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AIM: To compare the short-term postoperative visual acuity, visual disturbance phenomena, and spectacle independence rate in patients who underwent monocular implantation with trifocal, multifocal, or extended range of vision intraocular lens(IOL).METHODS: A retrospective analysis was conducted on 67 cataract patients(67 eyes)who underwent phacoemulsification cataract extraction combined with IOL implantation from March 2019 to December 2022. A total of 35 cases(35 eyes)received Symfony extended range of vision IOL implantation, 21 cases(21 eyes)received AcrySof IQ ReSTOR +3D multifocal IOL, and 11 cases(11 eyes)received AcrySof IQ PanOptix trifocal IOL. The preoperative uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA)and 3 mo postoperatively were documented. Moreover, defocus curves, visual disturbance phenomena, and spectacle independence rates were recorded at 3 mo postoperatively.RESULTS: At 3 mo postoperatively, no statistically significant differences were observed in UDVA among the three groups(P>0.05). A comparison of UIVA showed superior results in the Symfony and PanOptix groups compared to the ReSTOR group(all P<0.01). The UNVA of both the ReSTOR and PanOptix groups outperformed the Symfony group(all P<0.01). The defocus curves indicated that in the intermediate vision range(-1.00 to -1.50 D), the Symfony group exhibited better performance than the ReSTOR group(P<0.05); while in the near vision range(-2.50 to -3.50 D), the ReSTOR group was superior to the Symfony group(P<0.05). The PanOptix group demonstrated superior visual acuity in the near vision range(-2.00 to -3.50 D)compared to the Symfony group(P<0.05)and was also superior in the intermediate vision range(-1.00 to -2.00 D)compared to the ReSTOR group(P<0.05). No significant differences were observed in the incidence of glare or halo and binocular interference phenomena among the three groups(P>0.05). The PanOptix and ReSTOR groups exhibited a higher spectacle independence rate compared to the Symfony group(P<0.0167).CONCLUSION: Compared to Symfony extended range of vision IOL and ReSTOR multifocal IOL, PanOptix trifocal IOL offers a balanced approach to distance, intermediate, and near visual acuity, without a high incidence of glare and halo, and with a higher spectacle independence rate. Caution is still advised when considering monocular implantation with presbyopia-correcting IOLs.
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With the wide application of phacoemulsification and intraocular lens implantation, many cataract patients have effectively recovered vision. Postoperative intraocular lens opacification is an important indicator for evaluating biocompatibility, as it affects the visual quality of patients. The manifestation and risk factors of opacification vary among different materials used for intraocular lenses. However, better visual quality after surgery is not determined by a single factor. The material of the intraocular lens and the patient's response to the intraocular lens are all factors that affect the postoperative visual quality. With the continuous advancement of technology, an increasing number of new materials are being applied in the field of intraocular lenses. Fully understanding the characteristics of intraocular lens materials, selecting suitable intraocular lens for patients and reducing complications caused by materials will be beneficial to patients. The characteristics of different intraocular lens materials and the risk factors of opacification after intraocular lens implantation were discussed in this paper.
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Objetivo: Caracterizar los resultados refractivos del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal, en el que se incluyeron 30 pacientes (30 ojos) seguidos por un período de un año de septiembre de 2019 a septiembre de 2021, después del implante de una lente intraocular de cámara posterior suturada al iris en la afaquia. Se les realizó examen oftalmológico completo y se evaluaron variables como mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, astigmatismo inducido, densidad celular y complicaciones. Resultados: La mejor agudeza visual sin corrección en el preoperatorio fue del 93,3 % (<0,1) y con corrección de 0,66, al año del posoperatorio fue de 0,493/0,890, respectivamente. La presión intraocular preoperatoria fue de 20,7 mmHg, y al año 19,7 mmHg. La densidad celular en el preoperatorio fue de 1755,7 cél/mm2 y al año fue de 1363,8 cél/mm2, y en los pacientes bien corregidos al mes del posoperatorio fue de 73,4 % y al año de 70 %. El astigmatismo inducido en el posoperatorio al año fue de -0,51 D. Conclusiones: La agudeza visual sin corrección y con corrección mejoran después del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Predominan los pacientes bien corregidos, sin cambios en la presión intraocular y la complicación más frecuente fue el edema corneal.
