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.

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.

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.

Implantation of foldable posterior chamber intraocular lens in aphakic vitrectomized eyes without capsular support / Implantação lente intraocular dobrável de câmara posterior em olhos afácicos vitrectomizados sem apoio capsular

ABSTRACT Purpose: To evaluate the outcomes of three different surgical techniques for foldable posterior chamber intraocular lens (PCIOL) implantation in vitrectomized eyes without capsular support. Methods: A total of 60 patients with aphakic and vitrectomized eyes without capsular support were enrolled. All patients underwent three-piece foldable PCIOL implantation into the posterior chamber through a small corneal incision. Transscleral fixation (TSF), iris fixation (IF), and intrascleral tunnel fixation (ISF) surgical techniques were performed. Results: Postoperative PCIOL subluxation or dislocation occurred in one case in the TSF group and two cases in the ISF group. Intraoperative PCIOL dislocation occurred in two patients in the IF group. The incidence of temporary postoperative complications, such as mild intraocular hemorrhage and cystoid macular edema, was higher in the ISF group. No statistically significant difference in PCIOL-related astigmatism was observed between groups. Visual acuity improved in all groups. Conclusions: Postoperative outcomes were comparable between TSF, IF, and ISF for PCIOL in vitrectomized eyes without capsular support.

RESUMO Objetivo: Avaliar os resultados de três diferentes técnicas cirúrgicas para implantação da lente intraocular de câmara posterior (PCIOL) dobrável em olhos vitrectomizados sem apoio capsular. Métodos: Um total de 60 olhos de 60 pacientes afácicos vitrectomizados, sem apoio capsular foram inscritos. Todos os pacientes foram submetidos ao implante de PCIOL dobrável de três peças na câmara posterior, através de uma pequena incisão na córnea. Foram utilizados as técnicas cirúrgicas de fixação transescleral (TSF), fixação iriana (IF) e túnel de fixação intraescleral (ISF). Resultados: Subluxação ou luxação da PCIOL ocorreu em um caso no grupo TSF e em dois casos no grupo ISF. Deslocamentos intraoperatórios da PCIOL ocorram em dois pacientes no grupo IF. Frequência de complicações pós-operatórias temporárias como hemorragia intraocular leve e edema macular cistóide foi maior no grupo ISF. Não houve diferença estatisticamente significativa do astigmatismo relacionado à PCIOL entre os grupos. A acuidade visual melhorou em todos os grupos. Conclusões: Nenhuma das três técnicas cirúrgicas teve destaque em termos de resultados cirúrgicos comparativos.