Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients

Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

Ahmed glaucoma valve implanting through the ciliary sulcus in the treatment of intraocular lens glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the efficacy of Ahmed glaucoma valve implanting through the ciliary sulcus in the treatment of intraocular lens(IOL)glaucoma.METHODS: Retrospective case series study. The clinical data of 18 patients(18 eyes)with IOL glaucoma from February 2020 to February 2022 in Liuzhou Red Cross Hospital were collected. All patients underwent Ahmed glaucoma valve implanting through the ciliary sulcus. The visual acuity, intraocular pressure, corneal endothelial cell density, corneal endothelial cell loss rate and complications were observed before operation and 1, 3, 6 and 12mo after operation.RESULTS: The mean intraocular pressure before operation was 43.41±5.33 mmHg. The mean intraocular pressure at 1, 3, 6 and 12mo after operation were 12.11±3.26, 13.82±4.12, 13.54±3.83 and 15.80±4.35 mmHg respectively. The mean intraocular pressure at each follow-up point after operation was significantly lower than that before operation(F=203.40, P&#x003C;0.01). The corneal endothelial cell density at each time point after surgery was lower than that before surgery(F=6.18, P&#x003C;0.01), but there were no significantly differences in the density and loss rate of corneal endothelial cell at 1, 3, 6 and 12mo after surgery(P&#x003E;0.05). Furthermore, the overall surgery success rate was 83%.CONCLUSIONS: Ahmed glaucoma valve implanting through the ciliary sulcus is safe and effective in the treatment of IOL glaucoma, and the damage to corneal endothelial cells is mild. The corneal endothelial cells density doesn't decrease with time after surgery.

Correlation between ciliary sulcus diameter and corneal diameter of patients with low to moderate myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To determine the correlation among horizontal ciliary sulcus(HCS)diameter, vertical ciliary sulcus(VCS)diameter and corneal diameter in different anterior chamber depth(ACD)levels from patients with low to moderate myopia.METHODS: Retrospective study. A total of 78 patients(129 eyes)with low to moderate myopia who had preoperative examination of implantable contact lens(ICL)implantation in Shanghai Bright Eye Hospital from April 2021 to April 2022 were included. HCS, VCS and white to white(WTW)were measured and compared. Patients were divided into shallow ACD group(2.8 mm ≤ ACD ≤3.2 mm), medium ACD group(3.2 mm < ACD ≤3.4 mm)and deep ACD group(ACD > 3.4 mm)based on the ACD obtained by Pentacam. The HCS, VCS and WTW within and among groups were compared, and the correlation of WTW, HCS and VCS among each group was analyzed by Pearson and linear regression equation.RESULTS: There was no statistical difference in WTW and HCS overall and in groups with different ACD(P>0.05), while there was difference between VCS and both HCS and WTW(P<0.01). The WTW had a correlation with both HCS and VCS in each group, while correlation between WTW and VCS was weak in the deep ACD group(r=0.470, R2=0.221, P<0.01). Furthermore, the WTW, HCS and VCS in the shallow ACD group were statistically different from those in the medium and deep ACD groups(P<0.01).CONCLUSION: The WTW was suggested predicting HCS rather than perfectly replacing HCS before patients had the ICL operation among patients with low to moderate myopia. The predictability of VCS would decline as the ACD depth increasing, predicting VCS by WTW was not recommended.

Efficacy of two kinds of posterior chamber intraocular lens fixation in the treatment of lens dislocation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS: Retrospective case-control study. A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected, among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture, and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens. The patients in both groups were followed up until 3mo after surgery to observe the operative time, best corrected visual acuity(BCVA), corneal endothelial cell count(CECC), central corneal thickness(CCT)and postoperative complications.RESULTS: The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs. 45.38±8.04min, P&#x003C;0.001). BCVA in both groups was significantly improved after surgery(all P&#x003C;0.05), and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs. 0.57±0.25, P&#x003C;0.001). At 3mo after surgery, CECC in both groups was lower than that before surgery(all P&#x003C;0.01). The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P&#x003C;0.01), and there was no significant change in CCT before and after surgery in the sutureless group. During follow-up period, the total complication rate in the sutureless group was lower than that in the suture group(26% vs. 38%, P&#x003E;0.05).CONCLUSION: 25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time, faster postoperative visual acuity improvement and fewer postoperative complications.

