Management of Spherophakia- or Microspherophakia-associated Mild to Moderate Glaucoma with Lensectomy, Anterior Vitrectomy, and Iris-Claw Intraocular Lens Implantation.

Update on Microinvasive Glaucoma Surgery.

Aim: To study the visual outcome and complications of irisclaw intraocular lens implantation to correct aphakia. Objectives: To study the visual outcome in patients with irisclaw lens implantation. To document the various complications associated with irisclaw lens implantation. To evaluate the safety of irisclaw lens implantation. Materials and Methods: Patient's eyes with no capsular support that had iris claw intraocular lens to correct aphakia between 2016 to 2018. Results: The study comprises of 50 eyes of 50 patients who underwent iris claw intraocular lens implantation to correct aphakia with no posterior capsular support. In our study population, the maximum number (70%) of patients had the preoperative BCVA of logMAR 0.18, ranging 0.18–0.78, with a mean of 0.28 ± 0.18, At 6month postoperative followup, of the total patients, 4% had the BCVA of log MAR 0.78, 2% had the BCVA of logMAR 0.6, maximum 88% had the BCVA of logMAR 0.18, and 6% had the BCVA of logMAR 0.3. In the early postoperative complications, 22% of patients had raised IOP, which was controlled on a shortterm antiglaucoma drug (timolol e/d bd); 12% of patients had pupil distortion; and 12% had corneal edema, which subsides on subsequent followup. 6% of patients had anterior chamber reaction and hyphema. Conclusion: Irisclaw lens implantation gives the good visual outcome in the patients of cataract with inadequate capsular support. The anatomical position of IOL is well maintained by the technique. Minor complications were treatable with no visionthreatening complication. Few patients had the late postoperative complication, which needs to be minimized. The technique is easy to master, generally safe, and effective on shortterm followup.

RATIONAL:The rationale of this study was to evaluate the visual and anatomical outcomes of pars plana lensectomy and iris-claw Artisan intraocular lens (IOL) implantation in patients with subluxated crystalline lenses secondary to Marfan syndrome.MATERIALS AND METHODS:In this retrospective case series, we evaluate the records of 21 eyes of 15 patients with Marfan syndrome and moderate-to-severe crystalline lens subluxation who underwent pars plana lensectomy/anterior vitrectomy and implantation of iris-claw Artisan IOL at referral hospital from September 2015 to October 2019.RESULTS:Twenty-one eyes of 15 patients (10 males and five females) with a mean age of 24.47 ± 19.14 years were included. Mean best-corrected visual acuity was improved from 1.17 ± 0.55 logMAR to 0.64 ± 0.71 logMAR at the final follow-up visit (P < 0.001). The mean intraocular pressure did not change significantly (P = 0.971). The final refraction showed a mean sphere of 0.54 ± 2.46 D and a mean cylinder of 0.81 ± 1.03 at the mean axis of 57.92 ± 58.33 degrees. One eye developed rhegmatogenous retinal detachment 2 months after surgery.CONCLUSIONS:Pars plana lensectomy and iris-claw Artisan IOL implantation seem to be a useful, impressive, and safe procedure with a low rate of complications in Marfan patients with moderate-to-severe crystalline lens subluxation. Visual acuity was significantly improved with acceptable anatomical and refractive outcomes.

