Deslocamento espontâneo do núcleo do cristalino para câmara anterior / Spontaneous displacement of the lens nucleus into the anterior chamber

RESUMO Ao longo da vida, o cristalino produz novas fibras dispostas de forma concêntrica, que aumentam seu diâmetro anteroposterior e peso, tornando seu núcleo mais compacto e endurecido. A catarata hipermadura é uma forma de progressão avançada dessa proliferação de fibras, que pode desencadear uma variedade de complicações. A ruptura espontânea da cápsula anterior do cristalino, evoluindo com deslocamento anterior do núcleo, é uma complicação rara e com poucos casos publicados na literatura. Descrevemos o caso de uma paciente do sexo feminino, 68 anos, que apresentou ruptura espontânea da cápsula anterior do cristalino com deslocamento anterior do núcleo em olho esquerdo sem histórico de trauma ocular. A paciente foi submetida à facoemulsificação do cristalino e ao controle da pressão intraocular, evoluindo com melhora do quadro clínico.

ABSTRACT Throughout life, the lens produces new fibers arranged concentrically, which increase its anteroposterior diameter and weight, making its nucleus more compact and hardened. Hypermature cataract is an advanced stage of this fiber proliferation, which can trigger a variety of complications. Spontaneous rupture of the anterior lens capsule evolving with anterior displacement of the nucleus is a rare complication, with few cases published in the literature. We describe the case of a 68-year-old female patient, who presented spontaneous rupture of the anterior lens capsule with anterior displacement of the nucleus in the left eye, without a history of ocular trauma. The patient underwent phacoemulsification and clinical control of intraocular pressure, improving her condition.

Capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the application effect of iris hooks combined with suture fixation of capsular tension ring(CTR)in the treatment of phacoemulsification with secondary glaucoma associated with lens subluxation.METHODS: Retrospective case series. A total of 18 eyes of patients with serious secondary glaucoma associated with lens subluxation were enrolled in Aier Eye Hospital(Changchun)from October 2017 to May 2020 as the observation group. All the patients had iris hooks inserted to support the capsule during the phacoemulsification combined with intraocular lens(IOL)implantation. Iris hooks were inserted through the incisions and placed in the capsulorhexis to support the capsule, then CTR was implanted and sutured onto the sclera of the dislocation side. A total of 11 eyes of patients had intracapsular cataract extraction combined with IOL suspension were enrolled in Aier Eye Hospital(Changchun)from October 2015 to October 2017 as the control group. The postoperative complications were recorded. The postoperative examinations included visual acuity, intraocular pressure(IOP)and positions of the capsule and IOL.RESULTS: The postoperative follow-up at least 12(12-40)mo, both the IOP of observation group and control group returned to normal, with statistically significant difference compared with pre-operation(t=9.994, 8.790, all P<0.001). At 12mo after operation, the best corrected visual acuity of the two groups were significantly improved compared with surgery before(Z=-3.900, P<0.001; Z=-3.002, P=0.003). The IOL in the observation group of the 18 eyes were in the expected position without complications such as an obvious tilt or displacement. In the control group with 11 eyes, the position of IOL in 8 eyes were centered, 3 eyes were slightly biased, and 2 eyes with cystoids macular edema.CONCLUSION: The application of suture fixation capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation in patients can be used as an effective auxiliary method, it could effectively control the IOP and maintain long-term stability of the capsule.

