Síndrome do bloqueio capsular tardio - relato de dois casos / Capsular block syndrome - report of two cases

Relato de dois casos de síndrome do bloqueio capsular, de ocorrência tardia, nove e cinco anos após facoemulsificação, respectivamente, em um olho com pseudoexfoliação capsular e outro operado de glaucoma, com bolha funcionante. A condição se constituiu na retenção de grande quantidade de líquido esbranquiçado, atrás da lente intraocular, o que levou à redução da AV, de quatro linhas de Snellen, nos dois casos. Houve pronta resolução do quadro com mínima capsulotomia posterior.

Two cases of late capsular block syndrome are reported. They were observed nine and five years after facoemulsification, in one eye with pseudoexfoliation syndrome and the other operated on for glaucoma with a functioning bleb. There was a large amount of milky material behind the intraocular lens, and reduction of the visual acuity (four lines of the Snellen chart in both cases). The condition was promptly resolved through minimal YAG laser posterior capsulotomy.

Capsulorrexe em duplo anel: estudo clínico patológico / Double ring capsulorhexis: clinic opathologic study

Apresentamos caso de capsulorrexe em duplo anel em paciente feminina de 81 anos. O espécime cirúrgico foi submetido a estudo anatomopatológico que evidenciou os achados típicos da capsulorrexe em duplo anel. Comentamos a possível relação com a exfoliação capsular verdadeira. Salientamos que é possível realizar a cirurgia com bom resultado mesmo que o duplo anel não seja completo - como no caso apresentado - , porém desde que os folhetos capsulares estejam fundidos de forma contínua.

We present a case of double ring capsulorhexis in a 81 year-old female patient. Surgical specimen was submitted to histopathologic study resulting in typical double ring capsulorhexis findings. We discuss the questioned relation to true capsular exfoliation. We call attention to the fact that it is possible to obtain a good surgical result even when the double ring is not complete - as the case presented - , since both capsular flaps are fused in a continuous form.

Cataracts among Adults Aged 30 to 49 Years: A 10-Year Study from 1995 to 2004 in Korea

PURPOSE: To investigate the long-term characteristics of cataracts among adults aged 30 to 49 years in Korean over a span of 10 years. METHODS: Subjects between the ages of 30 to 49 years who underwent cataract surgery at St. Mary's Hospital from 1995 to 2004 (n = 976) were included. Patients with a history of ocular trauma, uveitis, other ocular or systemic diseases, and congenital cataracts were excluded. Additional information including type of lens opacity, urban/rural region, and pre- and postoperative visual acuities were analyzed. Lens opacity grading was conducted using Lens Opacity Classification System III. The Cochran-Armitage proportion trend test was used to analyze vision changes with the passage of time. RESULTS: Among the patients who had undergone cataract surgeries, 8.8% (976 / 11,111) met the inclusion criteria. The mean age was 41.7 +/- 5.45 years. Gender breakdown of the patient population included 79.0% male and 21.0% female. In terms of home environment, 60.9% were from an urban region and 39.1% from a rural region. Opacity type included anterior polar (AP), posterior subcapsular (PSC), AP and PSC, cortical, and nuclear in 35.7%, 35.1%, 7.0%, 6.0%, and 5.4% of patients, respectively. At a 2-month postoperative follow-up appointment, 92.7% of patients showed a best-corrected visual acuity of more than 20 / 40. CONCLUSIONS: Predominance of AP and PSC opacities as well as male patients was observed in this study population.

Técnica Tied Out Open Sky: fixação iriana de lente intraocular combinada com transplante penetrante de córnea / Tied Out Open Sky technique: new method for iris fixation of intraocular lens in the absence of capsular support during penetrating keratoplasty

O objetivo é descrever uma nova técnica cirúrgica para fixação iriana de lente intraocular durante transplante de córnea em pacientes sem suporte capsular. A técnica de fixação iriana Tied Out Open Sky é uma técnica de fácil execução comparado com as técnicas já descritas, dispensando manobras cirúrgicas complexas, minimizando a manipulação e as complicações pós-operatórias.

To describe a new method for iris fixation of intraocular lens in the absence of capsular support during penetrating keratoplasty. Its a new technique of iris fixation of intraocular lens without capsular support during penetrating keratoplasty. This technique is used in cases with a healthy iris and partial or total absence of capsular support during penetrating keratoplasty. Tied Out Open Sky is a technique easy to perform for iris fixation of intraocular lens during penetrating keratoplasty. The big advantage is being able to tie off the intraocular lens off the eye and fasten it securely.

