Pseudoexfoliation syndrome. Ocular manifestation of a systemic disorder?

The pseudoexfoliation syndrome has recently been suggested to represent the local manifestation of a more widespread disorder. In this study, a case of classic bilateral pseudoexfoliation syndrome with systemic distribution of pseudoexfoliation material involving a variety of organ systems is described. Using transmission electron microscopy, typical pseudoexfoliation fibers were identified in autopsy tissue specimens of skin, heart, lungs, liver, kidney, and cerebral meninges in addition to the classic intraocular locations. The pseudoexfoliation material was mainly localized to connective-tissue portions or septa traversing the various organs. The pseudoexfoliation fibers were consistently associated with connective-tissue components, particularly fibroblasts and collagen and elastic fibers; myocardial tissue specimens; and heart-muscle cells. These findings provide evidence for the systemic nature of the pseudoexfoliation syndrome, which apparently involves an aberrant connective-tissue metabolism throughout the body.

Corneal abnormalities in Pax6+/- small eye mice mimic human aniridia-related keratopathy

PURPOSE

To investigate corneal abnormalities in heterozygous Pax6(+/Sey-Neu) (Pax6(+/-), small eye) mice and compare them with aniridia-related keratopathy in PAX6(+/-) patients.

METHODS

Fetal and postnatal corneal histopathology, adult corneal thickness, and the distribution of K12-immunostained cells were compared in wild-type and Pax6(+/-) mice.

RESULTS

Prenatally, the corneal epithelium was thinner in Pax6(+/-) fetuses than wild-type littermates, but the stroma appeared irregular, hypercellular, and thickened. The anterior chamber angle was obliterated, and the iris was hypoplastic from early developmental stages. The adult Pax6(+/-) corneal epithelium was thinner, had fewer layers, and included goblet cells, indicating repopulation from conjunctival epithelium. The ocular surface was often roughened, with epithelial vacuolation and lens tissue within the stroma. The corneal stroma was thicker centrally, with an irregular lamellar alignment. Many adult Pax6(+/-) corneas were vascularized or contained cellular infiltrates, but some remained clear. Corneal degeneration was age-related: Older Pax6(+/-) mice had prominent subepithelial pannus and more goblet cells in the peripheral corneal epithelium. Cytokeratin 12 stained very weakly in the peripheral and superficial corneal epithelium in 12-month-old Pax6(+/-) mice.

CONCLUSIONS

Corneal abnormalities in Pax6(+/-) mice are similar to those in aniridia-related keratopathy in PAX6(+/-) patients. This extends the relevance of this mouse model of human aniridia to include corneal abnormalities. Incursion of goblet cells suggests impaired function of Pax6(+/-) limbal stem cells, abnormal expression of cytokeratin 12 may result in greater epithelial fragility, and corneal opacities in older mice may reflect poor wound-healing responses to accumulated environmental insults.

Clinical signs of the pseudoexfoliation syndrome

Pseudoexfoliation syndrome (PXS) is a common cause of glaucoma throughout the world. It is most commonly diagnosed after the observation of pseudoexfoliation material (PXM) on the anterior lens surface. However, there are numerous clinical signs of PXS that should alert the examiner to search carefully for PXM on the anterior lens surface. These include pupillary ruff defects, iris sphincter transillumination, a characteristic whorl-like pattern of particulate pigment deposition on the iris sphincter, particulate pigment deposition on the peripheral iris and trabecular meshwork, and exfoliation material on the zonules and ciliary body. Accuracy of diagnosis is important for purposes of treatment, prognosis, and basic research in he mechanisms of glaucoma, particularly tissue culture.

