Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

Status changes and influencing factors of intraocular lens implantation into capsule / 中华实验眼科杂志

Objective:To observe the unfolding status of foldable acrylic intraocular lens (IOL) of different materials, designs and refractive powers implanted in the capsular bag during cataract surgery, and to investigate its influence on the IOL implantation procedure.Methods:An observational case series study was conducted.A total of 1 005 patients who underwent routine phacoemulsification and IOL implantation in Shaanxi Eye Hospital from February to August 2021 were enrolled.The status and unfolding time of the leading haptic, optical region, and trailing haptic of the IOL in the capsular bag and the surgeon were recorded in real-time intraoperative video.Of the 1 005 IOL implants, 681 were hydrophobic, 324 hydrophilic, 733 C-loop, 272 plate-haptic, 909 single-piece, 96 three-piece, 620 preloaded, and 385 non-preloaded.The differences in unconventional implantation factors and IOL unfolding time were compared.The factors influencing IOL implantation status were analyzed by multivariate logistic regression.Multivariate logistic regression was used to analyze the relevant factors affecting IOL implantation status.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Xi'an People's Hospital (Xi'an Fourth Hospital)(No.20200035). Written informed consent was obtained from each subject.Results:There were 14(1.4%) IOLs with unconventional leading haptic status during implantation, including 7 recurved, 4 folded, 2 twisted and 1 straightened.There were 101(10.0%) IOLs with unconventional trailing haptic status during implantation, including 49 stuck in the injector, 40 folded, 10 recurved and 2 broken.There were 22(2.2%) IOLs with overlapped leading and trailing haptic requiring additional separation.There were 4(0.4%) IOLs with reversed optical regions and 2(0.2%) with damaged optical regions.The occurrence rate of unconventional leading haptic status using C-loop IOL was higher than that using plate IOL, and the difference was statistically significant ( P<0.05). The occurrence rate of unconventional trailing haptic status using hydrophilic, non-preloaded, three-piece, and C-loop IOL was higher than that using hydrophobic, preloaded, single-piece, and plate IOL, respectively, and the differences were statistically significant ( χ2=9.100, 61.400, 81.885, 7.587; all at P<0.05). The 22(2.2%) IOLs with overlapped leading and trailing haptic were hydrophobic.The 4 (0.4%) IOLs with reversed optical region were non-preloaded.The results of multivariate logistic regression analysis showed that IOL material, loading method, design and surgeons were related to the unconventional trailing haptic status in implantation ( OR=9.894, 3.720, 6.810, 1.338; all at P<0.05). The average unfolding time of hydrophobic IOL was 26.12(21.21, 30.91)s, which was significantly longer than 3.03(2.16, 4.49)s of hydrophilic IOL ( Z=-25.603, P<0.05). The average unfolding time of C-loop IOL was 25.53(19.41, 30.25)s, which was significantly longer than 2.70(2.08, 3.69) s of plate IOL ( Z=-23.764, P<0.05). Conclusions:A variety of unconventional statuses of IOL can occur during implantation into the lens capsular bag.The use of hydrophobic, preloaded, single-piece, and plate IOLs can reduce the occurrence of unconventional status.The use of hydrophilic IOLs can reduce the overlap of leading and trailing haptic.The use of preloaded IOLs can reduce the occurrence of IOL optical region reversal.The use of hydrophilic and plate IOLs can shorten the operation time.

PHACOSIT: A sitting phacoemulsification technique for patients unable to lie down flat during cataract surgery

Phacoemulsification is routinely performed with the patient lying supine on the surgical table with his or her head flat and facing the overhead microscope. This routine technique can be a challenge in medical conditions such as kyphosis, scoliosis, orthopnea, Meniere抯 disease, and CNS abnormality. Some cardiovascular and respiratory conditions make the patients breathless when they lie down, whereas other neurological and spinal problem patients are also equally uncomfortable. The only reasonable solution to conduct surgery on a patient who cannot lie down flat on the operating table is to position them face to face in a sitting position. We describe an innovative phacoemulsification technique in a sitting position called 損hacosit� in an 80?year?old wheelchair?bound female patient who was denied cataract surgery by other eye surgeons owing to her medical condition.

