Anterior lens capsule: Biological drape

Small perforations are often managed with cyanoacrylate glue - bandage contact lens (BCL). An additional layer with substances like sterile drape often enhances the strength of the glue. Herein, we describe a novel method of using anterior lens capsule as biological drape to secure perforation. The anterior capsule was secured from femtosecond laser–assisted cataract surgery (FLACS) and placed over the perforation after folding it twice. The area was dried and a small aliquot of cyanoacrylate glue was applied over it. The BCL was applied over it after the glue was dry. In our series of five patients, none of them needed repeat surgery and all cases healed by three months without vascularization. It is a unique technique to secure small corneal perforations.

Morphologic and molecular study on the lens anterior capsule in systemic sclerosis / Relato sobre estudo morfológico e molecular da cápsula anterior do cristalino na esclerose sistêmica

ABSTRACT This study aimed to analyze the anterior lens capsule specimens from both eyes of a patient with systemic sclerosis and compare them to the eyes of a control patient. No significant differences between systemic sclerosis and control eyes were observed in the results from the hematoxylin-eosin and picrosirius staining. In the samples obtained from both systemic sclerosis and control eyes, there were expressions of caspase, a molecule expressed in cell death by apoptosis. Heparanase was overexpressed in the systemic sclerosis sample compared to the control sample. Therefore, the anterior lens capsule of the patient with systemic sclerosis is probably affected by the disease since it showed marked expression of heparanase 1.(AU)

RESUMO Analisamos as amostras das cápsulas anteriores do cristalino de uma paciente com esclerose sistêmica e comparamos com as de um paciente controle. Não foram observadas diferenças significativas entre esclerose sistêmica e controle nos resultados da coloração com hematoxilina-eosina e picrosirius. Nas amostras obtidas da esclerose sistêmica e do controle, obtivemos expressão de caspase, uma molécula expressa na morte celular por apoptose. A heparinase foi expressa de forma mais marcante na amostra de esclerose sistêmica quando comparada ao controle. Portanto, a cápsula anterior do cristalino da paciente com esclerose sistêmica provavelmente foi afetada pela doença, uma vez que mostrou expressão aumentada de heparinase 1.(AU)

The effects of v?tal dyes on mechan?cal propert?es of the human anter?or lens capsule

Purpose: The purpose of this study was to evaluate the mechanical effects of vital dyes on the anterior lens capsule via the nanoindentation method. Methods: Twenty anterior lens capsules of 20 different patients were dissected into four equal fragments. Each fragment was stained separately with dyes for intraocular surgeries, such as trypan blue 0.06% (TB), brilliant blue 0.025% (BB), and indocyanine green 0.05% (ICG), for 1 min. The remaining fragment was assessed as an untreated control group. The alterations on the mechanical characteristics of the anterior lens capsule were evaluated using a nanoindentation testing device with Oliver朠harr and Martens hardness methods. Results: The mean values of elasticity were 7.842 � 0.55 GPa for capsules fragments stained with TB (P < 0.05), 8.407 � 0.82 GPa for capsules fragments stained with BB (P < 0.05), 8.557 � 0.60 GPa for ICG (P < 0.05), and 6.09 � 0.57 GPa for the untreated control group. The mean values of stiffness were 299.7 � 47 MPa for TB (P < 0.05), 317.9 � 34 MPa for BB (P < 0.05), 331.8 � 48 MPa for ICG (P < 0.05), and 229.85 � 44 MPa for the untreated control group. The elasticity of the capsules statistically decreased in comparison to the control group, and the capsule stiffness showed a statistically significant increase in comparison to the untreated controls. Conclusion: The mechanical characteristics of the human anterior lens capsule were affected in association with the alterations in the elasticity and stiffness properties of the capsule as a result of exposure to three different dyes.

