Intracorneal implantation of a misdirected foldable intraocular lens during phacoemulsification surgery: a case report / Implantação intracorneana de uma lente intraocular dobrável direcionada incorretamente durante cirurgia de facoemulsificação: relato de caso

ABSTRACT A 59-year-old man presented with a unilateral blurring of vision in his left eye. His left eye's visual acuity was hand movements level. He underwent phacoemulsification surgery, and an intrastromal posterior chamber intraocular lens was implanted. The intrastromal intraocular lens was extracted and a new intraocular lens was implanted. Usinge the Snellen chart, the final best-corrected visual acuity was 20/40. With this case report, we wish to emphasize that a single stepwise clear corneal incision merged with wound-assisted intraocular lens injections can result in intraocular lens misdirection into the corneal stroma. As a result, while performing a misdirected intraocular lens removal, we recommend that the wound be carefully constructed.

RESUMO Um homem de 59 anos apresentou embaçamento visual unilateral no olho esquerdo. Sua acuidade visual nesse olho era no nível de movimentos da mão. O paciente havia se submetido a uma cirurgia de facoemulsificação em que foi feita a implantação intraestromal de uma lente intraocular de câmara posterior. Foi feita a extração dessa lente intraestromal intraocular e uma nova lente intraocular foi implantada. A melhor acuidade visual corrigida final foi de 20/40 pela tabela de Snellen. Com este relato de caso, os autores desejam apontar que uma incisão de degrau único em córnea clara, quando combinada com a injeção de uma lente ocular através da incisão, pode levar a um direcionamento incorreto da lente intraocular para dentro do estroma corneano. Portanto, recomenda-se uma construção cuidadosa da incisão ao se remover uma lente intraocular direcionada incorretamente.

Calculation formulas and influence factors of effective lens position / 中华实验眼科杂志

Cataract extraction is often combined with the implantation of intraocular lens (IOL) with the diopter matching the operated eye to restore optimal visual function after surgery.However, there are often errors between the actual refractive power of the operated eye and the predicted value.One of the major causes of postoperative refractive error is the change in IOL position compared with the expected position.In order to improve the accuracy of postoperative refraction prediction, Holladay proposed to introduce the concept of effective lens position (ELP) into the IOL diopter calculation formula.The differences in the parameters and algorithms incorporated in the calculation of ELP lead to differences in the accuracy of IOL calculation formulas.With the application of multi-parameter calculation methods, especially the formula based on the artificial intelligence algorithm, the accuracy of IOL calculation formula has been significantly improved.ELP is also affected by various factors such as differences in ocular anatomy, IOL design and material, and surgical procedures, especially the factors affecting the stability of the capsular bag that increase the difficulty of accurately predicting ELP.Therefore, the changes in postoperative ELP need to be further discussed in order to obtain more accurate postoperative refraction.This article aimed to give a review of the development of calculation formulas and the influencing factors of ELP.

Equivalent keratometer reading para cálculo biométrico em córneas assimétricas: série de casos / Equivalent keratometer reading tool for biometric calculation in asymmetric corneas: case series

RESUMO A acurácia do cálculo da lente intraocular não é perfeita, podendo ser comuns erros refrativos pós-operatórios, especialmente em pacientes submetidos à cirurgia refrativa prévia ou na presença de córneas assimétricas. O poder corneano após cirurgia refrativa pode ser medido com maior acurácia utilizando o mapa de poder óptico total na zona central de 4mm, com Orbscan II ou pelo mapa equivalent keratometric reading disponível no pentacam, com medidas centrais de 1,0, 2,0, 3,0 e 4,5mm. O objetivo desta série de casos é demonstrar a abordagem de quatro olhos em condições especiais corneanas, por meio do equivalent keratometric reading do pentacam para mensuração do poder corneano e o utilizando na biometria, em comparação com possíveis resultados obtidos com outras estratégias. Os quatro olhos foram submetidos a procedimentos refrativos prévios, e a lente intraocular escolhida a partir do uso do poder corneano calculado pelo equivalent keratometric reading mostrou excelentes resultados pós-operatórios.

ABSTRACT The accuracy of the intraocular lens calculation is not perfect, and postoperative refractive errors are common, especially in patients who have undergone previous refractive surgery or in presence of asymmetric corneas. Corneal power after refractive surgery can be more accurately measured using the total optical power map in the 4-mm central zone, by means of Orbscan II or equivalent keratometric reading map available on pentacam, with central measurements of 1.0, 2.0, 3.0 and 4.5 mm. The purpose of this case series is to demonstrate four approaches performed in special corneal conditions, using pentacam equivalent keratometric reading to measure corneal power and biometrics, and comparing with possible results obtained with other strategies. The four eyes were submitted to previous refractive procedures, and the intraocular lens chosen from the use of the corneal power calculated by equivalent keratometric reading showed excellent postoperative results.

