Secondary intraocular lens implantation: Complication rates, visual acuity, and refractive outcomes.

PURPOSE: To compare complication rates, visual acuity, and refractive outcomes of secondary intraocular lens (IOLs) implantation. SETTING: Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: All secondary IOLs placed by the anterior segment service were reviewed. Preoperative data, operative reports, and data from each subsequent postoperative visit were evaluated. Patients were divided into 5 groups based on the final IOL position: (1) sulcus with optic capture, (2) sulcus without optic capture, (3) anterior chamber (AC), (4) iris-fixated, and (5) transscleral-sutured. Complication rates, visual acuity, and refractive outcomes were compared for each group. RESULTS: The sulcus with and without optic capture groups had the lowest complication rates and best visual acuity outcomes. There was no difference in final corrected distance visual acuity (CDVA) between the transscleral-sutured IOL, iris-fixated IOL, and AC IOL groups, although the AC IOL group had the lowest rates of early postoperative complications and a significant improvement in vision. The transscleral-sutured IOL group had the highest complication rates, and 25% of patients in the iris-fixated IOL group lost 2 or more lines of CDVA. CONCLUSIONS: When a secondary IOL cannot be placed within the capsular bag, sulcus with optic capture is the best alternative, followed by sulcus without optic capture. There was no difference in visual acuity outcomes between transscleral-sutured IOLs, iris-fixated IOLs, and AC IOLs. Anterior chamber IOLs resulted in fewer early complications.

Outcomes of femtosecond laser-assisted cataract surgery performed by surgeons-in-training.

PURPOSE: To compare intraoperative factors and post-operative outcomes of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery performed by resident surgeons. METHODS: All cases of FLACS performed by resident surgeons during the 2013-2014 academic year were compared to a control group of manual cataract surgery cases with regards to pre-operative patient data, operative complications, cumulative dissipated energy (CDE), postoperative corrected distance visual acuity (CDVA), refractive prediction error (RPE), and corneal edema. RESULTS: There were no significant preoperative differences in the FLACS (n = 57) and manual (n = 68) groups. Operative complication rates were similar in cases with sufficient data and follow-up with a higher rate of posterior capsule tear in the manual group. CDE (percent-seconds) was lower in the FLACS group (FLACS: 14.5 ± 7.5; manual: 21.6 ± 11.5; p < 0.01). CDVA (LogMAR) was comparable at 1 month postoperatively (FLACS: 0.004 ± 0.08; manual: 0.024 ± 0.11; p = 0.24) and 1 year postoperatively (FLACS: 0.013 ± 0.06; manual: 0.032 ± 0.09; p = 0.37). No difference in RPE was found at 1 month postoperatively (FLACS: 0.38 ± 0.24 D; manual: 0.41 ± 0.49 D; p = 0.66) and 1 year postoperatively (FLACS: 0.49 ± 0.63 D; manual: 0.34 ± 0.26 D; p = 0.31). CONCLUSIONS: Femtosecond laser-assisted cataract surgery is safe and effective compared to manual cataract surgery when performed by resident surgeons. Both 1-month and 1-year outcomes show no difference in refractive predictive error in FLACS compared to manual cataract surgery in surgeons in training.

Outcomes of anterior chamber intraocular lenses placed by surgeons in training.

PURPOSE: To evaluate risk factors and outcomes of unplanned, primary anterior chamber intraocular lenses (AC IOLs) placed by surgeons in training. SETTING: Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: Cataract surgeries performed primarily by a resident surgeon that resulted in an unplanned AC IOL were included. Cases that had concomitant retinal surgery were excluded. Preoperative data gathered included corrected distance visual acuity (CDVA), intraocular pressure (IOP), and ocular comorbid conditions. Operative times and complications requiring an AC IOL were assessed. Postoperative CDVA, IOP, corneal edema, persistent intraocular inflammation, macular edema, and need for additional surgery were analyzed for the first postoperative year. RESULTS: Twenty-two eyes were included. The mean preoperative CDVA was 1.24 logMAR ± 0.92 SD and the mean preoperative IOP was 17.55 ± 3.88 mm Hg. The mean operative time was 103 ± 30 minutes. The most common operative complications necessitating an AC IOL were 7 (32%) capsule tears with vitreous prolapse requiring anterior vitrectomy and 7 (32%) capsule tears, zonular dehiscence, and vitreous prolapse requiring anterior vitrectomy. By the first postoperative year, the mean visual acuity was 0.40 ± 0.58 logMAR and the IOP was 15.05 ± 6.01 mm Hg. The most common complications 1 year postoperatively included persistent macular edema (23%) and need for additional surgery (18%). CONCLUSION: This group of patients who received unplanned primary AC IOLs by surgeons in training had improved visual acuity and well-controlled IOP 1 year postoperatively. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.