Objective: To characterize the refractive outcomes of implanting a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Methods: A descriptive, prospective and longitudinal study was carried out, including 30 patients (30 eyes) followed up for a period of one year, from September 2019 to September 2021, after being implanted a posterior chamber intraocular lens sutured to the iris in aphakia. Complete ophthalmologic examination was performed and variables were assessed, such as best visual acuity without correction, with correction, refractive results, intraocular pressure, induced astigmatism, cell density and complications. Results: The best visual acuity without correction in the preoperative period was 93.3 % (<0.1) and 0.66 with correction; while one-year postoperative visual acuity was 0.493 and 0.890, respectively. Preoperative intraocular pressure was 20.7 mmHg, while it was 19.7 mmHg at one year. Preoperatively cell density was 1755.7 cells/mm2, and it was 1363.8 cells/mm2 at one year it; while in well-corrected patients, it was 73.4% at one month postoperatively and 70% at one year. Postoperative induced astigmatism at one year was -0.51 D. Conclusions: Both uncorrected and corrected visual acuity improve after implantation of a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Well-corrected patients predominate, with no change in intraocular pressure, while the most frequent complication was corneal edema.
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Objetivo: Caracterizar resultados visuales del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos. Métodos: Se realizó un estudio preexperimental, prospectivo, longitudinal con 17 niños, con seguimiento de un año. Se les realizó examen oftalmológico completo y se evaluaron variables como edad, sexo, lateralidad, mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, y complicaciones. Resultados: La edad promedio fue de 13,2 años, masculinos fueron el 64,7 %. La mejor agudeza visual sin corrección en el preoperatorio fue del 47,1 % <0,1 y con corrección de 0,7, al año del posoperatorio fue de 0,43/0,78, respectivamente. La presión intraocular preoperatoria fue de 14,1 mm Hg, y al año 14,71 mm Hg. La densidad celular en el preoperatorio fue de 2559.76 células/mm2 y al año de 2475,88 células/mm2. La hexagonalidad preoperatorio fue del 53,12 % y al año del 56,94 %. El cilindro preoperatorio -1,35 D y el 23,5 % presentó astigmatismo inducido al año del posoperatorio. Conclusiones: La aplicación del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos logra mejorar su agudeza visual y la complicación más frecuente fue el edema corneal.
Objective: To characterize visual outcomes of iris-sutured posterior chamber foldable intraocular lens implantation in traumatic aphakia in pediatric patients. Methods: A pre-experimental, prospective, longitudinal, pre-experimental study was performed with 17 children, with a one-year follow-up. A complete ophthalmologic examination was performed and variables such as age, sex, laterality, best visual acuity without correction, with correction, refractive results, intraocular pressure and complications were evaluated. Results: The average age was 13.2 years, 64.7% were male. The best visual acuity without correction preoperatively was 47.1 % <0.1 and with correction 0.7, one year postoperative visual acuity was 0.43/0.78, respectively. Preoperative intraocular pressure was 14.1 mm Hg, and at one year 14.71 mm Hg. Cell density preoperatively was 2559.76 cells/mm2 and at one year 2475.88 cells/mm2. The preoperative hexagonality was 53.12 % and at one year 56.94 %. Preoperative cylinder -1.35 D and 23.5 % presented induced astigmatism at one year postoperatively. Conclusions: The application of posterior chamber foldable intraocular lens implant sutured to the iris in traumatic aphakia in pediatric patients achieves improved visual acuity and the most frequent complication was corneal edema.
