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Chang-Sotomayor M, Gϋell JL, de Rojas Silva MV, Corretger X, Bandeira F, Mendez-Mourelle A, Veillet LZ, Adán A, Figueras-Roca M. Comparison of intraocular lens tilt after capsular sutured scleral fixation with capsular segments versus uneventful cataract surgery. Eur J Ophthalmol 2024; 34:1450-1457. [PMID: 38179681 DOI: 10.1177/11206721231223997] [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] [Indexed: 01/06/2024]
Abstract
PURPOSE To evaluate and compare intraocular lens (IOL) tilt between uneventful phacoemulsification with in-the-bag IOL implantation and sutured scleral fixation (SSF) of the lens bag with a capsular tension segment (type 6 D / Morcher) using a Sheimpflug camera. SETTING Clinical Practice, Hospital. Barcelona and A Coruña, Spain. DESIGN Retrospective, comparative multicenter study. METHODS IOL tilt was compared between patients who underwent sutured scleral fixation with a capsular tension segment in a single eye (SSF group, n = 15) with patients who underwent uneventful IOL implantation (control group, n = 12) that were matched by biometric measurements. Post-operative refractive accuracy of biometric formulas by means of mean absolute error (MAE) was also reported. All patients underwent a general ophthalmic evaluation, anterior segment photography, and postoperative optical biometry (Zeiss IOLMaster® 500). In addition, IOL tilt was measured with a Scheimpflug camera (Pentacam R, Oculus Optikgerate Gmbh). RESULTS Mean vertical tilt was similar in both groups (2.20+/-2.47° SSF vs 1.97 +/- 1.79° control; p = 0.836) but mean horizontal tilt tended to higher values in the SSF series (2.09 +/- 2.74° vs 0.94 +/- 1.17°; p = 0.139). Considering post-operative refractive error in diopters by MAE calculations, there was an underestimation of IOL power in the SSF group which was only statistically significant for Barrett Universal II (1.07 vs 0.32; p = 0.028) and Hill-RBF (0.95 vs 0.26; p = 0.024) formulas, but not for SRK/T (0.99 vs 0.42; p = 0.285) and Kane (0.96 vs 0.33; p = 0.083). CONCLUSION Sutured scleral fixation of capsular tension segments in the presence of zonular instability does not seem to induce clinically significant IOL tilt compared to uneventful cataract extraction cases.
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Affiliation(s)
- Meilin Chang-Sotomayor
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | - José L Gϋell
- Instituto de Microcirugía Ocular (IMO), Cornea and Refractive Surgery unit, Barcelona, Spain, 08035
| | | | - Xavier Corretger
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | - Francisco Bandeira
- São Gonçalo Eye Hospital, Cornea and Refractive Surgery unit, Rio de Janeiro, Brasil, 8600-502
| | - Andrea Mendez-Mourelle
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | | | - Alfredo Adán
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
| | - Marc Figueras-Roca
- Department of Ophthalmology, Hospital Clinic de Barcelona (ICOF), Barcelona, Spain, 08028
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Stephenson KA, O'Keefe M, Keegan DJ. Surgical management of non-syndromic ectopia lentis. Int J Ophthalmol 2020; 13:1156-1160. [PMID: 32685406 DOI: 10.18240/ijo.2020.07.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare whether aphakic contact lenses or secondary iris-claw intraocular lenses are superior in the refractive management post-pars plana vitreolensectomy in a pedigree with an FBN1 mutation causing non-syndromic ectopia lentis (NSEL) with retinal detachment (RD). METHODS Eight affected individuals had pars plana vitreolensectomy for bilateral ectopia lentis (EL). Twelve eyes of 6 patients had secondary iris-claw intraocular lenses inserted and 4 eyes of 2 patients were managed with contact lenses. Rhegmatogenous retinal detachment (RRD) was treated when necessary. Pre- and post-operative assessment included visual acuity, endothelial cell count and dilated fundal examination. RESULTS Macula-on RRD was present in all individuals >18y, 64% (7/11 eyes) presenting post-vitreolensectomy with 57% having bilateral non-synchronous RRD. Surgical aphakia was managed with iris-fixated intraocular lenses (IOL group, n=6), or contact lenses (CL group, n=2). Visual acuity ≥0.3 logMAR (driving standard) was achieved in 75% of IOL group eyes and 25% of the CL group eyes. Mean loss of corneal endothelial cell count in the IOL group was 4% at 2y post-operative. CONCLUSION In this cohort, refractive management with iris-claw IOLs provided superior outcomes to contact lenses and the authors recommend this as the optimal refractive correction in EL patients.