Trocar-assisted, flanged haptics, sutureless intrascleral fixated intraocular lens implantation combined with Descemet membrane endothelial keratoplasty / Implante de lente intraocular assistida com trocarte, com háptico flangeado e fixação intraescleral sem sutura, combinada com ceratoplastia endotelial da membrana de Descemet

ABSTRACT This article reports a combined technique of sutureless intrascleral fixated intraocular lens implantation and Descemet membrane endothelial keratoplasty in a patient with anterior pseudophakic bullous keratopathy. Two scleral tunnels were created, corneal incisions were made, and a foldable intraocular lens was cut and removed from the anterior chamber. After performing anterior vitrectomy, a 3-piece foldable intraocular lens was implanted into the anterior chamber. One of the intraocular lens haptics was grasped with a forceps and pulled out from the scleral tunnel. Then, the end of the haptic was cauterized. Similar maneuvers were applied for the other haptic. Next, an 8-mm-diameter donor tissue was prepared, and the recipient endothelial tissue was peeled and removed from the center of the recipient cornea. The prepared donor tissue was injected into the anterior chamber. After proper opening and placement of the donor tissue, an air bubble was injected below the tissue. There were no postoperative complications during the 1-month follow-up.

RESUMO Relato de uma técnica que combina o implante de uma lente intraocular com fixação intraescleral sem sutura e uma ceratoplastia endotelial da membrana de Descemet em paciente com ceratopatia bolhosa pseudofácica anterior. Foram criados dois túneis esclerais. Foram feitas incisões na córnea e a lente intraocular dobrável foi cortada e removida da câmara anterior. Foi então efetuada uma vitrectomia anterior e uma lente intraocular dobrável de 3 peças foi implantada na câmara anterior. Um dos hápticos da lente intraocular foi pinçado com um fórceps e puxado para fora do túnel escleral. A extremidade do háptico foi cauterizada. Manobras semelhantes foram feitas no outro háptico. Foi preparado um tecido de doador com 8 mm de diâmetro e o tecido endotelial da área receptora foi removido do centro da córnea. O tecido preparado do doador foi injetado na câmara anterior. Após abertura e posicionamento adequados do tecido do doador, foi injetada uma bolha de ar abaixo do tecido. Não foi observada nenhuma complicação pós-operatória durante um mês de acompanhamento.

In-the-bag toric intraocular lens implantation in the case of an anterior capsule tear: a case series / Implantação de lentes intraoculares tóricas no saco capsular em casos de ruptura da cápsula anterior: uma série de casos

ABSTRACT Purpose: To analyze the outcomes of in-the-­bag toric intraocular lens implantation for anterior capsular tears during phacoemulsification. Methods: The cohort of this re­trospective, consecutive, interventional case series included eight patients. One patient was excluded as the tear was used to enlarge the rhexis. The mean preoperative astigmatism was -1.67D (± 0.98) and the mean preoperative unaided logMAR visual acuity was 0.62 (± 0.76). The mean angle between the anterior capsule tear and the closest intraocular lens haptic was 51.25° (range, 30°-90°). Results: The final unaided logMAR visual acuity was 0.16 (± 0.21) and the final cylinder was -1.1 D (± 0.59). The mean follow-up duration was about 2 ± 1.2 months. In this case series, no lens had to be explanted or rotated postoperatively. Placement of a toric intraocular lens in the presence anterior capsule tear was safe in all patients. An angle of at least 30° remained between the tear and the intraocular lens haptic. Conclusion: Placement of toric intraocular lens in the presence of an anterior capsule tear may be safe, at least in cases with a 30° angle between the anterior capsule tear and the intraocular lens haptic.

RESUMO Objetivo: Analisar os resultados do implante de lentes intraoculares tóricas para rupturas capsulares anterio­res durante a facoemulsificação. Métodos: A coorte desta série re­trospectiva, consecutiva e intervencional de casos que inclui 8 pacientes. Um paciente foi excluído quando a lágrima foi usada para aumentar a rexe. O astigmatismo pré-operatório médio foi de -1,67 D (± 0,98) e a média da acuidade visual logMAR sem intervenção pré-operatória foi de 0,62 (± 0,76). A média do ângulo entre a ruptura da cápsula anterior e o háptico mais próximo da lente intraocular foi de 51,25° (variação, 30°-90°). Resultados: A acuidade visual logMAR final sem ajuda foi de 0,16 (± 0,21) e o cilindro final foi de -1,1 D (± 0,59). O tempo médio de acompanhamento foi de aproximadamente 2 ± 1,2 meses. Nesta série de casos, nenhuma lente teve que ser removida ou rotacionada no pós-operatório. A colocação de uma lente intraocular tórica na presença de uma ruptura da cápsula anterior mostrou-se segura em todos os pacientes. Um ângulo de pelo menos 30° permaneceu entre a ruptura e o háptico da lente intraocular. Conclusão: A colocação de lente intraocular tórica na presença de uma ruptura da cápsula anterior pode ser segura, pelo menos em casos com um ângulo de 30° entre a ruptura da cápsula anterior e o háptico da lente intraocular.

