Mosaic chromosome 18q partial deletion syndrome with bilateral full-thickness corneal disease: surgical intervention and histopathology.

A 2-month-old boy diagnosed with a mosaic chromosome 18q partial deletion syndrome was referred for bilateral cloudy corneas. The abnormal metaphases had a terminal deletion of the long arm of chromosome 18 as clonal abnormality. The cytogenetics findings were 46,XY, del (18)(q21.2)[12]/46,XY[20]. Ocular findings included bilateral microcornea with dense opacification and unilateral iris and chorioretinal coloboma. Penetrating keratoplasty (PK) was performed on both eyes. Histopathology of the host corneal button showed complete loss of Bowman's layer, hyperkeratosis of the epithelium, stromal neovascularization, and leukocyte infiltration. Descemet's membrane and endothelium were irregular in both specimens. CD45 stain for leukocytes confirmed perivascular and epithelial leukocytes infiltration. Mosaic chromosome 18q deletion syndrome is a rare genetic abnormality with a variable phenotype - including ocular findings - and hence, warrants an ophthalmic evaluation and genetic counseling.

Inferolateral migration of hydrogel orbital implants in microphthalmia.

PURPOSE: Hydrogel spheres may be useful in treating orbital hypoplasia associated with congenital microphthalmia. The authors describe migration associated with the use of these devices. METHODS: The authors retrospectively reviewed 5 cases in which a hydrogel orbital expander (Osmed) was implanted to treat orbital hypoplasia in pediatric patients with congenital microphthalmia (with or without previous surgery). RESULTS: In all 5 cases, a lateral orbitotomy, conjunctiva-sparing approach was used to insert the hydrogel spheres. Two cases involved previously unoperated orbits; 3 patients had prior orbit or socket surgery. Inferolateral movement outside the desired central, deep orbital position occurred in all 5 cases. Four of 5 cases required further procedures to achieve an adequate orbital implant position. CONCLUSIONS: Inferolateral migration may occur with hydrogel spheres implanted via a lateral orbitotomy approach in microphthalmia.

Toxic anterior segment syndrome.

Toxic anterior segment syndrome (TASS) is a sterile postoperative inflammatory reaction caused by a noninfectious substance that enters the anterior segment, resulting in toxic damage to intraocular tissues. The process typically starts 12 to 48 hours after cataract/anterior segment surgery, is limited to the anterior segment of the eye, is always Gram stain and culture negative, and usually improves with steroid treatment. The primary differential diagnosis is infectious endophthalmitis. Review of the literature indicates that possible causes of TASS include intraocular solutions with inappropriate chemical composition, concentration, pH, or osmolality; preservatives; denatured ophthalmic viscosurgical devices; enzymatic detergents; bacterial endotoxin; oxidized metal deposits and residues; and factors related to intraocular lenses such as residues from polishing or sterilizing compounds. An outbreak of TASS is an environmental and toxic control issue that requires complete analysis of all medications and fluids used during surgery, as well as complete review of operating room and sterilization protocols.

Evaluation of the cataractogenic effect of viscoanesthetic solutions on the rabbit crystalline lens.

PURPOSE: To evaluate the toxicity and cataractogenic effect of solutions combining sodium (Na) hyaluronate 1.0% and 1.5% with lidocaine 1.0% on the rabbit crystalline lens. The amount of pupil dilation provided by the addition of lidocaine to the Na hyaluronate solutions was also assessed. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Five solutions were injected into the anterior chamber of 18 pigmented rabbits in a randomized manner by the same surgeon, the intraocular component of VisThesia (Na hyaluronate 1.5%/lidocaine 1.0%), the intraocular component of VisThesia Light (Na hyaluronate 1.0%/lidocaine 1.0%), Ophthalin Plus (Na hyaluronate 1.5%), and a balanced salt solution; and both eyes of 2 other rabbits were injected with nonpreserved aqueous lidocaine 1.0%. The pupil diameter of each eye was measured before injection, immediately after, and 1 and 5 minutes after injection. After a follow-up of 3 months with slitlamp examinations, the rabbits were killed, and their eyes were enucleated. The crystalline lenses were evaluated from a posterior or Miyake-Apple view, and the eyes were fixated in 10% formalin for histopathologic analyses. RESULTS: Pupil diameter was significantly larger 1 and 5 minutes after injection in the VisThesia (P = .01 and P = .007) and VisThesia Light (P = .008 and P = .007) groups, whereas the differences were not significant in the Ophthalin Plus (P = .317 and P = .102) and balanced salt solution groups (P = .317 and P = .180). Fast and large pupillary dilation was observed in the aqueous lidocaine group, starting during the injection. No differences in the transparency of the natural lens and the red fundus reflex were noted during slitlamp examinations. Postmortem analyses from a posterior view also showed no differences in the transparency of the crystalline lens. The histopathologic appearance of the lens capsule, anterior and equatorial lens epithelial cells, and epithelial lens bow was comparable in the eyes, without signs of cell vacuolization or disruption. CONCLUSIONS: Intracameral injection of the solutions used in this study caused no localized opacity or overall change in the transparency of the crystalline lenses as observed during clinical and postmortem examinations as well as histopathologic analyses of the enucleated rabbit eyes. Viscoanesthesia may have application in phakic intraocular lens implantation.

Acute haptic-induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses.

