Three-piece intraocular lens in the sulcus with optic capture in patients with mild to moderate zonular weakness in exfoliation

Purpose: To study the use of sulcus placement of a 3?piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Methods: Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3?piece IOL implanted in the sulcus with optic capture over a 5?year period between January 2017 and January 2022 were included in this retrospective case series. Results: The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil?expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of “in the bag” posterior chamber IOL or major complications. There was a significant improvement in visual acuity. Conclusion: The sulcus placement of 3?piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of “in the bag” IOL

Posterior optic capture of intraocular lens in difficult cases of pediatric cataract

We describe the technique of posterior optic capture without anterior vitrectomy in two difficult cases of pediatric cataract. We demonstrate how a three?piece foldable intraocular lens can be maneuvered behind the posterior capsule after an improvised posterior capsulotomy. This technique provided excellent intraocular lens (IOL) stability with the absence of lens epithelial cell proliferation in infants with altered posterior capsule morphology

Peripheral iridectomy for preventing iris-related complications in glued intraocular lens surgery in children

Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ? 20/200) and post BCVA was 0.40 (±0.50) (Snellen ? 20/50). The mean preoperative refraction was ? 9 D (±8D) (range: ?5 D to ?23D) and postoperative was ?1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.

Comparison of posterior optic capture of intraocular lens without vitrectomy vs endocapsular implantation with anterior vitrectomy in congenital cataract surgery: A randomized prospective study

Purpose: To compare surgical outcome of two procedures in pediatric cataract surgery. Methods: Prospective randomised interventional study. Consecutive patients with bilateral congenital cataract who were operated during January 2016 to October 2016 at a tertiary care referral institute were included. One eye of all patients underwent Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis (PPC) without vitrectomy while in the other eye endocapsular IOL implantation was performed along with PPC and anterior vitrectomy. Intraoperative challenges and postoperative complications were noted. Results: 15/18 children who fulfilled the inclusion criteria were included for follow up analysis. Mean age at the time of surgery was 21 � 14.7 months. At a mean follow up of 25.69 � 1.06 months; all eyes in both groups maintained a clinically centred IOL with clear visual axis. One patient with endocapsular IOL implantation developed anterior capsular phimosis. The rate of fibrinous complications (IOL deposits and synechiae) were more in the eyes with IOL in the bag (6 eyes) vs eyes where posterior optic capture was done (1 eye); P = 0.039. Conclusion: Posterior optic capture is a safer alternative to conventional pediatric cataract surgery in terms of inflammatory sequelae and lens epithelial cell proliferation. However the two methods work equally well in preventing visual axis obscuration over a long follow-up.

Two Cases of Intraocular Lens Pupillary Optic Capture Treated with Argon Laser Iridotomy

PURPOSE: We report two cases of intraocular lens (IOL) pupillary optic capture following IOL scleral fixation treated with argon laser iridotomy. CASE SUMMARY: (Case 1) A 69-year-old man presented with suddenly decreased visual acuity of the left eye. The best-corrected visual acuity was finger count (FC) 30 cm in the left eye. Slit lamp examination revealed subluxation of the left eye IOL. An IOL scleral fixation and anterior vitrectomy were performed and no specific findings were observed. During the follow-up period, pupillary optic capture was repeated without specific causes, such as trauma, or IOL decentration thus, argon laser iridotomy was performed. (Case 2) A 77-year-old man presented with a 3-day history of congestion of the left eye and decreased visual acuity. Best-corrected visual acuity was 0.4 logarithm of the minimum angle of resolution (logMAR) in the left eye. Slit lamp examination revealed subluxation of the left eye IOL. An IOL scleral fixation and anterior vitrectomy were performed, and no specific findings were observed. During the follow-up period, pupillary optic capture was found, and IOL repositioning and argon laser iridotomy were performed. CONCLUSIONS: Laser iridotomy can be used to prevent recurrence of pupillary optic capture in eyes with IOL scleral fixation without decentration or distortion.

Cataract Extraction and Intraocular Lens Implantation in Megalocornea

PURPOSE: To report a case that underwent successful centration of intraocular lens (IOL) and visual acuity improvement after cataract extraction in a megalocornic eye in our medical center. CASE SUMMARY: A 27-year-old man with bilateral megalocorneas came to our medical center. The patient had progressive loss of vision and floaters in both eyes for 3 months. His horizontal corneal diameter was approximately 14 mm in both eyes. The initial best corrected visual acuity was 0.02 in the right eye and 0.5 in the left eye. There was a white cataract and nuclear sclerotic cataract without lens luxation, respectively. The cataract was extracted from the patient's right eye after anterior continuous curvilinear capsulorrhexis (CCC), the preloaded custom IOL was inserted in the bag, and pars plana vitrectomy was performed. Two months later, after the cataract was extracted from the left eye, optic capture through a posterior capsule was attempted but converted to anterior capsule (reverse optic capture) because of the posterior CCC's radial tear, and pars plana vitrectomy performed. The IOL had a 6 mm optic and an overall length of 12.5 mm. The IOL in the right eye was decentrated inferiorly in the bag due to a large capsule diameter, but the IOL captured through the anterior capsule in the left eye had good centration. The best corrected visual acuity of both eyes improved to 0.8 without other complications.