Lente Macular Scharioth / Scharioth Macula Lens (SML)

Resumo Objetivo: Revisar criticamente a literatura sobre o implante intraocular da Lente Macular Scharioth (SML) em pacientes com estágios avançados de Degeneração Macular Relacionada à Idade (DMRI). Métodos: A pesquisa bibliográfica foi feita nas bases de dados do Pubmed e Google Acadêmico, com os termo dry AMD, devices e Scharioth Macula Lens. Utilizamos os artigos prospectivos, retrospectivos ou relatos de casos publicados em inglês ou português nos últimos cinco anos, com esses termos. Resultados: Foram encontrados um total de 19 artigos, todos em inglês. Sendo que destes, 5 relacionavam-se a complicações da cirurgia de catarata e outro à degeneração macular exsudativa e foram excluidos. Portanto, foram utilizadas 13 referências para esta revisão. Conclusão: A Scharioth Macula Lens foi desenvolvida como lente intraocular suplementar para olhos pseudofácicos com DMRI, mas vem sendo usada também em pacientes com outra maculopatias. Os resultados iniciais relatados são animadores.

Abstract Objective: In this review we critically evaluated the publications on the intraocular implant of the Scharioth Macular Lens (SML) in patients with advanced stages of Age-Related Macular Degeneration (AMD). Methods: The literature search was done in Pubmed and Google Scholar database, with the term dry AMD, devices and Scharioth Macula Lens. We use prospective, retrospective articles or case reports published in English or Portuguese in the last five years under these terms. Results: A total of 19 articles were found, all in English. Of these, 5 were related to complications of cataract surgery and another to Exudative Macular Degeneration. Therefore, 13 references were used for this review. Conclusion: Scharioth Macula Lens was developed for pseudophakic eyes with AMD and has also been used in patients with other maculopathies. The initial results reported are encouraging.

Results of Scharioth macular lens implant in patients with age-related macular degeneration / Resultado do implante de lente macular Scharioth em pacientes com degeneração macular relacionado a idade

Abstract Objective: To describe the outcomes in terms of near visual acuity and quality of life in 10 patients submitted to Scharioth Macular Lens implantation. Setting: João Eugênio Eye Institute, Brasilia, Brazil. Design: Uncontroled clinical trial. Methods: Ten pseudophakic patients with DMRI were submitted to the implantation of intraocular SML in the dominant eye in the period of December of 2017 to the March of 2018. All the patients had answered the Low-Vision Quality of Life Questionaire (LVQOLQ) before and after the surgery, with interval of 30 days. Results: The results points showed a statistical significant improvement (p<0.001) in the near visual acuity (NVA), without interference in the distance vision. All patients had significant improvements (p<0,05) in LVQOLQ on the item that evaluates the near visual acuity. Conclusion: There was an improvement of NVA in all 10 patients, as well as an enhancement to the quality of life in the postoperative period when compared to the preoperative period.

Resumo Objetivo: Descrever os resultados em termos de acuidade visual para perto e qualidade de vida em 10 pacientes submetidos ao implante de Lentes Maculares Scharioth. Local: Clínica de Olhos João Eugênio, Brasilia, Brasil. Design: Ensaio clínico não controlado. Métodos: Dez pacientes pseudofácicos com DMRI foram submetidos ao implante de SML intraocular no olho dominante no período de dezembro de 2017 a março de 2018. Todos os pacientes responderam ao Questionário de Qualidade de Vida em Baixa Visão (LVQOLQ) antes e após a cirurgia, com intervalo de 30 dias. Resultados: Os pontos de resultados mostraram uma melhora estatisticamente significativa (p <0,001) na acuidade visual para perto (AVP), sem interferência na visão à distância. Todos os pacientes tiveram melhora significativa (p <0,05) no LVQOLQ no item que avalia a acuidade visual para perto. Conclusão: Houve melhora na AVP em todos os 10 pacientes, além de um aumento da qualidade de vida no período pós-operatório quando comparado ao período pré-operatório.

A case of late-onset capsular block syndrome and its surgical treatment / Um caso de síndrome de bloqueio capsular tardio e uma abordagem cirúrgica

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.

Bilateral clear lens extraction and intraocular lens implantation in a child with microspherophakia and Marfan syndrome / Extração bilateral de cristalino transparente e implante de lente intraocular em criança com microesferofacia e síndrome de Marfan

ABSTRACT We report the case of a 4-year-old boy with Marfan syndrome whose parents reported he had had low visual acuity since birth. On examination, there was microspherophakia and a small subluxation of the lens. The objective refraction was -23.75 - 2.75 x 70 in the right eye and -25.50 -3.50 x 90 in the left eye. Since the microspherophakia and the high myopia severely affected the boy's quality of life, clear lens extraction, anterior vitrectomy, posterior surgical capsulotomy via the pars plana, and intraocular lens implantation were performed. Two years postoperatively, the patient had centered intraocular lenses and a corrected visual acuity of 20/30 in both eyes. The child was satisfied with his vision and was able to study and perform daily activities without visual limitations.