Effects of different viscoelastic agents on corneal endothelium of patients after phacoemulsification and foldable IOL implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effects of dual viscoelastic agents DisCoVisc and sodium hyaluronate on corneal endothelium of patients after phacoemulsification and foldable intraocular lens(IOL)implantation.METHODS: A total of 247 patients(285 eyes)with cataract treated in Jingmen Aier Eye Hospital between June 2017 and December 2019 were selected, and they were divided into DisCoVisc group(123 cases, 141 eyes)and sodium hyaluronate group(124 cases, 144 eyes)by random number table method. Both groups were treated with phacoemulsification and foldable IOL implantation. DisCoVisc and 1.7% sodium hyaluronate were used as viscoelastic agents in DisCoVisc group and sodium hyaluronate group, respectively. The two groups were compared in terms of intraoperative ultrasound time(UST), cumulative dissipated energy(CDE), time for aspiration of viscoelastic agents after IOL implantation, corneal edema at 1d, 1wk, 1 and 3mo after operation, corneal endothelial cell density(ECD)and ECD loss rates before operation and at 3mo after operation, coefficient variation of corneal endothelial cell size(CV), percentage of corneal hexagonal endothelial cells(6A), intraocular pressure, the proportions of patients with uncorrected visual acuity ≥0.5 and central corneal thickness(CCT)values before and after operation at 1d, 1wk and 1mo.RESULTS:There was no statistically significant difference between the two groups in UST, CDE, aspiration time of viscoelastic agents(P &#x003E;0.05)or corneal edema both rate on day 1 after operation(P&#x003E;0.05). Corneal edema disappeared at 1 wk after operation. The ECD loss rate in DisCoVisc group was significantly lower than that in sodium hyaluronate group at 3mo after operation(P&#x003C;0.05). Intraocular pressure, the proportion of patients with uncorrected visual acuity ≥0.5 and CCT values showed no statistically significant differences between the two groups before and after operation at 1d, 1wk and 1mo(P &#x003E;0.05).CONCLUSION: DisCoVisc, as the viscoelastic agent in phacoemulsification and foldable IOL implantation for patients with Emery-Little grade Ⅱ-Ⅲ lens nucleus hardness, can better protect the patients' corneal endothelium.

Long-term results of in-the-bag primary intraocular lens implantation in children younger than 24 months / Resultados a longo prazo de implante primário de lente intraocular no saco capsular em crianças menores que 24 meses

ABSTRACT Purpose: The purpose of this study was to analyze the safety of primary intraocular lens implantation in a large number of eyes in children aged <24 months. Methods: The medical records of patients aged 5-24 months, who underwent primary intraocular lens implantation in the capsular bag, were reviewed. A foldable three-piece acrylic intraocular lens was implanted by the same surgeon using a single surgical technique. Patients who had <1 year of follow-up after the surgery were excluded. The main outcome measurements included visual acuity, myopic shift, follow-up complications, and additional surgeries. Results: Sixty-eight patients (93 eyes) were analyzed. The mean age of the patients at the time of surgery was 15.06 ± 6.19 months (range: 5-24 months), and the spherical equivalent 1 month after surgery was 3.62 ± 2.32 D. After 5.67 ± 3.10 years, the spherical equivalent was -0.09 ± 3.22 D, and the corrected distance visual acuity was 0.33 ± 0.33 and 0.64 ± 0.43 logMAR in bilateral and unilateral cases, respectively (p=0.000). The highest myopic shift was observed in infants who underwent surgery at ages 5 and 6 months. The most frequent complications included visual axis opacification and corectopia. Glaucoma and retinal detachment were not reported. Conclusion: Primary in-the-bag intraocular lens implantation in children aged 5-24 months is safe, and is associated with low rates of adverse events and additional surgery.

