Artificial iris implantation in a 9-year-old boy.

PURPOSE: To demonstrate the successful surgical treatment of congenital aniridia. METHODS: Development of sight-impairing cortical cataracts in a young boy with congenital aniridia led to the decision to perform phacoemulsification, intraocular lens implantation, and artificial iris implantation in each eye. RESULTS: Thorough examination showed that aniridia and cataract were the explanation for the patient's symptoms (sensitivity to glare and visual impairment). Combined surgery was performed without complication. A follow-up visit showed an improved corrected distance visual acuity of 8/20 (OU) and correctly centered implants. CONCLUSIONS: Artificial Iris® implantation combined with cataract surgery was successful in treating this child with congenital aniridia and lens opacification.

Erufosine, a phosphoinositide-3-kinase inhibitor, to mitigate posterior capsule opacification in the human capsular bag model.

PURPOSE: To determine whether erufosine alone or erufosine-loaded intraocular lenses (IOLs) can inhibit growth of human lens epithelial cells after a single administration in the human capsular bag model. SETTING: Laboratory for Cell Biology, Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. DESIGN: Experimental study. METHODS: Sixteen human cadaver eyes had sham cataract surgery. The capsular bag was transferred into cell culture. The tissue was exposed to the half maximum inhibitory concentrations of erufosine alone for 72 hours; solvent-only tissue served as a control. Erufosine is a potent inhibitor of phosphoinositide-3-kinase, a downstream kinase with major implications in posterior capsule opacification (PCO) pathogenesis. The IOLs were soaked with erufosine and implanted in the capsular bags; unsoaked IOLs served as controls. For both settings, the time until confluence of the capsular bag was measured. Cell growth was observed and photodocumented. RESULTS: Erufosine as a single therapeutic agent increased the time until confluence of the capsular bag, but not significantly compared with the control. When IOLs were soaked with erufosine, a long-term prophylactic effect was observed in this organ model for PCO, which is known to closely reflect the clinical situation. CONCLUSION: Erufosine-soaked IOLs effectively inhibited PCO formation as seen in long-term organ culture and might become of clinical relevance. FINANCIAL DISCLOSURES: Drs. Kampik and Eibl-Lindner are inventors of IOLs treated with alkylphosphocholines for pharmacological after-cataract prophylaxis, patent international application PCT/EP2010/051490. No other author has a financial or proprietary interest in any material or method mentioned.

Reposition of a misaligned Zeiss AT TORBI 709M® intraocular lens 15 months after implantation.

PURPOSE: To report the treatment of a patient with a misaligned intraocular lens (IOL). METHODS: We describe a case of a misaligned bitoric single-piece, plate haptic IOL (AT TORBI 709M®, Carl Zeiss Meditec AG, Jena, Germany) 15 months after uneventful phacoemulsification and IOL implantation in the capsular bag. Keratoconus with partly regular astigmatism was preexisting. RESULTS: Thorough examination showed a misalignment of the bitoric IOL of 25 degrees, explaining the patient's symptoms (monocular diplopia). Despite capsular fibrosis, surgical revision with IOL rotation was advised and could be performed without major difficulty. A follow-up visit showed a corrected distance visual acuity of 16/20 and a correctly aligned toric IOL. CONCLUSIONS: A long preceding operation should not detain the surgical revision of a misaligned toric IOL in the capsular bag.

Anatomic success of scleral buckling for rhegmatogenous retinal detachment--a retrospective study of 524 cases.

BACKGROUND/AIM: Our purpose was to investigate the anatomic success of scleral buckling surgery for rhegmatogenous retinal detachment. MATERIAL AND METHODS: A total of 524 consecutive patients were retrospectively analysed. Several parameters including the lens status, number of breaks and extent of retinal detachment, preoperative proliferative vitreoretinopathy and refractive errors were examined. The minimum follow-up was 6 months. The primary success rate was defined as anatomic success being stable over a period of at least 6 months after surgery. The secondary success rate was defined as anatomic success after the second intervention if necessary. Besides an analysis over all patients, the patients were grouped according to the severity of the preoperative situation in simple, medium and severe cases. RESULTS: The overall primary anatomic success rate was 84.7% and the secondary success rate 96.4% after 1 initial scleral buckling surgery and 1 additional surgery in case of persisting retinal detachment, and 19.1% of the patients with an initially attached retina after 1 scleral buckling surgery experienced a redetachment in the postoperative course and were successfully treated in 60/85 cases. In phakic patients (n = 359) the primary success rate was 89.7%, whereas in pseudophakic patients (n = 165) a primary success rate of 73.9% was obtained. The primary success was additionally influenced by the extent of the retinal detachment measured in clock hours (p < 0.001), undetected holes (p = 0.004), small (p = 0.037) and no gas tamponade (p = 0.021). In simple, medium and severe cases, phakic patients always achieved better anatomic results (89.9, 89.1 and 90.2%) compared to pseudophakic ones (82.5, 70.3 and 36.4%). CONCLUSION: Scleral buckling is a very good surgical option in phakic patients irrespective of the preoperative severity and simple cases in pseudophakic patients. Scleral buckling represents a surgical technique worth being trained and performed in the light of favourable results especially in phakic eyes.