RESUMO Reportamos o caso de um menino de 4 anos de idade com Síndrome de Marfan, cujos pais referiam que o mesmo apresentava baixa acuidade visual desde o nascimento. Ao exame oftalmológico, observou-se microesferofacia e discreta subluxação do cristalino bilateralmente. A refração estática era -23.75 - 2.75 x 70 no olho direito e -25.50 -3.50 x 90 no olho es querdo. Como a microesferofacia e a alta miopia traziam sérios prejuízos à qualidade de vida do paciente, foi submetido à facoemulsificação de cristalino transparente, vitrectomia anterior, capsulotomia posterior via pars plana e implante de lente intrao cular. Em seguimento pós-operatório de dois anos, mantinha lentes intraoculares centradas, eixo visual livre, acuidade visual corrigida de 20/30 em ambos os olhos. Paciente satisfeito com a visão podendo estudar e exercer todas as atividades do dia a dia sem limitações visuais.

Incidence and risk factors of macular edema after cataract surgery in patients with type 2 diabetes mellitus / 中国基层医药

Objective To investigate the incidence and risk factors of macular edema (ME) after cataract surgery in patients with type 2 diabetes mellitus (T2DM),and to provide a reference for clinical treatment.Methods From March 2014 to April 2017,128 cases of cataract phacoemulsification and intraocular lens implantation in Jincheng Ophthalmology Hospital were retrospectively analyzed,of whom 36 cases(36 eyes) without diabetes were A group,41 patients(41 eyes) with no retinopathy were B group,51 cases(51 eyes) of T2DM patients with retinopathy were C group.The incidence of ME,the BCVA and the CSMT of the three groups were compared,and the Logistic multiple factor regression analysis was used to analyze the risk factors of DME after T2DM cataract surgery.Results The incidence rates of ME in A,B and C group were 5.56％,29.27％ and 50.98％,respectively,and the difference was statistically significant (x2 =6.567,P ＜ 0.05),and that of C group ＞ B group ＞ A group (x2 =4.419,19.951,all P ＜0.05).The BCVA after operation in A group,B group and C group,was (0.26 ±0.08),(0.19± 0.04) and (0.08 ± 0.01),respectively,the difference was statistically significant (F =9.352,P ＜ 0.001),and that of group A ＞ group B ＞ group C (t =4.950,2.030,P ＜ 0.05).The CSMT after operation in A group,B group and C group was (246.35 ± 23.73) μm,(249.52 ± 20.95) μm and (289.31±43.82) μm,respectively,the difference was statistically significant (F =9.352,P ＜ 0.001).Logistic multivariate regression analysis showed that preoperative retinopathy [3.672 (0.261-0.961),P =0.000],preoperative ME [3.862 (0.136-0.769),P =0.001] were independent risk factors for the occurrence of ME after T2DM.Conclusion The incidence of ME is higher after T2DM cataract surgery,and the risk of ME is higher in patients with preoperative ME and preoperative diabetic retinopathy.

The role of a femtosecond laser in congenital cataract associated with aniridia / O papel do laser de femtosegundo na catarata congênita associada à aniridia

ABSTRACT A patient with bilateral aniridia and progressive congenital cataract was treated at the age of 7 years through phacoaspiration with femtosecond laser capsulotomy, in-the-bag intraocular lens implantation, and pars plana vitrectomy (combined with posterior capsulotomy). The diameter of the planned anterior capsulotomy was 4.7 mm; however, due to elevated tension in the young capsular bag, the capsulotomy diameter increased (to around 6 mm) shortly after release of the tension by the laser. In addition, the patient had a very flat and small cornea, causing the formation of air bubbles in the curved laser interface. This was addressed by filling the gap by using a viscoelastic. A very similar situation was observed in both eyes. Use of the femtosecond laser facilitated a successful outcome in a complex congenital cataract case with a safe capsulotomy that ensured in-the-bag intraocular lens placement.

RESUMO Paciente com aniridia bilateral e catarata congê­nita progressiva foi tratado com a idade de 7 anos através de facoemulsificação com capsulotomia anterior por laser de femtosegundo, implante de lente intra-ocular e vitrectomia via pars plana (combinada com capsulotomia posterior). O diâmetro da capsulotomia anterior prevista foi de 4,7mm, porém, devido à elevada tensão do saco capsular jovem, o diâmetro da capsulotomia aumentou (para cerca de 6mm) logo após a liberação da tensão pelo laser. Além disso, o paciente tinha uma córnea muito plana e pequena, causando a formação de bolhas de ar na interface do laser. Isso foi resolvido preenchendo a lacuna usando um viscoelástico. Uma situação muito semelhante foi observada em ambos os olhos. O uso do laser de femtosegundo facilitou um resultado bem-sucedido em um caso complexo de catarata congênita com uma capsulotomia anterior segura que garantiu a colocação da lente intra-ocular dentro do saco capsular.