Clinical observation of Yamane's technique in acute secondary angle-closure caused by lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical efficiency of phacoemulsification combined with intrascleral fixation of intraocular lens(IOL)by using Yamane's technique in the treatment of acute secondary angle-closure(ASAC)caused by lens subluxation.<p>METHODS: Clinical data of 15 patients(15 eyes)with ASAC caused by lens subluxation who underwent phacoemulsification combined with intrascleral fixation of IOL by using Yamane's technique from June 2019 to December 2020 were reviewed retrospectively. The patients were followed for 3mo. The preoperative and postoperative intraocular pressure(IOP), best corrected visual acuity(BCVA), positions of the IOL and complications were observed. <p>RESULTS: All the operations were successfully completed. The postoperative IOPs were lower than preoperative IOPs. There were overall differences between preoperative and postoperative IOPs(F=165.57, P<0.001). Through further pairwise comparison, the IOPs at 1d, 1wk, 1, and 3mo after operation were significantly different from IOPs before operation(all P<0.001). The IOPs remained normal range at 1wk, 1, and 3mo after operation. The BCVA at 3mo after operation was significantly better than the preoperative BCVA(t=10.717, P<0.001). All IOLs were in the expected position without an obvious tilt or displacement. No serious complications occurred after the operation. <p>CONCLUSION: The surgical strategy of phacoemulsification combined with intrascleral fixation of IOL by using Yamane's technique in the treatment of ASAC caused by lens subluxation was safe and effective by lowing IOP, rescuing visual, maintaining stability of IOL and reducing complications.

Clinical characteristics of glaucoma associated with primary retinitis pigmentosa / 中华眼底病杂志

Objective:To observe the clinical characteristics of primary retinitis pigmentosa (RP) complicated with glaucoma.Methods:A retrospective clinical study. From June 2008 to March 2020, the diagnosis of primary RP were included in the diagnosis confirmed by the eye examination of West China Hospital of Sichuan University included 4794 eyes of 2432 patients. Among them, 4679 eyes (97.2%, 2364/2432) were in 2364 cases with RP alone, and 115 eyes were in 68 cases with RP combined with glaucoma (2.80%, 68/2432). All affected eyes underwent best corrected visual acuity (BCVA) and intraocular pressure examination. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. The 67 eyes of 40 patients with RP and glaucoma with complete follow-up data were analyzed to observe the proportion of different glaucoma types, logMAR BCVA, intraocular pressure and other clinical characteristics, as well as treatment methods and post-treatment intraocular pressure control. After treatment, the intraocular pressure ≤21 mm Hg (1 mm Hg=0.133 kPa) was regarded as intraocular pressure (IOP) control; >21 mm Hg was regarded as uncontrolled IOP.Results:Among the 67 eyes of 40 cases with complete follow-up data, 5 cases (7 eyes) with primary open-angle glaucoma (10.45%, 7/67), 56 cases (58 eyes) with angle-closure glaucoma (ACG) (86.57%, 58/67), 4 cases (4 eyes) with neovascular glaucoma (5.97%, 4/67), 2 of them had both ACG and neovascular glaucoma. Among 58 ACG eyes, 17 eyes were acute ACG (25.37%, 17/67), 21 eyes were chronic ACG (31.34%, 21/67), and 2 eyes were suspicious angle closure (2.99%, 2/67), lens dislocation secondary to angle-closure glaucoma in 8 eyes (11.94%, 8/67), chronic angle-closure glaucoma after anti-glaucoma surgery, intraocular lens shift in 5 eyes (7.46%, 5/67), 5 eyes (7.46%, 5/67) secondary to glaucoma with true small eyeballs. The logMAR BCVA 3.50 of the affected eye,<3.50->2.00, ≤2.00-≥1.30,<1.30->1.00, ≤1.00- 0.52,<0.52 were 9 (13.43%, 9/67), 30 (44.78%, 30/ 67), 7 (10.45%, 7/67), 4 (5.97%, 4/67), 11 (16.42%, 11/67), 6 (8.96%, 6/67) eyes, which correspond to mean intraocular pressure were 32.31±11.67, 30.15±14.85, 28.17±13.19, 31.50±17.25, 18.71±8.85, 14.12±4.25 mm Hg. Among 67 eyes, 37eyes (55.22%, 37/67), 18eyes (26.86%, 18/67), and 6 (8.96%, 6/67) eyes underwent surgery, medication alone, and peripheral iris laser perforation treatment, respectively. The treatment of 6 eyes was abandoned (8.96%, 6/67). Malignant glaucoma occurred in 3 eyes (8.11 %, 3/37) after the operation, all of which were after trabeculectomy of the ACG eye. After treatment, intraocular pressure was controlled in 37 eyes (55.22%, 37/67), 19 eyes were not controlled (28.36%, 19/67), and 11 eyes were lost to follow-up (16.42%, 11/67).Conclusions:The incidence of glaucoma in patients with primary RP is 2.80%. ACG is more common, and the combined lens dislocation or intraocular lens shift is more common.

