Analysis of opacification patterns in intraocular lenses (IOL)

Objective

Intraocular lens (IOL) opacification may cause severe visual impairment. The pathogenesis remains unclear. The aim of this study was to analyse opacification patterns in different IOLs. Therefore, this multicentre, retrospective, observational study was conducted at Ludwig-Maximilians-University, Munich, Germany and University-Hospital Basel, Switzerland.

Methods and analysis

In this study, 75 opacified IOLs were identified and classified after extraction. Macroscopical photo documentation, light and electron microscopic analysis were done.

Results

68 acrylic-hydrophilic single-piece-IOLs, 1 acrylic-hydrophilic 3-piece-IOL, 6 acrylic-hydrophobic 3-piece-IOLs were extracted. The dataset comprised IOLs known for opacification and IOLs not having been reported yet. 67 IOLs showed a fine-granular and 8 IOLs a crust-like opacification pattern. According to literature, 62 of the fine-granular opacified IOLs were graded into type 1 (processing/packaging-induced primary opacification) and 13 into type 2 (secondary opacification of unknown aetiology). The anterior surface of the IOLs was affected in all 75 IOLs, the posterior surface only in 23 cases. Of all 67 fine-granular IOLs, 43 had a central defect and 21 had a zone without opacification (clear islet).

Conclusion

In our series, the morphology of IOL opacification did not follow the existing pathogenetic classification that strictly discriminates between primary and secondary causes. Fine-granular IOL opacification occurs with similar patterns in both type 1 and type 2 IOL opacification, while a crust-like pattern was only detected in type 2 IOL opacifications. Consequently, susceptibility of an IOL to opacification is caused by a multifactorial combination of material and processing properties as well as individual (pathological) conditions of the patient.

A pilot study to compartmentalize small melanocytic choroidal tumors and choroidal vessels with speckle-noise free 1050 nm swept source optical coherence tomography (OCT choroidal "tumoropsy")

PURPOSE

The purpose was to illustrate small melanocytic choroidal tumors with speckle-noise free swept-source optical coherence tomography (SSOCT).

METHODS

Twenty-five small melanocytic choroidal tumors in 24 eyes underwent 1050 nm OCT. All tumors were measured manually with the built-in caliper tool and compared to data derived from a semiautomated algorithm that removed speckle noise but preserved the structure of the tumors from the SSOCT data.

RESULTS

The average manual measurements for the horizontal, vertical, and axial diameters were 1535.28 μm (range, 547-2807 μm), 1713.8 μm (range, 574-3921 μm), and 227.28 μm (range, 115-489 μm), respectively. The measured average volumes of the tumors were 835,248,212 μm(3) (range, 48,818,700 to 4,567,401,810 μm(3)) and 228,588,535 μm(3) (range, 22,879,641 to 787,668,886 μm(3)) for caliper measurements, respectively, for the extracted volumes. The average volume variation between the two methods was 66.16 % (range, 46.5 % to 82.75 %). The average ratio between the caliper and extracted volumes was 3.402 (range, 1.346-8.198, SD 1.681), 2.367 (range, 1.346-3.258, SD 0.618), 2.321 (range, 1.346-3.258, SD 0.611), 2.402 (range, 1.518-3.258, SD 0.591), and 1.749 (range, 1.518-1.733, SD 0.239) for all tumors, all tumors with the exclusion of extreme parameters, tumor <3 mm, tumor <2 mm, and tumor <1 mm, respectively. The average ratio (tumor index) between the tumor volume and the choroidal vessel volume was 12.539 (range, 0.489-73.701).

CONCLUSION

Speckle-noise free swept-source OCT may be an illustrative OCT imaging technology. OCT may be useful for describing and monitoring small melanocytic choroidal tumors and the choroidal vessels.

[Comparison of laser treatment of patients with the replace with "computer-based laser" between experienced and unexperienced operators]

INTRODUCTION

The aim of this study was to compare individual accuracy and speed of laser application using the Navilas laser system in patients with diabetic and vascular macular oedema.

METHODS

The Navilas laser system was used by an experienced retina specialist and a relatively inexperienced ophthalmologist. Obtained results were retrospectively assessed with regard to precision and speed of laser application.

RESULTS

Precision of laser therapy was quite similar, 88 % and 84 % for experienced and inexperienced operators, respectively. The treatment procedure took on average 5.5 minutes and 5.34 minutes for experienced and inexperienced operators, respectively.

CONCLUSIONS

Precision and duration of therapy using the Navilas laser system do not seem to be correlated with the individual experience of the treating physician.

[Traumatic proptosis]

The emergency consultation of a female patient revealed a left-sided prolapse of the eyeball with visual loss. The patient had fallen against an object hitting the left eye 40 min prior to the consultation. Motility of the eye was severely restricted and retinoscopy was impossible due to a corneal edema. The pupil was moderately dilated and non-reactive. The ocular pressure was 50 mmHg. Spontaneous repositioning was unsuccessful and an immediate lateral canthotomy was performed. The follow-up control showed that the patient had recovered good visual acuity with a reduction of intraocular pressure and pain. The latest findings were uneventful.

Early postoperative recovery of idiopathic macular hole in a young adult

BACKGROUND

Idiopathic macular holes usually develop in the elderly. We report the case of a spontaneous macular hole in a 23-year-old man.

HISTORY AND SIGNS

The patient noticed decreased central vision in his left eye since 5 days without any history of trauma or intraocular inflammation. On examination the best corrected visual acuity was 20/20 in the right eye and 20/50 in the left. Fundus biomicroscopy and OCT showed a full-thickness macular hole. Microperimetry demonstrated a scotoma within the macular hole.

THERAPY AND OUTCOME

2 months later the patient underwent pars plana vitrectomy, ILM-peeling with trypan blue staining and fluid-air exchange followed by face down positioning for 12 h a day for 2 days. On the 4th post-surgical day visual acuity was 20/32 and OCT showed a complete closure of the macular hole. During the further follow-up visual acuity in the left eye improved to 20/20. OCT examination showed a restored foveal depression, and microperimetry demonstrated an increased foveal sensitivity in the area of the previous scotoma.

CONCLUSIONS

The aetiology of the macular hole in this patient is unclear. It is most likely an idiopathic macular hole in a young person. Post-surgical follow-up OCTs and microperimetry disclosed an early recovery of the foveal anatomy and function.