Effect of capsular LECs removal on capsular stability in patients with high myopia and cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the effect of LECs removal on the stability of lens capsule bag in patients with high myopia.<p>METHODS: From March 2018 to April 2019, 98 cases(120 eyes)of cataract patients with high myopia were treated in Cataract Department of Hebei Province Eye Hospital. They were divided into two groups according to whether the LECs were removed during the operation. In group A, the anterior and posterior capsule were polished in 50 cases(60 eyes), while in group B, 48 cases(60 eyes)were not polished. During the follow-up period we used anterior segment OCT to detect the change of effective intraocular lens position(ELP), the eccentricity of intraocular lens(IOL)and the reduction of anterior capsule opening in the two groups, and used slit lamp to observe the occurrence and degree of PCO.<p>RESULTS: We compared the changes of ELP(0.16±0.06mm <i>vs</i> 0.55±0.07mm)and the changes of contraction of anterior capsule(0.18 ± 0.16mm <i>vs</i> 0.92 ± 0.13mm)on the first day and three months after operation. Three months after operation, we compared the IOL eccentricity of the two groups(0.02±0.005mm <i>vs</i> 0.69±0.23mm). There were differences between the two groups(<i>P</i><0.05). At 3mo after operation, the PCO of group A was observed by slit lamp: grade I 4 eyes, grade II 2 eyes, grade III 1 eye. The PCO of group B: grade I 16 eyes, grade II 8 eyes, grade III 4 eyes and grade IV 3 eyes. There was significant difference between the two groups(<i>Z</i>=-4.765, <i>P</i><0.01).<p>CONCLUSION: The removal of LECs could reduce the contraction of anterior capsule, decrease the change of ELP and enhance the stability of bag IOL complex, which played a good role in reducing PCO.

Ocular findings in Fabry disease in Colombian patients / Manifestaciones oculares de la enfermedad de Fabry en pacientes colombianos

ABSTRACT Fabry disease is a rare X-linked disorder caused by an alpha-galactosidase enzyme deficiency, which leads to a progressive lysosomal glycosphingolipids accumulation, mainly globotriaosylceramide, in multiple organism tissues including the eye. This case series describes the first ophthalmological Colombian report of Fabry disease highlighting the importance of ocular signs as markers of the disease, useful in diagnosis and treatment to avoid long-term complications that lead to a morbi-mortality increment. We describe five cases of Fabry disease from Bogotá, Colombia, including a complete clinical history, ophthalmologic, optometric examination, and photographs. We found that all patients had refractive defects and that in all cases corneal verticillata pattern was found. Four patients presented with posterior capsule lens brown-beige deposits and four patients had conjunctival and retinal tortuous vessels. A complete ophthalmologic examination is important for prompt diagnosis, which is key to starting a multidisciplinary treatment and reducing morbi-mortality.

RESUMEN La enfermedad de Fabry es un raro trastorno ligado al cromosoma X causado por deficiencia de la enzima alfa-galactosidasa y la consiguiente y progresiva acumulación lisosómica de glucoesfingolípidos, especialmente la globotriaosilceramida, en múltiples tejidos del organismo, incluido el ojo. En este reporte se presenta la primera serie de casos de manifestaciones oculares de la enfermedad de Fabry en Colombia, resaltando la importancia de los signos oculares como ayuda para el diagnóstico temprano. Se presentan cinco casos de la enfermedad en Bogotá y se da cuenta de las historias clínicas y los exámenes oftalmológicos y de optometría, y se incluyen fotografías. En todos los pacientes se hallaron errores de refracción y se evidenció el patrón de córnea verticillata. Cuatro pacientes presentaban depósitos de color café y castaño claro en la cápsula posterior del cristalino, y cuatro tenían tortuosidad vascular conjuntival y retiniana. El examen oftalmológico completo es importante para hacer un diagnóstico oportuno con el fin de iniciar el tratamiento multidisciplinario y reducir la morbimortalidad.

Uveítis facolítica asociada a ruptura espontánea de la cápsula anterior en un paciente con síndrome de Alport / Phacolytic uveitis associated with spontaneous rupture of anterior capsule in a patient with Alport syndrome

RESUMEN 24. El síndrome de Alport es un trastorno genético raro causado por mutaciones en los genes del colágeno tipo IV, caracterizado por insuficiencia renal, hipoacusia neurosensorial y anomalías oculares. Se presenta el caso de un paciente de 24 años con un cuadro de un día de disminución súbita de la agudeza visual en el ojo izquierdo, posterior a ruptura espontánea de la cápsula anterior del cristalino, asociado a catarata, uveítis facolítica e hipertensión ocular. En la anamnesis se encontraron antecedentes personales de hipoacusia e insuficiencia renal y, dos familiares con el diagnóstico clínico de síndrome de Alport. El heredograma sugirió una herencia dominante ligada al cromosoma X. Se inició el tratamiento tópico con prednisolona, atropina y brimonidina/timolol. Posteriormente, se realizó facoemulsificación y aspiración de restos de cristalino, con mejoría del cuadro clínico.

SUMMARY 30. Alport syndrome is a rare genetic disorder due to mutations involving the coding genes for type IV collagen characterized by renal failure, sensorineural hearing loss and ocular abnormalities. This article presents a 24-year-old man with one day of sudden decrease in visual acuity in left eye due to spontaneous rupture of anterior lens capsule, related to cataract, phacolytic uveitis and ocular hypertension. In the anamnesis, personal history of hearing loss, renal failure and two-family members with a clinical diagnosis of Alport syndrome were found. The inheritance map was suggestive of a dominant inheritance X-linked pattern. Topical treatment was initiated with prednisone, atropine and brimonidine/timolol. Subsequently, phacoemulsification and aspiration of lens residues was performed, obtaining clinical relief.