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Purpose: To evaluate the accuracy of intraocular lens (IOL) power prediction of the formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) post?refractive calculator in eyes with prior radial keratotomy (RK) for myopia. Methods: This retrospective study included 25 eyes of 18 patients whose status was post?RK for treatment of myopia, which had undergone cataract extraction with IOL implantation. Prediction error was calculated as the difference between implanted IOL power and predicted power by various formulae available on ASCRS post?refractive calculator. The formulas compared were Humphrey Atlas method, IOLMaster/Lenstar method, Barrett True?K no?history formula, ASCRS Average power, and ASCRS Maximum power on ASCRS post?refractive calculator. Results: Median absolute errors were the least for Barrett True?K and ASCRS Maximum power, that is, 0.56 (0.25, 1.04) and 0.56 (0.25, 1.06) D, respectively, and that of Atlas method was 1.60 (0.85, 2.28) D. Median arithmetic errors were positive for Atlas, Barrett True?K, ASCRS Average (0.86 [?0.17, 1.61], 0.14 [?0.22 to 0.54], and 0.23 [?0.054, 0.76] D, respectively) and negative for IOLMaster/Lenstar method and ASCRS Maximum power (?0.02 [?0.46 to 0.38] and ? 0.48 [?1.06 to ? 0.22] D, respectively). Multiple comparison analysis of Friedman抯 test revealed that Atlas formula was significantly different from IOLMaster/ Lenstar, Barrett True?K, and ASCRS Maximum power; ASCRS Maximum power was significantly different from all others (P < 0.00001). Conclusion: In post?RK eyes, Barrett True?K no?history formula and ASCRS Maximum power given by the ASCRS calculator were more accurate than other available formulas, with ASCRS Maximum leading to more myopic outcomes when compared to others
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Purpose: To study posterior capsular opacification (PCO) and neodymium?doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates in patients implanted with square?edged and non?square?edged intraocular lenses (IOLs) in manual small?incision cataract surgery (MSICS). Setting: Tertiary eye care center. Design: Prospective, comparative, and randomized controlled study. Methods: This study included patients with senile cataracts scheduled for MSICS and IOL implantation. One eye of each patient was randomized to the implantation of square?edged (S group) or non?square?edged IOL (NSQ group). An independent observer analyzed PCO at 6, 12, 18, and 24 months under slit?lamp illumination. Results: A total of 104 eyes were included in this study. The mean age of the participants in the two groups was 63.2 (�2) years, and there were 65 (62.5%) men and 39 women (37.5%). The mean best?corrected visual acuity (BCVA) values at 6, 12, and 18 months were 0.157 (�10), 0.11 (�12), and 0.12 (�11), respectively, in the S group and 0.17 (�10), 0.17 (�12), and 0.20 (�17), respectively, in the NSQ group. At 12 (P = 0.03) and 18 months (P = 0.01) follow?up, the BCVA of the S group was significantly better than that of the NSQ group. Four eyes in the NSQ group and one eye in the S group required Nd:YAG. Conclusion: Evaluation of PCO and Nd:YAG capsulotomy rates showed that the 360� square of the posterior IOL edge plays a role in the prevention of PCO. Owing to the low cost of the material and the easy availability of IOLs manufactured from it, square?edged IOL has a definite role in the prevention of PCO in MSICS.
