A Case of Personal Identification Via Postmortem Computed Tomography Confirmation of Aphakic Eyes.

Postmortem computed tomography (PMCT) is used commonly in forensic medicine. Postmortem computed tomography of the head provides information on the eyes and orbits and may reveal intraocular abnormalities. We present a case in which the identity of a deceased man was confirmed by the presence of aphakic eyes detected on PMCT. A decomposed body was found in a house and suspected to be a man in his 40s who lived alone. Autopsy identified pontine hemorrhage as the cause of death. Although signs of previous dental treatment were evident, the storage period of the householder's dental records had expired. He had no family members to provide DNA for a comparative DNA analysis. Postmortem computed tomography before autopsy revealed aphakia (ie, the absence of eye lenses) suggestive of previous ocular surgery. His medical records revealed that he had undergone ocular surgery for secondary glaucoma due to uveitis, which had resulted in artificial aphakia. Peripheral iridectomy scars fully matched the findings in his medical records, thus identifying the body. The unusual finding of artificial aphakia in a man in his 40s facilitated the personal identification in this case. In conclusion, PMCT provides additional information, and the correct interpretation of intraocular PMCT findings by forensic pathologists is crucial.

[Diagnostic capabilities of ultrasound biomicroscopy in phaco surgery].

Capabilities of ultrasound biomicroscopy (UBM) as a diagnostic method for surgical planning and outcome analysis in nonstandard situations in phaco surgery have been investigated. The study enrolled 270 patients (278 eyes) with pseudophakia and 26 patients (33 eyes) with aphakia. The scanning was done on OTI HF 35-50 Ultrasound System biomicroscope (UBM) - OTI, Canada. An original method of intraocular lens (IOL) position evaluation by means of UBM, providing precise information on relative position of the IOL and ocular axes, planes, and anatomical structures, has been developed. The proposed technique has been applied to determine both whether the position of the IOL is correct (46 eyes) and, if not, which of three types of its dislocation is present (232 eyes). Clinical and functional features of each of the dislocation types have been analyzed. Detailed analysis of UBM scans of 47 patients (47 eyes) showed that secondary glaucoma development was triggered by loss of proper endocapsular fixation of the IOL with consequent traumatic contact between IOL haptics and uveal tract. This contact, on the one hand, leads to excessive wash-out of pigment and obstruction of outflow routes. On the other hand, it causes subacute reactive uveitis which aggravates preexisting ocular hypertension and glaucoma course. It has been demonstrated that UBM performed prior to IOL implantation enables adequate assessment of the implant bed, accounting for lens capsule integrity, ciliary sulcus configuration and parameters, as well as the extent of structural changes in the globe, which may result from trauma, uveitis or improper evacuation of lens matter during cataract removal. Authors recommend to include UBM into assessment of aphakic patients planned for secondary IOL implantation and to decide on IOL model and its fixation type depending on the UBM results.

[Ultrasound biomicroscopy in evaluation of conditions for secondary intraocular lens implantation in aphakia].

In order to evaluate conditions for secondary intraocular lens (IOL) implantation detailed analysis of ultrasound biomicroscopy (UBM) images of 26 patients (33 eyes) with aphakia was performed. The etiology of cataract was congenital (12 eyes), traumatic (9 eyes), senile (8 eyes) and uveal (4 eyes). The results showed that UBM provides an opportunity to evaluate the implantation site considering capsule integrity, configuration and parameters of ciliary line. The authors have demonstrated that UBM is scarcely the only visualization method in aphakic eyes that lets find and evaluate structural changes of the globe, induced by trauma, uveitis or improper lens removing during cataract surgery (iridocapsular or iridocorneal synechiae, iris defects, pupillar membranes, lens remnants, vitreoretinal proliferation and others). The authors propose UBM to be included into diagnostic examination of patients with aphakia before secondary IOL implantation and consider the results of UBM in choice of lens model and type of fixation.

Posterior iris fixation of the iris-claw intraocular lens implantation through a scleral tunnel incision.