A case of late-onset capsular block syndrome and its surgical treatment / Um caso de síndrome de bloqueio capsular tardio e uma abordagem cirúrgica

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.

Pseudocapsulorrexis: desdoblamiento idiopático de la cápsula anterior del cristalino / Pseudocapsulorhexis: idiopathic split of the anterior lens capsule

Se presenta el caso de una mujer de 81 años que acude para valoración de cirugía de catarata en el ojo derecho. El examen biomicroscópico revela la existencia de una catarata C2N4 (Lens Opacities Classifi cation System, versión III) con una cápsula anterior que en su región central pareciera estar abierta a modo de capsulorrexis, aunque sin trasvase de material lenticular ni signos inflamatorios en cámara anterior Figura 1. Su consistencia y morfología nos hacen pensar en un posible desdoblamiento idiopático de la cristaloides anterior, ya que tanto el reborde pupilar como la gonioscopia son rigurosamente normales. De ahí nuestro título de "pseudocapsulorrexis".

Comparison of Anterior Capsule Stability Following Implantation of Three Single Piece Acrylic Intraocular Lenses with Different Haptic Design

PURPOSE: To compare the anterior capsule contraction and intraocular lens (IOL) decentration among three types of IOL to determine the influence of haptic design on anterior capsule stability. METHODS: One hundred fifty patients were enrolled in this prospective, randomized study and 260 eyes underwent implantation of one of the following IOLs: modified L-haptic IOL (n = 74), modified C-haptic IOL (n = 97), or a plate-haptic IOL (n = 89). The area of the anterior capsule opening, IOL decentration, and capsule overlap were measured using retroillumination photospot 1 day and 2 months after cataract surgery. RESULTS: The area of capsule opening at postoperative day 1 was significantly different between the three IOLs (p < 0.01). All IOLs showed reduction of the anterior capsule opening from 1 day to 2 months after surgery, and greater reduction was shown in the modified C-haptic IOL (p < 0.001). At postoperative month 2, IOL decentration was significantly different between the IOLs and showed a positive correlation with the mean area reduction during month 2. CONCLUSIONS: The degree of anterior capsule contraction and IOL decentration in modified L-haptic IOLs were less than those in modified C-haptic IOLs and comparable to those in plate-haptic IOLs.

Application of anterior vitrectomy combined with Cionni tension ring in traumatic lens subluxation surgery with anterior vitreous prolapse / 眼科新进展

Objective To investigate the effectiveness and safety of anterior vitrectomy combined with capsular retractor and Cionni modified capsular tension ring (MCTR) in traumatic lens subluxation surgery with anterior vitreous prolapse.Methods This study comprised 16 patients (16 eyes) of traumatic lens subluxation with anterior vitreous prolapse,in which iridodialysis was in 3 eyes,express implantation in 1 eye and Ahmed glaucoma valve implantation in 1 eye.According to the severity of lens subluxation,the patients were divided into three levels,including 90°-120° (7 eyes),120°-180° (5 eyes) and 180°-270° (4 eyes).Considering the anterior vitreous prolapse,anterior vitrectomy or/and pars plan vitrectomy was conducted with assistance of triamcinolone acetonide.After continuous curvilinear capsulorhexis,two to four capsular retractors were placed in the capsulorhexis to support and center the capsule.MCTR was inserted with scleral suture fixation after phacoemulsification.At last,the foldable IOL was implanted to capsular bag.Postoperative visual acuity,intra-and post-operative complications,anterior capsular opening,IOL positions and intraocular pressure (IOP) were assessed during 3 months' follow up.Results All patients had successfully undergone phacoemulsification,MCTR insertion and IOL implantation.Seven eyes were inserted with 2-eyelet MCTR and nine eyes were inserted with 1-eyelet MCTR.The postoperative visual acuity was better than 0.5 in 9 eyes,between 0.3 and 0.5 in 4 eyes,between 0.1 and 0.3 in 2 eyes,and less than 0.1 in 1 eye.Compared with pre-operation,the difference in the visual acuity was statistically significant (x2 =17.503,P =0.000).The scheimpflug images obtained from the Pentacam,which demonstrated that the IOL was well centered,and no MCTR and IOL decentration occurred.The common intraand post-operative complications were residual cortex,aqueous misdirection syndrome,anterior capsular tears,anterior capsular phimosis and posterior capsular opacification.Conclusion The effective application of anterior vitrectomy is the key point to reduce surgical complications.Anterior vitrectomy combined with insertion of capsular retractor and MCTR is an ideal surgical option for patients of traumatic lens subluxation with anterior vitreous prolapse.

