Immediate versus delayed sequential bilateral ICL implantation: A retrospective comparison of vault height and visual outcomes.

PURPOSE: To compare the visual outcomes and risks of suboptimal vault-related complications between immediate sequential bilateral ICL surgery (ISBICLS) and delayed sequential bilateral ICL surgery (DSBICLS). DESIGN: A retrospective cohort study. METHODS: Patients who underwent bilateral ICL implantation between November 2014 and December 2021 at the Eye and ENT Hospital of Fudan University (Shanghai, China) were included and divided into two groups: (1) ISBICLS: both eye surgeries performed on the same day, and (2) DSBICLS: second eye surgery performed < 7 days following the first one. Propensity score matching (PSM) was performed to compare the visual outcomes. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of the suboptimal vaults. RESULTS: Finally, 10,985 eyes were included. After PSM, 204 first surgery eyes and 162 s surgery eyes with complete postoperative data were matched. The safety and efficacy indices did not statistically differ between groups (all > 1.00), except that ISBICLS first surgery eyes achieved better efficacy index than DSBICLS group (1.03 ± 0.26 vs. 1.08 ± 0.23, P = 0.034). Excessive vault was observed in eight (4.06 %) ISBICLS first eyes, one (0.50 %) DSBICLS first eye, and none in the second surgery eye in either group. An insufficient vault was observed in one second eye and one DSBICLS second eye. We found no evidence of differences in the rate of excessive vault (OR = 0.831, 95 % CI: 0.426-1.622, P = 0.588) or insufficient vault (OR = 0.609, 95 % CI:0.062-5.850, P = 0.668). CONCLUSION: ISBICLS provided safety, efficacy, and refraction predictability comparable to DSBICLS without increasing the risk of suboptimal vault-related complications.

Comparison of pain between bilateral ICL surgeries in patients with myopia.

PURPOSE: The purpose of this study was to compare the preoperative anxiety, aqueous humor monocyte chemoattractant protein-1 (MCP-1) concentration, intraoperative pain, and degree of cooperation of the first eye implantable collamer lens (ICL) surgery with the second eye surgery, of the 1-day interval group with the 1-week interval group, and to investigate the possible causes of these differences, as well as to determine the appropriate interval between bilateral eye ICL surgeries. METHOD: The study was a prospective observational study. A total of 120 patients who underwent bilateral ICL surgery at the Department of Ophthalmology, West China Fourth Hospital, Sichuan University, from July to September 2023, were enrolled. The patients were divided into a 1-day interval group and a 1-week interval group. The ICL surgery was performed on both eyes according to the schedule. Anxiety levels, aqueous humor MCP1, cooperativeness, surgical time, pain and satisfaction, and patients' estimations of the time spent in the operation were recorded for each eye. The patients were instructed to recall the intraoperative pain of the first eye surgery after the operation of the second eye. Statistical analyses (two independent samples t-test,two paired samples t-test, the rank-sum test, the chi-square test, non-parametric test with multiple independent samples) were performed to compare the differences between each score in both eyes and two groups. Furthermore, we examined the relationship between pain levels and the reproductive history of the patients. RESULTS: In the 1-day interval group, male/female is 22/52, average age is 25.24±5.00. In the 1-week interval group, male/female is 17/29, average age is 25.39±5.57. There was no statistically significant difference between the two groups. In both groups, patients were less nervous, had significantly more pain, had less surgical satisfaction, had a longer estimated operative time, and had elevated preoperative MCP1 during the second eye operation. In the second eye surgery, the patient's cooperation worsened, but it did not lead to an increase in surgical time. A significant proportion of patients, particularly in the 1-week interval group, recalled experiencing reduced pain during the first eye surgery. The 1-week interval group had a higher difference in all indicators between the bilateral surgeries. In the second eye surgery, patients in the 1-week interval group experienced more severe pain, less cooperation, longer estimated operation duration, and a greater MCP1 than those in the 1-day interval group. CONCLUSION: Patients undergoing second eye ICL surgery had decreased nervousness, increased pain, decreased cooperation, and satisfaction, and increased MCP1 compared to the first eye surgery. It is recommended that an interval of about one week should be avoided between bilateral surgeries when developing a surgical schedule to improve patients' cooperation, satisfaction, and comfort.