Background Vitreous amyloidosis is an autosomal dominant hereditary disease, often leads to reduction of visual acuity and affects life quality of patients.Vitrectomy is the main treatment for vitreous amyloidosis, but the analysis of curative efficacy in China is rarely reported. Objective The study was to observe and analyze the efficacy of vitrectomy for vitreous amyloidosis. Methods The clinical data of 11 eyes from 6 patients with vitreous amyloidosis who received vitrectomy from March 2011 to February 2013 in Affiliated Hospital of Guizhou Medical University.The best corrected visual acuity (BCVA), intraocular pressure (IOP), manifestations under the slit lamp microscope, findings of ocular fundus and results of fundus fluorescence angiography (FFA) were observed after surgery.Pathological examination for vitreous samples was carried by Congo red staining. Results Before surgery, the visual acuity was counting fingers for 30 cm in 5 eyes and hand movement for 30 cm in 6 eyes, and the mean IOP was (13.09±2.12)mmHg (1 mmHg=0.133 kPa). Fixed white flocks in vitreous and white membrane on the posterior lens capsule were seen under the slit lamp microscope.The BCVA remained 1.0 in 7 eyes and 0.8 in 4 eyes 1 week, 6 months and 2 years after vitrectomy, and the mean IOP was (13.32±2.07), (14.09±2.47), (12.32±1.87)mmHg at 1 week, 6 months and 2 years after vitrectomy, respectively.FFA showed a little fluorescein leakage at peripheral retinal vessel in all eyes at 1 week after vitrectomy but the leakage disappeared at 6 months after vitrectomy.The white flocks increased at peripheral retina in 4 eyes at 2 years after vitrectomy, but the BCVA remained the same in the eyes.Pathological examination of vitreous specimens comfirmed the diagnosis of vitreous amyloidosis. Conclusions Vitrectomy is an effective method for the treatment of vitreous amyloidosis, which can effectively improve the visual acuity of patients.Postoperative recurrence of vitreous amyloidosis appear in parts of patients, but the BCVA is unaffected. Key words: Amyloidosis, vitreous/surgery; Eye diseases/surgery; Vitrectomy; Vitreous body; Treatment outcome; Humans

Objective To evaluate the long-term efficacy of intravitreal Bevacizumab (IVB) combined with trabeculectomy and panretinal photocoagulation (PRP) in the management of neovascular glaucoma.Methods It was a retrospective case series study.Eighteen eyes of 17 patients with neovascular glaucoma were included.Patients first received an intravitreal injection of Bevacizumab (1.25 mg in 0.05 ml).Trabeculectomy with intraoperative mitomycin C was then performed after the complete regression of neovascularization of the iris (NVI).PRP or supplementary photocoagulation was performed postoperatively.Compare the intraocular pressure (IOP) pre-IVB,pre-trabeculectomy and 1 week,1 month,3 months,6 months,12 months after trabeculectomy and the final visit.In addition,pre-IVB visual acuity (VA) was compared to VA at the final visit.The follow-up period ranged from 12 to 32 months,mean 20.5±7.4 months.Data were analyzed with paired t test and one-way ANOVA.Results NVI completely regressed in 18 of the eyes after IVB.The mean time for regression was 3.7±1.4 days (range from 2 to 7 days).Pre-IVB mean IOP was 51.9±10.9 mmHg,with 3.9±0.7 anti-glaucoma medications,and the mean logMAR VA was 2.26±0.43.Mean IOPs were 45.2±7.1,8.6±2.1,13.9±6.3,16.5±6.9,17.7±7.2,19.2±7.8,16.1±3.7 mmHg before trabeculectomy and at postoperative 1 week,1 month,3 months,6 months,12 months and the final visit,respectively.The reduction between pre-trabeculectomy IOP and pre-IVB IOP was statistically significant (t=5.437,P＜0.05).The reduction between post-trabeculectomy IOPs and pre-trabeculectomy IOP was statistically significant (F=64.79,P＜0.05).At the final visit,only 3 eyes were using anti-glaucoma medications,and the mean LogMAR VA was 2.1±0.6.The change in the mean LogMAR VA was not statisticallysignificant.Recurrence of NVI occurred in 4 eyes,two of which received ciliary photocoagulation.The complete success,qualified success and failure at the final visit was 13 eyes,3 eyes and 2 eyes,respectively.Conclusion IVB combined with trabeculectomy and PRP is an effective method for controlling intraocular pressure in NVG over the long term. Key words: Glaucoma,neovascular; Bevacizumab; Light coagulation,panretinal; Trabeculectomy

