Sutureless transconjunctival intrascleral intraocular lens fixation: the modified Yamane technique / Fixação de lente intraocular intraescleral transconjuntival sem sutura: técnica de Yamane modificada

ABSTRACT Purpose: To evaluate the efficacy and safety of the modified Yamane technique with sutureless transconjunctival intrascleral intraocular lens fixation. Methods: Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dislocated intraocular lenses. A clear corneal incision (2.8 mm) was made into the temporal quadrant and a three-piece intraocular lens was implanted into the anterior chamber. The haptics of the intraocular lens were externalized with a 27 G needle via transconjunctival scleral tunnels at the 6 and 12 o'clock positions. The transconjunctival scleral tunnels were prepared to conform to the haptic position and curvature. The site of the scleral tunnels was 2mm from the limbus with a length of 2 mm in the sclera and was aimed at the end of the posterior chamber. The tips of the haptics were cauterized to create a terminal knob. The haptics were pushed back and the knobs were implanted into the scleral tunnels. Results: The study cohort included 21 patients with unilateral aphakia and dislocated intraocular lenses. All patients were examined postoperatively and at postoperative day 1, day 7, month 1, and month 3. All examinations revealed formation of the anterior chamber and well-centralized intraocular lenses. No haptic-related complications of exposure, foreign body sensation, or discomfort were observed. Conclusion: Sutureless transconjunctival intrascleral haptic fixated intraocular lensimplantation is an effective, safe, and practical surgical alternative. This technique was superior to the Yamane method with regard to comfort and surgical duration. Further studies with longer follow-up evaluations are warranted to verify long-term complications.

RESUMO Objetivo: Avaliar a eficácia e a segurança da técnica de Yamane modificada com a fixação de lenta intraocular transconjuntival sem sutura. Métodos: O implante de lente intraocular intraescleral e transconjuntival sem sutura foi realizado em pacientes com afacia e lentes intraoculares luxadas. Uma incisão em córnea clara (2,8 mm) foi feita no quadrante temporal e uma lente intraocular de três peças foi implantada na câmara anterior. Os hápticos da lente intraocular foram externalizados com uma agulha 27G através de túneis esclerais transconjuntivais nas posições de 6 e 12 horas. Os túneis esclerais transconjuntivais foram preparados para se ajustarem à posição e curvatura hápticas. O local dos túneis esclerais foi de 2 mm do limbo com um comprimento de 2 mm na esclera e foi destinado ao final da câmara posterior. As pontas dos hápticos foram cauterizadas para criar uma saliência terminal. Os hápticos foram empurrados para tras e as saliências foram implantadas nos túneis esclerais. Resultados: A coorte do estudo incluiu 21 pacientes com afacia unilateral e lentes intraocular deslocada. Todos os pacientes foram examinados no pós-operatório e no dia 1, 7, 1 mês e 3 meses do pós-operatório. Todos os exames revelaram formação da uma câmara anterior e lentes intraoculares bem centralizadas. Nenhuma complicação hápticas relacionada à exposição, sensação de corpo estranho ou desconforto foram observadas. Conclusão: O implante de lente intraocular transconjuntival intraescleral sem sutura é uma alternativa cirúrgica eficaz, segura e prática. Esta técnica foi superior ao método de Yamane no que diz respeito ao conforto e duração cirúrgica. Mais estudos com avaliações de seguimento mais prolongados são necessários para verificar as complicações de longo prazo.

New comparative ultrasound biomicroscopic findings between fellow eyes of acute angle closure and glaucomatous eyes with narrow angle / Novos achados comparativos de biomicroscopia ultra-sônica entre olhos contralaterais com fechamento angular agudo e olhos glaucomatosos com ângulo estreito

PURPOSE: To compare morphometric features between fellow acute primary angle-closure (APAC) eyes and glaucomatous or suspect eyes with narrow angle (NA). METHODS: Fellow eyes of 30 patients with unilateral APAC and 30 with NA were evaluated by ultrasound biomicroscopy (UBM) under light and dark conditions. UBM parameters such as anterior chamber depth (ACD), angle opening distance at 250 µm/500 µm from the scleral spur (AOD250/AOD500), trabecular ciliary process distance (TCPD) and iris-lens contact distance (ILCD) were measured in the superior (SQ) and inferior (IQ) quadrants. RESULTS: Significant differences between APAC fellow and NA eyes were found in ACD, P<0.001; AOD250 at SQ and IQ, P<0.001; AOD500 at SQ and IQ, P<0.001; TCPD light, P=0.010 and TCPD dark at SQ, P=0.031; and TCPD light at IQ, P=0.010. Significant differences between light and dark examinations of APAC fellow eyes were found in ILCD (P=0.009) at SQ and ILCD at IQ (P=0.006), and of NA eyes in ILCD at SQ (P=0.047) and ILCD at IQ (P<0.001). CONCLUSIONS: APAC fellow eyes have a more crowded anterior segment and shallower ACD than NA eyes. ILCD decreases in both groups when the illumination conditions change from light to dark.

