Lens Subluxation Following Trivial Trauma

Trauma is the main cause of subluxation or dislocation of the lens followed by ocular surgery and spontaneous dislocation due to hypermature cataract. Other causes are Marfan’s, Homocystinuria, Ehler Danlos syndrome and pseudoexfoliation. We report a case of dislocated lens by a trivial trauma with a wooden stick which was left unattended unless patient noticed decreased vision in that eye.

A randomized crossover study of elbow-forearm support and traditional shoulder sling in the treatment of shoulder subluxation after stroke / 中华物理医学与康复杂志

Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.

Assessment of the level of satisfaction of patients submitted to latarjet surgery under outfit system compared to hospital system / Avaliação do grau de satisfação do paciente submetido à cirurgia de latarjet em regime ambulatorial em comparação com o regime hospitalar

ABSTRACT Anterior shoulder instability causes functional changes that affect patients' quality of life. The Latarjet procedure is one of the most frequently performed surgeries for cases of recurrent shoulder instability. Objective: To assess the level of satisfaction of patients who underwent the Latarjet procedure in outpatient settings (day hospital) compared with inpatient settings. Methods: A questionnaire was administered to both groups and a descriptive analysis of the results was performed. Results: 51 patients were included, with a mean age of 29.9 years, 82.3% men and 17.6% women. Of the patients who underwent surgery in the day hospital, 46.1% were operated within 100 days of their first outpatient visit; among those in the inpatient group, 76.3% underwent surgery more than 200 days later. Delays occurred in 15.3% of cases in the day hospital compared with 68.4% in the inpatient group. Of the patients in the day hospital, 92.3% felt comfortable contacting the medical team in case of complications and would perform the procedure again in the same setting. Moreover, 63.2% of inpatients would have preferred to have been discharged on the same day. The final satisfaction rate for both groups was 100%. Conclusion: Outpatient surgery guarantees more patient comfort, safety, and can be performed in a timely manner and with fewer delays, which has influenced patients' decision to have surgery during the COVID-19 pandemic. Level of Evidence V, Cross-sectional Study.

RESUMO A instabilidade anterior do ombro acarreta alterações funcionais que impactam a qualidade de vida do paciente. A cirurgia de Latarjet é um dos procedimentos mais executados para casos de instabilidade recorrente de ombro. Objetivo: Comparar o grau de satisfação dos pacientes submetidos ao procedimento de Latarjet no regime ambulatorial (hospital dia) com o dos operados no regime hospitalar. Métodos: Um questionário foi aplicado em ambos os grupos e uma análise descritiva dos resultados foi realizada. Resultados: Foram incluídos 51 pacientes, com idade média de 29,9 anos, sendo 82,3% homens e 17,6% mulheres. Dos submetidos à cirurgia no hospital dia, 46,1% operaram em até 100 dias depois do primeiro atendimento ambulatorial; já entre os do grupo hospitalar, 76,3% operaram mais de 200 dias depois. O atraso na cirurgia ocorreu com 15,3% dos pacientes do hospital dia contra 68,4% do grupo hospitalar. Do hospital dia, 92,3% pacientes sentiram-se confortáveis em contatar a equipe médica em caso de intercorrências e fariam novamente o procedimento de forma ambulatorial. Além disso, 63,2% dos internados gostariam de ter recebido alta no mesmo dia. O grau de satisfação final em ambos os grupos foi de 100%. Conclusão: A cirurgia ambulatorial garante mais conforto para o paciente, mostrando-se segura e podendo ser performada em tempo hábil e com menos atrasos, o que influenciou a decisão dos pacientes em operar durante a pandemia de COVID-19. Nível de Evidência V, Estudo Transversal.

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.