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Affiliation(s)
- Kirk Aj Stephenson
- Retinal Research Group, Mater Misericordiae University Hospital & Mater Private Hospital, Dublin 7, Ireland
| | - Michael O'Keefe
- Retinal Research Group, Mater Misericordiae University Hospital & Mater Private Hospital, Dublin 7, Ireland
| | - David J Keegan
- Retinal Research Group, Mater Misericordiae University Hospital & Mater Private Hospital, Dublin 7, Ireland
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Esfandiari H, Ansari S, Mohammad-Rabei H, Mets MB. Management Strategies of Ocular Abnormalities in Patients with Marfan Syndrome: Current Perspective. J Ophthalmic Vis Res 2019; 14:71-77. [PMID: 30820290 PMCID: PMC6388525 DOI: 10.4103/jovr.jovr_29_18] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Marfan syndrome is an autosomal dominant genetic connective tissue disorder that results from mutations in the fibrillin-1 gene located on chromosome band 15q15-21. Fibrillin, a glycoprotein, is widely expressed throughout the body and contributes to the elasticity and force-bearing capacity of connective tissue. In the eye, fibrillin is a key constituent of the ciliary zonules, which suspend the crystalline lens in place. The zonular defect leads to ectopia lentis, which is a hallmark of Marfan ocular abnormalities and occurs in 60% to 80% of cases. Other less common ocular features of Marfan syndrome are increased axial length, astigmatism, and flat cornea. Visual function in Marfan syndrome could be affected in several ways: ectopia lentis, refractive error, amblyopia, retinal detachment, cataract, and glaucoma. Management of a subluxated lens starts with the correction of refractive error with eyeglasses in mild cases. In more severe cases, especially when the lens bisects the pupil, complete correction of refractive error is impossible without removing the subluxated lens. The best method for visual rehabilitation after lens extraction is still debated. Aphakic Artisan lens implantation at the time of subluxated lens removal results in good visual outcomes with an acceptable safety profile. Studies with longer term follow-up and larger sample populations are needed to evaluate the safety of this procedure in patients with Marfan syndrome.
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Affiliation(s)
- Hamed Esfandiari
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shabnam Ansari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mohammad-Rabei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marilyn B Mets
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Rabie HM, Malekifar P, Javadi MA, Roshandel D, Esfandiari H. Visual outcomes after lensectomy and iris claw artisan intraocular lens implantation in patients with Marfan syndrome. Int Ophthalmol 2016; 37:1025-1030. [PMID: 27709371 DOI: 10.1007/s10792-016-0366-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To review our experience with crystalline lens extraction and iris claw Artisan IOL implantation in patients with lens subluxation secondary to Marfan syndrome. METHODS A retrospective analysis of 12 eyes of 9 patients with lens subluxation due to Marfan syndrome who underwent crystalline lens removal and Artisan IOL (Ophtec, Groningen, Netherlands) implantation. A questionnaire of pre- and post-operative data, including demographics, pre- and postoperative comorbidities and complications was completed. Patients were evaluated for visual outcome and occurrence of complications. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalents (SE) were compared before and after lens extraction and IOL insertion. RESULTS The mean age of the participants was 30.03 ± 15.02 years, and mean post-operative follow-up time was 44.5 ± 16.4 months. Mean BCVA also showed a significant improvement from 0.5 ± 0.3 at the baseline to 0.2 ± 0.2 post-operatively (P = 0.006). SE changed significantly from -11.38 ± 1.99 preoperatively to -0.45 ± 1.65 post-operatively (P = 0.003). All eyes had the IOL implanted at desired position. Post-operative complications were retinal detachment in one case and IOL dislocation in another patient. No other complication such as ocular hypertension, angle abnormalities, clinical cystoids macular edema, and corneal decompensation was observed during the follow-up period. CONCLUSION Artisan IOL implantation after lens extraction appears to be an attractive alternative for optical correction in cases of Marfan syndrome with ectopia lentis. It confers a significant improvement in visual acuity with reasonable risk profile.
