Ultrasound biomicroscopy of zonular anatomy in clinically unilateral exfoliation syndrome.

PURPOSE: To evaluate the ability of ultrasound biomicroscopy (UBM) to detect abnormalities in the zonular apparatus in unaffected eyes of patients with clinically unilateral exfoliation syndrome (XFS) using a standardized grading system. METHODS: The affected and unaffected eyes of 17 patients with clinically unilateral XFS and 17 eyes of 17 control subjects underwent UBM. Radial sections detailing the lens and zonules at 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00 and 10:30 clock hours were obtained. The images were graded by a masked, experienced UBM observer using a standardized scoring system based on the zonular appearance (0, none; 1 and 2, uneven or disrupted zonules with or without patchy deposits; 3, diffuse granulation, thick zonules or both; 4, total zonular disruption). Affected meridians were compared by the Friedman test, while distributions of unaffected and affected eyes were compared using the Student t-test. RESULTS: In the control group, 15/17 eyes showed normal zonules; the remaining two eyes showed grade 1 changes in some meridians. The mean grade score was 0.33 [standard deviation (SD) 0.84]. Eyes with XFS had a higher score than control eyes, with a mean score of 14.35 (SD 7.14, P < 0.001, Student t-test). In clinically unaffected fellow eyes, the mean score was 10.53 (SD 7.44), and was less than that of XFS eyes (P = 0.008, Student t-test). Twelve XFS eyes (71%) and six unaffected fellow eyes (35%) had grade 3 or 4 in at least one meridian (P = 0.07, Friedman test). CONCLUSION: Bilateral zonular involvement is present in subjects with clinically unilateral XFS. These zonular changes may be extensive in fellow eyes without clinically evident exfoliation material. UBM assessment of zonular status in fellow eyes prior to cataract extraction may aid in surgical planning.

Capsular block syndrome after cataract surgery: clinical analysis and classification.

PURPOSE: To study the incidence of and risk factors for postoperative capsular block syndrome (CBS) and propose a new classification based on etiology. SETTING: Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Republic of Korea. METHODS: Charts of 1100 eyes of 990 patients who had phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation between January 2003 and June 2006 were retrospectively reviewed. Demographic data, axial length (AL), type of PC IOL implanted, and intraoperative ophthalmic viscosurgical devices (OVDs) were recorded. The cases of postoperative CBS were collected and the characteristic clinical findings evaluated. RESULTS: There were 8 cases (7 patients) of postoperative CBS (incidence 0.73%). Longer AL (>or=25.0 mm) was a risk factor for postoperative CBS (P= .008; odds ratio [OR], 5.75, 95% confidence interval [CI], 1.353-24.413). The PC IOL with 4 haptics (Akreos Adapt, Bausch & Lomb) was also associated with an increased incidence of postoperative CBS (P= .001; OR, 7.388; 95% CI, 1.751-31.168). The CBS was classified as noncellular, inflammatory, or fibrotic according to the clinical characteristics. CONCLUSIONS: Although postoperative CBS was a rare complication after cataract surgery, AL and PC IOL design had a significant influence on the incidence. Evaluation of clinical characteristics showed 3 distinct types of CBS.

Proposed classification of lens capsule defects.

BACKGROUND: Capsule defects are common during or after intraocular surgery of various kinds. The purpose of this work is to establish a classification system of lens capsule defects to provide uniform description of these defects for ophthalmic research and IOL implantation. METHODS: A retrospective study of 128 patients (156 eyes) with lens capsule injury after ocular trauma and intraocular surgery was performed. The patients were divided into two groups. Capsule defects were defined and classified according to the location, size, shape and tension of the capsule and its effect on posterior chamber IOL implantation. RESULTS: Lens capsule defects were classified into four types: Type I - complete capsule; Type II - incomplete capsule, but has enough area and tension to support two IOL haptics; Type III - incomplete capsule, is able to support only one IOL haptic and the other haptic needs a suture; Type IV - no capsule, both IOL haptics need suture fixation. Type I and Type II were each divided into three subtypes. Type III was divided into two subtypes. The shape of the capsule defects included fissure-like, triangle, round, irregular and fan-like. All eyes with capsule defects can be sorted into one of these types, and it is easy to guide IOL implantation according to the classification. Type II was the most common among the two groups in this study. CONCLUSION: The classification of lens capsule defects is feasible and favorable for uniform clinical description, clinical research and IOL implantation.