Preclinical diagnosis of pseudoexfoliation syndrome

Although the diagnosis of pseudoexfoliation syndrome (PXS) is made by observation of pseudoexfoliation material (PXM) deposited on the anterior lens capsule, there are several additional signs related to pigment dispersion that are often present both in eyes with PXS and fellow eyes in unilateral cases. On the basis of the presence of these signs, we have categorized a group of patients as "pseudoexfoliation suspects" who demonstrated no evidence of PXM on the lens capsule in either eye. As PXM has previously been identified in the conjunctiva of affected eyes as well as fellow eyes in unilateral cases, we hypothesized that it could also be present in PXS suspect eyes. Inferior bulbar conjunctival biopsies were performed on four eyes with PXS, five fellow eyes, and 23 PXS suspect eyes, and specimens were examined by transmission electron microscopy. In eight PXS suspect eyes biopsy specimens demonstrated PXM, suggesting that PXS is more prevalent and possibly responsible for a greater proportion of glaucoma than previously suspected.

A review of manifestations of diabetes mellitus in the anterior eye and cornea

Diabetes mellitus can lead to blindness through its effects on the retina and lens, yet diabetes is a systemic disease influencing the entire eye. The current interest in extended wear contact lenses emphasizes the need for the practitioners to have a thorough knowledge of the pathophysiology of the anterior eye and cornea of the diabetic. The current literature is reviewed, and its relevance to contact lens wear is discussed.

Uveitis in Behçet's disease

The ocular complications of Behçet's disease are considered one of the major criteria upon which the diagnosis is based. Its complications are frequently sight threatening and require constant attention. The ocular disease is characterized by repeated, explosive ocular inflammatory attacks which get better by themselves, so that in-between attacks there is little or no evidence of inflammatory disease in the eye. The anterior segment can be involved alone, most frequently presenting as a severe anterior uveitis, frequently with hypopyon. This is not associated with a poor visual outcome, and usually treated with topical medication to make the patient more comfortable. However, the anterior segment disease is usually accompanied by recurrent retinal vaso-occlusive disease which is sight threatening if repeated attacks occur. Treatment is with systemic medications, including corticosteroids, cyclosporine, FK506, anti-metabolites, and cytotoxic agents. Complications of the inflammation can include retinal and optic atrophy, vitreous hemorrhage, neovascular glaucoma, and retinal detachment.

Optic disc size in exfoliative, primary open angle, and low-tension glaucoma

We examined the magnification-corrected optic disc size in 54 patients with exfoliative glaucoma, 61 patients with primary open angle glaucoma, and 50 patients with low-tension glaucoma. The mean optic disc area in low-tension glaucoma was statistically significantly larger than that in primary open angle and exfoliative glaucoma. The mean values of eyes with primary open angle and exfoliative glaucoma did not differ significantly from each other. Frequency distribution of the optic disc size showed, however, that all three diagnostic groups differed significantly from each other. Small discs were more frequent in eyes with exfoliative glaucoma, and large discs were more frequent in eyes with low-tension glaucoma. In primary open angle glaucoma, small and large optic discs were found equally frequently. It is possible that in some eyes large optic discs are vulnerable to even low intraocular pressures due to qualitative properties of the extracellular matrix.

Ocular inflammation in Crohn's disease

During a 4-year period, the authors examined 19 patients with Crohn's disease and associated ocular inflammation. Seven patients had uveitis, eight had episcleritis, and four had anterior scleritis. Large peripheral corneal infiltrates developed in two patients with scleritis. Increased bowel activity was closely related to the presence of acute episcleritis but not to uveitis or scleritis. To determine risk factors for the development of ocular inflammation, this group of 19 patients was compared with a group of 93 patients with Crohn's disease in whom ocular inflammation was not present. There were no demographic differences between the groups. Patients with colitis or ileocolitis were more likely to suffer from ocular inflammation (23.9%, 17 of 71), than patients with small bowel involvement alone (2.8%, 1 of 36) (P = 0.013). Those with arthritis or arthralgia had a higher incidence of ocular inflammation (29.4%, 15 of 51), than patients without joint involvement (6.6%, 4 of 61) (P = 0.003). These results suggest that the risk of developing ocular inflammation in Crohn's disease may be related to the site of bowel involvement and to the presence of arthritis.

