacovitrectomy by injecting OVD and removing the fibrous membranous material. J Cataract Refract Surg 2021; 47:e66-e69. [PMID: 33929794 DOI: 10.1097/j.jcrs.0000000000000675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
Implantation of an intraocular lens (IOL) after combined vitrectomy and cataract surgery is usually required to reduce postoperative refraction errors. However, because of the severe fibrosis of the anterior capsule and the adhesion between the anterior and posterior capsules, it is difficult to reopen the capsular bag to complete the secondary IOL implantation. In this study, a surgical approach is described for reopening the severe adhesion between capsules and removing the significant fibroproliferative membranous material by injecting ophthalmic viscosurgical device into the periphery of the capsular bag to separate the anterior and posterior capsules. The IOL was implanted into the capsular bag without any zonular rupture or posterior capsule tear. The position of the IOL was stable during postoperative follow-up up to 3 months. This procedure to open a severely fibrosis capsule was safe and effective.
Collapse
Affiliation(s)
- Ya-Jun Liu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | | | | | | | | |
Collapse
|
2
|
Baur ID, Auffarth GU, Yildirim TM, Mayer CS, Khoramnia R. Reversibility of the duet procedure: Bilateral exchange of a supplementary trifocal sulcus-fixated intraocular lens for correction of a postoperative refractive error. Am J Ophthalmol Case Rep 2020; 20:100957. [PMID: 33102931 PMCID: PMC7575835 DOI: 10.1016/j.ajoc.2020.100957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose We present the case of a 49-year old female who underwent bilateral exchange of a supplementary trifocal sulcus-fixated intraocular lens (IOL) to correct a residual refractive error. Six months beforehand, she had been treated for hyperopia, astigmatism and presbyopia with a duet procedure to create reversible trifocality. Observations Refractive lens exchange with combined implantation of a monofocal toric IOL into the capsular bag and a trifocal supplementary IOL into the ciliary sulcus (duet procedure) had been performed in both eyes. Decreased uncorrected distance visual acuity due to the refractive outcome of −0.75 diopter sphere (DS)/-0.25 diopter cylinder (DC)x10° for the right eye and −1.0DS for the left eye as well as the perception of photic phenomena were inacceptable for the patient. In the second operations, we exchanged the supplementary IOLs to correct the residual refractive error and achieve the target refraction of emmetropia. UDVA increased from 0.50 logMAR in both eyes prior to the IOL exchange to −0.22 logMAR in the right eye and −0.20 logMAR in the left eye. Binocular uncorrected near and intermediate visual acuity were −0.10 logMAR and 0.00 logMAR respectively after exchanging the sulcus-fixated supplementary IOLs, allowing for complete spectacle independence. Conclusions This case demonstrates one of the most important benefits of the duet procedure: the possibility, if necessary, to easily remove or exchange the supplementary IOL from the ciliary sulcus. The duet procedure offers a safe treatment option in the event of postoperative complications like residual refractive error or intolerance to a multifocal optic.
Collapse
Affiliation(s)
- Isabella Diana Baur
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Gerd Uwe Auffarth
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Timur Mert Yildirim
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Steffen Mayer
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| |
Collapse
|
3
|
Lens Placement in the Absence of Capsular Support: Scleral-fixated Versus Iris-fixated IOL Versus ACIOL. Int Ophthalmol Clin 2017; 56:93-106. [PMID: 27257725 DOI: 10.1097/iio.0000000000000116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Tan X, Lin H, Lin Z, Chen J, Tang X, Luo L, Chen W, Liu Y. Capsular Outcomes After Pediatric Cataract Surgery Without Intraocular Lens Implantation: Qualitative Classification and Quantitative Measurement. Medicine (Baltimore) 2016; 95:e2993. [PMID: 26962807 PMCID: PMC4998888 DOI: 10.1097/md.0000000000002993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to investigate capsular outcomes 12 months after pediatric cataract surgery without intraocular lens implantation via qualitative classification and quantitative measurement.This study is a cross-sectional study that was approved by the institutional review board of Zhongshan Ophthalmic Center of Sun Yat-sen University in Guangzhou, China.Digital coaxial retro-illumination photographs of 329 aphakic pediatric eyes were obtained 12 months after pediatric cataract surgery without intraocular lens implantation. Capsule digital coaxial retro-illumination photographs were divided as follows: anterior capsule opening area (ACOA), posterior capsule opening area (PCOA), and posterior capsule opening opacity (PCOO). Capsular outcomes were qualitatively classified into 3 types based on the PCOO: Type I-capsule with mild opacification but no invasion into the capsule opening; Type II-capsule with moderate opacification accompanied by contraction of the ACOA and invasion to the occluding part of the PCOA; and Type III-capsule with severe opacification accompanied by total occlusion of the PCOA. Software was developed to quantitatively measure the ACOA, PCOA, and PCOO using standardized DCRPs. The relationships between the accurate intraoperative anterior and posterior capsulorhexis sizes and the qualitative capsular types were statistically analyzed.The DCRPs of 315 aphakic eyes (95.8%) of 191 children were included. Capsular outcomes were classified into 3 types: Type I-120 eyes (38.1%); Type II-157 eyes (49.8%); Type III-38 eyes (12.1%). The scores of the capsular outcomes were negatively correlated with intraoperative anterior capsulorhexis size (R = -0.572, P < 0.001), but no significant correlation with intraoperative posterior capsulorhexis size (R = -0.16, P = 0.122) was observed. The ACOA significantly decreased from Type I to Type II to Type III, the PCOA increased in size from Type I to Type II, and the PCOO increased from Type II to Type III (all P < 0.05).Capsular outcomes after pediatric cataract surgery can be qualitatively classified and quantitatively measured by acquisition, division, definition, and user-friendly software analyses of high-quality digital coaxial retro-illumination photographs.
Collapse
Affiliation(s)
- Xuhua Tan
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Lin H, Tan X, Lin Z, Chen J, Luo L, Wu X, Long E, Chen W, Liu Y. Capsular Outcomes Differ with Capsulorhexis Sizes after Pediatric Cataract Surgery: A Randomized Controlled Trial. Sci Rep 2015; 5:16227. [PMID: 26537991 PMCID: PMC4633668 DOI: 10.1038/srep16227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/29/2015] [Indexed: 12/23/2022] Open
Abstract
Capsular outcomes of anterior/posterior capsulorhexis opening (ACO/PCO) are essential for performing a secondary in-the-bag intraocular lens implantation. To compare the capsular outcomes with different primary capsulorhexis sizes, Thirty-eight eligible patients (45 eyes) were randomly assigned to three groups by anterior capsulorhexis diameter (Group A: 3.0-3.9, Group B: 4.0-5.0, and Group C: 5.1-6.0 mm). The areas of ACO/PCO and posterior capsule opening opacity (PCOO) as primary outcomes, while, the incidence of visual axis opacity (VAO) as secondary outcome were measured at follow-up visits. Among the thirty eyes included in the final analysis, the mean area of the ACO decreased significantly, whereas the PCO enlarged with time. Group A had the highest anterior capsule constriction and percentage reduction, which increased with time. There were significant differences in the percentage reductions at 6 months and 1 year compared to 1 month in Group A and B. Group C had the highest posterior capsule enlargement. The percentage of PCOO to PCO area and the incidence of VAO was highest in Group A and lowest in Group C. Thus, Capsulorhexis diameter of 4.0-5.0 mm may yield better capsular outcomes, considering moderate contraction of ACO, moderate enlargement of PCO, and lower percentage of PCOO and VAO.