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Affiliation(s)
- Hossein Mohammad Rabie
- Ophthalmic Research Center, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St., Tehran, 1666694516, Iran
| | - Parviz Malekifar
- Ophthalmic Research Center, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St., Tehran, 1666694516, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St., Tehran, 1666694516, Iran
| | - Danial Roshandel
- Ophthalmic Research Center, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St., Tehran, 1666694516, Iran
| | - Hamed Esfandiari
- Ophthalmic Research Center, Ophthalmology Department, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Pasdaran Ave. Boostan 9 St., Tehran, 1666694516, Iran.
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Groman-Lupa S, Santos-Cantú D, Quiroz-Mercado H. What is the best surgical approach for ectopia lentis in Marfan syndrome? REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2015.05.015] [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] Open
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Miraldi Utz V, Coussa RG, Traboulsi EI. Surgical management of lens subluxation in Marfan syndrome. J AAPOS 2014; 18:140-6. [PMID: 24698610 DOI: 10.1016/j.jaapos.2013.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 12/06/2013] [Accepted: 12/22/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the literature on the surgical management, describe a simplified surgical technique, and to report the postoperative clinical course of ectopia lentis removal in patients with Marfan syndrome. METHODS The medical records of patients with a clinical diagnosis of Marfan syndrome and clinically significant lens subluxation were retrospectively reviewed. Patients underwent lens extraction by a single surgeon via a simplified anterior segment approach. The pre- and postoperative best-corrected visual acuity, biometric measurements, intraocular pressure, and incidence of surgery-related complications were reviewed. RESULTS A total of 42 eyes of 22 patients were included. Mean postoperative follow-up was 4.9 ± 2.9 years (range, 1-10 years). Average age at surgery was 10.2 ± 9.2 years (range, 2-37 years), with 18 patients (36 eyes) ≤ 18 years of age. The average preoperative best-corrected visual acuity was 20/80, and the average postoperative best-corrected visual acuity at last follow-up was 20/25, with an average improvement of 6 lines on the Snellen chart. All eyes had a best-corrected visual acuity > 20/30 at last follow-up with aphakic correction. One eye of 1 patient developed a retinal detachment following blunt trauma. No other intra- or postoperative complications were reported. CONCLUSIONS Anterior lensectomy and limited vitrectomy with aphakic correction is safe and provides a consistent visual outcome in patients with lens subluxation secondary to Marfan syndrome. This is especially important in pediatric patients, in whom long-term follow-up for iris- and scleral-fixated intraocular lenses is limited.
