Visual outcomes and complications of intraocular lens placement in the absence of capsular support in a Philippine Tertiary Hospital

Background@#Surgical correction of aphakia without capsular support continues to be a challenge. Improvements in the technology of cataract surgery have provided advancements in techniques in surgical management of aphakia. Locally, we have limited data on the outcomes of the different intraocular lenses used in aphakia.@*Objective@#This study aimed to determine visual outcomes and complications associated with different techniques of intraocular lens implantation in the absence of capsular support.@*Methods@#We reviewed the medical charts of 207 patients who underwent intraocular lens implantation without capsular support. Excluded were patients with incomplete follow up, pediatric patients, and lost records. Best corrected visual acuity at day 1, 1st month, 3rd month and 6th month postoperatively, and the complications were noted.@*Results@#Mean age was 60 and 51% (n=105) were females. The mean follow-up time was 9.33 ± 0.71 months. Loss of capsular support was most frequently caused by intraoperative complication (n=146, 70%) and trauma. Retropupillary fixation iris claw intraocular lens was frequently used (n=93, 44.9%). Across all patients, visual acuities showed excellent outcomes with 20/50 or better. Across IOL types, the most frequent postoperative complication was increase in IOP. Statistically significant results were set at P <0.05. @*Conclusion@#There is a notable preference towards iris claw retropupillary lenses through time. Iris claw lenses showed the shortest operative time. All intraocular lenses used in aphakia showed comparably good postoperative visual acuities, except for the superior visual acuity trend seen among retropupillary iris claw and anterior chamber IOL groups. Complications included elevated intraocular pressures, corneal edema, and pigment dispersion.

Corrección de la afaquia postraumática en niños con lentes plegables suturadas al iris / Correction of Posttraumatic Aphakia in Children with Folding Lenses Sutured to the Iris

Objetivo: Caracterizar resultados visuales del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos. Métodos: Se realizó un estudio preexperimental, prospectivo, longitudinal con 17 niños, con seguimiento de un año. Se les realizó examen oftalmológico completo y se evaluaron variables como edad, sexo, lateralidad, mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, y complicaciones. Resultados: La edad promedio fue de 13,2 años, masculinos fueron el 64,7 por ciento. La mejor agudeza visual sin corrección en el preoperatorio fue del 47,1 por ciento <0,1 y con corrección de 0,7, al año del posoperatorio fue de 0,43/0,78, respectivamente. La presión intraocular preoperatoria fue de 14,1 mm Hg, y al año 14,71 mm Hg. La densidad celular en el preoperatorio fue de 2559.76 células/mm2 y al año de 2475,88 células/mm2. La hexagonalidad preoperatorio fue del 53,12 por ciento y al año del 56,94 por ciento. El cilindro preoperatorio -1,35 D y el 23,5 por ciento presentó astigmatismo inducido al año del posoperatorio. Conclusiones: La aplicación del implante de lente intraocular plegable de cámara posterior suturada al iris en la afaquia traumática de pacientes pediátricos logra mejorar su agudeza visual y la complicación más frecuente fue el edema corneal(AU)

Objective: To characterize visual outcomes of iris-sutured posterior chamber foldable intraocular lens implantation in traumatic aphakia in pediatric patients. Methods: A pre-experimental, prospective, longitudinal, pre-experimental study was performed with 17 children, with a one-year follow-up. A complete ophthalmologic examination was performed and variables such as age, sex, laterality, best visual acuity without correction, with correction, refractive results, intraocular pressure and complications were evaluated. Results: The average age was 13.2 years, 64.7 percent were male. The best visual acuity without correction preoperatively was 47.1 percent <0.1 and with correction 0.7, one year postoperative visual acuity was 0.43/0.78, respectively. Preoperative intraocular pressure was 14.1 mm Hg, and at one year 14.71 mm Hg. Cell density preoperatively was 2559.76 cells/mm2 and at one year 2475.88 cells/mm2. The preoperative hexagonality was 53.12 percent and at one year 56.94 percent. Preoperative cylinder -1.35 D and 23.5 percent presented induced astigmatism at one year postoperatively. Conclusions: The application of posterior chamber foldable intraocular lens implant sutured to the iris in traumatic aphakia in pediatric patients achieves improved visual acuity and the most frequent complication was corneal edema(AU)

Caracterización del implante secundario de una lente intraocular plegable suturada al iris en la afaquia / Characterization of Second Implantation of a Foldable Intraocular Lens Sutured to the Iris in Aphakia