The middle-Norway eye-screening study. II. Prevalence of simple and capsular glaucoma

In this population-based screening study, dealing with 1941 persons above 64 years of age from three different municipalities, the overall open-angle glaucoma prevalence was found to be 8.3%. The prevalence in the separate areas (7.0%, 8.6%, and 9.5%) were not statistically different. Roughly 30% of the population with pseudo-exfoliation syndrome had glaucoma, and 4.2% had ocular hypertension, whereas the corresponding figures for those without pseudo-exfoliation were 4% and 0.8%, respectively. The high glaucoma rates are partly due to the high pseudo-exfoliation prevalence in the area. The prevalence of the capsular glaucoma increased towards a maximum between 75 and 79 years of age, whereafter the curve declined. This may indicate reduced survival time of glaucomatous patients.

Generalized transluminance of the iris and the frequency of the pseudoexfoliation syndrome in the eyes of transient ischemic attack patients

BACKGROUND

Abnormal generalized iris transluminance has been reported to have connection with the pseudoexfoliation syndrome (PXS). According to angiographic studies, microvascular changes are found to be present on the iris of these patients, which suggests that hypoxia has a role in the development of PXS. On the other hand, carotid transient ischemic attack (TIA) patients have been shown to have some ocular key symptoms due to hypoxia.

METHODS

Iris photographs of 62 unselected TIA patients (124 eyes) and 32 healthy subjects (64 eyes) were evaluated in a blind trial to show the presence of iris transluminance of these eyes. Biomicroscopic examination was performed to show the presence of the PXS.

RESULTS

Abnormal iris transluminance was positive in 42% of the right eyes and in 45% of the left eyes in patients in the study group. The corresponding figures for the control group were 16% in both eyes (P = 0.01, chi-square test). When the study group was divided into subgroups according to stenosis of carotid bifurcation, the figures were highest in those cases where one or both carotid arteries were stenosed over 50%. Pseudoexfoliation syndrome was found in 18% of the right eyes and in 23% of the left eyes of TIA patients. The frequency of PXS in these eyes was approximately two times higher than reported in earlier studies of the frequency of PXS in healthy subjects of the same age in a Finnish population.

CONCLUSION

Abnormal iris transluminance is one of the ocular key symptoms of extracranial cerebrovascular disease. Coexistence of cerebrovascular disease with abnormal iris transluminance, together with increased prevalence of pseudoexfoliation supports the theory that hypoperfusion is a contributory factor in the development of PXS.

Ocular involvement in the respiratory vasculitides

The respiratory vasculitides are idiopathic inflammatory syndromes, characteristically involving the pulmonary vasculature as well as that of several other organ systems. The inflammatory response in these diseases is uniformly granulomatous. There are three distinct, recognized respiratory vasculitides: Wegener's granulomatosis, Churg-Strauss syndrome (allergic granulomatosis and angiitis), and lymphomatoid granulomatosis. Each of these entities may have ophthalmic manifestations, and ocular involvement may, in fact, be the presenting sign. The systemic and ocular manifestations, as well as the differential diagnosis and management of each of these entities are discussed.

The effect of ketorolac tromethamine solution 0.5% in reducing postoperative inflammation after cataract extraction and intraocular lens implantation

Ketorolac tromethamine solution 0.5% (1 drop 3 times daily) was more effective than the placebo vehicle solution in suppressing postoperative anterior ocular inflammation after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in this multicenter, double-masked, randomized study. Four of 60 ketorolac-treated patients compared with 25 of 58 placebo-treated patients required supplemental corticosteroid therapy to suppress inflammation in the postoperative period which was statistically significant (P less than 0.001). Even though these supplemental steroid-treated patients were kept in the analysis, the placebo-treated group showed more evidence of anterior ocular inflammation as measured by anterior segment fluorophotometry. This was consistent with slit-lamp observations of increased anterior ocular inflammation. This study supported previous studies that suggested ketorolac tromethamine ophthalmic solution 0.5% was effective and safe as a nonsteroidal anti-inflammatory agent for topical use after ECCE and IOL implantation.

