Late Opacification of Hydrophilic Acrylic Intraocular Lenses

PURPOSE: To report clinical, pathological, histochemical, ultrastructural, and spectrographic analysis of explanted hydrophilic acrylic intraocular lenses (IOLs). By IOL extraction and new IOL implantation, patients resulted in increased visual acuity. METHODS: Four hydrophilic acrylic IOLs (ACRL-C160,Opthalmed(R),California,USA)were explanted from the 3 patients who had developed decreased visual acuity after about 5months from uneventful phacoemulsification and IOL implantation. Four IOLs were examined by gross and light microscopy. Staining of IOLs was performed with 1% alizarin red and von Kossa method (both stains for calcium). Some were submitted for scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Infrared spectral analysis (IR), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS). RESULTS: Microscopic analysis showed opaque materials on explanted IOL surface. The deposits were stained positive with Alizarin red and the von Kossa method for the detection of calcium. SEM revealed IOL surface covered by calcium crystals and collagen fibers. Many studies such as XPS, IR, EDS showed that the causes of opacification of IOLs were calcium phosphate hydroxide (hydroxyapatite). We suspect silicone promoted this reaction as catalyst. CONCLUSIONS: This is the rarest cases and clinical, pathological and spectroscopic report of opacified hydrophilic acrylic IOLs (ACRL-C160,Opthalmed(R),California,USA). We found out materials causing opacification by many special studies. Additional studies should be done to determine possible mechanisms and biocompatibility of the IOLs materials containing UV absorbable coating materials, packaging system and foldable systems in the intraocular conditions

Clinical Results after Surgical Treatment in Congenital Cataract

There are many unknown factors in the surgical treatment of congenital cataract such as time of surgery, surgical problems, and aphakic visual correction. Recently, the advancement of microsurgical technique and visual rehabilitation have reduced the rate of postoperative complications and visual losses. We have studied 81 eyes of 55 patients who had recieved cataract surgery from January 1994 to January 1998 at the department of ophthalmology, Yonsei University College of Medicine. These eyes have been categorized by age into three groups : Group l (0~1 year), Group ll (2~5 years), and Group lll(6~10 years). Cataract extraction was done in all eyes and posterior chamber intraocular lens implantation was performed in groups ll and lllfor aphakic visual correction and the followings were investigated : preoperative vision; surgical method; postoperative vision; refractive error;and complications. Improvements in surgical procedures such as lens aspiration, posterior continuous circular capsulorhexis, anterior vitrectomy, intraocular lens implantation, and intraocular lens capture (Group ll) have brought better visual outcomes in groups II and III as well as decreased incidence of after-cataract. Thus, intraocular lens implantation in congenital cataract of 1year and older should actively be considered.

Surgical Result in Glaucoma Associated with Iridocorneal Endothelial Syndrome

Iridocorneal endothelial(ICE) syndrome is charaterized by unilateral glaucoma, abnormal corneal endothelium with proliferation, and iris stromal abnormalities. Uncontrolled glaucoma in ICE syndrome has been treated with filtering surgery, but the late failures occurred frequently. The medical records of nine patients with ICE syndrome that underwent glaucoma surgery were retrospectively reviewed. 6 eyes were progressive iris atrophy, and 3 eyes were Cogan-Reese syndrome. The success rates of primary trabeculectomy at 1 and 2 years were 57.1% and 33.3%, respectively. Ahmed glaucoma valve implant oeprations were performed on 6 eyes with failed previous filtering operation. 4 of 6 eyes resulted in controlled IOP until last follow up visit(mean ; 18.8 months). Overall, 1.9 times operations were needed to control IOP. Operations were performed only one time in 4 patients and two times in 3 patients to control IOP.

Response of Patients in Strabismus Surgery under the Topical Anesthesia

Local anesthesia in strabismus surgery allows for the evaluation of ocular alignment during the operation and enables early postoperative recovery.However, extraocular muscle traction results in decreased heart rate and discomfort for the patient. Therefore, it is our attempt to reveal the degree of of decreased heart rate during extraocular muscle traction and the patient`s pain perception. This was done prospectively on personalities of the patient, preoperative heart rate in the operating room, change of heart rate and pain perception of the patient during surgery. The statistically significant decrease in heart rate due to the ocular cardiac reflex occurs during medial rectus resection, lateral rectus recession, and leads to less satisfaction in the anxious patients. Strabismus surgery under topical anesthesia does not decrease the heart rate significantly, therefore it is relatively safe and the patient`s personality was influence on the intraoperative pain perception of the patients.

Ciliary Malignant Melanoma with Neovascular Glaucoma

Malignant melanoma is a rare tumor of the eye occuring anywhere on the uvea. Due to its fatal prognosis when it metastasizes to the liver, early diagnosis and treatment are needed.Glaucoma is frequently noted when the tumor is located on the ciliary body. A 73-year-old man who had com-plained of foreign body sensation for 4 months showed increased intraocular pressure, moderate anterior chamber reaction, and rubeosis iridis accompanied by a white exudative mass. The result of localized tumor excision and anterior chamber aspiration proved to be a malignant tumor. Therefore, enucleation was done and pathological examination showed ciliary malignant melanoma with seeding on the iris and anterior chamber angle structures.