Objetivo: Caracterizar los resultados refractivos del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Métodos: Se realizó un estudio descriptivo, prospectivo y longitudinal, en el que se incluyeron 30 pacientes (30 ojos) seguidos por un período de un año de septiembre de 2019 a septiembre de 2021, después del implante de una lente intraocular de cámara posterior suturada al iris en la afaquia. Se les realizó examen oftalmológico completo y se evaluaron variables como mejor agudeza visual sin corrección, con corrección, resultados refractivos, presión intraocular, astigmatismo inducido, densidad celular y complicaciones. Resultados: La mejor agudeza visual sin corrección en el preoperatorio fue del 93,3 por ciento (<0,1) y con corrección de 0,66, al año del posoperatorio fue de 0,493/0,890, respectivamente. La presión intraocular preoperatoria fue de 20,7 mmHg, y al año 19,7 mmHg. La densidad celular en el preoperatorio fue de 1755,7 cél/mm2 y al año fue de 1363,8 cél/mm2, y en los pacientes bien corregidos al mes del posoperatorio fue de 73,4 por ciento y al año de 70 por ciento. El astigmatismo inducido en el posoperatorio al año fue de -0,51 D. Conclusiones: La agudeza visual sin corrección y con corrección mejoran después del implante de una lente intraocular plegable de cámara posterior suturada al iris en la afaquia sin o con inadecuado soporte capsular. Predominan los pacientes bien corregidos, sin cambios en la presión intraocular y la complicación más frecuente fue el edema corneal(AU)

Objective: To characterize the refractive outcomes of implanting a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Methods: A descriptive, prospective and longitudinal study was carried out, including 30 patients (30 eyes) followed up for a period of one year, from September 2019 to September 2021, after being implanted a posterior chamber intraocular lens sutured to the iris in aphakia. Complete ophthalmologic examination was performed and variables were assessed, such as best visual acuity without correction, with correction, refractive results, intraocular pressure, induced astigmatism, cell density and complications. Results: The best visual acuity without correction in the preoperative period was 93.3 % (<0.1) and 0.66 with correction; while one-year postoperative visual acuity was 0.493 and 0.890, respectively. Preoperative intraocular pressure was 20.7 mmHg, while it was 19.7 mmHg at one year. Preoperatively cell density was 1755.7 cells/mm2, and it was 1363.8 cells/mm2 at one year it; while in well-corrected patients, it was 73.4 percent at one month postoperatively and 70 percent at one year. Postoperative induced astigmatism at one year was -0.51 D. Conclusions: Both uncorrected and corrected visual acuity improve after implantation of a posterior chamber foldable intraocular lens sutured to the iris in aphakia without or with inadequate capsular support. Well-corrected patients predominate, with no change in intraocular pressure, while the most frequent complication was corneal edema(AU)

Fijación de lentes intraoculares a esclera sin suturas / Sutureless scleral intraocular lens fixation

La corrección quirúrgica de la afaquia se realiza mediante varias técnicas que permiten fijar los lentes intraoculares en la cámara posterior, suturados al sulcus ciliar o por fijación transescleral de las hápticas sin suturas. El cirujano determina cuándo, dónde y cómo, además del tipo de lente a implantar. Se presenta un paciente con una afaquia traumática del ojo izquierdo, con agudeza visual sin corrección de cuenta dedos a un metro y refracción dinámica de +8,00 dioptrías con agudeza visual mejor corregida de 0,8 por cartilla de Snellen. Tensión ocular de 16 mmHg. En el examen biomicroscópico con lámpara de hendidura del ojo izquierdo se observó midriasis traumática. Se le realizó examen con biomicroscopia indirecta y resultó sin alteraciones. Se implantó el lente intraocular de tres piezas (Tecnis ZA9003) de la cámara posterior y se fijaron las hápticas a la esclera sin utilizar suturas. Al mes de la cirugía la agudeza visual mejor corregida fue la unidad de visión(AU)

Surgical aphakia correction is based on several techniques allowing to fix intraocular lenses in the posterior chamber, sutured to the ciliary sulcus or by sutureless transcleral fixation of the haptics. The surgeon will decide when, where and how, as well as the lens type to implant. A case is presented of a male patient with traumatic aphakia of his left eye, finger counting uncorrected visual acuity at one meter and dynamic refraction of +8.00 diopters with best corrected visual acuity of 0.8 by the Snellen chart. Ocular tension was 16 mmHg. Biomicroscopic slit lamp examination of the left eye found traumatic mydriasis. Indirect biomicroscopy did not find any alteration. A three-piece intraocular lens (Tecnis ZA9003) was implanted in the posterior chamber, fixing the haptics to the sclera without the use of sutures. One month after surgery, best corrected visual acuity was the vision unit(AU)

Resultados refractivos del implante secundario de lente en la cámara anterior con apoyo angular y de lente suturado a iris / Refractive results of anterior chamber angle-supported and iris-suture-fixated secondary lens implantation

