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.

Prediction of vault after implantable collamer lens implantation and its research progress / 国际眼科杂志(Guoji Yanke Zazhi)

Myopia is considered to be a disease occurred under the influence of genetic and environmental factors, and it can only be restored by corrective surgeries. The current surgical methods include laser surgeries and phakic intraocular lens(PIOL)implantation, and PIOL has the advantages of wide range of correction, repeatable procession and small damage to corneal tissue. Furthermore, good visual acuity can be achieved after implantation of intraocular lens. Implantable collamer lens(ICL)is the most common surgical method in this group. The vertical distance between the highest point of the posterior central surface of the implanted lens and the anterior surface of the crystalline lens is called vault. It will cause serious complications if the vault turns out to be abnormal. Up to now, there is no optimal prediction method. This research focuses on vault, discusses the ideal range of postoperative vault, the safety and effectiveness of this surgery, and analyzes the existing prediction methods to provide directions for future clinical research.

Clinical application progress of Piggyback intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#With the continuous progress and development of modern surgical equipment, the types of intraocular lens and the continuous improvement of people's requirements for visual quality, cataract surgery has been transformed from traditional vision restoration surgery into a high-quality and high-demand refractive surgery. Piggyback intraocular lens implantation was originally a new surgical method for clinicians to implant two or more posterior chamber intraocular lenses in patients' eyes to correct hyperopia or secondary correction refractive errors after cataract surgery. With the birth and promotion of functional lenses in recent years, this surgical method has been applied to the field of refractive cataract surgery, which expanded the application of functional intraocular lens and achieved good postoperative effect. This review discusses the development and current clinical application of Piggyback intraocular lens implantation, and further expounds its development trend in the future.

Implante secundario de lente en cámara anterior con apoyo angular versus lente suturado a iris / Secondary implantation of angle-supported lens in the anterior chamber versus iris-suture-fixated lens

Objetivo: Comparar los resultados del implante secundario de lentes intraoculares de cámara anterior rígido con apoyo angular y de lentes intraoculares plegables de cámara posterior suturados a iris, en cuanto a efectividad, seguridad y calidad de vida relacionada con la función visual (cuestionario NEI VFQ-23). Métodos: Se realizó un estudio cuasi experimental de 50 ojos de pacientes afáquicos sin soporte capsular, después de la cirugía de catarata, divididos en dos grupos según el tratamiento. Resultados: Se observó que en el grupo de pacientes tratados con lente intraocular suturado a iris el porcentaje de pacientes con una visión de 20/40 o más fue significativamente superior (96,0 vs. 60,0 , p = 0,000), mientras que los resultados del cuestionario de calidad de vida fueron menores en cuanto a la frecuencia de pacientes con visión de 20/200 o menos (0,0 vs. 16,0 por ciento, p = 0,110); la inducción de astigmatismo, la disminución de la densidad de células endoteliales (361,6 ± 220,5 vs. 556,1 ± 340, p = 0,021) y el porcentaje de pacientes con complicaciones (36,0 vs. 52,0 por ciento, p = 0,254). Conclusiones: Se logran mejores resultados con el implante de lente intraocular plegable suturado a iris(AU)

Objective: Compare the results of secondary implantation of rigid angle-supported intraocular lenses in the anterior chamber versus foldable iris-suture-fixated intraocular lenses in the posterior chamber, in terms of effectiveness, safety and vision-related quality of life (questionnaire NEI VFQ-23). Methods: A quasi-experimental study was conducted of 50 eyes of aphakic patients without capsular support after cataract surgery, who were divided into two groups according to the treatment indicated. Results: It was found that in the group treated with iris-suture-fixated intraocular lens implantation the percentage of patients with 20/40 vision or more was significantly higher (96.0 vs. 60.0 percent, p = 0.000), whereas the results of the quality of life questionnaire were lower in terms of frequency of patients with 20/200 vision or less (0.0 vs. 16.0 percent, p = 0.110), induction of astigmatism, endothelial cell density reduction (361.6 ± 220.5 vs. 556.1 ± 340, p = 0.021) and percentage of patients with complications (36.0 vs 52.0 percent, p = 0.254). Conclusions: Better results were obtained with the implantation of foldable iris-suture-fixated intraocular lenses(AU)

Resultados refractivos del implante secundario de lente en la cámara anterior con apoyo angular y de lente suturado a iris / Refractive results of anterior chamber angle-supported and iris-suture-fixated secondary lens implantation