Surgical Techniques and Postoperative Complications in Pediatric Cataract Surgery

PURPOSE: To evaluate postoperative complications of different surgical techniques in pediatric cataract. METHODS: We retrospectively reviewed 105 eyes of 72 patients who had undergone irrigation and aspiration of cataracts with posterior chamber intraocular lens (IOL) implantation from January 1994 to June 2004. All the eyes were divided into three groups according to the surgical techniques used: group 1 (n=39), IOLs in the bag + intact posterior capsule; group 2 (n=24), IOLs in the bag + posterior continuous curvilinear capsulorhexis (PCCC) + anterior vitrectomy; group 3 (n=42), IOLs in the bag + PCCC + optic capture. Postoperative posterior capsular opacity (PCO), secondary intervention for PCO, strabismus, inflammation, glaucoma, vitreoretinal complications were evaluated. RESULTS: Different from those in the past, current surgical methods for pediatric cataract entail either the optic capture of IOL or anterior vitrectomy through PCCC. PCO is the most frequent postoperative complication. Thirty-five eyes (87.1%) in group 1, 2 eyes (8.3%) in group 2, and no eyes in group 3 developed PCO. Five eyes (33.3%) had recurrence of PCO when PCO was treated by Nd:YAG laser posterior capsulotomy. None had PCO recurrence with secondary optic capture of IOL. Postoperative inflammation and IOL decentration were more common in group 2 than in the other groups. There was no statistically significant difference in the prevalence of postoperative glaucoma between the groups. Neither vitreoretinal complication nor infection was found in our series. CONCLUSIONS: Optic capturing of IOL through PCCC permanently maintains the visual axis with the anterior vitreous face preserved.

Optic Capture in a patient with Congenital Lens Coloboma

PURPOSE: To report the effect of the optic capture in the treatment of congenital lens coloboma. METHODS: A 5-year old boy was transferred to Maryknoll Hospital with congenital lens coloboma in his right eye. Lens coloboma at superotemporal area and capsular cataract around the coloboma was observed in the slit lamp examination. Posterior continuous curvillinear capsulorrhexis was performed after irrigation and aspiration of the lens. Optic was captured behind the posterior capsule while its haptics were placed in the sulcus. RESULTS: Best corrected visual acuity improved from preoperative 20/63 to 20/20 postoperatively. Intraocular lens decentration and rotation and other sight threatening complications were not found during the follow up period. CONCLUSIONS: Optic capture is thought to be a safe and effective means to prevent IOL decentration and posterior capsular opacity in the treatment of congenital lens colobomas.

Surgeon factor on Laser In Situ Keratomileusis in low and moderate myopia.

This study evaluated the surgical outcome of various surgical technique in paediatric cataract implant surgery, at Jakarta Eye Center, Jakarta, Indonesia. This was a retrospective study of 57 eyes in 44 children who had primary cataract implants surgery. Three surgical techniques used were : 1. Extracapsular cataract extraction with intraocular lens implantation with intact posterior capsule which was performed on 21 eyes (group 1). 2. Extracapsular cataract extraction with intraocular lens implantation and posterior capsulorhexis (PCCC) and optic capture which was performed on 24 eyes (group 2). 3. Extracapsular cataract extraction with intra­ocular lens implantation, posterior capsulorhexis and anterior vitrectomy which was performed on 24 eyes (group 3). All patients were followed up more than one year. Our results showed that posterior capsule opacity (PCO) was developed in 20 eyes with intact capsules in group 1. All eyes had a clear visual axis in group 2. PCO developed only in one eye in group 3. In conclusion, PCCC and optic capture with or without anterior vitrectomy are effective methods in preventing PCO in infant and children.

Surgical Outcomes of Implantation of Newly Designed T-shaped Intraocular Lens in Congenital Cataract

PURPOSE: We evaluated the surgical outcomes and complications of new pediatric intraocular lens in congenital cataract. METHODS: A retrospective study was carried out on 29 eyes of 22 patients diagnosed with congenital cataract that underwent optic capture following lens emulsification. New pediatric intraocular lens (LJC 575A, Lucid Korea, Seoul, Korea) implantation into the bag was performed with posterior capsulorrhexis and anterior vitrectomy. RESULTS: After follow-up of 17.79+/-7.08 months, 15 eyes showed a visual acuity of 0.5 or above, and 10 (71.4%) of the 14 eyes showed a visual acuity of 20/470 or above. As for complications, posterior synechia developed in 8 eyes, exudative membrane was found in 3 eyes, iris capture by IOL haptic was found in 1 eye, and slight opacification of posterior capsule was identified in 1 eye. CONCLUSIONS: Use of new 8 mm pediatric intraocular lens in congenital cataract may be considered selectively.

One-Year Follow-up of 1000 Cases of Silicone Intraocular Lens Implantation

Implantation of silicone intraocular lens(IOL), which is inserted through a small incision, has as its advantages reduced postoperative astigmatism and early visual rehabilitation. It, however, has such disadvantages as unknown long-term biocompatibility, relatively more Nd:YAG laser-induced damage, and unstable fixation. Another difficulty is the possibility of damage to IOL and intraocular tissue during the process of folding and unfolding of the silicone IOL. One thousand cases of the silicone IOL implantation from Sept. 1993 to Mar. 1996 had been followed-up over 1 tear for intraoperative and postoperative complications. Postoperative conditions such as naked visual acuity, and intraocular pressure were also measured. Postoperative naked visual acuity showed fast recovery, with measurements above 20/50 in 71.8% and 85.1% atk postoperative Day 1 and Day 3, respectively. Intraoperative complication was observed in a single case in which an incomplete continuous curvilinear capsulorhexis resulted in cases(7.8%) of posterior capsule opacification requiring Nd:YAG laser posterior capsulotomy. None of the above 57 cases requiring Nd:YAG laser capsulotomy, however, resulted in reduced visual acuity. Other brane(0.4%), pupillary capture of the optic(0.4%), decentration of the IOL(0.3%) and elevated intraocular pressure(0.3%). The silicone IOL implantation showed early visual rehabilitation without severe intraoperative and postoperative complications.