Objetivo: Comparar los resultados refractivos del implante secundario de lentes intraoculares rígidos de la cámara anterior con apoyo angular y de lentes intraoculares plegables de la cámara posterior suturados a iris. Métodos: Se realizó un estudio casi experimental con control no equivalente (cohorte histórica). Se estudiaron 50 pacientes (50 ojos) con afaquia e inadecuado soporte capsular después de la cirugía de catarata, a quienes se les realizó implante secundario de lente intraocular con dos técnicas diferentes: lente intraocular en la cámara anterior con apoyo angular (25 ojos) y lente intraocular plegable de la cámara posterior suturado a iris (25 ojos). Resultados: Se observó que en el grupo de pacientes tratados con lente intraocular suturado a iris el porcentaje de pacientes con una visión de 20/40 o más fue significativamente superior (96,0 por ciento vs. 60,0 por ciento, p= 0,000) en los resultados refractivos obtenidos según el grupo de tratamiento. En el grupo A predominaron los pacientes que quedaron emétropes, seguidos de los pacientes miopes. En el grupo B predominaron los pacientes miopes y a diferencia del grupo anterior ningún paciente quedó hipermétrope. Conclusiones: La lente intraocular plegable de la cámara posterior suturada a iris mostró ser más eficaz, indujo menos astigmatismo y fue mejor en la predictibilidad de la esfera en un rango estricto de ± 1,00 dioptrías(AU)

Objective: Compare the refractive results of secondary implantation of rigid angle-supported intraocular lenses in the anterior chamber and foldable iris-suture-fixated intraocular lenses in the posterior chamber. Methods: A quasi-experimental non-equivalent control (historical cohort) study was conducted of 50 patients (50 eyes) with aphakia and inadequate capsular support after cataract surgery, who underwent secondary intraocular lens implantation with two different techniques: angle-supported intraocular lens in the anterior chamber (25 eyes) and foldable iris-suture-fixated intraocular lens in the posterior chamber (25 eyes). Results: In the group treated with iris-suture-fixated intraocular lens implantation the percentage of patients with 20/40 vision or more was significantly higher (96.0 percent vs. 60.0 percent, p= 0.000) in the refractive results obtained for each treatment group. In Group A a predominance was found of emmetropic, followed by myopic patients. In Group B myopic patients prevailed and unlike the other group no patient was hyperopic. Conclusions: Foldable iris-suture-fixated posterior chamber intraocular lenses proved more effective, induced less astigmatism and displayed better sphere predictability in a strict range of ± 1.00 diopters(AU)

Scleral Fixation of Intraocular Lens and Retropupillary Fixation of Iris Claw Lens for Aphakic Eyes

PURPOSE: To compare the efficacy and complications of scleral fixation of posterior chamber intraocular lens (IOL) and retropupillary fixation of iris claw IOL for dislocated IOL or aphakia without sufficient capsular support. METHODS: This retrospective study was comprised of 17 eyes of 16 patients undergoing scleral fixation and 14 eyes of 13 patients undergoing retropupillary fixation from August 2013 to June 2018. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp examination, corneal topography, refractive indices, corneal curvatures, corneal endothelial cell density, and complications of both groups were examined preoperatively and 1 day, 1 week, 1 month, 2 months, and 6 months postoperatively. RESULTS: Six months after the operation, UCVA and BCVA improved in both groups; however, there were no significant differences between the two groups (UCVA, p = 0.162; BCVA, p = 0.418). IOP was temporarily higher in the scleral fixation group at one day postoperatively (p = 0.023). The mean absolute prediction error was smaller in the retropupillary iris fixation group at 6 months postoperatively (p = 0.034). Postoperative total astigmatism, corneal astigmatism, and corneal endothelial cell density were not significantly different between the two groups. CONCLUSIONS: The retropupillary iris fixation group did not show significant improvement in visual acuity compared with the scleral fixation group. However, the retropupillary iris fixation group provided better mean absolute prediction error and a low risk of postoperative increase in IOP compared with the scleral fixation group. Retropupillary fixation of iris claw IOL is a promising option for scleral fixation of posterior chamber IOL for dislocated IOL or aphakia without sufficient capsular support.

Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

PURPOSE: To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term follow-up study. METHODS: In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binocularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors. RESULTS: Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052). CONCLUSIONS: Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.

Temporary Haptic Externalization and Four-point Fixation of Intraocular Lens in Scleral Fixation to Enhance Stability

PURPOSE: To report the results of a new technique for intraocular lens scleral fixation of temporary haptic externalization and four-point fixation for enhanced stability. METHODS: Two 10–0 polypropylene strands were fixed at two points 2 mm apart on each haptic of a conventional three-piece intraocular lens, using our previously reported method of temporary haptic externalization after injector implantation. Postoperative refractive outcome and stability were evaluated. RESULTS: Although the intraocular lens was fixed at a total of four points, no intraoperative difficulties were observed during the process. Patients showed successful fixation of the intraocular lens postoperatively. The fixed intraocular lens showed good centering and minimal tilting. When compared to the two-point fixation technique, postoperative astigmatism was significantly smaller in the four-point fixation group (1.80 ± 0.84 vs. 1.00 ± 0.0.50, p = 0.033). Lens-induced astigmatism calculated from subtraction of corneal astigmatism from total astigmatism was also significantly smaller in the four-point fixation group (2.23 ± 0.98 vs.1.17 ± 0.0.70, p = 0.043). No postoperative complications were identified during a mean follow-up period of 14.8 months (range, 10 to 19 months). CONCLUSIONS: By fixing the intraocular lens at two points on each side of the haptics, this method minimizes the tilting of the intraocular lens and thus decreases postoperative lens-induced astigmatism. Also, the possibility of intraocular lens dislocation in the long term might be decreased by this two-point fixation technique.