Late in-the-bag dislocation of IOL bag complex:Mechanisms in etiology and risk factors / 眼科新进展

Late in-the-bag dislocation of intraocular lens bag complex is a rare but potential complication after cataract surgery,which can affect the quality of patients'life seriously,and usually need surgical treatment.People are paying more attention to this complication,because it has been reported with increasing frequency in recent years.This complication may present after a long time frame.There is a research showing that the interval between cataract surgery and the dislocation was 10.9 years.The cumulative risk of IOL dislocation at 10 years,20 years,and 25 years after cataract extraction was 0.1％,0.7％,and 1.7％ respectively.Late in-the-bag IOL dislocation is a result of progressive zonular dehiscence up to many years after cataract surgery,and its genesis is multifactorial.This article reviews the incidence,possible mechanism and risk factors of late in-the-bag IOL dislocation.

Inhibition effects of sulforaphane-induced autophagy flux to cell proliferation on ex vivo human capsular bags / 中华实验眼科杂志

Background Sulforaphane (SFN) is an effective chemopreventive agent and can regulate the biological molecular mechanisms to inhibit the overgrowth of cells.Autophagy is a biological process of maintaining cellular internal environment.Understanding the affection of SFN to biological behavior of human lens epithelial cells (LECs) and the association of SFN with autophagy is helpful for the prevention and target treatment of posterior capsule opacification (PCO).Objective This study was to investigate the eradication effeccts of SFN on residual lens cell population in vitro posterior capsule opacification (PCO) model and evaluate the mechanism of SFN-induced cell death.Methods In vitro human capsular bag models were generated from fresh donor eyes by phacoemulsification and were cultured in EMEM containing 2％ fetal bovine serum (FBS).Different concentrations of SFN (0,1,10 and 100 μ mol) were added in the medium for 30 days respectively according to grouping,and the growth of LECs was observed by optical microscope and immunofluorescence technique.FHL124,a human LEC line,was cultured with EMEM containing 5％ FBS and divided into 0,1,10,30 and 100 μmol SFN groups.Lactate dehydrogenase (LDH) release rate in the medium was detected to evaluate cell damage/death.The migration of the cells on capsular bags was assessed by scratch test.The ultrastructure and number of autophagosomes were examined under the transmission electron microscope.The expression of LC3 in the cells were detected using Western blot in the presence or absence of autophagy inhibitors.Results The cell coverage rates on the capsular bags were significantly lower in the 10 and 100 μ mol/L SFN groups than those in the 0 and 1 μmol/L SFN groups,with a statistically significant difference among the groups (F =48.57,P ＜ 0.01).Immunofluorescence showed that the density of F-actin-and Vimentin-positive cells was evidently decreased in the 10 and 100 μmol/L SFN groups compared with 0 and 1 μ mol/L SFN groups.The releasing levels of LDH (absorbancy) were 0.19± 0.03,0.39±0.06,0.56±0.07,0.68±0.08 and 0.89±0.09 in the 0,1,10,30 and 100 μ mol/L SFN groups,respectively,and the releasing level of LDH was gradually increased in the 10 and 100 μ mol/L SFN groups in comparison with the 1 μmol/LSFN group (all at P＜0.01).With the increase of SFN concentration,the reduction rate of scratched area decreased with the increase of SFN concentration,and the decrease of scratch area was significantly lower than that of adjacent low mass concentration group and the differences were statistically significant (P＜0.05).The relative expressions of LC3-Ⅱ protein were 0.423±0.003,14.543±0.024,0.668±0.024 and 0.576±0.056 in the blank control group,SFN group,SFN + 3-MA group and 3-MA group,respectively,and the relative expressions of LC3-Ⅱ protein were significantly lower in the SFN+3-MA group and 3-MA group than those in the SFN group (all at P＜0.01).The number of autophagosomes was 4.07±0.32,4.13±0.34,9.21 ±0.53 and 21.02± 1.34 in the blank control group,and 1,10,100 μmol/L SFN groups,and the number of autophagosomes in the 10 and 100 μ mol/L SFN groups was significantly higher than that in the blank control group and 1 μmol/L SFN group (all at P＜0.01).Conclusions SFN mediates LECs death by promoting autophagy in ex vivo capsular bags,and SFN may be a novel agent of potential chemopreventive and target treatment for PCO.

