Efficacy of two kinds of posterior chamber intraocular lens fixation in the treatment of lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS: Retrospective case-control study. A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected, among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture, and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens. The patients in both groups were followed up until 3mo after surgery to observe the operative time, best corrected visual acuity(BCVA), corneal endothelial cell count(CECC), central corneal thickness(CCT)and postoperative complications.RESULTS: The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs. 45.38±8.04min, P<0.001). BCVA in both groups was significantly improved after surgery(all P<0.05), and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs. 0.57±0.25, P<0.001). At 3mo after surgery, CECC in both groups was lower than that before surgery(all P<0.01). The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P<0.01), and there was no significant change in CCT before and after surgery in the sutureless group. During follow-up period, the total complication rate in the sutureless group was lower than that in the suture group(26% vs. 38%, P>0.05).CONCLUSION: 25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time, faster postoperative visual acuity improvement and fewer postoperative complications.

Managing intraocular lens dislocation with one-port pars plana vitrectomy under direct vision with microscope illumination / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To describe a technique of managing intraocular lens(IOL)with deep dislocation in the vitreous cavity by performing pars plana vitrectomy(PPV)with only one pars plana incision under the direct illumination of the surgical microscope.<p>METHODS: Patients who had in-the-bag or out-of-the-bag(spontaneous)IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study.<p>RESULTS:A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity(CDVA)ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range.<p>CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

In-the-bag dislocation of polyfocal full-optics accommodative intraocular lens: A case report

Herein, we report a case of in-the-bag dislocation of a WIOL-CF® polyfocal full-optics intraocular lens (IOL), without a history of trauma. A 56-year-old man was referred to our hospital with the chief complaint of sudden-onset visual disturbance in his left eye. He had undergone uneventful phacoemulsification with WIOL-CF® IOL implantation in the left eye at the local clinic 7 years prior. In fundus examination, IOL-capsular bag complex dislocated into the posterior vitreous was observed. We believe this is the first report of in-the-bag dislocation of a WIOL-CF® IOL that has been subluxated or dislocated in a characteristic pattern, not an in-the-bag pattern.

Bilateral idiopathic spontaneous filtering bleb with ectopia lentis: A case report and review of literature

A 26-year-old male presented with superior filtering bleb with scleral thinning, dislocated lens, and hypotony in both the eyes. His cornea was normal without any sign of ectasia, and there was no history of recurrent redness, trauma, or surgery in either eye. Anterior segment optical coherence tomography did not reveal communicating fistula between the anterior chamber and subconjunctival space. Physical examination and blood investigations did not reveal any systemic association. He was diagnosed to have spontaneous filtering bleb, which is a rare condition observed with ocular or systemic abnormalities.

Clinical Outcomes of Combined Vitrectomy and Intrascleral Fixation of New Intraocular Lenses in In-the-bag Dislocations

PURPOSE: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. METHODS: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. RESULTS: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. CONCLUSIONS: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.

Research advances on late intraocular lens dislocation after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

Late intraocular lens dislocation is one of the most severe late complications after phacoemulsification.It often occurs 3mo after the surgery.Different from early intraocular lens dislocation, late intraocular lens dislocation is caused by zonular dehiscence and contraction of the capsular bag many years after phacoemulsification.In recent years, the incidence of late intraocular lens dislocation gradually increases, having a risk of 0.1% after 10a and 1.7% after 25a.In the long-term follow-up patients who underwent cataract surgery, 90% had zonular insufficiency and capsular contraction.Among the multiple factors which may contribute to zonular weakness and capsular contraction, pseudoexfoliation is the most common cause, accounting for 50% of all the cases.Other risk factors include aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders.The understanding of these predisposing factors will suggest necessary preventions for high-risk patients in the future.

