Massive anterior capsule shrinkage after plate-haptic silicone lens implantation in uveitis

Complete Occlusion of Anterior Capsular Opening in Patient Operated for Cataract With Penetrating Keratoplasty

A 68-year-old female underwent a full-thickness penetrating keratoplasty (PK) and developed a mature cataract for which she was operated on using the phacoemulsification technique with the implantation of polymethyl methacrylate lens. The patient developed diminished vision one month after the cataract surgery. The patient had a contraction of the anterior capsular opening. Neodymium-doped yttrium aluminum garnet laser (ND:YAG) anterior capsulotomy was performed to create an opening in the anterior capsule, following which the patient regained her vision. To the best of our knowledge, this is the first report of early anterior capsular contraction in a patient operated for PK.

Four-flanged prolene fixation for a toric trifocal intraocular lens of the double C-Loop design in an eye with severe capsular phimosis

Purpose

To report a rare case of severe capsular phimosis after toric trifocal intraocular lens implantation, in a patient who was already on systemic immunosuppression and to present a modified fixation technique, based on the four-flanged prolene technique, which could be adapted for fixation of intraocular lenses of the double-C-loop design.

Observations

A 33 year old gentleman, who underwent uneventful, sequential, bilateral phacoemulsification with implantation of toric trifocal intraocular lenses, presented 6 weeks post-operatively, with severe capsular phimosis, causing decentration of the IOL and deformation of the haptics in both eyes. The left eye was successfully managed by Nd-YAG laser anterior capsulotomy, while the right eye required surgical intervention.

Conclusion and importance

In the present case report, we describe a novel technique to successfully reposition and realign a decentered toric trifocal intraocular lens of the double C-loop haptic design, after severe capsule phimosis.

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A novel technique using four-flanged prolene suture to reposition a toric-trifocal IOL without the need for explantation.

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Secondary IOL repositioning and fixation made possible even for toric trifocal IOLs.

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Successful re-centration and re-alignment of a toric-trifocal IOL after aggressive capsular phimosis.

Complete Anterior Capsule Phimosis following Cataract Surgery in a Patient with a History of Retinopathy of Prematurity, Nystagmus, and a Narrow Angle

The authors present a case of complete anterior capsule phimosis and vision decline which developed 4 weeks postoperatively in the right eye after uncomplicated cataract surgery. Prior ocular history included retinopathy of prematurity in both eyes, acute angle closure glaucoma in the left eye, prophylactic laser peripheral iridotomy for a narrow angle in the right eye, and nystagmus in both eyes. This condition was addressed by surgically releasing the anterior capsule with microscissors to open the pupillary space which had been completely obscured by the anterior capsule, also causing the haptics of the 1-piece intraocular lens to deform. When cataract surgery was performed on his left eye, the surgeon performed prophylactic relaxing incisions at 4 points on the capsular opening. It is notable that his left eye did not develop anterior capsule phimosis postoperatively.

Long-Term Visual Acuity and its Predictors after Cataract Surgery in Patients with Uveitis

Purpose.

To analyze the outcomes of phacoemulsification and posterior intraocular lens (IOL) implantation in patients with uveitis and to determine factors responsible for poor visual outcome.

Methods.

The records of 155 patients (180 eyes) with uveitis who had phacoemulsification and IOL implantation between August 2001 and March 2008 were examined retrospectively. Best-corrected visual acuity (BCVA) was recorded at the immediate preoperative visit and at follow-up examinations every 3 months. At each postoperative visit, a complete ophthalmologic examination was performed. The postoperative visual outcomes and complications were analyzed. Univariate regression analysis was done to determine risk factors for poor visual acuity during follow-up.

Results.

The mean follow-up was 31.4 months (range 3–78 months). An underlying systemic disease was present in 70 (45.2%) patients (82 eyes, 45.6%). The mean preoperative logMAR BCVA was 1.13±0.62 (95% CI: 0.85–1.02) and increased to 0.42±0.57 (95% CI: 0.32–0.59) at last medical visit (p<0.001). A total of 107 eyes (59.4%) had postoperative complications including posterior capsular opacification, newly developed macular edema, recurrence of uveitis, macular epiretinal membrane, and deposits on the IOL surface. Preoperatively observed macular lesions was the factor most strongly associated with poor visual outcome after cataract surgery (odds ratio: 5.43; 95% CI: 3.41–7.34; p<0.001). Anterior segment pathologies, age at surgery, etiology of uveitis (idiopathic, uveitis associated systemic disease), and gender did not influence visual rehabilitation after surgery (p>0.05).