Retropupillary iris claw lens versus Gore-Tex assisted scleral fixated intraocular lens in children with large lens subluxations

Purpose: To compare the functional outcome of retropupillary iris claw lenses (RPIC?IOL) and scleral fixated intraocular lenses (SFIOL) in children with large lens subluxations. Methods: Sixty eyes of patients between 6 and 18 years of age having ?7 clock hour lens subluxation were included and equally divided into group A (RPIC?IOL implantation) and group B (Gore?Tex sutured SFIOL implantation). Cases with anterior and posterior segment abnormalities, trauma and glaucoma were excluded. Primary outcome was improvement in best?corrected visual acuity (BCVA) at 1.5 years. Secondary outcomes were assessment of intraocular lens (IOL) tilt, mean change in astigmatism at 1.5 years, and median operating time. All surgeries were performed by the same surgeon. Results: The mean improvement in BCVA in group A was 0.28 ± 0.41 logMAR and group B was 0.44 ± 0.45 logMAR (P = 0.3). Significant IOL tilt was seen in 4 eyes in group A (13.33%) and 5 eyes in group B (16.66%) (P = 0.120). Mean change in astigmatism was 4.38 ± 5.9D in group A and 4.91 ± 4.4D in group B (P = 0.299). The median operating time was 40 min in group A and 90 min in group B (P < 0.001). No significant posterior segment complications were seen in either technique. Conclusion: Both procedures had comparable visual outcomes. RPIC?IOL implantation was relatively quick and comparatively easier; it may be preferred in cases with high risk of retinal detachment.

Analysis of Kawasaki disease complicated with atlantoaxial rotatory subluxation / 中华实用儿科临床杂志

Objective:To investigate the clinical characteristics of children with Kawasaki disease (KD) complicated with atlantoaxial rotatory subluxation (AARS).Methods:Clinical characteristics of 60 AARS patients complicated with KD (the atlantoaxial rotatory subluxation group) and 60 patients with KD only diagnosed (the control group)in the Children′s Hospital of Chongqing Medical University from December 2010 to December 2019 were retrospectively analyzed.Differences between groups were compared by the Chi- square test and the t test. Results:A total of 8 365 KD patients were diagnosed during the study period, involving 60 cases (0.72%) complicated with AARS.which usually occurred in the acute phase with the onset ages of 3 to 6 years ( P<0.001). Initial clinical symptoms of KD complicated with AARS included fever with restricted neck movement (100.00%), neck mass (66.67%), torticollis (21.67%) and neck pain (11.67%). CT or X-ray exa-mination of the neck indicated AARS, with thickening and swelling of the cervical soft tissues in some cases.Compared with those of control group, red, dry, cracked lips ( P=0.01) and cervical lymph node swollen ( P<0.001) were significantly pronounced in KD patients complicated with AARS.The absolute and relative count of neutrophils were significantly higher in KD patients complicated with AARS (all P< 0.05). Cervical soft tissue swelling and thickening in B-ultrasound were more obvious than those in the control group( P<0.05). However, there were no significant differences in coronary artery lesions and the response to intravenous immunoglobulin (IVIG) combined with Aspirin between groups ( P>0.05). Head traction could relieve neck symptoms to a certain extent, but there was no significant difference between groups ( P>0.05). Conclusions:Cervical lymphadenopathy, red, dry, cracked lips, increase of absolute and relative count of neutrophils, and swelling and thicke-ning of cervical soft tissues were the high-risk factors of KD complicated with AARS.The complication of AARS in KD patients did not increase the risk of coronary artery injury and IVIG resistance.IVIG combined with aspirin achieved a good prognosis in the majority of KD patients complicated with AARS.

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.

Symptomatic Unilateral Triceps Medial Head Snapping and Subluxating Ulnar Nerve without Neuropathy after Push-Ups: A Case Report

@#The coexistence of ulnar nerve subluxation and snapping medial head triceps is an uncommon occurrence. There have been few studies and case reports since it was first described in 1970. In this article, we present a case in which the condition occurred after a push-up. We analysed the pathoanatomy of the condition, and reviewed the literature regarding potential causes, typical presentations of the coexistence of both ulnar nerve subluxation and medial snapping triceps and describe our surgical technique in treatment. Elbow pain is very often under evaluated as many physicians may not be aware that elbow pain could be attributed to the coexistence of both ulnar nerve subluxation and medial snapping triceps. A thorough evaluation with physical examination and imaging are recommended. Early surgery with an appropriate rehabilitation programme may hasten recovery and return to sports in patients who continue to remain symptomatic following a trial of conservative therapy.

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&#x003C;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&#x003C;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.