RESUMO Objetivo: O objetivo deste estudo foi analisar a segurança do implante de lente intraocular primária em um grande número de olhos em crianças <24 meses. Métodos: Foram revisados os prontuários de pacientes com idade entre 5-24 meses, submetidos a implante primário de lente intraocular no saco capsular. Uma lente intraocular acrílica de três peças dobrável foi implantada pelo mesmo cirurgião usando uma única técnica cirúrgica. Pacientes que tiveram <1 ano de acompanhamento após a cirurgia foram excluídos. Os principais resultados incluíram medidas de acuidade visual, mudança miópica, complicações pós operatórias e cirurgias adicionais. Resultados: Foram analisados 68 pacientes (93 olhos). A média de idade dos pacientes no momento da cirurgia foi de 15,06 ± 6,19 (5 a 24) meses, e o equivalente esférico 1 mês após a cirurgia foi de 3,62 ± 2,32 D. Após 5,67 ± 3,10 anos, o equivalente esférico foi de -0,09 ± 3,22 D, e a acuidade visual corrigida à distância foi de 0,33 ± 0,33 e 0,64 ± 0,43 logMAR em casos bilaterais e casos unilaterais, respectivamente (p=0,000). A maior mudança míopica foi observado em bebês submetidos à cirurgia aos 5 e 6 meses de idade. As complicações mais frequentes incluíram opacificação do eixo visual e corectopia. Glaucoma e descolamento de retina não foram relatados. Conclusão: O implante primário de lente intraocular no saco capsular em crianças de 5-24 meses é seguro e está associado à baixas taxas de eventos adversos e cirurgias adicional.

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.

Three-dimensional digital visualization of phacoemulsification and intraocular lens implantation

Purpose: To evaluate the feasibility and safety of heads-up three-dimensional (3D) vision system for phacoemulsification and intraocular lens (IOL) implantation surgery. Methods: In this prospective, randomized controlled study, 20 eyes with age-related cataract received phacoemulsification and IOL implantation and were randomly divided into “heads-up” 3D vision group and conventional surgery group. Ocular and surgical parameters such as surgery time, pre and postoperative best-corrected visual acuity (BCVA), and corneal endothelial cells density were recorded and statistically analyzed. Results: The result showed significant postoperative improvement of BCVA in both groups. There was no difference in either mean surgery time or postoperative mean endothelial cell density between the 3D group and the conventional group. No major complication occurred during surgery in either group. Conclusion: The heads-up 3D vision system is suitable and safe for cataract phacoemulsification and IOL implantation. This technique can be of widespread use.

A surgical treatment strategy in promoting normal refractive development after infantile cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the eye development and complications after primary intraocular lens implantation(IOL)in infantile cataract.<p>METHODS: The postoperative complications, corrected vision, refractive state, ocular axis of 46 patients(92 eyes)with congenital cataract treated by IOL implantation within 10y were retrospectively analyzed.<p>RESULTS: Five eyes(5%)had postoperative complications. In this study, the average corrected visual acuity was 0.40±0.10 at 3a follow-up after surgery, 0.51±0.01 at 5a follow-up after surgery, and 0.71±0.01 at 7a follow-up; The axial length of the eyes was 20.04±0.02mm at 3a after surgery, 22.09±0.09mm at 5a after surgery, and the axial length of the eyes was 22.96±0.06mm at 7a after surgery; The mean refractive state(equivalent spherical lens degree)at 3a after surgery was observed to be +5.37±0.12 DS, +3.20±0.20 DS at 5a after surgery, and +0.92±0.20 DS at 7a after surgery.<p>CONCLUSION: The appropriate surgical strategies can give safely and effectively opportunity for the patients with infantile cataract, which also have relatively normal refractive development.

Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

PURPOSE: To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term follow-up study. METHODS: In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binocularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors. RESULTS: Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052). CONCLUSIONS: Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.

Vertical fixation with fibrin glue-assisted secondary posterior chamber intraocular lens implantation in a case of surgical aphakia.

