Visual outcomes after bilateral implantation of Versario intraocular lenses: six-month follow-up

Management of uveitic cataract in patients with juvenile idiopathic arthritis (JIA) is challenging, and intraocular lens (IOL) implantation is controversial. This study investigated the outcome after minimally invasive surgery with IOL implantation. Retrospective analysis after phacoemulsification with in-the-bag IOL implantation was performed in 16 patients (17 operations) with ANA-positive JIA-associated chronic uveitis. In these patients, 25 G capsulectomy and anterior vitrectomy was performed and they received an intravitreal triamcinolone (TA) injection. Mean age at uveitis onset was 5 ± 2 years, and surgery was performed at a mean age of 11 ± 2.2 years. Preoperatively, uveitis was inactive in all patients, and visual acuity was logMAR 0.8 ± 0.44; additional uveitis complications were present in all patients, and 15 patients were receiving systemic immunosuppression/biologicals. After surgery (mean follow-up 26.5 ± 11.7 months), presence of cystoid macular oedema, papilloedema, ocular hypertension/glaucoma and hypotony did not increase compared with baseline. There was no significant worsening of AC inflammation (by cell numbers and laser flare values). IOL deposits persisted in four patients, and synechiae developed in eight. The visual acuity was improved (≥2 lines) in all patients (mean logMAR 0.3 ± 0.24). Retrolental membrane formation was not noted. Secondary capsular opacification was observed in seven patients, requiring Nd:YAG capsulotomy in five of them. Phacoemulsification and in-the-bag IOL implantation may improve visual outcome in JIA-associated uveitis with minimally invasive surgical technique and intravitreal TA injection. Well-controlled uveitis with appropriate use of topical steroids and systemic immunosuppression or biologicals appears as a perioperative requirement.

Purpose: To assess the visu al ou tcome of cataract su rgery in a tertiary hosp ital in Nigeria. Methods: Three hu nd red and seventy eyes (370) that had cataract su rgery in the op hthalmology d ep artment of University of Benin Teaching Hosp ital (UBTH) from July 2007 to December 2008 were includ ed in the stu d y. Case record s were retrieved and d ata from them analysed . The age range was 4 to 95 years (mean age 41.1 years). There were 181 males and 189 females . Senile cataract was the commonest (64.6%) typ e, followed by traumatic cataract (13%). Extracapsu lar cataract extraction with p osterior chamber intraocu lar lens (IOL) imp lant (75.4%) was the commonest p roced u re, followed by ECCE with anterior chamber intraocu lar lens imp lant (11.6%), ECCE withou t IOL (4.1%) and intracapsular cataract extraction with or withou t IOL ( 8.9% ). Results: Preoperative visu al acu ity was less than 3/ 60 in 73.8% and 6/ 18 – 6/ 60 in 4% of the eyes. The best corrected p ostop erative visu al acu ity at 6 weeks was 6/ 6 – 6/ 18 (good ou tcome) in 161 (43.5%) eyes, bord erline in 107(28.9%) and p oor in 73 (19.7%). The best corrected visu al ou tcome at 6 m onths w as good in 221 (59.7%), bord erline in 59 (15.9%) and p oor in 34 (9.3%) eyes. The visu al ou tcome was u nknown in 56 (15.1%) eyes. Conclusion: The visu al ou tcome after cataract extraction in this centre is still less than the WHO recommend ation of 90% for best corrected visual acu ity of 6/ 6-6/ 18 vision. There is the need for biometry, good p atient selection, p rop er management of comp lications and sp ectacle correction of refractive errors in ord er to imp rove visual ou tcome after cataract extraction.Key words: visu al ou tcome, cataract extraction, intraocu lar lens imp lant

Primary versus secondary intraocular lens implantation in traumatic cataract after open-globe injury in pediatric patients

