Outcomes of lensectomy with glued intraocular lens and factors associated with failure in eyes with spherophakia and glaucoma

Purpose: To evaluate the outcomes of lensectomy with a glued intraocular lens (IOL) in spherophakic eyes with secondary glaucoma and assess factors associated with failure. Methods: We prospectively evaluated outcomes of lensectomy with glued IOL in 19 eyes with spherophakia and secondary glaucoma (intraocular pressure (IOP) ?22 mm Hg and/or glaucomatous optic disc damage) between 2016 and 2018. The vision, refractive error, IOP, antiglaucoma medications (AGMs), optic disc changes, need for glaucoma surgery, and complications were assessed. Success was defined as complete when IOP was ?5 and ?21 mmHg without AGMs; qualified success as similar IOP with up to 3 AGM; the need for >3AGM/additional surgery for IOP control was considered a failure. Results: Preoperatively, the median (interquartile range: IQR) age was 18 (13.5–30) years. IOP was 16 (14–22.5) mmHg on a median of 3 (2,3) AGMs. Median postoperative follow up was 27.7 months (11.9, 39.7). Postsurgery, most patients achieved emmetropia, with significantly decreased refractive error from a median spherical equivalent of ?12.5D to + 0.5D, P < 0.0002. The complete success probability was 47% (95% confidence intervals (CIs): 29–76%) at 3 months and was 21% (8 ? 50%) at 1 year and 3 years. The qualified success probability was 93% (82–100%) at 1 year, which reduced to 79% (60–100%) in 3 years. None of the eyes had any retinal complications. The higher number of preoperative AGM was found to be a significant risk factor (p < 0.02) for the failure of complete success. Conclusion: One?third of the eyes had IOP control without the need for AGM postlensectomy with glued IOL. Surgery resulted in significant improvement in visual acuity. The higher number of preoperative AGM was associated with poor glaucoma control after glued IOL surgery

Management of pediatric subluxated cataract and different methods to face the challenges

Background: Traumatic cataracts present in multiple and different forms. Based on the nature of injury, it necessitates a customized approach for individual case. Capsulorhexis and in the bag intraocular lens (IOL) placement are vital for long term centration of pediatric IOLs. Paediatric lenses having elastic capsule provide more challenges to perform optimum rhexis and the surgery becomes further complicated, when it is subluxated or fibrosed. Here is a pediatric case with such challenges managed using capsular tension ring (CTR) and capsular tension segment (CTS). Purpose: To demonstrate the making of optimum rhexis in a fibrosed capsule in subluxated lens and placing the IOL along with fixation of bag using CTR and CTS. Synopsis: A 13?year?old boy sustained an injury in the right eye from an air pistol, underwent lid tear repair in a local hospital, and presented to us one month post trauma with visual acuity of 6/60 in the right eye and 6/6 in the left eye. On examination, there was more than 180° temporal zonular dialysis with fibrosis of the anterior capsule. In this situation, creating an intact capsulorhexis was a challenge which was solved using micro?scissors and micro?vitreo?retinal forceps, in addition to routine instruments. After removing the lens material, CTS was placed initially in the bag to stabilize it while introducing CTR. The CTS was then fixated to the sclera. Foldable IOL was placed in the bag. Technique and tips to make intact rhexis and easy passage of suture are demonstrated. Highlights: This video shows tips and different methods adopted in each step of the surgery for successful placement of IOL in bag along with fixation of bag using CTR and CTS in a case of traumatic subluxated cataract with shrunken anterior lens capsule.

Outcomes of surgical intervention in cases of ectopia lentis

Purpose: To evaluate the outcomes of surgical intervention in cases of ectopia lentis. Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra?operative and post?operative complication, and specular count were recorded. Results: Seventy?eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra?lenticular lens aspiration was the most common (n?62/78; 79.5%) surgical procedure followed by lens aspiration, intra?capsular cataract extraction, phaco?aspiration, and pars?plana lensectomy. Simultaneous intra?ocular lens (IOL) implantation was performed in 46.2% (n?32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow?up. The post?operative CDVA was significantly better in the pseudo?phakic group compared to the aphakic group (p?0.02). The patient’s age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra?operative complication included vitreous hemorrhage (n?1) and lens matter drop (n?1). Post?operative complications were noted in 26.9% of the eyes (n?21/78) with a higher complication rate in the pseudo?phakic group (p?0.00). A second intervention was required in 7.7% of the eyes (n?6/78). Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate.