We report the first case of vertical fixation by fibrin glue-assisted secondary posterior chamber intraocular lens implantation in a case of surgical aphakia. Advantages of vertical fixation are discussed.

Clinical Outcomes of Secondary Intraocular Lens Implantation in Vitrectomized Aphakic Eyes Due to Ocular Trauma

PURPOSE: To evaluate the clinical outcomes of secondary intraocular lens (IOL) implantation in eyes that underwent pars plana vitrectomy and lens removal due to ocular trauma. METHODS: We retrospectively investigated 40 vitrectomized aphakic eyes that had received secondary IOL from March 2005 to January 2012. Various parameters including pre- and postoperative best corrected visual acuity (BCVA) were reviewed. RESULTS: Incidence was higher in males (n = 35, 89.7%) and highest in the 6th decade of life (n = 13, 33.3%). Mean preoperative refractive error was +9.99 +/- 2.80 D in spherical equivalent, and astigmatism was 1.80 +/- 1.73 D. Mean BCVA (log MAR) was 0.53 +/- 0.51 preoperatively and 0.54 +/- 0.46 at 6 months postoperatively. Postoperative refractive error was -1.28 +/- 1.40 D and the astigmatism was 2.54 +/- 1.52 D. The difference between the target and postoperative refractive error was a myopic shift of -0.63 +/- 1.44 D. Postoperative BCVA had no significant correlation with preoperative factors other than preoperative BCVA (p < 0.001). The most common complication was temporarily increased IOP in 4 eyes. Choroidal detachment, recurrence of retinal detachment, bullous keratopathy, and cystoid macular edema were each found in 1 eye. IOL dislocation was corrected with reoperation in 2 eyes. CONCLUSIONS: Secondary IOL implantation can be performed safely in vitrectomized aphakic eyes due to ocular trauma and can be recommended in patients with good preoperative BCVA. Myopic shift of the postoperative refractive error should be considered when calculating IOL power.

Surgical Results of Transscleral Fixation of Foldable Acrylic Intraocular lens with Unique Shape of Haptics

PURPOSE: To report the surgical results of transscleral fixation of foldable acrylic intraocular lens with a unique haptic shape (CORNEAL(R), ACR6D, France). METHODS: We analyzed the medical records of 18 patients (19 eyes) who had transscleral fixation of posterior chamber intraocular lens implantation from July 2004 to July 2006. RESULTS: According to the cause of operation, there were five eyes with complicated cataract, eight with trauma, and six with aphakia associated with a previous operation. The mean age of the patients was 55.9+/-21.2 years. The mean preoperative best-corrected visual acuity was 0.31+/-0.35, and the postoperative value was 0.63+/-0.29 (p<0.05). The mean preoperative spherical refractive equivalent was 6.58+/-5.33 diopter, and the postoperative value was -1.77+/-1.59 diopter. The mean refractive error was -1.13+/-1.57 diopter. This showed a myopic shift (p<0.05). The mean astigmatism decreased with time, and it stabilized two months after the operation. The trend was toward mild against-the-rule astigmatism. The mean follow-up duration was 11.0+/-7.6 months. CONCLUSIONS: In eyes with inadequate capsular support, transscleral fixation of posterior chamber intraocular lens implantation with CORNEAL(R) lenses is a safe and effective procedure for visual correction.

Comparison of IOL Formulas in Pediatric Intraocular Lens Implantation

PURPOSE: To evaluate the refractive outcomes using 5 different IOL power calculation formulas (SRK II, Holladay I, Hoffer Q, SRK T, Binkhorst II) in pediatric cataract patients. METHODS: A retrospective analysis of biometric and refractive data was performed on 63 eyes of 44 pediatric patients, who successfully underwent primary and secondary IOL implantation. For analysis, the eyes were divided into three groups: those with axial length or =22 mm but or =24.5 (group L). And also divided into another three groups: those with mean keratomery value or =42.5D but or =44.5D (group III). The postoperative refractive outcome was taken as a spherical equivalent of the refraction at 1 week and 2 to 3 months after surgery. The 'predictive error' was defined as absolute error between the target and actual postoperative refraction. RESULTS: SRK II had a best predictive error but there was no statically significant in short eye group and medium eye group at 1 week and 2 to 3 months after the surgery. And SRK II also had a best predictive error but there was no statically significant in group I, II, and III at 1 week and 2 to 3 months. CONCLUSIONS: In our study, theoretical formulas did not outperform the regression formula in pediatric IOL implantation. This may be related to the variability of the relationship between axial length and corneal curvature in pediatric eyes and to dependent variables inherited in the formulas.

