Implantation of a black diaphragm intraocular lens in ten cases of post-traumatic aniridia.

PURPOSE: To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia. METHODS: Ten patients (mean age 48 years, range 21-75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, trans-sclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12-52). RESULTS: Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye. CONCLUSIONS: Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.

Posterior capsule opacification and Nd:YAG capsulotomy rates after implantation of silicone, hydrogel and soft acrylic intraocular lenses: a two-year follow-up study.

PURPOSE: To compare the posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) laser posterior capsulotomy rates associated with three different posterior chamber foldable intraocular lenses (IOL). METHODS: We retrospectively evaluated the rates of PCO and Nd:YAG laser capsulotomy in 1150 eyes two years after standard phacoemulsification with a no-stitch 3.5mm clear corneal incision (CCI) and in-the-bag implantation of one of three types of IOL: 190 eyes received a one-piece round-edged hydrogel IOL (Hydroview H60M, Bausch & Lomb); 475 eyes a three-piece round-edged silicone IOL (AMO PhacoFlex SI-40NB, Allergan); 485 eyes a three-piece square-edged soft acrylic lens (AcrySof MA60MA, Alcon). RESULTS: The PCO and Nd:YAG laser capsulotomy rates were respectively 43.15% and 20.5% in the Hydroview H60M group, 27.57% and 9.68% in the AMO PhacoFlex SI-40NB group, 10.5% and 2.47% in the AcrySof MA60MA group. CONCLUSIONS: PCO and Nd:YAG laser capsulotomy rates were significantly higher in the Hydroview H60M group and significantly lower with the AcrySof MA60MA lenses, which combine a bioactive constitutive material with the square-edged optic design.

Frequency doubling perimetry in glaucoma early diagnosis.

Frequency-doubling perimetry (FDP) is a new, out-of-the-ordinary, visual field testing method. Its sensitivity and reliability was tested in 16 patients (32 eyes) with ocular hypertension and 21 patients (37 eyes) with early chronic glaucoma. Significant defects were found in almost 10% of hypertensive eyes and in 67.7% of glaucomatous eyes. FDP is an effective and sensitive technique for glaucoma functional loss assessment.

Capsulorhexis size and posterior capsule opacification.

PURPOSE: Posterior capsule opacification (PCO) after intraocular lens (IOL) implantation has a multifactored pathogenesis. Capsulorhexis and capsular bag implantation of a one-piece, biconvex poly(methyl methacrylate) (PMMA) IOL are likely to reduce the PCO incidence. This study was performed to determine whether an ideal capsulorhexis size able to reduce PCO incidence exists. METHODS: A retrospective study of 107 patients who had extracapsular cataract extraction with capsulorhexis and capsular bag IOL implantation was carried out. The PCO site (central, paracentral, and peripheral) and degree (mild, moderate, and severe) were evaluated in relation to the capsulorhexis edge location relative to the IOL optic. Slitlamp biomicroscopy and photography and examination with a three-mirror Goldmann lens were performed. Patients were divided into three groups. Group 1: capsulorhexis free edge located on the IOL optic for 360 degrees; Group 2: capsulorhexis free edge located asymmetrically on and peripherally to the IOL optic; Group 3: capsulorhexis free edge located peripherally to IOL optic for 360 degrees. Each group was divided into two subgroups; one received polyHema IOLs and the second, PMMA IOLs. RESULTS: In Groups 1 and 2, the capsular transparency was higher than in Group 3 (P < .04). Central opacification percentage was lower in Group 1 than in Groups 2 and 3 (P < .04). No statistically significant differences between the polyHema and the PMMA subgroups were seen. CONCLUSIONS: Capsulorhexis with a slightly smaller diameter than the IOL optic appears to be better than a large-size capsulorhexis in reducing the incidence of PCO.

A double perfusion system with two-channel recording for the simultaneous study of the contractile responses of the circular and longitudinal smooth muscle layers of the rat vas deferens.

A device for double perfusion of the vas deferens externally and through the lumen is described in detail. The perfusion system allows the simultaneous recording of drug-induced or spontaneous contractions of the circular and longitudinal smooth muscle layers of the organ. Isometric contractions of the longitudinal (external) layer are recorded through a tension transducer. The contractions of the circular (internal) smooth muscle layer are recorded as changes of the pressure of internal perfusion. Therefore, four different effects can be recorded for a given concentration of agonist by combining the variables related to the route of perfusion (external or internal) and type of muscle (longitudinal or circular). In addition, antagonism or synergism can be studied by simultaneously perfusing a second drug. Results can be expressed as single records or as mean concentration-response curves from which drug-receptor parameters can be directly or indirectly obtained. The importance of employing this method for the analysis of some less usual problems related to the mechanism of drug action is discussed.

Simultaneous measurement of contractile effects in the circular and longitudinal smooth muscle of the rat vas deferens by drugs perfused externally or via the lumen.

The effects of noradrenaline and barium chloride were studied in the rat isolated vas deferens by perfusion of drugs either externally or through the lumen of the organ. Two effects were recorded simultaneously in the same preparation: (a) isometric contractions, due to the tension elicited by drugs on the external (longitudinal) smooth muscle layer and (b) pressure of internal perfusion, due to contractions of the internal (circular) smooth muscle layer. It was found with the longitudinal muscle that: (a) the potency, expressed as pD2 values, and the maximum response to noradrenaline were lower if the drug was perfused internally rather than externally; (b) the differences in maximum effects were pronounced on the prostatic half but were not observed on the epididymal half; (c) the maximum response obtained by internal perfusion could be increased by simultaneously adding the same dose of drug externally; (d) when barium chloride was used instead of noradrenaline no significant differences were observed on pD2 values, but differences on maximal responses were similar to that observed for noradrenaline; (e) it was possible to block completely the effect of internal or external noradrenaline on the longitudinal muscle, by perfusing external phenoxybenzamine. In these conditions the responses of the circular muscle to the agonist were only partly blocked. With the circular muscle, the differences related to internal and external perfusion were less marked than in the longitudinal muscle. However, unlike the latter, the circular layer was slightly more sensitive to drugs applied internally, in relation to pD2 values. It is suggested that the difference in pD2 values may be due to the removal of noradrenaline by the neuronal uptake process, whereas the difference in maximal effect is due to the inaccessibility of part of the receptor population when drugs are added through the lumen.