Collapse
Affiliation(s)
- Haotian Lin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Xuhua Tan
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Zhuoling Lin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Jingjing Chen
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Lixia Luo
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Xiaohang Wu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Erping Long
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Weirong Chen
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| | - Yizhi Liu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, People´s Republic of China
| |
Collapse
|
6
|
Ollerton A, Werner L, Strenk S, Strenk L, Leishman L, Bodnar Z, Kirk KR, Michelson J, Mamalis N. Pathologic comparison of asymmetric or sulcus fixation of 3-piece intraocular lenses with square versus round anterior optic edges. Ophthalmology 2013; 120:1580-7. [PMID: 23597794 DOI: 10.1016/j.ophtha.2013.01.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/09/2013] [Accepted: 01/14/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the pathologic findings of 3-piece intraocular lenses (IOLs) with asymmetric or sulcus fixation in pseudophakic cadaver eyes, comparing IOLs with square or round edges on the anterior optic surface. DESIGN Comparative case series with pathology. PARTICIPANTS A total of 661 pseudophakic cadaver eyes, obtained from eye banks within the United States, implanted with different IOLs. METHODS Anterior segment scanning of whole eyes with a high-frequency ultrasound system or high-resolution anterior segment magnetic resonance imaging followed by gross examination. Selected eyes were processed for complete histopathologic analysis. MAIN OUTCOME MEASURES Findings from imaging, gross, and histopathologic evaluation that could be related to out-of-the-bag fixation of the lenses. RESULTS Of 661 pseudophakic cadaver eyes obtained, 13 had 3-piece hydrophobic acrylic IOLs with anterior and posterior square optic edges, and 14 had 3-piece lenses with anterior round edges (13 silicone lenses and 1 hydrophobic acrylic lens) without symmetric in-the-bag fixation. These 27 selected eyes were processed for complete histopathologic analysis. Gross findings in both groups were composed of IOL decentration and tilt, pigmentary dispersion within the anterior segment and on the IOL surface, and iris transillumination defects. Histopathology of the 14 eyes with 3-piece IOLs with round anterior optic edges showed mild focal disruption of the iris pigmented layer and loop protrusion/erosion in the ciliary sulcus. Additional changes observed in the 13 eyes with square anterior optic edge IOLs included iris changes, such as vacuolization, disruption and loss of the pigmented epithelial layers, iris thinning and atrophy, synechiae, and pigmentary dispersion within the trabecular meshwork. One eye also exhibited initial signs of optic nerve disc cupping. CONCLUSIONS In this series, pathologic findings were more severe in eyes implanted with 3-piece IOLs with square anterior optic edges, suggesting that IOLs with round anterior edges are more suitable for sulcus fixation. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Andrew Ollerton
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Goh YW, Misra S, Patel DV, McGhee CNJ. Combining primary and piggyback intraocular lenses to treat extreme myopic astigmatism in stable keratoconus following cataract surgery. Clin Exp Optom 2013; 96:242-4. [PMID: 23448261 DOI: 10.1111/cxo.12050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 02/03/2013] [Accepted: 02/04/2013] [Indexed: 01/14/2023] Open
Abstract
The majority of those with keratoconus can maximise visual acuity with spectacle or contact lens correction as they age; however, as subjects enter their sixties, cataracts may supervene and contact lens tolerance diminishes with consequent reduction in visual acuity. Following cataract extraction, the complex refractive error associated with keratoconus may not be readily corrected by an intraocular lens alone. This report highlights the planned implantation of a primary posterior chamber toric intraocular lens with a secondary piggyback, sulcus-based, intraocular lens in advanced but stable keratoconus with extreme myopic astigmatism and cataract.
Collapse
Affiliation(s)
- Yi Wei Goh
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | | |
Collapse
|
8
|
Apple DJ, Escobar-Gomez M, Zaugg B, Kleinmann G, Borkenstein AF. Modern cataract surgery: unfinished business and unanswered questions. Surv Ophthalmol 2012; 56:S3-53. [PMID: 22117905 DOI: 10.1016/j.survophthal.2011.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/06/2011] [Indexed: 11/18/2022]
Abstract
We summarize information, based on clinicopathologic studies over the past decade, on various cataract intraocular lens (IOL) procedures and modern "specialized" IOLs, that will help surgeons continuously improve long-term results for cataract patients. Although most operations do initially provide excellent refractive correction and visual rehabilitation, late complications occur. These sometimes are missed because they are outside of the routine period of follow-up care. We have tried to determine if the various techniques and IOLs truly deliver the long-term results that we desire. Most safety and efficacy information is derived from the manufacturer and is passed through the U.S. Food and Drug Administration (FDA). This is often based on limited, relatively short-term observations made by the manufacturer. After a lens receives FDA approval, there are few means to assess the outcome of each procedure and lens years later. We rarely hear of a 10- or 20-year follow-up study. We have found that one of the best means to assess long-term results is pathologic analyses. We discuss recently studied aspects of pathologic reactions, such as posterior capsule opacification, intracapsular fibrosis, glistenings, intralenticular opacification, and other issues with the various IOL platforms; we then present a clinicopathological overview of tissues and IOLs from our database. These include hydrophobic and hydrophilic acrylic designs, plate lenses, and a dual optic lens.