Objetivo: Comparar los resultados refractivos del implante secundario de lentes intraoculares rígidos de la cámara anterior con apoyo angular y de lentes intraoculares plegables de la cámara posterior suturados a iris. Métodos: Se realizó un estudio casi experimental con control no equivalente (cohorte histórica). Se estudiaron 50 pacientes (50 ojos) con afaquia e inadecuado soporte capsular después de la cirugía de catarata, a quienes se les realizó implante secundario de lente intraocular con dos técnicas diferentes: lente intraocular en la cámara anterior con apoyo angular (25 ojos) y lente intraocular plegable de la cámara posterior suturado a iris (25 ojos). Resultados: Se observó que en el grupo de pacientes tratados con lente intraocular suturado a iris el porcentaje de pacientes con una visión de 20/40 o más fue significativamente superior (96,0 por ciento vs. 60,0 por ciento, p= 0,000) en los resultados refractivos obtenidos según el grupo de tratamiento. En el grupo A predominaron los pacientes que quedaron emétropes, seguidos de los pacientes miopes. En el grupo B predominaron los pacientes miopes y a diferencia del grupo anterior ningún paciente quedó hipermétrope. Conclusiones: La lente intraocular plegable de la cámara posterior suturada a iris mostró ser más eficaz, indujo menos astigmatismo y fue mejor en la predictibilidad de la esfera en un rango estricto de ± 1,00 dioptrías(AU)

Objective: Compare the refractive results of secondary implantation of rigid angle-supported intraocular lenses in the anterior chamber and foldable iris-suture-fixated intraocular lenses in the posterior chamber. Methods: A quasi-experimental non-equivalent control (historical cohort) study was conducted of 50 patients (50 eyes) with aphakia and inadequate capsular support after cataract surgery, who underwent secondary intraocular lens implantation with two different techniques: angle-supported intraocular lens in the anterior chamber (25 eyes) and foldable iris-suture-fixated intraocular lens in the posterior chamber (25 eyes). Results: In the group treated with iris-suture-fixated intraocular lens implantation the percentage of patients with 20/40 vision or more was significantly higher (96.0 percent vs. 60.0 percent, p= 0.000) in the refractive results obtained for each treatment group. In Group A a predominance was found of emmetropic, followed by myopic patients. In Group B myopic patients prevailed and unlike the other group no patient was hyperopic. Conclusions: Foldable iris-suture-fixated posterior chamber intraocular lenses proved more effective, induced less astigmatism and displayed better sphere predictability in a strict range of ± 1.00 diopters(AU)

Exactitud de las fórmulas de cálculo del poder de Lente Intraocular en Cirugía de Cataratas. Comparación de 8 fórmulas / Accuracy of formulas for Intraocular Lens power calculation in Cataract Surgery. A comparison of 8 formulas

Introducción: La cirugía de cataratas tiene como objetivo restablecer la función visual comprometida por la opacificación del cristalino; con el implante del Lente Intraocular se pretende obtener la mejor agudeza visual posible sin corrección adicional. Objetivos: Comparar la exactitud de 8 fórmulas de cálculo de Lentes Intraoculares en la predicción de la refracción postoperatoria con un único dispositivo de biometría óptica en pacientes operados de cirugía de catarata con técnica de facoemulsificación. Materiales y métodos: Serie de casos consecutivos retrospectivos. 100 pacientes fueron sometidos a cirugía de catarata no complicada con de Lente Intraoculares por un único cirujano; del 1 mayo del 2017 al 1 de mayo del 2018; donde la cirugía fue realizada por córnea clara facoemulsificación. En el período preoperatorio todos los pacientes fueron medidos con biometría óptica. La refracción manifiesta se obtuvo al mes de realizada la cirugía. Resultados: La fórmula más precisa y con mejor desempeño general fue PANACEA con un DRA de 0,18 D; cuando consideramos ojos cortos y largos la fórmula Barrett Universal 2 obtuvo menor error de predicción. HAIGIS y LADAS obtuvieron el mejor desempeño en ojos con cámaras estrechas y profundas respectivamente. Conclusión: No se encontraron diferencias en el defecto refractivo absoluto entre las fórmulas tradicionales de tercera generación y las de reciente desarrollo. Algunas fórmulas tuvieron mejor desempeño al considerar ciertas características anatómicas particulares. Es importante personalizar la elección de la fórmula para cada caso específico.

Introduction: Cataract surgery aims to reestablish visual function compromised by lens opacification; Intraocular Lens implantation the aim is to achieve the best visual acuity without additional correction. In recent years, new Intraocular Lens calculation formulas have appeared that could be more accurate than traditional formulas. Objectives: To compare the accuracy of 8 intraocular lens calculation formulas in the prediction of postoperative refraction with a single optical biometry device in patients undergoing cataract surgery with phacoemulsification technique. Materials and methods: Consecutive retrospective case series. Between May 1 2017 and May 1 2018; 100 patients undergo uncomplicated cataract surgery with Intraocular Lens implantation using the phacoemulsification technique. One surgeon did the cases. Optical Biometry was performed using the IOL Master 500 device. Manifest refraction was obtained one month after the surgery. Results: PANACEA was the most accurate formula; with an Absolute Refractive Defect of 0,18 D. When Considering only short and long eyes Barrett Universal 2 got the smallest defect. HAIGIS and LADAS performed better in eyes with narrow and deep anterior chamber respectively. Conclusion: No differences in Absolute Refractive Defect were found between traditional third-generation formulas and those of recent development. Some formulas performed better when considering certain particular anatomical features. It is important to customize the choice of the formula for each specific case.

