Glued intraocular lens in eyes with deficient capsules: retrospective analysis of long-term effects.

PURPOSE: To assess the long-term (6-12 years) results and complications of glued transscleral-fixated intraocular lens (IOL). SETTING: Dr. Agarwal's Eye Center, Chennai, India. DESIGN: Retrospective case series. METHODS: Eyes with glued IOL of more than 5-year follow-up were evaluated. Visual acuity (logarithm of the minimum angle of resolution [logMAR]), IOL tilt, corneal topography, corneal endothelial cell density, intraocular pressure, central corneal thickness, central foveal thickness, and ocular residual astigmatism (ORA) were evaluated. RESULTS: Overall, 91 eyes (63 patients) with mean postoperative 8.2 ± 2.3 years were analyzed. The duration was 10 to 12 years in 31 eyes (34%), 9 years in 14 eyes (15.3%), and 6 to 9 years in 46 eyes (50.5%). No subscleral haptic was visible in 50% eyes. Mild, moderate, and severe grade of haptic visibility was noted in 33.5%, 9.4%, and 7%, respectively. The corrected distance visual acuity (CDVA) was 0.50 ± 0.50 logMAR. Clinically, no tilt was seen in 87 eyes (95.6%), whereas detectable tilt was seen in 4 eyes (4.3%). The optical coherence tomography microtilt was 0.8 ± 1.7 and 0.4 ± 1.2 degrees in 90- and 180-degree axes, respectively. The mean iris vault was 0.45 mm, and the mean ORA was 1.10 ± 1.00 diopter. Complications were glaucoma (7.6%), IOL luxation (4.4%), retinal detachment (3.2%), macular edema (4.3%), corneal decompensation (3.2%), uveitis (2.1%), and uveitis-glaucoma-hyphema syndrome (1%). Haptic reposition (3.2%), retinal detachment surgery (3.2%) keratoplasty (1%), pupilloplasty (2.1%), and IOL explantation (1%) were the second surgeries performed. CONCLUSIONS: Glued IOL has shown good anatomical and functional stability with minimal incidence of vision-threatening complications on long-term.

Short-term fluctuation of lens corneal distance and clinical correlation with phacodonesis.

BACKGROUND: To analyze the role of short-term lens-corneal distance (LCD) fluctuation in quantifying preoperative phacodonesis and predicting intraoperative zonular weakness. METHODS: Patients were divided into control (lens without clinical phacodonesis) and study (lens with suspicious and clinical phacodonesis) groups for evaluation. Slit-lamp examination followed by IOLMaster (Carl Zeiss) for LCD assessment was performed. Five readings were taken at five time points (0 s, 15 s, 30 s, 45 s & 60 s) continuously over a minute (short term) for the LCD fluctuation calculation. RESULTS: A total of 135 eyes (82 controls and 53 study) were assessed. Study group included 32 (60.3%) suspicious and 21 (39.6%) moderate to severe phacodonesis. There was difference between the control and study eyes (p = 0.000) in short-term LCD fluctuation. Twenty-one study eyes (39.6%) showed LCD difference > 1 mm, including 11 eyes (52.3%) with > 2 mm. There was a difference in LCD with respect to severity of phacodonesis (p = 0.000). In the study eyes, 13 eyes underwent glued IOL implantation (clinical phacodonesis - ten, suspicious phacodonesis - three), and two eyes (suspicious phacodonesis) had glued capsular hook. Thirteen eyes (clinical phacodonesis - ten, suspicious phacodonesis - three) required intraoperative vitrectomy due to vitreous ingress. Intraoperative zonular weakness in 62.5% of eyes with suspicious donesis and association (Chi-square = 0.000) of weakness with preoperative LCD fluctuation was noted. CONCLUSIONS: Short-term lens-corneal distance fluctuation can be used as a parameter for quantifying lens stability and as an aid in assessing the intraoperative risk.

Implantation of glued intraocular lenses in eyes with microcornea.

PURPOSE: To evaluate the intraoperative modifications for and vision outcomes after implantation of glued intraocular lenses (IOLs) in eyes with microcornea. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective case series. METHODS: Eyes with a horizontal cornea of 10.0 mm or less were evaluated for intraoperative modifications and postoperative vision after implantation of a glued IOL. The type of surgery, type of IOL, incision and optic sizes, haptic length modifications, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and postoperative complications were analyzed. RESULTS: A glued IOL was implanted in 15 eyes to treat subluxated cataract (9 eyes), aphakia (5), and intraoperative capsule loss (1). In cases involving a subluxated cataract, implantation of the glued IOL was followed by lensectomy (7 eyes) or intracapsular cataract extraction (2 eyes). The mean follow-up was 22.4 months ± 17.2 (SD). The mean horizontal corneal diameter and axial length were 8.0 ± 0.6 mm and 21.0 ± 2.4 mm, respectively. The mean amount of IOL haptic trimmed intraoperatively was 1.54 ± 0.33 mm. There was significant correlation between the horizontal corneal diameter and the amount of haptic trimmed (P = .000). The mean size of the main incision was 3.70 ± 0.98 mm. Three-piece foldable IOLs with a 6.0 mm optic were used. There were no cases of haptic extrusion or subconjunctival haptic placement. There was statistically significant improvement in CDVA (P = .032) and UDVA (P = .012) after surgery. CONCLUSION: Glued IOLs were safely implanted in eyes with microcornea using modifications such as custom haptic trimming and 6.0 mm optic foldable IOLs. FINANCIAL DISCLOSURE: Dr. Amar Agarwal is a paid consultant to Staar Surgical Co. No other author has a financial or proprietary interest in any material or method mentioned.

Aqueous reaction quantification after phacoemulsification: Fourier-domain optical coherence tomography versus slitlamp biomicroscopy.

PURPOSE: To compare anterior chamber cell detection after phacoemulsification between Fourier-domain optical coherence tomography (OCT) and slitlamp biomicroscopy. DESIGN: Observational prospective comparative case series. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. METHODS: Eyes with preoperative nuclear opalescence (NO) grades 1 to 3 that had phacoemulsification with posterior chamber intraocular lens implantation were included. Slitlamp biomicroscopy and Fourier-domain OCT (Cirrus HD) of the anterior chamber were performed 1 day postoperatively. The results were evaluated, and a correlation analysis between the results and preoperative NO, effective phacoemulsification time (EPT), postoperative central corneal thickness (CCT), and intraocular pressure (IOP) was performed. RESULTS: The preoperative NO grade was 1 in 20 eyes, 2 in 55 eyes, and 3 in 42 eyes. Anterior chamber grading was possible by slitlamp biomicroscopy and Fourier-domain OCT in 106 eyes (90.5%) and 117 eyes (100.0%), respectively. A positive correlation between slitlamp biomicroscopy and OCT grading was noted (R(2) = 0.986, P=.000). Slitlamp grading was not possible in 11 eyes (9.4%) with corneal edema (mean CCT 754 µm ± 44.2 [SD]); OCT detected cells in all 11 eyes. There was a difference in slitlamp grading and OCT grading in 7 eyes (6.6%). There was a significant correlation between the OCT cell count and the EPT (P=.000) and NO (P=.000). CONCLUSION: Fourier-domain OCT was as reliable as slitlamp biomicroscopy in assessing postoperative anterior chamber cells.