Outcomes of prosthetic iris implantation in patients with albinism.

PURPOSE: To assess the safety and efficacy of implantation of prosthetic iris devices in patients with albinism. SETTING: Private practice, Cincinnati, Ohio, USA. METHODS: This retrospective noncomparative case series comprised 13 eyes of 8 patients with diminished pigment epithelium of the iris secondary to albinism. All eyes had anterior segment surgery with intraocular lens (IOL) and prosthetic iris device implantation. Eleven eyes received an endocapsular-type iris reconstruction implant (Morcher aniridia interdigitating rings), and 2 eyes (1 patient) received a combined iris-IOL device (Ophtec model 311). The visual acuity, subjective glare reduction, postoperative anatomical outcomes, and intraoperative or postoperative complications were reviewed. RESULTS: All eyes achieved the desired anatomic result. The best corrected visual acuity improved in 8 of 13 eyes, remained stable in 3 eyes, and decreased in 2 eyes. Glare and photophobia improved subjectively in 6 of 8 patients, remained unchanged in 1 patient, and increased in 1 patient after implantation of an artificial iris diaphragm. There were no intraoperative or postoperative complications. CONCLUSIONS: Implantation of prosthetic iris devices appears to be useful in the management of patients with iris deficiency secondary to albinism. The procedure was safe and particularly effective in reducing glare and photophobia in most patients.

Long-term follow-up of indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair.

OBJECTIVE: To determine the long-term efficacy of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair. DESIGN: Retrospective, interventional, noncomparative case series. PARTICIPANTS: One hundred twenty-one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003. INTERVENTION: All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks. MAIN OUTCOME MEASURES: Long-term postoperative anatomic results, visual acuity (VA), and complications. RESULTS: Patients were observed postoperatively for an average of 26 months (range, 12-53). Anatomic closure of the macular hole was achieved in 118 eyes (98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by > or =2 lines in 116 eyes (96%). Mean visual improvement after surgery was 6 lines (range, 0-14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG. CONCLUSIONS: Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.

Visualizing vitreous using Kenalog suspension.

We developed and evaluated a method of visualizing vitreous gel in the anterior segment. In this study, 0.2 mL of injectable triamcinolone (Kenalog) 40 mg/mL was captured in a 5 microm filter and rinsed with 2 mL of balanced salt solution (BSS). It was then resuspended in 5 mL of BSS and recaptured to thoroughly remove the preservative. The Kenalog particles were ultimately resuspended in 2 mL of BSS and injected into the anterior chamber through a 27-gauge cannula. Kenalog particles were trapped on and within the vitreous gel, making it clearly visible. The visualization provided direct observation of vitreous behavior in various experimental settings and assisted surgeons intraoperatively in the identification and removal of vitreous in the anterior segment.

Thinning of the anterior capsule associated with congenital aniridia.

PURPOSE: To report the unusual finding of intraoperative fragility of the anterior capsule in some patients with congenital aniridia and determine the histopathologic etiology of this finding. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Anterior lens capsule specimens were obtained from aniridic and nonaniridic patients during cataract surgery. The intraoperative behavior of each capsule was noted, after which the specimens were submitted for histopathologic evaluation. RESULTS: All anterior capsule specimens from the nonaniridic patients were of normal thickness. Some, but not all, anterior capsule specimens from the aniridic patients were remarkably thin. Thin capsules were associated with extreme intraoperative fragility. CONCLUSIONS: Greater awareness of anterior capsule fragility in some aniridic patients may reduce the risk of capsule complications and lead to safer surgical outcomes.