Result of implantation of scleral-fixated posterior chamber intraocular lenses / Шинэ санаа Шинэ нээлт

Purpose@#The aim of this study was to determine the surgical and visual outcomes of scleral fixated intraocular lens implantation in eyes with as subluxated and dislocated crystalline lens or traumatic aphakic eyes.@*Methods@#A retrospective and short-term prospective cohort study was carried out in 45 eyes of 43 individuals who underwent SFIOL implantation surgery in First Central Hospital of Mongolia between January 2017 and January 2020 and had a minimum follow-up of 3 months. Pre-operative and post-operative best corrected visual acuity, postoperative outcomes and complications were summarized. Patients after the implantation of a scleral fixated PCIOL were evaluated for the disease etiology, pre- and post-operative best corrected visual acuity, and occurrence of postoperative complications.@*Results@#The analysis included 45 eyes from 43 patients. Thirty-two (74.4%) patients were men and eleven (24.6%) were women . The mean age at implantation was 57.2 ± 20.0. Indications for the IOL implantation included ocular trauma (48.9%), pseudoexfoliation syndrome (22.2%) and Marfan syndrome (15.6%). Disease etiology and age group were compared and results were Marfan syndrome is mostly diagnosed in 20-29 years of age, ocular trauma is usually diagnosed in 30-69 years of age and pseudoexfoliation syndrome is occurred in 70 and above of age. Post-operative visual acuity was improved in all cases from which 35 of patients (77.77%) visual outcome was 6/12 and above. </br> The mean preoperative best corrected visual acuity (BCVA) was 0.083 ± 0.088, which improved to 0.569 ± 0.221 (p<0.001) third month postoperatively and these were statistically significant.</br> The most frequent complication was induced astigmatism, which occurred in 6 eyes which successfully corrected with glasses. Suture erosion occurred in three eyes which successfully relocate it. The most serious complications such as vitreous hemorrhage, retinal detachment, suprachoroidal hemorrhage, endophthalmitis and suture degradation or breakage was not seen.@*Conclusion@#Ab externo SFIOL implantation is a reasonable technique for the management of eyes with aphakia or absence of capsular support, with relatively high visual outcomes and few serious complications.</br> The most frequent cause of aphakia and absence of capsular support was ocular trauma thus, pseudoexfoliation and Marfan syndrome were the most common in elderly and in young age, respectively.

Analysis on influencing factors of corneal edema after phacoemulsification and intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the risk factors of corneal edema after phacoemulsification and intraocular lens implantation in patients with cataract. <p>METHODS: The clinical data of 623 patients with cataract(957 eyes)who underwent phacoemulsification and intraocular lens implantation in our hospital between March 2018 and September 2020 were retrospectively analyzed. Patients with corneal edema observed at any time within the first three days after surgery were included in corneal edema group(82 cases, 82 eyes), and patients without corneal edema were enrolled as non-corneal edema group(541 cases, 875 eyes). The preoperative, intraoperative and postoperative related indexes of the two groups were collected and included in Logistic regression model to screen the high-risk factors. <p>RESULTS: Logistics regression analysis showed that age(<i>OR</i>=1.162), Emery lens nuclear hardness grading(<i>OR</i>=1.301)and perfusion time(<i>OR</i>=1.172)were independent risk factors for corneal edema after phacoemulsification and intraocular lens implantation, and the anterior chamber depth(<i>OR</i>=0.651)were independent protective factors avoiding occurrence(<i>P</i><0.05).<p>CONCLUSION:The factors involved in corneal edema after phacoemulsification and intraocular lens implantation are complicated in patients with cataract. It is necessary to be vigilant for high-risk patients in clinical practice and take preventive measures during perioperative period so as to promote rapid recovery of prognosis and visual function.