Lentes plegables suturadas a iris / Iris-sutured foldable lenses

Para la corrección quirúrgica de la afaquia existen en la actualidad varias técnicas quirúrgicas que permiten fijar los lentes intraoculares plegables o rígidos en cámara posterior suturados al iris o al sulcus ciliar. En estas circunstancias el cirujano determinará cuándo, dónde y el tipo de lente mejor a implantar. Se presenta un paciente con una afaquia traumática del ojo izquierdo, con agudeza visual sin corrección de movimiento de mano a 1 m. Se le realizó implante secundario de lente intraocular plegable de cámara posterior suturada al iris. En el examen biomicroscópico en lámpara de hendidura del ojo izquierdo se observó midriasis media paralítica, refracción dinámica de +11,00 (0,6) y tensión ocular normal. Se le realizó examen por bimicroscopía indirecta sin alteración. Al mes de operado la agudeza visual mejor corregida alcanzó la unidad de visión. Las complicaciones presentadas fueron ovalización de la pupila y depósitos de pigmentos de iris en el lente intraocular(AU)

There are several surgical techniques for the surgical correction of aphakia, which allow fixing foldable or rigid intraocular lenses in the posterior chamber by suturing them to iris or to ciliary sulcus. Under these circumstances, the surgeon will determine the time, the place and the type of lenses that is better to be implanted. This is a patient with traumatic aphakia in his left eye, with visual acuity without correction equals to hand movement at 1 m distance. He was performed a secondary implantation of a iris-sutured posterior chamber foldable intraocular lens. In the biomicroscopic exam of the left eye using the slit lamp, there was observed mean paralytic midriasis, dynamic refraction of +11,00 (0.6) and normal ocular pressure. He also underwent an indirect biomicroscopy with no alteration. After a month of his surgery, the best corrected visual acuity reached the vision unit. The complications found were ovalization of pupil and iris pigment depots in the intraocular lens(AU)

Vicios de refracción en personas de 65 años y más: guía de práctica clínica - problema de salud AUGE N°29 / Refractive errors in people 65 years of age and older: clinical practice guideline - health problem AUGE N°29

OBJETIVOS -Generar recomendaciones basadas en la mejor evidencia disponible acerca del manejo de personas con vicios de refracción. -Entregar recomendaciones acerca del diagnóstico y tratamiento de personas mayores de 65 años con vicios de refracción. TIPO DE PACIENTES Y ESCENARIO CLÍNICO -Diagnóstico y tratamiento de personas de 65 años y más con vicios de refracción que reciben atención en el nivel primario, secundario en el sector público y privado de salud USUARIOS DE LA GUÍA -Todos los profesionales de salud con responsabilidades en personas con vicios de refracción: Médicos de Atención Primaria de Salud y oftalmólogos del nivel secundario y terciario de atención y a tecnólogos médicos de oftalmología. METODOLOGÍA Las recomendaciones de esta Guía fueron elaboradas de acuerdo con el sistema "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE). Luego de priorizadas las preguntas a responder, se realizó la búsqueda y la síntesis de evidencia, para finalmente generar las recomendaciones a través del juicio del Panel de Expertos. La búsqueda y selección de la evidencia de esta Guía se basó en un método sistemático, transparente y reproducible. Una vez seleccionada la evidencia, se resumió en un formato claro y conciso que permitiera al Grupo Elaborador realizar los juicios respecto a la calidad de dicha evidencia, el balance entre los riesgos y beneficios asociados a la intervención o calidad de una prueba, un tratamiento, los valores y preferencias de los pacientes, y los costos derivados de su implementación.

Desprendimiento de retina no regmatógeno: guía de práctica clínica - problema de salud AUGE N°32 / Non-rhegmatogenous retinal detachment: clinical practice guideline - health problem AUGE N°32