The treatment effect of intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens on children with traumatic cataract / 中华实验眼科杂志

Objective To compare the treatment effect of intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens and simple intraocular lens ciliary sulcus implantation.Methods We retrospectively analyzed 60 eyes of 60 children with traumatic cataract from June 2012 to June 2015 in the Second People's Hospital of Yunnan Province,including 44 males and 16 females and the average age ranged from 1 to 14 years.The patients were divided into two groups according to the situation of posterior capsular,30 eyes of 30 children for each group.The patients in combined surgery group were performed intraocular lens ciliary sulcus implantation combined with posterior capsular incarceration of intraocular lens,and the patients in simple surgery group were performed simple intraocular lens ciliary sulcus implantation.The follow-up time ranged from 1 month to 6 months.The best corrected visual acuity(BCVA),grade of optic axis turbid,dislocation of intraocular lens,postoperative complications and surgical duration were compared between the two groups.Results The BCVA after surgery was significantly different from that before surgery in both groups (combined surgery group:x2 =7.548,P＜ 0.05;simple surgery group:x2 =5.579,P＜0.05).The postoperative turbidity of central axis area and BCVA were not significantly different between the 2 groups (x2 =0.362,P＞0.05).The dislocation degree of intraocular lens and proportion of postoperative complications were lower in the combined surgery group than those in the simple surgery group (x2 =9.858,P＜0.05;x2 =7.200,P＜0.05).The duration of surgery was not significantly different between the 2 groups (x2 =0.658,P ＞ 0.05).Conclusions Posterior capsular incarceration of intraocular lens has fewer complications,lower dislocation degree of intraocular lens and more effective for children with traumatic cataract than intraocular lens ciliary sulcus implantation.

Trocar-assisted intrascleral sutureless fixation of a dislocated three-piece sulcus intraocular lens / Fixação intra-escleral sem sutura da lente intraocular de sulco de três peças deslocada com uso de trocarte

ABSTRACT Trocar-assisted intraocular lens (IOL) reposition surgery using a scleral fixation method was performed for a patient with a dislocated sulcus IOL. Two 3-mm-long scleral tunnels 2 mm from and parallel to the limbus were formed using a 23-gauge vitrectomy trocar transconjunctivally entering the sclera at an angle of approximately 10°. Haptics were collected using a 23-gauge serrated retinal forceps entering from the trocar cannula and externalized from the scleral tunnels together with the trocar. The same procedure was applied for the other haptic. Both haptics were pushed into the scleral tunnel and a transconjunctival secure 10-0 nylon suture was placed at the scleral tunnel entry site around the haptic. Sutures were removed 1 week later. No complications occurred intraoperatively or postoperatively. At a 10-month follow-up, IOL was stabilized. IOL reposition surgery using the trocar-assisted IOL scleral fixation method is a viable alternative to intrascleral fixation surgery.

RESUMO Relatamos uma cirurgia de reposição de lentes intraoculares (LIO) usando o método de fixação escleral de lentes intraoculares usando o trocarte em paciente com lentes intraoculares deslocada no sulco. Nós formamos dois túneis esclerais de 3 mm de comprimento, de 2 mm e paralelos ao limbo, com trocarte de vitrectomia de calibre 23 passando pela esclera transconjonctivalmente em um ângulo de aproximadamente 10 graus. Os hápticos foram capturados por uma pinça dentária dentada de calibre 23 que entrou na cânula do trocarte e os hápticos foram externalizados pelos túneis esclerais, através do trocarte. O mesmo procedimento aplicado para o outro háptico. Ambos os hápticos foram empurrados para o túnel escleral e uma sutura segura transconjuntival é colocada no local de entrada do túnel escleral em torno do háptico com uma sutura de nylon 10-0. As suturas foram removidas uma semana depois. Não foram observadas complicações intraoperatórias ou pós-operatórias. Após o período de seguimento de 10 meses, a lentes intraoculares foi vista estabilizada. A cirurgia de reposição de lentes intraoculares usando o método de fixação escleral de lentes intraoculares assistido com trocarte é uma cirurgia alternativa de fixação intraescleral.

Iris-claw intraocular lens implantation in children with ectopia lentis / Implante de lente intraocular de fixação iriana em crianças com ectopia lentis

ABSTRACT Purpose: Artisan iris-claw lens implantation (AICLI) is a surgical technique for treating ectopia lentis. We aimed to compare visual outcomes and possible long-term complications of AICLI surgery in pediatric patients with ectopia lentis with or without a diagnosable hereditary disease. Methods: Seventeen children with non-traumatic ectopia lentis were retros pectively classified into two groups: group 1 included children with a diagnosable hereditary disease (11 patients, 65%), and group 2 included children without any definable hereditary disease (six patients, 35%). Patients were evaluated for post-surgical refraction, best-corrected visual acuity, and clinical follow-up complications. Results: The average follow-up time was 38 months, and the average age of the patients was 103 ± 53 months (30-196 months). Best-corrected visual acuity values were significantly increased in both groups after surgery (p<0.05). Target refraction values were achieved at a rate of 47% in group 1 and 22% in group 2. Post-surgery complications, such as lens dislocation (36%, 11 eyes of 10 patients) and hypotonia (10%, three eyes of three patients) were observed in both groups, and retinal detachments (10%, three eyes of three patients) were observed in three patients from group 1. Conclusions: Compared with previous similar studies, this study utilized the largest pediatric patient group and had the longest post-surgery follow-up time. Moreover, it is advisable that pediatric patients with non-traumatic ectopia lentis be carefully screened for any underlying hereditary disease, especially diseases related to connective tissue metabolism.

