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Hapca MC, Muntean GA, Nemeș-Drăgan IA, Vesa ȘC, Nicoară SD. Visual Outcomes of Traumatic Lens Dislocations and Subluxations Managed by Pars Plana Vitrectomy and Lensectomy. J Clin Med 2023; 12:6981. [PMID: 38002596 PMCID: PMC10671993 DOI: 10.3390/jcm12226981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
AIM The aim of this study was to evaluate the visual outcome of lens dislocation and subluxation managed by pars plana vitrectomy (PPV) and lensectomy in patients with open (OGIs) or closed globe injuries (CGIs). METHODS Medical records of 70 consecutive patients treated by PPV and lensectomy over a period of 11 years (1 January 2010-31 December 2020) were retrospectively reviewed. We collected demographic data, best corrected visual acuity (BCVA) using a Snellen Chart pre- and postoperatively, associated ocular injuries and treatment strategy. Visual outcome was evaluated according to the final BCVA which was defined as poor <0.1 or good ≥0.1. RESULTS The mean age was 57.9 ± 17.6 years. CGIs were present in 49 (70.0%) cases and open OGIs in 21 (30.0%) cases. The dislocation mechanism was zonular lysis in 59 cases (84.3%) and capsular rupture in 11 cases (15.7%). The intraocular lens implant (IOL) was sutured to the sclera in 51 (72.9%) cases or positioned in the capsular bag or in the sulcus in 3 (4.3%) cases and 1 (1.4%) case, respectively, whereas 15 (21.4%) patients remained aphakic. A good BCVA ≥ 0.1 was achieved in 45.71% of the eyes. The presence of retinal detachment (RD) (p = 0.014), iridodonesis (p = 0.011) and initial BCVA (p = 0.000) achieved statistical significance in predicting visual outcome. After treatment, 45.71% of patients achieved a final BCVA ≥ 0.1. CONCLUSION RD, iridodonesis and initial BCVA were risk factors for poor visual outcome in our series.
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Affiliation(s)
- Mădălina-Claudia Hapca
- Doctoral School of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania;
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania;
| | - George-Adrian Muntean
- Doctoral School of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania;
| | - Iulia-Andrada Nemeș-Drăgan
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania;
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Simona-Delia Nicoară
- Doctoral School of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania;
- Ophthalmology Clinic, Emergency County Hospital, 3–5 Clinicilor Str., 400006 Cluj-Napoca, Romania;
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, V. Babeș Str. 8, 400012 Cluj-Napoca, Romania
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Traumatic Lens Dislocation in an Eye with Anterior Megalophthalmos. Case Rep Ophthalmol Med 2022; 2022:6366949. [PMID: 35586154 PMCID: PMC9110200 DOI: 10.1155/2022/6366949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/25/2022] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Anterior megalophthalmos is a rare, bilateral, nonprogressive, hereditary, congenital disorder characterized by the enlargement of all anterior segment structures of the eye, with megalocornea, iris atrophy, and zonular abnormalities. We report a case of an 8-year-old male who presented to the emergency department with a history of visual loss after a blunt ocular trauma to the left eye. The patient presented with markedly enlarged corneas and deepened anterior chambers bilaterally. Best-corrected visual acuity (BCVA) was hand motion in the left eye. An additional examination revealed multiple anterior segment abnormalities, leading to the diagnosis of megalophthalmos and lens dislocation in the anterior chamber. The patient underwent a lensectomy and anterior vitrectomy in the left eye. At six months postoperatively, the BCVA was 20/200 in the left eye. Lens dislocation in patients with megalocornea is rare. Cataract surgery in these patients requires attention to the zonular abnormalities and lens enlargement, resulting in increased rates of intraoperative and postoperative complications. Ophthalmologists should be able to diagnose this rare disorder and manage the associations and complications.
