Caracterización del implante secundario de una lente intraocular plegable suturada al iris en la afaquia

Objetivo: Caracterizar los resultados refractivos del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal, en el que se incluyeron 30 pacientes (30 ojos) seguidos por un período de un año de septiembre de 2019 a septiembre de 2021, después del implante de una lente intraocular de cámara posterior suturada al iris en la afaquia. Se les realizó examen oftalmológico completo y se evaluaron variables como mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, astigmatismo inducido, densidad celular y complicaciones. Resultados: La mejor agudeza visual sin corrección en el preoperatorio fue del 93,3 % (<0,1) y con corrección de 0,66, al año del posoperatorio fue de 0,493/0,890, respectivamente. La presión intraocular preoperatoria fue de 20,7 mmHg, y al año 19,7 mmHg. La densidad celular en el preoperatorio fue de 1755,7 cél/mm2 y al año fue de 1363,8 cél/mm2, y en los pacientes bien corregidos al mes del posoperatorio fue de 73,4 % y al año de 70 %. El astigmatismo inducido en el posoperatorio al año fue de -0,51 D. Conclusiones: La agudeza visual sin corrección y con corrección mejoran después del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Predominan los pacientes bien corregidos, sin cambios en la presión intraocular y la complicación más frecuente fue el edema corneal.

Objective: To characterize the refractive outcomes of implanting a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Methods: A descriptive, prospective and longitudinal study was carried out, including 30 patients (30 eyes) followed up for a period of one year, from September 2019 to September 2021, after being implanted a posterior chamber intraocular lens sutured to the iris in aphakia. Complete ophthalmologic examination was performed and variables were assessed, such as best visual acuity without correction, with correction, refractive results, intraocular pressure, induced astigmatism, cell density and complications. Results: The best visual acuity without correction in the preoperative period was 93.3 % (<0.1) and 0.66 with correction; while one-year postoperative visual acuity was 0.493 and 0.890, respectively. Preoperative intraocular pressure was 20.7 mmHg, while it was 19.7 mmHg at one year. Preoperatively cell density was 1755.7 cells/mm2, and it was 1363.8 cells/mm2 at one year it; while in well-corrected patients, it was 73.4% at one month postoperatively and 70% at one year. Postoperative induced astigmatism at one year was -0.51 D. Conclusions: Both uncorrected and corrected visual acuity improve after implantation of a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Well-corrected patients predominate, with no change in intraocular pressure, while the most frequent complication was corneal edema.

Corrección de la afaquia postraumática en niños con lentes plegables suturadas al iris

Objetivo: Caracterizar resultados visuales del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos. Métodos: Se realizó un estudio preexperimental, prospectivo, longitudinal con 17 niños, con seguimiento de un año. Se les realizó examen oftalmológico completo y se evaluaron variables como edad, sexo, lateralidad, mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, y complicaciones. Resultados: La edad promedio fue de 13,2 años, masculinos fueron el 64,7 %. La mejor agudeza visual sin corrección en el preoperatorio fue del 47,1 % <0,1 y con corrección de 0,7, al año del posoperatorio fue de 0,43/0,78, respectivamente. La presión intraocular preoperatoria fue de 14,1 mm Hg, y al año 14,71 mm Hg. La densidad celular en el preoperatorio fue de 2559.76 células/mm2 y al año de 2475,88 células/mm2. La hexagonalidad preoperatorio fue del 53,12 % y al año del 56,94 %. El cilindro preoperatorio -1,35 D y el 23,5 % presentó astigmatismo inducido al año del posoperatorio. Conclusiones: La aplicación del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos logra mejorar su agudeza visual y la complicación más frecuente fue el edema corneal.

Objective: To characterize visual outcomes of iris-sutured posterior chamber foldable intraocular lens implantation in traumatic aphakia in pediatric patients. Methods: A pre-experimental, prospective, longitudinal, pre-experimental study was performed with 17 children, with a one-year follow-up. A complete ophthalmologic examination was performed and variables such as age, sex, laterality, best visual acuity without correction, with correction, refractive results, intraocular pressure and complications were evaluated. Results: The average age was 13.2 years, 64.7% were male. The best visual acuity without correction preoperatively was 47.1 % <0.1 and with correction 0.7, one year postoperative visual acuity was 0.43/0.78, respectively. Preoperative intraocular pressure was 14.1 mm Hg, and at one year 14.71 mm Hg. Cell density preoperatively was 2559.76 cells/mm2 and at one year 2475.88 cells/mm2. The preoperative hexagonality was 53.12 % and at one year 56.94 %. Preoperative cylinder -1.35 D and 23.5 % presented induced astigmatism at one year postoperatively. Conclusions: The application of posterior chamber foldable intraocular lens implant sutured to the iris in traumatic aphakia in pediatric patients achieves improved visual acuity and the most frequent complication was corneal edema.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

