Outcomes of the sutureless-intrascleral fixation of posterior chamber intraocular lens implantation using modified Yamane's technique / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the post-operative outcomes, safety and complications of the sutureless-intrascleral fixation of posterior chamber intraocular lens(SF-PCIOL)by using the modified Yamane's technique.<p>METHODS:This study involved 5 patients who underwent SF-PCIOL with the modified Yamane's technique, from December 2017 to September 2018. The longest follow-up time was 12mo, and the primary outcomes included uncorrected visual acuity(UCVA, LogAMR)and bestcorrected visual acuity(BCVA, LogMAR), intraocular pressure and the location and stability of IOLs.<p>RESULTS: The BCVA of 3 patients were ranged from 0.0 to 0.1 by the time of following up 12mo postoperatively. The difference between the spherical equivalent refraction and the predicted spherical equivalent refraction was in a range of 0.11-0.62 diopters. In the other two cases, at 3mo after the surgery, the UCVA was 0.2 for one case, and the BCVA was the same as preoperative corrected visual acuity for another case, where the patient manifested corneal leucoma and macular edema prior to surgery. During the follow-up period, the flanges and the IOL haptics of all the recruited patients were maintained in an ideal position, the optics were located in center of the pupils, and no visible IOL decentration or tilt was observed. Neither hypotony nor other complications were discovered in all the cases.<p>CONCLUSION: For SF-PCIOL by using modified Yamane's technique, smaller incisions and shorter operation time are feasible, and the need for scleral flaps, sutures and fibrin glue is eliminated. The IOLs are well centered and fixed securely. A learning curve is necessary to master this surgery technique. As revealed by our initial observation, the surgery is capable of producing satisfactory and consistent postoperative outcomes for patients with fewer postoperative complications as long as the crucial points are fully understood.

Long-term outcomes of cataract surgery in children with uveitis

Purpose: To evaluate the long-term outcomes of cataract surgery in children with uveitis. Methods: Retrospective, noncomparative review of medical records of children (?16 years) with uveitic cataract who had undergone cataract surgery between January 2001 and December 2014 at a tertiary care center was done. The main outcome measures were visual acuity and postoperative complications. Results: We recruited 37 children (58 eyes) who were diagnosed with uveitic cataract and underwent cataract surgery. The etiology of uveitis included juvenile idiopathic arthritis (n = 19), presumed intraocular tuberculosis (n = 8), idiopathic (n = 4), Behçet's disease (n = 2), Vogt–Koyanagi–Harada syndrome (n = 2), human leukocyte antigen B-27 associated uveitis (n = 1), and toxocariasis (n = 1). Phacoemulsification with intraocular lens (IOL) implantation was performed in 17 patients (27 eyes; 46.55%), while 20 patients (31 eyes; 53.44%) were left aphakic after pars plan lensectomy and vitrectomy. At an average follow-up of 3.69 ± 7.2 (SD) years, all cases had significant improvement in corrected distance visual acuity post cataract extraction; visual acuity of 20/40 or more was achieved in 32 eyes (55.17%). The most common complication was capsular opacification (37.93%). Incidence of secondary procedures as well as glaucoma was not statistically different in patients undergoing IOL implantation from those who were aphakic. Conclusion: Even though number of secondary procedures was more in pseudophakic group, meticulous choice of surgical technique and adequate immunosuppression lead to a modest gain of visual acuity in children undergoing IOL implantation in uveitis. However, scrupulous case selection and aggressive control of pre- and postoperative intraocular inflammation are the key factors in the postoperative success of these patients.

Novel technique of sutureless glueless scleral fixated intraocular lens (SFIOL)

Purpose: To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia. Methods: In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant. Results: Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability. Conclusion: We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Medium and long term observation of ICL V4c implantation for correction of high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy and safety of central hole phakic posterior chamber intraocular lens(ICL V4c)implantation for correction high myopia.<p>METHODS: Fifty-eight high myopia patients(116 eyes)who underwent the ICL V4c implantation in our hospital from January 2016 to June 2017 were observed 1wk, 1mo and 1a after operation respectively. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), equivalent spherical mirrors(SE), intraocular pressure(IOP), corneal endothelial cell count, ICL-vault, adverse reaction and complication were investigated.<p>RESULTS: Postoperative UCVA and BCVA were significantly higher than that in preoperative group(<i>P</i><0.01). Significant differences were found between postoperative groups except between 1mo and 1a(<i>P</i>>0.05). Postoperative SE at all time points were lower than that in preoperative group(<i>P</i><0.01). SE at 1mo and 1a after operation were close to 0 diopter. The safety index in 1a postoperative was 1.33±0.67 and the effective index was 1.32±0.69. No significant differences were found in IOP and endothelial cell density after surgery comparing to that in preoperative group(<i>P</i>>0.05). None of subjects developed cataract, glaucoma and decompensation of corneal endothelium. The degree of postoperative satisfaction was 100%.<p>CONCLUSION: ICL V4c implantation is a safe and effective method for correction of high myopia. The visual acuity stabilized 1mo after operation.