Collapse
Affiliation(s)
- David J Apple
- Laboratory for Ophthalmic Devices Research, Sullivan's Island, South Carolina, USA
| | | | | | | | | |
Collapse
|
9
|
Khaja WA, Verma M, Shoss BL, Yen KG. Visual axis opacification in children. Ophthalmology 2011; 118:224-5. [PMID: 21199720 DOI: 10.1016/j.ophtha.2010.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 08/17/2010] [Indexed: 10/18/2022] Open
|
10
|
Kahraman G, Amon M. New supplementary intraocular lens for refractive enhancement in pseudophakic patients. J Cataract Refract Surg 2010; 36:1090-4. [DOI: 10.1016/j.jcrs.2009.12.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 12/23/2009] [Accepted: 12/24/2009] [Indexed: 10/19/2022]
|
11
|
Almond CM, Wu MC, Chen PP. Pigment dispersion and chronic intraocular pressure elevation after sulcus placement of 3-piece acrylic intraocular lens. J Cataract Refract Surg 2009; 35:2164-6. [DOI: 10.1016/j.jcrs.2009.06.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/18/2009] [Accepted: 06/21/2009] [Indexed: 11/24/2022]
|
12
|
Solving intraocular lens-related pigment dispersion syndrome with repositioning of primary sulcus implanted single-piece IOL in the capsular bag. J Cataract Refract Surg 2009; 35:1459-63. [PMID: 19631135 DOI: 10.1016/j.jcrs.2009.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 05/22/2009] [Accepted: 05/25/2009] [Indexed: 12/31/2022]
Abstract
We describe 2 cases of pigment dispersion syndrome (PDS) after uneventful phacoemulsification and implantation of a posterior chamber single-piece intraocular lens (IOL) with a sharp-edge design. In both cases, several days after IOL implantation, marked pigment dispersion was seen on the iris and in the trabecular meshwork, associated with an elevation in intraocular pressure (IOP). Thorough examination showed that the implanted IOL was in the ciliary sulcus. After surgical repositioning of both IOLs in the capsular bag, the pigment dispersion regressed and the IOP returned to normal limits. The 2 cases suggest that particularly in PDS patients, an IOL with an anterior sharp-edge design should be implanted in the capsular bag. Implantation in the ciliary sulcus should be avoided.
Collapse
|
13
|
Werner L, Izak AM, Isaacs RT, Pandey SK, Apple DJ. Evolution of Intraocular Lens Implantation. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
14
|
Sekundärer Augeninnendruckanstieg nach komplikationsloser Kataraktoperation mit Hinterkammerlinsenimplantation. Ophthalmologe 2008; 106:156-60. [DOI: 10.1007/s00347-008-1771-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Davison JA. August Consultation # 4. J Cataract Refract Surg 2007. [DOI: 10.1016/j.jcrs.2007.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Pokroy R. Pseudophakic pigmentary glaucoma. J Cataract Refract Surg 2007; 33:1350-1; author reply 1351-2. [PMID: 17662407 DOI: 10.1016/j.jcrs.2007.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 03/08/2007] [Indexed: 11/17/2022]
|
17
|
Kleinmann G, Apple DJ, Chew J, Mamalis N. New Endoscopic Technique to Analyze Various Modern Specialized Intraocular Lenses in Research Eyes and Human Eyes Obtained Postmortem. Ophthalmology 2006; 113:591-7. [PMID: 16581421 DOI: 10.1016/j.ophtha.2005.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Revised: 10/21/2005] [Accepted: 10/31/2005] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To describe a new modification of the Miyake-Apple posterior video photographic technique and its 2 variations. We have developed a new endoscopic technique that is especially amenable for observation of modern specialized intraocular lenses (IOLs). DESIGN Laboratory study. PARTICIPANT Three cadaver eyes obtained postmortem. METHODS Human eyes obtained postmortem were prepared according to our modified preparation technique used for analyses of whole globes. An intraocular endoscope was utilized to demonstrate all aspects of the interior of an experimentally implanted IOL, with specialized reference to anterior segment structures, obtaining posterior, oblique, and side view images. MAIN OUTCOME MEASURES Different interior dynamic views of the anterior segment structures before and after implantation of an IOL. RESULTS High-magnification images of different intraocular structures both before and after device insertion as well as the device itself were obtained. Oblique and side view images from different locations were also available and informative. These images helped to create a 3-dimensional view of these objects and their relations to the surrounding structures. CONCLUSION The combination of the intraocular endoscope with the closed-system technique is a useful addition to our 3 previously described techniques: (1) the original Miyake-Apple posterior video/photograph technique and the (2) closed system and (3) side/oblique view (keyhole technique) modifications.
Collapse
Affiliation(s)
- Guy Kleinmann
- David J. Apple, MD, Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah 84132, USA.
| | | | | | | |
Collapse
|
18
|
Bayramlar H, Hepsen IF, Yilmaz H. Myopic shift from the predicted refraction after sulcus fixation of PMMA posterior chamber intraocular lenses. Can J Ophthalmol 2006; 41:78-82. [PMID: 16462878 DOI: 10.1016/s0008-4182(06)80072-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND To evaluate the refractive results of sulcus-fixated polymethylmethacrylate (PMMA) posterior chamber intraocular lenses (PC IOLs) after cataract surgery with and without posterior capsule complications. METHODS The charts of patients who had undergone cataract surgery were reviewed, and eyes that had received sulcus-fixated PMMA PC IOLs were included in the study. Postoperative refraction, predicted postoperative refraction for in-the-bag IOL with the same diopter, intraoperative posterior capsular complications and vitrectomy, axial eye length, incision type (corneal or scleral), and surgery type were recorded and analyzed. The difference between actual postoperative refraction and predicted refraction for the in-the-bag lens was calculated for each patient. RESULTS Of 143 patients (84 men and 59 women), 162 eyes with a sulcus-fixated posterior chamber intraocular lens were investigated. Mean age was 63.7 +/- 12.1 years. A mean myopic shift of -1.02 +/- 0.96 D from the predicted in-the-bag refraction was found. There were no significant differences between eyes with or without vitreous loss-vitrectomy (p = 0.8), eyes with scleral or corneal incisions (p = 0.11), and eyes having phacoemulsification or extracapsular cataract extraction (p = 0.93). In terms of axial length, there were no significant differences between long, normal, or short eyes (p = 0.85). INTERPRETATION Sulcus fixation of a PMMA IOL originally planned for in-the-bag fixation caused approximately -1.00 D myopic shift in this study. We recommend that when sulcus fixation is necessary PMMA IOL power should be approximately 1.25 to 1.50 D less than the power for in-the-bag fixation. Axial length, incision type, vitreous loss and use of vitrectomy, and type of the surgery do not appear to alter the postoperative refraction significantly in eyes with sulcus fixation.
Collapse
Affiliation(s)
- Hüseyin Bayramlar
- Inonu University, Turgut Ozal Medical Center, Department of Ophthalmology, Malatya, Turkey.
| | | | | |
Collapse
|
19
|
LeBoyer RM, Werner L, Snyder ME, Mamalis N, Riemann CD, Augsberger JJ. Acute haptic-induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses. J Cataract Refract Surg 2005; 31:1421-7. [PMID: 16105617 DOI: 10.1016/j.jcrs.2004.12.056] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2004] [Indexed: 02/03/2023]
Abstract
We report an analysis of 3 single-piece hydrophobic acrylic intraocular lenses (IOLs) that were explanted because of complications related to the presence of their haptics in the ciliary sulcus. In 2 cases, the IOL was primarily implanted in the ciliary sulcus because of inadequate posterior capsule support. In the third case, postoperative displacement of 1 haptic in the sulcus was associated with hyphema and vitreous hemorrhage. Ultrasound biomicroscopy confirmed the contact between the haptic and iris. Areas of iris atrophy were observed in all cases. Light microscopy and scanning electron microscopy of the explanted lenses revealed the presence of pigmentary dispersion on the anterior surfaces. In Case 3, the pigments were concentrated on the surface of the haptic that was displaced from the capsular bag and on the corresponding optic-haptic junction. Scanning electron microscopy also showed the IOL's squared edges and unpolished side walls. The flexibility and thickness of the single-piece hydrophobic acrylic haptics, as well as the square optic and haptic edges, may increase the risk for iris chafing when the haptics are in the sulcus. Therefore, sulcus fixation of this IOL design is not recommended.