Comparison between Combined Surgery and Sequential Surgery in Performing Phacoemulsification, Pars Plana Vitrectomy, and IOL Implantation in non-diabetic Patients

PURPOSE: To evaluate the effectiveness and safety of combined phacoemulsification, pars plana vitrectomy and IOL implantation in non-diabetic patients, and to compare the clinical results with that of sequential surgery. METHODS: The results of combined phacoemulsification, pars plana vitrectomy and IOL implantation in 15 patients (15 eyes) were retrospectively analyzed. Major outcome measures were pre-and postoperative best-corrected visual acuity (BCVA), postoperative BCVA 0.5 or better, and postoperative complications. Comparison between the combined surgery in 12 eyes and sequential surgery in 9 eyes were also analyzed for the same outcome measures. RESULTS: Of the 15 eyes postoperative visual acuity improved in 14 eyes (93.3%), and BCVA 0.5 or better was achieved in 6 eyes (40.0%). Of the 15 eyes postoperative complications consisted of transient IOP increase in 8 eyes (53.3%), hyphema in 4 eyes (26.7%), retinal detachment in 3 eyes (20.0%), vitreous hemorrhage in 2 eyes (13.3%), anterior chamber fibrin exudation in 2 eyes (13.3) and posterior capsular rupture in 2 eyes (13.3%). The difference in complications between the combined surgery group and sequential surgery group were not statistically significant. CONCLUSION: Combined surgery in selected patients is a safe and effective approach, and the outcome is comparable to sequential surgery.

Simultaneous Phacoemulsification, Pars Plana Vitrectomy, Intraocular Foreign Body Extraction, and Intraocular Lens Implantation

PURPOSE: To evaluate the effectiveness of simultaneous phacoemulsification, pars plana vitrectomy, the removal of posterior intraocular foreign body(IOFB), and primary intraocular lens implantation(IOL). METHODS: Simultaneous phacoemulsification, pars plana vitrectomy, the removal of posterior IOFB, and primary IOL implantation were performed in 10 eyes of 10 patients with ocular perforation and traumatic cataract due to posterior IOFB. The results showed no retinal detachment and endophthalmitis based on retrospective analysis. RESULTS: The follow-up period ranged from 3 to 45months(mean 19.6 months). In 8 eyes(80%), the final visual acuity was better than 0.9 but in remaining 2 eyes, it was less than 0.5 due to postoperative retinal detachment. There were enlargement of posterior capsule rupture and vitreous prolapse into anterior chamber in 2 cases, and lens dislocation into the vitreous cavity in 1 case during phacoemulsification. IOL was implanted into the bag in 4 eyes and into the ciliary sulcus without scleral fixation in remaining 6 eyes. CONCLUSIONS: Simultaneous phacoemulsification, pars plana vitrectomy, the removal of IOFB, and primary IOL implantation is a relatively safe operation. It provides rapid rehabilitation of the visual acuity and helps to save time and money in selected patients without the large posterior capsule rupture, retinal detachment, endophthalmitis and injury of macula and center of cornea due to IOFB.