Effects of different viscoelastic agents on corneal endothelium of patients after phacoemulsification and foldable IOL implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effects of dual viscoelastic agents DisCoVisc and sodium hyaluronate on corneal endothelium of patients after phacoemulsification and foldable intraocular lens(IOL)implantation.METHODS: A total of 247 patients(285 eyes)with cataract treated in Jingmen Aier Eye Hospital between June 2017 and December 2019 were selected, and they were divided into DisCoVisc group(123 cases, 141 eyes)and sodium hyaluronate group(124 cases, 144 eyes)by random number table method. Both groups were treated with phacoemulsification and foldable IOL implantation. DisCoVisc and 1.7% sodium hyaluronate were used as viscoelastic agents in DisCoVisc group and sodium hyaluronate group, respectively. The two groups were compared in terms of intraoperative ultrasound time(UST), cumulative dissipated energy(CDE), time for aspiration of viscoelastic agents after IOL implantation, corneal edema at 1d, 1wk, 1 and 3mo after operation, corneal endothelial cell density(ECD)and ECD loss rates before operation and at 3mo after operation, coefficient variation of corneal endothelial cell size(CV), percentage of corneal hexagonal endothelial cells(6A), intraocular pressure, the proportions of patients with uncorrected visual acuity ≥0.5 and central corneal thickness(CCT)values before and after operation at 1d, 1wk and 1mo.RESULTS:There was no statistically significant difference between the two groups in UST, CDE, aspiration time of viscoelastic agents(P &#x003E;0.05)or corneal edema both rate on day 1 after operation(P&#x003E;0.05). Corneal edema disappeared at 1 wk after operation. The ECD loss rate in DisCoVisc group was significantly lower than that in sodium hyaluronate group at 3mo after operation(P&#x003C;0.05). Intraocular pressure, the proportion of patients with uncorrected visual acuity ≥0.5 and CCT values showed no statistically significant differences between the two groups before and after operation at 1d, 1wk and 1mo(P &#x003E;0.05).CONCLUSION: DisCoVisc, as the viscoelastic agent in phacoemulsification and foldable IOL implantation for patients with Emery-Little grade Ⅱ-Ⅲ lens nucleus hardness, can better protect the patients' corneal endothelium.

Effect of radial axial incision on corneal astigmatism after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the effect of radial axial incision on corneal astigmatism after phacoemulsification.METHODS: Totally 60 cases (62 eyes) of cataract patients were selected from our hospital, divided into Group A and Group B randomly.Two groups were both required to have a corneal incision, while Group A took it in the maximum corneal refractive radial axial and the Group B took it in the traditional temporal side (right eye) or nasal side (left eye).At the same time two groups received phacoemulsification and foldable intralocular lens (IOL) implantation.We measured their date before surgery, after surgery in 1d, 1wk and 1mo respectively with CT200 corneal topography measurement.The date was compared in two groups of corneal astigmatism, surgically induced astigmatism and visual acuity.According to the corneal astigmatism and axial, surgically induced astigmatism was calculated.RESULTS: Group A and Group B were compared in age, gender, lens nucleus hardness, visual acuity, corneal astigmatism before the surgery, which has no statistically significant differences (P>0.05).Postoperative visual acuity of both groups was higher than preoperative (P0.05).Corneal astigmatism was not statistically significant in two groups at 1d after surgery (P>0.05).The corneal astigmatism was significantly less in Group A than that in Group B in 1wk and 1mo after surgery, and the difference was statistically significant (P<0.05).After the surgery for 1wk and 1mo, the surgically induced astigmatism of Group B was significantly higher than that of the Group A, with the difference was statistically significant (P<0.05).CONCLUSION: Making clear corneal incision along the maximum curvature of the cornea in cataract surgery can make the corneal astigmatism and the degree of astigmatism less after surgery.