Collapse
Affiliation(s)
- Russell M LeBoyer
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
| | | | | | | | | | | |
Collapse
|
20
|
Davison JA. Neodymium:YAG laser posterior capsulotomy after implantation of AcrySof intraocular lenses. J Cataract Refract Surg 2004; 30:1492-500. [PMID: 15210228 DOI: 10.1016/j.jcrs.2003.11.042] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2003] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the incidence of neodymium:YAG (Nd:YAG) laser posterior capsulotomy after phacoemulsification and implantation of AcrySof (Alcon) intraocular lenses (IOLs). SETTING Private practice, Wolfe Clinic, Marshalltown, Iowa, USA. METHODS A retrospective diagnosis and procedure code review of 12419 consecutive cases having phacoemulsification and AcrySof IOL implantation from January 1995 through December 2002 was performed. The outcome parameter was the incidence of Nd:YAG laser posterior capsulotomies. RESULTS An Nd:YAG laser posterior capsulotomy was performed in 763 (6.1%) of the 12419 cases. The incidence of posterior capsulotomy was approximately 1% at 1 year, increasing in linear fashion by approximately 1% to 2% per year. CONCLUSIONS The Nd:YAG laser posterior capsulotomy rate after implantation of AcrySof IOLs was relatively low; the cumulative rate was approximately 1% to 2% new cases per year over a 7-year period, with a plateau suggested at year 6.
Collapse
Affiliation(s)
- James A Davison
- Wolfe Clinic, 309 East Church Street, Marshalltown, IA 50158, USA.
| |
Collapse
|
21
|
Pereira FAS, Cronemberger S. Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation. Ophthalmology 2003; 110:1799-806. [PMID: 13129880 DOI: 10.1016/s0161-6420(03)00623-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To report quantitative changes in the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation by means of ultrasound biomicroscopy (UBM). DESIGN Prospective, nonrandomized, comparative (self-controlled) trial. PARTICIPANTS Twenty-one eyes of 19 patients with senile or presenile cataracts and no other ocular illness. METHODS Patients were examined with UBM before and 1 and 3 months after surgery. At each UBM examination, axial images of the anterior chamber and radial sections of the angle at the superior, lateral, inferior, and medial quadrants were obtained. MAIN OUTCOME MEASURES Central anterior chamber depth (ACD), iris-lens contact distance, iris-lens angle (ILA), angle opening distance at points 250 (AOD250) and 500 microm (AOD500) from the scleral spur, trabecular-iris angle (TIA), iris thickness 500 microm from the scleral spur (IT), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), iris-zonule distance, iris-sclera angle (ISA), and ciliary process-sclera angle (CPSA). After surgery, central anterior chamber depth was also measured from the cornea to the IOL (ACD) and from the cornea to the pupillary plane (ACD2). Each variable was measured twice in different days by the same observer. RESULTS The variables IT, TCPD, ICPD, IZD, and CPSA did not significantly change after surgery (P > 0.01). Central anterior chamber depth increased approximately 30% after surgery (approximately 850 microm; P < 0.001), by both measurement methods used (ACD x ACD and ACD x ACD2). Anterior chamber angle significantly increased, by approximately 50% of the initial value, by the three measurement methods used: AOD250 (P <or= 0.002), AOD500 (P < 0.001), and TIA (P <or= 0.003). The ISA increased by approximately 10 degrees (30%) after surgery (P < 0.001). The ILCD and ILA did not exist after surgery, except in two eyes. CONCLUSIONS After phacoemulsification and foldable IOL implantation, UBM revealed that the iris diaphragm shifted backward, deepening the anterior chamber by approximately 850 microm and widening its angle by approximately 10 degrees. These findings may be of clinical significance in eyes with angle-closure glaucoma or with occludable angles.
Collapse
Affiliation(s)
- Frederico A S Pereira
- Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
| | | |
Collapse
|
22
|
Beltrame G, Salvetat ML, Chizzolini M, Driussi GB, Busatto P, Di Giorgio G, Barosco F, Scuderi B. Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia. Eur J Ophthalmol 2003; 13:62-8. [PMID: 12635676 DOI: 10.1177/112067210301300109] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia. METHODS Ten patients (mean age 48 years, range 21-75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, trans-sclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12-52). RESULTS Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye. CONCLUSIONS Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.
Collapse
Affiliation(s)
- G Beltrame
- Department of Ophthalmology, Hospital of San Donà di Piave, Venezia, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Escobar-Gomez M, Apple DJ, Vargas LG, Werner L, Arthur SN, Pandey SK, Izak AM, Schmidbauer JM. Scanning electron microscopic and histologic evaluation of the AcrySof SA30AL acrylic intraocular lens. Manufacturing quality and morphology in the capsular bag. J Cataract Refract Surg 2003; 29:164-9. [PMID: 12551685 DOI: 10.1016/s0886-3350(02)01435-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the properties of the AcrySof(R) SA30AL (Alcon Laboratories, Inc.) single-piece foldable posterior chamber intraocular lens (IOL). SETTING Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS Two nonimplanted clinical-quality AcrySof IOLs were examined by gross, light, and scanning electron microscopy (SEM). In addition, 2 eyes implanted with this IOL obtained post-mortem, the first such eyes accessioned in our laboratory and the first described to date, were examined using the Miyake-Apple posterior photographic technique and by histologic sections. RESULTS Scanning electron microscopy of the SA30AL IOL showed excellent surface finish. The edge of the optic was square (truncated) and had a matte (velvet or ground-glass) appearance, a feature that may minimize edge glare and other visual phenomena. A well-fabricated square or truncated optic edge was demonstrated. Miyake-Apple analysis revealed that the SA30AL IOL showed appropriate fit and configuration within the capsular bag. Histologic correlation of the IOL's square edge and its relation to the capsular bag and adjacent Soemmering's ring were noted. CONCLUSIONS The AcrySof SA30AL IOL is a well-fabricated lens that situates well in the capsular bag. The truncated optic and its relationship to adjacent structures show a morphological profile that has been shown to be highly efficacious in reducing the rate of posterior capsule opacification.