Spherophakia is a rare diagnosis that is characterized by weak zonules encircling a more spherical, smaller, and thicker anteroposterior crystalline lens.[1] The eye is usually severely myopic. The lens zonules are abnormally weak and hypoplastic during development. It frequently coexists with lenticular myopia, lens subluxation, angle-closure glaucoma, and a shallow anterior chamber.[1] The crystalline lens in this situation has an increased anterior–posterior diameter and a smaller equatorial diameter.[2] Lens subluxation can cause pupillary block glaucoma[3] and can happen anteriorly, inferiorly, or posteriorly.[4] The indication of undergoing a lensectomy has already been mentioned for treating a displaced lens.[5] The surgeon and the patient's characteristics play a significant role in the intraocular lens (IOL) selection. Both iris-fixated lenses[6] and angle-supported anterior chamber lenses (ACIOLs) are frequently used. Numerous case studies have also discussed posterior chamber IOLs (PCIOLs) and scleral-fixated IOLs (SFIOLs) – glued or sutured with/without capsule tension rings (CTR).[7,8] In 2008, Agarwal et al.[9] introduced the glued IOL technique, which was glued intrascleral haptic fixation of a PCIOL. Zonular weakness is frequently linked to ectopia lentis, congenital cataract with luxation, or traumatic cataract. A PCIOL (foldable or nonfoldable) is implanted in the eyes with a defective posterior capsule using a quick-acting surgical fibrin sealant. Glued IOL in various indications has shown very promising results. In nearly half of the cases of spherophakia, it is accompanied with subsequent glaucoma.[10] When the intraocular pressure (IOP) is uncontrolled, there is disagreement over the treatment to manage these eyes. Based on our previous experience and various studies, lens removal alone appears to help with IOP management in around 50% of the eyes, with the remainder perhaps handled with additional drugs. Glaucoma surgery is seldom required for IOP management.[11] Lensectomy, vitrectomy, and glued IOL have been done in eyes with spherophakia and secondary glaucoma in the current investigation. The findings of these procedures seem to be favorable in terms of the procedure's safety and effectiveness. In one-third of the eyes, the IOP was managed without the use of Anti-Glaucoma Medications (AGM); the remaining eyes required AGM for IOP management. Lensectomy with glued IOL resulted in significant improvement in visual acuity and correction of refractive error to almost emmetropia in a majority of the eyes. Other factors associated with poor glaucoma control were also evaluated. Preoperative AGM, male gender, and low preoperative visual acuity were shown to be related to poor glaucoma management and the requirement for AGM or surgery to reduce IOP. Rao et al.[11] previously showed that younger age at presentation, higher IOP, and more disk injury at presentation were all substantially linked with increased failure after lensectomy. Muralidhar et al.[5] did report that lensectomy did not have any impact on IOP. Lensectomy was performed in 16 eyes in their study, but only four eyes had raised IOP before lensectomy. Hence, from four eyes, one cannot interpret that lensectomy is not effective in controlling IOP. In a study by Rao et al.,[11] following lensectomy, close to half of the patients had IOP control without AGM, while only one-third of the patients in this glued IOL cohort could achieve the same. The percentage of eyes needing surgical intervention for IOP control was similar (16%) either with lensectomy or with lensectomy with glued IOL surgery in eyes with spherophakia and secondary glaucoma. To the best of our knowledge, this was the first study to report on the results of lensectomy with glued IOL in spherophakia and glaucoma eyes.[12] Overall, IOP was managed well in 30% of the eyes after lensectomy and glued IOL without the need for AGM, 65% of the eyes required AGM for IOP management, and only 5% of the eyes required glaucoma surgery. The study's shortcomings include a small sample size and a short postoperative follow-up period. The benefits of conducting lensectomy with glued IOL in eyes with spherophakia include not only improved IOP management, but also improved uncorrected and corrected visual acuity. There were no intraoperative or postoperative complications in this sample, indicating that the technique is safe. The authors would like to advocate lensectomy with glued IOL in spherophakic eyes with subluxated crystalline lens and increased IOP in the absence of syndromic disease due to these benefits and the shorter learning curve.[12] However, these individuals require regular monitoring of IOP; one-third of the eyes had well-controlled IOP, and almost two thirds required further antiglaucoma drugs or surgery for IOP management. Because this is a recent surgery, long-term results and complications must be investigated to determine the technique's long-term effectiveness and safety.