Late Onset Capsular Block Syndrome in a Diabetic Patient: Case Report.

We report a case of capsular block syndrome in a diabetic patient who had undergone phacoemulsification after circular capsulorhexis and intraocular lens (IOL) implantation in the left eye. Five years later, the posterior capsule had vaulted far posteriorly, the capsular opening was apparently sealed by the lens optic, and fluid had accumulated between the posterior capsule and the IOL. The retrolental fluid was emptied from the capsular bag posteriorly into the vitreous using a neodymium-doped yttrium aluminium garnet laser capsulotomy, and the distended capsule lieved.

Clinical study of foldable intraocular lens secondary implantation after lens -vitrectomy in residual capsular with traumatic eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To investigate the operation methods and clinical effects of foldable intraocular lens secondary implantation after lens-vitrectomy in residual capsular with traumatic eyes. METHODS: During January 2012 to January 2014, foldable intraocular lens was implanted on 47 cases following lens - vitrectomy in residual capsular with traumatic eyes 3~6mo. Follow-up period was 6 ~12mo, averaged (8. 21±2. 63)mo.RESULTS:All of 47 eyes had successful operation at one time, and position deviation was not appeared. The naked vision of the last postoperative follow-up was (0. 44±0. 19). Compared with best corrected visual acuity (0. 41±0. 23), and There was no significant difference between visual acuity of preoperative and last follow-up period ( t=0. 879, P=0. 342). No severe complication was found. CONCLUSlON: Secondary implantation of foldable intraocular lens is a safe and reliable method for correcting ametropia after lens- vitrectomy in residual capsular with traumatic eyes.

Scleral fixation of one piece intraocular lens by injector implantation.

Aim of Study: With an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fi xation through small clear corneal incision. Materials and Methods: Case report and literature review. Results: This procedure has been performed in eight aphakic eyes with four diff erent types of IOLs. Good centration was achieved with minimal technical eff ort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up. Conclusion: We managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fl uid leakage and consecutive hypotony can be minimized.

Glue-assisted intrascleral fixation of posterior chamber intraocular lens.

Purpose: To analyze the visual outcome of patients undergoing glue-assisted intrascleral fixation of posterior chamber intraocular lens (IOL) in the absence of posterior capsular support. Materials and Methods: This retrospective study analyzes 25 eyes which underwent IOL implantation by the glued intrascleral fixation technique. The pre and post-operative uncorrected visual acuity (UCVA), pre and post-operative best corrected visual acuity (BCVA), intraocular pressure (IOP), IOL position, anterior chamber reaction and central macular thickness were assessed and recorded. Immediate and late post-operative complications were also recorded. Results: A total of 25 eyes of 22 patients were reviewed and analyzed over a period of one year. All eyes had a foldable three-piece IOL implanted. About 84% of the eyes had a gain of one or more lines, 12% had no gain, and 4% had a fall of three lines of BCVA on Snellen's visual chart, which was attributed to cystoid macular edema (CME). Postoperatively, there was a significant improvement in the UCVA (P < 0.05) and in the BCVA (P < 0.05). Postoperative complications included decentration in one case and vitritis with chronic macular edema in another case. Optical coherence tomography (OCT) demonstrated well placed IOL with no tilt. Conclusion: Although the results of one year follow-up of glued intrascleral fixation are promising, long term studies are recommended.

Biocompatibility of intraocular lens materials / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.25.026

Lentes intraoculares plegables y astigmatismo posquirúrgico en la catarata pediátrica / Foldable intraocular lenses and postsurgical astigmatism in pediatric cataract

Objetivo: determinar el astigmatismo posquirúrgico en pacientes con diagnóstico de catarata pediátrica operados y con implante de lente intraocular plegable. Métodos: estudio observacional, descriptivo y transversal en 20 pacientes 28 ojos entre 2 y 14 años de edad, operados de enero de 2008 a septiembre de 2010 en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se excluyeron los pacientes que presentaban alteraciones corneales. Se realizó lensectomía con capsulotomía posterior y vitrectomía anterior. Se implantó lente de acrílico hidrofóbico e hidrofílico plegable. Resultados: el 55 por ciento de los pacientes tenían entre 5 a 8 años de edad promedio 5,7 años. El tipo de catarata más frecuente fue la congénita 85 por ciento. La agudeza visual preoperatoria en el 60,7 por ciento de los casos era inferior a 0,3, a los 4 meses de operados 32,1 porciento tenían más de 0,9 y al año 35,7 por ciento alcanzó más de 0,9 y 28,6 por ciento entre 0,3 y 0,6. El astigmatismo antes de la cirugía en 32,2 por ciento estaba entre 0,5 y 1,5, a los 4 meses y al año fue entre 0,5 y 1,5 en 35,7 porciento. Conclusiones: el astigmatismo no sufrió variaciones con la realización de este tipo de cirugía. Una estrategia quirúrgica personalizada permite una mejor recuperación anatómica y funcional en estos pacientes