Subluxación sacroilíaca en un equino criollo colombiano / Sacroiliac subluxation in a horse in Colombia

Resumen La subluxación sacroilíaca es una enfermedad claudiocógena de los miembros posteriores que se puede presentar de forma aguda o crónica. La causa de esta patología se debe principalmente a resbalones, tropezones o caídas de los miembros posteriores, el diagnóstico es difícil de realizar debido a la profunda ubicación anatómica de la articulación, métodos como la ecografía y pruebas de estrés entre otros, son los procedimientos más usados en el diagnóstico de la subluxación sacroiliaca. Por tratarse de una alteración que fácilmente puede confundirse con otras condiciones patológicas de la columna, la pelvis y/o de los miembros posteriores, el diagnóstico muchas veces se realiza por eliminación de otras causas de cojera. Los tratamientos convencionales aún se proponen en la literatura, sin embargo, cada vez como opción para el tratamiento de esta patología. El presente reporte describe el caso de un equino criollo que padeció una subluxación sacroiliaca aguda del lado derecho, la cual fue diagnosticada con un examen clínico que incluía ecografía percutánea y transrectal, y tratada con infiltraciones ecoguiadas de corticoides y aspirado de médula ósea. Un mes después de la última terapia, el caballo mostró una mejoría clínica en un 80% a 90% aproximadamente y retoma actividad física controlada.

Abstract Sacroiliac subluxation is a claudiogenic disease of the hind limbs that can present acutely or chronically. The cause of this pathology is mainly due to slipping, tripping, or falling of the hind limbs, the diagnosis is difficult to make due to the deep anatomical location of the joint, methods such as ultrasound and stress tests among others, are the procedures most used in the diagnosis of sacroiliac subluxation. As it is an alteration that can easily be confused with other pathological conditions of the spine, pelvis and / or the hind limbs, the diagnosis is often made by eliminating other causes of lameness. Conventional treatments are still proposed in the literature, however regenerative therapy is increasingly used as an option for the treatment of sacroiliac joint injuries. This report describes the case of a Creole horse that suffered an acute sacroiliac subluxation on the right side, which was diagnosed with a clinical examination that included percutaneous and transrectal ultrasound and treated with ultrasound-guided infiltrations of corticosteroids and cells of the bone marrow of the sternum without processing. One month after the last therapy, the horse showed an 80% to 90% recovery and resumed controlled physical activity.

Traumatic Atlantoaxial Rotatory Subluxation in Adult: Case Report

Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits.We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommontraumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Inestabilidad de hombro en adolescentes: Indicaciones para cirugía. Reporte de caso y estado del arte / Shoulder instability in adolescents: Indications for surgery. Case report

La inestabilidad de hombro es una condición frecuente en personas involucradas en actividades deportivas de alta demanda física. Debido a sus particularidades anatómicas, los adolescentes presentan mayor riesgo de recidiva luego de un primer episodio de luxación de hombro. El sexo masculino, edad y participación en actividades deportivas de alto impacto son los principales factores de riesgo para recurrencia. En esta publicación, reportamos el caso de una adolescente porrista con inestabilidad anterior de hombro con evolución favorable luego de estabilización abierta complementado por una revisión del estado del arte de las aproximaciones terapéuticas de la inestabilidad recurrente de hombro en adolescentes.

Shoulder instability is a frequent condition in people involved in sport activities of high-physical demand. Due to their anatomical features, adolescents are at greater risk of recurrence after a first episode of shoulder dislocation. Male gender, age and participation in high-impact sport activities are the main risk factors for recurrence. We report the case of a cheerleader teenager with anterior shoulder instability with favorable evolution after open stabilization complemented by a review of the state of the art of the therapeutic approaches of recurrent shoulder instability in adolescents.

Discussing tuina for atlantoaxial subluxation in adults based on the theory of 'tendon-bone balance' / 针灸推拿医学（英文版）

According to Chinese medicine, the atlantoaxial joint is a composite joint composed of tendons and bones, and the stability of the joint depends on the 'tendon-bone balance' involving tendons, ligaments, atlas and axis. Multiple causes of 'tendon off-position, joint subluxation' will lead to joint 'tendon-bone imbalance', which will evolve into atlantoaxial subluxation (AAS), endangering human health. Chinese therapeutic massage (tuina) is a very effective treatment for AAS in adults, but conventional manipulations are prone to ineffectiveness or accidents due to neglect of the causal relationship of the 'tendon-bone imbalance' and inappropriate manipulations. Compared with conventional manipulations, the rational choice of modified manipulations under the guidance of 'tendon-bone balance' theory is more effective and less risky, and more worthy of clinical promotion. From the 'tendon-bone balance' theory, we considered the shortcomings of conventional manipulations, and introduced several modified manipulations that have their own strengths in 'tendon smoothing' and 'bone setting', in order to provide new ideas for treatment of AAS in adults.