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.

Study on the correlation between horizontal corneal diameter and anterior chamber diameter and ciliary sulcus diameter / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the correlation between horizontal corneal diameter(WTW), horizontal anterior chamber diameter(HACD)and horizontal ciliary sulcus diameter(S-S). <p>METHODS: A total of 62 cases(115 eyes)with high myopia were collected from those who were examined in our hospital from August 2015 to August 2016. Their WTW and HACD were measured with SIRIUS, while S-S was measured with UBM, and the results were compared and analyzed. <p>RESULTS: In all patients, WTW was 11.91±0.37mm, HACD was 12.45±0.43mm, S-S was 11.78±0.46mm. There was negative correlation between HACD or S-S and age(<i>r</i>=-0.423 and <i>r</i>=-0.386 respectively, all <i>P</i><0.05). Correlation comparison with central anterior chamber depth(ACD)showed in group with ACD≤3.5mm, WTW and HACD were related with S-S; while in group with ACD>3.5mm, there was no significant correlation between WTW or HACD and S-S. <p>CONCLUSION: 1)WTW and S-S has better correlation, but due to the influence of age and anterior chamber depth, S-S is recommended to be measured with reference to the UBM to determine ICL when the patient is equal to or over 40 years old or with ACD>3.5mm; 2)SIRIUS Anterior Segment System is safe, simple and repeatability in measuring WTW and HACD.

Clinical observation of ciliary sulcus fixation of posterior chamber intraocular lens in aphakic eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical efficacy of ciliary sulcus fixation of posterior chamber intraocular lens(IOL)in aphakic eyes with inadequate capsule support. <p>METHODS: A retrospective review of medical records of 38 eyes of 38 patients who were underwent ciliary sulcus fixation of posterior chamber IOL from 2015 to 2018 were analyzed for the intraoperative and postoperative complications, intraocular pressure and position of intraocular lens. Also, the preoperative and postoperative visual acuity and refractive status were compared respectively. The follow-up time was 3mo after surgery. <p>RESULTS:The intraoperative hyphema occurred in 6 eyes(16%)postoperative hypotony in 4 eyes(11%)transient high intraocular pressure in 11 eyes(29%), yet all were cured by treatment. Four eyes(11%)with obvious tilt of intraocular lens were observed. All the cases were an visual improvement according to the last postoperative follow-up(<i>P</i><0.05). No obvious difference between target refraction(spherical lens)and actual refraction(spherical lens)at postoperative 3mo was discovered(<i>P</i>>0.05).<p>CONCLUSION: The ciliary sulcus fixation of posterior chamber IOL is a safe and effective way to treat the aphakic eyes, but the possible complications should be attentional.

Efficacy of ciliary sulcus suture fixation of intraocular lens through reverse partial-thickness scleral flap / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To assess the application of ciliary sulcus suture fixation of intraocular lens(IOL)through reverse partial-thickness scleral flap.<p>METHODS: The clinical data of 14 patients(14 eyes )who needed secondary IOL implantations due to different reasons in our department were retrospectively analyzed. All cases underwent ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap. One or two reverse partial-thickness scleral flap were made during the surgery. Preoperative and postoperative visual acuity, intraoperative and postoperative complications and the stability of the IOLs were observed.<p>RESULTS: The mean follow-up time was 3.5-6mo. The preoperative best-corrected visual acuity(BCVA)(LogMAR)was 0.50±0.54, and the uncorrected visual acuity(UCVA)at 1mo after surgery was 0.46±0.39(<i>P</i>>0.05). The BCVA at 1mo after surgery was 0.36±0.35, which was improved compared with the preoperative one, but the difference was not statistically significant(<i>P</i>>0.05). Three cases had transient intraocular hypertension postoperatively. One case had vetrious hemorrhage. One case had moderate anterior chamber inflammatory response. There were serious complications, such as cystoid macular edema, choroidal detachment, retinal detachment during the follow-up period.<p>CONCLUSION: Ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap is a effective and safe method for aphakia.