Comparison of early visual quality between PPCIOL implantation and femtosecond laser LASIK / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the effects of posterior chamber intraocular lens implantation(PPCIOL)and femtosecond laser LASIK in the treatment of high myopia on postoperative visual quality.<p>METHODS: Randomly selected 83 patients with 168 eyes with high myopia from 2015-06/2017-06 in our hospital, they were divided into two groups according to the treatment. Group A was treated with PPCIOL, and group B was treated with femtosecond laser LASIK. The efficacy index, safety index, visual acuity and diopter, high-order aberration changes, contrast sensitivity values, and complications in both group were compared.<p>RESULTS: There was no significant difference in the efficacy index between the two groups(<i>P</i>>0.05), and the safety index of group A was higher than that of group B(<i>P</i><0.05). The number of patients with UCVA and BCVA greater ≥1.0 after surgery in both groups were increased, while the diopter decreased, and the difference between the two groups was not statistically significant(<i>P</i>>0.05). Compared with preoperative, there was no significant difference in the contrast sensitivity between the visual acuity, scotopic glare and glare in group A(<i>P</i>>0.05). Compared with group A, the visual sensitivity, glare-free glare and glare contrast sensitivity values of group B decreased, and the differences between groups and groups were statistically significant(<i>P</i><0.05). There was no significant difference in the incidence of complications between the two groups(<i>P</i>>0.05).<p>CONCLUSION: PPCIOL and femtosecond laser LASIK can effectively correct the vision of patients with high myopia, but PPCIOL has less influence on high-order aberrations and contrast sensitivity, and has more advantages in postoperative visual quality.

Central aperture posterior chamber intraocular lens implantation for moderate and low myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy and safety of central hole phakic posterior chamber intraocular lens(ICL V4c)implantation for correction low to moderate myopia.<p>METHODS: Twenty low to moderate myopia patients(forty eyes)who underwent the ICL V4c implantation in our hospital from January 2016 to June 2017 were observed 1wk, 1mo and 1a after operation respectively. Uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), equivalent spherical mirrors(SE), intraocular pressure, corneal endothelial cell count, ICL-vault, adverse reaction and complication were investigated.<p>RESULTS: Postoperative UCVA and BCVA were significantly higher than that in preoperative group(<i>P</i><0.01). Significant difference was found in UCVA between postoperative groups except between 1mo and 1a. No significant difference were found in BCVA among postoperative groups(<i>P</i><0.05). Postoperative SE at all time points were lower than that in preoperative group(<i>P</i><0.01). Average SE after 1wk after operation were close to 0 diopter. The safety index in 1a postoperative were 1.05±0.14 and the effective index was 1.07±0.14. No significant difference was found in intraocular pressure and endothelial cell density after surgery comparing to that in preoperative group(<i>P</i>>0.05). None of subjects developed cataract, glaucoma and decompensation of corneal endothelium. The degree of postoperative satisfaction was 100%.<p>CONCLUSION: ICL V4c implantation is a safe and effective method for the correction of low to moderate myopia. The visual acuity stabilized 1mo after operation.

Topiramate-induced acute angle closure with severe panuveitis: A challenging case report

A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery.

Swivel haptics anterior capsule-fixated intraocular lens

The purpose of the study is to report the feasibility of implantation of a new design of anterior capsule-fixated intraocular lens (IOL). The new IOL design is a foldable, hydrophilic, open-loop posterior chamber IOL with two extra polymethyl methacrylate swivel haptics created on the optic surface to capture the anterior capsulotomy after the IOL is implanted in the bag. In the pilot phase, the new IOL was implanted in 10 eyes of 10 patients of which 8 eyes underwent phacoemulsification and 2 eyes had laser cataract surgery. The mean spherical equivalent changed from *1.75 D to ?0.75 D at 6 months. Postoperatively, from 1 week to 6 months, all eyes showed stable refraction and anterior chamber depth with no evidence of decentration. Subjective questionnaire revealed high patient satisfaction with no complaints of dysphotopsia. No intra- or postoperative complications such as swivel haptic breakage, iris chafing, pigment dispersion, postoperative uveitis, or endophthalmitis occurred in any of the eyes necessitating explantation of the IOL. The new IOL design was feasible to implant and provided satisfactory outcomes in terms of no dysphotopsias and stable effective lens position.

