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Purpose: Cataract development is a common sequelae associated with uveitis. Despite phacoemulsification being the popular method of cataract surgery today, manual small-incision cataract surgery (MSICS) may still be a safe and effective alternative because of several inherent benefits. There is not much literature and studies on the efficacy and safety of MSICS under topical anesthesia in complicated cataract in patients with uveitis. We aimed to study the safety and visual outcome of MSICS under topical anesthesia for post uveitis complicated cataract. Methods: This was a retrospective observational study. The electronic medical records of adult patients who underwent MSICS under topical anesthesia for post uveitis cataract were reviewed. The records were reviewed and analyzed for preoperative clinical characteristics and visual acuity, intraoperative complications and postoperative visual acuity, and complications. Results: A total of 71 eyes of 59 patients were taken for final analysis. The average age of patients was 59.9 years. There was improvement in the best corrected visual acuity by 0.7 logMAR (P value <0.0001). Average follow-up period was 9.8 months. The mean gain in visual acuity in eyes that received preoperative steroids was 0.6 logMAR compared to the eyes that did not receive steroids (0.71 logMAR). The difference was not statistically significant (P = 0.407). Complications seen during long-term follow-up were recurrence (15.5%), cystoid macular edema (7%), Epiretinal membrane (8.5%), and posterior capsular opacification (5.5%). Conclusion: With proper technique and precautions, MSICS can be safely and comfortably performed under topical anesthesia even in complicated cataracts with excellent visual and safety outcomes
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@#AIM: To explore the postoperative refractive error and influence factors using the Optical Biometry(IOL Master)in patients with silicone oil filled eye complicated cataract after silicone oil removal combined with cataract surgery.<p>METHODS: From August 2020 to November 2020 in the Affiliated Eye Hospital of Nanchang University, 41 patients with silicone oil removal combined with cataract surgery were divided into 2 groups: 18 patients(18 eyes)in high myopia group and 23 patients(23 eyes)in non-high myopia group. Collected and recorded the patients' IOL Master measurement data. Statistical analysis was performed in SPSS20.0.<p>RESULTS: The mean spherical degree or astigmatism of the IOL Master measurement and refraction in high myopia and non-high myopia group performed by paired <i>t</i>-test(<i>P</i>>0.05). The mean axial difference ΔAL were -0.28±0.29 and 0.05±0.31mm between the two groups has no difference(<i>P</i><0.05), while ΔK, mean absolute refractive error(MARE)and Δastigmatism(<i>P</i>>0.05). The preoperative and postoperative axial length(AL)in high myopia groups were 28.37±1.73 and 28.10±1.55mm(<i>t</i>=3.994, <i>P</i><0.05), yet the non-high myopia group(<i>P</i>>0.05). Bivariate linear correlation analysis: in the high myopia group, there was a moderate positive correlation between preoperative AL and MARE(<i>r</i>=0.742, <i>P</i><0.05), and a moderate negative correlation between ΔAL and MARE(<i>r</i>=-0.646, <i>P</i><0.05), but in non-high myopia group, preoperative AL, ΔAL, preoperative K, ΔK had no correlation(<i>P</i>>0.05).<p>CONCLUSION: IOL Master performed the small biostatistical error and high measurement accuracy of the intraocular lens in patients with silicone oil filled eye complicated cataract. The longer preoperative AL, the more changes in the axial length after silicone oil removal, and the greater the refractive error of patients with high myopia silicone oil filled eye complicated cataract.