RESUMO Objetivo: A implantação de lentes intraoculares de fixação iriana em garra (AICLI) é uma técnica cirúrgica para o tratamento de ectopia lentis. Nosso objetivo foi comparar resultados visuais e possíveis complicações em longo prazo da cirurgia de AICLI em pacientes pediátricos com ectopia lentis com ou sem doença hereditária diagnosticável. Métodos: Dezessete crianças com ectopia lentis não-traumática foram classificadas retrospectivamente em dois grupos: o grupo 1 com pacientes apresentando doença hereditária diagnosticável (11 pacientes, 65%) e o grupo 2 com pacientes sem qualquer doença hereditária definível (6 pacientes, 35%). Os pacientes foram avaliados quanto à sua refração pós-operatória, acuidade visual melhor corrigida e complicações. Resultados: O tempo médio de seguimento foi 38 meses. A média de idade dos pacientes foi de 103 ± 53 meses (30-196 meses). Os valores de acuidade visual me lhor corrigida aumentaram significativamente em ambos os grupos (p<0,05). Os valores de refração alvo foram alcançados a uma taxa de 47% no grupo 1 e 22% no grupo 2. Complicações pós-operatórias como luxação da lente (36%, 11 olhos de 10 pacientes) e hipotonia (10%, 3 olhos de 3 pacientes) foram observados nos dois grupos e foram observados descolamentos de retina (10%, 3 olhos de 3 pacientes) em 3 pacientes do grupo 1. Conclusões: Em comparação com relatos anteriores na literatura, este estudo utilizou um grupo maior de pacientes pediátricos e tempo de seguimento pós-operatório mais longo. É aconselhável que pacientes pediátricos com ectopia lentis não-traumática sejam cuidadosamente selecionados em relação a doença subjacente hereditária, especialmente as doenças relacionadas com o metabolismo do tecido conjuntivo.

Optical performance of rotation and decentration of Toric intraocular lens implant in Hwey-Lan Liou model eye / 中华实验眼科杂志

Background Cornea astigmatism can be effectively corrected by implanting Toric intraocular lens (IOL) during cataract surgery and therefore improve visual acuity of patients.However,the decentration and rotation position errors were inevitable sometime.What's the difference of effect of position errors on quality of image between spherical IOL and Toric IOL needs further research.Objective This study was to evaluate the optical performance and wavefront with rotation and decentration of Toric IOL.Methods Different decentration for SN60AT IOL(spherical IOL) and Toric IOL in Hwey-Lan Lion model eyes was set with the role as follows:decentration 0.25 mm to 0.75 mm in a 5°-interval from 0° to 90°.Furthermore,Toric IOL was rotated at 5° and 10°,respectively.Then the image performances of SN60AT IOL and Toric IOL at different decentration distances and rotated degrees were evaluated with modulation transfer function (MTF) and value of wavefront aberration under all conditions.Results At the centration,the MTF curves of spherical IOL and Toric IOL were similar under 3,4 and 5 mm pupil diameter at each spatial frequency.Under the condition of 4 mm pupil diameter,when the decentration was 0.25 mm,the MTF values of SN60AT IOL at 6 c/d and 12 c/d were 0.581 087 and 0.411 960,respectively.T3 IOL were 0.454 259 and 0.382 313,T4 IOL were 0.426 020 and 0.360 490,T5 IOL were 0.425 606 and 0.359 877.When the decentration was 0.50 mm,the MTF values of SN60AT at 6 c/d and 12 c/d were 0.573 073 and 0.412 787,respectively.T3 IOL were 0.450943 and 0.379481,T4 IOL were 0.423 153 and 0.356 664,T5 IOL were 0.422 881 and 0.356 230.When the decentration was 0.75 mm,the MTF values of SN60AT at 6 c/d and 12 c/d were 0.560 038 and 0.413 624,respectively.T3 IOL were 0.445 597 and 0.374 322,T4 IOL were 0.418 522 and 0.350 087,T5 IOL were 0.418 468 and 0.349 976.When the IOL decentralized along 0°,5°,10°,90°meridian line,the MTF values were almostly same.The root mean square (RMS) of spherical IOL and Toric IOL was increased when the IOL decentralized from 0 mm to 0.75 mm,with the most increasing level in coma aberration and slight increase in trefoil aberration.When the T4 IOL decentralized from centre to 0.75 mm,the coma increased from 0 to C(3,-1)-0.049 79 μm,C (3,1)-0.037 59 μm and the trefoil aberration increased from 0 to C (3,3) 0.005 72 μm,C (3,-3) 0.004 64 μm.With the increase of rotation degrees (from 5°to 10°) of Toric IOL,the MTF was worse at high spatial frequency.Toric IOL rotation caused the increase of astigmatism and residual astigmatism and spherical error,but not high order aberration.Conclusions The tolerance of Toric IOL to decentration is very close to the spherical IOL,and optical performance is only associated with the amount of decentration but not direction.The aberration caused by Toric IOL decentration is mainly coma.The rotation of Toric IOL causes astigmatism error but not high order aberrations.

Choice of operative time and method for pseudoexfoliation syndrome combined cataract with zonular defect / 中华实验眼科杂志

Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.