Wnt3a-induced extracellular matrix production and gel contraction in human lens epithelial cells / 中华实验眼科杂志

Background Excessive production,deposition and contraction of extracellular matrix (ECM) of human lens endothelial cells (LECs) is one of main causes to posterior capsular opacification (PCO).Researches indicated that Wnt3a protein was involved in production of ECM and fibrosis in epithelial cells,but its effect on LECs is still unclear.Objective This study aimed to elucidate the roles of Wnt3a in production of ECM and gel contraction of LECs.Methods Lipofectamine-mediated transient transfection technique was used to introduce cDNA of Wnt3a gene and pcDNA3-HA vector into the LEC cell line SRA01/04 to act as Wnt3a transfection group and control group respectively.After 48 h of transfection,Western blot was used to detect the expression of Wnt3a,main components of ECM Col-Ⅰ,Col-Ⅳ and integrin β1.Immunofluorescence was used to detect the expression and distrubition of α-SMA and F-actin;collagen contraction was observed by mingling SRA01/04 cells with Col-Ⅰ.Results After 48 hours of transfection using lipofectamine 2000,the expressions of wnt3a protein in SRA01/04 cells was 0.703 ±0.105 in the wnt3a transfected group,and that in the control group was 0.290 ± 0.066,showing a significant difference between the two groups (t =5.782,P＜0.01).Western blot assay showed that the expression levels of Col-Ⅰ and Integrin β1 was 0.697±0.021 and 0.875±0.055 in the Wnt3a transfected group,and which was significantly higher than 0.370±0.020 and 0.580±0.030 in the control group (t =19.600,8.156,both P＜0.01).The expression level of Col Ⅳ in the Wnt3a transfected group was higher than that of the control group (0.430±0.020 vs 0.383 ±0.031),but the difference was not significant (t =2.514,P＞0.05).Immunofluorescence assay revealed that F-actin and α-SMA were weakly expressed in the cell membrane primarily in the control group,while they were strongly expressed in the cell membrane,cytoplasma in the Wnt3a transfected group.Tewnty-four hours after addtion of Col-Ⅰ,the gel contraction area ratio appeared to be more obvious in comparison with the 8 hours (64.1％ ±2.3％ vs 98.9％ ± 1.0％),and gel contraction area ratio was lower in the Wnt3a transfected group than that in the control group (64.1％ ± 2.3％ vs 93.9％ ± 3.1％).Conclusions The overexpression of Wnt3a activates the production of ECM,and the remodeling of celluar skeleton and cellular contraction.

In vitro epithelial-mesenchymal transition model for LECs of human posterior capsule opacification / 中华实验眼科杂志

Background Epithelial-mesenchymal transition (EMT) is one of the pathogenesis mechanisms of posterior capule opcification (PCO).Studying EMT is of important significance for the prevention and treatment of PCO.However,EMT model is lack.Objective This study was to establish an in vitro EMT model for the study of human PCO.Methods In vitro mimic cataract enucleation was performed on 40 donor eyes,including anterior capsulorhexis,nucleus hydroexpression,and aspiration of lens fibers.The capsular bag of lens was dissected free during the surgery and pinned flat on a plastic culture dish with DMEM/F12 supplemented containing 10％ fetal bovine serum for 4 weeks.The proliferation of LECs on the capsular bag was observed by phase-contrast and dark-field microscope in 0,3,7,14 and 28 days after culture.The capsular bag tissues were collected in cultured 0,3,7 and 28 days for the preparation of sections and hematoxylin-eosin stain,and the growth and morphology of LECs were examined with optical microscope.The expression and location of α-SMA,E-cadherin and Vimentin were assessed by immunochemistry.The expression levels of α-SMA,E-cadherin and Vimentin mRNA and proteins were detected by using real-time fluorescnce quantitative PCR and Western blot in different time points.Results No LECs were seen on the uncultured capsular bag.LECs appeared in cultured day 3 on the periphery capsular bag and grew toward the center and covered the posterior capsule 7 days after cultured,with a cobblestone-like appearance.Wrinkles occurred and extended gradually along with the enhancement of bag tension.Immunochestry showed that the expression intensity of E-cadherin in the capsular bag gradually weakened,and that of α-SMA or Vimentin was gradually enhanced during the culture duration.The relative expression levels of E-cadherhin mRNA at 0,3,7,14 and 28 days after culture were 3.35±0.13,1.47±0.20,1.13±0.14,1.00±0.85 and 0.23±0.03,and relative expression levels of Vimentin mRNA were 1.00 ± 0.73,1.05 ± 0.14,2.24 ± 0.43,2.84 ± 0.34 and 8.57 ± 0.40,and those of α-SMA mRNA were 1.00 ± 0.06,2.68 ± 0.28,4.24 ± 0.05,2.05 ± 0.90 and 15.30 ± 0.19,showing significant differences among different time points (E-cadherhin mRNA:F =23.430,P =0.000;Vimentin mRNA F =8.915,P =0.002;α-SMA mRNA:F =103.500,P =0.000),with the lowest expression levels in the E-cadherhin mRNA and the highest expression levels in the Vimentin mRNA and α-SMA mRNA at 28 days during the culture period (all at P＜0.01).The gray values of E-cadherin protein expression were 1.443 ± 0.017,1.023 ± 0.003 and 0.568 ± 0.018,and those of Vimentin protein were 0.565±0.012,1.156±0.007 and 1.241±0.009,and those of α-SMA protein were 0.195±0.045,0.693±0.036 and 1.501±0.005 at 0,3 and 28 days,with significnant differences among various time points (E-cadherin:F =2 787.000,P =0.000;Vimentin:F =4 488.000,P =0.000;α-SMA:F =1 173.000,P =0.000).The expression levels were significantly declined in E-cadherhin protein and elevated in Vimentin and α-SMA proteins at 3 and 28 days after culture in comparison with before culture.Conclusions A novel in vitro EMT model of LECs is established in this study.This model can mimic a natural EMT procedure after extracapsular cataract enucleation and therefore is a useful model for the further research of the mechanism and prevention and treatment of PCO.