Phacoemulsification combined with CTR implantation in the treatment of high myopia with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy of phacoemulsification combined with capsular tension ring(CTR)implantation in the treatment of patients with high myopia complicated with cataract, and to analyze its safety. <p>METHODS: A retrospective analysis was performed on the clinical data of 186 patients(186 eyes)with high myopia and cataract who underwent phacoemulsification+ intraocular lens(IOL)implantation treatment in our hospital. Among them, 98 cases(98 eyes)were combined with CTR implantation(combined group)and 88 cases(88 eyes)were not combined with CTR implantation(control group). The best corrected visual acuity(BCVA, LogMAR), visual quality \〖root mean square value(RMS)of higher-order aberration(HOA)\〗 and corneal endothelial cell density were recorded in the two groups before surgery and at 1, 3 and 6mo after surgery, and the area of anterior capsular orifice and inclination angle of IOL were evaluated at 1, 3 and 6mo after surgery, and the occurrence of complications such as postoperative anterior capsule opacification, posterior capsule opacification and capsular contraction syndrome were compared between the two groups.<p>RESULTS: There were interaction effects in the BCVA between the two groups(<i>P</i><0.05). The BCVA of the two groups after surgery was decreased compared with that before surgery(<i>P</i><0.05), and the BCVA of combined group after surgery was lower than that of control group(<i>P</i><0.05). There were interaction effects in the total HOA RMS(<i>P</i><0.05), and the total HOA RMS of the two groups after surgery was increased compared with that before surgery(<i>P</i><0.05), and the total HOA RMS after surgery in combined group was lower than that in control group(<i>P</i><0.05). There were interaction effects in the anterior capsular orifice area after surgery between the two groups(<i>P</i><0.05), and the area in the two groups was decreased with the prolongation of postoperative time(<i>P</i><0.05), and the area in combined group at 3 and 6mo after surgery was higher than that in control group(<i>P</i><0.05). The IOL inclination angle of the two groups had interaction effects between the two groups(<i>P</i><0.05), and the angle of the two groups was increased with the prolongation of postoperative time(<i>P</i><0.05), and the angle of combined group at 3 and 6mo after surgery was lower than that of control group(<i>P</i><0.05). The corneal endothelial cell density in the two groups after surgery was lower than that before surgery(<i>P</i><0.05), but there was no interaction effect(<i>P</i> >0.05).<p>CONCLUSION: Phacoemulsification+ IOL implantation + CTR implantation can improve the visual function of patients with high myopia complicated with cataract, with few postoperative complications and good efficacy and safety.

Curative effect of phacoemulsification and IOL implantation combined with trabeculectomy in the treatment of cataract with glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe the effect of phacoemulsification and intraocular lens(IOL)implantation combined with trabeculectomy on the central anterior chamber depth(ACD)and astigmatism of patients with cataract and glaucoma.<p>METHODS:This prospective study included 100 patients(100 eyes)with cataract and glaucoma who were admitted to the hospital between November 2018 and November 2019. The patients were divided into control group(<i>n</i>=50, 50 eyes)and observation group(<i>n</i>=50, 50 eyes)by the random number table method. The control group was treated with phacoemulsification and IOL implantation, while the observation group was treated with phacoemulsification and IOL implantation combined with trabeculectomy. The LogMAR visual acuity, intraocular pressure(IOP), ACD and astigmatism at 1wk, 2wk and 1mo after operation, visual quality, and the incidence of complications were compared between the two groups. <p>RESULTS:Compared with preoperative, the ACD of the two groups increased, LogMAR visual acuity and IOP decreased at 1wk, 2wk and 1mo after operation(<i>P</i><0.05). Moreover, the ACD of the observation group at 1wk, 2wk and 1mo after operation were higher than those of the control group, and the LogMAR visual acuity, IOP was lower than that of the control group(<i>P</i><0.05). The astigmatism of the two groups increased at 1,2wk after operation, and obseration group decreased at 1mo after operation(<i>P</i><0.05). Meanwhile, the astigmatism of the observation group was lower than that of the control group(<i>P</i><0.05). At 1mo after operation, the scores of watching TV, reading and writing, and fine operation of the observation group were higher than those of the control group(<i>P</i><0.05). The incidence of complications in the observation group was lower than that in the control group(6% <i>vs </i>22%, <i>P</i><0.05). <p>CONCLUSION:Phacoemulsification and IOL implantation combined with trabeculectomy is markedly effective in the treatment of patients with cataract and glaucoma, which can improve vision and visual quality. Lower intraocular pressure and astigmatism, reduce changes in astigmatism, deepen the central anterior chamber depth, and reduce the incidence of complications.

Analysis of effectiveness and influencing factors of phacoemulsification combined with IOL implantation in the treatment of PACG / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the effectiveness and influencing factors of phacoemulsification combined with intraocular lens(IOL)implantation in the treatment of primary angle-closure glaucoma(PACG). <p>METHODS: Clinical data of 75 patients(75 eyes)with PACG who received phacoemulsification and IOL implantation in our hospital from January 2017 to December 2018 were retrospectively analyzed. Postoperative intraocular pressure(IOP), best-corrected visual acuity(BCVA), changes of anterior segment and incidence of complications were counted. The patients were grouped by efficacy, and multivariate Logistic regression analysis was performed to analyze the risk factors influencing the effectiveness of phacoemulsification and IOL implantation in patients with PACG. <p>RESULTS: Postoperative IOP of patients with PACG was decreased while BCVA was increased, and there were statistically significant differences compared with those before operation(<i>P</i><0.05). Central anterior chamber depth(ACD), angle opening distance(AOD500), trabecular iris angle(TIA500)and angle recess area(ARA)were increased significantly compared with those before operation(<i>P</i><0.05). Multivariate Logistic regression analysis showed that chronic PACG and preoperative IOP were independent risk factors for efficacy of phacoemulsification and IOL implantation in patients with PACG(<i>P</i><0.05). <p>CONCLUSION: Phacoemulsification combined with IOL implantation has good efficacy and safety in the treatment of PACG. However, it is necessary to pay attention to preoperative IOP control. What's more, it should be carefully considered whether this operation is necessary for patients with chronic PACG.

