Refractive precision in uncomplicated eyes with pseudoexfoliation: three-piece versus one-piece intraocular lens implantation.

PURPOSE: To evaluate the refractive precision of three-piece versus one-piece intraocular lenses (IOLs) in eyes with pseudoexfoliation (PXF) and changes in anterior chamber depth (ACD) following cataract surgery. METHODS: This prospective, nonrandomized, interventional, comparative case series included PXF eyes, which were implanted with one-piece acrylic IOL or three-piece acrylic IOLs (Group A; n = 31, Group B; n = 30). Non-PXF control eyes were implanted with one-piece acrylic IOL (Group C; n = 30). Postoperative refractive error (RE) and absolute RE, as well as pre- to postoperative ACD changes, were statistically analysed. A p value < 0.05 was considered statistically significant. RESULTS: Changes in ACD (mean ± standard deviation) in Groups A, B and C were 0.9 ± 0.4, 1.0 ± 0.3 and 0.7 ± 0.4 mm, respectively. Significant differences were found between Groups A and C (p = 0.043) and between Groups B and C (p = 0.008). In Groups A, B and C, the median and interquartile (Q1 to Q3) values were 0.3 (-0.8 to 1.0), -0.5 (-0.8 to -0.3) and 0.1 (-0.4 to 0.3) for RE and 1.0 (0.4 to 1.3), 0.5 (0.3 to 0.8) and 0.3 (0.3 to 0.5) for absolute RE, respectively. The RE differences between Group A and B (p = 0.009) and Group B and C (p < 0.001) were statistically significant. For absolute RE, the differences were significant for all comparisons (p < 0.05). CONCLUSION: Refractive precision in PXF eyes may be better with three-piece than with one-piece IOL implantation, but worse than with one-piece IOL implantation in non-PXF eyes. Significant changes in ACD in PXF eyes may be related to RE.

Sutureless transconjunctival intrascleral intraocular lens fixation: the modified Yamane technique / Fixação de lente intraocular intraescleral transconjuntival sem sutura: técnica de Yamane modificada

ABSTRACT Purpose: To evaluate the efficacy and safety of the modified Yamane technique with sutureless transconjunctival intrascleral intraocular lens fixation. Methods: Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dislocated intraocular lenses. A clear corneal incision (2.8 mm) was made into the temporal quadrant and a three-piece intraocular lens was implanted into the anterior chamber. The haptics of the intraocular lens were externalized with a 27 G needle via transconjunctival scleral tunnels at the 6 and 12 o'clock positions. The transconjunctival scleral tunnels were prepared to conform to the haptic position and curvature. The site of the scleral tunnels was 2mm from the limbus with a length of 2 mm in the sclera and was aimed at the end of the posterior chamber. The tips of the haptics were cauterized to create a terminal knob. The haptics were pushed back and the knobs were implanted into the scleral tunnels. Results: The study cohort included 21 patients with unilateral aphakia and dislocated intraocular lenses. All patients were examined postoperatively and at postoperative day 1, day 7, month 1, and month 3. All examinations revealed formation of the anterior chamber and well-centralized intraocular lenses. No haptic-related complications of exposure, foreign body sensation, or discomfort were observed. Conclusion: Sutureless transconjunctival intrascleral haptic fixated intraocular lensimplantation is an effective, safe, and practical surgical alternative. This technique was superior to the Yamane method with regard to comfort and surgical duration. Further studies with longer follow-up evaluations are warranted to verify long-term complications.

RESUMO Objetivo: Avaliar a eficácia e a segurança da técnica de Yamane modificada com a fixação de lenta intraocular transconjuntival sem sutura. Métodos: O implante de lente intraocular intraescleral e transconjuntival sem sutura foi realizado em pacientes com afacia e lentes intraoculares luxadas. Uma incisão em córnea clara (2,8 mm) foi feita no quadrante temporal e uma lente intraocular de três peças foi implantada na câmara anterior. Os hápticos da lente intraocular foram externalizados com uma agulha 27G através de túneis esclerais transconjuntivais nas posições de 6 e 12 horas. Os túneis esclerais transconjuntivais foram preparados para se ajustarem à posição e curvatura hápticas. O local dos túneis esclerais foi de 2 mm do limbo com um comprimento de 2 mm na esclera e foi destinado ao final da câmara posterior. As pontas dos hápticos foram cauterizadas para criar uma saliência terminal. Os hápticos foram empurrados para tras e as saliências foram implantadas nos túneis esclerais. Resultados: A coorte do estudo incluiu 21 pacientes com afacia unilateral e lentes intraocular deslocada. Todos os pacientes foram examinados no pós-operatório e no dia 1, 7, 1 mês e 3 meses do pós-operatório. Todos os exames revelaram formação da uma câmara anterior e lentes intraoculares bem centralizadas. Nenhuma complicação hápticas relacionada à exposição, sensação de corpo estranho ou desconforto foram observadas. Conclusão: O implante de lente intraocular transconjuntival intraescleral sem sutura é uma alternativa cirúrgica eficaz, segura e prática. Esta técnica foi superior ao método de Yamane no que diz respeito ao conforto e duração cirúrgica. Mais estudos com avaliações de seguimento mais prolongados são necessários para verificar as complicações de longo prazo.