Result of implantation of scleral-fixated posterior chamber intraocular lenses / Шинэ санаа Шинэ нээлт

Purpose@#The aim of this study was to determine the surgical and visual outcomes of scleral fixated intraocular lens implantation in eyes with as subluxated and dislocated crystalline lens or traumatic aphakic eyes.@*Methods@#A retrospective and short-term prospective cohort study was carried out in 45 eyes of 43 individuals who underwent SFIOL implantation surgery in First Central Hospital of Mongolia between January 2017 and January 2020 and had a minimum follow-up of 3 months. Pre-operative and post-operative best corrected visual acuity, postoperative outcomes and complications were summarized. Patients after the implantation of a scleral fixated PCIOL were evaluated for the disease etiology, pre- and post-operative best corrected visual acuity, and occurrence of postoperative complications.@*Results@#The analysis included 45 eyes from 43 patients. Thirty-two (74.4%) patients were men and eleven (24.6%) were women . The mean age at implantation was 57.2 ± 20.0. Indications for the IOL implantation included ocular trauma (48.9%), pseudoexfoliation syndrome (22.2%) and Marfan syndrome (15.6%). Disease etiology and age group were compared and results were Marfan syndrome is mostly diagnosed in 20-29 years of age, ocular trauma is usually diagnosed in 30-69 years of age and pseudoexfoliation syndrome is occurred in 70 and above of age. Post-operative visual acuity was improved in all cases from which 35 of patients (77.77%) visual outcome was 6/12 and above. </br> The mean preoperative best corrected visual acuity (BCVA) was 0.083 ± 0.088, which improved to 0.569 ± 0.221 (p<0.001) third month postoperatively and these were statistically significant.</br> The most frequent complication was induced astigmatism, which occurred in 6 eyes which successfully corrected with glasses. Suture erosion occurred in three eyes which successfully relocate it. The most serious complications such as vitreous hemorrhage, retinal detachment, suprachoroidal hemorrhage, endophthalmitis and suture degradation or breakage was not seen.@*Conclusion@#Ab externo SFIOL implantation is a reasonable technique for the management of eyes with aphakia or absence of capsular support, with relatively high visual outcomes and few serious complications.</br> The most frequent cause of aphakia and absence of capsular support was ocular trauma thus, pseudoexfoliation and Marfan syndrome were the most common in elderly and in young age, respectively.

Spontaneous repositioning of posterior chamber intraocular lens: a mere coincidence? / Reposicionamento espontâneo de uma lente intraocular na câmara posterior: uma mera coincidência?

ABSTRACT Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.

RESUMO Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.

Retrospective analysis of surgical strategies for lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To analyze the effectiveness and safety of different surgical strategies for cataract combined with subluxated lens. <p>METHODS: This is a retrospective study. Data are acquired from patients who diagnosed with cataract combined with subluxated lens between November 2018 to May 2019 in the ophthalmological center of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine. There are 11 eyes in 11 patients(9 males and 2 females), 10 eyes were caused by trauma and 1 eye was unknown. Cataract combined with subluxated lens were treated with different surgery procedures according to the degree of dislocation. Four eyes with lens dislocation larger than 270° underwent intraocular lens suspension; Four eyes with lens dislocation about 180° underwent IOL and tension ring implant in capsular, at the same time, the iris hook was hooked to the lens capsule bag and fixed to the sclera. Three eyes with lens dislocation less than 180° underwent IOL implantation combined with 5-0 polypropylene suture, iris hook was also hooked to the lens capsule bag and fixed to the sclera. If the anterior chamber has vitreous prolapse, anterior vitrectomy was performed. Best corrected visual acuity(BCVA)and intraocular pressure(IOP)were observed before and after surgery. <p>RESULTS: All eyes were successfully implanted with intraocular lens(IOL). Best corrected visual acuity(LogMAR)increased from 0.77±0.26 to 0.35±0.28. Mean IOP decreased from 24.33±13.55 to 13.85±3.80mmHg. No intraoperative complications occurred in all cases.<p>CONCLUSION: In the treatment of lens dislocation with cataract, individualized surgical plan and flexible treatment measures can make cataract surgery safe and effective.