A Case of Pseudophakic Malignant Glaucoma

PURPOSE: Malignant glaucoma is a rare secondary glaucoma characterized by a flat anterior chamber with increased intraocular pressure (IOP). It may occur after intraocular surgery, trauma, inflammation, the use of miotic agents, and so on. We report a case of malignant glaucoma after uncomplicated phacoemulsification with foldable intraocular lens implantation (IOL) using scleral tunnel incision. METHODS: A 74-year-old woman underwent a phacoemulsification with foldable IOL implantation in her left eye. Ten days after cataract surgery, she had severe ocular pain, a high IOP, and a flat anterior chamber. Pupillary block was suspected, and a peripheral iridectomy was done. But she was referred to our hospital for evaluation of persistent IOP elevation with flat anterior chamber. A diagnosis of pseudophakic malignant glaucoma was made, and we performed a core vitrectomy through peripheral iridectomy site. The anterior chamber deepened postoperatively with control of IOP. On the fourth postoperative day, she developed flattening of the anterior chamber with IOP elevation. A recurrence of malignant glaucoma was diagnosed, and anterior vitrecomy with a widening of previous iridectomy wound was done. RESULTS: Postoperatively, the patient had normal IOP, a deep anterior chamber and improved visual acuity. We got successful results from a surgical anterior vitrecomy through peripheral iridectomy site.

Cause analysis of failure to IOL implantation during cataract surgery / 眼科新进展

Objective　To study the causes of failure to IOL implantation during cataract surgery.Methods　We reviewed 540 eyes in which 23 eyes were failed to implant IOL during cataract surgery.Results　Detachment of suspended zonular ligament, rupture of posterior capsule and vitreous prolapse are the main factors influencing IOL implantation during cataract surgery.Conclusion　Improvement of surgical technique and reduction of complications are the key points for the IOL implantation successfully during cataract surgery.

A Survey of Post -Operative Daily Life Behavior and Degree of Satis faction in Patients Two or More Years after Cataract Surgery

Recently, the number of cataract surgeries has rapidly increased. This study was devised to evaluate the post-operative daily life behavior and degree of satisfaction in the patients who underwent cataract surgery two or more years ago. Of 400 patients who underwent ECCE with IOL implantation, 125 patients[31%]replied to the mail questionnaire consisted of thirty questions. Hospital records were also reviewed. 84%of the patients were satisfied with outcomes of cataract surgery, which was significantly correlated with current visual acuity[p<0.01]. Degree of satisfaction was significantly higher in patients with bilateral surgery compared with those with unilateral surgery[p<0.05]. Age, sex, occupation, economic and general health status were not significantly associated with degree of satisfaction. As for life behavior, discomfort while driving an automobile was the most common complaint, especially in the patients who underwent unilateral surgery. Concerning ocular symptoms, many patients complained of foreign body sense, epiphora, glare, fatigue, and near vision discomfort. We reconfirmed that the decision to perform cataract surgery should be made with careful consideration of long term prognosis and above results.

A Case of Isolated Posterior Capsule Rupture Caused by Blunt Ocular Trauma

Isolated rupture of the posterior capsule caused by blunt ocular trauma is rarely reported and is usually detected incidentally during surgery for the associated cataract. We report a case of isolated posterior capsule rupture detected during cataract surgery in a 33-year-old man who had traumatic cataract. In this case, the ruptured posterior capsule had relatively large defect in size(5x5 mm)with thickened and fibrosed edge and vitreous opacity existed. The surgical management of this case consisted of phacoemulsification with PC-IOL implantation and pars plana vitrectomy. During surgery, although the posterior capsule rupture was large, further rupture of the capsule was prevented by the fibrosed edge which tightened the margin ofthe ruptured capsule, and so PC-IOL implantation could be possible securely.

A Clinical Observation of Corneal Laceration with Traumatic Cataract

The clinical results of 20 patients(20 eyes) who were operated due to perforated corneal laceration with traumatic cataract between March 5, 1991 and July 14, 1994 were analysed for the predictors of postoperative good visual outcome and compared simultaneous cataract surgery and implantation with secondary implantation. The most significant predictor of postoperative good visual outcome was the location of corneal laceration. Timing of lens implantation didn't influence significantly final visual acuity and postoperative inflammation. But postoperative complication were less frequent in patients where secondary IOL implantation was performed as opposed to those simultaneous IOL implantated.