The prevalence of visual axis opacification in the Swedish Pediatric Cataract Register.

PURPOSE: To report on the occurrence of postoperative visual axis opacification (VAO) in children younger than 5 years of age operated for cataract in Sweden, and to analyse correlations with age at surgery and surgical method. METHODS: Data were derived from the Swedish Pediatric Cataract Register (PECARE). All children operated on between 1 January 2007 and 31 December 2020 were included. Follow-ups at 1, 2 and 5 years of age were analysed. RESULTS: Cataract surgery were performed on 770 eyes belonging to 549 children (n = 282 boys, 51.4%); 327/770 (42.5%) of the children underwent surgery before 3 months of age and 216/770 (28%) before 6 weeks of age. Data on 881 follow-up visits were registered. At the follow up-visits at 1, 2 and 5 years of age, VAO was present in 154/349 (44.1%), 41/323 (12.7%) and 25/208 (12%). The majority of the children with VAO underwent cataract surgery before age 6 months, with a predominance before age 2 months. Primary IOL was implanted in 601/770 (78%) of eyes; 40.8% had an acrylic one-piece lens, 31.8% had a bag-in-the-lens IOL, 21.9% were aphakic and 5.2% had an acrylic three-piece lens. Implantation of a bag-in-the-lens IOL was related to a significantly lower occurrence of VAO compared to other types of IOL, including aphakia (p < 0.0002). CONCLUSION: Our results are in accordance with the literature. Primary bag-in-the-lens IOL implantation before 2 years of age seems adequate and safe, with a low occurrence of VAO, and can thus be continued as routine in Sweden.

Efficacy Comparison Between Steep-Meridian Incision and Non-Steep-Meridian Incision in Implantable Collamer Lens Surgery with Low-to-Moderate Astigmatism.

INTRODUCTION: To compare the visual outcomes of astigmatism correction with implantable collamer lens (ICL) surgery with low-to-moderate astigmatism through a steep-meridian corneal relaxing incision (SM-CRI) and non-steep-meridian corneal relaxing incision (NSM-CRI). METHODS: Seventy eyes of 70 patients with myopia and myopic astigmatism who underwent ICL V4c implantation were classified into two groups: SM-CRI and NSM-CRI. Refractive outcomes and vector analysis were evaluated preoperatively and 6 months postoperatively. RESULTS: At the postoperative 6 month visit, all participants in both groups achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better. The difference vector (DV) showed that the residual astigmatism in the SM-CRI group was much smaller than that in the NSM-CRI group (P = 0.021), and the correction index (CI) was 0.84 ± 0.30 and 0.67 ± 0.35 for the SM-CRI and NSM-CRI groups, respectively, with a significant statistical difference (P = 0.013). Approximately 71% of eyes in the SM-CRI group had an angle of error (AE) within ± 15°, whereas 55% of eyes in the NSM-CRI group were within that range. The absolute mean AE was 10.13 ± 14.57° in the SM-CRI group, compared with 23.88 ± 28.22° in the NSM-CRI group (P = 0.038). CONCLUSION: SM-CRI can alleviate corneal astigmatism and decrease the cylindrical diopter of the ICL, thus improving postoperative visual quality compared with NSM-CRI.

Wave-like calcification on the posterior surface of an acrylic hydrophilic bag-in-the-lens (BIL) implant.

Purpose: To report secondary opacification of a hydrophilic bag-in-the-lens (BIL) which is a rare manifestation that can happen years after initial surgery. Observations: We describe a case of a prominent wave-like, rippled opacification on the posterior surface of the BIL. The opacification was composed of calcium deposits and seems to start in the periphery as a ring and progresses to the centre of the posterior surface. Due to the specific design of the BIL, there is direct contact between the BIL and the posterior chamber, both with the space of Berger, and the anterior hyaloid, particularly in this very hyperopic eye. Conclusions and importance: Abnormal fluid flow and stagnation in an unusual retrolenticular space is a possible explanation for this unusual pattern of posterior surface opacification.