Ocular manifestations of Noonan syndrome

Noonan syndrome is a genetic condition inherited in an autosomally dominant manner, characterised by congenital heart disease, short stature, abnormal facies and the somatic features of Turner's syndrome, but a normal Karyotype. The ophthalmological and orthoptic findings on 58 patients with Noonan syndrome are reported. External features were hypertelorism (74%), downward sloping palpebral apertures (38%), epicanthic folds (39%) and ptosis (48%). The orthoptic examination revealed strabismus in 48%, refractive errors in 61%, amblyopia in 33%, and nystagmus in 9% of cases. Sixty-three per cent of cases had anterior segment changes consisting of: Prominent corneal nerves (46%), anterior stromal dystrophy (4%), cataracts (8%) and panuveitis (2%). Fundal changes occurred in 20% of the study group, including optic nerve head drusen, optic disc hypoplasia, colobomas and myelinated nerves. Forty-seven per cent required non surgical treatment and a further 16% had undergone surgery for strabismus or ptosis. Only three patients had no visual defects. With such a high incidence of ophthalmic abnormalities it is clearly important that children with Noonan syndrome are screened by an ophthalmologist at an early age.

Hyperbaric oxygen therapy for nonarteritic anterior ischemic optic neuropathy

PURPOSE

To evaluate the effectiveness of hyperbaric oxygen therapy in reducing optic nerve damage in acute nonarteritic anterior ischemic optic neuropathy.

METHODS

Twenty-two eyes in 20 patients with acute nonarteritic anterior ischemic optic neuropathy were treated with hyperbaric oxygen (100% oxygen, 2.0 absolute atmospheres of pressure) in two 90-minute inhalation sessions per day for ten days. Changes in mean visual acuity and mean sensitivity loss were compared with those of 27 untreated control patients with acute nonarteritic anterior ischemic optic neuropathy, and proportions of patients with a change in acuity or mean sensitivity loss were compared with controls. Similar analysis was performed on subgroups based on time delay from symptom onset to therapy.

RESULTS

Mean values for visual acuity were increased at final examination in both groups; although the increase was greater in controls, the difference was not statistically significant. Mean visual field sensitivity loss was minimally increased; although the increase was smaller in controls, the difference between groups was not significant. There was no significant difference between groups in proportions of patients with change in acuity score or mean sensitivity loss. Stratification by time delay to therapy did not suggest that treatment within nine days produced better visual results than that for either controls or those treated later.

CONCLUSIONS

Hyperbaric oxygen therapy using 100% oxygen and 2.0 absolute atmospheres of pressure did not produce a significant improvement in visual acuity or visual field for patients with acute nonarteritic anterior ischemic optic neuropathy.

Ultrasound biomicroscopy: role in diagnosis and management in 130 consecutive patients evaluated for anterior segment tumours

BACKGROUND/AIM

Ultrasound biomicroscopy (UBM) is an important tool for assessing anterior segment pathology. This study sought to evaluate UBM in the management of anterior segment tumours.

METHODS

Retrospective analysis of medical records of consecutive patients referred to the ocular oncology unit, University of California San Francisco (UCSF), for suspected anterior segment tumours from 1999 to 2004.

RESULTS

132 eyes from 130 patients were evaluated, including 55 uveal melanomas (UM), 21 iris naevi, 30 iris cysts, and 26 remaining lesions. Of the melanomas, 45 were also evaluated with conventional A/B-scan. There was 29% correspondence between the anatomical structures invaded by melanoma as identified by B-scan v disease extent defined by UBM. Ciliary body and peripheral iris involvement by melanomas was significantly more frequently observed by UBM than B-scan. Seven of 30 benign cysts were diagnosed as cystic before UBM evaluation. In three cases, neuroepithelial cysts were associated with intercurrent pathology including iris naevus (n = 2) and ciliary body melanoma (n = 1). Two ciliary body melanomas showed cavitation, including one patient with a pseudocyst. Histopathological correlation was possible in six cases.