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Ocular Trauma. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_176] [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]
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Rajendrababu S, Senthilkumar V. Traumatic subtle anterior subluxated lens with impending pupillary block. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_145_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Goyal K, Shekhawat N, Khilnani K. Management of traumatic dislocation of crystalline lens: Retropupillary iris-claw versus sutureless intrascleral-fixated intraocular lens. Taiwan J Ophthalmol 2021; 11:389-394. [PMID: 35070669 PMCID: PMC8757526 DOI: 10.4103/tjo.tjo_48_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/08/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: The purpose of this study was to compare the long-term efficacy and safety of posterior iris-claw lens and scleral-fixated posterior chamber lens for aphakia after traumatic posterior dislocation of the crystalline lens. MATERIAL AND METHODS: Out of 120 evaluated cases, 60 were randomly assigned in each group. A 23G vitrectomy was done and intraocular lens was implanted by two different techniques. Extensive preoperative and postoperative evaluation was performed including optical coherence tomography and Scheimpflug imaging. Follow-up was done on days 1, 7, and 28 at 3 months, 6 months, and 12 months. RESULTS: A significant improvement was found in uncorrected visual acuity in both the groups. Surgical time in iris fixation was significantly less (P < 0.001), whereas pupil peaking and pigment release were more. Difference in mean intraocular pressure and change in astigmatism in both the groups were insignificant. CONCLUSION: Both the techniques had similar good visual results. Although operating time was shorter for iris fixation, it had several disadvantages, including immediate postoperative inflammation and ovalling of the pupil. However, scleral fixation had a better outcome in terms of postoperative complications.
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Affiliation(s)
- Karishma Goyal
- Department of Ophthalmology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Nagendra Shekhawat
- Department of Ophthalmology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Kamlesh Khilnani
- Department of Ophthalmology, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
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Monera Lucas CE, Escolano Serrano J, Romero Valero D, Fernández Martínez C, Navarro Navarro A, Martínez Toldos JJ. Posterior bilateral lens luxation in an agitated patient: Cause or consequence? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:93-96. [PMID: 32868083 DOI: 10.1016/j.oftal.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases.
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Affiliation(s)
- C E Monera Lucas
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, España.
| | - J Escolano Serrano
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - D Romero Valero
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - C Fernández Martínez
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - A Navarro Navarro
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - J J Martínez Toldos
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, España
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Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol 2020; 65:530-547. [PMID: 32057763 DOI: 10.1016/j.survophthal.2020.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.
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Meredith TJ, Embry S, Hunter R, Noble B. Ocular Trauma. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lin HL, Qin YJ, Zhang YL, Zhang YQ, Niu YY, Chen YL, Hu YY, Xie WJ, Zhang HY. Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study. J Ophthalmol 2020; 2020:6974202. [PMID: 32802489 PMCID: PMC7415100 DOI: 10.1155/2020/6974202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare ocular anatomy differences of lens subluxation between eyes with or without acute angle closure (AAC). METHODS This is a retrospective and case-control study. Sixty cases with mild lens subluxation were recruited. Among them, 30 eyes with acute angle closure were assigned to the AAC group and 30 eyes without AAC were assigned to the non-AAC group. The anterior segment was quantitatively evaluated by ultrasound biomicroscopy (UBM). The axial length (AL) was measured with IOL Master. All patients underwent lens extraction surgery and were followed up for six months. RESULTS The history of blunt trauma accounted for 22 (73.3%) cases in the AAC group and 21 (70%) cases in the non-AAC group. Fifteen (50%) patients in the AAC group had iridotomy history, and high intraocular pressure recurred. The UBM analysis showed that the average central chamber depth of the affected eyes in the AAC group was 1.82 mm, which was significantly shallower than that in the fellow eyes (2.58 mm, P < 0.05) or both eyes in the non-AAC group.Both eyes in the AAC group presented a shorter AL and shallower anterior chamber than the eyes in the non-AAC group. CONCLUSIONS An asymmetrical anterior chamber between bilateral eyes is an important feature in lens subluxation-induced AAC. The crowded anterior chamber and shorter AL might be the anatomic basis for the eye with lens subluxation-induced AAC.