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

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

Therapeutic effect of a new posterior chamber intraocular lens implantation for high myopia with low astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To observe the efficacy and safety of a new posterior chamber intraocular lens ( ICMO V4c ) implantation in patients with high myopia and low astigmatism and to provide reference for the clinical diagnosis and treatment of these patients. ·METHODS: The study was to analyze the clinical data of patients with high myopia who underwent ICMO V4c implantation with low degree of astigmatism in our hospital from January 2015 to December 2016. The patients were followed up for 1, 3 and 6mo after operation. The items we analyzed including preoperative and postoperative uncorrected visual acuity ( UCVA) and best corrected visual acuity ( BCVA), diopter, spherical and cylinder equivalent, and manifest refraction spherical equivalent ( MRSE ), intraocular pressure ( IOP ), endothelial cell counting, anterior chamber depth (ACD), arch height and postoperative complications. ·RESULTS: Postoperative UCVA and BCVA improved compared with preoperative, and the difference between preoperative and postoperative was statistically significant (P<0. 05). All spherical and cylinder equivalent, and MRSE were reduced after surgery ( t = 38. 510, 20. 100, 34. 300; P<0. 01). The mean intraocular pressure increased at 1 and 3mo after operation ( t= 3. 998, 2. 837, all P<0. 05), but it returned to normal at 6mo ( t=0. 383, P>0. 05). The corneal endothelium counts in the patients at 3mo and 6mo after surgery were lower than those before surgery (t= 2. 119, 2. 411; all P<0. 05). The depth of anterior chamber was reduced to a certain extent within 6mo after operation, and recovered after surgery at 6mo after surgery, but it was still lower than the preoperative level (t=5. 850, 5. 260, 2. 556; all P<0. 05). The overall level of ocular arch after operation was stable and no significant fluctuations were observed. The incidence of postoperative complications in the surgical eye was low and significantly improved after active treatment. ·CONCLUSION: The new posterior chamber intraocular lens implantation in the treatment of high myopia with low astigmatism reaches satisfaction with less complications, is a good supplement to corneal refractive surgery.

Correction effect of phakic posterior chamber implantable contact lens implantation on high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To analyze the clinical efficacy of phakic posterior chamber implantable contact lens (ICL) implantation on high myopia patients. · METHODS: Thirty - four patients (68 eyes) who checked and diagnosed as high myopia in our hospital from June 2014 to June 2015 were selected as the clinical research subjects,and all the patients were given phakic posterior chamber intraocular lens implantation treatment. The diopter, visual acuity recovery, central anterior chamber depth, corneal endothelial cell count, and intraocular pressure after treatment were observed. ·RESULTS: The equivalent spherical refraction, central anterior chamber depth, uncorrected visual acuity and best corrected visual acuity recovery at 1, 3 and 6mo, 1 and 2a after treatment were better than those before treatment, and the differences were statistically significant (P < 0. 05). There were no significant differences in corneal endothelial cell count and intraocular pressure at 1, 3 and 6mo, 1 and 2a after treatment compared with those before treatment (P>0.05). There were no significant differences in uncorrected visual acuity, best corrected visual acuity, equivalent spherical refraction and central anterior chamber depth at 1, 3mo and 1 and 2a after treatment (P>0.05).·CONCLUSION: The application of phakic posterior chamber intraocular lens implantation for the treatment of high myopia patients can improve the equivalent spherical refraction and central anterior chamber depth, improve uncorrected visual acuity, meanwhile, it has less effect on the patient's intraocular pressure and corneal endometrial cells, the effect maintenance and safety is better which meet their expectations.

Correcting effect and visual quality after LASlK and lCL implantation in high myopia patients / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To study correcting effect and visual quality after laser - assisted in situ keratomileusis ( LASIK ) with femtosecond and posterior chamber intraocular lens ( ICL) implantation in high myopia patients.?METHODS: Fifty-five patients ( 106 eyes ) with high myopia from February 2012 to February 2015 in our hospital were analyzed. According to the different operation, patients were divided into the observation group( using ICL implantation, 27 cases with 53 eyes) and the control group (using LASIK, 28 cases with 53 eyes). Postoperative follow-up was 1a, to observe and analyze the visual quality, higher order aberration and complications of two groups.?RESULTS: Uncorrected visual acuity ( UCVA ) , the best corrected visual acuity ( BCVA ) , effectiveness index and security index at 1a postoperatively of observation group, were 1. 04±0. 86(LogMAR), 0. 97±0. 19(LogMAR), 104. 69± 18. 56, 108. 79 ± 17. 68, significantly higher than those of control group 0. 78 ± 0. 11 ( LogMAR ), 1. 04 ± 0. 09 (LogMAR), 93.78±15. 65, 100. 71±11. 68 (P 0. 05 ). No severe complications were observed in both groups.?CONCLUSION: LASIK with femtosecond and ICL lens implantation can effectively improve the patient’s visual quality, but for patients with high myopia, ICL lens implantation effect is more significant, the safety index of ICL implantation, as well as the effectiveness index and the visual quality are better than those of LASIK.

