Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses

To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy [PPV] to manage dislocated intraocular lenses [IOLs]. A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded. Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85years [mean 52.6]. The range of follow-up was 3 to 108 months [mean +/- SD 19.4 +/- 17.4months]. The final visual acuity was 20/50 or better in 52 [55.3%] eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic [P=0.0092]. There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome [20/200 or better] in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in [90.0%] of eyes with good vision [20/200 or better] compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 [9.6%], glaucoma in 9 [9.6%], bullous keratopathy in 8 [8.5%], retinal detachments in 6 [6.4%] eyes, and relapsing uveitis in 2 [2%]. In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies

Diagnostic and therapeutic value of the replica technique in herpetic keratitis

The recommendation of corneal replicas in the management of superficial herpetic keratitis serves a dual purpose. The first purpose is diagnostic to facilitate histopathological examination of the intact corneal epithelium including the herpetic lesions. The second purpose is therapeutic to promote uneventful healing of the corneal ulcer without any complications and perhaps to reduce the recurrence rate. The causes of recurrences may be either due to stromal affections in which the epithelial lesion only was cured. In cases of simple epithelial herpetic keratitis, corneal replicas proved to be effective in healing the condition within 3-5 days without any complications. If the recurrence has occured and it is very low percentage, it may be attributed to insufficient amount of replica or missed diagnosis of significant stromal affection