The influence of size and shape of Nd:YAG capsulotomy on visual acuity and refraction / A influência do tamanho e forma da capsulotomia por laser de Nd:YAG sobre a acuidade visual e refração

ABSTRACTPurpose:To evaluate the influence of size and shape of neodymium:yttrium aluminum- Garnet (Nd:YAG) laser capsulotomy on visual acuity and refraction.Methods:We retrospectively evaluated 85 eyes of 67 patients treated with Nd:YAG laser posterior capsulotomy for posterior capsule opacification (PCO). The mean age of included patients was 57.57 ± 9.26 (mean ± standard deviation, 38-75 years). The mean interval between surgery and Nd:YAG laser capsulotomy was 26.09 ± 7.08 (10-38) months. Patients were divided into four groups according to the shape and size of capsulotomy. Groups comprised patients with cruciate shape capsulotomies with openings of less than or equal to 3.5 mm (Group 1) or greater (Group 2) and patients with circular shape capsulotomies with openings of less than or equal to 3.5 mm (Group 3) or greater (Group 4).Results:The mean number and energy of laser firings were significantly higher in Group 4 (p=0.00), and significantly lower in Group 1 (p=0.00), compared with that in other groups. Pre-procedural and post-procedural mean spherical equivalent (SE) values were significantly higher in Group 1 (p=0.026 and p=0.011, respectively). No statistical difference in best-corrected visual acuities (BCVA) or intraocular pressures (IOP) were observed between groups before (p=0.44 and p=0.452, respectively) or after capsulotomy (p=0.108 and p=0.125, respectively). A significantly higher number of patients in Group 4 (p=0.001), and a significantly lower number of patients in Group 1 (p=0.001), reported floating bodies compared with that in other groups. No significant changes in SE or intraocular pressure were observed after capsulotomy in any group (p=0.074 and p=0.856, respectively). Best-corrected visual acuity was significantly improved following capsulotomy in all groups (p<0.01).Conclusion:Cruciate shape capsulotomy with an opening of 3.5 mm or less provides the greatest improvement in visual function with minimal complications.

RESUMOObjetivo:Avaliar a influência do tamanho e forma da capsulotomia a laser de Neodímio: Ítrio-Alumínio-Granada (Nd:YAG) na acuidade visual e refração.Métodos:Oitenta e cinco olhos de 67 pacientes, com opacificação de cápsula posterior (PCO), que tinham sido submetidos a capsulotomia por laser de Nd:YAG, foram avaliadas retrospectivamente. A idade foi 57,57 ± 9,26 (média ± desvio padrão), variação 38-75 anos. O intervalo médio entre a cirurgia e a capsulotomia a laser de Nd:YAG foi 26,09 ± 7,08 (variação 10-38) meses. Os pacientes foram divididos em 4 grupos de acordo com a forma e o tamanho da capsulotomia. O grupo 1 incluiu pacientes com forma cruzada e tamanho igual ou menor do que 3,5 mm de abertura capsulotomia, Grupo 2, forma cruzada e tamanho maior do que 3,5 mm, Grupo 3, forma circular e tamanho igual ou menor do que 3,5 mm e Grupo 4, forma circular e tamanho superior a 3,5 mm.Resultados:A quantidade média de energia utilizada e tiros aplicadas foram significativamente maiores no Grupo 4 (p=0,00) e significativamente menores no grupo 1 (p=0,00). O equivalente esférico (SE), antes e após o procedimento, foi significativamente mais elevado no Grupo 1 (p=0,026, p=0,011). Não houve diferença estatística entre os grupos em relação à acuidade visual melhor corrigida (BCVA) e pressão intraocular (IOP) antes do procedimento (p=0,44, p=0,452) e após o procedimento (p=0,108, p=0,125). O número de pacientes com sintomas de moscas volantes foi significativamente maior no grupo 4 (P=0,001) e significativamente inferior no grupo 1 (p=0,001). SE e IOP após o procedimento não foram estatisticamente diferentes daqueles antes do procedimento (p=0,074, p=0,856, respectivamente) em todos os grupos. BCVA após o procedimento foi significativamente melhor do que antes do procedimento (p=0,00) em todos os grupos.Conclusões:Em conclusão, para complicações mínimas e máximas funções visuais, o tamanho ótimo capsulotomia deve ser igual a ou menor do que 3,5 mm e deve ser em forma cruzada.

