Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

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

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.

Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy

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.

Diagnostic Accuracy of Ultrasound in Detection of Traumatic Lens Dislocation

INTRODUCTION

Traumatic eye injuries (TEI) involved about 3% of cases referred to the emergency departments of developing countries. Lens dislocation is one of the critical cases of ophthalmic emergencies. The present study was aimed to evaluate the diagnostic accuracy of ultrasonography in detection of traumatic lens dislocation.

METHODS

In this cross-sectional study the findings of ultrasonography and orbital computed tomography (OCT) of head and face trauma patients, referred to Imam Reza hospital, Tabriz, Iran, from July 2013 to June 2014, have been compared. The sensitivity, specificity, positive and negative likelihood ratio, positive and negative predictive value, and accuracy of ultrasonography were calculated. Cohen's kappa coefficient was presented to assess the agreement of ultrasonography with OCT findings.

RESULTS

One hundred thirty patients with the mean age of 35.4±18.0 were evaluated (75.4% male). Sensitivity and specificity of ultrasonography were 84.6% (95% Cl: 53.7-97.3) and 98.3% (95% Cl: 93.3- 99.7), respectively. In addition, positive and negative likelihood ratio were calculated 49.5 (95% Cl: 12.3-199.4) and 0.15 (95% Cl: 0.04- 0.56), respectively. Cohen's kappa coefficient of 0.83 (95% Cl: 0.66-1.0; p<0.0001) was representative of excellent agreement of these two tests.

CONCLUSION

The finding of this project was representative of 84.6% sensitivity, 98.3% specificity, and 96.9% accuracy of ultrasonography in detection of traumatic lens dislocation. It seems that in cases, which OCT is not possible, ultrasonography, could be an acceptable option to assess traumatic eye injuries.