Objectives: To compare visual outcomes, principally myopic shift, visual acuity, intraocular pressure and strabismus between primary and secondary intraocular lens (IOL) implantation following congenital cataract surgery. Methods: A retrospective study of the long-term ocular outcomes in primary versus secondary IOL implantation (IOL-I) following congenital cataract surgery was conducted. We analyzed the files of all children with congenital cataract who underwent unilateral or bilateral lensectomy, posterior capsulotomy and anterior vitrectomy followed by primary or secondary IOL-I between 2000 to 2012, at King Abdulaziz University Hospital, Jeddah. Preoperative and postoperative assessment of each operated eye in terms of axial length, refractive errors, strabismus as well as (post IOL-I) intraocular pressure (IOP) and best corrected visual acuity (BC-VA) were collected and analyzed. Results: Data of 26 eyes of 14 patients (9 males, 6 females) was analyzed: 16 (61.5%) eyes underwent lensectomty and anterior vasectomy with primary IOL-I and 10 (38.5%) eyes underwent lumpectomy and anterior vasectomy with secondary IOL-I. Mean age at cataract surgery was 67.53 (± 48.70) months in the group of primary IOL-I versus 5.90 (± 3.72) months in the group of secondary IOL-I; and patients were followed up for 49.33 (± 26.23) versus 86.50 (± 23.36) months, respectively (p=.051). In the secondary IOL-I group, the mean of time from primary lensectomy to IOL-I was 50.44 (± 18.41) months. Last BC-VA showed better outcomes in primary IOL-I group as 10 eyes (83.3%) with good VA versus only 2 eyes (20%) in the secondary IOL-I, (p=0.009). Myopic shift was greater in secondary IOL group 10.86 (± 11.62) versus 0.19 (± 2.38) diopters (D) in primary IOL (p=0.046*); while no significant difference was observed in IOP (p=0.697). No case of isotropic was detected in primary versus 6 cases in the secondary IOL group. Conclusion: Visual outcomes, including visual acuity, strabismus and myopic shift were better in the group of children who underwent primary IOL implantation at age of >2 years, when compared to those with secondary IOL implantation at the age of <2 years, following congenital cataract surgery. However, poor visual acuity in the secondary IOL group was mainly explained by the relatively higher prevalence of eye complications in this group.

Secondary intraocular lens implantation after pediatric aphakia

Complications and Visual Outcomes after Secondary Intraocular Lens Implantation in Children

Objective To compare and analyze the visual outcome and safety of phacoemulsification with small incision non-phacoemulsification for cataract and provide a reference for the selection of surgery methods in Tibet. Methods A prospective cohort study was performed.Eighty eyes of 80 consecutive patients with age-related cataract were included in Titet Autonomous Region Tibetan Tradition Medicine Hospital from July to August 2016.The eyes were assigned to non-phacoemulsification extracapsular cataract extraction with small incision combined with intraocular lens (IOL) implantation group (small incision group) and phacoemulsification extracapsular cataract extraction combined with IOL implantation group (phacoemulsification group), with 40 eyes for each group.The uncorrected visual outcome and complications were compared between the two groups after surgery. Results There were no significant differences in gender, age, preoperative visual acuity, and lens nuclear hardness between the two groups (all at P>0.05). The eyes in various post-operative uncorrected visual acuity outcome was not significantly different 1 day and 5 days after surgery between the two groups (both at P>0.05). In the fifth day after surgery, the eye number in various post-operative uncorrected visual acuity outcome was not significantly different in the eyes with grade Ⅱ and Ⅲ nuclei between the two groups (Z=0.503, P=0.478; Z=0.952, P=0.329). The eye number of acuity ≥0.5 in the small incision group was significantly more than that in the phacoemulsification group in the eyes with grade Ⅳ nuclei (Z=4.501, P=0.034). The eye number with post-operative transiently ocular hypertension was increased in small incision group compared with phacoemulsification group. Conclusions Non-phacoemulsification surgery with small incision has comparable visual outcome with phacoemulsification surgery, and small incision non-phacoemulsification surgery combined with IOL implantation can serve as the preferred surgical method in basic level medical institutions of Tibet. Key words: Cataract/surgery; Small incision extracapsular cataract extraction; Phacoemulsification; Tibet; Comparative study

Influence of angle κ on visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens.

Bilateral IOL implantation in children

Fuchs Heterochromic Iridocylitis (FHI) is a rare form of uveitis which is frequently complicated by cataract and glaucoma, but it does not show typical features of uveitis like pain, redness and posterior synechia. To study the clinical characteristics and outcome of cataract extraction with Intra Ocular Lens (IOL) implantation in patients with FHI. The present prospective study was carried out in the Postgraduate Department of Ophthalmology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Bemina from March 2012 to January 2015. The study included 33 eyes of 32 patients of FHI who underwent thorough clinical examination and cataract surgery with IOL implantation and were evaluated based on their visual outcome and intra and post-operative complications. Post-operative follow-up was done on 1st day, one week, one month, two month, six month and at twelve months. Mean age of our study group was 33.9 years (Range 18 to 65 years). No male or female preponderance was seen. There was bilateral involvement of eyes in only one case. Cataract and stellate keratic precipitates were present in all cases whereas, heterochromia was present in only six eyes (18.75%). Best Corrected Visual Acuity (BCVA) showed a significant improvement following cataract surgery (p<0.001). Post-operatively, 26 eyes (78.78%) showed an improvement of four lines or more (BCVA of > 6/12). Most common causes of decreased vision post-operatively were vitreous opacities in nine eyes (27.27%) followed by glaucoma in eight eyes (24.24%) and posterior capsular opacification in six eyes (18.18%). Cataract extraction with IOL lens implantation in FHI is a safe procedure associated with good visual prognosis and few complications. However, glaucoma is one of the main concerns and should be closely monitored both pre and post-operatively.