Fixação iriana de lentes de câmara posterior para o tratamento da afacia / Iris fixation of posterior chamber intraocular lenses for the treatment of aphakia

OBJETIVO: avaliar os resultados de uma série de casos de fixação iriana de lentes intra-oculares de câmara posterior para correção de afacia, realizados no setor de catarata da disciplina de Oftalmologia da Faculdade de Medicina do ABC e compará-los a literatura existente. MÉTODOS: estudo prospectivo de oito pacientes afácicos, que apresentavam ausência de suporte capsular adequado e foram submetidos à cirurgia para implante secundário de LIO de câmara posterior com fixação iriana seguindo a técnica modificada de McCannel. RESULTADOS: sete dos oito pacientes (87,5 por cento) que não tiveram complicações cirúrgicas obtiveram melhora na acuidade visual corrigida. Um paciente (12,5 por cento) apresentou complicação intra-operatória, evoluindo com ceratopatia bolhosa do pseudofácico. Um paciente (12,5 por cento) apresentou glaucoma secundário à dispersão pigmentar. CONCLUSÃO: em nosso estudo a técnica de fixação iriana de câmara posterior se mostrou eficaz e segura para o tratamento da afacia, em concordância com os dados da literatura.

PURPOSE: evaluate the results of a case series of iris-sutured posterior chamber IOLs for the correction of aphakia in the cataract sector of the department of Ophthalmology of the ABC School of Medicine and compare them with the existing data. METHODS: prospective study of eight patients who underwent foldable IOL implantation using modified McCannel iris suture fixation for aphakia in the absence of capsule support. RESULTS: seven of eight patients (87,5 percent) without surgical complications improved their best corrected visual acuity. One patient (12,5 percent) with surgical complication developed pseudophakic bullous keratopathy. One patient (12,5 percent) developed secondary glaucoma caused by dispersion syndrome. CONCLUSION: in our study the iris-sutured posterior chamber IOLs prove to be safe and effective in the treatment of aphakia, in accordance with existing data.

Exfoliação capsular verdadeira: relato de dois casos / True capsular exfoliation: report of two cases

Relatamos dois casos de exfoliação verdadeira da cápsula, acontecendo em pacientes idosos sem história de exposição prolongada a altas temperaturas ou passado de inflamação intra-ocular. Os aspectos biomicroscópicos, anátomo-patológicos e possíveis implicações cirúrgicas são comentados.

We report two cases of true capsular exfoliation occurring in elderly patients with no known history of prolonged heat exposure or intraocular inflammation. The biomicroscopic aspects, histopathologic findings and possible surgical implications are discussed.

Análise da camada de fibras nervosas pelo GDx em pacientes pseudofácicos com opacidades da cápsula posterior / Analysis of the nerve fiber layer using GDx in pseudophakic patients with posterior capsular opacification

OBJETIVO: Avaliar se a opacificação de cápsula posterior (OCP) influenciaria na análise da camada de fibras nervosas pela polarimetria "scanning laser" (GDx). MÉTODOS: Trinta e sete pacientes pseudofácicos não glaucomatosos foram submetidos a análise da camada de fibras nervosas pelo GDx antes e após a realização de capsulotomia com Nd:YAG laser. RESULTADOS: Em cinco olhos, o GDx não conseguiu imagens aceitáveis pelos parâmetros de aquisição do aparelho. Em todos os outros, não foi observada diferença significante entre os valores médios das variáveis antes e após a realização da capsulotomia posterior. CONCLUSÃO: A presença de OCP em graus moderados e/ou quando há imagens aceitáveis em pacientes pseudofácicos não influencia o resultado da análise das imagens das fibras do nervo óptico pelo GDx. Apenas intensos graus de OCP que impeçam a obtenção de imagem analisável pelo aparelho inviabilizam o exame.