Collapse
Affiliation(s)
- Marcela Escobar-Gomez
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Micheli T, Cheung LM, Sharma S, Assaad NN, Guzowski M, Francis IC, Norman J, Coroneo MT. Acute haptic-induced pigmentary glaucoma with an AcrySof intraocular lens. J Cataract Refract Surg 2002; 28:1869-72. [PMID: 12388044 DOI: 10.1016/s0886-3350(02)01644-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A 49-year-old man had uneventful endocapsular phacoemulsification with in-the-bag implantation of an AcrySof SA60AT single-piece intraocular lens (IOL) (Alcon) in the right eye. Twenty-seven days postoperatively, he presented with ocular pain, intraocular pressure of 48 mm Hg, 360 degrees of hyperpigmentation of the trabecular meshwork, and iris pigment epithelial atrophy in the region of the upper temporal haptic, which had dislocated into the sulcus. The patient made an excellent recovery following IOL removal and exchange. Scanning electron microscopy of the explanted IOL demonstrated that the haptic had a rough lateral surface and anterolateral edge. We do not think this IOL should be implanted in the sulcus placement of the heptics. In this article, we report the case of a patient with an AcrySof SA60ATIOL (Alcon) who developed acute pigmentary glaucoma when the inferior haptic slipped out of the bag and came into contact with the pigmented iris and ciliary body.
Collapse
Affiliation(s)
- Tasha Micheli
- Ophthalmic Surgery Centre, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Even though cataract surgery has been practiced for over 2000 years, modern cataract surgery started just some 50 years ago. with the first IOL implantation by Sir Harold Ridley. The development of intraocular lenses was accompanied by great successes and disasters. With the fast development of cataract surgical techniques over the past 15 years (ECCE, Phacoemulsification, Capsulorhexis) a successful marriage between IOL-developments and surgery was established. Indication profiles for cataract surgery and IOL implantation extended to more and more patient groups. At this time classical cataract surgery is further developing into refractive intraocular lens surgery to correct higher ametropia in clear lens or phakic eyes. This development was only possible because of the improvements of surgical techniques and implants in classical cataract surgery.
Collapse
Affiliation(s)
- G U Auffarth
- Universitäts-Augenklinik, Ruprecht Karls Universität Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg.
| | | |
Collapse
|
26
|
Escobar-Gomez M, Arthur SN, Apple DJ, Vargas LG, Pandey SK, Schmidbauer J. Evolution of surgical techniques and intraocular lens designs for the developing world. Int Ophthalmol Clin 2001; 41:197-210. [PMID: 11481547 DOI: 10.1097/00004397-200107000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Escobar-Gomez
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | | | | | | | | |
Collapse
|
27
|
Schmidbauer JM, Vargas LG, Peng Q, Escobar-Gomez M, Werner L, Arthur SN, Apple DJ. Posterior capsule opacification. Int Ophthalmol Clin 2001; 41:109-31. [PMID: 11481543 DOI: 10.1097/00004397-200107000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J M Schmidbauer
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Ram J, Pandey SK, Apple DJ, Werner L, Brar GS, Singh R, Chaudhary KP, Gupta A. Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification. J Cataract Refract Surg 2001; 27:1039-46. [PMID: 11489573 DOI: 10.1016/s0886-3350(00)00841-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. SETTING Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. RESULTS Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P <.001, chi-square test) after a mean follow-up of 2.4 years +/- 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P <.001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P <.05, chi-square test). CONCLUSIONS In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.
Collapse
Affiliation(s)
- J Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Wintle R, Austin M. Pigment dispersion with elevated intraocular pressure after AcrySof intraocular lens implantation in the ciliary sulcus. J Cataract Refract Surg 2001; 27:642-4. [PMID: 11311638 DOI: 10.1016/s0886-3350(00)00792-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 45-year-old white woman had phacoemulsification with intraocular lens (IOL) implantation. The surgery was routine except for a linear tear in the posterior capsule; there was no disruption of the anterior vitreous face. After residual soft lens matter was removed, an AcrySof IOL was placed in the ciliary sulcus. One month postoperatively, the patient presented with an intraocular pressure (IOP) of 30 mm Hg and signs of pigment dispersion with 360 degrees of heavy pigmentation of the trabecular meshwork and iris transillumination defects. Intraocular pressure was controlled with a topical beta-blocker. The optic disc appearance and visual field remained normal, but the uniocular hyperpigmentation of the trabecular meshwork was still present. We hypothesize that the sharp square edge of the AcrySof IOL increases the risk of a chafing effect on the posterior iris pigment and advocate that this IOL be placed in the capsular bag and ideally have 360 degrees of protective overlapping of the anterior capsule over the edge of the optic.
Collapse
Affiliation(s)
- R Wintle
- Department of Ophthalmology, Singleton Hospital, Swansea, Wales, United Kingdom
| | | |
Collapse
|
30
|
Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, Ram J, Auffarth GU. Eradication of posterior capsule opacification: documentation of a marked decrease in Nd:YAG laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem. Ophthalmology 2001; 108:505-18. [PMID: 11237905 DOI: 10.1016/s0161-6420(00)00589-3] [Citation(s) in RCA: 209] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE (1) To report the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy rate (%) of eight rigid and foldable intraocular lens (IOL) designs in a series of 5416 pseudophakic human eyes obtained postmortem, accessioned in our center between January 1988 and January 2000. (2) To identify factors that are instrumental in reducing the incidence of posterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy. DESIGN Comparative autopsy tissue analysis. PARTICIPANTS A total of 5416 globes with posterior chamber intraocular lens (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000. METHODS Miyake-Apple posterior photographic technique. Special reference was given to the presence or absence of Nd:YAG laser posterior capsulotomy orifice on the posterior capsule of each eye. MAIN OUTCOME MEASURES The Nd:YAG laser posterior capsulotomy rate (%) as of January 2000 was documented. In addition, the Nd:YAG laser posterior capsulotomy rate for each lens was plotted on a monthly basis for the same period, creating a computerized trend or "timeline" for each IOL style. RESULTS Relatively high Nd:YAG laser posterior capsulotomy rates ranging from 20.3% to 33.4% were noted with four relatively older designs (high incidence of implantation between 1988 and the early 1990s). Four modern foldable IOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acrysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant (P < 0.0001, chi-square test). Comparing foldable versus rigid designs, the foldable IOLs were associated with a much lower Nd:YAG laser posterior capsulotomy rate (14.1% vs. 31.1%). CONCLUSIONS By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons can genuinely lead in the direction of virtual eradication of secondary cataract, the second most common cause of visual loss worldwide.