Objective: to determine the postsurgical astigmatism in patients operated on from pediatric cataract and with foldable intraocular lens implantation. Methods: an observational, descriptive and cross-sectional study of 20 patients 28 eyes between 2 and 14 years of age, who were operated on in the period of January 2008 through September 2010 at Ramon Pando Ferrer Cuban Institute of Ophthalmology. Some patients were excluded if they presented corneal alterations. Lensectomy, posterior capsulotomy and anterior vitrectomy were performed; hydrophobic and hydrophilic acrylic lenses were implanted. Results: fifty five percent of patients were 5 to 8 years of age average of 5.7 years. The more frequent type of cataract was the congenital 85percent. The initial visual acuity in 60.7 percent of cases was below 0.3; four months after surgery, 32.1 percent reached over 0.9 and after a year 35.7 percent reached more than 0.9, and 28.6 percent from 0.3 to 0.6. The astigmatism before the surgery in 32.2 percent of cases ranged 0.5 to 1.5, but four months and one year after surgery, it was 0.5 to 1.5 in 35.7 percent of patients. Conclusions: astigmatism did not vary with the performance of this type of surgery. A personalized surgical strategy allows achieving better anatomical and functional recovery of these patients

Scleral Fixation of Foldable Intraocular Lenses Using Injector

PURPOSE: To introduce the method of scleral fixation, using Mport(TM) (Bausch & Lomb) injector and silicone three-piece foldable IOL (Silens 6, Bausch & Lomb). METHODS: The study was conducted for five cases of aphakia requiring secondary implantation of IOL. The partial-thickness scleral flaps were made on 2 and 8 o' clock site. A double-armed 10-0 polypropylene suture and 26G needle were inserted through each sclera. Surgical and 26G needle were conjoined and passed out through 2 o' clock site sclera. The clear corneal incision was made on 10 o' clock site through which a suture was pulled out and cut. The end of suture which originated from 8 o' clock site was passed through the injector and tied to the leading haptic of IOL, then inserted. The other end of suture was tied to the following haptic and complete the insertion of IOL with forceps. RESULTS: Time taken for the above procedure was within 20 minutes and postoperatively induced astigmatism was less than 1.5 diopters. No specific complication was noticed. CONCLUSIONS: This technique may be an effective and substitute procedure for that have been used for reasons of less astigmatism, and stable chamber maintenance during procedure.

A Clinical Study in Transscleral Fixation of Foldable Intraocular Lenses

PURPOSE: To evaluate the results and complications of transscleral fixation of the foldable intraocular lens(IOL). METHODS: We performed a retrospective review of the medical records of 26 patients who had undergone transscleral fixation of acrylic three-piece foldable IOL from January 2002 to April 2004 in our hospital. There were 5 eyes with aphakia, 2 with idiopathic lens subluxation, 3 with trauma, 5 with dislocation or opacification of IOL, and 11 with complicated cataract surgery. RESULTS: The mean age of the patients was 70.6 years (range, 47~87 years). The range of preoperative best corrected visual acuity (BCVA) was from light perception to 0.6. The mean preoperative refraction and mean preoperative target refraction were 2.0 +/- 6.51D (-8.5~13D) and -0.45 +/- 0.70D (-3.75~0.39D), respectively, in spherical equivalent. The mean preoperative corneal astigmatism was -1.0 +/- 0.65D (-0.25~-2.5D). The postoperative BCVA ranged between 0.02 and 1.0, and the mean refractive error was -0.66 +/- 1.15D (-3.3~1.75D) at the last follow-up visit. The mean corneal astigmatism was -1.55D +/- 1.67 (-9~-0.25D) at the last follow-up visit (p=0.99, paired t-test). CONCLUSIONS: Transscleral fixation of the foldable IOL through small incision results in fewer complications, due to the large incision and the shorter time, and therefore, instantly improved visual acuity.