Objective To compare the effect of 23G vitrectomy and 20G vitrectomy combined with intemal limiting membrane (IML) peeling and silicone oil tamponade for macular hole retinal detachment (MHRD) in highly myopia eyes.Methods A retrospective case series study.Thirty-nine patients (39 eyes) with macular hole retinal detachment (MHRD)in highly myopic eyes underwent either 23G (20 eyes,23G group) or 20G vitectomy (19 eyes,20G group) combined with internal IML and silicone tamponade.Preoperatively,all the patients had A/B-ultrasonography,intraocular pressure,best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations.Postoperatively,intraocular pressure,BCVA,the rate of the macular hole closure and retinal reattachment were observed.The BCVA was converted to logarithm of the minimal angle of resolution (logMAR)and analyzed.Results The mean preoperative and postoperative BCVA in 23G group were logMAR2.19±0.14 and logMAR1.33±0.55.The difference between preoperative and postoperative logMAR BCVA was significant (Z =-3.728,P =0.000＜0.05).The mean preoperative and postoperative BCVA in 20G group were logMAR 2.05±0.35 and logMAR1.74±0.44.The difference between preoperative and postoperative logMAR BCVA was significant (Z =-2.887,P =0.004＜0.05).The difference between postoperative logMAR BCVA in two groups was significant (U =108.5,P =0.021＜0.05).Seven (35％) cases of low intraocular pressure (IOP) after surgery were found in 23G group.The mean IOP at day 1 after surgery was 9.62±4.03mmHg.Comparing with preoperative IOP,the difference was significant (t =2.747,P =0.013＜0.05).Two (10.52％) cases of low intraocular pressure (IOP) after surgery were found in 20G group.The mean IOP at day 1 after surgery was 1 1.79±6.9mmHg.Comparing with preoperative IOP,the difference was not significant (t =-0.432,P =0.671＞0.05).The difference of the mean IOP at day 1 after surgery between two groups was significant (t =2.118,P =0.041＜0.05).The final OCT showed seven eyes (35％) in 23 G group were found macular hole closure and four eyes (26.3％) in 20G group.The reattachment rate in final visit of 23G and 20G were 100％ and 94.7％.Conclusions There is a high retinal reattachment rate and a significant improvement without many complications in VA in MHRD patients for 23-gauge vitrectomy with IML peeling and silicone oil tamponade.The macular hole closure rate of two groups is low. Key words: Vitrectomy; High myopia; Retinal detachment; Macular hole

Introduction: Cataract surgery with intraocular lens (IOL) implantation is one of the most common intraocular surgeries performed in the Department of Ophthalmology of the Lagos State University Teaching Hospital (LASUTH). Failure to implant an IOL in the posterior chamber can result in a compromised posterior capsule because of rupture or weak zonular support. Iris claw lens (ICL) implantation posterior to the iris (retropupillary) allows for posterior chamber implantation in the absence of adequate capsular support. Objectives: To assess the immediate and short-term outcomes of retropulillary ICL implantation as well as the immediate and short-term complications in patients at the LASUTH. Materials and Methods: A retrospective analysis of all patient case notes seen from January 2022 to November 2022 at the Ophthalmology department of LASUTH who met the inclusion criteria and had ICL implantation were collected and assessed. Patient’s demographic data, indication for ICL implantation, visual status preoperatively, postoperatively, and complications were analyzed. Results: A total of 20 eyes of 20 patients had the procedure in the study period. The age range was 12–70 and the longest follow-up period was 7 months with the shortest being 3 weeks. The mean preoperative visual acuity was 3/60, and the mean postoperative best-corrected distant visual acuity was 6/12. Immediate postoperative complications were uveitis (23%), raised IOP (5%), hypotony (10%), vitreous inflammation (13%), and cornea edema (13%). Conclusion: Retropupillary ICL implantation carries a good postoperative visual outcome; it is encouraged that this procedure is considered as an alternative to both anterior chamber IOL and scleral fixated IOL.