To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL. All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively. Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients. Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.].

ObjectiveTo study the visual, refractive and surgical outcomes of intraocular lens (IOL) implantation versus aphakia in children with microspherophakia.DesignRetrospective, comparative, non-randomised interventional study.MethodsAll consecutive children with microspherophakia who satisfied the...

Background/aimsTo investigate outcomes following cataract surgery with and without primary intraocular lens (IoL) implantation in children under 2 years of age with congenital or infantile cataract.MethodProspective population based cohort study...

Background: The crystalline lens is part of the optical system of the eye that focuses rays of light on the retina. Apart from contributing to the optical power of the eye as a whole, the crystalline lens can dynamically change the optical power of the system by the process of accommodation for younger eyes. During life the ability of the crystalline lens to change in shape decreases, leading to presbyopia. For optimal visual performance, crystalline lens should be transparent. Cataract describes the pathological opacification of the crystalline lens. Removal of the crystalline lens followed by implantation of an artificial intraocular lens (IOL) in the capsular bag of the eye, as practiced in cataract surgery, offers an opportunity to address refractive anomalies in patients who are ametropic due to the removal of cataract. Implantation of an IOL with a fixed focal point (monofocal IOL) will render a patient at best emmetropic for a single fixed working distance only, leading to a postoperative result comparable to presbyopia in an emmetropic subject; pseudoaccommodation can play a role in increasing the depth of field but spectacle independence for a range of working distances is not be expected after implantation of a monofocal IOL. To restore the missing accommodation, we can implant multifocal IOLs. Multifocal IOLs, on the other hand, are designed to have two or more fixed focal points, thus, facilitating a sharp retinal image of objects at multiple working distances resulting in increased spectacle independence, but these lenses can cause a reduction in contrast sensitivity and higher incidence of photic phenomena such as halos, flare, and glare. Aim of The Study: The study was carried out with the aim of comparing the visual outcome after cataract surgery with multifocal IOLs and monofocal IOLs in respect to distant visual acuity, near visual acuity, contrast sensitivity, subjective symptoms, and to assess functional status and quality of life. Materials and Methods: A prospective observational study was conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi on patients undergoing cataract surgery during January 1, 2015–December 31, 2015. The study was approved by the Ethical and Research Committee of Jawaharlal Nehru Medical College, Belagavi. Forty eyes of forty patients who undergone phacoemulsification surgery with IOL implantation under LA. Choice of IOL inserted given according to their desire for spectacle independency. Monofocal group was taken as control. Both groups were evaluated postoperatively after 3 weeks and 6 weeks for distant vision, near vision, contrast sensitivity for distance, subjective satisfaction by standard questionnaire method and subjective symptoms such as glare and halos and difficulty in night driving. Data were analyzed by Chi-square test (P < 0.05%). Results: Distant visual acuity was 6/6–6/9 in 80% and 75% of the patients of multifocal and monofocal groups, respectively, remaining patients had 6/12–6/18 vision. 85% of multifocal group had N6–N8 vision (P < 0.0001). High contrast sensitivity for distance was almost similar in both groups, but low contrast was significantly reduced in multifocal group as compared to monofocal group (P = 0.0023). Fifteen percent of multifocal group had complained of glare and halos compared to monofocal group who never had these visual sensations. About 5% of patients in multifocal group had difficulty with nighttime driving. Nearly, 80% of patients in multifocal group and 40% of patients in monofocal group had become spectacles independent. Interpretation and Conclusion: Multifocal IOL group experienced reduced spectacle dependency for near vision and a high level of patient satisfaction despite some reports of halos, glare, and difficulty in night driving. Monofocal IOL group experienced spectacle dependency for near vision. Overall, multifocal IOLs offer best near vision acuity, good distance visual acuity, less limitation in visual function in selected and motivated individuals.

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