Conclusions.

The outcomes of phacoemulsification and IOL implantation in patients with uveitis were satisfactory. Patients with observed preoperative macular lesions are at risk for poor visual outcome.

Elevated TGF-β2 level in aqueous humor of cataract patients with high myopia: Potential risk factor for capsule contraction syndrome

PURPOSE

To evaluate the level of transforming growth factor-β2 (TGF-β2) in the aqueous humor of highly myopic cataract patients and its correlation with capsule contraction syndrome.

SETTING

Eye and ENT Hospital of Fudan University, Shanghai, China.

DESIGN

Prospective comparative case series.

METHODS

The highly myopic cataract patients were divided into the following 2 groups according to the Lens Opacity Classification System III: nuclear color (NC) 2 to 3 and NC 5 to 6. Aqueous humor TGF-β2 concentrations were assayed in the highly myopic cataract and age-related cataract groups. The TGF-β2, TGF-βRII (the type II receptor for TGF-β2), and α-smooth muscle actin (α-SMA) expressions in lens epithelial cells (LECs) were detected by real-time polymerase chain reaction and immunofluorescent staining.

RESULTS

The study comprised 40 highly myopic cataract patients (40 eyes) and 20 patients (20 eyes) with age-related cataract as the control group. Compared with the control group, the highly myopic cataract group had significantly higher TGF-β2 concentration in the aqueous humor and increased TGF-βRII expression in LECs, especially in NC 5 to 6 cases. Expression of α-SMA was barely detectable in both groups.

CONCLUSION

In highly myopic cataract patients, especially those with dark nuclei, elevated aqueous humor TGF-β2 levels and the upregulated TGF-βRII expression in LECs might contribute to the pathogenesis of capsule contraction syndrome through transdifferentiation of LECs into myofibroblasts.

FINANCIAL DISCLOSURE

None of the authors has a financial or proprietary interest in any material or method mentioned.

In-the-bag decentration of an intraocular lens in a patient with a tendency to hypertrophic scarring

We report a case of rapid anterior lens capsular contraction leading to decentration of a hydrophilic acrylic lens with stiff haptics (Rayner design). To our knowledge, this is the first report to investigate early capsular contraction with folding of the haptic over the optic in a patient with a tendency toward hypertrophic scar formation.

The impact of capsulorhexis diameter, localization and shape on posterior capsule opacification

BACKGROUND

The aim of this study was to evaluate the impact of capsulorhexis diameter, localization and shape on posterior capsule opacification (PCO) development after cataract extraction with phacoemulsification.

MATERIAL/METHODS

We retrospectively analyzed of 297 patients who underwent phacoemulsification and AcrySof SA60AT implantation. In a first group of 97 patients, 53 received small capsulorhexis (3.9 to 4.9 mm in diameter) and 44 patients received large capsulorhexis (5.0 to 5.9 mm in diameter). Another group of 99 patients was split into subgroups--66 patients whose capsulorhexis were centrally located and 33 patients whose capsulorhexis were paracentral. A third group of 101 patients was split into subgroups--a subgroup of 59 patients were classified as having a regularly rimmed capsulorhexis and a subgroup of 42 patients as having an irregularly rimmed capsulorhexis. At 6 months follow-up, PCO was classified as none, mild, moderate, or severe, depending on the number of quadrants involved.

RESULTS

86.79% of the patients with a small capsulorhexis had no or mild PCO (p<0.001), whereas, 68.18% of the patients with a large capsulorhexis experienced moderate or severe PCO; 89.4% of the patients with a central capsulorhexis had no or mild PCO (p<0.001), whereas, 75.75% of the patients with a paracentral capsulorhexis had moderate or severe PCO; 86.44% of the patients with a regularly rimmed anterior capsulorhexis had no or mild PCO (p<0.001); and 69.04% of the patients with an irregular capsulorhexis rim had moderate or severe PCO.

CONCLUSIONS

A small capsulorhexis diameter, its central localization and regular shape result in less PCO following phacoemulsification.