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This article explains a technique of scleral fixation of intraocular lens (SFIOL) by using a 30?gauge (g) needle. Background: The X?nit needle by “Aurolab” uses a 26?g needle, while in this technique, a 30?g needle is used, thus reducing the incision size and relevant complications. Purpose: In this technique, glue or end-gripping forceps are not used, thus making it hassle free and more economical. There is no dependency on assistant; because of using 30 g needle, bleeding is minimal and wound healing is faster. Synopsis: A 30?g needle is bent at 3/4–1/4 junction (from the tip) and a piece of 240 silicon band is inserted into the needle to be used as a stopper. After completing vitrectomy, a 1.5?mm marking is done perpendicular to the limbus at 3’o clock and 9’o clock positions. Another marking is done 1.5 mm away from the first mark parallel to the limbus. A 30?g needle is inserted into partial?thickness sclera from the second mark toward the first marking, thus making a tunnel. The needle is penetrated into the sclera to enter in the vitreous cavity. The needle is then progressed toward the anterior vitreous cavity and brought out through the lip of previously made scleral tunnel in the superior quadrant. The tip of leading haptic of three?piece intraocular lens (IOL) is fed into the tip of needle and gradually, the needle is withdrawn. As soon as the tip of needle is visualized, the piece of band is gradually slipped into the haptic and the needle freed from the haptic. In a similar fashion, the trailing haptic is withdrawn from the opposite side. The bands are removed and the haptics are adjusted by pulling or pushing to centralize the IOL in the pupillary axis. Haptics are trimmed and ends are cauterized to make them blunt. Tunnel and conjunctiva are sutured with one or two (8?0) absorbable Vicryl sutures. The 25?g ports are removed and no suturing of ports is done. Highlights: It is a minimally invasive and glueless technique in which end?gripping forceps is not used. So, it is very economical with faster wound healing and minimal bleeding and no post?op hypotony. Since the temporal scleral flaps are not made and 30 g needle is used so minimal invasive. Astigmatiam induced by scleral tunnel is seen i;e about 0.75 ? 1.15 D of cylinder.
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Introducción: El síndrome de uveítis-glaucoma-hifema (UGH) es una complicación infrecuente de las cirugías de catarata, debido a un roce mecánico ejercido por una lente intraocular (LIO) sobre el iris. Caso clínico: Un varón de 64 años, con antecedente de cirugía de catarata, presenta disminución de la agudeza visual y dolor en el ojo derecho. En el examen oftalmológico, se evidenciaron signos de uveítis anterior, presión intraocular (PIO) elevada, microhifema y una LIO de una pieza plegable en sulcus que provocaba un roce mecánico con la cara posterior del iris. El tratamiento médico fue insuficiente, por lo que se realizó una cirugía de explante de LIO de una pieza plegable y se reemplazó por una LIO de tres piezas plegables. La evolución posoperatoria fue favorable. Conclusión: Se debe sospechar de esta complicación, en pacientes con antecedente de cirugía de catarata, especialmente en casos en los cuales la LIO es de una pieza y ha sido implantada fuera del saco capsular.
Introduction: Uveitis-glaucoma-hyphema syndrome (UGH) is a rare complication of cataract surgery, due to mechanical chafing exerted by an intraocular lens (IOL) on the iris. Clinical case: A 64-year-old man with a history of cataract surgery, who presented decreased visual acuity and pain in the right eye. The ophthalmological examination revealed signs of anterior uveitis, elevated intraocular pressure (IOP), microhyphema, and a single-piece foldable IOL in the sulcus that caused a mechanical chafing with the posterior face of the iris. The medical treatment was insufficient; for this reason, a folding simple-piece IOL explant surgery was performed and replaced by a three-piece IOL. Postoperative evolution was favorable. Conclusion: Should be suspected this complication in patients with a history of cataract surgery, especially in cases in which the IOL is in single-piece and has been implanted outside the capsular bag.
