Optical and reconstructive surgery of a patient with a contusion damage of the eyeball and iridodialysis of 180 degrees: a clinical case

Traumatic eyeball damages is a topical issue in present-day ophthalmology as they constitute one of the main causes of vision loss in people of working age. Purpose: to assess the feasibilty, effectiveness and safety of one-time early-stage microinvasive optical reconstructive surgery of a patient with traumatic eyeball damage consequences: a swelling cataract, lens ligamentous apparatus defect, iridodialysis, and traumatic mydriasis. Material and methods. Patient V., 27, was under observation with the following diagnosis: “OS — condition after a contusion damage to the eyeball: traumatic swelling cataract; stage II subluxation of the lens; traumatic mydriasis, iridodialysis of 180 degrees”. OS visual acuity — correct light projection. The patient underwent an ORO of the left eye: phacoaspiration of a swelling cataract with implantation of an intracapsular ring and an intraocular lens in combination with closed iridoplasty. Results. No intraoperative complications took place. In the postoperative period, the best corrected visual acuity was 0.6, IOP remained stable, the lens was centered in the capsular bag, the iris sutures were consistent, the pupil rounded, centered, 4 mm in diameter. The patient felt satisfied with the cosmetic and functional result of surgery. Conclusion. One-time iridoplasty in combination with cataract surgery is an effective and safe method of surgical treatment of traumatically damaged iris and lens.

[Correction of ametropia with posterior chamber phakic intraocular lens]

Posterior chamber phakic intraocular lens (PIOL) implantation is a widely accepted and performed refractive surgery for correction of moderate and high myopia used when corneal laser ablation procedures are not suitable. This paper analyzes literature data to reveal the advantages and limitations of the technology.

[Method of surgical treatment of patients with oculocutaneous albinism using artificial iris]

Oculocutaneous albinism is a group of autosomal recessive disorders that directly affect the hypopigmentation of the skin, hair, and eyes. According to the World Health Organization, albinism occurs in 1 out of 20 000 people in Europe and North America. Congenital changes in the organ of vision in albinism lead to a significant decrease in the visual functions of patients, worsening their quality of life.

PURPOSE

To study the results of surgical treatment with implantation of an artificial iris as a diaphragm element in patients with albinism.

MATERIAL AND METHODS

This article was based on the examination and treatment of 2 patients suffering from oculocutaneous albinism, which is characterized by hypopigmentation of the iris and retinal pigment epithelium of the retina, foveolar hypoplasia, low visual acuity, nystagmus, strabismus and excruciating photophobia. The patients were implanted an artificial iris in both eyes with fixation in the capsular bag in the first patient, and in the ciliary sulcus in the second.

RESULTS

In both patients, complaints of photophobia and optical phenomena have ceased. Visual acuity increased to 0.2 and remained without regression throughout the entire period of observation. Intraocular pressure and hydrodynamic parameters also remained stable throughout the observation period. The artificial irises were observed by ultrabiomicroscopy to remain in a stable position both when it was implanted in the capsule bag, and when it was seamlessly fixed in the ciliary sulcus.

CONCLUSION

The surgical interventions relieved patients from glare, at the same time improving visual acuity without correction, as well as achieving a pronounced cosmetic effect and visual rehabilitation. Artificial irises have proven to be a safe and effective way to treat patients with oculocutaneous albinism.

[Outcomes of surgical treatment of rhegmatogenous retinal detachment after phaco surgery and implantation of a trifocal intraocular lens in patients with myopia (clinical observations)]

PURPOSE

To analyze visual functions in moderate and high myopic patients with retinal detachment that developed after implantation of a trifocal intraocular lens (IOL).

MATERIAL AND METHODS

The study analyzed the functional outcomes achieved in 3 patients (4 eyes) with retinal detachment developed after implantation of AcrySof IQ PanOptix («Alcon», USA) and AT LISA tri 839 MP («Carl Zeiss Meditec», Germany) during the follow-up period of 24 months. Patient examination included measurements of visual acuity at far (4 and 5 m), near (40 cm) and intermediate distances (60 cm, 80 cm), spatial contrast sensitivity, spherical equivalent of refraction, and a survey of patients for subjective satisfaction of the obtained vision.

RESULTS

In four eyes of three patients with moderate and high myopia, rhegmatogenous retinal detachment was diagnosed during the follow-up period at 4 to 12 months after phacoemulsification of cataract with trifocal IOL implantation. The best visual indicators were found in patient N. as a result of surgical treatment of bilateral rhegmatogenous retinal detachment due to high myopia: visual acuity (VA) at far distance was 1.0 for each eye (with 100 points on the VF-14 questionnaire). In patients P. and M., after the development of unilateral rhegmatogenous retinal detachment, complete retinal reattachment was achieved after surgery with VA at far distance 0.55 (OS) in patient P. and 0.4 (OD) in patient M. (95 and 86 points on VF-14, respectively).

CONCLUSION

Good visual functions were achieved in three patients with trifocal IOL after surgical treatment of the rhegmatogenous retinal detachment that developed due to myopia. The implanted trifocal IOL did not affect the effectiveness of vitrectomy. After the treatment patients retained the ability to see at different distances.

[Comparative analysis of the functional results after implantation of various diffractive trifocal intraocular lenses]

PURPOSE

To compare visual outcomes after implantation of two models of diffractive trifocal IOLs using various vision assessment systems.