Distribution of preoperative angle alpha and angle kappa values in patients undergoing multifocal refractive lens surgery based on a positive contact lens test.

PURPOSE: To assess the preoperative objective angle alpha and angle kappa measurements of patients deciding to undergo multifocal refractive lens surgery based on a subjective positive multifocal contact lens test (MCLT). METHODS: Retrospective, consecutive case series. Alpha and kappa angles were measured using the iTrace aberrometer. All patients also performed a 1-week MCLT. Only patients with a positive MCLT underwent surgery. Visual outcome (UCVA) was obtained in the 1-year follow-up. We assessed the preoperative distribution of angle values within MCLT positive and negative patient groups. RESULTS: Two hundred seventeen eyes (111 patients) were included. Mean age was 56.4 years (SD 5.6) and 46.9% were female. In 71 eyes (38 patients), MCLT was positive. Of them, 12 eyes (17%) had an angle alpha and angle kappa ≥ 0.5mm. Of 146 eyes (73 patients) who refrained from surgery due to a negative MCLT, 71 eyes (48.6%) had both angles small (<0.5mm). In the 1-year follow-up, UCVA improved by 0.68 logMAR (SD 0.51; p<0.001) from baseline. Eyes with both small angle alpha and kappa sizes improved by 0.78 logMAR (SD 0.56), as did eyes with high (≥0.5mm) angle sizes (0.82 logMAR (SD 0.53). UCVA of eyes (n=24) with high alpha but low kappa sizes improved less (-0.31 logMAR (SD 0.13; p=0.019)). CONCLUSION: Four out of five patients with a positive MCLT also had correspondingly small angle values. One-half of patients with low preoperative angle values refrained from surgery due to a negative MCLT result. One-year visual acuity improvement was substantial and independent from angle sizes.

Double-Needle Yamane Technique Using Flanged Haptics in Ocular Trauma-A Retrospective Survey of Visual Outcomes and Safety.

To evaluate visual outcomes and safety of the double-needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double-needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow-up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow-up at three months. Further studies with longer follow-up evaluations are required to verify long-term complications.

Retinal detachment after phacoemulsification in refractive surgery clinics: a large series analysis with variable follow-up during 16 years.

PURPOSE: To determine the long-term incidence of pseudophakic retinal detachment (PRD) after phacoemulsification and the weight of the main risk factors in the appearance of such complication in a large sample. To implement a customized formula and a software calculation program able to quantify the risk of suffering PRD applicable to all lens extraction patients. METHODS: Retrospective cumulative risk analysis conducted on 178,515 eyes operated under similar conditions in a group of refractive surgery clinics (Clínica Baviera SL) located in a relatively limited geographical area (Spain). A survival analysis was performed and the data were modelled using the Weibull regression to determine the risk over a period of 16 years and to estimate the association of different risk factors: sex, age, axial length (AXL) of the eye, intraoperative posterior capsule rents (PCR), and YAG laser capsulotomies. The resulting estimates were translated into a predictive equation for hazard rates and survival probabilities. Later, an application was developed to make prediction available for the clinical community in order to estimate the potential risk of any hypothetical case before lens surgery. RESULTS: Globally, 1521 (0.85%) cases of PRD were diagnosed during the period. The risk for PRD was significantly greater in males (5.48 [2.94-10.2]; p < 0.001), in long eyes (1.24 [1.21-1.26]; p < 0.001), and also after posterior capsule rents (13.97 [11.61-16.82]; p < 0.001). Posterior capsule rupture increased the risk of PRD up to fourteen times. CONCLUSIONS: From weaker to stronger impact, age, axial length, sex, and intraoperative posterior capsule rent were significant risk factors for the appearance of PRD after lens extraction.