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@#AIM:To evaluate the visual quality of different types of cataracts by double-pass optical quality analysis system(OQAS).<p>METHODS: A cross-sectional study was conducted. Totally 30 age-related cataract patients(30 eyes), which were aged group, with an average age of 71.69±3.79 years, thirty patients(30 eyes)with complicated cataract were in the complicated group with an average age of 61.00±4.56 years and 30 normal patients(30 eyes)were in the normal group, with an average age of 65.34±4.06 years old, both of which with naked eye vision(UCVA)≤0.5, and from June 2019 to June 2020 in the eye Center of Renmin Hospital of Wuhan University were collected. The ocular surface and optical quality examination on the patient's visual quality, including anterior chamber depth(ACD), ocular axis(AL), IOP, corneal curvature(K), objective scattering index(OSI), MTF cut off frequency(MTF cut off), Sterl ratio(SR), contrast sensitivity VA100%, VA20%, VA9% and other visual quality were operated by the same doctor. <p>RESULTS: Compared with glaucomatous cataract, the MTF cut off of uveitis cataract was lower(<i>P</i>=0.025), but higher than that of fundus cataract(<i>P</i>=0.013), and diabetic cataract(<i>P</i>=0.001). The MTF cutoff value of glaucomatous cataract was higher than that of fundus cataract(<i>P</i>=0.013), and diabetic cataract(<i>P</i>=0.007); the MTF cutoff of fundus cataract was higher than that of diabetic cataract and there was significant difference(<i>P</i>=0.010).<p>CONCLUSION: There are some differences in the ocular surface and visual quality parameters of each subtype of complicated cataract, especially MTF cut off, so we should paid attention to the cataract types before surgery.
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Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.
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@#AIM: To explore the effect of different intraocular irrigating solutions on lens opacity after pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).<p>METHODS: Totally 48 subjects(48 eyes)patients with proliferative diabetic retinopathy from March 2018 to February 2019 were enrolled in this study, randomly divided into BSS intraocular irrigating solution group(23 cases and 23 eyes)and Shike intraocular irrigating solution group(25 cases and 25 eyes). LOCS grading system Ⅲ was applied to grade lens opacity. Pentacam occipital analyzer was applied to analyze the density and thickness of lens, and the results were compared and discussed.<p>RESULTS:Three months after PPV,NC, P score and the density of lens in LOCSIII grade in the two groups were significantly higher than those before surgery(<i>P</i><0.05), but the C score was not different significantly(<i>P</i>>0.05). In addition, the thickness of the lens in BSS intraocular irrigating solution group was significantly higher than that before PPV(<i>P</i><0.05), but there was no significant difference in the Shike intraocular irrigating solution group(<i>P</i>>0.05). NC, P score, the density and thickness of lens were significantly lower in Shike intraocular irrigating solution group than those in the BSS intraocular irrigating solution group. But the C score was not different significantly between the two groups(<i>P</i>>0.05).<p>CONCLUSION: Shike intraocular irrigating solution can delay the development of postoperative complicated cataract formation.
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Background: Complicated cataracts or secondary cataracts are those cataracts that occurs secondary to other intraocular diseases. There are many causes of complicated cataracts but the most common cause is intraocular inflammation. Aim: To evaluate the clinical patterns of complicated cataracts in patients presenting to the Out–Patient Department of B. P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). Material and Methods: All patients fulfilling the diagnostic criteria for complicated cataracts were enrolled from 1st January 2015 to 30th June 2016 (18 months). Detailed history and systematic examination along with necessary investigations were done. Results: Ninety two eyes of 69 patients had complicated cataracts. The mean age of presentation was 45.19 years (SD ± 18.1). Twenty four cases (34.8%) were male. The female to male ratio was 1.875:1. Forty six (66.7%) cases had unilateral involvement. The most common clinical pattern of complicated cataract was posterior subcapsular cataract (63, 68.5%). Conclusion: Posterior subcapsular cataract was the most common clinical pattern of complicated cataracts
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A 36-year-old female presented with the complaints of pain, photophobia, redness, and sudden diminution of vision in both the eyes following topiramate for migraine treatment. On examination, there was panuveitis with angle-closure glaucoma in both the eyes with fibrinous exudate with pigments in the anterior chamber of the left eye. B scan revealed increased choroidal thickness in both the eyes. Serial anterior segment optical coherence tomography scans were done in the left eye to demonstrate the gradual resolution of the fibrin material from the anterior chamber. There was complete resolution of inflammation in both eyes following discontinuation of topiramate and treatment with systemic and topical steroids. There was an improvement in visual acuity in the left eye following complicated cataract surgery.