Collapse
Affiliation(s)
- D J Apple
- Center for Research on Ocular Therapeutic and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-2236, USA
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Cataract Surgery With Rigid and Foldable Posterior Chamber IOLs, ECCE and Phacoemulsification. Surv Ophthalmol 2000. [DOI: 10.1016/s0039-6257(00)00172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
32
|
|
33
|
|
34
|
Epilogue. Surv Ophthalmol 2000. [DOI: 10.1016/s0039-6257(00)00175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Evolution of Cataract Surgery and Intraocular Lenses (IOLs). Surv Ophthalmol 2000. [DOI: 10.1016/s0039-6257(00)00180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
36
|
Apple DJ, Peng Q, Visessook N, Werner L, Pandey SK, Escobar-Gomez M, Ram J, Whiteside SB, Schoderbeck R, Ready EL, Guindi A. Surgical prevention of posterior capsule opacification. Part 1: Progress in eliminating this complication of cataract surgery. J Cataract Refract Surg 2000; 26:180-7. [PMID: 10683785 DOI: 10.1016/s0886-3350(99)00353-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup. SETTING Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering's ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake-Apple posterior photographic analysis. RESULTS The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering's rings, showed virtually no net change since the early 1980s. The intensity of Soemmering's ring was higher in the most recent specimens than in those in the early 1980s. CONCLUSION The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy.
Collapse
Affiliation(s)
- D J Apple
- Department of Ophthalmology, Medical University of South Carolina, Charleston 29425-2236, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
BACKGROUND Surgery for congenital cataracts in early infancy usually includes a primary posterior capsulectomy and an anterior vitrectomy. Initially, most of these infants have aphakia after surgery. Over time, remaining equatorial lens epithelial cells produce new cortical fibers, resulting in a ring of cortex trapped between the lens equator and the fused anterior and posterior capsulectomy edges. A potential space is maintained between the anterior and posterior capsular leaflets. We describe a technique for placing a secondary intraocular lens (IOL) within the capsular bag. PATIENTS AND METHODS Eight children, ranging in age from 11 months to 14 years, who originally had aphakia after cataract extraction were operated on with the intent to reopen the capsular bag and place an IOL in the bag. RESULTS Secondary in-the-bag IOL implantation was successfully completed in 7 of 8 children. This was accomplished by reopening the capsular bag 360 degrees at the edge of the fused anterior and posterior capsulectomy remnants, using the previously published vitrectorhexis technique. Residual cortical material was aspirated, and an IOL was placed within the capsular bag. In 1 child, aged 14 years, the capsular bag was reopened, but the lens was placed in the ciliary sulcus because the new anterior capsule edge could not be visualized for 360 degrees . CONCLUSION Placement of secondary IOLs within the capsular bag can be accomplished successfully for selected patients in the pediatric population. Surgeons operating on infantile cataracts without primary IOL placement can facilitate capsular IOL sequestration later by limiting the anterior and posterior capsulectomy to 4 to 5 mm and performing a generous anterior vitrectomy to help prevent secondary closure of the smaller capsulectomy.
Collapse
Affiliation(s)
- M E Wilson
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston 29425, USA.
| | | | | |
Collapse
|
38
|
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.
Collapse
Affiliation(s)
- S K Pandey
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, MUSC, Charleston, USA
| | | | | | | | | | | | | |
Collapse
|
39
|
Ram J, Apple DJ, Peng Q, Visessook N, Auffarth GU, Schoderbek RJ, Ready EL. Update on fixation of rigid and foldable posterior chamber intraocular lenses. Part II: Choosing the correct haptic fixation and intraocular lens design to help eradicate posterior capsule opacification. Ophthalmology 1999; 106:891-900. [PMID: 10328386 DOI: 10.1016/s0161-6420(99)00506-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Posterior capsule opacification (PCO) is one of the most common complications of cataract surgery, and there is an urgent need to reduce its incidence. Its main treatment, neodymium:YAG (Nd:YAG) laser posterior capsulotomy, may be associated with significant morbidity and is expensive. In this study, the authors ascertain the effect of posterior chamber intraocular lens (PC-IOL) fixation and various IOL designs (rigid polymethyl methacrylate [PMMA] optic and small-incision foldable designs) on the pathogenesis of PCO. DESIGN Prospective analysis of pseudophakic eyes obtained postmortem. PARTICIPANTS A total of 3493 eyes with PC-IOLs obtained postmortem and received between 1984 and 1998. METHODS Miyake-Apple posterior photographic technique. MAIN OUTCOME MEASURES Peripheral Soemmering's ring, central PCO in the visual axis, and eyes that have had Nd:YAG laser posterior capsulotomy were analyzed and scored, and these findings were correlated with the type of fixation and IOL design. RESULTS The degree of formation of peripheral Soemmering's ring was not influenced by IOL fixation. The acrylic design revealed relatively low Soemmering's ring scores. In contrast, central PCO and Nd:YAG laser capsulotomy scores were consistently influenced by fixation. The scores were significantly lower in eyes with in-the-bag fixation. The bag-bag fixated acrylic-PMMA design and the three modern silicone IOL designs analyzed in this study had less central PCO and lower posterior capsulotomy scores than did the PMMA IOLs. CONCLUSIONS The formation of peripheral PCO (the Soemmering's ring), the precursor of clinically significant, vision-threatening PCO, is not significantly influenced by the haptic fixation pattern. It is much more dependent on the quality and thoroughness of surgical cortical cleanup. Reduction of Soemmering's ring is an important goal because the retained regenerative cortical cells within this lesion are the cells of origin of PCO. The acrylic IOL design was associated with a lessor amount of peripheral Soemmering's ring as compared with all other designs. In sharp contrast to peripheral PCO, fixation of the IOL was a highly significant factor affecting the formation and quantity of central PCO-the clinically significant opacity behind the IOL optic, measured in this series either by scoring an intact retro-optical membrane or by documenting the presence of a Nd:YAG laser posterior capsulotomy orifice. The quantity of central PCO was consistently much lower in eyes with in-the-bag fixated IOLs compared with lenses with one or both haptics out of the bag. This is best explained by the fact that secure in-the-bag fixation positions the IOL optic in the best possible position to create a barrier effect. The lowest PCO rates were generally noted with the acrylic and modern silicone IOL designs.
Collapse
Affiliation(s)
- J Ram
- Post-Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | | | | | | | | | | |
Collapse
|
40
|
Awad AH, Mullaney PB, Al-Hamad A, Wheeler D, Al-Mesfer S, Zwaan J. Secondary posterior chamber intraocular lens implantation in children. J AAPOS 1998; 2:269-74. [PMID: 10646747 DOI: 10.1016/s1091-8531(98)90082-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary intraocular lens (IOL) implantation after cataract aspiration is a widely accepted means of correcting pediatric aphakia. However, little is available in the literature on secondary IOL implantation in children. We present our experience over the past 6 years. METHODS The charts of 57 aphakic children (61 eyes) who underwent secondary posterior chamber IOL implantation between January 1989 and April 1996 were reviewed. In general, these children were either intolerant of or noncompliant with their contact lenses. An attempt was made to correlate visual outcome with patient variables. Evaluation of the ciliary sulcus structure was made in selected patients by ultrasonographic biomicroscopy to reveal any changes resulting from the presence of the IOL haptic in the sulcus. RESULTS The age range at the time of surgery was 2 to 16 years (mean 8 y). Mean follow-up was 14 months (range 6 to 48 months). Forty-two percent of the patients had a best-corrected visual acuity of 20/40 or better and 78% saw better than 20/80. Posterior capsular opacification occurred in 10 eyes, 8 of which required neodymium:yttrium-aluminum-garnet laser capsulotomy. No major complications occurred. Ciliary sulcus evaluation by biomicroscopy did not reveal any significant ciliary body or scleral erosion. No changes were noted when the implanted sulcus was compared with the normal contralateral side. CONCLUSION Although follow-up was short, this review suggests that secondary posterior chamber IOL implantation is a safe alternative when other methods of correcting pediatric aphakia fail.