Management of pediatric subluxated cataract and different methods to face the challenges

Background: Traumatic cataracts present in multiple and different forms. Based on the nature of injury, it necessitates a customized approach for individual case. Capsulorhexis and in the bag intraocular lens (IOL) placement are vital for long term centration of pediatric IOLs. Paediatric lenses having elastic capsule provide more challenges to perform optimum rhexis and the surgery becomes further complicated, when it is subluxated or fibrosed. Here is a pediatric case with such challenges managed using capsular tension ring (CTR) and capsular tension segment (CTS). Purpose: To demonstrate the making of optimum rhexis in a fibrosed capsule in subluxated lens and placing the IOL along with fixation of bag using CTR and CTS. Synopsis: A 13?year?old boy sustained an injury in the right eye from an air pistol, underwent lid tear repair in a local hospital, and presented to us one month post trauma with visual acuity of 6/60 in the right eye and 6/6 in the left eye. On examination, there was more than 180° temporal zonular dialysis with fibrosis of the anterior capsule. In this situation, creating an intact capsulorhexis was a challenge which was solved using micro?scissors and micro?vitreo?retinal forceps, in addition to routine instruments. After removing the lens material, CTS was placed initially in the bag to stabilize it while introducing CTR. The CTS was then fixated to the sclera. Foldable IOL was placed in the bag. Technique and tips to make intact rhexis and easy passage of suture are demonstrated. Highlights: This video shows tips and different methods adopted in each step of the surgery for successful placement of IOL in bag along with fixation of bag using CTR and CTS in a case of traumatic subluxated cataract with shrunken anterior lens capsule.

Femtosecond laser-assisted successful management of subluxated cataractous lens with vitreous in anterior chamber

Femtosecond laser-assisted cataract surgery was performed in a case of posttraumatic cataract with six clock hours subluxation and vitreous in the anterior chamber (AC). Femtosecond laser pretreatment allowed a closed-chamber creation of corneal incisions, capsulotomy, and lens fragmentation with minimal sudden lens-diaphragm movements and zonular stress. Integrated imaging systems allowed customization of the size and position of capsulotomy and nuclear fragmentation, based on the extent and site of subluxation. Presence of vitreous in AC did not hamper femtosecond laser application. Triamcinolone-assisted vitrectomy was performed before phacoemulsification and after implanting the intraocular lens (IOL). Postoperative uncorrected visual acuity was 20/20 with a stable IOL.

Clinical observation on transscleral sutured fixation intraocular lens implanted in the capsular bag for subluxated lens / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of transscleral sutured fixation intraocular lens(IOL)implanted in the capsular bag combined with phacoemulsification for subluxated lens(SL). <p>METHODS: A prospective study of 18 consecutive cases(18 eyes)with SL(≤270°)was treated with phacoemulsification by Nagahara's chop method combined with the iris hook. Then according to the extent of SL, one or two IOL haptics were transscleral sutured suspension in the capsular bag. Moreover, two cases were performed 25G minimal invasive vitrectomy. The clinical efficacy was observed such as visual acuity, best corrected visual acuity(BCVA), intraocular pressure(IOP), the position of IOL and complications.<p>RESULTS: All cases were performed successfully. With following-up ranged from 6-12mo, the BCVA was improved obviously, which had significant difference contrasted to that of preoperation(<i>t</i>=7.30, <i>P</i><0.01). All cases' IOP ≤21mmHg, the position of IOL were normal without dislocation. No several complications took pace in intraoperative or postoperative surgical process.<p>CONCLUSION: Without implanting capsular tension ring(CTR), IOL in the capsular bag sutured fixation by one or two haptics suspension is an alterative approach for SL. This method maintains the position of IOL and rehabilitates visual acuity, and obviates CTR dislocation. So this way is effective and economical to be accepted by some basic hospital.

Application of femtosecond laser technology in the management of subluxated lens / 南方医科大学学报

