Development of lens surgery in the treatment of primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#The lens plays a crucial part in the etiology of primary angle-closure glaucoma(PACG). The changes in the thickness and position of the lens have been related to common structural deviations observed in PACG eyes such as: shallow anterior chamber, pupillary block and crowded anterior chamber angle. Lens extraction has long been used to treat PACG, which combined with anti-glaucoma surgeries remains a commonly employed therapy. This article aims to summarize the medical outcome and role of phacoemulsification with or without anti-glaucoma surgeries in the treatment of PACG.

Combined endothelial keratoplasty and clear lens extraction for corneal decompensation in irido-corneal endothelial syndrome.

A 38-year-old woman presented with corneal decompensation in left eye secondary to irido-corneal endothelial (ICE) syndrome. She underwent simultaneous Descemet’s stripping endothelial keratoplasty (DSEK) and clear lens extraction with posterior chamber intraocular lens implantation. The surgery was accomplished comfortably without rupture of peripheral anterior synechiae (PAS). 5 weeks postoperatively, the graft was a􀄴 ached, the cornea was clear and best-corrected visual acuity improved from 20/400 to 20/30. DSEK combined with clear lens extraction appears to be an eff ective measure to treat corneal decompensation in patients with ICE syndrome. Associated lens extraction in such cases increases the working space in anterior chamber for DSEK, which minimizes the intra-operative graft manipulation. This also avoids a future diffi cult cataract surgery in the presence of PAS and an endothelial graft, which may increase the chances of graft survival.

Comparative study on two different operations of high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the safety, efficacy and stability of posterior chamber phakic intraocular lens ( ICL ) implanation and clear lens extraction for the correction of high myopia. METHODS: The study enrolled 56 cases ( 100 eyes ) of high myopia. Group I comprised 32 cases ( 58 eyes ) receiving ICL implantation and Group II comprised 24 cases (42 eyes) undergoing clear lens extraction. In this study, we evaluated the two groups of subject's the visual and refractive results, intraocular pressure ( IOP ) , endothelial cell density ( ECD ) , anterior chamber depth ( ACD) , lens transparency, the surgical complications as well as visual adverse symptoms before and after surgery. RESULTS: The postoperative subjects in group I and group II were followed, uncorrected vision acuity ( UCVA)>0. 5 were 69. 0% in group I and 71. 4% in group II after 3mo. UCVA>0. 5 were 72. 4% in group I and 73. 8% in group II after 1a. Predictability of the manifest spherical equivalent refraction within±1. 00D was achieved in 62. 1%of eyes in group I and 57. 1% in group II after 1a. The central vault of the ICL ( distance from posterior surface of ICL to the crystalline lens ) measured with anterior segment optical coherence tomography ( AS-OCT ) was 0. 35-0. 54 (0. 40±0. 16) mm. Twelve point one percent of eyes in group I and 7. 1% of eyes in group II had transient mild increase in IOP. Here were statistically significant differences between preoperative and postoperative ECD (PCONCLUSION: ICL implantation and clear lens extraction are effective, safe and predictable surgical option for the management of high myopia. No severe complications occurred, but its long time effect and safety still need more time to prove.

Clear lens extraction and intraocular lens implantation in a case of microspherophakia with secondary angle closure glaucoma.

Phacoemulsification with implantation of single-piece acrylic foldable intraocular lens (IOL) in a 19-year-old boy with microspherophakia, high myopia and angle closure glaucoma is described. The associated myopia and angle closure glaucoma was severely compromising the quality of life. Post-surgical visual recovery was 20/20 with sustained normal intraocular pressure. Management of such cases at times calls for innovations in current surgical technique.

Clear Lens Extraction for the Correction of Severe High Myopia: Seven-year Follow-up

PURPOSE: To evaluate the postoperative outcomes and complications 7 years after clear lens extraction (CLE) for the correction of high myopia. METHODS: The medical records of 23 eyes of 15 patients who had undergone CLE to correct myopia higher than -12 diopter and who could be followed up for more than 7 years were reviewed. A scleral tunnel incision and continuous curvilinear capsulorhexis were made, followed by phacoemulsification and posterior chamber intraocular lens implantation. Refractive error, visual acuity and postoperative complications were recorded. RESULTS: Mean follow-up was 98.2 (84~118) months. Posterior capsular opacification developed in 12 eyes (52.2%) and neodymium: YAG laser posterior capsulotomy was performed in 7 eyes. Retinal detachment developed in 3 eyes of 2 patients at 6 months, 34 months, and 9 years after CLE. At 7 years after CLE, the spherical equivalent (SE) of 14 (60.9%) of 20 eyes was within +/- 2 diopter of targeted refractive error. Shift to myopia occurred by 1 diopter compared to SE at 1 year after CLE. Best corrected visual acuity improved by 2 lines in 14 eyes (60.9%) and was 0.5 or better in 17 eyes (73.9%). CONCLUSIONS: CLE for correction of high myopia had good visual outcomes with acceptable predictability. However, long term follow-up revealed gradual increase of serious complications like retinal detachment, posterior capsular opacification, and myopic shift by 1 diopter between 1 year and 7 years after CLE.