Collapse
Affiliation(s)
- A H Awad
- Pediatric Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
PURPOSE To measure the size of the lens and the empty capsular bag and evaluate the relationship between them. SETTING Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS In 46 eye-bank eyes, the equatorial diameter of the lens was measured after a corneoscleral button and the iris were removed. Empty capsular bag diameter was measured after extracapsular cataract extraction through an intact capsulorhexis. RESULTS Mean lens size was 10.20 mm +/- 0.38 (SD) and mean capsular bag size, 10.38 +/- 0.35 mm. The difference between the size of the lens and that of the empty capsular bag varied from 0 to 0.50 mm (mean 0.20 +/- 0.17 mm). Lenses measuring less than 10.25 mm in diameter showed an increase of 0.25 mm while lenses larger than 10.25 mm showed an increase of 0.09 mm. CONCLUSION Lens size was larger in our population than in previous studies. The increase in the empty capsular bag size was related to initial lens size.
Collapse
Affiliation(s)
- A Vasavada
- Iladevi Cataract & IOL Research Centre, Ahmedabad, India
| | | |
Collapse
|
42
|
Laurell CG, Zetterström C, Lundgren B. Phacoemulsification and lens implantation in rabbit eyes: capsular bag versus ciliary sulcus implantation and 4.0 versus 7.0 mm capsulorhexis. J Cataract Refract Surg 1998; 24:230-6. [PMID: 9530598 DOI: 10.1016/s0886-3350(98)80204-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the effects of intraocular lens (IOL) implantation in the capsular bag versus the ciliary sulcus and of a 4.0 versus 7.0 mm continuous curvilinear capsulorhexis (CCC) on postoperative inflammation and after-cataract formation. SETTING St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS Trial 1 comprised 40 rabbits that had CCC, endocapsular phacoemulsification, and a poly(methyl methacrylate) IOL implanted in the capsular bag in one eye and the ciliary sulcus in the fellow eye. In Trial 2, 40 rabbits had a 4.0 mm CCC in one eye and a 7.0 mm CCC in the fellow eye followed by phacoemulsification and IOL implantation in the capsular bag. White blood cell (WBC) counts and prostaglandin E2 (PGE2) concentrations in aqueous humor were determined at 1, 3, 7(8), 28, and 56 days postoperatively. Wet mass of the dissected after-cataract was measured at day 56. In Trial 1, wet mass of the iris-ciliary body was measured at each observation. RESULTS In Trial 1, WBC counts at day 1 were higher with a sulcus-fixated IOL (P = .05). The median wet mass of the dissected after-cataract was 108.5 mg in eyes with a sulcus-fixated IOL and 62.5 mg in eyes with a capsule-fixated IOL (P = .01). In Trial 2, WBC counts at day 8 were significantly higher in eyes with a 7.0 mm CCC than in those with a 4.0 mm CCC (P < .05). There was no significant difference in the amount of after-cataract. CONCLUSIONS The results indicate that IOL implantation in the capsular bag causes less inflammation and after-cataract formation than sulcus fixation and that using a large CCC does not affect the total amount of after-cataract but may enhance the inflammatory response.
Collapse
|
43
|
Anand N, Tole DM, Morrell AJ. Effect of intraocular lens fixation on acute intraocular pressure rise after neodymium-YAG laser capsulotomy. Eye (Lond) 1996; 10 ( Pt 4):509-13. [PMID: 8944108 DOI: 10.1038/eye.1996.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Neodymium-YAG laser posterior capsulotomy is associated in some cases with an acute rise in the intraocular pressure (IOP), possibly caused by blockage of the trabecular meshwork by debris. To test the hypothesis that the IOP rise is preventable if fixation of the intraocular lens (IOL) in the capsular bag is ensured, we conducted a study comparing IOP changes at 1, 2, 3 and 24 hours after Nd:YAG capsulotomy between eyes with capsular bag-fixated, one haptic in the bag (haptic in/out) and cillary sulcus-fixated IOLs. Analysis of variance for repeated measures showed that after capsulotomy there were significant increases in IOP from baseline (p < 0.05) in both the sulcus-fixated (1, 2 and 3 hours) and haptic in/out groups (2 and 3 hours), while IOPs in the bag-fixated group did not show any significant increase. The increases in IOP in the sulcus-fixated group at 1, 2 and 3 hours after capsulotomy were significantly higher than the IOP changes at the corresponding periods in the other two groups (Kruskal-Wallis test, p < 0.01). The mean maximum IOP rise in the sulcus-fixated group (11.33 +/- 7.85 mmHg) was significantly higher than that in the haptic in/out group (3.89 +/- 7.14 mmHg) and the bag-fixated group (1.10 +/- 2.71 mmHg), while there was no difference between the latter two groups. In 57.5% of the sulcus-fixated group, 5% of the haptic in/out group and none of the eyes of the bag-fixated group the IOP rise was more than 10 mmHg. A significantly larger proportion of sulcus-fixated eyes had anterior chamber cells and capsular debris after capsulotomy (chi 2 test, p < 0.001). In the haptic in/out group significant correlation (-0.56, p = 0.009) between IOP rise at 1 hour and the percentage enclosure of the IOL by the anterior capsule was demonstrated. There was no significant difference in maximum IOP rise between glaucomatous and non-glaucomatous eyes (Mann-Whitney U-test, p = 0.49).
Collapse
Affiliation(s)
- N Anand
- St James's University Hospital, Leeds, UK
| | | | | |
Collapse
|
44
|
Mandal AK. Endocapsular surgery and capsular bag fixation of intraocular lenses in phacolytic glaucoma. J Cataract Refract Surg 1996; 22:288-93. [PMID: 8778358 DOI: 10.1016/s0886-3350(96)80237-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Performing endocapsular surgery can be more difficult in eyes with phacolytic glaucoma because the capsule is fragile and zonules are weak. In this study, I investigated the safety and efficacy of a technique for performing endocapsular surgery with and without posterior chamber intraocular lens (IOL) implantation in 19 eyes of 19 patients with phacolytic glaucoma. This technique involves aspiration of the fluid cortex from the capsular bag using a 26 gauge bent needle. After anterior capsulotomy with angled Vannas scissors, the nucleus is delivered using minimal pressure on the irrigating vectis. The remaining cortex is completely removed using minimal irrigating fluid. At the end of the procedure, a posterior chamber IOL is inserted in the bag as indicated. A V-shaped anterior capsulectomy is completed using Vannas scissors, without exerting traction on the zonules. Intraoperatively, internal structures can be clearly visualized and the entire procedure performed with minimal trauma to the fragile lens capsule and zonular apparatus. I encountered no major complications. Follow-up ranged from 12 to 36 months with satisfactory visual outcome and good intraocular pressure control without antiglaucoma medication in all patients.