Long-time follow-up results of phakic posterior chamber intraocular lens and iris-claw phakic intraocular lens implantation for high myopia / 中华实验眼科杂志

Background With the development of refractive surgery,phakic intraocular lens implantation (PIOL) for high myopia is proving its outstanding merits in short-term treating outcomes.However,its long-term safety and effectiveness were still in more attention.Objective This study was to evaluate and compare the long-term safety,stability and efficacy of Verisyse PIOL implantation with implantable contact lens (ICL) implantation for high myopia.Methods The clinical data of 18 eyes (9 patients) who received Verisyse iris-claw intraocular lens implantation for high myopia and matched 22 eyes (11 patients) who received ICL implantation for high myopia from 2009 to 2011 were retrospectively analyzed.The patients were followed-up for 2 years after surgery.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),spherical equivalence (SE),axial length,corneal endothelial cell density (ECD),contrast sensitivity (CS),wave-front aberrations and postoperative complications were recorded during the following-up.The efficacy index,predictable and safety index were compared between the two groups.Results There was no significant difference in UCVA,BCVA and SE between Verisyse group and ICL group(t =0.92,1.32,4.32;all at P＞0.05).Non-glare CS under the 1.5,3.0,6.0,12.0 and 18.0 c/d spatial frequencies were insignificantly different between the two groups(Z=0.782,0.956,0.495,0.874,0.293;all at P＞0.05),and the similar outcomes were found in glare CS (Z=0.985,1.254,0.896,1.652,0.492;all at P＞0.05) in postoperative 2 years.Root meas square of total high order aberration (RMSh),vertical-trefoil,vertical-coma,horizontal-coma,spherical aberration(SA),were significantly elevated in the Verisyse group compared with the ICL group (Z =4.72,4.24,3.12,3.65,2.16;all at P ＜ 0.05).The mean efficacy index was 108.49 ± 16.62 in the V erisyse group and 106.71±15.88 in the ICL group,showing a significant difference (t =0.54,P＞0.05).The mean safety index was 140.56±33.89 in the Verisyse group and 143.34±34.56 in the ICL group,with a significant difference between them (t=0.29,P＞0.05).The mean predictable index was-0.25(-0.97,4.23)in the Verisyse group and 0.98 (-1.44,1.52) in the ICL group,and the difference was significant (Z =-2.68,P ＜ 0.05).Conclusions Both Verisyse PIOL implantation and ICL implantation for high myopia are safe,predictable and effective.The vusial quality and predictability of ICL implantation are much better than Verisyse PIOL implantation.A long-term effect should be observed for the further evaluation.

Comparison of IOL refractive power caculation using different apparatus and various formulas in cataract eyes with silicon oil tamponade / 中华实验眼科杂志

Background Silicon oil tamponade eyes following vitrectomy accelerate and induce lens opacification,so the accurate measurement and calculation of intraocular lens (IOL) diopter before cataract extraction+ IOL implantation is very important for the recovery of visual function.Objective This study was to compare the differences of IOL powers measured and calculated by different apparatus and different IOL power formulas before cataract extraction + IOL implantation silicon oil tamponade combined with cataractous eyes.Methods A prospective,consecutive,nonrandomized study was performed.Thirty-six silicon oil tamponade with cataract eyes of 36 patients were included in the Second Affiliated Hospital of Soochow University from August 2011 to October 2013.Patients with silicone oil emulsification for 4 months to 2 years prepared to treat by cataract extraction + IOL implantation+silicon oil removal.Axial length (AL),corneal curvature (CC) and anterior chamber depth (ACD) were measured with IOLMaster and A-scan with manual kerameter (MK) in the eyes for the prediction of IOL power by SRK-Ⅱ,SRK/T,Hoffer Q,Holladay 1 and Haigis formulas under the oral informed consent.The mean predictive error (MPE) and mean absolute refractive error (MAE) between predictive IOL diopters before operation and actual IOL diopters after operation were evaluated.Results The AL and ACD values measured by IOLMaster was (25.43± 0.90)mm and (3.22±0.38)mm,which were significantly higher than (25.21±1.02)mm and (3.07±0.62) mm by A-scan+ MK respectively,the difference between the two measure methods was statistical significance (both at P =0.000).No significant difference was found in measured CC values between IOLMaster and A-scan+MK ([44.58±1.57] D vs.[44.56±1.62] D) (P=0.568).When the parameters measured by IOLMaster were used,the MAE from SRK/T formula was smaller than that from SRK-Ⅱ,Hoffer Q,Holladay 1 and Haigis formulas (P =0.017,0.009,0.012,0.001),and the MAE from Haigis formula was significantly larger than that from SRK-Ⅱ,Hoffer Q and Holladay 1 formulas (P =0.026,0.035,0.021).When measured by A-scan + MK,the MAE from Haigis formula was significantly larger than that from SRK-Ⅱ,SRK/T,Hoffer Q and Holladay 1 formulas (P=0.007,0.004,0.018,0.006).There was no significant difference in the number of eyes with MAE ≤ 1.0 D between IOLMaster and A-scan+MK measurements under the calculation of SRK-Ⅰ,SRK/T,Hoffer Q and Holladay 1 formulas (x2 =0.107,2.250,0.845,0.084,all at P＞0.05).However,the number of eyes with MAE ≤ 1.0 D was significantly increased in IOLMaster measurement compared with A-scan+MK under the calculation of Haigis formula (x2 =4.431,P =0.035).Conclusions In silicon oil-filled cataract eyes,SRK/T formula appears to have a more accurate predictive value of IOL power than that of other formulas when employ IOLMaster;when use A-scan+MK measurement,the predictive value of IOL power seems to be better by using SRK-Ⅱ,SRK/T,Holladay 1 or Hoffer Q formulas.