Ciliary sulcus diameter measurements in normal adult Filipino eyes Using ultrasound biomicroscopy

Objective@#To measure the ciliary sulcus diameters (CSD) in phakic eyes of adult Filipinos using ultrasound biomicroscopy (UBM).@*Methods@#This was an observational, cross-sectional study involving Filipino patients recruited from the Outpatient Department of Makati Medical Center, Philippines from September 2006 to December 2006. Vertical and horizontal CSDs in phakic eyes were measured using a UBM Scan 1000 (Ophthalmic Technologies Inc., Toronto, Ontario, Canada). Three repeated measurements of each meridian were taken and averaged. The average CSD for each eye was computed as the average of the horizontal and vertical CSDs. Student’s t-test was used to analyze data. @*Results@#Seventy-one (71) patients (142 eyes) were included in the study. Mean CSD measurements were as follows: horizontal CSD = 9.76 ± 0.42 mm; vertical CSD = 10.00 ± 0.48 mm; average CSD = 9.88 ± 0.47 mm. There was a significant difference between the means of the vertical and horizontal CSD measurements (P<0.01). There was no significant difference in the mean CSD measurements of the right and left eyes (P= 0.50). @*Conclusions@#In this cohort of adult Filipino patients, the UBM-measured vertical CSD is significantly greater than the horizontal CSD. Establishment of CSD measurements of adult Filipino eyes may be helpful in selecting appropriately-sized intraocular lenses for ciliary sulcus implantation.

Clinical Outcome of Ciliary Sulcus-Implanted Single-Piece Foldable Acrylic Intraocular Lens

PURPOSE: To evaluate complications and refractive outcomes of implantation of a single-piece acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification complicated with posterior capsule tear (PCT). METHODS: This retrospective study included patients who visited our hospital from 2014 January to 2015 June with implantation of a SPA-IOL (RAYNER 920H Superflex) in the ciliary sulcus during phacoemulsification complicated with PCT. Patients had their IOL power reduced by 1 diopter (D) from that calculated for in-the-bag implantation. At 3 months after operation, best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA) and a refraction test were performed. RESULTS: PCT requiring implantation of IOL in the ciliary sulcus occurred in 17 eyes. Postoperative complications included corneal edema (3 eyes), anterior segment inflammation (1 eye), intraocular pressure elevations (3 eyes). However, improvements resulting from proper management and no significant IOL decentration were observed. At 3 months after operation, the mean spherical equivalent was -0.79 ± 0.39 D (-0.25 to -1.5 D), the mean UCVA was 0.77 ± 0.22 (0.4 to 1.0), and the mean BCVA was 0.94 ± 0.08 (0.8 to 1.0). CONCLUSIONS: Sulcus implantation of a SPA-IOL (RAYNER 920H Superflex) has no clinically significant complication, and the mean spherical equivalent after 3 months with a power reduction of 1.0 D was -0.79 ± 0.39 D (-0.25 to -1.5 D).

Correlation between anterior chamber angle diameter and ciliary sulcus distance measured by Suowei panoramic 50-MHz digital ultrasound blomicroscopy / 中华实验眼科杂志

Background Measurement of ciliary sulcus distance is important for phakic intraocular lens implantation.Suowei panoramic 50-MHz digital ultrasound biomicroscopy makes it possible for the direct measurement of ciliary sulcus distance.Objective The aim of this study was to investigate the correlation between anterior chamber(AC)angle diameter and ciliary sulcus distance in different AC depth population and offer a clinical guide.Methods The anterior chamber angle diameter and ciliary sulcus distance were measured in 30 right eyes with shallow anterior chamber caused by suspect glaucoma and 30 right eyes with deep anterior chamber dut to the high myopia with Suowei panoramic 50-MHz digital ultrasound biomicroscopy.Three horizontal B-scans with the focal plane approximately at a depth corresponding to the iris plane were acquired for each eye.The differences of the anterior chamber angle diameter and ciliary sulcus distance were calculated and compared between the two groups.The correlation of the anterior chamber angle diameter and ciliary sulcus distance were evaluated in respective group.Results In shallow AC group,the mean angle diameter was(11.49+0.75)mm,the mean ciliary sulcus distance was (10.97±0.86)mm with the mean standard deviation of the difference of(-5.14± 0.55)mm,showing a statistically significant difference(t =-5.092,P =0.000).In shallow AC group,linear regression analysis showed a statistically significant correlation between ciliary sulcus distance and angle diameter(R2=0.593,P=0.000)and the Pearson's correlation coefficient was 0.767.In deep AC group,the angle diameter was(12.69±0.67)mm;while ciliary sulcus distance was(12.31 ± 0.61)mm with the mean slandard deviation(-0.38 ± 0.17)mm,which was statistically significantly different(t=-5.531,P=0.000).The ciliary sulcus distance was found to be linear correlation with the angle diameter(R2 =0.699,P=0.000)and Pearson' s correlation coefficient of 0.836.Conclusions Panoramic ultrasound biomicroscopy is an useful tool to the measurement of ciliary sulcus distance.This study exhibited that the ciliary sulcus distance is significant associated with the anterior chamber angle diameter,which may offer a guide for phakic intraocular lens implantation.

