Refractive Outcome of Cataract Surgery in Eyes With Prior Trabeculectomy: Risk Factors for Postoperative Myopia.

PURPOSE: To examine refractive outcomes after phacoemulsification in eyes with prior trabeculectomy. DESIGN: Retrospective observational case-control study METHODS:: Comparison of eyes of glaucoma patients undergoing cataract surgery after trabeculectomy (study group) with a matched group with medically controlled glaucoma (control group). Laser interferometry was used to obtain ocular biometry. We measured the difference between the expected and actual postoperative refraction using third-generation and fourth-generation intraocular lens (IOL) prediction formulae (Haigis, Holladay 2, Hoffer Q, and SRK-T). A residual difference of >1.0 D of hyperopia or myopia was considered a "refractive surprise." RESULTS: In total, 86 eyes (85 patients) were included, including 23 eyes (22 patients) in the study group and 63 eyes (63 patients) in the control group. The mean follow-up was 12.2±4.1 months. Eyes (n=13) with trabeculectomy and a preoperative intraocular pressure (IOP)≤9 mm Hg had significantly more large myopic surprises than the control group for all IOL formulae (P=0.015 Haigis, P=0.003 Holladay 2, P=0.004 Hoffer Q, P=0.003 SRK-T). Eyes (n=10) with trabeculectomy and preoperative IOP>9 mm Hg, however, did not have significantly more myopic errors than the control (P>0.05, all formulae). An "IOP spike" defined as a >50% rise in IOP from baseline within 1 month of cataract surgery in the subgroup with preoperative IOP≤9 mm Hg (n=8) was associated with increased risk of large myopic surprise (3/8 subset vs. 1/63 control eyes for all formulae; P=0.004 Haigis, P=0.004 Holladay 2, P=0.001 Hoffer Q, P=0.004 SRK-T) as well as for large myopic and hyperopic surprises overall (4/8 subset vs. ≤2/63 depending upon formulae; all P≤0.001). CONCLUSIONS: Low posttrabeculectomy IOP (≤9 mm Hg) is a risk factor for significant myopic surprise when undergoing subsequent cataract surgery despite using laser interferometry to measure ocular biometry and later generation formulae to determine IOL power. In addition, an IOP spike was associated with a 50% risk for large refractive surprise in this low IOP group.

Ipilimumab-associated bilateral optic neuropathy.

Ipilimumab is a novel monoclonal antibody targeting the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) receptor that has been shown to improve survival in metastatic melanoma. Previous case reports have documented its association with drug-induced uveitis. We report a patient who developed bilateral optic neuropathy with disc edema while taking this medication.

Pathology of 219 human cadaver eyes with 1-piece or 3-piece hydrophobic acrylic intraocular lenses: capsular bag opacification and sites of square-edged barrier breach.

PURPOSE: To assess capsular bag opacification and sites of initial posterior capsule opacification (PCO) in human cadaver eyes with square-edged 1-piece or 3-piece hydrophobic acrylic intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Eyes were immersed in 10% formalin after enucleation and had anterior segment scanning with very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess capsular bag opacification, anterior capsule coverage of the IOL edge, and IOL fixation. Selected eyes had histopathologic examination. RESULTS: One hundred nineteen eyes with 1-piece IOLs and 100 with 3-piece IOLs were included in the analyses of capsular bag opacification. There was no difference in central (P=.29) or peripheral (P=.76) PCO. In 63 of 84 eyes with a 1-piece IOL and peripheral PCO, the optic-haptic junction was the site of initiation. In eyes with a 3-piece IOL, initial peripheral PCO was observed at nearly the same rate whether there was full 360-degree anterior capsulorhexis overlap of the optic or no overlap (P=.13). In the latter, the site of PCO initiation was in areas lacking capsulorhexis coverage in 46% of eyes. CONCLUSIONS: There was no difference in central or peripheral PCO between 1-piece and 3-piece hydrophobic acrylic IOLs. With 1-piece IOLs, PCO tended to start at the optic-haptic junctions. With 3-piece IOLs, full anterior capsule coverage did not produce a statistically significant benefit with respect to PCO prevention.

Pathology of 157 human cadaver eyes with round-edged or modern square-edged silicone intraocular lenses: analyses of capsule bag opacification.