CONCLUSION

UBM is an indispensable tool for the management of anterior segment tumours. This study demonstrates the superiority of UBM v conventional B-scan for the precise localisation of uveal melanoma, especially involving the ciliary body and peripheral iris.

Anterior segment sparing to reduce charged particle radiotherapy complications in uveal melanoma

PURPOSE

The purpose of this investigation is to delineate the risk factors in the development of neovascular glaucoma (NVG) after helium-ion irradiation of uveal melanoma patients and to propose treatment technique that may reduce this risk.

METHODS AND MATERIALS

347 uveal melanoma patients were treated with helium-ions using a single-port treatment technique. Using univariate and multivariate statistics, the NVG complication rate was analyzed according to the percent of anterior chamber in the radiation field, tumor size, tumor location, sex, age, dose, and other risk factors. Several University of California San Francisco-Lawrence Berkeley National Laboratory (LBNL) patients in each size category (medium, large, and extralarge) were retrospectively replanned using two ports instead of a single port. By using appropriate polar and azimuthal gaze angles or by treating patients with two ports, the maximum dose to the anterior segment of the eye can often be reduced. Although a larger volume of anterior chamber may receive a lower dose by using two ports than a single port treatment. We hypothesize that this could reduce the level of complications that result from the irradiation of the anterior chamber of the eye. Dose-volume histograms were calculated for the lens, and compared for the single and two-port techniques.

RESULTS

NVG developed in 121 (35%) patients. The risk of NVG peaked between 1 and 2.5 years posttreatment. By univariate and multivariate analysis, the percent of lens in the field was strongly correlated with the development of NVG. Other contributing factors were tumor height, history of diabetes, and vitreous hemorrhage. Dose-volume histogram analysis of single-port vs. two-port techniques demonstrate that for some patients in the medium and large category tumor groups, a significant decrease in dose to the structures in the anterior segment of the eye could have been achieved with the use of two ports.

CONCLUSION

The development of NVG after helium-ion irradiation is correlated to the amount of lens, anterior chamber in the treatment field, tumor height, proximity to the fovea, history of diabetes, and the development of vitreous hemorrhage. Although the influence of the higher LET deposition of helium-ions is unclear, this study suggests that by reducing the dose to the anterior segment of the eye may reduce the NVG complications. Based on this retrospective analysis of LBNL patients, we have implemented techniques to reduce the amount of the anterior segment receiving a high dose in our new series of patients treated with protons using the cyclotron at the UC Davis Crocker Nuclear Laboratory (CNL).

Ocular manifestations in antiphospholipid syndrome

Antiphospholipid syndrome (APS) is characterized by increased hypercoagulability and divergent symptoms including ocular manifestations. In APS patients arterial and/or venous thromboses and repeated fetal loss are diagnosed in presence of antiphospholipid (aPL) antibodies. Antiphospholipid antibodies are heterogeneous group of immunoglobulins with different antigenic structure. Primary APS is defined in the absence of underlying disease, while secondary APS is seen within another pathological condition. In both primary and secondary APS ocular and neuroophthalmic manifestations, such as retinal arteritis, retinal venous occlusion, ischemic optic neuropathy, transient loss of vision - amaurosis fugax, diplopia and others can be diagnosed. In secondary APS occlusion of central retinal artery and vein (OACR, OVCR) is the most common finding, thus when found in younger patients it should be considered indicative of APS. Bilateral ocular changes are considered more significant since they affect both ocular function and life prognosis.

Exfoliation syndrome and extracapsular cataract extraction with implantation of posterior chamber lens

Extracapsular cataract extraction followed by implantation of a one-piece posterior chamber polymethylmethacrylate intraocular lens (IOL) into the capsular bag was performed in 25 eyes with exfoliation syndrome and 20 control eyes. The patients were investigated preoperatively and then 1 day, 1 week, 3, 6 and 12 months after surgery. Preoperatively, maximal pupil dilatation was significantly smaller in eyes with exfoliation syndrome compared to controls. During surgery the incidence of complications such as ruptures of the zonule or posterior lens capsule, were higher in eyes with exfoliation syndrome. Furthermore, postoperative complications, such as fibrinoid reaction anterior to the IOL followed by posterior synechias and cell deposits, were more common in eyes with exfoliation syndrome compared to control eyes. The results imply that compared to control eyes, eyes with exfoliation syndrome are likely to present more complications both during extracapsular cataract extraction with implantation of intraocular lenses and postoperatively.