Capsule contraction syndrome in Behcet's disease

We reported the case of a 39-year-old patient with inactive Behcet's syndrome developed capsule contraction syndrome after uneventful phacoemulsification and a foldable intraocular lens implantation. Two weeks after the operation, the patient was accepted to hospital with severe decrease of visual acuity (VA) on the operated eye. Capsule opening area had been reduced considerably by fibrotic tissue, which evaluated with full dilated pupil. Since capsule contraction syndrome (CCS) had been diagnosed in very early stage and which structure was not severely thick, the fibrotic band was treated successfully, 360 degree circular shape, by neodymium YAG (Nd:YAG) laser. Capsule opening area was remained stable during follow up period of one month. But a significant reocclusion was developed that need surgical reopening 3 months after initial operation. Continuous curvilinier capsulorhexis (CCC) may be recurred again after a successful treatment in patient with uveitis like Behcet's disease.

Capsular peeling in anterior capsule contraction syndrome: surgical approach and histopathological aspects

We present 4 cases of anterior capsule contraction syndrome in which progressive shrinkage of the anterior capsulorhexis developed after uneventful phacoemulsification. Three eyes were pseudophakic, and 1 eye remained aphakic. The newly formed membrane was surgically peeled from the anterior capsule, restoring the capsular bag.

Neodymium:YAG laser capsulotomy in vitrectomized pseudophakic eyes with persistent endotamponade

PURPOSE

To evaluate the feasibility and limits of neodymium:YAG (Nd:YAG) laser capsulotomy in eyes with persistent endotamponade.

SETTING

Department of Ophthalmology, University Cologne, Cologne, Germany.

METHODS

In this consecutive series, an Nd:YAG laser capsulotomy was performed by 1 surgeon in 6 eyes with posterior capsule opacification (PCO) and persistent endotamponade caused by proliferative vitreoretinopathy. The endotamponade was with silicone oil (5000 centistokes) in 5 eyes and with perfluorohexyloctane (F(6)H(8)) in 1 eye. Also evaluated were 6 vitrectomized eyes without endotamponade that had an Nd:YAG laser capsulotomy for PCO by the same surgeon. All 12 eyes were pseudophakic. The mean follow-up after capsulotomy was approximately 6 months (range 2 to 12 months). Follow-up examinations included visual acuity, intraocular pressure measurement, and IOL centration and capsule reopacification evaluation.

RESULTS

The total energy required was higher in eyes with persistent endotamponade. In 3 of these eyes, the laser capsulotomy could not be successfully completed and was surgically enhanced. The laser capsulotomy in eyes without endotamponade was successful in all cases. Complete reopacification occurred in 2 eyes with persistent endotamponade within 2 months and in no eye without endotamponade. Improvement in visual acuity was limited in all eyes because of retinal pathology.

CONCLUSIONS

Neodymium:YAG laser capsulotomy in pseudophakic eyes with persistent endotamponade was successful but had a relatively high reintervention rate. The visual prognosis was limited in all cases because of retinal pathology.

Post cataract-intraocular lens (IOL) surgery opacification

Intraocular lens (IOL) implantation has no doubt been one of the most satisfying advances of medicine. Millions of individuals with visual disability or frank blindness from cataracts had and continue to have benefit from this procedure. It has been reported by ophthalmologists that the modern cataract-intraocular lens (IOL) surgery is safe and complication-free most of the time. This makes the watchword for any cataract surgeon to be 'implantation,' 'implantation,' 'implantation.' In the mid-1980s, as IOLs were evolving rapidly, the watchword of the implant surgeon was 'fixation,' 'fixation,' 'fixation.' Most techniques, lenses and surgical adjuncts now allow us to achieve the basic requirement for successful IOL implantation, namely long-term stable IOL fixation in the capsular bag. However despite this advancement some items 'slipped through cracks.' In this article, we would like to alert the reader to a new watchword, namely 'opacification,' 'opacification,' 'opacification.' Here we will be talking about the good, the bad, and the ugly. Examples of the 'good' include the recent successes now being achieved in reducing the incidence of posterior capsule opacification. Examples of the 'bad' include various proliferations of anterior capsule cells, problems caused by silicone oil adherence to IOLs and problems with piggyback IOLs. The 'ugly' include the sometimes striking and often visually disabling opacifications occurring on and within IOL optics, both on some modern foldable IOLs as well as a poly(methyl methacrylate) (PMMA) optic degradation occurring with some models a decade or more after implantation.