OBJETIVOS -Generar recomendaciones basadas en la mejor evidencia disponible acerca del manejo de desprendimiento de retina regmatógeno no traumático. -Entregar recomendaciones para el diagnóstico y tratamiento de personas con desprendimiento de retina regmatógeno no traumático. TIPO DE PACIENTES Y ESCENARIO CLÍNICO Personas con desprendimiento de retina regmatógeno no traumático que reciben atención en el nivel secundario y terciario de salud en el sector público y privado de salud. USUARIOS DE LA GUÍA Todos los profesionales de salud con responsabilidades en personas con desprendimiento de retina regmatógeno no traumático: Médicos de Atención Primaria de Salud y de Servicios de Urgencia, y Oftalmólogos del nivel secundario y terciario de atención. METODOLOGÍA Las recomendaciones de esta Guía fueron elaboradas de acuerdo con el sistema "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE). Luego de priorizadas las preguntas a responder, se realizó la búsqueda y la síntesis de evidencia, para finalmente generar las recomendaciones a través del juicio del Panel de Expertos. La búsqueda y selección de la evidencia de esta Guía se basó en un método sistemático, transparente y reproducible. Una vez seleccionada la evidencia, se resumió en un formato claro y conciso que permitiera al Grupo Elaborador realizar los juicios respecto a la calidad de dicha evidencia, el balance entre los riesgos y beneficios asociados a la intervención o calidad de una prueba, un tratamiento, los valores y preferencias de los pacientes, y los costos derivados de su implementación.

Comparison of effect of silicon oil on central corneal thickness and corneal endothelial-cell density

Objective: To compare the mean changes in central corneal thickness [CCT] and corneal endothelial-cell density [CED] after removal of silicon oil [ROSO] using anterior [limbal] versus posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery

Study Design: Randomized controlled trial

Place and Duration of Study: Armed Forces Institute of Ophthalmology [AFIO] Rawalpindi, from Dec 2014 to Aug 2015

Material and Methods: Sixty eyes of 60 aphakic patients who underwent removal of silicon oil from December 2014 to August 2015 in AFIO after successful retinal re-attachment surgery were analysed. Thirty eyes underwent removal of silicon oil through anterior [limbal] approach [groupl] and 30 eyes through posterior [pars plana] approach [group-2]. Pre-operative central corneal thickness and corneal endothelial-cell density was measured and compared with central corneal thickness and corneal endothelial-cell density measurements 3 months after removal of silicon oil

Results: Mean age of study population was 49.93 +/- 5.18 years. Both groups were age and sex matched [p=0.694 and p=0.80 respectively]. In group 1, mean change in CCT was 1.80 +/- 6.58 micro meters [jum] and mean change in CED was 196.30 +/- 33.78 cells per millimetres square [mm[2]], while in group 2, mean change in CCT was 1.63 +/- 8.96 microm and mean change in CED was 60.20 +/- 39.75 cells/mm2 after 3 months of ROSO. Mean change in CCT between two groups was not statistically significant [p=0.935], however, mean change in CED between two groups was statistically significant [p<0.001]

Conclusion: Removal of silicon oil through anterior [limbal] approach causes significant reduction in CED, as compared to posterior [pars plana] approach in aphakic patients following successful retinal re attachment surgery

Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

PURPOSE: The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. RESULTS: This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). CONCLUSIONS: Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Implantation of foldable posterior chamber intraocular lens in aphakic vitrectomized eyes without capsular support / Implantação lente intraocular dobrável de câmara posterior em olhos afácicos vitrectomizados sem apoio capsular

ABSTRACT Purpose: To evaluate the outcomes of three different surgical techniques for foldable posterior chamber intraocular lens (PCIOL) implantation in vitrectomized eyes without capsular support. Methods: A total of 60 patients with aphakic and vitrectomized eyes without capsular support were enrolled. All patients underwent three-piece foldable PCIOL implantation into the posterior chamber through a small corneal incision. Transscleral fixation (TSF), iris fixation (IF), and intrascleral tunnel fixation (ISF) surgical techniques were performed. Results: Postoperative PCIOL subluxation or dislocation occurred in one case in the TSF group and two cases in the ISF group. Intraoperative PCIOL dislocation occurred in two patients in the IF group. The incidence of temporary postoperative complications, such as mild intraocular hemorrhage and cystoid macular edema, was higher in the ISF group. No statistically significant difference in PCIOL-related astigmatism was observed between groups. Visual acuity improved in all groups. Conclusions: Postoperative outcomes were comparable between TSF, IF, and ISF for PCIOL in vitrectomized eyes without capsular support.

RESUMO Objetivo: Avaliar os resultados de três diferentes técnicas cirúrgicas para implantação da lente intraocular de câmara posterior (PCIOL) dobrável em olhos vitrectomizados sem apoio capsular. Métodos: Um total de 60 olhos de 60 pacientes afácicos vitrectomizados, sem apoio capsular foram inscritos. Todos os pacientes foram submetidos ao implante de PCIOL dobrável de três peças na câmara posterior, através de uma pequena incisão na córnea. Foram utilizados as técnicas cirúrgicas de fixação transescleral (TSF), fixação iriana (IF) e túnel de fixação intraescleral (ISF). Resultados: Subluxação ou luxação da PCIOL ocorreu em um caso no grupo TSF e em dois casos no grupo ISF. Deslocamentos intraoperatórios da PCIOL ocorram em dois pacientes no grupo IF. Frequência de complicações pós-operatórias temporárias como hemorragia intraocular leve e edema macular cistóide foi maior no grupo ISF. Não houve diferença estatisticamente significativa do astigmatismo relacionado à PCIOL entre os grupos. A acuidade visual melhorou em todos os grupos. Conclusões: Nenhuma das três técnicas cirúrgicas teve destaque em termos de resultados cirúrgicos comparativos.