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.

Secuelas de Trauma Ocular Contuso, en paciente económicamente activo / Sequelae of blunt eye trauma, in an economically active patient

El trauma ocular es una causa frecuente de consulta en los servicios de oftalmología, es más frecuente en el género masculino. Dependiendo de la gravedad del daño ocasionado, el tratamiento representa un reto para el oftalmólogo, porque, se enfrenta ante un daño patológico integral y complejo. El presente caso corresponde a un paciente masculino con baja de agudeza visual importante en ojo derecho, con antecedente de trauma ocular contuso, ocasionado con una piedra, en su ambiente laboral, que acude dos meses posterior al trauma ocular. Al examen presenta secuelas del trauma ocular contuso, fibrosis capsular anterior, catarata traumática, subluxación de cristalino, etc. El pronóstico visual tras un procedimiento quirúrgico es bueno, sin embargo, el paciente rechaza la cirugía. Por lo tanto, es muy importante el uso de lentes de trabajo que puede prevenir accidentes laborales.

The ocular trauma is a frequent cause of consultation in ophthalmology services, it is more frequent in males. Depending on the severity of the damage caused, the treatment represents a challenge for the ophthalmologist, because, he faces an integral and complex pathological damage. The present case corresponds to a male patient with low visual acuity in the right eye, with a history of blunt eye trauma, caused by a stone, in his work environment, who came two months after the eye trauma. On examination, he presented sequels of blunt ocular trauma, anterior capsular fibrosis, traumatic cataract, lens subluxation, etc. The visual prognosis after a surgical procedure is good, however, the patient rejects the surgery. Therefore, it is very important to wear work glasses that can prevent workplace accidents.

Peripheral iridectomy for preventing iris-related complications in glued intraocular lens surgery in children

Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ? 20/200) and post BCVA was 0.40 (±0.50) (Snellen ? 20/50). The mean preoperative refraction was ? 9 D (±8D) (range: ?5 D to ?23D) and postoperative was ?1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.

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.

Traction for the treatment of traumatic atlantoaxial subluxation in adults / 中国骨伤

OBJECTIVE@#To observe the application of modified traction therapy in traumatic atlantoaxial subluxation in adults.@*METHODS@#The clinical data of 31 patients with atlantoaxial subluxation treated from March 2018 to June 2019 were restropectively analyzed. There were 15 males and 16 females, aged from 18 to 68 years old with an average of 39 years old, including 10 cases of 18-40 years, 15 cases of 41-60 years, 6 cases of 51-68 years. The main manifestations of the patients were limited neck movement, pain, and atlantoaxial CT scan showed different degrees of atlantoaxial subluxation. Three dimensional multifunctional traction bed was used for traction for 2 min, relaxation for 10 s. The traction angle starts from the rearward extension of 5°-10° and weight from 3-6 kg. The weight increased by 1 kg every two days until the symptoms were improved. Traction time was 30 min twice a day and 10 days for a course of treatment. One course of treatment was performed in patients with 1-2 mm left and right equal width of atlantoaxial space, and two courses of treatment were performed in patients with 3-4 mm left and right equal width of atlantoaxial space, and the course of treatment could be increased to 3 months in especially patients with serious problems, such as 4 mm left and right equal width of atlantoaxial space and no improvement after conventional treatment. The criteria to evaluate the clinical effect was cure:no pain in the neck, normal range of neck movement, CT showed normal atlantoaxial space and odontoid process was in the middle, patients with normal neck movement were followed up 1 month after the end of treatment;improvement:neck pain was significantly improved and CT showed that the left and right atlantoaxial space was less than 1 mm in equal width.@*RESULTS@#Among the 31 patients, 17 cases were cured by one course of treatment, 11 cases were cured by 2 courses of treatment, and 2 caseswere improved.@*CONCLUSION@#The modified traction therapy has obvious effect on adult traumatic atlantoaxial subluxation, especially the subluxation of 3-4 mm equal width in left and right atlantoaxial space, and this method is safe and reliable with good efficacy and the patients without discomfort.