The Surgical Outcome of Clear Lens Extraction in High Myopia

PURPOSE: The authors evaluated the clinical results, the degree of satisfaction regarding daily activities and the quality of life after clear lens extraction in high myopes. METHODS: Thirty nine eyes of 23 high myopes over minus 10 diopters underwent clear lens extraction and had minimum follow up of 3 months. The preoperative and postoperative refractive status and subjective satisfaction about surgical result were evaluated. The average follow up period was 10.4 months. (range, 3~24 months) RESULTS: Preoperative mean spherical equivalent and mean target refractive error were -17.40+/-4.00D (range, -11.25~-28.25D) and -1.40+/-0.46D (range, -0.3~-2.2D), respectively. Three months postoperatively, mean spherical equivalent was -1.64+/-0.96D (range, +0.5~-3.62 D). Three months postoperatively uncorrected visual acuity was compared with preoperative best spectacle corrected visual acuity. Visual acuity was decreased two lines or more in 4 eyes (10.3%) and in 23 eyes (59.9%) 20/20 was noted or visual acuity increased 2 lines or more. Posterior capsular opacification (PCO) was noted in 12 eyes (30.8 %) and was the most common postoperative complication within 3 months. Three months postoperatively, every patient was asked about their satisfaction of surgery. All except one patient were satisfied with their daily activities after surgery. and all patients except two complained of difficulty in near vision. CONCLUSIONS: The clear lens extraction can improve quality of life in extremely high myopes, but posterior capsular opacity and decreased near visual acuity should be considered in deciding surgery.

The Clinical Results of Clear Lens Extraction with Posterior Chamber Intraocular Lens Implantation for the Correction of High Myopia

We retrospectively studied 26 eyes of 16 patients(male :9 patients, female:7 patients, mean age:39.3 years)who received clear lens extraction by phacoemulsification and low-power posterior chamber intraocular lens implantation. To investigate the effectiveness of clear lens extraction, visual acuity, refractive results, and intraoperative and postoperative complication were analyzed. The mean follow-up was 14.7 months. For reasons of lattice degeneration, retinal tear, or hole, we performed argon laser photocoagulation before clear lens extraction in 84.6% of patients. The IOL power was calculated using the SRK/T formula. Uncorrected visual acuity improved in all cases, with 65.4%of eyes achieving 20/40 or better and 23.1%, 20/25 or better. Corrected visual acuity improved in all cases, the percentage of eyes achieving corrected visual acutiy of 20/40 or better increased from 69.2%preoperatively to 100%postoperatively and the percentage of 20/25 or better, from 3.8%to 80.8%.The mean postoperative spherical equivalent was -15.85D (-10.25 to -23D), 50%of eyes were within 1.0D of the goal diopter and 100%were within 2.0D of the goal diopter.No intraoperative complications occurred.During the follow-up, 42.3% of eyes developed mild posterior capsule opacification and 1 eye(3.8%) received a YAG laser posterior capsulotomy 22 months postoperatively. No retinal tear, retinal detachment, or cystoid macular edema was observed. Clear lens extraction with low-power IOL implantation was effective for the correction of high myopia but additative cases and longer follow-up periods are needed to fully assess the complication.

The Surgical Outcome of Clear Lens Extraction for Correction of Severe High Myopia

The authors performed clear lens extraction on 22 eye to treat severe high myopia more than 12 diopters(D). The changes in spherical equivalent (S. E.), visual acuity improvement, and the complications were evaluated during 6 months postoperatively. A scleral pocket incision and continuous curvilinear capsulorhexis was made and lens extraction was performed via phacoemulsification and low power poserior chamber intraocular lens was implanted. The postoperative refractive error target were form -1.5D to-2.0D. More than 85% of eyes were within +/-1D of targeted refractive error. The posoperative uncorrected visual acuities were increased more than 20/200 in all eyes and 20% of eyes were increased more than 20/40 at postoperative two months. The postoperative corrected visual acuities were increased two or more limes in more than 80% of eyes. Intraoperatively, hyphema in one eye, wound leaking in two eyes and radial tear during contimuous curvilinear capsulorhexis in one eye were developed. Poltoperatively, retinal detachment in two eyes, subretinal neovascularization in one eye and posterior capsular opacification in three eyes were developed. In conclusion, the clear lens extraction was a effective method for correction of severe high myopia but longer follow-up of large number of cases is needed to fully assess the safety.