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Affiliation(s)
- Hong-Liang Lin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yong-Jie Qin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Yu-Lin Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yu-Qiao Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yong-Yi Niu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Yan-Lei Chen
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Yun-Yan Hu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Wen-Juan Xie
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Hong-Yang Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
- Southern Medical University, Guangzhou, Guangdong, China
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Ke G, Zhou E, Zhu K, Wei Y, Wang Z, Jia Y, Wang S, Gu Y. Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy. Graefes Arch Clin Exp Ophthalmol 2019; 258:693-697. [PMID: 31781882 DOI: 10.1007/s00417-019-04530-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/19/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Both ectopia lentis and retinal injury are common results of blunt ocular trauma. Here, we investigated the incidence and characteristics of retinal breaks associated with ectopia lentis caused by blunt ocular trauma. METHODS Patients who underwent pars plana vitrectomy to treat traumatic lens subluxation and dislocation were retrospectively reviewed. The incidence, characteristics, and outcomes of retinal breaks were analyzed. RESULTS Forty-five eyes from 45 patients were included in the study. Seventeen eyes (37.7%) were complicated by retinal breaks or detachment, but only four (8.9%) were identified pre-operation. Our study revealed that retinal breaks were more frequently located at the superior (72.7%) and peripheral (81.8%) retina. All patients achieved anatomic recovery post-surgery. The eyes with and without retinal breaks did not differ significantly with respect to initial or final visual acuity. The final visual outcomes were independently and significantly associated with visual acuity at presentation (P = 0.001). CONCLUSIONS Retinal breaks occurred in approximately one-third of patients with traumatic ectopia lentis and were difficult to observe pre-operation. Complete ophthalmic evaluation and timely intervention may help achieve favorable outcomes.
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Affiliation(s)
- Genjie Ke
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Enliang Zhou
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Kai Zhu
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yingying Wei
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zhiling Wang
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yangxue Jia
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Shiying Wang
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yonghao Gu
- Department of Ophthalmology, Eye Center, First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
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Arthur J, Schubert B, Topp SS. Traumatic ocular lens dislocation. Afr J Emerg Med 2019; 9:106-107. [PMID: 31193762 PMCID: PMC6543072 DOI: 10.1016/j.afjem.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 12/07/2018] [Accepted: 01/04/2019] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Ocular lens dislocation is a relatively rare and difficult to diagnose disorder. Computed tomography often confirms the diagnosis, however may be unavailable in resource limited settings. Bedside ultrasound offers an alternative method of diagnosis which is rapid, inexpensive, and relatively easy. CASE A 59-year-old man presented with a complaint of decreased vision in his right eye after being assaulted. Exam was remarkable for decreased visual acuity and increased intraocular pressure. Maxillofacial and brain CT as well as bedside ultrasound demonstrated a posteriorly dislocated ocular lens. The patient's intraocular pressures were medically managed and he was discharged with close follow-up with ophthalmology. CONCLUSION Ocular lens dislocation may be easily diagnosed with ultrasound. Direction of lens dislocation dictates management, however posterior dislocations may be amenable to outpatient management.