Scleral Fixation of Foldable Posterior Chamber Intraocular Lenses

PURPOSE: To evaluate the surgical result and complications of scleral fixation of foldable intraocular lenses. METHODS: We reviewed the medical records of 17 patients who had undergone scleral fixation of acrylic three-piece foldable intraocular lens. RESULTS: Uncorrected visual acuity were improved in all eyes with time. Postoperative best corrected visual acuity were better than preoperative best corrected visual acuity in 14 eyes from 1.18+/-0.84 to 0.26 +/-0.25 in logMAR visual acuity. Estimated refractive error were 0.01+/-0.34 diopter in spherical equivalent preoperatively and .0.59+/-1.00 diopter postoperatively (p=0.02, paired t-test). The corneal astigmatic changes (dK) of mild against-the-rule astigmatism decreased as time passed. There was no intraoperative bleeding. There were postoperative complications such as increased intraocular pressure in 2 eyes, corneal epithelial defect in 1 eye. CONCLUSIONS: In cases of scleral fixation, by using acrylic foldable intraocular lens through small incision, we were able to reduce corneal astigmatism and complications due to large incision and therefore, improve visual acuity instantly.

Refractive Change and Complications of Reverse-inserted Foldable Intraocular Lens

To evaluate the refractive consequences and complications of inadvertently implanting reverse-inserted foldable posterior chamber intraocular lenses (IOL)from May 1997 to December 1998, a total of 8 eyes (8 patients) were analyzed.One of these patients was male, seven were female and the mean age of patients was 70 years.The used IOLs were Chiroflex 32-C31SX (4 eyes), Corneal SP57T (2 eyes), and AcrySof MA60BM (2 eyes).The SRK-II formula was used to predict target spherical equivalent refractive error (SE).Actual postoperative SE were determined at 1 year after surgery and these results were compared with nonreversed control group (29 eyes). The target postoperative SE were subtracted from the actual postoperative SE to calculate diopter differences, between the actual SE and the target SE.The mean (+/-standard deviation)diopter difference in reversed IOL group was -0.95D +/-1.04D (ranged from -2.81D to 0.87D)more myopic than control group :-0.13D +/-0.98D (ranged from -3.23D to 1.47D), but the differ-ence (0.82D)was not statistically significant (p=0.07).The mean postoperative 1 year visual acuity in reversed IOL group was 0.74 +/-0.24, and in control group 0.76 +/-0.22;the difference (0.02)was not statistically significant (p=0.83).Posterior capsular opacity (PCO)developed in only 1 eye in reversed IOL group after 1 year postoperatively, and it occurred in 1 eye in the control group.No statistically significant difference was found in the incidence of PCO between the two groups (Chi-Square test, p>0.05).There-fore reversed IOL group is likely to produce a satisfactory refractive result and not to warrant the risks of repositioning the lens.

Clinical Results of Silicone Foldable Intraocular Lens Implantation: Diabetics vs Nondiabetics

To evaluate the visual, astigmatic results and incidence of complications in cases of no-stich, small incision cataract surgery with a square sclerocorneal tunnel and silicone flexible intraocular lens we cornpared the resuite of catarct surgery in DM patients with those of non-DM patients. 305 eyes of 284 patients including 21 eyes of 20 patients of diabetes mellitus from October, 1994 to Decernber, 1996 who underwent cataract surgery with silicone foldable intraocular lens were enrolled in this retrospective study. During follow-up examination, the change of visual acuity, astigmatism, the incidence of postoperative complications was evaluated. Early visual rehabilitation because of small surgically induced refractive change during im.mediate postoperative period can be achieved. During 2 months follow-up, no against-the-rule shift of astigmatism detected. The incidence of postoperative complication were nearly the same as previous report : decentration 0.7%, hyphema 2%, uveitis 0.4%, posterior casular opacification 4.2%. In cases of posterior capsular opacification, Nd-YAG laser posterior capsulotomy showed significant increment of vision. The visual acuities in DM patients were comparably as good as those of non-DM patients. The incidence of posterior capsular opacification and corneal edema was relatively high in DM patients. In conclusion, no stitch snaall incision cataract, surgery through which silicone foldable intraocular lens im. planted showed good visual, astigmatic results in uncomplicated and selected cases of cornplicated with DM patients.