PURPOSE: To evaluate if posterior capsule opacification (PCO) would alter the analysis of nerve fiber layer using the scanning laser polarimetry (GDx). METHODS: Pseudophakic non-glaucomatosous eyes (37 patients) underwent nerve fiber layer analysis using GDx before and after posterior capsulotomy with Nd:YAG Laser. RESULTS: In five eyes, GDx did not obtain acceptable images using the device's parameters of acquisition. In the others, mean variable values did not reach significant difference before and after posterior capsulotomy. CONCLUSION: Moderate degrees of PCO and/or acceptable images in pseudophakic patients do not alter the analysis of nerve fiber layer by GDx. Only intense degrees of PCO that hinder analyzable images make the examination impracticable.

Delayed accumulation of lens material behind the foldable intraocular lens.

Foldable acrylic intraocular lenses (IOLs) are known to reduce posterior capsule opacification by preventing migration of lens epithelial cells with its square edge design and its property of tackiness. Studies have reported a mean adhesiveness to posterior capsule more than three times higher for certain acrylic foldable IOLs than polymethyl methacrylate IOLs. The authors would like to report two cases where the force of tackiness was compensated, thereby presenting with delayed accumulation of lens material in the capsular bags behind the IOL with temporary loss of vision.

Herniation of the anterior lens capsule.

Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM) and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous) in the area of herniation giving it a characteristic appearance.

Posterior capsular rupture during phacoemulsification

To find out the reasons for Posterior Capsular Rupture during Phacoemulsification in our cases. Retrospective study from 2001 to 2005. Setting: Hamdard University Hospital and Nisar Eye Hospital, Karachi. A total of 300 patients who underwent Phacoemulsification were included in the study. Cases with +4 nuclei and those operated in camps were not included in this study. After thorough examination and investigations the patients were operated, mostly under retrobulbar anaesthesia. First follow up was on the first post operative day and then after one week, three weeks and eight weeks. Posterior capsular rupture was the most common intra-operative complication, seen in around 16% of our initial phacoemulsification cases. In most [43%] cases it was caused by the sharp and heated phaco tip. In every stage of the phacoemulsification we have to be very careful. Fluid dynamics change during phacoemulsification that may lead to rupture of the thin posterior capsule, and we should be alert to save it

Preoperative prediction of posterior capsule plaque in eyes with posterior subcapsular cataract.

AIM: To determine whether the plaque on the posterior capsule can be predicted preoperatively, in patients with posterior subcapsular cataract (PSC), undergoing cataract surgery. MATERIALS AND METHODS: A prospective study of 140 consecutive eyes with PSC, who underwent cataract surgery, was conducted. The prediction of preoperative presence or absence of plaque within the PSC was noted on slit lamp examination, in dilated pupils. A single observer made the observations under oblique illumination, where the slit lamp was placed at an angle of 30 degrees to 45 degrees. Evaluation of the plaque through slit lamp examination was standardized in terms of illumination and magnification. The observations were recorded using a video camera (Image archiving system, Carl Zeiss, Jena Germany) attached to a slit lamp (Carl Zeiss, SL 120 Jena, Germany), keeping the illumination at 100%. The prediction of plaque was noted in terms of its presence or absence on the posterior capsule. All the patients received counseling regarding the presence of plaque. Capsule polishing of the posterior capsule in Cap Vac mode, was done in all cases. The posterior capsule was examined for presence or absence of plaque, either on the first postoperative day, or within a week, with maximal mydriasis. The observer's results were tabulated and later analyzed to judge the incidence of predictability of plaque in PSC. RESULTS: The mean age of the patients was 45+/-6.2 years (range 32-61 years); 104 (74.3%) were males. One hundred and eight (77.1%) patients were under 50 years. The presence or absence of plaque was predicted correctly in 124 (88.6%) eyes. The prediction of plaque was incorrect in 16 (11.4%) eyes. CONCLUSION: The prediction of presence or absence of plaque was accurate in 88.6% cases. We believe that counseling patients with posterior capsule plaque before the surgery is the key to avoiding unpleasant surprises.