MATERIAL AND METHODS

The study included 25 patients (25 eyes) who were implanted with AcrySof IQ PanOptix (TFN) and 25 patients (25 eyes) implanted with AT LISA tri 839 MP (TRI). Postoperative examination at 1 year included assessment of monocular visual acuity for far, intermediate and near distance using decimal scale, as well as LogMAR and an interactive computer program (ICP). Contrast sensitivity was assessed with the Optec 6500 device. A questionnaire was used to evaluate subjective quality of vision and the intensity of optical phenomena.

RESULTS

Uncorrected visual acuity (UCVA) at distance, intermediate and near was better in the TFN group in comparison with the TRI group as measured with decimal scale, ICP and LogMAR. Under photopic and mesopic conditions with and without glare, at all spatial frequencies the contrast sensitivity function (CSF) was higher after implantation of TFN in comparison with TRI. The average VF-14 score was 97.2 after implantation of TFN and 96.7 after implantation of TRI. The amount of patients who required spectacle correction after the surgery was 5.5% less in the TFN group compared to the TRI group.

CONCLUSION

High visual outcomes at all distances were observed in patients after implantation of both trifocal IOLs with TFN showing a slight advantage. Evaluation of the visual outcomes using various systems showed the benefits of the ICP assessment. The CSF had typical configuration with maximum value in the mid-range region and a decrease in the high-frequency range after implantation of both IOLs, however the indicators were better in the TFN group. The postoperative period was characterized by high levels of patient satisfaction and spectacle independence in both groups.

[Clinical and theoretical substantiation of geometrical, optical and functional features of the pupil of the artificial iris]

Presence of an extensive iris defect requires implantation of artificial iris (AI) to close it. With biometric parameters of the AI being as close to an intact eye as possible, it becomes viable to achieve good clinical and functional results with the surgery.

PURPOSE

To validate the optimal biometric parameters of the pupil of artificial iris using methods of clinical and theoretical analysis.

MATERIAL AND METHODS

Mathematical modeling was used to determine the main criteria characterizing natural aperture diaphragm of the eye (pupil) which were considered in the theoretical substantiation of optimal biometric parameters of the AI's pupil. Parameters determined during the theoretical stage of the study were used in the development of iris-lens diaphragm (ILD) for clinical application. The study included 6 patients (6 eyes) with post-traumatic aniridia and cataract requiring reconstructive surgery. In the course of the surgery, intraocular lens and ILD were sequentially implanted into the capsular bag using injector system. The patients underwent standard and special ophthalmic examination including optical coherence tomography (OCT) of the central retina before the surgery and after 3 months.

RESULTS

According to mathematical modeling, optimal shape of the ILD pupil was determined to be a circle. The suggested diameter for the ILD pupil is 3.2 mm. The pupil must be located on the optical axis of the eye. Distortions of the retinal image become minimal with pupil's edge thickness of 0.2 mm and cone-shaped profile. After Implantation of the developed ILD with pupil parameters determined during the theoretical substantiation, patients of the study exhibited increased visual acuity and satisfaction with results of the surgery.

CONCLUSION

The biometric parameters of the ILD pupil determined during the clinical-theoretical study can be used in modern ILD models.

[Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation]

The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring.

AIM

to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD).

MATERIAL AND METHODS

We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2).

RESULTS

Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications.

CONCLUSION

The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

[Surgical correction of presbyopia with multifocal diffractive intraocular lenses]

The authors analyzed the results of binocular refractive lens exchange with a pseudoaccomodative AcrySof ReSTOR multifocal diffractive intraocular lens (IOL) in 24 patients (48 eyes) aged 40 to 61 years. Preoperative hyperopic refraction ranged from 1.0 to 6.0 diopters. One week postoperatively, a high percentage of the operated eyes had fine results of uncorrected distance and near visual acuity; the mean contrast sensitivity was found to be slightly reduced at high frequencies. 87.5% of the patients were completely satisfied with the results of binocular AcrySof ReSTOR implantation. Refractive lens exchange with an AcrySof ReSTOR multifocal IOL is a reasonable option for presbyopia in hyperopic patients and provides high functional results. A contrast sensitivity reduction on high frequencies on high frequencies can limit satisfactory results after AcrySof ReSTOR IOL implantation in case of some professions.

[A comparative analysis of the inclination angle of rigid and soft IOLs with intracapsular fixation]

Eighty-four eye were examined in 67 patients after phacoemulsification with intracapsular IOL implantation. The patients were shared, with respect to IOL rigidity, between 2 groups: group 1--rigid PMMA lenses and group 2--soft hydrogel and acryl lenses. The inclination angle was evaluated for different lens types by using an elaborated mathematical formula. The lenses had capsular fixation in all cases. The deviation angle ranged from 0.58 to 1.22 degrees. The difference between the inclination angle and ocular visual axis for rigid and soft lenses was statistically reliable (p < 0.05). The inclination angle of the optic axis in case of soft lenses versus rigid lenses was to a greater extent pronounced after 2 months of observation. However, the conclusion is not final due to continuous fibrosis of the capsular sac, which affects dynamically the IOL positioning. Therefore, similar studies will be made after 12-14 months to enable final conclusions.