Transscleral fixation of closed loop haptic acrylic posterior chamber intraocular lens in aphakic nonvitrectomized eyes.

Purpose: To evaluate the outcome of transscleral fixation of closed loop haptic acrylic posterior chamber intraocular lens (PCIOL) in aphakia in nonvitrectomized eyes. Materials and Methods: Patients with postcataract surgery aphakia, trauma with posterior capsule injury, subluxated crystalline lens, and per operative complications where sulcus implantation was not possible were included over a 1‑year period. Scleral fixation of acrylic hydrophilic PCIOL was performed according to the described technique, and the patients were evaluated on the day 1, 3, 14, and at 3 and 12 months postoperatively for IOL centration, pseudophakodonesis, change in best‑corrected visual acuity (BCVA), and any other complications. Results: Out of twenty‑nine eyes of 24 patients, who completed the study, 25 (86.2%) eyes had improved, 2 (6.9%) eyes showed no change, and 2 (6.9%) eyes had worsening of BCVA. Three (10.3%) eyes developed postoperative complications. A significant improvement in mean BCVA (P < 0.0001) was observed after the procedure. Mean duration of follow‑up was 26.2 months (range 22–35 months). Conclusion: The use of closed loop haptic acrylic IOL for scleral fixation appears to be safe and effective alternative to conventional scleral fixated polymethyl methacrylate intraocular lenses.

Spontaneous fracture of an implanted posterior chamber polyimide intraocular lens haptic: A case report.

A 57-year-old male patient visited our clinic for decreased visual acuity in the right eye for 10 days. He denied any trauma history, but recalled that the symptom developed after straining. He had undergone uncomplicated phacoemulsification and posterior chamber intraocular lens (IOL) implantation in the bag of the right eye 11 years ago. The IOL was a three-piece silicone polyimide-haptics design. On slit-lamp examination, the IOL optic and proximal part of nasal fractured haptic were found in the anterior chamber. The distal part of fractured haptic was observed in the capsular bag. He underwent IOL exchange. The fracture site of the haptic was near the optic–haptic junction. This is the unique case report of a spontaneous fracture of an implanted posterior chamber polyimide IOL haptic, which implies the possibility of IOL haptic fracture in various haptic materials.

Comparison of tilt and decentration of two aspheric intraocular lens by ultrasonic biomicroscope / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To compare the differences of tilt and decentration of two aspheric posterior chamber intraocular lens ( PC-lOL) implantation by ultrasonic biomicroscope ( UBM) .METHODS:Thirty-seven patients ( 45 eyes ) underwent cataract surgery were distributed to two groups randomly. Group A was implanted with Akreos AO ( Bausch &Lomb; four-haptic ) while group B implanted with ZCB00 ( Abbott Medical Optics, lnc. AMO; two-haptic) . All eyes underwent standard phacoemulsification with intraocular lens implantation. Diameter of capsulotomy was recorded. One month postoperatively, vision, best-corrected visual acuity ( BCVA) assessment, slit lamp examination, and anterior chamber depth ( ACD ) measured by UBM were performed. Tilt and decentration were measured horizontally and vertically, and total tilt and decentration were calculated by geometry method. RESULTS:No statistical difference was found in BCVA and diameter of capsulotomy between two groups ( P>0. 05). The mean ACD of group A and group B were 3. 86mm ± 0. 31mm and 4. 14mm ± 0. 31mm respectively, which showed it had statistically significant difference ( P0. 05).CONCLUSlON:Two-haptic lOL shows no difference in tilt and decentration with four-haptic lOL postoperatively.

