Long-term changes of the corneal endothelium following intracapsular cataract extraction with implantation of open-loop anterior chamber lenses

Secondary iris claw intraocular lens implantation for the correction of aphakia after pars plana vitrectomy

PURPOSE

The purpose of this study was to evaluate the safety and efficacy of iris claw intraocular lens implantation for correction of aphakia in vitrectomized eyes without capsular support.

METHODS

This was a prospective interventional case series. Twelve aphakic vitrectomized eyes without capsular support underwent iris claw intraocular lens implantation. The main outcome measures were changes in uncorrected visual acuity, best-corrected visual acuity, spheric equivalent, corneal endothelial cell density, corneal thickness, central macular thickness, and complications.

RESULTS

Mean follow-up was 15.58 +/- 3.80 months with no intraoperative complications. Postoperatively, uncorrected visual acuity increased significantly at all follow-up visits (P < 0.05). Mean best-corrected visual acuity increased 10 letters/2 lines at the final follow-up visit (P = 0.023). Mean postoperative spheric equivalent at the last visit was -1.68 +/- 063 D, and the spheric equivalent was within +/-2.00 D of emmetropia in 9 (75%) eyes. Mean central macular thickness increased only at postoperative Month 3 (P = 0.043). Mean endothelial cell density loss was 23.87% at the last visit. Mean corneal thickness did not change during follow-up (P > 0.05). No corneal edema was observed. Complications were transient intraocular pressure increase (n = 1), cystoid macular edema (n = 1), and haptic dislocation replaced by surgery (n = 1). Retinas remained attached in all eyes.

CONCLUSION

Secondary iris claw intraocular lens implantation is clinically safe and effective to correct aphakia in vitrectomized eyes without capsular support. Larger studies with longer follow-up are warranted.

COMBINED PARS PLANA PHACOFRAGMENTATION, VITRECTOMY, AND ARTISAN LENS IMPLANTATION FOR TRAUMATIC SUBLUXATED CATARACTS

PURPOSE

To report on the outcome of combined pars plana phacofragmentation, vitrectomy, and Artisan lens implantation in the management of subluxated cataracts.

METHODS

This prospective, interventional, nonrandomized case series included nine eyes of seven consecutive adult patients with traumatic lens subluxation. Pre- and postoperative data (complete manifest refraction, best spectacle-corrected visual acuity, slit-lamp examination findings, intraocular pressure, fundus status, numerical density of endothelial cells, corneal thickness, and complications) were collected prospectively for all patients.

RESULTS

After a median postoperative follow-up of 12 months (range, 8-18 months), a mean spherical equivalent of -0.50 +/- 0.87 diopter (range, +1 to -1.50 diopter) was achieved. The mean logarithm of the minimum angle of resolution visual acuity improved from 1 (preoperatively) to 0.1 (postoperatively) (P = 0.007, Wilcoxon test). Median endothelial cell losses of 15 +/- 8% (P = 0.008) and 14 +/- 16% (P = 0.011) were registered at follow-ups of 1 month and 12 months, respectively. Postoperative complications included chronic intraocular inflammation and superior corectopia.

CONCLUSIONS

Our procedure appears to be a safe, accurate, stable, and efficacious option for the management of traumatic subluxated cataracts in adults. However, longer-term data are needed to evaluate the corneal endothelium.

Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery

PURPOSE

To determine and quantify corneal endothelial damage after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs).

SETTING

Eye Clinic, University of Trieste, Trieste, Italy.

METHODS

This retrospective study comprised 125 patients who had implantation of an AC IOL from January 1987 to December 1998. The mean follow-up was 5.2 years. The IOLs were the Domilens Chiron Vision Z (n = 52), the Iolab U85J (n = 38), and the AMO AC51B (n = 35). The Konan specular microscope was used to perform full morphometric analysis of the corneal endothelium. The values obtained were compared with those in fellow eyes, which were phakic or pseudophakic with a posterior chamber IOL (PC IOL). Two years later, 63 patients (mean follow-up 2.1 years) had another morphometric analysis and the values obtained were compared with those in the same eye at the previous examination. The Student t test for unpaired groups was used to compare the results at a 5% significance level.

RESULTS

The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes (P<.01). Patients who had primary AC IOL implantation in 1 eye and PC IOL implantation in the fellow eye had a difference in ECD that was not statistically significant. The endothelial cell difference was significantly greater in aphakic patients who had a secondary AC IOL implantation (P<.05). The ECD ranged from 1015 to 2980 cells/mm(2). The endothelium in the various groups showed no significant changes in the coefficient of variation (CV) in cell size. The ECD and endothelial CV in the same eyes at the second examination were not significantly different from the values 2 years previously.

CONCLUSIONS

Anterior chamber IOL implantation did not appear to alter corneal endothelial function. Results indicate that the endothelial cell loss was related to surgical trauma rather than the presence of an IOL in the anterior chamber.

The effect of topical steroid on postoperative corneal edema and endothelial cell loss after intracapsular cataract extraction

In a prospective study of 89 patients the postoperative corneal edema and endothelial cell count was studied after cataract extraction. A double blind investigation was performed as the patients during the first 6 postoperative days were treated with three different types of eye-drops: Maxidex, Pred-Forte 1% or placebo, all containing Benzalkonium Chloride 0.004%. The content of steroid in Maxidex and Pred-Forte was equivalent. We found no significant difference in estimates of endothelial cells in the three groups postoperatively. Corneal edema was less in the two groups treated with steroid. There was no significant difference between the two postoperative groups (p > 0.05) treated with Maxidex and Pred-Forte. The group treated with Pred-Forte showed significantly less postoperative corneal edema, calculated as the graphical area represented by the increase of central corneal thickness (CCT) after operation.