Combined transscleral fixation of an artificial iris prosthesis with an intraocular lens / Combinação de fixação transescleral de prótese de íris artificial com lente intraocular

ABSTRACT Post-traumatic aniridia combined with aphakia may be seen after globe injury. Aside from esthetic aspects, partial or total loss of the iris tissue may also be related to various degrees of glare and photophobia. Such patients suffer from severe visual impairment secondary to aphakia. Herein we describe a novel surgical technique for the management of an aphakic eye with traumatic aniridia for a patient who underwent transscleral fixation of a custom-tailored artificial iris prosthesis combined with a rigid intraocular lens (IOL). Tight suturing of the IOL haptic eyelets on the silicone iris prosthesis and fixation of such a complex to the scleral wall may provide excellent cosmetic and functional outcomes in aphakic eyes with aniridia.

RESUMO Aniridia pós-traumática combinada com afacia pode ser observada após lesões do globo ocular. Além do ponto de vista estético, a perda parcial ou total do tecido da íris também pode estar relacionada com vários graus de ofuscamento e fotofobia. Estes pacientes sofrem de deficiência visual grave secundária a afacia. Relata-se uma técnica cirúrgica inovadora para tratamento de um olho com afacia associada à aniridia traumática que foi submetido à fixação transescleral de uma prótese de íris artificial feita sob medida combinada com uma lente intraocular rígida (IOL). A sutura das alças da IOL sobre a prótese iriana de silicone, e a fixação desse complexo na parede escleral podem proporcionar excelente resultado estético e funcional em olhos afácicos com aniridia.

Short-term Clinical Outcomes after Transscleral Fixation Using the Intrascleral Pocket Technique: A Retrospective Cohort Study Analysis

PURPOSE: To compare the two transscleral fixation (TSF) techniques of intrascleral pocket and conventional scleral flap with conjunctival division techniques in terms of short-term clinical effects. METHODS: This retrospective cohort study included all consecutive patients with aphakia in Gyeongsang National University Hospital in Jinju, Korea, who underwent TSF between January 2012 and December 2014. The medical records of all patients were retrospectively reviewed, and the endothelial cell count (ECC), refraction, best-corrected visual acuity (BCVA), intraocular pressure, slit lamp, and fundus examination results before and 1 day and 6 months after surgery were recorded. The postoperative complications and visual outcomes were also recorded. RESULTS: The intrascleral pocket and conventional-flap groups did not differ significantly in terms of demographics, presurgical BCVA, or ECC. However, the intrascleral pocket group had a significantly lower BCVA at 1 day and 6 months after surgery compared to the conventional-flap group. The two groups did not differ in terms of ECC 6 months after surgery. The intrascleral pocket group had no postoperative complications, but five patients in the conventional-flap group complained of irritation. In both groups, the intraocular lens was well positioned without tilting or subluxation, and astigmatism was significantly reduced at 1 day and 6 months after surgery. CONCLUSIONS: The intrascleral pocket technique of TSF does not involve conjunctival dissection and is a successful method of sulcus fixation. It stably corrects the intraocular lens and is easy to perform, which helps to reduce operation time. It also reliably yields rapid visual acuity recovery without complications.

Long-Term Results of Transscleral Fixation of Posterior Chamber Intraocular Lens

PURPOSE: To investigate the long-term results of transscleral fixation of posterior chamber intraocular lens (IOL) for unstable posterior capsular supporting structure. METHODS: We performed a retrospective review of 67 patients (67 eyes) with unstable posterior capsular supporting structure who underwent transscleral fixation at Soonchunhyang University Bucheon Hospital from March 2005 to January 2013. Transscleral fixation without scleral flap was performed by a single surgeon. We analyzed the causes of transscleral fixation and compared postoperative best-corrected visual acuity (BCVA) and spherical diopter. RESULTS: Among the 67 eyes of 67 patients, the causes of transscleral fixation included IOL subluxation (33 cases, 49.2%), IOL dislocation (11 cases, 16.4%), intraoperative posterior capsule rupture (8 cases, 11.9%), aphakia associated with previous intraocular surgery (7 cases, 10.4%), crystalline lens disorder with zonular dialysis (4 cases, 5.9%) and IOL opacity (4 cases, 5.9%). The mean BCVA before surgery was 1.26 +/- 0.94 (log MAR) and the visual acuity improved to 0.59 +/- 0.71, 0.60 +/- 0.69, 0.58 +/- 0.70, 0.55 +/- 0.70, 0.60 +/- 0.58 and 0.66 +/- 0.70 (1 week, 1 month, 3 months, 1 year, 3 years and 5 years, respectively, after the surgery; p < 0.05). CONCLUSIONS: Posterior chamber IOL transscleral fixation in unstable posterior capsular supporting structure is effective for increasing visual acuity and spherical diopter. Specifically, the most improvement was observed at one month after surgery. Transscleral fixation is an adequate surgical procedure for fast improvement of visual acuity with long-term effects.