We report an analysis of 3 single-piece hydrophobic acrylic intraocular lenses (IOLs) that were explanted because of complications related to the presence of their haptics in the ciliary sulcus. In 2 cases, the IOL was primarily implanted in the ciliary sulcus because of inadequate posterior capsule support. In the third case, postoperative displacement of 1 haptic in the sulcus was associated with hyphema and vitreous hemorrhage. Ultrasound biomicroscopy confirmed the contact between the haptic and iris. Areas of iris atrophy were observed in all cases. Light microscopy and scanning electron microscopy of the explanted lenses revealed the presence of pigmentary dispersion on the anterior surfaces. In Case 3, the pigments were concentrated on the surface of the haptic that was displaced from the capsular bag and on the corresponding optic-haptic junction. Scanning electron microscopy also showed the IOL's squared edges and unpolished side walls. The flexibility and thickness of the single-piece hydrophobic acrylic haptics, as well as the square optic and haptic edges, may increase the risk for iris chafing when the haptics are in the sulcus. Therefore, sulcus fixation of this IOL design is not recommended.

Experimental evaluation of the Corneal Concept 360 intraocular lens with the Miyake-Apple view.

PURPOSE: To evaluate a new single-piece, hydrophilic acrylic intraocular lens (IOL) designed to keep the anterior capsule away from the IOL optic, create the effect of a capsular tension ring, and prevent posterior capsule opacification (PCO). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. MATERIALS AND METHODS: Four Concept 360 IOLs (Corneal Laboratoire) were implanted in 4 human cadaver eyes of various sizes (Miyake-Apple technique). Lens centration, ovalization of the capsular bag and capsulorhexis opening, distance between the anterior optic surface and the anterior capsule and between the posterior optic surface and the posterior capsule, as well as presence of capsular striae were evaluated. The capsular bag was stained with trypan blue, and the ophthalmic viscosurgical device (OVD) was stained with fluorescein to enhance visualization. RESULTS: In each eye, the lens conformed to the capsular bag with precise centration. No ovalization or distortion of the capsular bag or the capsulorhexis and no posterior capsule striae were observed. Measurements of the capsulorhexis diameter before and after IOL implantation were the same. The anterior capsule remained at distance from the anterior optic surface for 360 degrees, and tight contact between the posterior optic edge and the posterior capsule was observed. CONCLUSIONS: Use of the Miyake-Apple technique is useful in the evaluation of new IOL designs in experimental studies. Design features of the Concept 360 IOL are likely to decrease the outcome of postoperative capsular bag opacification. Long-term clinical studies are necessary to confirm these findings.

Results of resident-performed laser in situ keratomileusis.

PURPOSE: To analyze the results of resident-performed laser in situ keratomileusis (LASIK). SETTING: Rush University Medical Center, Department of Ophthalmology, Chicago, Illinois, USA. METHODS: This retrospective study comprised 44 consecutive eyes of 22 patients who had LASIK performed from August 2000 through February 2002. Based on preoperative spherical equivalent, the eyes were divided into a low myopia group (A) (-1.0 to -6.0 diopter [D]) and a higher myopia group (B) (> -6.01 D). Preoperative and postoperative spherical equivalent (SE), best corrected visual acuity (BCVA), and uncorrected visual acuity (UCVA) were measured and analyzed within each group. Patients had at least 2 follow-up visits, with the second visit occurring between 1 and 9 months postoperatively. RESULTS: Preoperatively, the mean SE in Group A was -3.93 D +/- 1.53 (SD) and in Group B, -8.49 +/- 1.70 D. At the final visit, the SE in Group A decreased to -0.29 +/- 0.55 D and in Group B, -1.09 +/- 0.87 D. The UCVA in Group A at the final visit was 20/20 or better in 43% of eyes and 20/40 or better in 100% of eyes. In Group B, the UCVA was 20/20 or better in 31% of eyes and 20/40 or better in 75% of eyes. In all eyes, the BCVA improved by 1 line in 16% or remained the same in 84%. No eyes lost any lines of BCVA. The SE taken at the last visit was within +/-0.5 D in 69% of all eyes and within +/-1.0 D in 82% of all eyes. The incidence of patients needing retreatment in resident-performed LASIK surgery was 3 of 44 (6.8%). CONCLUSIONS: Laser in situ keratomileusis performed by residents is a safe and effective procedure for correction of refractive error. Postoperative UCVA, refractive error, retreatment rate, and loss of BCVA were consistent with published results from nonresident surgeons. These results also exceeded the U.S. Food and Drug Administration requirements for LASIK surgery.

Complications of foldable intraocular lenses requiring explantation or secondary intervention--2003 survey update.

The sixth annual survey of complications associated with foldable intraocular lenses (IOLs) requiring explantation or secondary intervention was sent to members of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. Preoperative data about visual acuity, patient signs and symptoms, and complications requiring IOL removal were evaluated. Complications were then tabulated for each of the following major foldable IOL groups: 3-piece monofocal silicone, 3-piece hydrophobic acrylic, 1-piece hydrophobic acrylic with haptics, 3-piece hydrophilic acrylic (hydrogel), 1-piece hydrophilic acrylic (hydrogel), 1-piece plate-type silicone, 3-piece multifocal silicone, and Collamer. Two hundred seventy-three surveys were returned for evaluation. Dislocation/decentration, incorrect lens power, IOL calcification, and glare/optical aberrations were the most common reasons for removing foldable IOLs. Good surgical technique, accurate IOL power measurements, and high manufacturing standards for foldable IOL materials and designs are the most important factors in avoiding complications with foldable IOLs.