Lens-based surgical correction of presbyopia. Where are we in 2020? / Corrección de la presbicia tras cirugía cristaliniana. ¿Dónde nos encontramos en 2020?

INTRODUCTION: Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years. MATERIAL AND METHODS: This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs. RESULTS: Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients. CONCLUSIONS: It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.

[Explantation of two historical posterior chamber phakic intraocular lenses 31 years after implantation]. / Explantation zweier historischer phaker Hinterkammerlinsen 31 Jahre nach Implantation.

This article reports the case of a 56-year-old male patient who had undergone implantation of posterior chamber phakic intraocular lenses in 1987 in Russia. The patient presented to this clinic 31 years after the initial surgery with anterior cortical cataracts and initial stages of corneal decompensation in both eyes. Strategic planning and execution of surgical treatment and the further clinical course are portrayed in this report.

Current Trends in Modern Visual Intraocular Lens Enhancement Surgery in Stable Keratoconus: A Synopsis of Do's, Don'ts and Pitfalls.

Keratoconus is a relatively common ectatic, non-inflammatory corneal disorder that involves gradual visual deterioration through progressive alteration of the shape of the cornea. The corneal thinning, irregular astigmatism and higher order aberrations that occur as the disease progresses pose major challenges in the visual rehabilitation of such patients. This paper summarizes the current literature regarding the results of visual enhancement procedures in patients with stable keratoconus treated with standalone anterior or posterior chamber phakic intraocular lens implantation and monofocal, toric or multifocal toric intraocular lens implantation following phacoemulsification for age-related cataract extraction or refractive lens exchange.

Diffractive trifocal pseudophakic intraocular lenses in high myopic eyes: 2-year assessment after implantation.

PURPOSE: To assess the visual outcomes and ocular safety when implanting diffractive trifocal intraocular lenses in a population of high myopic eyes. METHODS: This is a retrospective cumulative clinical study. Two hundred five myopic eyes consecutively operated in the hospitals of Clínica Baviera, Spain, were included. All eyes presented an axial length equal or greater than 26 mm and were treated and examined following the same methodology for at least 2 years. Refractive and visual outcomes and also intraoperative or postoperative complications were tabulated for later analysis. Furthermore, a subjective questionnaire was completed by all patients at the end of the follow-up period. RESULTS: The percentage of eyes that lost two or more lines of corrected distance visual acuity (CDVA) was 5.9%, 11.5% and 10.7% 3, 12 and 48 months after surgeries respectively. However, 33% of eyes gained two or more lines of CDVA 2 years after implantation. Excimer laser correction of residual refractive error was performed after implants in 29.75% of eyes. Uncorrected distance visual acuities (UDVAs) were significantly better 1 year (0.10 ± 0.3 logMAR) and 2 years after the surgeries (0.10 ± 0.14 logMAR) compared with those estimated 3 months postoperatively (0.14 ± 0.15 logMAR; Kruskal-Wallis; p < 0.001). Mean near and intermediate uncorrected visual acuities remained stable from the first to the last postoperative visit (Kruskal-Wallis; p > 0.05 for all comparisons). Of the eyes, 27.31% were diagnosed and treated with yttrium aluminum garnet (YAG) laser after being diagnosed as having posterior capsular opacification. Retinal detachment (RD) was diagnosed in six eyes (2.92%). CONCLUSIONS: Diffractive trifocal IOLs have good efficacy and predictability in high myopic eyes. Retinal concerns should lead the surgeons to explore other alternatives for refractive surgery in young patients without cataracts.