Collapse
Affiliation(s)
- A K Mandal
- VST Centre for Glaucoma Care, L.V. Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
45
|
Ravalico G, Tognetto D, Palomba M, Busatto P, Baccara F. Capsulorhexis size and posterior capsule opacification. J Cataract Refract Surg 1996; 22:98-103. [PMID: 8656372 DOI: 10.1016/s0886-3350(96)80277-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Posterior capsule opacification (PCO) after intraocular lens (IOL) implantation has a multifactored pathogenesis. Capsulorhexis and capsular bag implantation of a one-piece, biconvex poly(methyl methacrylate) (PMMA) IOL are likely to reduce the PCO incidence. This study was performed to determine whether an ideal capsulorhexis size able to reduce PCO incidence exists. METHODS A retrospective study of 107 patients who had extracapsular cataract extraction with capsulorhexis and capsular bag IOL implantation was carried out. The PCO site (central, paracentral, and peripheral) and degree (mild, moderate, and severe) were evaluated in relation to the capsulorhexis edge location relative to the IOL optic. Slitlamp biomicroscopy and photography and examination with a three-mirror Goldmann lens were performed. Patients were divided into three groups. Group 1: capsulorhexis free edge located on the IOL optic for 360 degrees; Group 2: capsulorhexis free edge located asymmetrically on and peripherally to the IOL optic; Group 3: capsulorhexis free edge located peripherally to IOL optic for 360 degrees. Each group was divided into two subgroups; one received polyHema IOLs and the second, PMMA IOLs. RESULTS In Groups 1 and 2, the capsular transparency was higher than in Group 3 (P < .04). Central opacification percentage was lower in Group 1 than in Groups 2 and 3 (P < .04). No statistically significant differences between the polyHema and the PMMA subgroups were seen. CONCLUSIONS Capsulorhexis with a slightly smaller diameter than the IOL optic appears to be better than a large-size capsulorhexis in reducing the incidence of PCO.
Collapse
Affiliation(s)
- G Ravalico
- Istituto di Clinica Oculistica, Università di Trieste, Ospedale Maggiore, Trieste, Italy
| | | | | | | | | |
Collapse
|
46
|
Ram J, Jain S, Pandav SS, Gupta A, Mangat GS. Postoperative complications of intraocular lens implantation in patients with Fuchs' heterochromic cyclitis. J Cataract Refract Surg 1995; 21:548-51. [PMID: 7473118 DOI: 10.1016/s0886-3350(13)80215-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We studied 29 eyes of 24 patients with Fuchs' heterochromic cyclitis who had extracapsular cataract extraction and posterior chamber intraocular lens implantation. Follow-up ranged from one to four years (mean two years). Intraoperative complications included mild hyphema (n = 4). Early postoperative complications included uveitis (n = 9), glaucoma (n = 7), pigment deposits on the lens surface (n = 8), vitreous opacities (n = 8), and cystoid macular edema (n = 1). Late postoperative complications included posterior capsule opacification (n = 6), recurrent uveitis (n = 4), and persistent glaucoma (n = 3). Best corrected visual acuity of 20/40 or better was achieved in 24 eyes (82.8%).
Collapse
Affiliation(s)
- J Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | |
Collapse
|
47
|
Abstract
Through a 4.5 mm corneoscleral incision, we implanted one of two types of foldable, silicone disc, posterior chamber intraocular lenses (IOLs) in the bag in 35 eyes of 32 patients after phacoemulsification and capsulorhexis. Five lenses were explanted in the early postoperative period because of complications. We followed 24 eyes for an average of 38 months. At the end of follow-up, 5 of the lenses had decentered by 1 mm; 8 (33%) had developed clinically significant posterior capsule opacification (PCO). We believe the IOLs' disc shape may not allow firm fixation, resulting in opacification. On average, there were no significant differences in long-term results between the two silicone disc lens types.
Collapse
|
48
|
|
49
|
Pavlin CJ, Harasiewicz K, Foster FS. Ultrasound biomicroscopic analysis of haptic position in late-onset, recurrent hyphema after posterior chamber lens implantation. J Cataract Refract Surg 1994; 20:182-5. [PMID: 8201571 DOI: 10.1016/s0886-3350(13)80162-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Late-onset, recurrent hyphema is an uncommon complication of posterior chamber intraocular lens implantation. Pathological studies and indirect clinical evidence, including iris transillumination defects and iris tucking, have implicated haptic-iris contact. The technique of high-resolution ultrasound biomicroscopy developed in our laboratories allows imaging of intraocular lens haptics and their relationship to surrounding structures. Examination of two cases with late-onset, recurrent hyphema revealed that the margins of the superior haptics were sulcus fixated and indenting the peripheral iris. Blood could be traced beneath the peripheral iris in one case. Our findings indicate that haptic-iris contact was the source of bleeding. Capsular fixation should make this complication less likely.
Collapse
Affiliation(s)
- C J Pavlin
- Department of Ophthalmology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | | | | |
Collapse
|
50
|
Orgül SI, Daicker B, Büchi ER. The diameter of the ciliary sulcus: a morphometric study. Graefes Arch Clin Exp Ophthalmol 1993; 231:487-90. [PMID: 8224950 DOI: 10.1007/bf02044237] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Based on a precise definition of boundaries of the ciliary sulcus, a new anatomical method was used to measure the diameter of the ciliary sulcus in postmortem eyes. In each of 41 globes, 24 different ciliary sulcus diameters were measured and were compared with the axial length, measured by ultrasonography. The mean ciliary sulcus diameter was 11.25 mm (SD = 0.38 mm). By linear regression, the axial length values were significantly correlated with ciliary sulcus diameters. In addition, our data suggest that existence of two groups of eyes differentiated exclusively by the diameter of the ciliary sulcus, independent of the axial length. We propose that the displacement of the pars plicata corporis ciliaris from the peripheral iris to the iris root during the embryonic period may be incomplete in eyes of shorter axial length. The findings of the present study may play a role in cataract surgery in which an intraocular lens is inserted into the ciliary sulcus.
Collapse
Affiliation(s)
- S I Orgül
- Universitäts-Augenklink Basel, Switzerland
| | | | | |
Collapse
|