Late spontaneous posterior capsule rupture after hydrophilic intraocular lens implantation.

PURPOSE: To describe and discuss the presentation and management of 4 cases of late (17 to 20 years) postoperative spontaneous posterior capsule rupture (PCR) and intraocular lens (IOL) subluxation in eyes implanted with the same hydrophilic 1-piece IOL. SETTING: Center for Applied Eye Research, Meir Medical Center and the Ein-Tal Eye Center, Israel. DESIGN: Case series. METHODS: Four patients presented with spontaneous rupture and posterior dislocation of the same design IOL (B-Lens) 17 to 20 years after implantation. No trauma or any other direct causative factor was identified in any of the cases. RESULTS: Of the 4 cases reported, the IOLs were successfully repositioned to the ciliary sulcus and sutured to the scleral wall (1 case) or the iris (2 cases), and the IOL was stable in the sulcus without the need for further sutured fixation in 1 case, with effective vision restored in all cases. CONCLUSIONS: Spontaneous PCR is a rare postoperative complication and has not been reported, to the authors' knowledge, in cases without predisposing factors. A mechanism of late capsular tear was not confirmed, but the specific design of the IOL might have been a contributing factor.

Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 2: repositioning of subluxated IOLs.

PURPOSE: To describe the technique of modified adjustable flange scleral fixation using 6-0 polypropylene sutures for repositioning of subluxated intraocular lenses (IOLs). SETTING: Center for Applied Eye Research, Meir Medical Center, and the Ein-Tal Eye Center, Israel. DESIGN: Case series. METHODS: Subluxated capsular-fixated posterior chamber IOLs are secured to the sclera using 6-0 polypropylene sutures looped around the IOL haptics. This method can be performed for any type of IOL: hydrophobic, hydrophilic, silicone, or poly(methyl methacrylate); 1-piece or 3-piece; and with either closed-loop or open-loop haptics. It can also be used in conjunction with capsular stabilizing devices. RESULTS: In the 18 cases performed, successful repositioning with stable and central fixation of the IOLs was achieved. One eye required a repeated surgery due to suture slippage. The eyes recovered relatively quickly with noted quiescence as early as 1 week postoperatively. Patients did not complain of ocular irritation from the subconjunctival flange up to the 6-month follow-up period. In 1 case, a flange was exposed postoperatively but the patient refused additional intervention and developed intraocular infection 7 months postoperatively. CONCLUSIONS: The adjustable 6-0 polypropylene flanged technique for IOL repositioning and scleral fixation was a relatively quick and simple method for management of subluxated IOLs. Complete coverage of the flange by conjunctiva and Tenon layer must be confirmed at the end of surgery.

The Effect on Post-Operative Intraocular Lens Centration by Manual Intraoperative Centration versus Auto-Centration.

INTRODUCTION: To determine if intraoperative manual centration of the intraocular lens (IOL) during cataract surgery results in better early post-operative centration. It is common practice for cataract surgeons to align intraocular lens centration to the visual axis by manual intraoperative manipulation of the intraocular lens. We aim to compare post-operative intraocular lens centration between intraocular lenses that were allowed spontaneous positioning in the capsular bag and IOLs that were manually centred during implantation. MATERIALS AND METHODS: One hundred and twenty-five consecutive eyes that underwent either femtosecond laser-assisted cataract surgery (FLACS) or phacoemulsification and IOL (monofocal/toric/multifocal) implantation by a single surgeon were included. Post-operative IOL centration at 4 weeks was assessed and measured on a slit-lamp by a masked observer. RESULTS: A total of 17 (13.6%) IOLs were off-centered to some extent at 4 weeks post-operatively. All the decentered IOLs were graded as minimal or mild (<0.5mm) decentration. There was no statistically significant difference in the proportion of decentered IOLs between the manual centration group and non-centration group (p = 0.59). CONCLUSION: The final position of the IOL is not dependent on manual centration but rather on the design and symmetry of the IOL, as well as the integrity of the capsular bag.

Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 1: primary fixation IOLs in aphakia, capsular stabilizing devices, and aniridia implants.

PURPOSE: To describe the technique and outcomes of modified adjustable flange intrascleral fixation using 6-0 polypropylene sutures in primary scleral fixation in a variety of intraocular lenses (IOLs) and capsular stabilizing devices. SETTING: Center for Applied Eye Research, Meir Medical Center, Israel. DESIGN: Case series. METHODS: Laboratory studies were performed to test the feasibility of passing 6-0 polypropylene sutures through hydrophobic and hydrophilic IOLs. The durability of the IOL, suture, and created flange was tested. IOL implantation was performed first on porcine eyes with assessment of IOL position. Surgery was then performed using this adjustable flange technique using a variety of IOLs, including hydrophilic, hydrophobic, and poly(methyl methacrylate) aniridic IOLs and the capsular anchor (AssiAnchor) to stabilize the capsular lens in eyes with compromised zonular fibers. RESULTS: Surgery was performed on 9 eyes. Both hydrophobic and hydrophilic IOLs together with the 6-0 polypropylene suture were sufficiently durable in laboratory tests. Intrascleral fixation of 3 hydrophobic IOLs and 1 hydrophilic IOL was successfully achieved in 4 aphakic eyes. Stable and secure capsular bag fixation using the AssiAnchor was achieved in 4 eyes. Fixation of an aniridia IOL was also performed with success in 1 eye. All cases had stable and securely fixated IOLs and good postoperative recovery at 3 months follow-up. There was improvement in uncorrected distance visual acuity postoperatively in all cases. CONCLUSIONS: The modified adjustable flange technique for scleral fixation using polypropylene 6-0 was effective, relatively quick, and technically simpler and safer than alternative methods in the management of aphakia and zonular instability.

Efficacy and safety of topical ganciclovir in the management of cytomegalovirus (CMV)-related anterior uveitis.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of topical ganciclovir 0.15 % gel in the management of patients with cytomegalovirus (CMV) anterior uveitis. RESULTS: This was a retrospective cohort study of the disease course of 31 patients (33 eyes) with aqueous polymerase chain reaction (PCR) positive for CMV. Data from a total of 160 episodes of anterior uveitis flare for 20 years, dating from December 1992 to December 2012, was collected. All patients were treated with concomitant topical anti-inflammatory medication. The disease course of each eye was analysed before and after the use of topical ganciclovir 0.15 %. The mean age at initial presentation of anterior uveitis was 57.5 ± 12.6 years. Twenty-eight (90.3 %) patients were Chinese. Patients on topical ganciclovir gel had a statistically significant fewer episodes of uveitis flare per person year (median -0.88 episodes/person years, p = 0.029). The time-to-quiescence was not significantly affected by topical ganciclovir use (median -1.25 days, p = 0.610). In the survival analysis using the Cox regression model, the use of topical ganciclovir was associated with a lower risk of recurrence, but this was not statistically significant (hazard ratio = 0.857, 95 % CI 0.543-1.36, p = 0.511). The overall median time-to-recurrence was 290 days (95 % CI 113 to 274 days) and 164 days (125 to 404 days) (p = 0.492), with and without topical ganciclovir, respectively. CONCLUSIONS: Topical ganciclovir may be beneficial in reducing the frequency of recurrence in patients with CMV anterior uveitis, but it was not statistically associated with prolonging the time-to-recurrence. The time-to-quiescence was also not significantly affected by topical ganciclovir. Prospective studies with a larger number of patients would be required to verify our findings.