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Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Eye Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Elias I Traboulsi
- The Cole Eye Institute, Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
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Zheng D, Wan P, Liang J, Song T, Liu Y. Comparison of clinical outcomes between iris-fixated anterior chamber intraocular lenses and scleral-fixated posterior chamber intraocular lenses in Marfan syndrome with lens subluxation. Clin Exp Ophthalmol 2011; 40:268-74. [DOI: 10.1111/j.1442-9071.2011.02612.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hirashima DE, Soriano ES, Meirelles RL, Alberti GN, Nosé W. Outcomes of iris-claw anterior chamber versus iris-fixated foldable intraocular lens in subluxated lens secondary to Marfan syndrome. Ophthalmology 2010; 117:1479-85. [PMID: 20466427 DOI: 10.1016/j.ophtha.2009.12.043] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare the outcome of phacoemulsification using 2 different iris-fixation techniques for intraocular lens (IOL) replacement, a foldable posterior chamber IOL (PCIOL; AcrySof MA60AC, Alcon Laboratories Inc, Fort Worth, TX) and an iris-claw anterior chamber IOL (ACIOL; Artisan, Ophtec BV), for treatment of subluxated lenses in patients with Marfan syndrome (MFS). DESIGN Randomized, controlled trial. PARTICIPANTS A total of 31 eyes of 16 patients with subluxated lenses associated with MFS and a preoperative corrected visual acuity (CVA) < or =20/40 based on the Early Treatment Diabetic Retinopathy Study chart. METHODS Patients were enrolled and the eye with worse visual acuity was randomly assigned to 1 of 2 study arms: phacoemulsification and iris-fixated PCIOL or phacoemulsification and iris-claw ACIOL; the second eye of the same patient received the other IOL type. Preoperative and postoperative ophthalmologic examination, optical coherence tomography, and endothelial cell counts were performed. MAIN OUTCOME MEASURES We recorded CVA results at 3, 6, and 12 months, complications, endothelial cell loss, and central retinal thickness. RESULTS In the iris-fixated PCIOL group, CVA was significantly improved at 3 (P = 0.011; n = 16), 6 (P = 0.006; n = 16), and 12 months (P = 0.002; n = 16). In the iris-claw ACIOL group, CVA was significantly improved at 3 (P = 0.001; n=15), 6 (P = 0.001; n = 15), and 12 months (P = 0.009; n = 12). The CVA results did not differ significantly between groups. Dislocation of the IOL occurred in 3 of 16 (18.75%) eyes in the PCIOL group. Retinal detachment occurred in 3 eyes (2 in the PCIOL group and 1 in the ACIOL group) and was successfully repaired. Postoperative foveal tomograms in both groups revealed a decrease in the mean foveal thickness (MFT; < or =172 microm) in 54.16% of the patients. CONCLUSIONS The iris-sutured PCIOL and iris-claw ACIOL produced comparable improvements in CVA at 3, 6, and 12 months postoperatively. Although IOL dislocation tended to occur more frequently in the iris-fixated PCIOL group, the difference was not significant. At 6 months postoperatively, all study patients tended to have a thinner MFT. None of the patients in either group developed cystoid macular edema.
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Ophthalmologic Manifestations of Systemic Disease. Clin Ophthalmol 2010; 50:27-43. [DOI: 10.1097/iio.0b013e3181f128ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Accommodation Measured with Optical Coherence Tomography in Patients with Marfan's Syndrome. Ophthalmology 2009; 116:1343-8. [DOI: 10.1016/j.ophtha.2009.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 11/23/2022] Open
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Tarongoy P, Ho CL, Walton DS. Angle-closure glaucoma: the role of the lens in the pathogenesis, prevention, and treatment. Surv Ophthalmol 2009; 54:211-25. [PMID: 19298900 DOI: 10.1016/j.survophthal.2008.12.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary angle-closure glaucoma is a major cause of blindness worldwide. It is a disease of ocular anatomy that is related to pupillary-block and angle-crowding mechanisms of filtration angle closure. Eyes at increased risk for primary angle-closure are small with decreased axial length, anterior chamber depth, and filtration angle width, associated with a proportionately large lens. Angle-closure glaucoma afflicts Asian and Eskimo eyes more frequently than eyes in other races with similar predisposing dimensions. The treatment of primary angle closure addresses its causal mechanisms. Laser peripheral iridotomy equalizes the anterior and posterior pressures and widens the filtration angle by reducing the effect of pupillary block. Argon laser peripheral iridoplasty contracts the iris stroma to reduce angle crowding and is helpful for some affected eyes. Lensectomy dramatically widens the angle and eliminates pupillary block. Clinical reports of lensectomy with posterior chamber intraocular lens implantation in the treatment of acute, chronic, and secondary angle-closure glaucoma describe very favorable results. The appropriate role for lensectomy in the management of primary angle closure, however, remains unproven. Prospective, randomized clinical trials are ongoing to determine the value and comparative risks and efficacy of lensectomy versus medical therapy, laser peripheral iridotomy, laser iridoplasty, and filtration procedures for the treatment of acute and chronic primary angle closure and for the prevention of chronic angle-closure glaucoma, both after and in place of laser peripheral iridotomy.