Objective To evaluate the clinical effect of 25-gauge transconjunctival sutureless vitrectomy (25GT-SV) infusion system in phacoemulsification after pars plana vitrectomy.Methods Under 25GTSV infusion system,phacoemulsification and intraocular lens implantation were performed in 41 cases (42 eyes) of cataract after pars plana vitrectomy.Postoperative visual acuity,intraocular pressure (IOP),subjective symptoms,scleral incision,intra-and post-operative complications were observed.Results All operations were successfully performed.The best corrected visual acuity (BCVA) of 40 eyes improved in different degrees 3 months after operation.The BCVA was ＞ 0.1 in 30 eyes and there was significant difference between before and after operation (x2 =13.77,P ＜0.01).The BCVA of 20 eyes was ≥0.3 and there was significant difference between before and after operation (x2 =12.81,P ＜ 0.01).The visual acuity of 2 eyes decreased because of vitreous hemorrhage caused by original disease of fundus.The mean IOP at 1 day,1 week after operation and at the end of the follow-up were (14.62 ± 0.56) mmHg,(14.82 ± 0.54) mmHg and(14.83 ± 0.57) mmHg,respectively.Compared with the mean IOP(14.86 ± 0.59) mmHg (1 mmHg =0.133 kPa) before surgery,there were no significant differences(t =1.70,0.19,0.40,P ＞ 0.05).After operation,the irritation of all eyes was light and the scleral incision was well closed.No obvious complications were observed intraoperatively and postoperatively.Conclusion In phacoemulsification after pars plana vitrectomy,25G vitreous infusion is a safe and effective method,which can maintain IOP,keep stable anterior chamber and decrease the complications. Key words: Infusion, vitreous, 25-gauge ; Cataract, vitrectomized ; Phacoemulsification

Objective To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation through pars plana for secondary glaucoma following lensectomy and vitrectomy surgery. Methods Thirteen eyes of 13 patients who had been diagnosed as secondary glaucoma after lensectomy and vitrectomy were selected in this study. All cases were treated with AGV implantation through pars plana with follow-up of 6 months. The intraocular pressure (IOP), complications, number of antiglaucoma medications applied and best-corrected visual acuity (BCVA) were evaluated during the followe-up. Results The BCVA of 9 eyes were improved, the visual acuities of 4 eyes were constant postopearatively after 6 months. The mean IOP was (40.6±7.7)mmHg preoperatively, (13.6±3.37)mmHg at 1 day after surgery, (17.6±4.5)mmHg in 1 week, (16.54±2.3)mmHg in 2 weeks, (18.46±1.66)mmHg in 1 month, (16.61±1.92)mmHg in 3 months, and (15.69±3.83)mmHg in 6 months(1 mmHg=0.133 kPa). The postoperative IOP descended noticeably(t=9.65~16.23, P<0.05). The mean number of antiglaucoma medications applied dreaseed from (2.92±0.64) kinds preoperatively to (1.23±0.93) kinds at the last follow-up (t=5.92, P=0.0001). The most common complications occurred were transient hyphema, early postoperative hyponoty, detachment of choroid and drainage tube blocking. Conclusion AGV implantation through pars plana is effective and safe in the management of secondary glaucoma following lensectomy and vitrectomy surgery. Key words: Glaucoma valve, Ahmed; Lensectomy; Vitrectomy; Glaucoma, secondary