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AIM:To compare the clinical outcome of anterior chamber intraocular lens (IOL) at Ⅰ stage versus sclerafixed IOL at Ⅱ stage in complicated cataract surgeries with inadequate capsular support.METHODS:Complicated cataract surgeries with anterior chamber IOL (ACIOL) or scleral-fixated IOL implantation from January 2003 to December 2014 when capsular support was inadequate were included and analyzed.Postoperative best-corrected visual acuity (BCVA) were compared.Postoperative complications were recorded and analyzed.RESULTS:Totally 84 eyes and 79 eyes were included in the ACIOL group and in the scleral-fixated IOL group,respectively.The mean postoperative logarithm of minimal angle of resolution (LogMAR) BCVA at 1a was 0.30±0.64 and 0.33±0.34 in the ACIOL group and the scleral-fixated IOL group,respectively (t=0.407,P=0.712).The mean latest LogMAR BCVA was 0.67±0.55 and 0.62 ± 0.50 in the primary ACIOL group and the secondary scleral-fixated IOL group,respectively (t=0.225,P=0.545).There were more early postoperative complications in the ACIOL group (x2 =14.613.P＜0.001).No difference in late postoperative complications was found between the two groups (x2 =0.231,P=0.267).Regression analysis suggested that ACIOL and scleralfixated IOL implantation had similar latest postoperative LogMAR BCVA (t=0.397,P=0.957);however the existence of late complications were related with a worse final visual outcome (t=22.156,P＜0.001).CONCLUSION:The long-term differences in the visual outcomes and complication profiles after ACIOL at Ⅰ stage or scleral-fixated IOL implantation at Ⅱ stage in a complicated cataract operation are not found when capsular support is inadequate.
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Retinoblastoma (RB) is one of the most common primary intraocular malignant tumors of children. With improvement of the medical care, the goal of RB treatment is saving the eyeball and even the vision. In the process of globe-salvaging treatment, complicated cataract has been a serious problem which affects the treatment and follow-up. It is important to operate a cataract surgery timely and safely. In this paper related research advances were summarized.
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Aims: To study the indications, safety, efficacy, post-operative outcome and complications in patients with primary scleral fixated IOL implantation. Materials and Methods: Forty patients, who underwent primary scleral fixated IOL implantation over a period of 2-years were analyzed for demographic data, indications, post-operative outcome, and complications of the procedure. Results: The study group ranged from 16-30 years. The male:female ration was 1.86:1. Subluxated cataract was the most common indication. All (100%) of our patients showed improvement in vision postoperatively. Complications were early complications like corneal odema, hyphema, iritis, and late complications including cystoid macular edema, secondary glaucoma, and astigmatism No vision-threatening complications including retinal detachment and endophthalmitis were observed. Conclusion: SF-IOLs give good anatomical and visual outcome in patients of cataract with inadequate capsular support.
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Background Pupil atresia increases the difficulty of cataract surgery.The improper enlarging pupil will lead to many complications.The appropriate method of pupil dilation is very important to improve the postoperative effect.Objective This study was to evaluate the pupillary function after manually enlarged pupil to different sizes for pupil atresia complicated cataract.Methods A retrospective case-controlled study was designed.Thirty-eight eyes of 30 cases suffered from pupil atresia complicated cataract induced by chronic uveitis were enrolled in Shandong Eye Institute from May 2006 to May 2012.The eyes underwent pupil forming and phacoemulsification and assigned to the pupil enlarged to ≥6.0 mm group (15 eyes) and 4.5-5.5 mm group (23 eyes).The fibrosis membrane at pupil zone was removed,and the fibrosis strip at pupil collar was cut evenly by 23G intraocular microscissors as zigzag shape.Then the pupil was enlarged in multipoint by a pair of left and right iris hook from the main and lateral incisions.The pupils of 15 eyes in the pupil enlarged to ≥6.0 mm group were dilated above 6.0 mm and 23 pupils in the 4.5-5.5 mm group were dilated to 4.5-5.5 mm and followed by routine phacoemulsification and foldable intraocular lens implantation.Topical and systemic corticosteroids and nonsteroidal anti-inflammatory