Ruptura de la cápsula posterior en la cirugía del cristalino / Posterior capsule rupture in crystalline lens surgery

RESUMEN La cirugía de catarata constituye hoy en día un reto para el cirujano oftalmólogo. Cada año se someten a este proceder miles de pacientes con el único propósito de mejorar su calidad visual, y por tanto su calidad de vida. Es por esto que lograr un acto quirúrgico libre de complicaciones es vital para que este procedimiento se pueda efectuar sin contratiempos. El advenimiento de nuevas técnicas quirúrgicas y de la tecnología de punta hace que el cirujano de catarata esté constantemente tratando de satisfacer las exigencias de los pacientes que se someten a esta intervención. Teniendo en cuenta que dentro de las complicaciones transoperatorias una de las más frecuentes y temidas es la ruptura de la cápsula posterior, se realizó una búsqueda de diversos artículos publicados en los últimos diez años, utilizando la plataforma Infomed, específicamente la Biblioteca Virtual de Salud, con el objetivo de conocer los principales factores de riesgo, el diagnóstico, el manejo y las complicaciones asociadas a la ruptura capsular tras la cirugía del cristalino(AU)

ABSTRACT Cataract surgery is nowadays a challenge for eye surgeons. Thousands of patients undergo cataract surgery every year with the sole purpose of improving their visual quality and thus their quality of life. It is therefore crucial that complications do not occur during surgery, so that the procedure may be conducted without any mishap. Cataract surgeons should be aware of the new surgical techniques and state-of-the-art technology in the field to meet the demands of patients undergoing this surgical procedure. Bearing in mind that posterior capsule rupture is one of the most common and feared intraoperative complications, a search was conducted of papers published on the Infomed platform, particularly the Virtual Health Library, in the past ten years, with the purpose of collecting information about the main risk factors, diagnosis, management and complications associated to capsule rupture after lens surgery(AU)

La ectopia lentis y las soluciones quirúrgicas en la cirugía de catarata / Ectopia lentis and surgical solutions in cataract surgery

RESUMEN La extracción del cristalino en pacientes con ectopia lentis se convierte en una cirugía desafiante para el cirujano. En el pasado surgieron serias complicaciones asociadas a esta intervención quirúrgica, como desprendimiento de retina y glaucoma. El avance de las técnicas quirúrgicas en las últimas décadas ha brindado mayor seguridad para la cirugía de esta afección del cristalino. Se presenta una paciente femenina de 47 años aquejada de disminución de la visión. Al examen oftalmológico se encuentra subluxación superior del cristalino bilateral. Previa discusión con la paciente de los posibles escenarios a presentarse durante la cirugía, se le sugiere una facoemulsificación bilateral secuencial del cristalino conservando el saco capsular mediante la colocación de un anillo de tensión capsular fijado a la esclera más implante de lente intraocular plegable en el saco capsular. Se realiza primeramente cirugía del ojo izquierdo y se presenta un desgarro radial de la rexis con extensión posterior, por lo que se varía el abordaje quirúrgico y se fija el implante al iris. Un mes después se realiza cirugía del ojo derecho siguiendo el plan quirúrgico inicial sin complicaciones. La recuperación visual fue satisfactoria (0,7 en cartilla de Snellen) en ambos ojos y se demostró la efectividad de ambas alternativas quirúrgicas. La planificación correcta de la técnica quirúrgica y de las posibles modificaciones ante circunstancias sobrevenidas, así como la oportuna información preoperatoria y la experiencia del cirujano resultan fundamentales para alcanzar el éxito quirúrgico, la recuperación funcional y la satisfacción del paciente(AU)

ABSTRACT Crystalline lens removal in patients with ectopia lentis is a challenge for eye surgeons. Serious complications, such as retinal detachment and glaucoma, were associated in the past to this surgical procedure. However, the progress in surgical techniques achieved in recent decades provides greater safety in the surgical treatment of this lens disorder. A female 47-year-old patient attends consultation complaining of vision reduction. Ophthalmological examination reveals bilateral crystalline lens upper subluxation. The possible scenarios to occur during surgery are discussed with the patient, and it is suggested that she undergoes sequential bilateral lens phacoemulsification preserving the capsular bag with the placement of a capsular tension ring fixed to the sclera plus implantation of a foldable intraocular lens in the capsular bag. The first eye to be operated on is the left eye, and radial tear of the rhexis with posterior extension occurs. Therefore, the surgical approach is changed and the implant is fixed to the iris. Surgery of the right eye is performed one month later, following the initial surgical plan without any complications. Visual recovery was satisfactory (0.7 by the Snellen chart) in both eyes, proving the effectiveness of both surgical alternatives. Correct planning of the surgical technique and its possible modifications in response to unexpected circumstances, alongside timely preoperative information and the surgeon's experience, are all crucial to achieve surgical success, functional recovery and patient satisfaction(AU)