This study aims to analyze the incidence of pseudophakic macular edema (PME) and the role of contributing risk factors following prepupillary or retropupillary implantation of iris-claw lenses. This retrospective cohort study included patients who underwent iris-claw intraocular lens implantation over a 16-year period at the University Hospital of Santiago de Compostela, Spain. The presence of risk factors for PME was recorded, and surgical outcomes included visual acuity, macular OCT scans, and description of complications. A total of 148 eyes from 147 patients were included. Seventy-nine eyes (54.4%) underwent prepupillary iris-claw lens implantation and 69 eyes (46.6%) underwent retropupillary implantation. The mean age of the patients was 68.9 ± 17.2 years. The incidence of PME post-surgery was 23.0% (26.6% prepupillary and 18.8% retropupillary), and the mean time between surgery and diagnosis was similar for both locations (4.8 and 4.7 months, respectively). PME recurred in 33% of the patients, reaching a high rate of 72.7% when the lens location was prepupillary. The mean best-corrected visual acuity was 0.66±0.55 logMAR preoperatively and 0.38±0.50 logMAR postoperatively. Postoperative complications occurred in 29 patients (19.6%). PME following iris-claw lens implantation tends to be more frequent and recurrent when the location is prepupillary. Planning for iris-claw lens surgery should consider the risk factors for the development of PME.

To study the effectiveness of unilateral selective laser trabeculoplasty (SLT) on the both eyes of patients with primary open-angle glaucoma (POAG). This was a self-controlled clinical study. Thirty-two patients of 32 eyes with OAG who used same anti-glaucoma medications for both eyes were included aat the Department of Ophthalmology Peking University third Hospital from February 2010 to April 2014. SLT was performed for the poorly controlled eye for each patient. Patients were examined before operation and 1 hour, 1 week, 1 month, 3 months and 6 months after operation. The intraocular pressure was examined after 1 hour of SLT. The rest time points were examined by visual acuity, intraocular pressure (IOP), slit lamp microscope, fundus ophthalmoscope and visual field. The paired t test (Bonferroni) was used to compare the IOP at each time point after SLT with the baseline IOP before SLT. Single factor analysis of variance was used to compare the percentage of IOP drop. Linear correlation analysis was used to analyze the amplitude of the decrease of IOP between treated eyes and untreated eyes at 6-month post-operatively and analyze the IOP between preoperative eyes and 6-month post-operative eyes. The magnitude of the decrease of IOP in patients with glaucoma medication and 6 months after surgery was analyzed. We also analyzed the types of antiglaucoma medications and IOP reductions range for 6 month after SLT. The preoperative mean IOP was (18.9±2.5) mmHg (1 mmHg=0.133 kPa) in the treated eye of patients with OAG. Mean IOP reduction for 1 week, 1, 3, and 6 months after SLT were (1.7±2.9) mmHg, (2.5±2.5) mmHg, (3.5±2.8) mmHg, (3.4±2.5) mmHg and the percentage of IOP reduction were (8±16) %, (13±13) % (18±14) %, (18±12) % respectively (compared with the baseline, P< 0.05) . With the success criteria of IOP reduction ≥3.0 mmHg or ≥20%, the success rate of SLT in the treated eye after 1 week, 1, 3, 6 months was 38%, 52%, 50% and 60% respectively. For the untreated fellow eyes, the preoperative mean IOP was (17.3±2.4) mmHg. Mean IOP reduction for 1 week, 1month, 3 month, and 6 month after SLT were (1.1±2.0) mmHg, (1.0±2.7) mmHg, (2.6±2.2) mmHg and (2.5±2.2) mmHg respectively (compared with the baseline, P<0.05) . There was a positive correlation between preoperative IOP and IOP reduction either in the treated or in the untreated eyes at 6-month post-SLT (R=0.63, P<0.01; R=0.60, P<0.01) . There was a positive correlation in IOP reduction between treated eyes and untreated eyes at 6-month post-operative (R=0.66, P<0.01). All patients didn't need further treatment such as another laser treatment or surgery. Anti-glaucoma medications were remained unchanged after SLT. In poorly anti-glaucoma medication controlled Chinese POAG eyes with mean IOP about 18.0 mmHg, unilateral STL can reduce the IOP about 18% at 6-month post-operative for the treated eyes. There was also a continuous IOP reduction effects for the fellow eyes.(Chin J Ophthalmol, 2016, 52: 410-415).