Predisposing Factors and Surgical Outcomes of Intraocular Lens Dislocation after Phacoemulsification

PURPOSE: To report the predisposing factors and surgical outcomes of intraocular lens dislocation (IOL) after phacoemulsification. METHODS: We performed a retrospective study of 131 eyes in 120 patients who were diagnosed with IOL dislocation after phacoemulsification between January 2008 and December 2013. The main outcomes are possible predisposing factors, characteristics of IOL dislocation, and outcomes of rectification surgery, including visual acuity (VA), and refractive status before and at 3 months after surgery. RESULTS: The main conditions associated with IOL dislocation were as follows: status after vitrectomy (27.5%), long axial length (9.2%), neodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy (8.4%), uveitis (6.1%), trauma (5.3%), mature cataract (3.8%), and pseudoexfoliation (2.3%). Mean uncorrected VA improved significantly after rectification surgery (p = 0.00), and best-corrected VA also improved significantly (p = 0.01). Mean value of spherical equivalent tended to decrease, although the decrease was not significant (p = 0.07). Whereas astigmatism showed a significant increase (p = 0.01). 6 eyes (4.6%) were associated with recurrence of IOL dislocation. CONCLUSIONS: Possible major predisposing factors for IOL dislocation are status after vitrectomy, long axial length, Nd:YAG posterior capsulotomy, uveitis, and trauma. The surgical outcome and improvement of postoperative visual acuity were satisfactory.

Clinical observation of one transscleral sutured fixation intraocular lens implanted in the capsular treating traumatic lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the safety and efficacy of one transscleral sutured fixation intraocular lens implanted in the capsular treating traumatic lens dislocation. METHODS: Twelve eyes with lens subluxation from 12 patients during Mar. 2013 to Mar. 2015 were reviewed. The stopping and chopping method combined with manual nuclear extraction was performed in extent of lens subluxation less than 1/2 quadrant and transscleral sutured fixation intraocular lens implanted in the capsular. Visual acuity, best - corrected visual acuity, intraocular pressure, corneal endothelial cell count and the position of IOL were observed and recorded. RESULTS: All the surgeries were performed successfully. Patients were followed up for 6 - 12mo. During the follow-up period, the number of eyes for BCVA ≥0. 8, 0. 4 - 0. 6 and ≤0. 3 was 2, 7 and 3, respectively. It meant 66. 67% of the eyes showed BCVA in 0. 5-0. 6. Intraocular pressure and the position of all intraocular lens were normal. Effects of operation on corneal endothelial cells were slight. No complications took place in and after surgery. CONCLUSION: Without implanting capsular tension ring ( CTR ) , we successfully use the intraocular lens ( IOL) single loop suture fixation in the capsular bag for the treatment of the patient with traumatic lens dislocation. It indicates that the pressure and place shift from the use of IOL avoided by this method without implantation of CTR. This method is safe and effective for the treatment of eyes with traumatic lens dislocation.

Retrospective analysis of surgical strategies for traumatic lens dislocation in 105 cases / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To retrospectively analyze the surgical strategies and outcome of traumatic lens dislocation.?METHODS: Retrospective study. Clinical data of 105 cases ( 105 eyes ) diagnosed with traumatic lens dislocation from April to June 2014 in our hospital were recruited. According to position of dislocated lens and complicated situations, different surgical approaches were performed, including intracapsular lens extraction, phacoemulsification, vitrectomy through pars plana and lensectomy. Meanwhile, vitreo-retinal or anti-glaucoma surgeries were performed in complicated cases. Preoperative and postoperative LogMar ( Logarithm of the Minimum Angle of Resolution ) visual acuity were compared by paired t-test. Perioperative complications including expulsive choroidal hemorrhages and recurrent retinal detachment were recorded and assessed.?RESULTS: All 105 dislocated lenses were removed completely. Visual acuity of 91 eyes ( 86. 7%) were significantly improved postoperatively. The visual acuity of most patients was 0. 1-0. 3 ( 42 eyes, 40. 0%) and 1 patient’s visual acuity with lens subluxation reached more than 0. 8 postoperatively. Expulsive choroidal hemorrhages occurred in 1 eye intraoperatively and 1 eye postoperatively. Recurrent retinal detachment was observed in 2 eyes postoperatively.? CONCLUSION: According to position of the lens dislocation, personalized surgery strategy is critical for therapy of traumatic lens dislocation. Expulsive choroidal hemorrhage is one of most several complications and should be managed properly.