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Purpose: To analyze retrospectively the outcomes of Hoffmann pocket scleral fixated intraocular lens implantation combined with penetrating keratoplasty at a tertiary institute by a single corneal surgeon. Methods: Forty?two eyes of 42 patients, aged between 11 and 84 years, had a mean follow?up of 2 ± 2.216 years. Overall, five (11.9%) had congenital and 37 had acquired pathology, 15 were pseudophakic, 23 were aphakic, and four were phakic. The commonest indication was trauma in 19 (45.2%), and 21 had previous multiple surgeries including five retinal procedures. Results: The grafts were clear in 20 (47.6%), they failed in 20, three had acute rejection, three were ectatic, two had infection, one had persistent edema, and one had endophthalmitis. The mean log of minimum angle of resolution (logMAR) best corrected visual acuity was 1.902 pre?op, 1.802 at the final follow?up, and 0.52 after excluding preexisting retinal pathologies. At the last follow?up, the vision improved in 18 (42.9%), maintained in 6, and worsened in 18, and three needed more than ?5.00 D and seven needed more than ?3.00 D cylinder correction. Five had glaucoma preoperatively, 10 developed the condition postoperatively, six needed cyclodestructive procedure, and three had valve surgery. Conclusion: Advantages of this surgery are avoidance of additional sections to insert the lens, direct positioning of the lens in the posterior chamber, rotational stability of the lens from four?point fixation, and untouched conjunctiva over the scleral pockets. The fact that 20 had clear grafts and 18 visually improved, though two needed lens removal and one developed retinal detachment postsurgery is encouraging. More cases with longer follow?ups will help understand the technique better
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The high prevalence of mature, hypermature, and traumatic cataracts in developing countries, combined with the limited availability of surgical resources and skill by anterior segment surgeons to manage the resultant aphakia, leaves the patient needlessly blind. Relying on posterior segment surgeons, expensive surgical setup, and appropriate lenses for aphakia management limits the number of patients receiving a secondary intraocular lens (IOL). Utilizing the well-acknowledged flanging technique and the readily available polymethyl methacrylate (PMMA) lenses with dialing holes in their optic, a hammock can be created through the dialing holes using a 7-0 polypropylene suture on a straight needle. This 4-flanged scleral fixation through the dialing hole of an IOL makes scleral fixation of PMMA lens possible by even anterior segment surgeons without requiring any specialized equipment or scleral fixated lens with eyelet. This technique was successfully performed in a series of 103 cases with no incidence of IOL decentration.
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Purpose: To evaluate the clinical outcomes of preloaded toric intraocular lens (IOLs) implantation in eyes undergoing phacoemulsification. Methods: This prospective study included 51 eyes of 51 patients with visually significant cataracts and corneal astigmatism ranging between 0.75 and 5.50 D. All patients underwent phacoemulsification with SupraPhob toric intraocular lens implantation under topical anesthesia. The main outcome measures were uncorrected distance visual acuity (UDVA), residual refractive cylinder, spherical equivalent, and IOL stability at 3 months follow?up. Results: At 3 months, 49% (25/51) of patients had UDVA equal to or better than 20/25 with 100% of eyes achieving better than 20/40. Mean logMAR UDVA improved from 1.02 ± 0.39, preoperatively to 0.11 ± 0.10 at 3 months follow?up (P < 0.001, Wilcoxon signed?rank test). The mean refractive cylinder improved from ? 1.56 ± 1.25 D preoperatively to ? 0.12 ± 0.31 D at 3 months follow?up (P < 0.001) while the mean spherical equivalent value changed from ? 1.93 ± 3.71D preoperatively to ? 0.16 ± 0.27D (P = 0.0013). The mean root mean square value for higher order aberrations was 0.30 ± 0.18 ?m while the average contrast sensitivity value (Pelli?Robson chart) was 1.56 ± 0.10 log unit, at the final follow?up. The mean IOL rotation at 3 weeks was 1.7 ± 1.61 degrees, which did not change significantly at 3 months (P = 0.988) follow?up. There were no intraoperative or postoperative complications. Conclusion: SupraPhob toric IOL implantation is an effective method for addressing preexisting corneal astigmatism in eyes undergoing phacoemulsification with good rotational stability
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Purpose: The ideal formula for intraocular lens (IOL) power calculation following cataract surgery in pediatric eyes till date has no answer. We compared the predictability of the Sanders–Retzlaff–Kraff (SRK) II and the Barrett Universal (BU) II formula and the effect of axial length, keratometry, and age. Methods: This was a retrospective analysis of children who were under eight years of age and who underwent cataract surgery with IOL implantation under general anesthesia between September 2018 and July 2019. The prediction error of SRK II formula was calculated by subtracting the target refraction and the actual postoperative spherical equivalent. Preoperative biometry values were used to calculate the IOL power using the BU II formula with the same target refraction that was used in SRK II. The predicted spherical equivalent of the BU II formula was then back?calculated using the SRK II formula with the IOL power obtained with the BU II formula. The prediction errors of the two formulae were compared for statistical significance. Results: Seventy?two eyes of 39 patients were included in the study. The mean age at surgery was 3.8 ± 2 years. The mean axial length was 22.1 ± 1.5 mm, and the mean keratometry was 44.7 ± 1.7 D. The group with an axial length >24 mm showed a significant and strong positive correlation (r = 0.93, P = 0) on comparison mean absolute prediction errors using the SRK II formula. There was a strong negative correlation between the mean prediction error in the overall keratometry group using the BU II formula (r = ?0.72, P < 0.000). There was no significant correlation between age and refractive accuracy using the two formulae in any of the subgroups of age. Conclusion: There is no perfect answer to an ideal formula for IOL calculation in children. IOL formulae need to be chosen keeping in mind the varying ocular parameters.