Comparison of outcomes of two intraocular lens implantation procedures for aphakic eyes without capsular support / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the curative effect of retropupillary iris claw intraocular lens(IOL)implantation and posterior chamber ciliary scleral suture fixed IOL in the aphakic eyes without capsular support.<p>METHODS: The present retrospective study included 70 aphakic eyes without capsular support. According to the different surgical methods, the patients were divided into two groups, including group A(35 eyes)with treatment of retropupillary iris claw IOL implantation, group B(35 eyes)with treatment of posterior chamber ciliary scleral suture fixed IOL. The uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), intraocular pressure(IOP)and corneal endothelial cell density(CECD)of the two groups were documented and compared before operation and 3d, 1, 3, 6mo and 1a after operation. Furthermore, the stability of IOL in both groups, as well as the intraoperative and postoperative complications were recorded.<p>RESULTS: The patients in the present study were followed up for 12 to 14mo. 3d after surgery, UCVA in group A was significantly improved compared with that before surgery(<i>P</i><0.01), while BCVA had no difference compared with that before surgery(<i>P</i>=0.073).UCVA in group B showed no difference(<i>P</i>=0.097), while BCVA was worse(<i>P</i>=0.002). UCVA and BCVA in both groups were significantly elevated 1mo after surgery(<i>P</i><0.05), and remained stable 6, 3mo later,respectively. Furthermore, IOP in both groups remained in normal level during the follow up period, 0.7% and 2.3% reduction of CECD in A group and B gruop was observed at 1a after operation respectively(<i>P</i><0.05). Both IOP and CECD between the two groups have no significant differenc at each time point during the follow up period(<i>P</i>>0.05).There was no significant difference between whole eye astigmatism and corneal astigmatism in A group and B gruop at 1 and 6mo after operation(<i>P</i>>0.05). Additionally, There was 1 case of IOL dislocation in each group after operation, which was further recovered by operation. Significant tilt and deviation of IOL were not observed in the rest of the patients during the follow up period. The other postoperative complications were mild with no difference in complications between the two groups(<i>P</i>>0.05).<p>CONCLUSION: For aphakic eyes without capsular support, both retropupillary iris claw IOL implantation and posterior chamber ciliary scleral suture fixed IOL are safe and effective surgical methods. Retropupillary iris claw IOL implantation has relatively simple operation, lower damage to the eyeball tissue, the shorter operation time, and the quicker recovery of postoperative visual acuity, which is one of the effective clinical treatments.

Application of 23G vitrectomy system in pediatric congenital cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the therapeutic effect of 23G vitrectomy system used in children with congenital cataracts.<p>METHODS: From November 2017 to December 2018, 11 children(19 eyes)aged 3-8 years old with congenital cataract were recruited in the Department of Ophthalmology, the First Affiliated Hospital of Hainan Medical University. 23G vitrectomy instruments were used to enter the anterior chamber through the incision at the corneal limbus, and complete ring resection of anterior capsule, cataract aspiration, intraocular lens implantation, and ring resection of posterior capsule combined with anterior vitrectomy. The visual acuity, intraocular pressure and ocular conditions of the children were observed during 3-24mo of follow-up.<p>RESULTS: All the surgeries were uneventful. During the surgeries, the anterior chambers were stable, the ring resections of lens capsules were accurate, and the IOLs were implanted at the 1^st phase. The postoperative visual acuity was significantly improved compared with that before surgery. Only 1 patient had intraocular pressure higher than 25mmHg after surgery, which was controlled within the normal range after medication was given. During the follow-up period, all the children had clear corneas, no anterior chamber hemorrhage, no pupil deformation, the intraocular lens was in the center and the right position, the optic axis was transparent, and no obvious complications occurred.<p>CONCLUSION: The 23G vitrectomy system is safe and effective for the surgery of congenital cataract, it can achieve little trauma, accurate lens capsule resection, little postoperative reaction and few complications.