Primary posterior capsulorhexis without anterior vitrectomy in pediatric cataract surgery: longer-term outcome

PURPOSE

To assess the effectiveness of primary posterior capsulorhexis without anterior vitrectomy in preventing posterior capsule opacification (PCO) in pediatric cataract surgery.

SETTING

Children's Hospital, Dublin, Republic of Ireland.

METHODS

The study comprised 32 eyes of 22 pediatric patients who had cataract extraction between 1994 and 1998. Extracapsular cataract extraction was performed using radiofrequency diathermy capsulorhexis to the anterior and posterior capsules without an anterior vitrectomy. Posterior chamber intraocular lens implantation was performed in 20 eyes. There were 23 congenital, 6 developmental, and 3 traumatic cataracts.

RESULTS

Patient age ranged from 1 month to 12 years. Mean follow-up was 19 months (range 6 to 50 months). Twenty-seven of 32 eyes (84.4%) had a clear visual axis at last follow-up. Five eyes required a neodymium: YAG capsulotomy, which was performed a mean of 5 months postoperatively (range 1 to 9 months). The incidence of PCO requiring capsulotomy was 15.6%.

CONCLUSION

Primary posterior capsulorhexis without anterior vitrectomy was safe and effective, with a low reopacification rate. Long-term follow-up of this patient cohort is necessary.

Pseudoexfoliation syndrome: clinical factors related to capsular rupture in cataract surgery

Extracapsular surgery has a high frequency of capsular rupture or disinsertion in patients with pseudoexfoliation syndrome. Irido-phakodonesis is one of the factors that suggests this complication. Irido-phakodonesis acts as an 'all or nothing' mechanism, as it does not appear until there is a certain degree of zonular lesion. We carried out a study on 330 eyes with pseudoexfoliation, relating irido-phakodonesis to 31 clinical signs. The results showed that irido-phakodonesis is related to cataracts, degree of mydriasis, presence of glaucoma, atrophy of the pupilar pigmentary ruff, and uniform pigmentation of the trabecular meshwork. These results suggest that the signs which indicate the existence of zonular lesion during extracapsular surgery, include poor dilation, the presence of glaucoma and pigmentary alterations, whilst the pseudoexfoliation material deposited in the anterior segment does not appear to have a bearing on this complication.

Exfoliation syndrome in patients scheduled for cataract surgery

A series of 305 consecutive patients 30 years of age or older scheduled for cataract surgery was examined to find out the frequency of exfoliation syndrome, the predominant type of cataract, and the intraocular pressure status. The mean age of 222 (72.8%) females and 83 (27.2%) males was 71.7 (+/- 11.1) years (range 32 to 91 years). Exfoliation was detected in 77 (25.2%) patients. It was unilateral in 37 (48.0%) patients, the affected eye being in 29 (78.4%) cases scheduled for cataract surgery, and bilateral in 40 (52.0%) patients. Exfoliation was increased steadily with age. It was most often seen on the anterior lens capsule (88.9%). Krukenberg's spindle was seen in 31 (20.4%) eyes of patients with and in 12 (2.6%) eyes of patients without exfoliation (p less than 0.001). Nuclear sclerosis predominated in eyes with (83.8%) as compared to those without (61.9%) exfoliation (p less than 0.01). Posterior subcapsular cataract was less common in eyes with exfoliation (1.5%) than in eyes (21.1%) without it (p less than 0.001). A tendency to slightly higher preoperative intraocular pressure was measured in eyes with exfoliation as compared to those without it, and glaucoma occurred much more frequently (33.8% vs 10.8%) in the former group (p less than 0.001). Exfoliation and capsular glaucoma, which must be promptly detected to avoid surgical complications, are frequent in patients scheduled for cataract surgery.

