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.

Myeloid-Derived Suppressor Cells Mediate Inflammation Resolution in Humans and Mice with Autoimmune Uveoretinitis.

Resolution of inflammation is an active process that leads to tissue homeostasis and involves multiple cellular and molecular mechanisms. Myeloid-derived suppressor cells (MDSCs) have recently emerged as important cellular components in the resolution of inflammation because of their activities to suppress T cell activation. In this article, we show that HLA-DR-CD11b+CD33+CD14+ human MDSCs and CD11b+Ly6G-Ly6C+ mouse MDSCs markedly increased in patients and mice during and before the resolution phase of autoimmune uveoretinitis. CD11b+Ly6C+ monocytes isolated from autoimmune uveoretinitis mice were able to suppress T cell proliferation in culture, and adoptive transfer of the cells accelerated the remission of autoimmune uveoretinitis in mice. Alternatively, depletion of CD11b+Ly6C+ monocytes at the resolution phase, but not CD11b+Ly6G+ granulocytes, exacerbated the disease. These findings collectively indicate that monocytic MDSCs serve as regulatory cells mediating the resolution of autoimmune uveoretinitis.

Risk factors for and management of pupillary intraocular lens capture after intraocular lens transscleral fixation.

PURPOSE: To analyze risk factors and management of pupillary intraocular lens (IOL) capture after IOL transscleral fixation. SETTING: Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: A chart review was performed of patients who had transscleral fixation of IOLs between January 1, 2012, and December 31, 2013. Eyes were divided into 2 groups depending on whether the IOL was pupillary captured. Perioperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), spherical equivalent (SE) with refraction, axial length (AL), and total follow-up time were compared between the 2 groups. Ultrasound biomicroscopy images were used to analyze iris morphology and IOL position. RESULTS: The chart review identified 138 patients, 112 patients of whom were included in this analysis. The preoperative and final mean CDVA, IOP, SE, AL, and most iris morphologic parameters were not significantly different between the 2 groups. In the pupillary capture IOL group, the mean age of patients with was younger, the anterior chamber depth (ACD) was narrower, and the rate of reverse pupillary block was higher (P = .003, P = .03, and P = .016, respectively). Intraocular lens decentration in the captured group was significantly larger (P = .002). Multiple logistic regression analysis showed that ACD, reverse pupillary block, and main decentration were associated with pupillary capture of the IOL. CONCLUSIONS: Pupillary capture of an IOL occurred more in eyes with reverse pupillary block and poor IOL positioning. Accordingly, laser iridotomy must be considered for treatment.

Long-term surgical outcomes of Quickert sutures for involutional lower eyelid entropion.

OBJECTIVES: To determine the long-term surgical outcomes associated with the use of Quickert sutures (Q-sutures) for involutional entropion and elucidate the risk factors for postoperative recurrences. METHODS: This is a retrospective, interventional case series. We recruited patients suffering from involutional entropion who were treated with Q-sutures during the period from January 2008 to August 2010. Preoperative clinical characteristics and surgical outcomes including recurrence at 1, 6, 12, and 24 months were investigated by reviewing the medical charts. RESULTS: Of 85 patients, 69 attended each follow-up visit and were included in the analysis. Thirty-four patients (49.3%) experienced recurrences within 2 years. The recurrence rate was 5 of 69 (7.2%) at 1 month, 15 of 64 (21.6%) at 6 months, 9 of 49 (13%) at 12 months, and 5 of 40 (7.2%) at 2 years. Multiple logistic regression analysis showed that men and patients with lower-lid laxity (OR = 2.852 [95% CI: 1.005-8.092] and OR = 3.780 [95% CI: 1.231-11.614], respectively) were susceptible to postoperative recurrences. CONCLUSIONS: The recurrence rate among patients treated with Q-sutures was highest at the 6-month follow-up visit. Alternative surgical options should be considered in males and those with lower-lid laxity in order to prevent recurrences.

The correlation between angle kappa and ocular biometry in Koreans.

PURPOSE: To investigate normative angle kappa data and to examine whether correlations exist between angle kappa and ocular biometric measurements (e.g., refractive error, axial length) and demographic features in Koreans. METHODS: Data from 436 eyes (213 males and 223 females) were analyzed in this study. The angle kappa was measured using Orbscan II. We used ocular biometric measurements, including refractive spherical equivalent, interpupillary distance and axial length, to investigate the correlations between angle kappa and ocular biometry. The IOL Master ver. 5.02 was used to obtain axial length. RESULTS: The mean patient age was 57.5 ± 12.0 years in males and 59.4 ± 12.4 years in females (p = 0.11). Angle kappa averaged 4.70 ± 2.70 degrees in men and 4.89 ± 2.14 degrees in women (p = 0.48). Axial length and spherical equivalent were correlated with angle kappa (r = -0.342 and r = 0.197, respectively). The correlation between axial length and spherical equivalent had a negative correlation (r = -0.540, p < 0.001). CONCLUSIONS: Angle kappa increased with spherical equivalent and age. Thus, careful manipulation should be considered in older and hyperopic patients when planning refractive or strabismus surgery.

The Effect of Horizontal Extraocular Muscle Surgery on the Heimann-Bielschowsky Phenomenon.

We report the effect of horizontal extraocular muscle surgery of Heimann-Bielshowsky phenomenon. A 52-year-old woman complained of binocular diplopia for a few months. In 2000, she underwent extracapsular cataract extraction with intraocular lens implantation in the right eye. After surgery, the diplopia persisted and developed further. She showed an esodeviation of 60 prism dioptres at near fixation and distance fixation. Cortical opacity and nucleus sclerosis were observed in the left lens, and phacoemulsification with intraocular lens implantation was performed in the left eye in October 2011. After cataract surgery, the patient suffered from oscillopsia and diplopia. Examination revealed unilateral coarse, slow, pendular vertical oscillations in the right eye and an esodeviation of 45 prism dioptres and a right hypodeviation of 8 prism dioptres, which were observed before the surgery. We performed a medial rectus muscle 6 mm recession and lateral rectus muscle 7 mm resection surgery on the right eye. After the operation, the oscillations disappeared and diplopia greatly improved. Moreover, the patient no longer complained of oscillopsia. We conclude that surgery performed on horizontal extraocular muscles could be an effective treatment for Heimann-Bielschowsky phenomenon also.