Clinical observation of combined lensectomy with vitrectomy, retaining the peripheral anterior lens capsule / 国际眼科杂志(Guoji Yanke Zazhi)

To investigate the curative effect of retaining the peripheral anterior lens capsule combined lensectomy with vitrectomy for ocular trauma. ●METHODS: Totally 33 patients ( 33 eyes ) with eye trauma underwent combined lensectomy with vitrectomy, retaining the peripheral anterior lens capsule and phase Ⅱposterior chamber lOL implantation. After follow - up of 6mo, visual acuity, intraocular pressure ( lOP ), lOL position, and intraoperative and postoperative complications were observed. ●RESULTS: Visions of all the patients were improved at varying degrees. After follow-up of 6mo, no obvious lens deflected and serious complications ( glaucoma, retinal detachment) appeared. ●CONCLUSlON: Combined lensectomy with vitrectomy, retaining the peripheral anterior lens capsule for ocular trauma has good curative effects of lessening complications during operation and postoperation and good visual acuity recovery.

Capsulorrexe em duplo anel: estudo clínico patológico / Double ring capsulorhexis: clinic opathologic study

Apresentamos caso de capsulorrexe em duplo anel em paciente feminina de 81 anos. O espécime cirúrgico foi submetido a estudo anatomopatológico que evidenciou os achados típicos da capsulorrexe em duplo anel. Comentamos a possível relação com a exfoliação capsular verdadeira. Salientamos que é possível realizar a cirurgia com bom resultado mesmo que o duplo anel não seja completo - como no caso apresentado - , porém desde que os folhetos capsulares estejam fundidos de forma contínua.

We present a case of double ring capsulorhexis in a 81 year-old female patient. Surgical specimen was submitted to histopathologic study resulting in typical double ring capsulorhexis findings. We discuss the questioned relation to true capsular exfoliation. We call attention to the fact that it is possible to obtain a good surgical result even when the double ring is not complete - as the case presented - , since both capsular flaps are fused in a continuous form.

Effect of drug-sustained capsular tension ring on proliferation of lens epithelial cells in vitro / 中国医师杂志

Objective Our study was performed to design a drug-sustained capsular tension ring (CTR) to evaluate its potentiality on prevention of PCO in the swine capsular bag model in vitro.Methods Following the continuous capsule curvilinear capsulorhexis ( CCCC),Phacomulsification with capsular tension ring implantation was pedormed.CTR-supported swine capsular bag models were prepared and divided into two groups,group CTR ( n =13 ) implanted with the original CTR without any modification and group CTR-PLGA-MG132 ( n =13) implanted with the CTR covered with PLGA and MG132.The CTRsupported capsular bags were cultured in vitro for up to 3 weeks.The area of lens epithelial cells (LEC) coverage over the posterior capsule surface was quantified every day under microscope.The capsules were treated for histological examination.The change of fibronectin was assessed by ELISA assay kit.Results After 2 ～ 3 days,outgrowth of LEC across the posterior capsule was observed,and the posterior capsule was totally covered by a confluent monolayer of cell after (9.06 ± 1.61 ) days in group CTR.Capsular wrinkles became increasingly apparent as time progressed.An increase in capsular thickness was also observed.In contrast,there was less LEC deposition in group CTR-PLGA-MG132.Histological examination showed LEC layers were closely arranged on the posterior capsular surface in group CTR.In group CTR-PLGA-MG132,there was comparatively looser cell arrangement.Compared with group CTR,the mean fibronectin level of posterior capsule by week 3 in group CTR-PLGA-MG132 was 25.14 μg/ml and 106.09 μg/ml respectively.Statistical analysis showed a significant difference ( P ＜ 0.01 ).Conclusions LEC migration,proliferation,and synthesis of EMT markers were inhibited in Group CTR-PLGA-MG132,compared with Group CTR.Drug-sustained capsular tension rings can effectively inhibit the migration,proliferation of LEC and the change of EMT ( epithelial-to-mesenchymal transition) in swine capsular bag models.Drug-sustained capsular tension rings might be a potential therapy to prevent the posterior capsular opacification in the future.