Vitrectomía pars plana y reimplante de lente intraocular en surco / Pars plana vitrectomy and intraocular lens repositioning in the sulcus

Se presentó un caso de lente intraocular luxado a vítreo en paciente con conteo bajo de células endoteliales e intolerancia a lentes de contacto. Se practicó vitrectomía pars plana con reimplante de lente en surco ciliar con el objetivo de demostrar la fiabilidad de la técnica para casos que presenten condiciones adecuadas y situaciones especiales. Se revisó la bibliografía para conocer las tendencias actuales con respecto al manejo de esta patología. El paciente alcanzó una agudeza visual de 20/30. El lente permaneció estable en el surco 3 meses después de practicada la vitrectomía. El manejo de esta entidad debe ser personalizado. La técnica utilizada debe ser siempre la primera opción de tratamiento y parece ser segura en casos cuidadosamente escogidos

A case of dislocated intraocular lens moved to the vitreous cavity in a patient with low endothelial cell count and contact lens intolerance was reported. A pars plana vitrectomy with lens repositioning was performed to demonstrate the safety of this technique for some special cases under adequate conditions. The literature was reviewed to learn about the current management of this pathology. Finally, patient's best visual acuity was 20/30. The stability of the lens was confirmed three month l after the vitrectomy. Management of this disorder should be customized. This technique should be considered as the first option of treatment and seems to be safe in selected cases

Ciliary Sulcus Ahmed Valve Implantation

PURPOSE: Ahmed glaucoma valves were implanted into the ciliary sulcus of two patients diagnosed with neovascular glaucoma with favorable outcomes. METHODS: The study patients presented to our hospital with ocular pain caused by increased intraocular pressure (IOP). A thorough history was taken, and an ophthalmic examination was performed. RESULTS: A 71-year-old male patient and a 57-year-old female patient visited our hospital for ocular pain and persistent, elevated IOP. Each were diagnosed with neovascular glaucoma and underwent an Ahmed glaucoma valve implantation to the sulcus. After surgery, the patients maintained stable IOPs without major complications. CONCLUSIONS: The method of Ahmed glaucoma valve implantation into the ciliary sulcus could reduce complications caused by implantation to the anterior chamber. It is thought to be an efficient method for the maintenance of appropriate IOP after surgery.

Changes in Ciliary Sulcus Size, Anterior Chamber Depth and Angle during Accommodation using Ultrasound Biomicroscopy

PURPOSE: To evaluate changes in the ciliary sulcus size, anterior chamber depth (ACD) and anterior chamber angle (ACA) during accommodation using an ultrasound biomicroscope (UBM). METHODS: Twenty-seven eyes of 27 healthy subjects were studied. We examined refractive error and intraocular pressure, measured the horizontal distance of the ciliary sulcus, ACD, and ACA at distant fixation and near fixation using a UBM (50 MHz transducer, model P45 UBM plus, Paradigm(R), Kent, U. K.). RESULTS: The subjects included 16 males and 6 females. The mean age of the subjects was 20.5 years (age range, 19-22 years), and mean spherical equivalent was -2.86+/-1.67 diopters. At distant fixation, horizontal ciliary sulcus size was 11.75+/-0.56 mm, ACD was 3.15+/-0.17 mm, and ACA was 38.5+/-4.2 . At near fixation, horizontal ciliary sulcus size was 11.34+/-0.65 mm, ACD was 2.92+/-0.15 mm, and ACA was 44.5+/-5.7 . CONCLUSIONS: During accommodation, horizontal ciliary sulcus size and ACD significantly decreased and ACA increased in the patients.