drugs combined topical mydriatic were applied before and after operation.The pupil diameter,light reflex and photophobia symptom in postoperation were compared between the two groups.The visual acuity before and after operation and intra-and post-operative complications were recorded.This study was approved by Ethic Committee of Shandong Eye Hospital,and written informed consent was obtined from each patient before operation.Results The pupil diameter in the pupil enlarged to ≥6.0 mm group was dilated to (6.9±0.4) mm and that of the 4.5-5.5 mm was dilated to (5.1 ±0.3) mm intraoperatively,with a statistical significance between them (t =16.100,P =0.000).Three months later,the pupil diameter in the pupil enlarged to ≥ 6.0 mm group was (4.9 ±0.4)mm,with different degrees of lacerated pupillary margins,and that in the pupil enlarged to 4.5-5.5 mm group was (3.5 ±0.5) mm,with rare lacerated pupillary margins,showing a statistically significant difference (t =9.820,P =0.000).The unresponsive or obtuse light reflex in the pupil enlarged to ≥6.0 mm group was significantly higher than in the pupil enlarged to 4.5-5.5 mm group(11 eyes vs.6 eyes) (x2 =8.200,P =0.005).The subjective photophobia symptom of 2-3 grades in the pupil enlarged to ≥6.0 mm group was in 12 eyes,which was higher than that in the pupil enlarged to 4.5-5.5 mm group (2 eyes) (H=19.840,P=0.000).The iris haemorrhage were seen in 3 eyes in the pupil enlarged to 4.5-5.5 mm group and 7 eyes in the pupil enlarged to ≥6.0 mm group (x2 =5.290,P=0.030).The visual acuities of the operated eyes in the two groups improved at different degrees.Conclusions Approximate physiological pupil and good visual quality can been obtained by manual releasing and enlarging pupil to less than 5.5 mm evenly during the surgery for pupil atresia complicated cataract induced by chronic uveitis.
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PURPOSE: To report the surgical results of transscleral fixation of foldable acrylic intraocular lens with a unique haptic shape (CORNEAL(R), ACR6D, France). METHODS: We analyzed the medical records of 18 patients (19 eyes) who had transscleral fixation of posterior chamber intraocular lens implantation from July 2004 to July 2006. RESULTS: According to the cause of operation, there were five eyes with complicated cataract, eight with trauma, and six with aphakia associated with a previous operation. The mean age of the patients was 55.9+/-21.2 years. The mean preoperative best-corrected visual acuity was 0.31+/-0.35, and the postoperative value was 0.63+/-0.29 (p<0.05). The mean preoperative spherical refractive equivalent was 6.58+/-5.33 diopter, and the postoperative value was -1.77+/-1.59 diopter. The mean refractive error was -1.13+/-1.57 diopter. This showed a myopic shift (p<0.05). The mean astigmatism decreased with time, and it stabilized two months after the operation. The trend was toward mild against-the-rule astigmatism. The mean follow-up duration was 11.0+/-7.6 months. CONCLUSIONS: In eyes with inadequate capsular support, transscleral fixation of posterior chamber intraocular lens implantation with CORNEAL(R) lenses is a safe and effective procedure for visual correction.
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Humans , Aphakia , Astigmatism , Cataract , Eye , Follow-Up Studies , Lens Implantation, Intraocular , Lenses, Intraocular , Medical Records , Refractive Errors , Visual AcuityABSTRACT
PURPOSE: To compare the clinical results of one-piece Acryl IOL C160 (Opthalmed(R), USA) with those of three-piece Acryl IOL AcrySof (MA60BM, Alcon(R), USA) in complicated cataracts. METHODS: In one eye of 30 patients with complicated cataracts, Acryl-C160 IOL was implanted and AcrySof IOL in the other eye. The degrees of anterior capsular fibrosis and posterior capsular opacification together with IOL decentration were evaluated for 12months prospectively. RESULTS: In 9 of 30 eyes with Acryl-C160 IOL, significant fibrosis of anterior capsule was seen as early as 1 month postoperatively. At 12 months, 15 eyes had more than grade 3 of capsular fibrosis. Five eyes had severe contraction of IOL haptic and one eye had significant IOL degradation to be exchanged. On the contrary, 2 of 30 eyes implanted with AcrySof IOL had moderate degree of capsular fibrosis. CONCLUSIONS: In complicated cataracts, Acryl-C160 IOL developed higher incidence of postoperative complications due to the inflammation and poor memory function of IOL haptic. The type and design of IOL haptic together with the function of IOL optic should be considered in selecting the IOLs best fitted in complicated cataracts.