Pressão intraocular antes e após a facoemulsificação em olhos normais / Intraocular pressure before and after phacoemulsification in normal eyes

OBJETIVO: Avaliar comparativamente a pressão intraocular (PIO) antes e após 1 dia, 3 dias, 1 semana, 1 mês, 3 meses, 6 meses e 1 ano, em olhos normais submetidos à facoemulsificação. MÉTODOS: Análise retrospectiva da pressão intraocular (medida pelo tonômetro de aplanação de Goldmann) de 221 olhos normais de 133 pacientes submetidos à facoemulsificação sem intercorrências. A PIO foi avaliada antes e após a facoemulsificação (1dia, 3 dias, 1 semana, 1 mês, 3 meses, 6 meses e 1 ano), e os valores encontrados nestes períodos foram submetidos a uma análise comparativa. RESULTADOS: A PIO média foi de 16,06±2,69 mmHg no pré-operatório; 18,76±5,96 mmHg após 1 dia; 14,82±4,08 mmHg após 3 dias; 14,03±3,06 mmHg após 1 semana; 13,88±3,26 mmHg após 1 mês; 12,74±2,45 mmHg após 3 meses; 12,74±2,01 mmHg após 6 meses; e 13,24±2,77 mmHg após 1 ano. A PIO aumentou 18,9 por cento após 1 dia; diminuiu 6,9 por cento após 3 dias; 12,3 por cento após 1 semana; 12,5 por cento após 1 mês; 19,3 por cento após 3 meses; 20,1 por cento após 6 meses; e 19,9 por cento após 1 ano. CONCLUSÃO: A cirurgia de facoemulsificação sem intercorrências leva a uma redução significativa da PIO em olhos normais. A diminuição da PIO é mais acentuada naqueles pacientes que apresentam PIO mais alta no pré-operatório.

PURPOSE: To assess intraocular pressure (IOP) before and after 1 day, 3 days, 1 week, 1 month, 3 months, 6 months and 1 year in normal eyes submitted to a phacoemulsification. METHODS: Intraocular pressure retrospective analyses (measured by Goldmann applanation tonometer) of 221 normal eyes of 133 patients submitted to an uneventful phacoemulsification. The IOP was evaluated before and after phacoemulsification ( 1day, 3 days, 1 week, 1 month, 3 months, 6 months and 1 year), and these values were submitted to a comparative analyses. RESULTS: The mean preoperative IOP of 16,06±2,69 mmHg rose postoperatively to 18,76±5,96 mmHg at 1 day; dropped to 14,82±4,08 mmHg at 3 days; 14,03±3,06 mmHg at 1 week; 13,88±3,26 mmHg at 1 month; 12,74±2,45 mmHg at 3 months; 12,74±2,01 mmHg at 6 months; and 13,24±2,77 mmHg at 1 year. The IOP rise was 18,9 percent at 1 day; fall of 6,9 percent at 3 days; 12,3 percent at 1 week; 12,5 percent at 1 month; 19,3 percent at 3 months; 20,1 percent at 6 months; and 19,9 percent at 1 year. CONCLUSION: In normal eyes, uneventful phacoemulsification reduced IOP. The greatest IOP decreases were in patients with a higher preoperative IOP.

Síndrome do bloqueio capsular precoce relato de caso e especulação sobre o tamanho da parte óptica da lente como fator de risco / Early caspsular block syndrome a case report and speculation about the size of the lens' optic as a risk factor

Apresentamos um caso de síndrome de bloqueio capsular precoce, tratado por reintervenção cirúrgica no segundo dia de pós-operatório. Comentamos as principais características da síndrome, os possíveis fatores predisponentes, as opções de tratamento e a importância do seu correto reconhecimento. Nós também especulamos sobre outro possível fator de risco, lentes intraoculares com parte óptica de 6mm ou maiores.

We present a case of early capsular block syndrome that was treated by re-operation on the second post operative day. We discuss the major characteristics of the syndrome, possible predisposing factors, therapeutic options and highlight the importance of its correct recognition. We also speculate about another possible risk factor, an intraocular lens with a optic part about 6mm or more.