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Affiliation(s)
- Jason Arthur
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, AR, USA
| | - Brett Schubert
- University of Florida College of Medicine – Jacksonville, Department of Emergency Medicine, Jacksonville, FL, USA
| | - Stephen S. Topp
- University of Florida College of Medicine – Jacksonville, Department of Emergency Medicine, Jacksonville, FL, USA
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Yi QY, Huang J, Chen N, Li WD, Chen LS, Wang YY, Wang JL, Song E. Managing dislocated hard lens nuclei: 23-gauge vitrectomy and lens extraction via a corneoscleral limbal incision versus 23-gauge vitrectomy and phacofragmentation. J Cataract Refract Surg 2019; 45:451-456. [PMID: 30661969 DOI: 10.1016/j.jcrs.2018.10.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare 23-gauge vitrectomy and lens extraction via a corneoscleral limbal incision (CSLI) with 23-gauge vitrectomy and phacofragmentation to treat dislocation of hard lens nuclei. SETTING Ningbo Eye Hospital, Zhejiang, China. DESIGN Retrospective case series. METHODS The study included consecutive patients with complete posterior dislocation of a hard nucleus (grade ≥ IV) into the vitreous cavity. All patients received 23-gauge 3-channel vitrectomy. Some patients also had phacofragmentation and others had lens extraction through a CSLI. RESULTS The CSLI group comprised 21 eyes of 21 patients and the phacofragmentation group, 22 eyes of 22 patients. The median follow-up was 10.8 months (range 6 to 24 months) and 11.3 months (range 5 to 18 months), respectively. Demographic characteristics, reason for lens dislocation, preoperative corrected distance visual acuity (CDVA), preoperative intraocular pressure (IOP), lens nucleus grade, and comorbidities were similar between groups. The CSLI group had a shorter mean surgical time than the phacofragmentation group (42.5 ± 7.2 minutes versus 68.2 ± 16.5 minutes); less frequent use of perfluorocarbon liquid, octafluoropropane, or air tamponade; lower incidence of retinal tears (9.5% versus 31.8%); and better CDVA but worse astigmatism 1 day and 1 week postoperatively (P < .05). The postoperative IOP did not differ between groups. Corneal edema and recurrent retinal detachment were less common in the CSLI group than in the phacofragmentation group. CONCLUSION The 23-gauge vitrectomy with lens extraction through a CSLI might have advantages over 23-gauge vitrectomy with phacofragmentation for management of dislocated hard lens nuclei.
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Affiliation(s)
- Quan-Yong Yi
- Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Ningbo Eye Hospital, Zhejiang, China
| | - Jiang Huang
- Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Nan Chen
- Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | | | | | | | - E Song
- Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China.
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Pars Plana Vitrectomy Combined With Either Secondary Scleral-Fixated or Anterior Chamber Intraocular Lens Implantation. Am J Ophthalmol 2016; 168:177-182. [PMID: 27189930 DOI: 10.1016/j.ajo.2016.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare visual outcomes among eyes that underwent pars plana vitrectomy (PPV) in combination with either anterior chamber intraocular lens implantation (ACIOL) or scleral suturing of posterior chamber lens (PCIOL). DESIGN Retrospective comparative case series. METHODS All eyes presented with aphakia or luxated or subluxated posterior chamber intraocular lens (IOL) following complicated cataract surgery, trauma, or spontaneous dislocation. Eyes involving visually significant macular pathology, past retinal detachment, follow-up of less than 6 months, and surgeries requiring the removal of an ACIOL were excluded. The main outcomes measured were final best-corrected visual acuity (BCVA) and surgical complication rates. RESULTS Fifty-seven eyes met inclusion criteria; median follow-up was 13.2 months. Initial median BCVA for ACIOL patients was logMAR 1.301 (Snellen equivalent 20/400, range 20/20 to light perception); final median BCVA was logMAR 0.477 (Snellen equivalent 20/60, range 20/20 to light perception, P < .001). Initial median BCVA for PCIOL patients was logMAR 1.239 (Snellen equivalent 20/347, range 20/60 to light perception); final median BCVA was logMAR 0.301 (Snellen equivalent 20/40, range 20/20 to hand motions, P < .001). The change in BCVA between the 2 groups over the course of the study was similar (P > .05). More epiretinal membrane (ERM) formations occurred postoperatively in the ACIOL group (P = .011). Other complication rates were similar between both groups. CONCLUSIONS PPV with secondary IOL placement is safe and effective, resulting in improved visual outcomes regardless of the technique used. Patients undergoing ACIOL placement have a higher incidence of ERM formation.