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ABSTRACT Purpose: To evaluate primary intraocular lens implantation in the treatment of children's aphakia in the Brazilian public health system and compare the outcomes among different age groups. Methods: Children aged 0-12 years old with unilateral or bilateral congenital/developmental cataracts and underwent primary intraocular lens implantation were included. Results: A total of 108 eyes from 68 children were evaluated, and the children were divided into four age groups (<7 months [mo]; 7 mo-2 years old [y/o]; 2-5 y/o, and >5 y/o) were evaluated. Nineteen eyes (17.59%) presented visual axis opacification as a postoperative complication, which was more frequently observed in the <7 mo age group (37.93%). The difference was significant between the <7 mo and >5 y/o age groups (p=0.002). Visual axis opacification was divided into two categories: pupillary membrane and lens cell proliferation. Eight eyes presented pupillary membrane, whereas 14 showed lens cell proliferation. Out of eight eyes with pupillary membrane, seven occurred in the <7 mo age group. The difference between the <7 mo age group and the 2-5 y/o or >5 y/o age group was significant (p=0.01). Lens cell proliferation was more frequent in the <7 mo and 2-5 y/o age groups, but the difference was significant only between the < 7 mo age group and >5 y/o age group (p=0.040). Glaucoma and glaucoma suspect cases were not observed during the follow-up period. Conclusions: The main complication found in the study was visual axis opacification, which had a higher incidence in children operated on or before the age of 7 months.
RESUMO Objetivo: Avaliar o implante de lente intraocular primária para tratamento da afacia pediátrica no Sistema Único de Saúde (SUS) e comparar os resultados em diferentes faixas etárias. Métodos: Foram incluídas crianças com catarata congênita e do desenvolvimento unilateral ou bilateral de 0-12 anos de idade e submetidas a implante de lente intraocular primária. Resultados: Cento e oito olhos de 68 crianças divididas em quatro grupos de idade (<7m; 7m-2a; 2-5a e > 5a) foram avaliados. Dezenove olhos (17,59%) apresentaram opacificação do eixo visual como complicação pós-operatória. Essa complicação foi mais frequente na faixa etária <7 meses (37,93%). A diferença foi significativa entre os grupos de idade <7 meses e > 5 anos (p=0,002). A opacificação do eixo visual foi dividida em duas categorias: membrana pupilar e proliferação de células do cristalino. Oito olhos apresentaram membrana pupilar e 14 proliferação de células do cristalino. Dos oito olhos com membrana pupilar, sete ocorreram na faixa etária <7 meses. A diferença entre o grupo de idade <7 meses e os grupos de 2-5 anos e > 5 anos foi significativa (p=0,01). A proliferação de células do cristalino foi mais frequente nos grupos de idade <7 meses e 2-5 anos, mas significativa apenas quando comparados o grupo de idade <7 meses com o grupo> 5 anos de idade (p=0,040). Glaucoma e suspeitos de glaucoma não foram observados durante o acompanhamento. Conclusões: A principal complicação encontrada no estudo foi a opacificação do eixo visual. Sua incidência foi maior em crianças operadas antes dos 7 meses de idade.