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Affiliation(s)
- Pamela Tarongoy
- Associated Cebu Eye Specialists (ACES), Cebu City, Philippines
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Kim SY, Choung HK, Kim SJ, Yu YS. Long-term results of lensectomy in children with ectopia lentis. J Pediatr Ophthalmol Strabismus 2008; 45:13-9; quiz 20-1. [PMID: 18286957 DOI: 10.3928/01913913-20080101-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical features and long-term visual results in children with ectopia lentis after lensectomy. METHODS A retrospective analysis was performed with the records of 78 eyes of 42 patients operated on and observed for at least 3 years. RESULTS Mean age at diagnosis was 4.6 years, mean age at surgery was 5.7 years, and follow-up period was an average of 7.1 years. Of 42 patients exhibiting bilateral ectopia lentis, 6 received monocular surgery. Mean age at diagnosis was significantly higher and mean postoperative best-corrected visual acuity was significantly lower in the monocular surgery group than in the binocular surgery group (P < .05). All eyes exhibited reduced hyperopia for 5 years postoperatively, but the reduction rate of hyperopia in the monocular group was significantly lower than inthe binocular group (P < .05). No complications occurred during operations and 1 eye (1.3%) in a patient with Marfan's syndrome exhibited retinal detachment 9 years after surgery. CONCLUSIONS Surgical treatment of ectopia lentis was safe and promising with regard to good visual outcomes after 7.1 years of follow-up. However, the possibility of amblyopia must be considered due to differences in the degree of dislocation between the two eyes.
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Affiliation(s)
- So Young Kim
- Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Bahar I, Kaiserman I, Rootman D. Cionni endocapsular ring implantation in Marfan's Syndrome. Br J Ophthalmol 2007; 91:1477-80. [PMID: 17947268 DOI: 10.1136/bjo.2007.131169] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the visual outcomes, intraoperative and postoperative complications of Cionni ring implantation in eyes with a subluxated lens associated with Marfan Syndrome. METHODS This case series included 15 eyes of 12 patients aged 19-56 years with a subluxated lens secondary to Marfan's syndrome operataed at the Departament of Ophtalmology, Toronto Western Hospital between 2003 and 2007. A 2-eyelet Cionni ring and an AcrySof (Alcon) foldable intraocular lens (IOL) were implanted in 13 eyes. Two eyes had trans-scleral IOL fixation in the ciliary sulcus. Best-corrected visual acuity, wavefront evaluation of eye aberration and complication rates were analysed. RESULTS In all eyes, capsular bag centration was excellent. Preoperative visual acuity ranged from 20/50 to counting fingers, and improved to better than 20/40 in all eyes. The mean follow-up duration was 14+/-9.49 months. The most frequent postoperative complication was posterior capsule opacification, which occurred in 3 eyes (18.7%), 2 of which required a neodymium:YAG posterior capsulotomy. No eye developed retinal detachment. Total eye aberration, tilt and high-order aberrations with a 6-mm pupil diameter decreased significantly after surgery (n = 5): Total eye aberration decreased from a mean of 14.8+/-5.5 preoperatively to 2.1+/-4.3 microns after the operation. Tilt was decreased from 4.1+/-2.5 to 0.12+/-2.1 microns, and high-order aberrations decreased from 4.37+/-3.8 microns, before the operation, to 1.47+/-3.5 after the operation. CONCLUSION Cionni ring implantation is an effective procedure to correct partial lens subluxation and has few complications (during 14 months of follow-up) in patients with Marfan's Syndrome.