Homocistinuria, reporte de un caso / Homocystinuria, Case Report / Homocistinuria, relato de um caso

Resumen: En este artículo se presenta el caso de una niña de 13 años con historia de cefalea de 2 años de evolución, la cual ha sido estudiada por subluxación del cristalino y fenotipo marfonoide. Para llevar a cabo la investigación se realizó una tomografía cerebral simple que evidenció trombosis de varios senos cerebrales. Posteriormente se hospitalizó a la paciente en la unidad de cuidados intensivos, mientras se anticoagulaba con enoxaparina. Se solicitó un estudio para trombofilia junto con homocisteina en sangre, ante la sospecha de homocistinuria. Luego de confirmarse el diagnóstico se recetó piridoxina y ácido fólico, con lo cual la paciente evolucionó de manera satisfactoria y recuperó las funciones perdidas. El seguimiento de este caso para la investigación permitió encontrar una disminución mayor del 20 % de la homocisteina, sin que sus niveles estuvieran por debajo de 50 µmol/L, hecho que hace a la paciente respondedora parcial a la piridoxina.

Abstract: This article presents the case of a 13-year-old girl with a 2-year history of headache, which has been studied for lens subluxation and Marfanoid phenotype. To carry out this research, a simple brain tomography was performed that showed thrombosis of several sinuses. Subsequently, the patient was hospitalized in the intensive care unit and anticoagulated with enoxaparin. A study was requested for thrombophilia along with homocysteine in blood, on suspicion of homocystinuria. After confirming the diagnosis, pyridoxin and folic acid were prescribed, with which the patient evolved satisfactorily and recovered lost functions. Follow-up on this case for the research allowed us to find a decrease in homocysteine greater than 20 %, without its levels being below 50 µmol/L, which makes the patient partially responsive to pyridoxine.

Resumo: Neste artigo, é apresentado o caso de uma menina de 13 anos, com história de cefaleia de dois anos de evolução, a qual tem sido estudada por subluxação do cristalino e fenótipo marfanoide. Para realizar a pesquisa, foi tomada uma tomografia cerebral simples que evidenciou trombose de vários seios cerebrais. Em seguida, a paciente foi internada na unidade de tratamento intensivo onde recebeu tratamento anticoagulante com enoxaparina. Foi solicitado um estudo para trombofilia junto com homocisteina em sangue, diante da suspeita de homocistinúria. Após o diagnóstico ter sido confirmado, foram receitados piridoxina e ácido fólico, com os quais o estado da paciente evoluiu de maneira satisfatória e ela recuperou as funções perdidas. O seguimento do caso para a pesquisa permitiu verificar uma diminuição maior de 20% da homocisteina, sem que seus niveis estivessem abaixo de 50 µmol/L, fato que torna a paciente apta parcialmente à piridoxina.

