Bag-in-the-lens implantation helps avoid posterior synechiae of the iris after phacovitrectomy.

PURPOSE: To compare the rate of posterior synechiae of the iris (PSI) occurrence after phacovitrectomy between a group with lens-in-the-bag (LIB) implantation, that is, implantation in the capsular bag, and a group with bag-in-the-lens (BIL) implantation. SETTING: CHU de Caen, Department of Ophthalmology, Caen, France. DESIGN: Comparative retrospective study. METHODS: One hundred consecutive cases of phacovitrectomies conducted between May 2013 and July 2016 were included. A retrospective analysis of the occurrence rate of PSI in the LIB group and in the BIL group was performed, using multivariate analysis including multiple risk factors such as preoperative synechiae, proliferative diabetic retinopathy, use of 20-gauge vitrectomy, use of gas or silicone tamponade, and use of endophotocoagulation. RESULTS: One hundred eyes of 92 patients were included in this study (55 eyes in the LIB group and 45 in the BIL group). The occurrence of PSI was significantly lower in the BIL group with 1 case (2%) versus 22 cases (40%) in the LIB group (P < .001). Among the risk factors studied, preoperative synechiae and the use of retinal endophotocoagulation were almost significantly associated with the occurrence of PSI (P = .068 and P = .087, respectively). In the LIB group, these PSI led to 1 case of acute elevation of intraocular pressure by pupillary seclusion and the use of laser iridotomy in 8 cases. CONCLUSION: The use of BIL rather than LIB implantation in phacovitrectomy practically eliminates PSI.

Optomechanical response of human and monkey lenses in a lens stretcher.

PURPOSE: To quantify the forces necessary to change the shape and optical power of human and monkey lenses. METHODS: Cynomolgus monkey (n = 48; age: 3.8-11 years), rhesus monkey (n = 35; age: 0.7-17 years) and human (n = 20, age 8-70 years) eyes obtained postmortem, including the lens, capsule, zonules, ciliary body, and sclera were mounted in an optomechanical lens-stretching system. Starting at zero load, the lenses were symmetrically stretched in a stepwise fashion in 0.25- or 0.5-mm steps. The load, lens diameter, inner ciliary body diameter, and lens power were measured at each step and the diameter- and power-load responses were quantified. RESULTS: The diameter- and power-load responses were found to be linear in the physiologically relevant range of stretching. The average change in cynomolgus, rhesus, and human lens diameter, respectively, was 0.094, 0.109, and 0.069 mm/g in young lenses, and 0.069, 0.067, and 0.036, mm/g in older lenses. For the same lenses, the average change in lens power was -3.73, -2.83, and -1.22 D/g in young lenses and -2.46, -2.16, and -0.49 D/g in older lenses. CONCLUSIONS: The force necessary to change the lens diameter and lens power increases with age in human and monkey lenses. The results agree with the Helmholtz theory of accommodation and with presbyopia theories that predict that the force required to disaccommodate the lens increases with age.

Efficacy of various drugs in the prevention of posterior capsule opacification: experimental study of rabbit eyes.

PURPOSE: To assess the efficacy of various drugs in the prevention of posterior capsule opacification (PCO) in a closed capsular bag technique. SETTING: Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA. METHODS: Lens material was removed using phacoaspiration or phacoemulsification through a microcapsulorhexis according to the hardness of the crystalline lens correlated with the weight and age of the rabbits. A mixture of an ophthalmic viscosurgical device (sodium hyaluronate 1.4% [SHA]) and a drug was injected into the empty capsular bag, allowed to remain inside for 3 minutes, and removed. The capsular bag was rinsed with balanced salt solution (BSS) and refilled with SHA. In a group of rabbits, the capsulorhexis was sealed with a minicapsulorhexis valve (MCV). Rabbits were treated with 1 of the following: SHA (control), BSS, mitomycin-C (MMC, 0.2 mg/mL), ethylenediaminetetraacetic acid (EDTA) (10 mM and 15 mM), 5-fluorouracil (5-FU, 33 mg/mL), acetic acid (3%, 0.3%, and 0.003%), and distilled water. RESULTS: Upon completion of the study, the control and treated eyes had PCO and new lens material (not residual). Anterior capsule proliferation was observed in eyes treated with 5-FU. The order of PCO appearance (earliest to latest) was as follows: 15 mM EDTA, SHA, MMC, acetic acid 0.3%, acetic acid 3%, BSS, distilled water (small animals; no MCV), acetic acid 0.003%, 5-FU, 10 mM EDTA, and distilled water (large animals; MCV). The earliest appearance was day 1 postoperatively and the latest, day 47. CONCLUSIONS: Distilled water and 10 mM EDTA treatments were the most efficient in retarding the appearance of PCO.

Adverse clinical consequences of neodymium:YAG laser treatment of posterior capsule opacification.

PURPOSE: To evaluate the clinical consequences of complications from neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) over the lives of cataract patients. SETTING: CHU de Caen, Caen, France. METHODS: A model was constructed to estimate the lifetime clinical consequences of postoperative PCO treated by Nd:YAG laser capsulotomy. The probability of death was modeled from French mortality tables as a polynomial function of sex and age. The probability of becoming blind was modeled as a function of age from data in the literature. The incidence of Nd:YAG complications came from the literature. The rate of Nd:YAG capsulotomy over time was modeled as a survival curve using data from a cohort of 3335 patients. RESULTS: Over 9 years in a 70-year-old population, switching from an IOL with a 20% Nd:YAG capsulotomy rate at 3 years to an IOL with a 5% rate would avoid 1 chronic intraocular pressure increase requiring medical follow-up in every 54 surgeries, 1 case of glaucoma in every 237 surgeries, 1 case of cystoid macular edema in every 265 surgeries, and 1 retinal detachment in every 265 surgeries. A 3-year clinical study would only capture one-third to one-half of long-term adverse events of Nd:YAG capsulotomy. CONCLUSION: Reducing PCO and the associated use Nd:YAG laser capsulotomy may contribute to preserving visual acuity in patients over their lifetimes.

Late anterior traumatic subluxation of a circular in-the-bag intraocular lens associated with lack of posterior capsule opacification.

We report a case of traumatic subluxation of a circular poly(methyl methacrylate) intraocular lens (IOL) 5 years after surgery. Slitlamp examination revealed the lack of epithelial cells or fibrosis in the intact capsule bag. Trauma was minor, and no other complication was found in the eye and orbit. The subluxated IOL was easily relocated in the bag with a hook, revealing the poor capsule sealing. Among the factors ensuring the fixation of IOLs placed in the bag after continuous curvilinear capsulotomy are sealing of the anterior and posterior capsules and proliferation of epithelial cells from the equator of the bag.