Golden half ring sign for identification of pseudophacocele.

Dislocation of intraocular lens (IOL) is a serious complication of blunt ocular trauma in pseudophakic eyes. Here, a 72‑year‑old male patient with subconjunctival dislocation of an IOL (pseudophacocele) secondary to bull horn injury was reported. In this case report, a new sign named as “golden half ring sign” was described for easy identification and localization of subconjunctival dislocation of IOL in patient with open globe injury (surgical wound dehiscence) associated dense subconjunctival hemorrhage.

lnnercapsular phacoemulsification with primary intraocular lens implantation in the treatment of lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

To observe the clinical results of innercapsular phacoemulsification with primary intraocular lens ( lOL ) implantation in the treatment of lens dislocation.METHODS: A total of 23 cases ( 23 eyes ) of lens dislocation ( lla and llb ) were underwent innercapsular phacoemulsification combined with primary lOL implantation. lOL implantation were underwent during operation, the complications of intraoperative and postoperative, postoperative vision, intraocular pressure ( lOP ) , corneal endothelial cell, lOL location were analyzed.RESULTS: The operations were successfully completed for all patients in accordance with the pre - surgery program; lens nucleus or its fragments did not crash into the vitreous cavity; 20 cases of corneal edema and 17 cases of lOP presented at the first day after surgery, the deviation or displacement of lOL and serious complications such as retinal detachment were not appeared. At the first week postoperation, the average lOP was 15. 81 ± 2. 10mmHg, with statistically significant differences when compared with the preoperative ( P0. 05) CONCLUSlON: lnnercapsular phacoemulsification combined with primary lOL implantation in the treatment of the whole lens dislocation (‖a and ‖b ) can restore function in patients with diplopia and control lOP effectively, reduce corneal endothelial cell damage, which is an effective method to treat the whole traumatic lens dislocation.

Observation of two types of foldable scleral - fixated posterior chamber intraocular lens to treat cataract dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To observe the clinical efficacy of two types of scleral-fixated posterior chamber intraocular lens ( lOL ) combined intra-capsule lens extraction to treat cataract dislocation. METHODS: After intra - capsule lens extraction of dislocated cataract, two types of lOL were used as scleral-fixated posterior chamber lOL . First group was with four seal loops, the second group was with two open loops. All 21 patients (23 eyes) took the examination of the best corrected visual acuity, intraocular pressure, fundus, and lOL decentration using camera system attached to slit - lamp ophthalmoscope and lOL tilted using ultrasound biomicroscopy (UBM) at 6mo after surgery.RESULTS: After 6mo, all patients had improved eye sight. There was significant difference in the mean lOL decentration between the two groups ( 0. 57mm vs 0. 79mm, P CONCLUSlON: lOL with four loops are more appropriate as scleral-fixated posterior chamber lOL with less tiltness and dicentration.

Phacofragmentation combined with vitrectomy in the treatment of traumatic dislocation lens / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To explore the clinical application effect of phacofragmentation combined with vitrectomy in the treatment of traumatic lens dislocation. METHODS:Totally 16 cases (16 eyes) of traumatic lens dislocation treated with phacofragmentation combined with vitrectomy were retrospectively analyzed, including 6 cases of high intraocular pressure ( lOP) and 10 cases of vitreous hemorrhage, and 1 case of retinal detachment. All patients were given conventional flat line standard three channel vitreous operation incision to remove the anterior, middle part and peripheral vitreous around lens dislocation. The crystalline lens were drawn to the center cavity of vitreous body and treated by ultrasonic disintegrator. ln the operation, the retina was examined and 8 of them had no retinal damage and in the first stage underwent fixation of posterior chamber intraocular lenses. RESULTS: All crystalline lens dislocated were completely grinded and suctioned. There was no retinal detachment occurred in 3mo followed up. 16 eyes had normal lOP (12-20mmHg) at 1wk after operation. The average visual acuity was improved and with 8 cases got improved of 0. 2 or more 1wk after operation. CONCLUSlON: Our research shows that phacofragmentation combined with vitrectomy is a safe and effective method for the treatment of traumatic lens dislocation. The patients with nondestructive retina in the operation are feasible to do first stage operation of intraocular lens suture fixation, which contributes to the best visual acuity.