Comparative study of lens subluxation in patients with angle-closure glaucoma and shallow anterior chamber with different axial lengths / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate whether there is a difference in the probability of partial zonular dehiscence and subluxation in patients with angle-closure glaucoma and shallow anterior chamber combined with cataract. <p>METHODS: A retrospective analysis was performed,for patients with angle-closure glaucoma and patients of shallow anterior chamber with cataract admitted to our hospital from February 2017 to March 2019. The patients underwent cataract surgeries and were divided into two groups: Group A(visual axis <22mm)and Group B(visual axis ≥22mm). Central anterior chamber depth(ACD)was measured with ultrasound biomicroscopy(UBM); Axial length(AL, length of optic axis)was measured with IOL-Master; Calculation of the ratio of AC depth to axial length(ACD/AL)was performed. The consistency of the anterior chamber depth in all directions in UBM images was analyzed. In cataract surgeries, partial zonulysis with or without lens subluxation was recorded.<p>RESULTS: The result indicated that the rate of partial zonular dehiscence in group B was higher than that in group A(8.46%±1.44% <i>vs</i> 7.56%±1.51%, <i>P</i><0.05). <p>CONCLUSION: When performing cataract surgery in patients of angle-closure glaucoma and shallow anterior chamber in group B, attention should be paid to the probability of zonular abnormality.

Temporary Haptic Externalization and Four-point Fixation of Intraocular Lens in Scleral Fixation to Enhance Stability

PURPOSE: To report the results of a new technique for intraocular lens scleral fixation of temporary haptic externalization and four-point fixation for enhanced stability. METHODS: Two 10–0 polypropylene strands were fixed at two points 2 mm apart on each haptic of a conventional three-piece intraocular lens, using our previously reported method of temporary haptic externalization after injector implantation. Postoperative refractive outcome and stability were evaluated. RESULTS: Although the intraocular lens was fixed at a total of four points, no intraoperative difficulties were observed during the process. Patients showed successful fixation of the intraocular lens postoperatively. The fixed intraocular lens showed good centering and minimal tilting. When compared to the two-point fixation technique, postoperative astigmatism was significantly smaller in the four-point fixation group (1.80 ± 0.84 vs. 1.00 ± 0.0.50, p = 0.033). Lens-induced astigmatism calculated from subtraction of corneal astigmatism from total astigmatism was also significantly smaller in the four-point fixation group (2.23 ± 0.98 vs.1.17 ± 0.0.70, p = 0.043). No postoperative complications were identified during a mean follow-up period of 14.8 months (range, 10 to 19 months). CONCLUSIONS: By fixing the intraocular lens at two points on each side of the haptics, this method minimizes the tilting of the intraocular lens and thus decreases postoperative lens-induced astigmatism. Also, the possibility of intraocular lens dislocation in the long term might be decreased by this two-point fixation technique.

Application of two capsular Tension ring sclera fixing methods in treatment of moderate and severe lens subluxation / 眼科新进展

Objective To compare the clinical effects of one-stage modified capsular tension ring (MCTR) scleral fixation and second-stage capsular tension ring (CTR) capsular bag complex scleral fixation in the treatment of moderate and severe subluxation of lens.Methods Retrospective study.Thirty cases (43 eyes) of patients with moderate and severe subluxation of lens from January 2012 to December 2015 were collected.Those patients were treated with phacoemulsification cataract extraction and MCTR or CTR and IOL intracapsular implantation under local anesthesia.23 eyes in group A were treated with MCTR combined with IOL implantation and one-stage scleral fixation.20 eyes in group B were treated with one-phase CTR combined with IOL implantation and second-stage of CTR-capsular bag complex scleral fixation after 3 to 6 months.The best corrected visual acuity,location of the postoperative capsular bag complex and complication were observed at 6 months after surgery.Results Postoperative 6-month,the best corrected visual acuity ≥0.6 were in 87％,95％ of the patients m group B,and there was no statistical significance difference (P ＞ 0.05).All CTR and IOL were located in the capsular bag after surgery.Two eyes in group A and 1 eye in group B were observed with moderate contraction and off-center of capsular bag,there was no significant difference (P ＞ 0.05).All groups achieved response after YAG laser anterior capsule relaxing incisions.Early complications of postoperative (1 month):3 eyes in group A and 1 eye in group B were observed with exudative membrane in anterior chamber;5 eyes in group A and 2 eyes in group B were with transient high intraocular pressure,and there was no significant difference (all P ＞ 0.05).Long-term complications of postoperative (6 months):3 eyes in group A and 1 eye in group B were observed with after cataract,and there was no significant difference (P ＞ 0.05).All groups conducted YAG laser posterior capsulotomy.Conclusion The location stability of the capsular complex after one-stage MCTR scleral fixation or secondstage CTR capsular bag sclera fixation is good.And the treatment is effective for moderate and severe lens dislocation.