Long Term Results of Clear Lens Extraction & LASIKLaser in situ Keratomileusis for Correction of High Myopia

This is a retrospective study of two series of eyes that received clear lens extraction[11 eyes] or laser in-situ keratomileusis[LASIK, 15 eyes] for correction of high myopia over -15.0D. The purpose of this study is to compare the 2year clinical results of two procedures. Mean preoperative spherical equivalent was -23.93+/-3.31D in clear lens extraction group and -19.12+/-4.52D in LASIK group. Postoperative uncorrected and best corrected visual acuities were significantly improved in both group[p0.1]. In clear lens extraction group, the change[0 or more than 1 line increased] of the preoperative uncorrected visual acuity versus the preoperative best corrected visual acuity significantly better than that of LASIK group at 1 month and 2 years p=0.020, p=0.036]. Predictability was significantly higher in clear lens extraction group than that of LASIK group[p=0.0024]. At long term follow-up during 2 years, clear lens extraction shows less myopic regression, more refractive correction effect, and much more predictable than LASIK in high myopia over -15.0D, but longer follow-up study is needed to evaluate its clinical effect. When performing refractive surgery in highly myopic patients, the method of operation should be chosen carefully, considering the age and retinal state.

The Surgical Outcome of Clear Lens Extraction for Correction of High Myopia

In order to investigate the clinical results of clear lens extraction for high myopia, the effects of 5.5mm sutureless corneoscleral procedure with low power IOL insertion on 21 patients (31 eyes) who were followed up averagely for 9.43 months were analyzed retrospectively. Prophylactic retinal treatment with argon laser was performed in 23 eyes to prevent retinal detachment. Eighty-seven percent (25/31 eyes) of eyes were within +/-1D of targeted refractive error and all eyes were within +/-2D of targeted refractive error. The postoperative corrected visual acuities were increased in 96.8% (30/31 eyes) and 80.7% (25/31 eyes) among them gained two or more lines. the corrected visual acuity of 20/40 or better were increased from 35.5%(11/31 eyes) preoperatively to 93.6% (29/31 eyes) postoperatively. Posterior capsular opacification was developed in two eyes and YAG laser posterior capsulotomy was performed at 2 and 7 months postoperatively. No retinal break, no cystoid macular edema were developed during the follow up period. In conclusion, the clear lens extraction was effective method for correction of severe high myopia but longer follow-up is needed to evaluate it`s complications.

The Surgical Outcome of Clear Lens Extraction for Correction of Severe High Myopia

The authors performed clear lens extraction to treat severe high myopia more than 12 diopters (D) of 24 eyes. The changes in spherical equivalent (S.E). visual acuity improvement, and the complications were evaluated during the average 15 months follow-up period. A scleral pocket incision and continuous curvilinear capsulohexis was made and lens extraction was performed via phacoeomulsification and low power posterior chamber intraocular lens was implanted. The postoperative refractive error targets were -1.0 D in 16 eyes. and -3.0 D in 8 eyes. Sixty-two percent(15/24 eyes) of eyes were within +/-1 D of targeted refractive error and 91.7%(22/24 eyes) of eyes were within +/-2 D of targeted refractive error. The postoperative uncorrected visual acuities were increased in all cases and 95.8%(23/24 eyes) of eyes gained two or more lines. There were increase in uncorrected visual acuity achieving 20/200 or more from 0% to 95.8%(23/24 eyes) postoperatively. The postoperative corrected visual acuities were increased in 83.3%(20/24 eyes) and 75%(15/20 eyes) among them gained two or more lines. The corrected visual acuity of 20/40 or better were increased from 41.7%(10/24 eyes) preoperatively to 79.2%(19/24 eyes) postoperatively. Posterior capsular opacification was developed in one eye and YAG laser posterior capsulotomy was performed at 4 months postoperatively. No retinal break, no retinal detach ment, no cystoid macular edema were developed during the follow-up period. In conclusion, the clear lens extraction was effective method for correction of severe high myopia but longer follow-up of large number of cases is needed to fully assess the complications.

Clear Lens Extraction for the Correction of High Myopia

Clear lens extraction and implantation of posterior chamber intraocular lens was performed on 12 eyes(7 patients) to correct high myopia. Average preoperative refractive error(spherical equivalent) was -19.08D with a range of -13.00D to -31.00D. 7 eyes(58.3%) achieved 0.5 or better uncorrected postoperative visual acuity and all eyes achieved 0.5 or better corrected visual acuity. In postoperative refractive errors, 4 eyes(33.3%) were 1.0D of emmetropia and 8 eyes(66.6%) were within 2.0D. In conclusion, clear lens extraction and posterior chamber intraocular lens implantation is a more favorable technique for correcting high myopia, but further study for complications such as retinal detachment, cystoid macular edema, and posterior capsular opacity and for precise results is needed.