OBJETIVO: Comparar características morfométricas entre olhos contralaterais com fechamento angular primário agudo (FAPA) e olhos glaucomatosos ou suspeitos com ângulo estreito (AE). MÉTODOS: Olhos contralaterais de 30 pacientes com FAPA unilateral e olhos de 30 pacientes com AE foram avaliados através da biomicroscopia ultra-sônica (BUS) no claro e escuro. Parâmetros da BUS como a profundidade central de câmara anterior (PCA), distância da abertura angular a 250 µm/500 µm do esporão escleral (AOD250/AOD500), distância entre o processo ciliar e o trabeculado (TCPD) e distância do contato iris-cristalino (ILCD) foram medidos nos quadrantes superior (QS) e inferior (QI). RESULTADOS: Diferenças significativas entre olhos contralaterais de FAPA e olhos com AE foram encontradas na PCA, p<0,001; AOD250 no QS e QI, p<0,001; AOD500 no QS e QI, p<0,001; TCPD no claro, p=0,010 e TCPD no escuro no QS, p=0,031; e TCPD no claro no QI, p=0,010. Diferenças significativas entre exames no claro e escuro realizados em olhos contralaterais com FAPA foram encontradas na ILCD (p=0,009) no QS e ILCD no QI (p=0,006), e em olhos com SE na ILCD no QS (p=0,047) e ILCD no QI (p<0,001). CONCLUSÕES: Olhos contralaterais de FAPA apresentam um segmento anterior mais aglomerado e uma PCA menor que olhos com AE. ILCD diminui em ambos os grupos quando as condições de iluminação mudam do claro para o escuro.

Biomechanical and histological evaluation of glycerol-preserved human sclerae

PURPOSE: To determine the histological and biomechanical characteristics of glycerol-preserved human sclera. METHODS: A total of 114 paired human sclerae were cleaned and preserved with 98 percent glycerol under refrigeration at 4 to 8ºC. The samples were divided into a control group with no preservation and 5 groups of 19 sclerae in 7, 15, 30, 90 and 180 days of preservation. Each specimen was submitted to histological examination and tested for traction distensibility functions. RESULTS: Preservation in glycerol did not cause alterations in the histological architecture of the scleral tissue. The mean load required to break the scleral tissue increased according to preservation time as a sigmoid function. A significant increase in mechanical resistance and decrease in distension of scleral tissue occurred after 90 days of preservation. CONCLUSIONS: Scleral preservation in glycerol keeps tissue integrity. The preserved material is less distensible after 90 days. Surgeons who use sclera in ophthalmic procedures should be aware of the mechanical characteristics of glycerol-preserved sclera and take into account tissue preservation time.

OBJETIVO: Determinar as características histológicas e biomecânicas de escleras humanas preservadas em glicerol. MÉTODOS: Escleras de ambos os olhos de 55 doadores foram limpas e preservadas com glicerol a 98 por cento sob refrigeração (4 a 8ºC). A amostra foi dividida em grupo controle sem preservação e 5 grupos de 19 escleras com 7, 15, 30, 90 e 180 dias de preservação. Todas as amostras foram submetidas à avaliação histológica e aos testes de tração e distensão. RESULTADOS: A preservação em glicerol não provocou alterações na arquitetura histológica do tecido escleral. A carga média necessária para romper o tecido escleral aumentou com o tempo de preservação segundo uma função sigmóide. Um incremento significativo na resistência mecânica e diminuição da elasticidade do tecido ocorreram após 90 dias de preservação. CONCLUSÕES: A preservação escleral com glicerol mantém a integridade tecidual. O material preservado torna-se menos distensível após 90 dias de preservação. Cirurgiões que usam esclera preservada em procedimentos oftalmológicos devem estar conscientes das propriedades mecânicas do material e levar em conta o tempo de preservação do material.

Ciliary staphyloma: very rare sequelae of conjunctival rhinosporiodosis.

The main ocular manifestation of rhinosporiosis is lid or conjunctival infection. Conjunctival rhinosporiodosis is very rately causing sclera necrosis. A patient named Shumi (8 years), D/O.- Rukan Uddin of Rupchandrapur, Atpara, Netrokona admitted on 09/03/2003 in the department of Ophtalmology, Mymensingh Medical College Hospital with complains of mass in right eye looks externally like a growth in upper lid and mild dimness of vision of right eye. On examination, it was found that she got VAR : 6/24 and having a shaphyloma near 12-00 O'clock position with a mass adjacent to it which was identified as rhinosporiodosis after excisional biopsy. No history of ocular trauma or any other ocular disease was found.