Incidência de opacificação de cápsula posterior em pacientes submetidos à facoemulsificação e implante de lentes intra-oculares acrílicas hidrofílicas expansíveis / Incidence of posterior capsule opacification in patients submitted to phacoemulsification and expandable acrylic intraocular lens implantation

OBJETIVO: Avaliar prospectivamente os resultados das lentes intra-oculares de polímeros expansíveis implantadas em pacientes submetidos à facoemulsificação, quanto à incidência de opacificação de cápsula posterior, levando em consideração a biocompatibilidade das lentes expansíveis. MÉTODOS: O grupo de estudo foi composto por 830 pacientes, 1.200 olhos, que foram submetidos a facoemulsificação, utilizando a mesma técnica, variando-se apenas o diâmetro da capsulorrexe, pelo mesmo cirurgião, no período de 1998 a 2002, com implante de lente intra-ocular hidrofílica expansível. O acompanhamento médio foi de 2,4 anos, variando de seis meses a quatro anos. RESULTADOS: O número total de opacificação de cápsula posterior foi de 54 casos. CONCLUSÃO: A incidência de opacificação de cápsula posterior encontrada no grupo foi de 4,6 por cento.

Comparison of acrylic and polymethyl methacrylate lenses in a pediatric population.

PURPOSE: To compare the intra-patient incidence of posterior capsular opacification (PCO) and their post operative course, in children with bilateral cataract, following implantation of acrylic (Group 1) and polymethyl methacrylate (PMMA) (Group 2) intraocular lenses (IOLs). MATERIALS AND METHODS: This was a prospective, interventional intra-patient case series. Twenty-five children with bilateral cataract, 5 years and older, underwent cataract surgery and implantation of an acrylic (AcrySof MA30BA, Alcon, Fortworth, TX) in one eye and PMMA (Indo Am IAB 203, Ocular Vision, Inc.) IOL in the other eye of each patient. They were followed up for an average of 11.1 +/- 9.5 months to assess the incidence of clinically significant PCO and occurrence of postoperative complications. RESULTS: Twenty-three children (46 eyes), were included in this study. Post-operatively, 22(95.6%) patients with acrylic IOLs and 20 (86.9%) patients with PMMA IOLs, either maintained or improved their vision. In the acrylic and PMMA IOL groups respectively, the incidence of clinically significant PCO was 21% (4) and 75% (12) ( P =0.002), with a median onset at 2.9 months and 0.7 months. Other complications included pupillary capture in 2 (8.7%) eyes and uveal prolapse in 1 (4.3%) eye in the acrylic group and increased uveal inflammation in 6 (26.1%) eyes and presumed noninfectious endophthalmitis in 2 (8.7%) eyes in the PMMA group. CONCLUSION: Incidence of PCO and post operative uveal inflammation is significantly less with acrylic lenses and were safe to use in pediatric eyes.

Late postoperative capsular block syndrome.

The authors report the case of a 61-year-old man with late postoperative capsular block syndrome who had undergone phacoemulsification and posterior chamber intraocular lens (IOL) implantation 3 years earlier. He presented with a decreased vision in the right eye caused by the accumulation of liquefied milky fluid in the space between the posterior surface of IOL optic and the posterior capsule. Neodymium: YAG laser posterior capsulotomy allowed a resolution of the milky fluid and the improvement of the visual acuity to 20/20.

Anterior "lenticonus" in exfoliation syndrome.

Presence of exfoliation syndrome (XFS) is associated with an increased risk of complications during cataract surgery. This risk is, in part, dependent on the severity of XFS. We describe a central bulge ("lenticonus") in the anterior lens capsule of some eyes with XFS. This finding is associated with very fragile zonules and a high risk for intraoperative zonular dialysis.

The Effect of Capsular Tension Ring on Posterior Capsular Opacity in Cataract Surgery

This study was performed to evaluate the efficacy and safety of the capsular tension ring on posterior capsular opacity in comparison with cases undergoing intraocular lens (IOL) implantation alone. We analyzed 127 eyes which had undergone cataract surgery, including capsular tension ring insertion, along with 127 eyes which had undergone IOL implantation alone by the same surgeon from September 1998 to March 2003. In the insertion group, 41 eyes (group A) had been followed up for more than one year after silicone IOL implantation, as had 40 eyes (group B) in the control group. We compared the incidence, type, and degree of capsular opacity between A and B groups and also endothelial cell loss after surgery between the two groups. For insertion group A, the frequency of posterior capsular opacity was lower (7.3%), the duration to development was longer, and the energy required for Nd-Yag capsulotomy of PCO was less than for control group B (25%) (p=0.037). The endothelial cell count loss rate was not significantly different between the two groups (p=0.522). The capsular tension ring is associated with a significantly reduced incidence of posterior capsular opacity and is a safe procedure.