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Affiliation(s)
- Irit Bahar
- Department of Ophthalmology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Nemet AY, Assia EI, Apple DJ, Barequet IS. Current concepts of ocular manifestations in Marfan syndrome. Surv Ophthalmol 2006; 51:561-75. [PMID: 17134646 DOI: 10.1016/j.survophthal.2006.08.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Marfan syndrome is a widespread disorder of connective tissue. It is characterized by systemic and ocular features due to mutations in the fibrillin gene. Awareness and prompt recognition of the ocular complications of Marfan syndrome may enable improvement and preservation of sight. Studies have been performed in the last few years that enable a better understanding of the genetics of the syndrome, earlier diagnosis, and improvement in the surgical techniques and options.
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Affiliation(s)
- Arie Y Nemet
- Department of Ophthalmology, Sapir Medical Center, Kfar Sava, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Lifshitz T, Levy J, Klemperer I. Artisan aphakic intraocular lens in children with subluxated crystalline lenses. J Cataract Refract Surg 2004; 30:1977-81. [PMID: 15342065 DOI: 10.1016/j.jcrs.2004.01.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2004] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the results of Artisan (Ophtec) aphakic intraocular lens (IOL) implantation in children with idiopathic subluxated lenses. SETTING Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel. METHODS This retrospective small case series comprised 4 eyes (3 children) with idiopathic essential subluxated lenses that had lens washout, lens capsule removal, Artisan IOL implantation, and peripheral iridectomy. The indications for surgery were reduced visual acuity and monocular diplopia. The main outcome measures were postoperative refraction and change in best corrected visual acuity (BCVA). RESULTS The postoperative follow-up ranged from 8 to 10 months. After surgery, the BCVA was 6/12 or better in the 3 cases that could be recorded. Visual acuity improved by 2 or more Snellen lines in all 4 eyes. The postoperative spherical equivalent was within +/-1.00 diopter in all cases. No significant postoperative complications were observed. CONCLUSIONS In 4 eyes with a subluxated crystalline lens, implantation of an Artisan aphakic IOL improved visual acuity. Studies with a larger number of patients and longer follow-up are necessary to confirm these results.
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Affiliation(s)
- Tova Lifshitz
- Ophthalmology Department, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kohnen T, Baumeister M, Bühren J. Scheimpflug imaging of bilateral foldable in-the-bag intraocular lens implantation assisted by a scleral-sutured capsular tension ring in Marfan's syndrome. J Cataract Refract Surg 2003; 29:598-602. [PMID: 12663031 DOI: 10.1016/s0886-3350(02)01510-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 35-year-old white man with bilateral high myopia, astigmatism, subluxated crystalline lenses, and incipient cataract had phacoemulsification and implantation of a hydrophobic acrylic intraocular lens (IOL) (Alcon MA60BM) in both eyes. The subluxated capsular bag was stabilized and recentered using a scleral-fixated capsular tension ring (CTR) (type 1L, Morcher). Measured with Scheimpflug photography, the capsular bag and IOL were in a stable intraocular position during the 18-month follow-up. There were no major changes in refraction. Despite the sharp-edged IOL design, both eyes had posterior capsule opacification (PCO) 18 months after surgery that in 1 eye caused a decrease in visual acuity of more than 2 lines. High myopia and subluxated lenses may be treatable long-term with a scleral-fixated CTR and foldable IOL implantation; further evaluation of PCO is necessary.
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Affiliation(s)
- Thomas Kohnen
- Johann Wolfgang Goethe University, Department of Ophthalmology, Frankfurt am Main, Germany.
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Ozdek S, Sari A, Bilgihan K, Akata F, Hasanreisoglu B. Surgical Treatment of Hereditary Lens Subluxations. Ophthalmic Surg Lasers Imaging Retina 2002. [DOI: 10.3928/1542-8877-20020701-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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