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Purpose: To study the complication rate following Nd: YAG posterior capsulotomy posterior capsular opacification (PCO) in patients with and without comorbid conditions. Methods: This was a prospective, interventional, comparative, and observational study. A total of 80 eyes, consisting of 40 eyes without ocular comorbidities (group A) and 40 eyes with ocular comorbidities (group B) that were being treated with Nd: YAG capsulotomy for PCO, were included. Visual outcome and complications of Nd: YAG capsulotomy were studied. Results: The mean age of group A patients was 61.65 ± 8.85 years and that of group B patients was 63 ± 10.46 years. Of the total, 38 (47.5%) were men and 42 (52.5%) were women. In group B, the ocular comorbidities were moderate nonproliferative diabetic retinopathy (NPDR) (n = 14 eyes; 14/40 = 35%), subluxated intraocular lens (IOL; <2 clock hours of subluxation; n = 6), age?related macular degeneration (ARMD; n = 6), post?uveitic eyes (having old signs of uveitis, no episode of uveitis since the last 1 year; n = 5), and operated cases of traumatic cataract (n = 4). The mean energy required in groups A and B was 46.95 ± 25.92 and 42.62 ± 21.85 mJ, respectively (P = 0.422). The average energy requirement in Grade 2, Grade 3, and Grade 4 PCO was 22.30, 41.62, and 79.52 mJ, respectively. An increase in intraocular pressure (IOP) of >5 mmHg from pre?YAG levels was observed in one patient in each group on day 1 postprocedure, for which medical treatment was given to both patients for 7 days. One patient in each group had IOL pitting. No patient had any other complications attributable to ND:YAG capsulotomy. Conclusion: Nd:YAG laser posterior capsulotomy is a safe procedure for PCO in patients with comorbidities. Visual outcomes were excellent after Nd:YAG posterior capsulotomy. Although a transient increase in IOP was noted, the response to treatment was good and a long?term increase in IOP was not observed
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Purpose: To report the 1?year clinical outcomes related to safety, efficacy, predictability, contrast sensitivity, patient satisfaction, complications, and overall results with Optiflex Genesis and Eyecryl Plus (ASHFY 600) monofocal aspheric intraocular lenses (IOLs) and compare the same with Tecnis?1 monofocal IOL. Methods: This prospective, single?center, single?surgeon, randomized, three?arm study included 159 eyes of 140 eligible patients who underwent cataract extraction with IOL implantation with any of the three study lenses. Clinical outcomes related to safety, efficacy, predictability, contrast sensitivity, patient satisfaction, complications, and overall results were compared at a mean follow?up of 1 year (12 ± 1.20 months). Results: Preoperatively, age and baseline ocular parameters of all the three groups were matched. At 12 months post?op, no significant differences were noted among the groups in terms of mean postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) sphere, cylinder, and spherical equivalent (SE; P > 0.05 for all parameters). Eighty?nine percent eyes in the Optiflex Genesis group as against 96% eyes in the Tecnis?1 and Eyecryl Plus (ASHFY 600) groups were within ± 0.5 D, and 100% of eyes in all the three groups were within ± 1.00 D of SE accuracy. Postoperative internal higher?order aberrations (HOAs) and coma, and mesopic contrast sensitivity at all spatial frequencies were comparable across all the three groups. Two eyes in the Tecnis?1 group, two eyes in the Optiflex group, and one eye in the Eyecryl Plus (ASHFY 600) group underwent YAG capsulotomy at the last follow?up. No eye in any of the groups showed glistenings or required IOL exchange due to any reason. Conclusion: At 1?year post?op, all the three aspheric lenses showed comparable results in visual and refractive parameters, post?op aberrations, contrast sensitivity, and posterior capsule opacification (PCO) behavior. Further follow?up is needed to evaluate the long?term behavior for refractive stability and PCO rates of these lenses. Trial registry: CTRI/2019/08/020754 (www.ctri.nic.in).
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The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.