Refractive Change after Transscleral Fixation of Intraocular Lens

PURPOSE: To evaluate the anterior chamber depth (ACD), extent of intraocular lens (IOL) tilt, and decentration and refractive error after transscleral fixation of IOL. METHODS: We retrospectively reviewed the medical records of 17 cases with transscleral fixation of IOL (6 with aphakia, 5 with IOL dislocation, and 6 with lens subluxation). The acrylic IOL (MN60AC(R)) was fixated in 12 eyes and the polymethylmethacrylate IOL (CZ70BD(R)) was fixated in 5 eyes at 1.0 mm posterior from the limbus. We analyzed the ACD, extent of IOL tilt and decentration, manifest refraction, refractive error, higher order aberration, and corneal endothelium at 2 weeks, 1 month and 2 months postoperatively. RESULTS: The mean ACD was 3.36 +/- 0.11 mm, 3.30 +/- 0.12 mm, and 3.27 +/- 0.13 mm, the mean extent of IOL tilt was 4.61 +/- 0.12degrees, 4.65 +/- 0.14degrees, and 4.60 +/- 0.12degrees and the mean extent of IOL decentration was 0.43 +/- 0.01 mm, 0.45 +/- 0.01 mm, and 0.45 +/- 0.01 mm at 2 weeks, 1 month and 2 months postoperatively, respectively in eyes with transscleral fixation of IOL. The ACD was shallower and the extent of IOL tilt and decentration was greater than with IOL in-the-bag insertion patients. The mean refractive errors were -0.55 +/- 0.27 D, -0.63 +/- 0.24 D, and -0.69 +/- 0.19 D at the same period, respectively. CONCLUSIONS: Although postoperative refractive error is influenced by surgeon factors such as incision size, distance of fixation suture from limbus, and tightness of suture material, according to our results, an IOL 0.75 D more hyperopic than predicted should be selected in transscleral fixation of IOL at 1.0 mm posterior from the limbus. Additionally, each surgeon should assess their specific results and modify the lens calculations accordingly.

Encuestas nacionales de ceguera y deficiencia visual evitables en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay / National surveys of avoidable blindness and visual impairment in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay

OBJETIVO: Describir la justificación y metodología usadas en la Evaluación Rápida de Ceguera Evitable empleada para efectuar encuestas a nivel nacional entre 2011 y 2013 en Argentina, El Salvador, Honduras, Panamá, Perú y Uruguay. MÉTODOS: La encuesta se dirige a personas de 50 años o más, lo que reduce al mínimo los requisitos de tamaño de la muestra, que oscila entre 2 000 y 5 000 personas. Se emplean sistemas simples de muestreo y técnicas de examen; el análisis de datos es automático y no requiere de un experto en estadística. Es relativamente económica, ya que no toma mucho tiempo, no requiere equipos oftalmológicos costosos y puede ser llevada a cabo por el personal local. Los informes son generados mediante el propio programa informático de la evaluación. RESULTADOS: Los indicadores generados son la prevalencia de la ceguera y la deficiencia visual severa y moderada (discriminadas por causas evitables y cataratas); la prevalencia de afaquia o pseudofaquia; la cobertura de la cirugía de cataratas; el resultado visual de las cirugías de cataratas; las causas de resultados malos; las barreras de acceso a la cirugía de cataratas; y los indicadores de servicio de la cirugía de cataratas. Los resultados de cada una de las encuestas serán publicados de manera secuencial en números sucesivos de la revista, y en un artículo final de resumen se hará un análisis de los resultados en su conjunto y comparativo entre las encuestas y con aquellas publicadas anteriormente, que aportará un estado de la situación actual en ese grupo de países. CONCLUSIONES: La Evaluación Rápida de Ceguera Evitable es una metodología sólida, sencilla y económica para determinar la prevalencia de ceguera y deficiencia visual y la cobertura y calidad de los servicios de salud ocular, y representa una herramienta muy valiosa para medir el progreso de los programas de prevención de la ceguera y su impacto en la población.

OBJECTIVE: Describe the rationale and methodology of the Rapid Assessment of Avoidable Blindness applied in surveys at the national level in 2011-2013 in Argentina, El Salvador, Honduras, Panama, Peru, and Uruguay. METHODS: The survey includes individuals aged 50 years and older, minimizing required sample sizes, which vary from 2 000 to 5 000 people. It uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. It is relatively inexpensive, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff. Reports are generated by the assessment software package. RESULTS: Indicators measured are prevalence of blindness and of moderate and severe visual impairment (broken down into avoidable causes and cataracts); prevalence of aphakia or pseudophakia; cataract surgical coverage; visual outcome of cataract surgeries; causes of poor outcomes; access barriers to cataract surgery; and cataract surgery service indicators. Results of each survey will be published sequentially in successive issues of the Journal, and a final summary article will analyze results as a whole and in comparison with the other surveys in this group and with those previously published, which will provide a current picture of the situation in this group of countries. CONCLUSIONS: The Rapid Assessment of Avoidable Blindness is a robust, simple, and inexpensive methodology to determine prevalence of blindness and visual impairment as well as eye health service coverage and quality. It is a very valuable tool for measuring progress by blindness prevention programs and their impact on the population.