PURPOSE: To evaluate the technique, efficacy, and safety of posterior iris fixation of iris-claw intraocular lens (IOLs) implantation through a scleral tunnel incision for aphakia correction. DESIGN: Noncomparative, interventional case series. METHODS: A secondary posterior iris fixation of the Artisan iris-claw IOL (Ophthec BV, Groningen, The Netherlands) was implanted for aphakia correction in the authors' clinical practice. Uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), astigmatism, manifest refraction, lens position, pigment dispersion, and intraocular pressure (IOP) were evaluated in 32 consecutive eyes of 32 patients. RESULTS: BSCVA was 20/40 or better in 28 eyes (87.50%) during the mean follow-up time (nine months). Mean postoperative spherical equivalent was -0.70 diopters (D; standard deviation [SD], 0.47 D) at six months after surgery. Mean prediction error was -0.13 D (SD, 0.28 D), and mean absolute prediction error was 0.26 D (SD, 0.15 D). Preoperative mean astigmatism was -1.08 D (SD, 0.55 D; range, 0.0 to -2.0 D). At six months after surgery, mean astigmatism was -2.1 D (SD, 0.81 D; range, -0.75 to -3.75 D). There was no significant postoperative IOP increase. Lens position, evaluated by Oculus Pentacam (Pentacam 70700: Oculus, Wetzlar, Germany) and ultrasound biomicroscopy [UBM] (Ophthalmic Technologies Inc, Toronto, Ontario, Canada), was parallel to the iris plane. CONCLUSIONS: Posterior iris fixation of the iris-claw IOL implantation through a scleral tunnel incision is a safe procedure and an effective option for aphakic eyes without capsule support.

[New aspects of corneal pachymetry in congenital glaucoma and pediatric aphakic glaucoma]. / Neue Aspekte der Hornhautpachymetrie beim kongenitalen Glaukom und kindlichen Aphakieglaukom.

BACKGROUND: Knowledge of individual corneal thickness in individual eyes is proving to be more and more crucial for correcting Goldmann applanation tonometry, as well as to assess its predictive value regarding the possible progression of glaucomatous damage. It has become an important factor in determining appropriate glaucoma therapy. Only few pachymetric data exist about eyes with congenital or secondary pediatric aphakic glaucoma. METHODS: 12 eyes with congenital glaucoma (6 patients, mean age 3.3 years, mean 3.9 previous operations) and 7 eyes with secondary pediatric aphakic glaucoma (4 patients, mean age 14.8 years, mean 3 previous operations) without clinical signs of corneal decompensation were investigated by ultrasound pachymetry. RESULTS: Eyes with glaucoma due to aphakia had a mean corneal thickness of 708 +/- 77.3 microm. Mean corneal thickness of the eyes with congenital glaucoma was 688.1 +/- 115.9 microm, which is far above the values known from the literature. Two eyes, which had a central corneal thickness of 646 microm and 640 microm, presented with a localised paracentral corneal thickness of only 402 microm and 405 microm, respectively, correlating with microscopic descemet scars. CONCLUSIONS: Congenital glaucoma and the pediatric aphakic glaucoma present with very heterogeneous clinical pictures. Especially for congenital glaucoma, this is confirmed by the high interindividual, but also intraindividual, variability of corneal pachymetry.

Ultrasound biomicroscopy in silicone oil-filled eyes.

PURPOSE: To establish reproducible ultrasound biomicroscopy (UBM) imaging patterns characteristic of the presence and behavior of silicone oil and of peripheral vitreoretinal proliferation in eyes that have undergone vitreoretinal surgery with silicone oil injection. METHODS: The study design was a case series. Ultrasound biomicroscopy was performed on 34 eyes of 34 patients (age range, 20-68 years). For an image to be considered a UBM pattern, it was required to be consistently reproducible in the same eye and to be observed in more than one eye. RESULTS: Four patterns are described: silicone oil particles, ghost images, "painting" or surface impregnation of iris and anterior chamber angle, and peripheral proliferative vitreoretinopathy. One type of ghost image, the secondary reflection of the cornea, paired with disappearance of the aqueous-silicone oil interface corresponded to massive silicone oil displacement into the anterior chamber. Gross proliferation produced funnel and tentlike images, whereas minute, networklike images seemed to represent early changes. There was a close correspondence between these UBM patterns and previous ophthalmologic clinical findings. CONCLUSION: Easily recognizable, distinct UBM patterns are characteristic of conditions found in silicone oil-filled eyes. Ultrasound biomicroscopy seems to be a useful tool for assessing changes in silicone oil-filled eyes.