Efectividad de la técnica manual de cirugía de catarata con incisión pequeña en un establecimiento privado de salud / Effectiveness of the manual technique of cataract surgery with small incision in a private health facility

Resumen Objetivo: Determinar la efectividad de la técnica manual de cirugía de catarata con incisión pequeña (MSICS) considerando agudeza visual, astigmatismo postoperatorio, complicaciones perioperatorias y mejora de la calidad de vida de los pacientes en función de la visión. Material y métodos: Estudio observacional, descriptivo, de corte transversal de pacientes operados de catarata con MSICS, entre el 2 de noviembre del 2009 y 30 de abril del 2010 en un centro oftalmológico privado de Lima. Se registraron las características demográficas y socioeconómicas, agudeza visual (AV), complicaciones perioperatorias, astigmatismo pre y postoperatorio y calidad de vida en función de la visión (CVFV). Resultados: Se realizaron 806 cirugías en 591 pacientes. La media de edad fue 75 años, 304 (51,49%) casos fueron del sexo femenino y 501 (84,74%) procedentes de Lima Metropolitana. Al alta, la AV sin corrección fue de 20/40 o mejor en 481 casos (59,64%), con astigmatismo quirúrgicamente inducido menor de 2,00 D en 732 (90,80%). En 64 (7,94%) casos ocurrieron complicaciones intraoperatorias y en 52 (6,45%), postoperatorias. La percepción de la CVFV del paciente en función de la visión a los 30 días fue: "Buena" en 311 (41,25%), "Muy Buena" en 405 (53,71%) con diferencia significativa (p<0.05) en relación a la evaluación preoperatoria. Conclusiones : El MSICS es una técnica quirúrgica altamente efectiva considerando una buena agudeza visual y bajo astigmatismo inducido postoperatorios, bajo porcentaje de complicaciones y significativa mejora de la CVFV del paciente.

Objective: To determine the effectiveness of the manual technique of cataract surgery with small incision (MSICS) considering visual acuity, postoperative astigmatism, perioperative complications and improvement of the quality of life of patients based on vision. Methods: Observational, descriptive, cross-sectional study in patients operated on cataract with MSICS, between November 2, 2009 and April 30, 2010 in a private ophthalmological center in Lima. Demographic and socioeconomic characteristics, visual acuity (VA), perioperative complications, pre and postoperative astigmatism and quality of life based on vision (CVFV) are included. Results: 806 surgeries were performed in 591 patients. The mean age was 75 years, 304 cases (51.49%) were female and 501 (84.74%) from Metropolitan Lima. The VA without correction at discharge was 20/40 or better in 481 (59.64%) cases, with surgically induced astigmatism less than 2.00 D in 732 (90.80%). Intraoperative complications occurred in 64 cases (7.94%) and postoperative complications in 52 (6.45%). The patient's CVFV perception based on vision at 30 days was "Good" in 311 (41.25%), "Very Good" in 405 (53.71%) with significant difference (p <0.05) in relation to the preoperative evaluation. Conclusions: The MSICS is a highly effective surgical technique considering good visual acuity and low postoperative induced astigmatism, low percentage of complications and significant improvement of the patient's CVFV.

Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: A randomized prospective study

Purpose: To compare surgical outcome of two procedures in pediatric cataract surgery. Methods: Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted. Results: 15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 � 14.7 months. At a mean follow up of 25.69 � 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039. Conclusion: Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.

Therapeutic effects of phacoemulsification respectively combined with diffractive multifocal IOL and monofocal IOL implantation in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the therapeutic effects of phacoemulsification respectively combined with diffractive multifocal intraocular lens(IOL)and monofocal IOL implantation in the treatment of cataract. <p>METHODS: A total of 99 cataract patients(145 eyes)who underwent phacoemulsification combined with IOL implantation in the hospital from January 2015 to February 2019 were divided into observation group(<i>n</i>=51, 75 eyes)and control group(<i>n</i>=48, 70 eyes)according to the non-randomized clinical trial and patient voluntary principles. The observation group was treated with diffractive multifocal IOL implantation, while the control group was treated with monofocal IOL implantation. The visual acuity, corneal endothelial cell count, loss rate of corneal endothelial cells, results of corneal topography, and contrast sensitivity(CS)in daytime, day glare time, nighttime and night glare time were compared between two groups. The complications and spectacles-independent rate were counted. <p>RESULTS: At 1wk, 1mo and 3mo, there were no significant differences in the best corrected distance visual acuity(BCDVA)and best corrected near visual acuity(BCNVA)between two groups(<i>P</i>>0.05). However, the uncorrected distance visual acuity(UCDVA)at 1wk and 1mo, the uncorrected near visual acuity(UCNVA)and the distance corrected near visual acuity(DCNVA)at 1wk, 1mo and 3mo of the observation group were significantly lower than those of the control group(<i>P</i><0.05). After surgery, corneal endothelial cell counts and astigmatism of two groups decreased significantly. No significant differences were found in corneal endothelial cell count, loss rate of corneal cells and astigmatism between two groups(<i>P</i>>0.05). CS in daytime of 1.5c/d frequency band, in day glare time of 1.5c/d, 3c/d and 6c/d frequency bands, in nighttime of 3c/d and 18c/d frequency bands, in night glare time of 3c/d, 6c/d and 18 c/d frequency bands were significantly lower, while CS in daytime of 12c/d frequency band was significantly higher in the observation group than in the control group. There was no significant difference in the incidence of complications between two groups(<i>P<</i>0.05), but the spectacles-independent rate was significantly higher in the observation group than in the control group(<i>P</i><0.05). <p>CONCLUSION: Phacoemulsification combined with diffractive multifocal IOL implantation can obtain good total range visual acuity, with a higher spectacles-independent rate and relatively low CS after surgery.