Intra-bleb pigmentation after trabeculectomy.

PURPOSE: To report the presence of intra-bleb pigmentation (IBP), appearing after trabeculectomy and combined clear cornea phacoemulsification, intraocular lens (IOL) implantation and trabeculectomy (combined surgery). METHOD: Ten eyes of 8 Asian patients with IBP were studied. Four eyes underwent trabeculectomy for uncontrolled glaucoma, and 6 eyes underwent combined surgery for cataract coexisting with glaucoma. Seven of the 10 eyes had adjunctive mitomycin C for the procedures. RESULTS: Mean follow-up time was 11.6 months (range 3-15 months). Five of the 10 eyes had intra-operative and post-operative complications requiring intraocular manipulation (ruptured posterior capsule and in-the-sulcus IOL, flat anterior chamber, malignant glaucoma, iris prolapse). Blebs were thin (8 eyes), or with moderate thickening of conjunctiva (2 eyes) with IBP either overlying the scleral flap or spread beneath the conjunctiva. IBP initially appeared at 2 to 44 weeks after the procedures. Nine of the 10 eyes (90%) had IOPs < or = 22 mmHg without medication. CONCLUSION: IBP is associated with iris trauma at surgery and dispersal of pigment into the bleb, where it spreads or proliferates. A thin bleb provides a clear view of IBP as well as functional filtration. IBP appears to be a favorable sign of the filtration.

Valor diagnóstico y terapéutico de la biopsia conjuntival en las enfermedades inflamatorias oculares externas / The conjunctival biopsy is an important role in the inflammatory processes the external structures of the eye

La conjuntiva desempeña un papel muy importante en los procesos inflamatorios de las estructuras oculares externas, incluyendo a la misma conjuntiva, la córnea y la esclera. La quetoconjuntivitis cicatrizante crónica representa un grupo de enfermedades con manifestaciones clínicas similares, pero con un diagnóstico diferencial muy extenso y en el cual la confirmación diagnóstica por medio de los hallazgos inmunohistopatológicos de la conjuntiva es de crucial importancia para instituir un tratamiento adecuado. Lo mismo es cierto para la queratitis ulcerativa periférica y la excleritis necrotizante, en las cuales la historia clínica detalla, en conjunto con la biopsia conjuntival, representan las dos armas diagnósticas fundamentales. Además, esta última es el punto crítico en la toma de decisiones respecto a si instituir o no quimioterapia inmunosupresiva en estos casos. De esta manera, el estudio histopatológico e inmunopatológico de la conjuntiva representa una arma fundamental en el diagnóstico, en el tratamiento, así como en el entendimiento de la patogénesis de las enfermedades inflamatorias oculares externas de origen inmunológico.

use of a modified compression shell after subscleral trabeculectomy

To determine the influence of a modified compression shell [with a cut out free space for the cornea] in guarded filtration procedures on flat anterior chambers, final intraocular pressure [IOP] reduction, success rate, tenon capsule cyst [TCC] and bleb appearance in patients with primary open angle glaucoma, we randomized in a prospective clinical trial 33 patients divided into two groups: Group A, 15 patients in whom the shell was applied immediately postoperatively; and group B, 18 patients without shell. Both groups were similar in age, sex, diagnosis and preoperative IOP. The shell was applied at the end of each surgery and used for three days postoperatively. There was no statistical difference after surgery in the incidence of flat anterior chamber [2/15 in group A and 3/18 in group B]. Also, there was no difference after three months in term of bleb appearance, but there was a tendency of fewer TCC in those receiving the shell [1/15 in group A and 3/18 in group B]. After two years there was no statistical difference in IOP reduction or in success rate in either group [73.5 percent group A and 72.5 percent group B]. Success is defined as 5 mmHg <22, with reduction of medication and no carbonic anhydratse inhibitors

Trabeculectomy with a scleral wing flap

The limbus is a critical area in ocular surgery, particularly glaucoma surgery. Surgical invasion of the external limbus in trabeculectomy weakens the insertion of the conjunctiva and disinserts tenon's capsule in limbus flap, and approximates conjunctival and scleral wounds in fornix-based flaps. This may lead to complications like leakage, buttonholing, Dellen formation, corneal dissection of bleb, thin-walled, cystic, and overhanging blebs. These complications are less likely to occur when the shape of the scleral flap is modified, giving it lateral extensions, "wings", resulting in an incision that reaches the scleral surface behind the sclero-corneal junction, yet can be carried forward into clear cornea for the internal wound lip