Ciliary Sulcus Size according to Refractive Error using Ultrasound Biomicroscopy

PURPOSE: To evaluate the correlation between the size of ciliary sulcus and ocular measurements such as anterior chamber depth, axial length and limbus size, we measured anterior chamber depth, axial length, corneal thickness, corneal limbus size and ciliary sulcus size. We also evaluated the difference in ciliary sulcus size according to the refractive errors. METHODS: Forty eyes of twenty patients were subdivided into three groups after refraction: high myopia (>or= 6 diopter; 13 eyes), moderated myopia (>or= 3 diopter, < 6 diopter; 17 eyes), and low myopia (< 3 diopter; 10 eyes). We measured the anterior chamber depth using ultrasound biomicroscopy (UBM), and calculated the size of the ciliary sulcus by mapping method. We measured the axial length with ultrasonography, the size of limbus with calipers, and performed corneal topography. RESULTS: Vertical ciliary sulcus sizes were 12.2 +/- 0.6 mm, 12.2 +/- 0.5 mm, and 11.8 +/- 0.5 mm, while horizontal ciliary sulcus sizes were 11.8 +/- 0.6 mm, 11.9 +/- 0.4 mm, and 11.6 +/- 0.6 mm, in the high, moderate and low myopia groups, respectively. There were no significant differences between groups. Horizontal ciliary sulcus size was most positively correlated with anterior chamber depth among the ocular measurements(Pearson r=0.46). CONCLUSIONS: There were no significant correlations between ciliary sulcus size and anterior chamber depth, axial length and limbus size, and there were no differences in the ciliary sulcus size according to the refractive errors.

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 Results of Posterior Capsular Rupture During Cataract Operation

To evaluate the character, management and clinical results of the posterior capsular rupture during cataract surgery, we retrospectively studied the cataract surgeries that were performed between May 1989 and Decemeber 1991. We discovered 64 eyes in which the posterior capsule was torn. The overall incidence of this complication was 4.4%. Our chart review of these surgical procedure revealed that the tear occurred most frequently during the nucleus removal(44%), occured more frequently at the periphery than the center and the extent was mostly below one-third of the whole posterior capsular surface(75%). We performed vitrectomy(58%) and peripheral iridectomy(14%). Posterior capsular lenses were implallted in 56 cases. The predicted power of lens calculated with SRK-II fomula and manufacturer's A-constant was approximately 0.46 diopter less than actual postoperative refraction. Final visual acuity of 20/40 or better was achieved in 73% of the 64 cases. Our results revealed that when properly managed, a torn posterior capsule is compatible with an excellent visual outcome.

Clinical Evaluation of Posterior Chamber Intraocular lens Implantation in thee Eye Without Poosterior Capsular Support

The use of a secondary intraocular lens is the best method for the management of spectacle-and contact lenses-intolerant aphakic eye. Because of the high incidence and the great variety of complications associated with anterior chamber lenses, a sulcus-fixed posterior chamber lens is more desirable than an anterior chamber lens. Therefore we have performed newly developed surgical techniques using 25-gauge needle for implanting a posterior chamber lens in the eye without posterior capsular support by securing haptic of the posterior chamber lens to the sclera at the ciliary sulcus with 9~0 prolene suture. These techniques have been sucessfully performed and have produced considerable visual improvement in thirteen aphakic eyes, two patients who had dislocated lens, and two pseudophakic patients who had sun-set syndrome. Eighty-eight percent of the 17 eyes had a postoperative visual acuity of 20/30 or better. The complications in three eyes were transient hyphema, transient vitreitis and exudate in lens surface, and pupillary capture. We have not yet experienced in our series any serious complication, such as lens dislocation, cystoid macular edema, retinal detachment, 2ndary glaucoma, endophthalmitis, and corneal decompensation, but long term follow up and more experience are necessary to establish the safety.

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.