Surgical effect observation of lens dislocation greater than 2 quadrants / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical effect of cataract combined lens dislocation greater than 2 quadrants` patients after having phase I intracapsular cataract extraction and anterior vitrectomy,postoperative corrected vision greater than 0.3,and then taking phase II small incision suture-fixation of intraocular lens suspension.METHODS: Totally 34 cases with cataract combined lens dislocation greater than 2 quadrants had been treated in our hospital from July 2014 to December 2016.We investigated their 1wk,1 and 3mo postoperative complications and the uncorrected visual acuity,best corrected visual acuity,intraocular pressure,corneal astigmatism who took phase II small incision suture-fixation of intraocular lens suspension with corrected vision greater than 0.3 after having phase I intracapsular cataract extraction and anterior vitrectomy.RESULTS: Along with the recovery time extension,patients` uncorrected visual acuity and best corrected visual acuity increased obviously than preoperative in each phase.On the 3mo postoperatively,the best corrected visual acuity of 1 eyes was between 0.3 and 0.1,8 eyes was between 0.5 and 0.3,16 eyes was between 0.7 and 0.5,and 9 eyes was better than 0.7.The best corrected visual acuity was achieved or near the best corrected visual acuity before surgery.Intraocular pressure rechecked became in the normal range at 1wk,1 and 3mo postoperative.Surgery did not significantly increase the corneal astigmatism.CONCLUSION: It is a safe and effective way in improving eyesight effectively,with stable intraocular pressure and fewer complications towards cataract combined lens dislocation greater than 2 quadrants` patients having phase I intracapsular cataract extraction and anterior vitrectomy,whose postoperative corrected vision greater than 0.3,and then phase II small incision suture-fixation of intraocular lens suspension.

Safety and effect of femtosecond laser-assisted cataract surgery combined with Cionni capsular tension ring implantation in the management of traumatic lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the safety and effect of femtosecond laser-assisted cataract surgery with Cionni modified capsular tension ring (MCTR) implantation in the management of traumatic lens subluxation.METHODS: Totally 11 patients (11 eyes) with traumatic lens subluxation were divided into three groups according to the severity of lens dislocation, ranging from 90° to 120° (4 eyes), 120° to 180° (5 eyes) and 180° to 270° (2 eyes).The contact LenSx femtosecond laser cataract surgery platform was applied to create the capsulotomy, prepare nuclear fragmentation and make corneal wound creation.Anterior vitrectomy was performed in some patients during the surgery.After capsular retractors insertion and phacoemulsification, the MCTR was inserted to the capsular bag and fixed to the sclera.Finally, the IOL was implanted into the capsular bag.Postoperative visual acuity, intra-and post-operative complications, anterior capsular opening, IOL and MCTR position and intraocular pressure (IOP) were assessed.RESULTS:The duration of follow-up was 2mo.All the operations were completed successfully.Five eyes underwent cataract surgery combined with anterior vitrectomy.Four eyes had been inserted with 2-eyelet MCTR and seven eyes with 1-eyelet MCTR.The best corrected visual acuity (BCVA) after operation was better than 0.5 in 4 eyes, between 0.3 and 0.5 in 3 eyes, between 0.1 and 0.3 in 3 eyes, and less than 0.1 in 1 eye.Compared with preoperative BCVA, the difference was statistically significant (P<0.05).All the IOLs were stably centered and the eyelet of MCTR was fixated steadily between the iris and the anterior capsule.The common intra-and post-operative complications were subconjunctival hemorrhage, incomplete capsulotomy, residual cortex, secondary glaucoma and posterior capsular opacification.CONCLUSION:Femtosecond laser-assisted cataract surgery can improve the success rate of capsulorhexis, and reduce the difficulty of nuclear fragmentation.Femtosecond laser-assisted cataract surgery combined with MCTR implantation is an ideal surgical method for traumatic lens subluxation.

