Combined surgical management of capsular and iris deficiency with glued intraocular lens technique.

PURPOSE: To determine the outcome after glued aniridia intraocular lens (IOL) and glued IOL with iridoplasty in eyes with combined lens capsular and iris deficiency. METHODS: Twenty-seven eyes of 25 patients (6 had congenital aniridia with subluxated cataract and 19 had acquired lens/iris defects) were included. Glued IOL with aniridia IOL (Intra Ocular Care, Gujarat, India) was performed in eyes with total aniridia and iridoplasty with glued IOL with a three-piece foldable IOL (Sofport; Bausch & Lomb, Rochester, NY) was performed in eyes with partial aniridia. The postoperative outcomes were analyzed at follow-up examination (range: 6 to 48 months). RESULTS: Eleven eyes underwent glued aniridia IOL and 16 eyes underwent glued IOL with iridoplasty. There was significant improvement in (spectacle) corrected distance visual acuity (CDVA) (P = .002). Postoperatively, pigment dispersion on the IOL (n = 1) and raised intraocular pressure was seen in the glued aniridia IOL group and chronic uveitis (n = 1), cystoid macular edema (n = 1), and hyphema (n = 1) in the glued IOL with iridoplasty group. The CDVA remained unchanged in 14 eyes (51.8%) and improved in 13 eyes (48.1%). There was a difference in postoperative CDVA (P = .001) between eyes with glued aniridia IOL and glued IOL with iridoplasty. There was no IOL decentration, retinal detachment, corneal decompensation, or endophthalmitis. There was reduction in glare and photophobia. CONCLUSIONS: Both glued aniridia IOL and glued IOL/iridoplasty showed good functional and anatomical results with fewer complications in eyes with lens capsule and iris deficiency. However, long-term follow-up is required.[J Refract Surg. 2013;29(5):342-347.].

Mirror telescopic intraocular lens for age-related macular degeneration: design and preliminary clinical results of the Lipshitz macular implant.

PURPOSE: To conduct a pilot study evaluating the visual and surgical outcomes of an intraocular mirror telescopic intraocular lens, the Lipshitz macular implant (LMI) (Optolight Vision Technology), for age-related macular degeneration (ARMD) and other macular pathology. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. METHODS: The LMI was implanted in patients with bilateral macular pathology and visual acuity worse than 20/200 in whom vision improved with a x2.5 external telescope preoperatively. The LMI was implanted after conventional phacoemulsification or microphakonit. The minimum follow-up was 6 months. RESULTS: Six eyes of 6 patients had surgery in the worse eye. Four eyes had ARMD, and 1 eye each had myopic macular degeneration or macular dystrophy. There were no intraoperative complications. The mean gain in distance acuity was 3.66 lines +/- 1.88 (SD), and the mean increase in the Early Treatment Diabetic Retinopathy Study score for near acuity was 50.83 +/- 9.15 logMAR. The best corrected distance acuity and near acuity improved significantly (both P = .014). The mean change in endothelial count was -5.79% +/- -4.07%. The mean postoperative corneal endothelial-LMI distance was 3.15 +/- 0.31 mm. A good central fundus view was possible around the mirrors in all eyes. Fundus fluorescein angiography showed good visibility of the retina up to the midperiphery. The mean score on a quality-of-life questionnaire was 11.16 +/- 1.72 (SD) preoperatively and 4.50 +/- 0.83 postoperatively, a statistically significant improvement (P = .014). CONCLUSIONS: The LMI may be an effective solution for optical rehabilitation of patients with ARMD or other macular pathology by increasing the central image on the retina while preserving peripheral vision. The surgery and visual recovery were quick, and the improvement in quality of life was significant.

Management of posteriorly dislocated capsular tension ring with vitrectomy using a "chandelier" illumination system.

Subluxation of the capsular tension ring (CTR) into the vitreous is a rare complication. The explantation of these rings from the vitreous by conventional vitrectomy is often a difficult procedure requiring great surgical skill. We report two cases of posteriorly subluxated endocapsular rings, which were explanted with pars plana vitrectomy using the chandelier illumination system. This illumination system has an external light source which is incorporated via a fibreoptic into the infusion cannula, thereby freeing both hands of the surgeon. This allows surgeon to easily perform bimanual intraocular maneuvers such as external scleral indentation, manipulation of CTR in the vitreous cavity and removal of these rings with the handshake technique.