Effect of phacoemulsification and intraocular lens implantation on corneal endothelial cells in patients with glaucoma and cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effect of phacoemulsification and intraocular lens implantation on corneal endothelial cells(CECs)in patients with glaucoma and cataract. <p>METHODS: The clinical data of 107 patients(113 affected eyes)with glaucoma and cataract who were treated in the hospital during the period from October 2016 to October 2018 were retrospectively analyzed. Patients treated with trabeculectomy or phacoemulsification combined with intraocular lens implantation were included in the control group(<i>n</i>=52, 54 affected eyes)and the study group(<i>n</i>=55, 59 affected eyes). The changes in visual acuity, anterior chamber depth and intraocular pressure before and after surgery, CECs related indexes and incidence of postoperative complications were compared between the two groups. <p>RESULTS: There was no significant difference in visual acuity between the two groups before surgery(<i>P</i>>0.05). The visual acuity of both groups were significantly improved after surgery(<i>P</i><0.05), and the improvement in study group was better than that in control group(<i>P</i><0.05).The anterior chamber depth in both groups increased, while intraocular pressure decreased after surgery(<i>P</i><0.05). After surgery, anterior chamber depth in study group was significantly larger than that in control group(<i>P</i><0.05), but there was no significant difference in intraocular pressure between the two groups(<i>P</i>>0.05). The cell area variation coefficient, hexagonal cell ratio, average cell area and corneal center thickness in control group increased significantly, while CECs density decreased significantly after surgery(<i>P</i><0.05). However, there was no significant difference in CECs related indexes in study group before and after surgery(<i>P</i>>0.05). After surgery, changes levels of CECs related indexes in study group were significantly lower than those in control group(<i>P</i><0.05). The incidence rates of postoperative complications in study group and control group were 5.1% and 20.4%, respectively(<i>P</i><0.05).<p>CONCLUSION: The application of phacoemulsification and intraocular lens implantation in the treatment of glaucoma with cataract can improve the visual acuity and intraocular pressure of patients, maintain structural integrity of CECs, with safety.

Effect of phacoemulsification combined with different types of IOL implantation in age-related cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the effects of phacoemulsification(Phaco)combined with different types of intraocular lens implantation(IOL)on age-related cataract. <p>METHODS: A retrospective study was performed on 105 elderly patients with age-related cataract who were treated with surgery in our hospital, and they were divided into group A(35 cases, 51 affected eyes), group B(35 cases, 49 affected eyes)and group C(35 cases, 52 affected eyes). All subjects were treated by IOL+Phaco, and types of IOL in the three groups were three-piece and single-piece Natural and Rayner. The preoperative and postoperative biological measurement indexes and postoperative complications were compared among the three groups. <p>RESULTS: At 3mo after surgery, the intraocular pressure(IOP)in three groups was significantly decreased(<i>P</i><0.05)while the angle opening distance(AOD500), trabecular iris angle(TIA500), central anterior chamber depth(ACD), trabecular-ciliary processes distance(TCPD), each quadrant angle, uncorrected visual acuity and best corrected visual acuity(BCVA)were significantly increased(<i>P</i><0.05). The ACD and TIA500 in group A were significantly higher than those in groups B and C(<i>P</i><0.05),and there were no significant differences in the uncorrected visual acuity, BCVA and other biological measurement indexes among the three groups(<i>P</i>>0.05). There were significant differences in vertical shift and horizontal shift of intraocular lens among the three groups at 1mo and 3mo after surgery(<i>P</i><0.05), and the vertical shift and horizontal shift of intraocular lens at 1mo and 3mo after surgery in group A were lower than those in groups B and C(<i>P</i><0.05), and there were no significant differences in vertical shift and horizontal shift between group B and group C(<i>P</i>>0.05).The incidence rate of posterior capsule wrinkle in group A after surgery was obviously higher than that in group B and group C(<i>P</i><0.05). <p>CONCLUSION: The intraocular stability and safety of Phaco+single-piece IOL are better than those of Phaco+ three-piece IOL, but Phaco+ three-piece IOL has deeper ACD after surgery and can prevent the forward shift of IOL, and they have their own advantages and disadvantages.