Clinical observation of capsular tension ring implantation in congenital lens subluxation treating by phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical results of capsular tension ring (CTR) implantation in phacoemulsification for eyes with congenital lens subluxation.METHODS: This study comprised 18 patients (31 eyes) with congenital ectopia lentis.All patients received phacoemulsification with CTR and intraocular lens (IOL) implantation.Visual acuity before and after surgery were examined.IOL decentration were measured with Image-Pro Plus image processing software.The complications were also recorded preoperatively and postoperatively.RESULTS: Uncorrected vision of all eyes increased after surgery, and all cases had different degree of IOL decentration after surgery.Two eyes received CTR scleral fixation 3mo after surgery because the IOL decentration aggravated during the follow-up period.CONCLUSION: Phacoemulsification with CTR and IOL implantation is effective and safe for congenital lens subluxation.The implantation of CTR increase the stability of the capsular bag, improve the safety of surgery, and maintain the right position of IOL.CTR scleral fixation is a effective supplement for progressive cases.

Dislocated Posterior Chamber Intraocular Lens (PCIOL) in Patients with Retinitis Pigmentosa (RP)

Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2 with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL) implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation, which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade after the cataract operation.

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.

Corneal characteristics in Marfan syndrome patients of different ages with lens subluxation and their significance / 眼科新进展

Objective To compare the corneal characteristics in Marfan syndrome (MFS) patients of different ages with lens subluxation and explore their clinical significance.Methods Together 84 eyes of 45 MFS patients (MFS group) and 84 eyes of 84 control subjects (control group) were recruited in this study,and the patients in the MFS group were subdivided into two groups by age:5-14 year-old group with 49 eyes and ＞ 14 year-old group with 35 eyes.The biometric characteristics,including corneal curvature (i.e.Km),central corneal thickness,and corneal astigmatism,were measured by Pentacam.Results Compared with the control group,MFS patients had decreased Km and increased corneal astigmatism,approaching significant difference (both P =0.000).There were significant differences in anterior corneal curvature [(40.02 ± 1.42) D vs.(41.03 ± 1.57) D],posterior corneal curvature [(-5.71 ± 0.23) D vs.(-5.89-± 0.31) D],and total corneal astigmatism [(-1.71 ±0.84)D vs.(-1.34 ±0.78)D] between 5-14 year-old group and ＞ 14year-old group (all P ＜ 0.05).The anterior corneal astigmatism was significantly higher in 5-14 year-old group than that in ＞ 14 year-old group(P =0.017),whereas the posterior corneal astigmatism had no significant difference between the two groups (P =0.377).In 5-14 year-old group,the astigmatic type of total cornea and anterior corneal surface was dominated by with-the-rule astigmatism (69.39％),whereas the proportion of with-the-rule and oblique astigmatism was approximately equal ＞ 14year-old group.The astigmatic type of posterior corneal surface in 5-14 year-old group (accounting for 85.71％) and ＞ 14 year-old group (accounting for 77.14％)was dominated by against-the-rule astigmatism.The total corneal astigmatism was overestimated by a mean of 0.32 D when only taking the magnitude of anterior corneal astigmatism into consideration.Conclusion A flattened cornea and increased corneal astigmatism are the corneal characteristics for MFS patients with lens subluxation especially for the children patients.The magnitude of posterior corneal astigmatism remains unchanged and is primarily against-the-rule astigmatism.And the total corneal astigmatism can be easily overestimated if posterior corneal astigmatism is not taken into consideration.