Anterior capsule staining for capsulorhexis in cases of white cataract

PURPOSE

To compare the safety and efficacy of trypan blue 0.1%, gentian violet 0.001%, indocyanine green 0.5% (ICG), fluorescein 2%, and the patient's autologous blood for anterior capsule staining in cases of white cataract.

SETTING

Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

METHODS

Fifty eyes of 50 patients with age-related white cataract had anterior capsule staining with trypan blue, ICG, or gentian violet under an air bubble or subcapsularly with fluorescein or autologous blood followed by phacoemulsification with foldable intraocular lens implantation. Each stain was used in 10 eyes. The ease of creating a continuous curvilinear capsulorhexis (CCC) and the complications during the surgery were noted. Postoperative examinations at 6 hours, 1 day, 1 week, and 1 month included slitlamp microscopy, uncorrected visual acuity, and best corrected visual acuity (BCVA). The staining patterns on the anterior capsule, side port, corneal tunnel, and anterior cortex were assessed intraoperatively and within 6 hours and at 1 day. The intraocular pressure (IOP) was assessed at 1 day; pachymetry, at 1 day and 1 month; and the endothelial cell count, at 1 month.

RESULTS

The surgeon had best visualization during the anterior capsulorhexis with trypan blue, ICG, and gentian violet, and a complete CCC was achieved in all eyes in the 3 groups. Two eyes each in the fluorescein and autologous blood groups had extension of the CCC so that the capsulorhexis was complete but not curvilinear. Anterior capsule fibrosis was detected with trypan blue (1 eye) and ICG (2 eyes). The anterior vitreous was stained with fluorescein in 2 eyes. All eyes achieved a BCVA of 20/30 or better from 1 week postoperatively to the last follow-up. The side port and corneal tunnel were stained most intensely with gentian violet followed by trypan blue and ICG and less intensely with fluorescein and autologous blood. The IOP, pachymetry, and endothelial cell loss were comparable between the stains.

CONCLUSION

Although trypan blue, ICG, gentian violet, fluorescein, and autologous blood were safely used to stain the anterior capsule for phacoemulsification in eyes with white cataract, trypan blue, ICG, and gentian violet were more effective in staining the capsule.

The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification

PURPOSE

To determine whether lens edge design or anterior capsule overlap on the intraocular lens (IOL) has greater effect on posterior capsule opacification (PCO).

DESIGN

Retrospective cohort clinical study.

METHODS

Retrospective.

SETTING

Academic clinical practice.

PATIENT POPULATION

The patient population consisted of 259 uncomplicated surgical patients (259 eyes) with no confounding comorbidity and at least 1 year of follow-up after surgical placement of a silicone or hydrophobic acrylic lens.

OBSERVATION PROCEDURES

Digital retroilluminated photographs were taken to ascertain PCO, anterior capsular opacification (ACO), previous neodymium:YAG capsulotomy and degree of anterior capsule overlap on the IOL optic.

MAIN OUTCOME MEASURES

PCO, ACO, YAG capsulotomy rate, and anterior capsule overlap on the IOL optic.

RESULTS

One hundred forty-eight digital images (74 silicone and 74 acrylic) were measurable for both anterior capsule overlap and PCO. Complete 360 degrees of anterior capsule overlap on the IOL was associated with decreased PCO (P = <.001). A significant negative correlation was found between the degree of anterior capsule overlap and PCO (P = <.001). Evaluation of PCO, and YAG capsulotomy rates were similar between acrylic and silicone lenses. Minimal anterior capsule overlap may also be associated with PCO prevention.

CONCLUSIONS

Implanting a lens with complete anterior capsule overlap on the IOL was found to significantly reduce PCO, which advantage appeared to be greater than PCO prevention by a truncated, sharp edge IOL design.