Influencing factors of curative effect of PHACO combined with intraocular lens implantation in the treatment of high myopia with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze influencing factors of the curative effect of phacoemulsification(PHACO)combined with intraocular lens implantation in the treatment of high myopia with cataract.<p>METHODS: The clinical data of 80 cases patients(91 affected eyes)with cataract and high myopia who underwent phacoemulsification and intraocular lens implantation in the hospital from February 2016 to March 2019 were analyzed retrospectively. According to the best corrected visual acuity(BCVA)at 3mo after operation, the patients were divided into low vision group(BCVA<0.3)and normal group(BCVA≥0.3). The preoperative clinical data of the two groups were compared, and the factors affecting visual recovery were analyzed.<p>RESULTS: All patients completed surgery successfully, and there were statistically significant differences in BCVA before and after surgery(<i>P</i><0.001). No serious complications such as corneal decompensation, secondary glaucoma and intraocular lens displacement were found. There were significant differences in age, myopia time, axial length, preoperative intraocular pressure, corneal astigmatism, anterior capsular opening area, central anterior chamber depth, grade of lens nucleus and incidence rates of diabetic retinopathy, posterior scleral staphyloma, macular degeneration and postoperative macular edema between the low vision group and the normal group(<i>P</i><0.05). Multivariate Logistic regression analysis showed that axial length >30 mm, preoperative intraocular pressure ≥21mmHg, corneal astigmatism ≥1.30D, grade Ⅲ-Ⅳ lens nucleus, preoperative diabetic retinopathy and macular degeneration were the independent risk factors for postoperative visual recovery in patients with high myopia and cataract(<i>P</i><0.05).<p>CONCLUSION: PHACO combined with intraocular lens implantation is markedly effective in the treatment of high myopia with cataract. However, the curative effect is affected by axial length, preoperative intraocular pressure, corneal astigmatism, grade of lens nucleus, preoperative diabetic retinopathy and macular degeneration, which deserves attention.

Sutureless transconjunctival intrascleral intraocular lens fixation: the modified Yamane technique / Fixação de lente intraocular intraescleral transconjuntival sem sutura: técnica de Yamane modificada

ABSTRACT Purpose: To evaluate the efficacy and safety of the modified Yamane technique with sutureless transconjunctival intrascleral intraocular lens fixation. Methods: Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dislocated intraocular lenses. A clear corneal incision (2.8 mm) was made into the temporal quadrant and a three-piece intraocular lens was implanted into the anterior chamber. The haptics of the intraocular lens were externalized with a 27 G needle via transconjunctival scleral tunnels at the 6 and 12 o'clock positions. The transconjunctival scleral tunnels were prepared to conform to the haptic position and curvature. The site of the scleral tunnels was 2mm from the limbus with a length of 2 mm in the sclera and was aimed at the end of the posterior chamber. The tips of the haptics were cauterized to create a terminal knob. The haptics were pushed back and the knobs were implanted into the scleral tunnels. Results: The study cohort included 21 patients with unilateral aphakia and dislocated intraocular lenses. All patients were examined postoperatively and at postoperative day 1, day 7, month 1, and month 3. All examinations revealed formation of the anterior chamber and well-centralized intraocular lenses. No haptic-related complications of exposure, foreign body sensation, or discomfort were observed. Conclusion: Sutureless transconjunctival intrascleral haptic fixated intraocular lensimplantation is an effective, safe, and practical surgical alternative. This technique was superior to the Yamane method with regard to comfort and surgical duration. Further studies with longer follow-up evaluations are warranted to verify long-term complications.

RESUMO Objetivo: Avaliar a eficácia e a segurança da técnica de Yamane modificada com a fixação de lenta intraocular transconjuntival sem sutura. Métodos: O implante de lente intraocular intraescleral e transconjuntival sem sutura foi realizado em pacientes com afacia e lentes intraoculares luxadas. Uma incisão em córnea clara (2,8 mm) foi feita no quadrante temporal e uma lente intraocular de três peças foi implantada na câmara anterior. Os hápticos da lente intraocular foram externalizados com uma agulha 27G através de túneis esclerais transconjuntivais nas posições de 6 e 12 horas. Os túneis esclerais transconjuntivais foram preparados para se ajustarem à posição e curvatura hápticas. O local dos túneis esclerais foi de 2 mm do limbo com um comprimento de 2 mm na esclera e foi destinado ao final da câmara posterior. As pontas dos hápticos foram cauterizadas para criar uma saliência terminal. Os hápticos foram empurrados para tras e as saliências foram implantadas nos túneis esclerais. Resultados: A coorte do estudo incluiu 21 pacientes com afacia unilateral e lentes intraocular deslocada. Todos os pacientes foram examinados no pós-operatório e no dia 1, 7, 1 mês e 3 meses do pós-operatório. Todos os exames revelaram formação da uma câmara anterior e lentes intraoculares bem centralizadas. Nenhuma complicação hápticas relacionada à exposição, sensação de corpo estranho ou desconforto foram observadas. Conclusão: O implante de lente intraocular transconjuntival intraescleral sem sutura é uma alternativa cirúrgica eficaz, segura e prática. Esta técnica foi superior ao método de Yamane no que diz respeito ao conforto e duração cirúrgica. Mais estudos com avaliações de seguimento mais prolongados são necessários para verificar as complicações de longo prazo.