Rapid assessment of avoidable blindness in Uruguay: results of a nationwide survey / Evaluación rápida de la ceguera evitable en Uruguay: resultados de un estudio a escala nacional

OBJECTIVE: To investigate and describe the prevalence and causes of blindness and moderate and severe visual impairment in older adults living in Uruguay. METHODS: All individuals aged ≥ 50 years old living in randomly selected clusters were eligible to participate. In each census enumeration unit selected, 50 residents aged 50 years and older were chosen to participate in the study using compact segment sampling. The study participants underwent visual acuity (VA) measurement and lens examination; those with presenting VA (PVA) < 20/60 also underwent direct ophthalmoscopy. Moderate visual impairment (MVI) was defined as PVA < 20/60-20/200, severe visual impairment (SVI) was defined as PVA < 20/200-20/400, and blindness was defined as PVA < 20/400, all based on vision in the better eye with available correction. RESULTS: Out of 3 956 eligible individuals, 3 729 (94.3%) were examined. The age- and sex-adjusted prevalence of blindness was 0.9% (95% confidence interval (CI): 0.5-1.3). Cataract (48.6%) and glaucoma (14.3%) were the main causes of blindness. Prevalence of SVI and MVI was 0.9% (95% CI: 0.5-1.3) and 7.9% (95% CI: 6.0-9.7) respectively. Cataract was the main cause of SVI (65.7%), followed by uncorrected refractive error (14.3%), which was the main cause of MVI (55.2%). Cataract surgical coverage was 76.8% (calculated by eye) and 91.3% (calculated by individual). Of all eyes operated for cataract, 70.0% could see ≥ 20/60 and 15.3% could not see 20/200 post-surgery. CONCLUSIONS: Prevalence of blindness in Uruguay is low compared to other Latin American countries, but further reduction is feasible. Due to Uruguay's high cataract surgical coverage and growing proportion of people ≥ 50 years old, the impact of posterior pole diseases as a contributing factor to blindness might increase in future.

OBJETIVO: Investigar y describir la prevalencia y las causas de la ceguera y de la discapacidad visual moderada y grave en los adultos mayores residentes en Uruguay. MÉTODOS: Todas las personas de 50 años o más que vivían en los agrupamientos seleccionados aleatoriamente reunían los requisitos para participar. En cada unidad de enumeración censal seleccionada, se escogieron 50 residentes de = 50 años de edad para participar en el estudio mediante el empleo de un muestreo por segmentos compactos. Los participantes fueron sometidos a una medición de la agudeza visual (AV) y a un examen del cristalino; los que mostraban una AV de presentación (AVP) < 20/60 también fueron sometidos a oftalmoscopia directa. La discapacidad visual moderada (DVM) se definió como una AVP < 20/60–20/200, la discapacidad visual grave (DVG) como una AVP < 20/200–20/400, y la ceguera como una AVP< 20/400, todas ellas basadas en la visión del ojo que obtuvo un mejor resultado con la corrección disponible. RESULTADOS: De las 3 956 personas que reunieron los requisitos, se examinaron 3 729 (94,3%). La prevalencia ajustada por edad y sexo de la ceguera fue de 0,9% (intervalo de confianza (IC) de 95%: 0,5–1,3). La catarata (48,6%) y el glaucoma (14,3%) fueron las principales causas de ceguera. La prevalencia de la DVG y la DVM fue de 0,9% (IC de 95%: 0,5–1,3) y 7,9% (IC de 95%: 6,0–9,7), respectivamente. La catarata fue la causa principal de DVG (65,7%), seguida del error de refracción no corregido (14,3%), que fue la principal causa de DVM (55,2%). La cobertura quirúrgica de la catarata fue de 76,8% (calculada por ojo) y de 91,3% (calculada por persona). De todos los ojos operados de catarata, 70,0% presentaba una agudeza visual de = 20/60 y 15,3% tenía una agudeza visual < 20/200 después de la intervención quirúrgica. CONCLUSIONES: En Uruguay, la prevalencia de la ceguera es baja en comparación con otros países latinoamericanos, pero es factible lograr una reducción adicional. Como consecuencia de la alta cobertura quirúrgica de la catarata y la creciente proporción de personas de = 50 años en Uruguay, la repercusión de las enfermedades de la cámara ocular posterior como factor contribuyente a la ceguera podría aumentar en el futuro.