PURPOSE: To assess the degree of capsular bag opacification in human cadaver eyes with silicone intraocular lenses (IOLs), specifically comparing the differences between round-edged IOLs and modern square-edged IOLs. SETTING: John A. Moran Eye Center, University of Utah, USA. DESIGN: Experimental study. METHODS: The eyes were immersed in 10% formalin on enucleation. They had anterior segment scanning with a very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess the degree of capsular bag opacification, coverage of the IOL edge by the anterior capsule, and IOL fixation. Selected eyes also had histopathologic examination. RESULTS: Eighty-seven eyes with a 3-piece round-edged IOL, 43 with a 3-piece square-edged IOL, 26 with a 1-piece plate IOL, and 1 with an accommodating IOL design were included in the analyses of capsular bag opacification. Comparison between 3-piece round-edged IOLs and square-edged IOLs showed statistically significant differences in central posterior capsule opacification (PCO) (P=.0001687) and peripheral PCO (P<.0001). In eyes with square-edged IOLs, PCO had a tendency to start in areas without capsulorhexis coverage of the optic. Twenty-one of 26 eyes with a silicone plate IOL had a neodymium:YAG posterior capsulotomy for dense PCO. CONCLUSIONS: This first study using pseudophakic human cadaver eyes that includes a significant number of modern 3-piece silicone IOLs with square optic edges confirmed the role of this design in the prevention of PCO. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Long-term pathological follow-up of obsolete design: Pannu universal intraocular lens.

We studied an enucleated postmortem eye from an 82-year-old white donor who had been implanted with a Pannu "universal" intraocular lens (IOL) in the anterior chamber approximately 20 years earlier. This IOL has design features characteristic of a 1-piece, C-loop posterior chamber IOL. Magnetic resonance imaging showed a relatively well-centered IOL in the anterior chamber with haptics impinging on the iris. Gross and light microscopic analyses of the eye and the IOL showed peripheral anterior synechiae enclaving one haptic, areas of angle widening, significant attenuation of the corneal endothelium, multiple areas of iris trauma secondary to optic and haptic iris abrasion, large areas of pigment dispersion in the angle, diffuse pigment accumulation within the anterior chamber, and attenuation of the ganglion cell layer. The histopathological findings were consistent with glaucoma and chronic inflammation.

Long-term follow-up of obsolete design: iris-clip glass intraocular lens.

An enucleated eye obtained post-mortem from a 95-year-old donor who had a 4-loop, iris-fixated (iris-clip) glass intraocular lens (IOL) that had been implanted 22 years earlier was analyzed. The patient had a history of mild corneal edema, glaucoma, and macular degeneration/macular pucker. High-frequency ultrasound showed a well-centered iris-fixated IOL. Gross and light microscopic analyses of the eye and the IOL showed fragments of iris tissue attached to the haptics, pigment dispersion within the eye, with pigmented epithelial cells attached to the lens haptics and interruptions of the iris pigmented epithelial layers, and signs of corneal decompensation.

Corneal endothelial safety with the irradiation system for light-adjustable intraocular lenses.

PURPOSE: To assess the safety to the corneal endothelium of the irradiation delivered through a system developed for noninvasive postoperative power adjustments of the Light Adjustable Lens (LAL) (Calhoun Vision). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: After anesthesia, 12 cats had a light beam of near ultraviolet light (365 nm), with an intensity of 250 mW/cm(2), applied to the central 6.0 mm of the right cornea for 120 seconds. The cats were killed 1 day, 1 week, and 1 and 3 months after light application (3 cats/time point). Their corneas were then removed and evaluated for evidence of morphological damage to the corneal endothelial cells by staining with trypan blue and alizarin red and quantification with a digital imaging program (EPCO system). RESULTS: The overall size and shape of the corneal endothelial cells were qualitatively similar in irradiated and nonirradiated eyes. Four corneas in the irradiated group and 3 corneas in the control group had small areas of cell damage (staining with trypan blue) within the central 6.0 mm. These areas were generally close to corneal folds. The differences in damaged areas between both groups at each time point, as well as the difference considering the overall results in both groups, were not significant (P>.05). CONCLUSIONS: Irradiation of cat corneas with the therapeutic dose used to lock in the power of the LAL was not associated with damage to endothelial cells. Further studies are necessary to confirm the absence of damage at the ultrastructural level.