Secondary posterior chamber intraocular lens implantation in children.

BACKGROUND: Primary intraocular lens (IOL) implantation after cataract aspiration is a widely accepted means of correcting pediatric aphakia. However, little is available in the literature on secondary IOL implantation in children. We present our experience over the past 6 years. METHODS: The charts of 57 aphakic children (61 eyes) who underwent secondary posterior chamber IOL implantation between January 1989 and April 1996 were reviewed. In general, these children were either intolerant of or noncompliant with their contact lenses. An attempt was made to correlate visual outcome with patient variables. Evaluation of the ciliary sulcus structure was made in selected patients by ultrasonographic biomicroscopy to reveal any changes resulting from the presence of the IOL haptic in the sulcus. RESULTS: The age range at the time of surgery was 2 to 16 years (mean 8 y). Mean follow-up was 14 months (range 6 to 48 months). Forty-two percent of the patients had a best-corrected visual acuity of 20/40 or better and 78% saw better than 20/80. Posterior capsular opacification occurred in 10 eyes, 8 of which required neodymium:yttrium-aluminum-garnet laser capsulotomy. No major complications occurred. Ciliary sulcus evaluation by biomicroscopy did not reveal any significant ciliary body or scleral erosion. No changes were noted when the implanted sulcus was compared with the normal contralateral side. CONCLUSION: Although follow-up was short, this review suggests that secondary posterior chamber IOL implantation is a safe alternative when other methods of correcting pediatric aphakia fail.

Ultrasound velocities for axial eye length measurement.

Since 1974, I have used individual sound velocities for each eye condition encountered for axial length measurement. The calculation results in 1,555 M/sec for the average phakic eye. A slower speed of 1,549 M/sec was found for an extremely long (30 mm) eye and a higher speed of 1,561 M/sec was noted for an extremely short (20 mm) eye. This inversely proportional velocity change can best be adjusted for by measuring the phakic eye at 1,532 M/sec and correcting the result by dividing the square of the measured axial length (AL1,532)2 by the difference of the measured axial length (AL1,532) minus 0.35 mm. A velocity of 1,534 M/sec was found for all aphakic eyes regardless of their length, and correction is clinically significant. The velocity of an eye containing a poly(methyl methacrylate) intraocular lens is not different from an average phakic eye but it does magnify the effect of axial length change. I recommend measuring the pseudophakic eye at 1,532 M/sec and adding to the result (AL1,532), + 0.04 + 44% of the IOL thickness. The speed for an eye with a silicone IOL was found to be 1,476 M/sec (or AL1,532 + 0.04 - 56% of IOL thickness) and for glass, 1,549 M/sec (or AL1,532 + 0.04 + 75% of IOL thickness). A speed of 1,139 M/sec was found for a phakic eye with silicone oil filling most of the vitreous cavity and 1,052 M/sec for an aphakic eye filled with oil. For varying volumes of oil, each eye should be calculated individually. The speed was 534 M/sec for phakic eyes filled with gas. Eyes containing a silicone IOL or oil or gas will create clinically significant errors (3 to 10 diopters) if the sound velocity is not corrected.

[Axial echometry of the eye. Results and possible clinical applications]. / Axiale Echometrie des Auges. Resultate und klinische Möglichkeiten.

This survey describes ultrasound measurement techniques and echograms of living phakic and cataract eyes. Results of clinical echometry on emmetropic and ametropic eyes are reported. In unilateral or bilateral cataract and in unilateral aphakia, appropriate ultrasound measurements are of fundamental importance for restoring compatible vision; in unilateral aphakia, by means of combinations of contact lenses and spectacles; in cataract, by means of precalculated artificial intraocular lenses.