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Purpose : To report a case of late opacification of the hydrophilic acrylic Intraocular Lens (IOL) after uneventful Cataract Surgery. Methods : A 60-year-old male presented with chief complaint of gradual diminution of vision in right eye over the past one year. He was Normotensive, Non-diabetic and had a normal Lipid Profile. History revealed that he underwent uneventful phacoemulsification with posterior chamber hydrophilic intraocular in the bag implantation for pre-senile cataract in his Right Eye ten years ago. He had the best corrected visual acuity of 6/6 in his Right Eye for nine years Post Cataract Surgery. Slit-lamp examination confirmed Intraocular Lens Opacification. Results : Intraocular Lens exchange was performed in his Right Eye. The hydrophilic IOL was replaced with poly methyl methacrylate intraocular lens. The explanted IOL showed uniform grayish-white opacification. Post operative period was uneventful. Intraocular pressure by applanation tonometry was 16.4 mm Hg in both the eyes. Patient抯 best corrected visual acuity was 6/6 with -1 D Cyl. at 90 degree, Postoperatively. Over a follow up period of one year, the patient did not develop complications like posterior capsular IOL opacification. Conclusion: Intraocular Lens opacification is an extremely rare late postoperative complication of Phacoemulsification which can be managed effectively by IOL exchange procedure in cases of opacified IOL optics causing visual morbidity
ABSTRACT
Haptic slippage is a frequently encountered and technically demanding complication in Yamane’s surgery. The slipped haptic could be regained when bimanual operations are workable. Management of haptic slippage is difficult when the right hand is occupied by the puncture needle, which could be solved easily with the self-rescue technique, which uses the needle tip as an intraocular instrument for better exposure and easier engagement of the slipped haptic. With the aid of bimanual operations and self-rescue technique, Yamane’s technique in situ is applicable when the haptic of dislocated intraocular lens suits for flange-making.
ABSTRACT
In this report, we have utilized a smartphone-based innovative tool named anterior segment photography with an intraocular lens (ASPI) with a cobalt blue filter on the smartphone flash for photographing fluorescein-stained corneas. An intraocular lens along with a cobalt blue filter was attached to the smartphone camera to achieve this purpose. The filter could block out all wavelengths of light except the blue wavelength (450–490 nm) emerging from the smartphone camera. A pilot study was conducted on 27 eyes of 25 patients where images of various corneal pathologies were obtained using ASPI blue light imaging. The images were clear and highly magnified and could be used for documentation, teleconsultation for expert opinion, education, and monitoring of disease progression. ASPI-aided blue light imaging could be easily fabricated and is a frugal inexpensive device, which is used by different ophthalmic personnel to obtain fluorescein-stained corneal images.
ABSTRACT
AIM: To evaluate the efficacy of Ahmed glaucoma valve implanting through the ciliary sulcus in the treatment of intraocular lens(IOL)glaucoma.METHODS: Retrospective case series study. The clinical data of 18 patients(18 eyes)with IOL glaucoma from February 2020 to February 2022 in Liuzhou Red Cross Hospital were collected. All patients underwent Ahmed glaucoma valve implanting through the ciliary sulcus. The visual acuity, intraocular pressure, corneal endothelial cell density, corneal endothelial cell loss rate and complications were observed before operation and 1, 3, 6 and 12mo after operation.RESULTS: The mean intraocular pressure before operation was 43.41±5.33 mmHg. The mean intraocular pressure at 1, 3, 6 and 12mo after operation were 12.11±3.26, 13.82±4.12, 13.54±3.83 and 15.80±4.35 mmHg respectively. The mean intraocular pressure at each follow-up point after operation was significantly lower than that before operation(F=203.40, P<0.01). The corneal endothelial cell density at each time point after surgery was lower than that before surgery(F=6.18, P<0.01), but there were no significantly differences in the density and loss rate of corneal endothelial cell at 1, 3, 6 and 12mo after surgery(P>0.05). Furthermore, the overall surgery success rate was 83%.CONCLUSIONS: Ahmed glaucoma valve implanting through the ciliary sulcus is safe and effective in the treatment of IOL glaucoma, and the damage to corneal endothelial cells is mild. The corneal endothelial cells density doesn't decrease with time after surgery.