Clinical Features and Efficacy of Lens Surgery in Patients with Lens Subluxation Misdiagnosed as Primary Angle-Closure Glaucoma.

PURPOSE: To investigate the clinical features and efficacy of lens surgery in patients with lens subluxation misdiagnosed as primary angle-closure glaucoma. METHODS: In total, 2054 inpatients with primary angle-closure glaucoma were consecutively recruited. Eighty-five of the patients were rediagnosed as lens subluxation following ultrasound biomicroscopy after hospitalization. Lens surgeries were performed in all patients, and 35 had a follow-up of at least 12 months. Risk factors of postoperative intraocular pressure control were identified with multivariate logistic regression analysis. RESULTS: Eighty-five inpatients (4.1%, 85/2054) with lens subluxation were misdiagnosed as primary angle-closure glaucoma, of which 71.8% (2.97% of all cases, 61 out of 2054 subjects) had ocular blunt trauma and 18.8% (0.78% of all cases, 16 out of 2054 subjects) had spontaneous dislocation. Lens surgery significantly decreased the intraocular pressure and improved best-corrected visual acuity, meanwhile increased the anterior chamber depth (all P < 0.001). Postoperatively, the intraocular pressure was controlled with antiglaucomatous eye drops administration in 17 eyes, in which greater range of preoperative angle closure and zonular dialysis, and longer operation time delay were detected. Risk factors for poor postoperative IOP control were more quadrants of angle closure (P = 0.038) and operation time delay (P = 0.045). CONCLUSION: Lens subluxation was the major cause of the misdiagnosed cases as primary angle-closure glaucoma. Misdiagnosed patients could benefit from the lens surgery, while more angle-closure quadrants and operation time delay indicated worse postoperative intraocular pressure control.

Management and pathology of the optical area fibrotic membrane underlying preserved anterior capsule after lensectomy / 中华实验眼科杂志

Background Lensectomy with anterior capsule preserving is still advisable under specific conditions during vitrectomy.Although lens epithelial cells were polished off during surgery,opacification in varying degrees could be observed.Understanding the composition of proliferative anterior capsule membrane is of an important clinical significance for the prevention and manegement.Objective This study was to investigate the management and pathology of the pupillary area membranous opacity underling preserved anterior capsule after lensectomy in diabetic eyes with silicone oil tamponade.Methods Twenty-three eyes of 21 patients with proliferative diabetic retinopathy (PDR) and cataract received vitrectomy combined with lensectomy preserved anterior capsule in China-Japan Friendship Hospital from January to December 2013,and the proliferative anterior capsular membrane specimens with the opacification grade C or D were obtained.The fibrotic membrane underlying anterior capsules were removed in order to make a clear optical area during the operation of silicone oil removal.The proliferative membrane at pupillary area was cut off by cutter probe for the eyes with the membrane attaching tightly or partial capsule laceration occurred.The available specimens were examined under the optical microscope and polarized microscope respectively after hemotoxylin and eosin staining,Van Gieson collagen staining,Masson collagen staining and Picrosirius staining.Results The proliferative fibrosis membranes were pilled to get a clear pupillary area in 15 eyes,with the successfully rate 65.2％ (15/23).In 14 eyes with degree C opacity,the proliferative fibrosis membranes were pilled in 9 eyes,with the successfully rate 64.3 ％ (9/14),and 5 eyes received anterior capsule cutthrough by cutter in pupillary area,with a diameter of 3-4 mm,and available specimens were obtained in 3 eyes.In 9 eyes with degree D opacity,the proliferative membranes were pilled in 6 eyes,with the successfully rate of 66.7％ (6/9),and 3 eyes underwent cut-through by cutter,and available specimens were obtained in 7 eyes.The best corrected visual acuity was obviously improved in 20 eyes and unchanged in 3 eyes after surgery.The histopathological examination showed fibroblasts,pigment particles and intracellular and extracellular vacuolus formation by hemotoxylin and eosin staining,fibril tissue with the pinke staining by Van Gieson,collage formation with green color by Masson staining in the specimens.Picrosirius staining plus polarization microscopy observation revealed that the collagen consisted of abundant type Ⅰ collagen with stronger reddish yellow color and small amount of type Ⅲ collagen with green color.Conclusions A combination of silicon oil removal with proliferative mambrane pelling is a available way to restore pupillary transparency in the eyes of PDR with cataract and silicone oil tamponade eyes.Proliferative residual lens epithelial cells,pigment epithelial cells and silicon oil granules are the main composition of opacity mambrane.The type Ⅰ collagen is dominant in proliferative collagen tissue.