Application of capsular tension ring combined with iris hooks in phacoemulsification of traumatic cataract with lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To evaluate the clinical efficacy and safety of capsular tension ring ( CTR) combined with iris hooks in eyes with large traumatic zonular dialysis or weakness that underwent micro -incision coaxial phacoemulsification with posterior chamber ( PC ) intraocular lens ( lOL) implantation.METHODS: This prospective study was carried on 21 patients ( 21 eyes ) with traumatic cataract and traumaticzonular dialysis (0. 8 in 5 eyes. lOPs were in normal range too. The lOLs in 20 eyes remained the required position to the final follow- up examination except one eye in which the PC lOL was dislocated into vitreous cavity due to a postoperative spontaneity PCR, and in which vitrectomy and lOL suture fixation was performed.CONCLUSlON: ln cases of cataract associated with traumatic zonular dialysis (<180.) , by setting the rational parameters of phacoemulsification, the CTR and iris hooks are found to be efficient in preventing lOL decentration and reducing operation complication. ln our cases, the CTR combined with iris hooks is relatively safe application.

Clinical application of incision cataract extraction after manual fragmentation and emulsification of nucleus for traumatic lenssubluxation and cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the surgical effects of the taumatic lens subluxation and cataract after manual fragmentation and emulsification of nucleus and foldable intraocular lens implantation. METHODS: A 3. 0mm tunnel limbus incision was operated through the predicted bulbar conjunctiva and sclera on 26 cases ( 26 eyes ) with taumatic lens subluxation ( suspensory ligament rupture range less than 120 ) and cataract (Ⅰ ~ Ⅲ) . And after the manual fragmentation and emulsification of nucleus, foldable intraocular lens was implantated. Intraocular lens loop was imbedded in the middle of the lens zonular ligament breakup to reset the pouch. The surgical complications and postoperative vision changes were observed. RESULTS:Three month after operation, 22 eyes had a intraocular lens centric position taking up 85% of the whole. Four eyes had a slightly eccentric position ( 1 ~2mm), taking up 15% of the whole. 21 eyes had their visual acuity 0. 5~0. 8, taking up 81% of the whole. Five eyes of visual acuity was 0. 2~0. 8. Within 24h intraocular pressure of 12 eyes (46%) after operation were elevated, and returned to normal after 2~7d. There was no severe complication during operation and postoperation. CONCLUSION: The manual fragmentation and emulsification of nucleus and foldable intraocular lens implantation of the traumatic lens subluxation and the cataract through the 3. 0mm corneal sclera limbus tunnel incision is a simple and effective surgery.

Modified Capsular Tension Ring Scleral Fixation and Toric Intraocular Lens Implantation in a Patient with Homocystinuria

PURPOSE: Purpose: To report a case of modified capsular tension ring scleral fixation and in-the-bag toric intraocular lens (IOL) implantation in a pediatric patient with severe crystalline lens subluxation due to homocystinuria. CASE SUMMARY: A 9-year-old male diagnosed with homocystinuria and crystalline lens subluxation presented with progressive decrease of visual acuity. Uncorrected distant visual acuity (UDVA) and corrected distant visual acuity were 0.03 and 0.6 in the right eye and 0.01 and 0.5 in the left eye, respectively. Slit-lamp examination showed severe crystalline lens subluxation toward the inferiomedial side in both eyes. Corneal astigmatism in the right eye and left eye was 2.75 diopters (D) and 3.00 D, respectively based on keratometry. A combination of subluxated crystalline lens aspiration, scleral-fixated modified capsular tension ring insertion and in-the-bag toric IOL implantation were performed in both eyes. After continuous curvilinear capsulorhexis, nucleus and cortex of the crystalline lens were removed by irrigation and aspiration. A modified capsular tension ring with 2 fixation hooks (Model 2-L) was inserted into the capsular bag and fixed at the scleral wall. Next, toric IOL was inserted into the capsular bag. UDVA was 0.8 in the right eye and 0.9 in the left eye and 3 months postoperatively, the IOL rotation was less than 3 degrees from intended axis in both eyes. CONCLUSIONS: In a patient with severe congenital crystalline lens subluxation and moderate to severe corneal astigmatism, scleral fixation of modified capsular tension ring and in-the-bag toric IOL implantation is a possible surgical option.