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Dogaroiu AC, Dudau M, Dogaroiu C, Tataru CP. Visual Outcomes in Ectopia Lentis in Marfan Syndrome: A Study of Four Surgical Techniques in Children and Adults. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1098. [PMID: 39064527 PMCID: PMC11279376 DOI: 10.3390/medicina60071098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/20/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
Background/Objectives: To evaluate how the surgical technique and type of implanted intraocular lens influence the postoperative visual acuity and complications in ectopia lentis associated to Marfan syndrome patients. Materials and Methods: The medical records and videos of ectopia lentis surgeries in patients (children and adults) with Marfan syndrome, were retrospectively reviewed and compared. The study included 33 eyes that underwent four different intraocular lens implantation (IOL) techniques: IOL in conjunction with a simple capsular tension ring, IOL in conjunction with a Cionni modified capsular tension ring (m-CTR), two-point scleral IOL fixation and IOL with one haptic in the bag and one haptic sutured to the sclera. Results: Vision significantly improved from a mean preoperative visual acuity of 0.1122 to a mean postoperative visual acuity of 0.4539 in both age groups (p < 0.0001), with no difference in the primary outcome between children and adults. The most common surgical technique used in both age groups was IOL in conjunction with an m-CTR. There was only one major postoperative complication requiring additional surgery. Conclusions: Zonular weakness mainly influenced by age was the most important selection criterion for the surgical approach. Regardless of the technique employed, the postoperative visual acuity was improved in both adults and children.
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Affiliation(s)
| | - Maria Dudau
- Laboratory of Biochemistry, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania;
- Department of Cell Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Dogaroiu
- Department of Morphological Sciences, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Calin Petru Tataru
- Alcor Clinic, 030829 Bucharest, Romania; (A.C.D.); (C.P.T.)
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Clinical Hospital for Ophthalmological Emergencies, 010464 Bucharest, Romania
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Ahmet S, Kemer Atik B, Kandemir Beşek N, Kırgız A, Gümüş Kasapoğlu G, Yayla Akıncılar G. Comparison of three techniques for simultaneous intraocular lens implantation in subluxated cataract surgery: Transconjunctival intrascleral, Z-suture knotless transscleral, and Cionni capsular tension ring assisted. Int Ophthalmol 2024; 44:152. [PMID: 38509438 DOI: 10.1007/s10792-024-03085-x] [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] [Received: 08/28/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate and compare the clinical outcomes of three different methods of intraocular lens (IOL) implantation in the surgery of subluxated cataracts. METHODS In this retrospective, comparative, clinical interventional study, the medical records of patients who underwent IOL implantation with sutureless 27-gauge needle-assisted transconjunctival intrascleral (Group 1), Z-suture knotless transscleral (Group 2), and Cionni capsular tension ring (Cionni-CTR) assisted (Group 3) simultaneously with subluxated cataract extraction between June 2010 and June 2022 were evaluated. Demographic characteristics, follow-up times, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical refractive values, and spherical equivalent (SE) values of three groups were compared. Intraoperative and postoperative complications were recorded. RESULTS There were 20 eyes in Group 1, 35 eyes in Group 2, and 40 eyes in Group 3. In all groups, statistically significant improvement was observed in postoperative UDVA and CDVA compared to preoperative values (each p < 0.05). There was no statistical difference between the groups in postoperative UDVA and CDVA values. (p = 0.130, p = 0.167 respectively). No significant difference was observed between the groups in terms of postoperative spherical, cylindrical, and SE values (each p > 0.05). CONCLUSION The study suggests that three different IOL implantation techniques for simultaneous IOL implantation in subluxated cataract surgery have similar effects on visual and refractive outcomes.
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Affiliation(s)
- Sibel Ahmet
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
| | - Burcu Kemer Atik
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Nilay Kandemir Beşek
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kırgız
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Güneş Gümüş Kasapoğlu
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Gizem Yayla Akıncılar
- Department of Ophthalmology, University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Liu Z, Xie Q, Chen X, Xie B, Cai S. Effect of sutureless scleral fixed intraocular lens implantation on aphakic eyes: a system review and meta-analysis. BMC Ophthalmol 2023; 23:493. [PMID: 38053049 PMCID: PMC10698919 DOI: 10.1186/s12886-023-03223-6] [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] [Received: 03/09/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Sutureless scleral fixed intraocular lens implantation (SF-IOL) has become one of the mainstream schemes in clinical treatment of aphakic eyes because of its advantages, such as avoiding dislocation of intraocular lens or subluxation caused by suture degradation or fracture and significant improvement of postoperative visual acuity. However, a consensus on the relative effectiveness and safety of this operation and other methods is still lacking. This study aimed to compare the efficacy and safety of sutureless SF-IOL with other methods. Aphakia means that the lens leaves the normal position and loses its original function, including absence or complete dislocation and subluxation of the lens which could cause anisometropic amblyopia, strabismus, and loss of binocular function in children and adolescents. For adults, the loss of the lens could lead to high hyperopia and affect vision. Above all this disease can seriously affect the quality of life of patients. METHODS Literature about sutureless SF-IOL in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Technical Journal VIP database, and Wanfang database published from 2000 to 2022 was reviewed. The weighted average difference was calculated by RevMan5.3 software for analysis. Two researchers independently selected the study and used the Cochrane collaboration tool to assess the risk of errors. Cochrane bias risk tool was used to evaluate the quality of evidence. This study is registered on PROSPERO (CRD42022363282). RESULTS The postoperative IOL-related astigmatism of sutureless SF-IOL was lower than that of suture SF-IOL, and there was statistical difference when we compared the absolute postoperative spherical equivalent after sutureless SF-IOL and suture SF-IOL. Indicating that the degree of refractive error after sutureless SF-IOL was lower. Meanwhile, the operation time of sutureless SF-IOL was shorter than that of suture SF-IOL. The subgroup analysis showed that the absolute postoperative spherical equivalent and astigmatism values in Yamane technique were lower than those in suture SF-IOL. CONCLUSION Sutureless SF-IOL has the advantages of stable refraction, short operation time, and less postoperative complications. However, high-quality literature to compare these technologies is lacking. Some long-term follow-up longitudinal prospective studies are needed to confirm the findings.