OBJECTIVE@#To evaluate the application of femtosecond laser technology in the management of subluxated lens.@*METHODS@#We retrospectively analyzed the data of the patients with subluxated lens undergoing femtosecond laser- assisted surgery at the Cataract Center of Guangzhou Aier Eye Hospital between March, 2017 and May, 2019. The LenSx femtosecond laser-assisted cataract surgery system was used to perform capsulotomy and lens fragmentation. According to the patients' eye condition, anterior vitrectomy was performed and capsular retractors was used. After phacoemulsification, I/A and insertion of the tension rings, the intraocular lens (IOL) was implanted into the capsular bag. The perioperative data, complications, visual acuity and intraocular pressure after the operation were recorded, and the stability of the capsular bag and IOLs were assessed.@*RESULTS@#We analyzed the data of 25 cases (29 eyes) of subluxated lens, including 16 (16 eyes; 55.17%) as the result of traumatic lens subluxation, 5 (9 eyes; 31.03%) of Mafan syndromes, 1 case (1 eye; 3.45%) of high myopia and 3 cases (3 eyes; 10.34%) of unknown causes. Thirteen 13 eyes (44.83%) showed mild subluxation, 7 (24.14%) had moderate subluxation, and 9 (31.03%) had severe subluxation. Femtosecond laser- assisted capsulorhexis, lens fragmentation and phacoemulsification were successfully completed for 29 eyes, of which 28 eyes (96.55%) retained the complete capsular bag and with successful implantation of the capsular tension devices and IOLs. Nine eyes (31.03%) were treated with anterior segment vitrectomy; iris hooks were used for 2 eyes (6.90%) and capsular bag hooks for 9 eyes (31.03%). The best corrected visual acuity was significantly improved in 29 eyes after operation ( < 0.05). At 1 month after the surgery, 26 eyes (89.66%) showed stably centered IOLs, 2 eyes (6.90%) showed slight tilt of the IOLs, and 3 eyes (10.34%) had anterior capsular contraction. The intraoperative complications included subconjunctival hemorrhage (75.87%), incomplete capsulotomy (17.24%) and contracted pupils (13.79%).@*CONCLUSIONS@#The application of femtosecond laser assisted technology enhances the surgical safety and effectiveness for subluxated lens, facilitates the choice of individualized surgical options, and promotes maximum recovery of the patients' visual function.

A Study of Anatomical and Visual Outcome in Primary Scleral Fixated Intraocular Lens Implantation.

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.

Linguatula serrata in the anterior chamber of the eye.

We report a case of intraocular Linguatula in healthy young female who presented with a history of trivial trauma, dislocated lens, inflammation and secondary glaucoma. A mobile worm was seen in the anterior chamber. Pars plana lensectomy and vitrectomy was planned to remove both the cataractous lens and the parasite during which the worm disappeared from view but was later recovered from the cassette fluid. It was identified as the nymphal form of Linguatula serrata (tongue worm).

Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children.

Purpose: To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children. Setting: Tertiary care setting Materials and Methods: We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90° up to 210° after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO). Results: Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL. Conclusions: Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation

The Application of Capsular Tension Ring in Phacoemulsification / 医学研究杂志

Objective To evaluate the effect of capsular tension ring (CTR) in phacoemulsification for the patients with subluxated lens extraction. Methods 15 patients (16 eyes) with subluxated ca tractous lenses were managed by implanting CTR after phacoemulsification and implantation of posterior chamber intraocular lens. Results Thirteen eyes with IOL were basically in the normal position, 3 with lightly tilting at 3 month after the operation. Postoperative visualacuity were all satisfitied. No complication was found caused by CTR. Conclusion It' s an effective way to perform phacoemulsification and CTR for cataract patients with subluxated lens. This method was simple with high security and good to the recovery of visual function in the early stage after the operation.

Clinical Evaluation of Subluxated Lens

The clinical and statistical evaluations of 25 patients(29 eyes) with subluxated lenses which were extracted at St. Mary's hospital from October 1984 to June 1990. The results were as follows: 1. The average age was 41.3 years and the sex distribution was 23 males and 2 females. 2. The causes were divided by 17 eyes(58.6%) with trauma and 12 eyes(41.4%) without trauma. 3. The associated diseases were cataract(9 eyes; 31.0%), glaucoma(6 eyes; 20.7%), retinal detachment(4 eyes; 13.8%) and uveitis(2 eyes; 6.9%). 4. There were 9 eyes(31.0%) in superonasal, 4 eyes(13.8%) in inferotemporal direction of lens displacement. 5. The surgical procedures were intracapsular cataract extraction(22 eyes; 75.9% ), lens aspiration(3 eyes; 10.3% ), extracapsular cataract extraction(1 eye 3.5% ) and pars plana lensectomy with vitrectomy(3 eyes; 10.3%). 6. There were 9 eyes(28.0%) associated with vitreous protrusion and the vitrectomy were done in 20 eyes(62.5% ). 7. Postoperative corrected visual acuity improved fairly. It was the same as preoperative corrected visual acuity in 7 eyes(24.1%), improved in 21 eyes(72.4%) and worse in 1 eye(3.4%).