25G PPV combined with IOL ciliary sulcus suture, fixation and replacement in the treatment of IOL capsule bag complex dislocation in the vitreous cavity / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the clinical effect of 25G pars plana vitrectomy(PPV)combined with intraocular lens(IOL)ciliary sulcus suture fixation and replacement of IOL capsular bag complex.<p>METHODS: A retrospective analysis of 21 patients(21 eyes)in our hospital who applied 25G PPV combined with IOL ciliary sulcus suture and fixation replacement in our hospital from January 2015 to January 2020 to treat the IOL capsular complex completely detached from the clinical data.<p>RESULTS: All the cases were successfully removed the dislocated IOL complex during the operation. There was no iatrogenic retinal damage. During the operation, 4 cases(4 eyes)were found to have the retina hole, 2 cases(2 eyes)were found to be retinal lattice degeneration area, which were treated with laser photocoagulation of the retina. Follow-up for 6-18mo, best corrected visual acuity(BCVA)(LogMAR)increased from 0.40±0.30 before operation to 0.33±0.25 after operation(<i>P</i>=0.040). The BCVA at the last follow-up of all cases reached the BCVA before surgery. The absolute value of the difference between the postoperative spherical equivalent power and the preoperative IOL refractive power prediction value is less than or equal to 0.75D. At the last follow-up, the position of the intraocular lenses in all cases was good, and there were no complications such as retinal detachment. <p>CONCLUSION: The technique of 25G PPV and the exchange of IOL ciliary sulcus fixation with intraocular IOL capsule complex is a safe and effective procedure for dislocation of IOL-capsular bag complex entirely into the vitreous cavity.

Postoperative Refractive Errors after Phacovitrectomy with Sulcus Fixation of an Intraocular Lens

PURPOSE: To evaluate the difference between the predicted postoperative refraction and the actual postoperative refraction after simultaneous vitrectomy and cataract surgery with sulcus fixation of an intraocular lens (IOL). METHODS: The records of patients with simultaneous vitrectomy and cataract surgery with sulcus IOL implantation (group 1) and with in-the-bag IOL implantation (group 2) were reviewed. We compared the spread between the predicted and actual refractive errors in the two groups. RESULTS: Group 1 consisted of 19 eyes in 19 patients and group 2 consisted of 23 eyes in 20 patients. The spread between the predicted and actual refraction (spread = actual-predicted) was -0.71 +/- 1.02 D in group 1 (p = 0.012) and -0.07 +/- 0.74 D in the group 2 (p = 0.86). The actual refractive errors in group 1 shifted toward myopia from the predicted in-the-bag refraction when compared with group 2. CONCLUSIONS: For the implantation of an IOL in the sulcus after simultaneous vitrectomy and cataract surgery, the IOL power should be approximately 1.0 D less than the power for in-the-bag fixation.

Clinical Results of Black-Diaphragm Intraocular Lens Implantation

PURPOSE: We studied the clinical products of sulcus fixation of Black-diaphragm intraocular lens and transscleral fixation of Black-diaphragm intraocular lens in congenital and acquired aniridia patients. METHODS: We retrospectively analyzed the records of 12 aniridic eyes in 20 patients who underwent Black-diaphragm intraocular lens implantation from December 2001 to December 2003 at our hospital. We divided the aniridia eyes into sulcus fixation (group 1, 3 eyes of 3 patients) and transscleral fixation (group 2, 8 eyes of 8 patients) groups, and congenital aniridia (group A, 3 eyes of 3 patients) and acquired anirida (group B, 9 eyes of 9 patients) groups. We compared results between groups 1 and 2, and between groups A and B. RESULTS: The differences (in diopter) between preoperatively expected refractive error and postoperative refractive error were -1.27 +/- 1.06 in group 1 and -1.06 +/- 1.06 in group 2, and this difference between groups 1 and 2 was not significant. Postoperative visual acuity results in group A (0.18 +/- 0.03) were significantly better than those in group B (0.61 +/- 0.29). CONCLUSIONS: In Black-diaphragm intraocular lens implantation of aniridia patients, the differences between preoperatively expected refractive error and postoperative refractive error were not different between sulcus fixation and transscleral fixation. Better postoperative visual acuity results are anticipated in acquired aniridia patients than in congenital aniridia patients.

An Anatomical Study on Transscleral Suture fixation of Posterior Chamber Intraocular Lens

We performed an anatomical study on transscleral suture fixation of posterior chamber intraocular lens implantation. Results showed that the relationship of the ciliary sulcus to the overlying posterior surgical limbus differed in the vertical and horizontal meridians. Needles that pierced the ciliary sulcus after being passed perpendicularly through the sclera entered the sclera 0.88+/-0.22mm posterior to the posterior surgical limbus in the vertical meridians and 0.44+/-0.37mm in the horizontal meridians. The scleral exit site of a suture passed from the inside of the eye through ciliary sulcus was 0.90+/-0.12mm posterior to the posterior surgical limbus in the vertical meridians, 0.85+/-0.17mm in the oblique meridians, and 0.45+/-0.10mm in the horizontal meridian.

Clinical Result of Iris Claw Lens and Trans-scleral Fixation Technique of Posterior Chamber Lens

Recently, with the development of ophthalmic surgical technique, many of aphakic patients want secondary implantation of intraocular lens. In aphakic eye without posterior capsule, implantation of posterior chamber lens can be performed by sulcus fixation of lens with prolene suture. But sulcus fixation technique has some complications as iP~rmanent fistula, rotation or tilting of the optics, hyphema, endophthalmitis and so on. In this study, 24 aphakic eyes, 22 patients implanted withl itis claw lens were compared with 13 aphakic eyes, 13 patients implanted with sulcus fixated posterior chamber IOLs. In 24 eyes implanted with iris claw lens, 18 eyes (75%) had a postoperative visual acuity of 20/40 or better and cystoid macular edema, intraocular lens dislocation were observed on each 2 eyes (8.3%) and iridodialysis on 1 eye (4.1 %). In 13 eyes implanted with sulcus fixed PCLs, 12 eyes (92%) had a postoperative visual acuity of 20/40 or better, and cystoid macular edema, vitreous hemorrhage, acute iridocyclitis and glaucoma were observed in each 1 case (7.7%). In aphakic eyes without posterior capsular support, iris claw lens will be a alternative method of intraocular lens implantation.

Intraocular pressure after extracapsular cataract extraction with implantation of posterior chamber lenses

The intraocular pressure (IOP) in 115 cases of extracapsular cataract extraction (ECCE) and ciliary sulcus fixation of posterior chamber lens implantation was measured more than 2 months postoperatively. These results were compared to the unoperated fellow eyes, as well as to a group of 14 patients who had ECCE and implantation of an anterior chamber lens. The posterior chamber lens implanted eyes demonstrated a significant IOP reduction after surgery compared to the unoperated fellow eyes and the anterior chamber lens implanted eyes. In the posterior chamber lens implanted eyes, there was a significant IOP reduction after surgery in all age groups and there was a significant IOP reduction in the eyes with a 2 to 6 months and a 7 to 12 months follow-up after surgery, but no IOP change in the eyes with more than 1 year follow-up after surgery. We concluded that in the case of ECCE and ciliary sulcus fixation of posterior chamber lens implantation, IOP was initially reduced after surgery, but approarhed the preoperative level over a period of time.