Effectiveness and safety evaluation of low-dose carbachol application during implantable collamer lens implantation for myopic eyes / 中华实验眼科杂志

Background Carbachol solution (0.01％) is an agonist of M cholinoceptor and skeletal muscle N cholinoceptor,and it is used to play miotic effect and open peripheral iridectomic hole during the surgery of implantable collamer lens (ICL) implantation in order to lower intraocular pressure (IOP).However,the anterior chamber injection of 0.01％ carbachol solution often causes relevant complications,while whether lower dose of carbachol solution is effective and safe is unclear.Objective This study was to compare the effectiveness and safety between 0.01％ carbachol solution and 0.005％ carbachol solution after anterior chamber injection during the ICL implantation.Methods One hundred and fifty-two eyes of 76 cataract patients were included in Daping Hospital of Third Military Medical University from September 2014 to September 2015.ICL implantation and periphery iridectomy were carried out on both eyes of the patients and the 0.01％ carbachol solution was injected into the anterior chamber during the surgery of the right eyes and 0.01％ carbachol solution was used in the left eyes.The operation duration and IOP at postoperative 2 hours and systemic choline-like reaction were compared between 0.01％ carbachol solution group and 0.005％ carbachol solution group.Results The mean operation duration was (11.86± 2.39) minutes and (11.22 ± 1.85) minutes in the 0.01％ carbachol group and 0.005％ carbachol group,without significant difference between two groups (t =1.851,P =0.066).IOP was (15.76 ± 2.18) mmHg and (13.58 ±2.24)mmHg in the 0.01％ carbachol group before and after surgery,and those in the 0.005％ carbachol group was (15.70±2.35)mmHg and (13.12±2.17)mmHg,there was no significant difference in the IOP between the two concentrations of carbachol (Fsroup =0.986,P=O.322).The IOP at postoperative 2 hours was lower than that before operation,the difference was statistically significant(Ftime =97.339,P =0.000).There was no interaction between drug concentration and time (Fcorrelation =0.772,P =0.381).The incidences of complications,such as dizziness,nausea and vomiting,were lower in the 0.005％ carbachol group than those in the 0.01％ carbachol group (x2 =13.01,5.16,4.03,all at P＜0.05).Conclusions Carbachol solution (0.005％) can play intraoperative miosis effect and maintain effective operation duration in ICL implantation.In addition,the application of 0.005％ carbachol solution is quite safe in both intraoperation and postoperation.

Timing and visual changes of secondary intraocular lens implantation in infants with congenital cataract / 中华实验眼科杂志

Background Bilateral congenital cataract is one of the vision-threating diseases during infant age.Intraocular lens (IOL) implantation is an ideal refraction correction method for children who have already received bilateral cataract extraction.However,the timing and effectiveness of secondary IOL implantation are still under debate.Objective This study was to analyze the visual changes and affecting factors before and after secondary IOL implantation and explore the operative timing.Methods The clinical data of 58 eyes of 29 patients who received bilateral cataract extraction-refractive correction and vision training-secondary IOL implantation in Peking University People's Hospital from January 2012 to December 2014 were retrospectively analyzed.All the patients received bilateral cataract extraction and posterior capsulotomy with anterior vitrectomy during their first year of life firstly,followed by the wearing of refractive spectacles or visual training,and secondary IOL implantation was simultaneously performed until ＞2 years old.Best corrected visual acurity (BCVA) (LogMAR) was examined at 1 week before and 3 months after secondary surgery under the mydriasis.Changes,distribution alternation of BCVA and the relationship of visual prognosis with preoperative visual acuity were evaluated.Results The average age at surgery of the patients was (3.26±2.07) months and that at secondary IOL implantation was (4.79± 1.38) years,with the operative interval of (4.28± 1.33) years.The BCVA before and after secondary IOL implantation was 0.790± 0.422 and 0.570±0.307 respectively,showing a significant difference between them (t =3.223,P＜0.001).The number of eyes with BCVA ≥ 0.5 after surgery was significantly more than that before surgery (x2=53.931,P＜0.001).A positive correlation in unilateral BCVA was seen between before and after secondary IOL implantation (R2 =0.232,F =17.037,P ＜ 0.001).Conclusions A systemic management of bilateral cataract extractionrefractive correction and vision training-secondary IOL implantation for congenital cataract is beneficial to BCVA improvement and amblyopia treatment,and it should be performed as early as possible on the premise of ensuring the safety of life.Secondary IOL implantation should be timely carried out for aphakic children with poor compliance and outcomes during vision training after congenital cataract extraction.