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Humans , Cataract , Fibrosis , Incidence , Inflammation , Memory , Postoperative Complications , Prospective StudiesABSTRACT
The potential visual acuity predicted by the laser interferometer (LI) was compared with the postoperative best corrected visual acuity (BCVA) measured by Hans visual acuity chart in 30 eyes of 28 patients with diabetes mellitus (group 1) and 36 eyes of 35 patients with previous retinal surgery or other ocular disease (group 2) to determine the predictive accuracy of LI in complicated cataracts. 55 eyes of 51 patients without diabetes mellitus or any other ocular diseases were served as control. In control group, the LI closely estimated (in the range of +/-25%) postoperative BCVA in 33 eyes (60%), underestimated in 15 eyes (27%), and overestimated in 7 eyes (13%). In group 1, the LI closely estimated in 16 eyes (54%), underestimated in 10 eyes (33%), and overestimated in 4 eyes (13). In group 2, the LI closely estimated in 16 eyes (45%), underestimated in 7 eyes (19%), and overestimated in 13 eyes (39%). There was no significant difference in predictability between group 1 and control group (P=0.82, chi-square test). But, there was significant difference between group 2 and control group (P=0.03, chi-square test), and LI tended to overestimate potential vision in patients with complicated cataracts (P=0.01, chi-square test).
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Humans , Cataract , Diabetes Mellitus , Retinaldehyde , Visual AcuityABSTRACT
Primary or secondary IOL implantation after cataract extraction was performed in 41 eyes of 36 lepromatous leprosy patients, who showed negative skin test, from October 1990 to April 1992 at Chilgok Catholic Skin Clinic. Mean follow-up period was 8.3 months. Visual improvement was achieved in 39 eyes (95.1%), including 25 eyes (61.0%) of corrected vision better than 0.5. There was no serious complication induced by IOL implantation. But photophobia was complained in 18 eyes (66.7%) of 27 iridectomized eyes. We think that we may as well implant IOL after cataract extraction in lepromatous leprosy patients with complicated cataract if there is no active inflammatiQn in anterior chamber, guarded iridectomy is performed and it is possible to follow up considerably.
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Humans , Anterior Chamber , Cataract Extraction , Cataract , Follow-Up Studies , Iridectomy , Leprosy, Lepromatous , Photophobia , Skin , Skin TestsABSTRACT
Twenty cases who had underwent extracapsular cataract extraction with pupilloplasty followed by implantation of posterior chamber intraocular lens (PCL) were followed up more than 3 months from May 1989 to April 1991. Postoperative uncorrected visual acuity was improved in all cases. Corrected visual acuity was 20/40 or better in 13 cases (65% of all cases) and refractive state was myotic (-1.1D in average) at 2 months after operation. Postoperative astigmatism was -1.3D in average at 2 months after operation, which became -0.8D in average at 1 year after operation. Postoperatively vitreous prolapse occured in 1 case and increased intraocular pressure due to posterior synechiae was observed in 1 case. After-catract developed in 1 case. We obtained good clinical results after ECCE and PCL implantation in leprosy patients for whom wearing the contact lens and glasses were impractical due to hand and finger deformities.
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Humans , Astigmatism , Cataract Extraction , Cataract , Congenital Abnormalities , Eyeglasses , Fingers , Glass , Hand , Intraocular Pressure , Lenses, Intraocular , Leprosy , Prolapse , Visual AcuityABSTRACT
41 cases of complicated cataract in leprosy patients were operated on from May 1989 to March 1990 at National Sorok Island Hospital. In all cases, extracapsular cataract extraction was attempted and sector or peripheral iridectomy was performed. Inferior sphincterotomy was not done in any of the cases. The postoperative results were very satisfactory in most of the operating cases. The results are as follows; 1) Corrected vision above 0.1 was obtained in 29 eyes(70.7%). 2) Corrected vision from F.C. to 0.09 was obtained in 8 eyes(19.5%). 3) Corrected vision below H.M. was obtained in 4 eyes(9.8%). 4) 37 eyes(90.2%) among the total 41 showed an improvement of corrected vision.