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Affiliation(s)
- Zhao Liu
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
| | - Qian Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
| | - XingWang Chen
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
- Guizhou Eye Hospital, Zunyi, 563003, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China
| | - Bing Xie
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China
- Guizhou Eye Hospital, Zunyi, 563003, China
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China
| | - ShanJun Cai
- Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi, 563003, China.
- Guizhou Eye Hospital, Zunyi, 563003, China.
- Guizhou Provincial Branch of National Eye Disease Clinical Research Center, Zunyi, 563003, China.
- Special Key Laboratory of Ocular Diseases of Guizhou Province, Zunyi Medical University, Zunyi, 563003, China.
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Zou M, Lian Z, Young CA, Liu S, Zhang X, Zheng D, Jin G. Improving Effective Lens Position Prediction for Transscleral Fixation of Intraocular Lens Among Congenital Ectopia Lentis Patients. Am J Ophthalmol 2023; 252:121-129. [PMID: 36972739 DOI: 10.1016/j.ajo.2023.03.021] [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: 01/02/2023] [Revised: 02/25/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To introduce a method of predicting effective lens position (ELP) among congenital ectopia lentis (CEL) patients undergoing transscleral fixation of intraocular lens (IOL), and evaluate its effect on improving refractive outcome by utilizing the Sanders-Retzlaff-Kraff / theoretical (SRK/T) formula. DESIGN Retrospective cross-sectional study. METHODS A training set (93 eyes) and validation set (25 eyes) was included. Z value as the distance between the iris plane and a hypothetic postoperative IOL position was introduced in this study. The Z-modified ELP consisted of corneal height (Ch) and Z (ELP = Ch + Z), and Ch was calculated by keratometry (Km) and white-to-white (WTW). The value of Z was identified by linear regression formula with the involvement of axial length (AL), Km, WTW, age, and gender. The comparison of mean (MAE) and mediate absolute error (MedAE) among Z-modified SRK/T formula, SRK/T, Holladay I, and Hoffer Q formula was performed to evaluate the performance of Z-modified SRK/T formula. RESULTS Z value was associated with AL, K, WTW, and age (Z = offset + 15.1093 × lg (AL) + 0.0953899 × Km - 0.3910268 × WTW + 0.0164197 × Age - 19.34804). The Z-modified ELP has good accuracy with no difference to back-calculated ELP. The accuracy of Z-modified SRK/T formula was better than other formulas (P < .001) as the MAE was 0.24 ± 0.19 diopter (D) and MedAE was 0.22 D (95% CI: 0.01-0.57 D). Sixty-four percent of eyes had a refractive error smaller than ±0.25 D, and none of the subjects had a prediction error greater than ±0.75 D. CONCLUSIONS ELP of CEL can be accurately predicted by AL, Km, WTW, and age. Z-modified SRK/T formula improved on the current formula by improving predicting accuracy of ELP and may serve as a promising formula for CEL patients with transscleral fixation of IOL.
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Affiliation(s)
- Minjie Zou
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | - Zhangkai Lian
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | | | - Siyuan Liu
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | - Xinyu Zhang
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China
| | - Danying Zheng
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China.
| | - Guangming Jin
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University (M.Z., Z.L., S.L., X.Z., D.Z., G.J.), Guangzhou, Guangdong, China.
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Akram H, Aragon-Martin JA, Chandra A. Marfan syndrome and the eye clinic: from diagnosis to management. THERAPEUTIC ADVANCES IN RARE DISEASE 2021; 2:26330040211055738. [PMID: 37181104 PMCID: PMC10032431 DOI: 10.1177/26330040211055738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/06/2021] [Indexed: 05/16/2023]
Abstract
Marfan syndrome (MFS) is an autosomal dominantly inherited disorder affecting the cardiovascular, ocular and musculoskeletal systems. Frequently, clinical suspicion and subsequent diagnosis begins in the ophthalmology clinic. Importantly, the ophthalmologist has a responsibility to cater not only to the eye, but also to be involved in a holistic approach for these patients. In this review, we discuss how MFS may present to an eye clinic, including clinical features, ocular morbidity, genetic diagnosis and management. Although this condition is ideally managed by a multidisciplinary team, our focus will be on MFS and the eye, including other conditions which may present with similar phenotypes. The ophthalmologist's role as the potential first contact for a patient with suspected MFS is crucial in making the proper investigations and referral, with the knowledge that not all ectopia lentis cases are MFS and vice versa. Management of ocular conditions in MFS may range from simple observation to surgical intervention; current options will be discussed.
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Affiliation(s)
- Haseeb Akram
- Southend University Hospital, Prittlewell
Chase, Westcliff-on-Sea SS0 0RY, Essex, UK
| | | | - Aman Chandra
- Southend University Hospital, Westcliff-on-Sea,
UK
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