Surgical effect of traumatic lens dislocation with secondary glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To retrospectively evaluate the effect of lens extraction combined with vitrectomy to treat traumatic lens dislocation with secondary glaucoma. METHODS: Thirty - one eyes ( 31 cases ) of lens dislocation caused by blunt trauma with secondary glaucoma were treated respectively with cataract extraction combined with anterior vitrectomy, trabeculectomy and intraocular lens implantation. The visual acuity and pressure were observed 1wk, 1 and 3mo after operative. RESULTS: Thirty - one eyes were all complete the operation successfully, and 6 eyes were given combined trabeculectomy, 9 eyes were implanted anterior chamber intraocular lens implantation ( IOL ) and 15 eyes were given posterior chamber suture fixation. Sixteen eyes were implanted in one-stage operation, while 8 eyes were implanted in two-stage operation. All intraocular pressure ( IOP ) were controlled to the normal level after operation and 23 eyes had visual acuity of more than 0. 3. CONCLUSION: Lens extraction combined with vitrectomy is an effective method for treatment of lens dislocation with secondary glaucoma. In order to control the IOP and get well visual function, we should choose IOL implantation or trabeculectomy according to the patient's condition.

Analysis of causes of the intraocular lens dislocation after trans-scleral fixation of intraocular lens / 中华实验眼科杂志

Background Trans-scleral fixation of intraoculalen(IOL) hamade greaprogress,buthe long-term stability of the implanposition of IOL aftesurgery inoideal.Objective Thistudy wato investigate the relevanfactorof IOL dislocation aftetrans-scleral fixation of IOL.Methodrespective case-observational study wadesigned.The clinical datfrom 321 eyeof 321 patientwho had received trans-scleral fixation of IOL were collected.total of 263 patientcompleted the effeetive follow-up,and 164 patientwith the follow-up fomore than 5 years.No IOL dislocation occurred within 5 yearin all 263 eyes.The relationship between IOL material,IOL implantation location,the time of IOL dislocation and the intraoculapressure with IOL dislocation were analyzed.ResultIOL dislocation appeared 7-10 yearaftesurgery in 9 eyewith an incidence rate of 5.49％.Breakage of IOL suture wafound in all the eyewith IOL dislocation.Dislocation wamore frequently found in IOL performed in the oblique position than thain the horizontal position (10.0％ vs.3.5％).The rate of IOL dislocation wahighesin traumatiretinal detachmeneyes,apercentage of 33.33％.Single piece IOL wamore easily dislocated.ConclusionThe breakage of anchosuturein IOL ileading cause of IOL dislocation aftetrans-scleral fixation of intraoculalens,which may be associated with the weighresulting from the fixation procesin non-level angulaIOL.Iirecommended thaIOL should be fixed in the horizontal position.

Perfluoro-N-octane as Postoperative Vitreous Substitutes in Retinal Detachment: A Case Report

PURPOSE: To report a case of retinal detachment with a giant retinal tear, which was treated with perfluorocarbon liquid as an intraocular substitute. CASE SUMMARY: A 37-year-old woman with a dislocated lens and a giant retinal tear underwent vitrectomy and lensectomy and was instructed to maintain a supine position after the operation. Perfluorocarbon liquid (Perfluoro-N-octane, C8F18) was used as a substitute in the vitreous cavity for 17 days. After 17 days, the perfluorocarbon liquid was removed and intraocular lens scleral fixation was performed. After removal of the perfluorocarbon liquid, the corneal endothelium was stable without other complications (including corneal edema, elevated intraocular pressure, ocular hypotony, macular pucker), and the best corrected visual acuity after intraocular lens scleral fixation was 0.4. CONCLUSIONS: Perfluorocarbon liquid is a useful surgical material in patients with a dislocated lens and retinal detachment with a giant retinal tear who have difficulty maintaining a prone position.