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Vyas S, Krishna S, Kumar A, Khandelwal N. 'Floating lens sign' in traumatic lens dislocations. Middle East Afr J Ophthalmol 2015; 22:129-30. [PMID: 25624690 PMCID: PMC4302470 DOI: 10.4103/0974-9233.148365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sameer Vyas
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satheesh Krishna
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Tandava KP, Rajyalakshmi R, Radke SN, Radke NV. Planned posterior assisted levitation in severe subluxated cataract: surgical technique and clinical results. Indian J Ophthalmol 2013; 61:774. [PMID: 24212217 PMCID: PMC3917406 DOI: 10.4103/0301-4738.121140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Krishnan Panakanti Tandava
- Department of Vitreo-Retina, Pushpagiri Eye Institute, 241, Uma Plaza Road No: 9, West Maredpally, Secunderabad, Andhra Pradesh, India
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Teke MY, Balikoglu-Yilmaz M, Yuksekkaya P, Citirik M, Elgin U, Ozdal P, Yenigun S, Sen E, Ozturk F. Thirteen-year vitreoretinal surgical outcomes of 5,097 cases from a tertiary referral center in Turkey. Ophthalmologica 2013; 230:186-94. [PMID: 24080789 DOI: 10.1159/000354062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/21/2013] [Indexed: 11/19/2022]
Abstract
A 13-year retrospective chart review of 5,097 consecutive cases that underwent pars plana vitrectomy (PPV) in a tertiary referral center in Turkey was performed. Age at onset, sex, laterality, associated systemic disease, pre- and postoperative visual acuities (VA), indications, type of surgery and outcomes of surgery were analyzed. The most common indications for vitreoretinal surgery (VRS) were rhegmatogenous retinal detachment (n = 1,802, 35.4%) and proliferative diabetic retinopathy (n = 1,505, 29.5%). The most common vitreoretinal technique combinations performed were PPV with encircling endolaser (EL) and phacoemulsification with intraocular lens implantation (33.0%), PPV with encircling EL (30.4%), and only PPV (7.0%). A statistically significant increase in the mean VA was noted at the first- (1.16 ± 0.44 logarithm of the minimum angle of resolution, logMAR) and sixth-month (1.06 ± 0.61 logMAR) visits when compared to the preoperative VA (1.77 ± 0.58 logMAR; p < 0.001). Comparisons in the top surgical indications, techniques and outcomes for vitrectomy between the countries could be important for the development of subspecialization in VRS.
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Olson JL, Velez-Montoya R, Erlanger M, Mackenzie D. Management of a dislocated intraocular lens with a suction-based grasping tool. J Cataract Refract Surg 2013; 39:154-7. [DOI: 10.1016/j.jcrs.2012.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 09/25/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
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Kongsap P. Combined 20-gauge and 23-gauge pars plana vitrectomy for the management of posteriorly dislocated lens: a case series. Clin Ophthalmol 2010; 4:625-8. [PMID: 20668665 PMCID: PMC2909892 DOI: 10.2147/opth.s11837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Indexed: 11/23/2022] Open
Abstract
Objective: To present a new surgical approach for the management of posteriorly dislocated lens by using a combination of 20-gauge (20G) and 23-gauge (23G) pars plana vitrectomy. Design: An interventional case series Methods: This technique was performed on six patients (five men, one woman; mean age, 66.67 years; range, 66–72 years). Two 23G trans-conjunctival sclerotomy ports were created for infusion and illumination along with a 20G sclerotomy port for introducing the vitrectomy probe or fragmatome. Results: This procedure was successfully performed on six eyes. On postoperative day one, the media were clear and the retina could be seen by indirect ophthalmoscopy. Hyphema developed in one eye and resolved within a week. There were no observed cases of retinal tear, wound leakage, hypotony, or endophthalmitis. The post-operative follow-up period ranged from three to twelve months (mean, 8.1 months). By the final visit, two patients had achieved a visual acuity of 20/40 or better, three patients, 20/70, and one patient, 20/200. Conclusion: The combination of 20G and 23G pars plana vitrectomy is an efficacious and safe procedure for management of posteriorly dislocated lens.
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Affiliation(s)
- Pipat Kongsap
- Department of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Affiliated with the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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