Sutureless transconjunctival intrascleral intraocular lens fixation: the modified Yamane technique.

PURPOSE: To evaluate the efficacy and safety of the modified Yamane technique with sutureless transconjunctival intrascleral intraocular lens fixation. METHODS: Sutureless transconjunctival intrascleral haptic fixated intraocular lens implantation was performed in patients with aphakia and dislocated intraocular lenses. A clear corneal incision (2.8 mm) was made into the temporal quadrant and a three-piece intraocular lens was implanted into the anterior chamber. The haptics of the intraocular lens were externalized with a 27 G needle via transconjunctival scleral tunnels at the 6 and 12 o'clock positions. The transconjunctival scleral tunnels were prepared to conform to the haptic position and curvature. The site of the scleral tunnels was 2mm from the limbus with a length of 2 mm in the sclera and was aimed at the end of the posterior chamber. The tips of the haptics were cauterized to create a terminal knob. The haptics were pushed back and the knobs were implanted into the scleral tunnels. RESULTS: The study cohort included 21 patients with unilateral aphakia and dislocated intraocular lenses. All patients were examined postoperatively and at postoperative day 1, day 7, month 1, and month 3. All examinations revealed formation of the anterior chamber and well-centralized intraocular lenses. No haptic-related complications of exposure, foreign body sensation, or discomfort were observed. CONCLUSION: Sutureless transconjunctival intrascleral haptic fixated intraocular lensimplantation is an effective, safe, and practical surgical alternative. This technique was superior to the Yamane method with regard to comfort and surgical duration. Further studies with longer follow-up evaluations are warranted to verify long-term complications.

Optical Coherence Tomography Findings in Pre-Eclampsia: A Preliminary Receiver Operating Characteristic Analysis on Choroidal Thickness for Disease Severity.

Purpose: To evaluate qualitative optical coherence tomography (OCT) findings and quantitative parameters, such as central macular thickness (CMT) and subfoveolar choroidal thickness (SFCT), in the eyes of preeclamptic women. Methods: The prospective, comparative, cross-sectional study included 52 eyes of 52 preeclamptic (PE) women and 54 eyes of 54 healthy pregnant women in their second or third trimester. Central macular thickness (CMT), subfoveolar choroidal thickness (SFCT), were evaluated in relation to presence of positive qualitative OCT findings such as any subretinal or intraretinal fluid, irregularity on the external photoreceptor and RPE layer, or presence of pigment epithelial detachment. Results: No significant difference was detected between the PE group and the healthy pregnant group with respect to CMT (P= 0.905), but the mean SFCT value was significantly higher in the PE group than in the healthy pregnant group (391.4 ± 71.1 vs 331.5 ± 53.8 µm, P < 0.001). Receiver operating characteristic analysis revealed that SFCT could predict qualitative OCT findings in preeclampsia, and the optimal cut-off value was 400 µm with a sensitivity of 91% and a specificity of 85%. Conclusion: The eyes of preeclamptic women, and particularly those with positive qualitative OCT findings, showed significantly increased SFCT values. A preliminary cut-off level of 400 µm for SFCT is proposed for the prediction of severe preeclampsia.

Comparison of two laser capsulotomy techniques: cruciate versus circular.

PURPOSE: To compare the safety and efficacy of two Nd: YAG laser capsulotomy techniques. METHODS: In this prospective comparative interventional case series, 60 eyes of 57 patients with posterior capsular opacification were enrolled. Thirty eyes were selected to undergo a cruciate capsulotomy (Cross group) and the other 30 eyes were selected to undergo a circular capsulotomy (Circular group). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), amount of energy used, mean macular thickness (MMT), and floater symptoms. RESULTS: The amount of energy used was significantly higher in the Circular group than in the Cross group (p < 0.001). BCVA and IOP were not significantly different between the two groups at baseline or follow-up. MMT was significantly higher in the Circular group than in the Cross group at one day after the laser procedure (p = 0.032). MMT was not significantly different between groups at one week, one month, and three months (p > 0.05). The number of patients with floater symptoms was significantly higher in the Circular group than in the Cross group at one week and one month (p < 0.05). CONCLUSION: Both the cross-like and circular Nd:YAG laser capsulotomy techniques induce similar visual and IOP changes. The circular technique is associated with a higher amount of energy used, more floater symptoms, and has a greater effect on macular thickness at one day after laser capsulotomy.