A Case of Weill-Marchesani Syndrome with Inversion of Chromosome 15

PURPOSE: To present a case of Weill-Marchesani syndrome with corneal endothelial dysfunction due to anterior dislocation of a spherophakic lens and corneolenticular contact. METHODS: A 17-year-old woman presented with high myopia and progressive visual disturbance. She was of short stature and had brachydactyly. Her initial Snellen best corrected visual acuity (BCVA) was 20/50 (-sph 20.50 -cyl 3.00 Ax 180) in her right eye and 20/40 (-sph 16.00 -cyl 6.00 Ax 30) in her left eye. Slit lamp examination revealed a dislocated spherophakic lens touching corenal endothelium. A microspherophakic lens, hypoplastic ciliary body, and elongated zonules were confirmed on rotating Scheimpflug camera (Pentacam(R)) and on ultrasound biomicroscopy. Specular microscopy showed corneal endothealial dysfunction. Systemic evaluation was performed, and chromosomal study showed 46, XX, inv (15) (q13qter). The patient was diagnosed with Weill-Marchesani syndrome. RESULTS: Due to impending corneal decompensation, phacoemulsification and suture fixation of the intraocular lens were performed. The operation and postoperative course were uneventful. Three months postoperatively, the visual acuity was 20/30 (OD) and 20/40 (OS) without correction, and BCVA was 20/20 (+sph 0.50 -cyl 2.00 Ax 160 : OD) and 20/25 (+sph 1.50 -cyl 3.00 Ax 30 : OS). During the follow-up period, increased corneal endothelial counts, hexagonality, and decreased corneal thickness were achieved. CONCLUSIONS: In Weill-Marchesani syndrome with a chromosomal anomaly, a dislocated spherophakic lens may cause severe corneal endothelial dysfunction due to corneolenticular contact, and prompt lensectomy is important to prevent such complications.

Bilateral Spontaneous Anterior Lens Dislocation in a Retinitis Pigmentosa Patient

PURPOSE: To report a case of bilateral spontaneous anterior lens dislocation associated with retinitis pigmentosa (RP). METHODS: A 45-year-old male with RP presented with elevated intraocular pressure (IOP) in the right eye and was treated with laser iridotomy (LI). After LI, complete crystalline lens dislocation into the anterior chamber occurred. Surgical intervention, including anterior vitrectomy, intracapsular cataract extraction (ICCE), and IOL scleral fixation was performed. Two years later, the same episode occurred in his left eye and a similar treatment was done. RESULTS: Surgery was successful in both eyes. CONCLUSIONS: This is the first report of bilateral spontaneous anterior lens dislocation in a RP patient.

Bilateral Spontaneous Dislocation of Intraocular Lenses within the Capsular Bag in a Retinitis Pigmentosa Patient

A 45-year-old man with retinitis pigmentosa (RP), who had undergone uneventful extracapsular cataract extraction (ECCE) in his right eye eight years previously, and phacoemulsification in his left eye six years previously, had spontaneously dislocated intraocular lenses (IOL) within the capsular bag in both eyes one month apart. We removed the dislocated IOLs, and performed anterior vitrectomy and scleral fixation of the new IOLs. Mild contraction of the capsular bags and uneven distribution of the zonular remnants' clumps along the equator of the capsules were found by scanning electron microscopic (SEM) examination. In this study, we propose the correlation between RP and zonular weakness. To our knowledge, this is the first case report of bilateral spontaneous dislocation of IOLs within the capsular bag of an RP patient.