Clinical Results of Secondary Intraocular Lens Implantation in Bilateral Congenital Cataract

PURPOSE: To evaluate the long-term visual outcomes of secondary posterior chamber intraocular lens implantation after 2 years of age for bilateral congenital cataract. METHODS: A retrospective case review was conducted of 42 pediatric patients who were diagnosed with bilateral congenital cataract and underwent irrigation and aspiration of lenses, posterior capsulectomy, anterior vitrectomy, and after two years of age secondary posterior chamber intraocular lens implantation. RESULTS: The median age at irrigation and aspiration of the lens was 21 weeks; the median age at secondary intraocular lens implantation was 5.5 years; the median age at the last follow-up was 11.1 years. The final visual acuities were 0.42 in the better eye and 0.23 in the fellow eye. The median refractive error at the final follow-up was -2.5 diopters of spherical equivalent, and 1.2 diopters in the amount of astigmatism. For all cases, no posterior capsule opacification, intraocular lens dislocation, or retinal detachment was found. There were 16 postoperative glaucoma patients (19.0%), and their intraocular pressures were well controlled with medical therapy. CONCLUSIONS: Secondary posterior chamber intraocular lens implantation performed after two years of age can be an effective therapy for visual development in patients with bilateral congenital cataract undergoing irrigation and aspiration of the lens, posterior capsulectomy, anterior vitrectomy, and aphakic spectacle correction.

Pupillary Block Following Phacoemulsification with Foldable Intraocular Lens Implantation in Adults

PURPOSE: To report on the pupillary block that rarely occurs after phacoemulsification with posterior chamber intraocular lens (IOL) implantation. METHODS: A series of four eyes in four diabetic patients treated for pupillary block after uneventful phacoemulsification with posterior chamber IOL is described. RESULTS: The interval between pupillary block development and the cataract surgery ranged from 1 week to 19 weeks. In all eyes, neodymium-YAG laser peripheral iridotomy relieved the block (-one procedure in three patients; and two procedures in one-). CONCLUSIONS: Despite the rarity of the complication of pupillary block after phacoemulsification with posterior chamber IOL, physicians should require closer follow-up is necessary, especially in diabetic patients.

Candida Albicans Endophthalmitis after Phacoemulsification and Intraocular Lens Implantation

A case of fungal infection after uncomplicated phacoemulsification with posterior chamber intraocular lens implantation is reported. Initially, aqueous tap showed no organism. Despite capsular bag wash and intravitreal vancomycin treatment, the inflanmation persisted. Pars plana vitrectomy sample showed yeast cells on smear examination. Intravitreal Amphotericin B alongwith IOL explanation was performed. Candidla albicans growth was seen 011 inoculated culture plates and over the explanted IOL. The patient postoperatively developed secondary glaucoma that required surgical management. At two years follow-up. the vision is 6/18 with RGP contact lenses and no complications is observed.

Translocation of the scleral suture knot on scleral-fixated posterior chamber intraocular lens

PURPOSE: To evaluate exposure rate of suture material at the transscleral suture fixation of posterior chamber intraocular lens (TSFPCIOL) with the method in which the scleral suture knots are trans positioned from both nasal and temporal sclera to superonasal. METHODS: With retrospective chart review 16 eyes of 15 patients who underwent TSFPCIOL with the transpositioned suture site, the authors checked their visual recovery rate and complicated disorders after the surgeries. RESULTS: Average corrected visual acuities at final visits improved to 0.67+/-0.32 from 0.14+/-0.17 at initial. Six eyes (37.5%) had complicated disorders at early postoperative period and 5 eyes (31.25%) had at their final visits. No exposure of suture material over the conjunctiva did occur. CONCLUSIONS: These results suggest that translocated suture to superotemporal sclera may be an efficient method for reducing exposure rate of suture material after TSFPCIOL.

4 Cases of Mdification of Scleral Fixation Using 30 G Needle for Posterior Chamber Intraocular Lens Dislocation

PURPOSE: Various methods of scleral fixation for the cases of posterior chamber intraocular lens (PCL) dislocation or subluxation into the vitreous cavity had been developed, and in the recent year a modification of internal scleral fixation using a hollow-bore needle has been introduced. The authors endeavored to evaluate clinical usefulness of the method. METHODS: The study was conducted for four cases of PCL dislocation or subluxation. A 10-0 polypropylene suture was threaded up the internal shaft of a 30 G straight needle and retrieved. The needle containing this suture was then inserted through the bed of the partial-thickness scleral flap 1.5 mm posterior to the limbus. The loop of suture was hooked with haphic of PCL. After the needle was retracted, the haptic was captured and the suture was tied to the sclera. The same maneuver was performed for the haptic in the opposite side. RESULTS: Except for pars plana vitrectomy, time taken for the above procedure was 10~15 minutes. Postoperatively induced astigmatism of all 4 cases were less than 3 diopters on the second postoperative day. No specific complication associated with this procedure was noted. IOL remained stable without tilting or rotation 18 months after procedure. CONCLUSIONS: This modified internal scleral fixation technique must be a convenient and effective procedure for repositioning posteriorly dislocated PCL.