Assessment on changes of anterior chamber parameters after ICL surgery with Allegro Oculyzer system and their correlation with IOP / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract? AIM: To investigate changes of anterior chamber parameters after posterior chamber phakic implantable collamer lens ( ICL ) surgery and its correlation with intraocular pressure ( IOP) .?METHODS: This was a retrospective case series study. Seventy four eyes in 43 myopia patients were examined by Allegro Oculyzer anterior segment tomography to obtain the changes of anterior chamber volume ( ACV ) , anterior chamber angle ( ACA) , central anterior chamber depth ( ACD) and vault, meanwhile, to measure the IOP to analyze the correlation with anterior chamber parameters.?RESULTS: Compared with preoperative, ACV, ACA, ACD all decreased apparently ( P 0.05).?CONCLUSION:For patients underwent ICL, the anterior chamber parameters all decreased which included ACV, ACA, ACD, and had stabilized since early postoperative period. Correspondingly, IOP was stable and had not correlate with ACV, ACA, ACD and vault, however the long-term observation is still necessary.

Factor analysis of hospitalization expenses for lens surgery / 中华医院管理杂志

Objective To identify the common factor affecting hospitalization expense of lens surgery operation, and propose effective measures to curb unreasonable increase of medical costs.Methods Collection of inpatients information of the year 2014 from a tertiary hospital in Beijing, for factor analysis of the hospitalization expenses of 555 inpatients categorized as DRGs of CB39 (lens surgery), using the BJ-DRGs platform.Results The highest factor of lens surgery expenses is disposable medical surgery materials, accounting for 42.77％;followed by surgery fee and medication fee, accounting for 23.19％ and 17.15％ respectively.Conclusion For the hospitals, medicine and medical material rank the highest in cost control, and they are recommended to work on them by means of clinical pathways, medical norms and purchasing policy, and to explore new means of payment in the meantime.

Síndrome do bloqueio capsular tardio - relato de dois casos / Capsular block syndrome - report of two cases

Relato de dois casos de síndrome do bloqueio capsular, de ocorrência tardia, nove e cinco anos após facoemulsificação, respectivamente, em um olho com pseudoexfoliação capsular e outro operado de glaucoma, com bolha funcionante. A condição se constituiu na retenção de grande quantidade de líquido esbranquiçado, atrás da lente intraocular, o que levou à redução da AV, de quatro linhas de Snellen, nos dois casos. Houve pronta resolução do quadro com mínima capsulotomia posterior.

Two cases of late capsular block syndrome are reported. They were observed nine and five years after facoemulsification, in one eye with pseudoexfoliation syndrome and the other operated on for glaucoma with a functioning bleb. There was a large amount of milky material behind the intraocular lens, and reduction of the visual acuity (four lines of the Snellen chart in both cases). The condition was promptly resolved through minimal YAG laser posterior capsulotomy.