Intrascleral-fixated intraocular lenses for aphakic correction in the absence of capsular support.

PURPOSE: To present results of experience with the authors" technique for intrascleral fixation of intraocular lenses for the correction of aphakia in the absence of capsular support. METHODS: Eleven patients (four children and seven adults) underwent surgery with the use of the method proposed by the authors (11 operations). The patients ranged in age from 11 to 75 years. The equatorial remnants in the lower segment of the capsular bag were revealed in 5 patients (45.5%). Absence of the capsular bag was observed in 6 patients (54.5%). RESULTS: During long-term follow-up evaluation, visual acuity without correction (mean 0.33+/-0.05) corresponded to the preoperative corrected one. Better visual acuity outcome of 0.41+/-0.06 was achieved with added correction. With intrascleral fixation, a mean refractive error of 1.48+/-0.39 D should be taken into account when calculating intraocular lens power with use of the SRK II formula. CONCLUSIONS: The results indicate that posterior chamber intraocular lens implantation with intrascleral fixation of haptics is a safe and effective technique for aphakic correction in the absence of capsular support and the presence of its defects. The technique used in the present study offers safety and stability of the intraocular lens position.

Non-freeze epikeratophakia in children.

We describe the use of unfrozen tissue lenses in 42 cases of epikeratophakia in children aged 2-14 years. Fourteen operations were performed in an aphakic eye, 28 in combination with congenital or traumatic cataract extraction. The tissue lenses, made from unfrozen donor cornea according to an original design, healed in 91.5% of cases. The tissue lens was removed when epithelial growth was inadequate on its surface. A five-year follow-up showed that correction within 3.0 D of emmetropia was achieved in 73.7% of the eyes. Preoperatively, mean keratometry readings were 43.5+/-0.2 D, increasing postoperatively to 53.6+/-0.8 D. Mean spherical equivalent at the spectacle plane increased by 9.6+/-0.9 D. Our investigations show the efficacy and safety of non-freeze epikeratophakia in the correction of pediatric aphakia.

Vitreous surgery in children.

This study examines the results of research on the surgical treatment of children with various vitreous diseases. Vitrectomy was performed on 44 eyes in children, from four months to fifteen years of age, suffering from the following diseases: lensectomy complications as vitreocorneal adhesions or immersion of lens mass into the vitreous; persistent hyperplastic primary vitreous (PHPV), trauma consequences, uveitis and eyeball subatrophy. Preoperational examination included measurement of visual acuity, biomicroscopy, direct and indirect ophthalmoscopy, tonography, ultrasonography and electrophysiological examinations. Vitreotome 'ocutome' was used to perform the operations. A transcyliar approach was used in all but 14 cases, for which the operations were performed by limbal incision. Improvement of visual functions was noted in 28 eyes (63.3%), and relatively good visual function was achieved in 7 eyes (16.9%). Visual acuity remained unchanged in 6 eyes (13.6%) because of severe amblyopia, although the transparency of optic zone was restored and the fundus did become visible. IN 10 (22.7%) of the children visual acuity could not be measured because of too young an age. One day after surgery a cellular suspension in the vitreous was observed in many eyes. This however, resolved within 3 days. Intraocular pressure usually returned during the first week after surgery. Hypotonia remained for 1-2 months after subtotal vitrectomy. The transcyliar extraction of pathological vitreous in children is generally a less traumatic and more convenient means of intravitreal manipulation, but 2 cases of intraoperational hemophthalmia suggested that iridiocyclitis is a contraindication for transcyliar approach. Transcorneal extraction is a less traumatic surgical method in such cases.