BACKGROUND: Conditions such as posterior capsular rupture, pseudoexfoliation syndrome, high myopia or Marfan's syndrome may cause inadequate posterior capsule support. Implantation of an anterior chamber IOL , iris-sutured IOL, scleral fixation IOL, or iris-claw IOL may be considered in these conditions. Iris-claw implantation is often preferred due to its convenience and timesaving in use but the visual outcomes in Prof Ngoerah General Hospital has not yet published. MATERIAL AND METHODS:. This retrospective observational study was aimed to determine the characteristics and outcomes of iris-claw (Artisan) IOL implantation. Data was obtained before, after one week and 30 days implantation at Sanglah Hospital from August 2019-July 2022. Patient characteristics were analyzed with descriptive analysis and presented as frequency, percentage, mean and standard deviation. The differences between visual acuity, intraocular pressure and endothelial cell count were analysed using paired T-test and Wilcoxon signed rank test. RESULTS: This study consisted of 21 eyes with the mean age was 45,38±25,86 years. The most common primary procedure was caused by secondary aphakia in 6 (28,6%) patients and lens subluxation and zonular weakness (due to high myopia) in 5 patients (23,8%). A total of 13 (61,9%) were implanted in the prepupillary. There was a significant increase in visual acuity from 1.69 ±0.76 logMAR to 0.50±0.33 logMAR after one week and constantly increase from one week to 0.37±0.27 after 30 days follow up (p=0.046). The complication reported was one patient (4,7%) with temporary increasing intraocular pressure. Spherical residual were mostly under -1.0 D (57.1%) and cylindrical residual were 9 (42.8%) less than -0,50D. Endothelial cell density were decreasing 2.1% from 2673.81 (948) cell/mm2 to 2616.9(800) cell/mm2 but the reduction were not statistically significant (p=0.192). There was no difference of intraocular pressure before and after implantation (p=0.638). CONCLUSION: This study showed that the implantation of iris claw lens were safe, has faster recovery and effective for either primary or secondary procedure.

To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.

Objective To observe the relationship between the size of idiopathic macular hole (IMH) and the healing types of postoperative photoreceptor layer after vitrectomy. Methods This prospective uncontrolled study included 33 eyes of 31 consecutive patients who underwent vitrectomy for IMH. There were 9 males (9 eyes) and 22 females (22 eyes), with the mean age of (58.16±9.10) years. The mean duration of symptoms was (4.97±5.97) months. The best corrected visual acuity (BCVA) and optical coherence tomography(OCT) were measured for all patients. BCVA was measured with international standard visual acuity chart and then converted to logarithm of the minimum angle of resolution (logMAR). The mean logMAR BCVA was 1.07± 0.38. The mean intraocular pressure was (14.05±0.54) mmHg (1 mmHg=0.133 kPa). The minimum size of the macular hole (MIN), the base diameter of the macular hole (BASE), the average width of the macular hole(AWMH) and the average height of the macular hole (AHMH) were (465.19±232.84), (943.63±389.26), (704.72±292.64), (443.84±72.47) μm, respectively. According to the MIN value, the hole size were divided into small, medium and large group which had 9 eyes, 15 eyes, 9 eyes, respectively. According to the postoperative OCT characteristics, the healing types of the photoreceptor layer were divided into 0 - Ⅳ types. All patients underwent pars plana vitrectomy (25G or 27G standard three-incision) with internal limiting membrane peeling with tamponade agents. The mean follow-up was (326.42±157.17) days. The first postoperative OCT characteristics were defined as the early period. The therapy results were evaluated according to the last follow- up time point. BCVA and intraocular pressure before and after operation were compared by paired t test. The postoperative BCVA were compared with preoperative BCVA, MIN, AWMH, AHMH and follow-up using Pearson correlation analysis. Results At the last follow-up, the LogMAR BCVA was 1.52 - 1.40 in 3 eyes, 1.30 - 0.52 in 22 eyes and 0.40 - −0.07 in 8 eyes. Compared with preoperative that, the difference was statistically significant (t=−6.023, P 0.05). Conclusion The preoperative sizes of IMH were associated with the postoperative healing types of photoreceptor layer. Key words: Retinal perforations/surgery; Photoreceptors, retinal; Tomography, optical coherence