Anterior Chamber Intraocular Lens Research Articles

Trends in Secondary Intraocular Lens Surgery among Vitreoretinal Surgeons

To identify changes in secondary lens techniques over time and to determine common complications of each technique. Retrospective cohort study. All patients in the database from January 2015-December 2021 who underwent secondary lens placement (anterior chamber IOL, scleral fixated IOL, or scleral sutured IOL). Rates of secondary IOL surgery technique were analyzed in 3597 participants in a nationwide aggregated electronic health care database using 2 sample independent T-tests. Rates of post-operative rhegmatogenous retinal detachment (RRD) following secondary IOL surgery were assessed using chi square test of proportion. Post-operative visual acuity was assessed using 2 sample independent T-tests. The primary outcome was change in IOL technique over time. Secondary datapoints examined were the development of post-operative rhegmatogenous retinal detachment (RRD) following secondary IOL surgery, visual acuity changes, the development of endophthalmitis, suture erosion, haptic erosion, or corneal edema following IOL surgery. ACIOL use decreased over the 7-year period from 93% of cases to 36% of cases (p<0.0001), while SFIOL use increased from 3% to 34% (p<0.0001), and SSIOL use increased from 4% to 30% (p<0.0001). Visual acuity increased for each surgical technique (ACIOL: 44.1 vs. 49.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, p<0.001; SFIOL: 48.7 vs. 57.6 letters, p<0.001; SSIOL: 51.5 vs. 61.2 letters, p<0.001), with larger visual acuity gains seen in SFIOL and SSIOL use (ACIOL vs. SFIOL, p=0.004; ACIOL vs. SSIOL, p=0.002; SFIOL vs. SSIOL, p=0.64). Average RRD rates did not significantly differ between techniques. Rates of endophthalmitis, haptic erosion, and suture erosion were low and did not significantly differ between techniques. Rates of corneal edema were significantly higher in ACIOL cases (vs. SFIOL, p<0.0001; vs. SSIOL, p<0.0001). Rates of ACIOL implantation performed by vitreoretinal surgeons have decreased over time with more vitreoretinal surgeons electing to place either a SFIOL or SSIOL towards the end of the study period; complication profiles among the three techniques may be similar.

Preferred surgical techniques for secondary intraocular lens implantation in adults with aphakia.

To identify the current surgical management of aphakia and the outcomes and complications of each technique. This cross-sectional study included ophthalmic surgeons with at least one-year experience in surgery for aphakia. A study questionnaire was formulated to collect data in Saudi Arabia and other regional countries. The questionnaire included 22 questions on demographics, preferred surgical techniques, complications and the factors related to surgeon decision and the choice for managing aphakia. The study included 145 participants (111; 76.6% were males) with mean age of 46.7 ± 11.5years. The mean duration of cataract surgery experience was 17.6 ± 11.1years. Most participants (86.2%) were trained in cataract surgery. Scleral fixation of intraocular lens (SFIOL) was the most commonly preferred technique, followed by iris fixation IOL, and anterior chamber IOL (75.2%, 9%, and 15.9%, respectively). The main determinants for selection of a surgical technique were simplicity (56.6%), surgical instrument availability (48.3%), and training on the technique (47.6%). The most frequent postoperative complications were pupil distortion, high intraocular pressure (IOP), pupillary capture of the IOL, and IOL decentration. SFIOL is the preferred surgical technique for managing aphakia. The decision to choose one technique over another is complex and is based on several factors, including technical difficulty, previous training, anatomical variations, ocular comorbidities, and the potential complications.The most frequent complications after surgical correction of aphakia are pupil distortion, high IOP, pupillary capture of the IOL, and decentered IOLs.

Evaluation of Ocular Diameter Parameters Using Swept-Source Optical Coherence Tomography.

Purpose: To investigate the iridocorneal angle-to-angle (ATA), sclera spur-to-sclera spur (STS), and white-to-white (WTW) ocular diameters and their potential influence on anterior chamber intraocular lens (ACIOL) and implantable collamer lens (ICL) sizing in Chinese subjects by using a swept-source optical coherence tomography system (SS-OCT). Design: A retrospective, observational, cross-sectional study. Methods: In 60 right eyes (60 subjects), the ATA, STS, and WTW were measured in six axes (0°-180°, 30°-210°, 60°-240°, 90°-270°, 120°-300°, and 150°-330°) using SS-OCT. The ACIOL and ICL sizes were calculated based on horizontal and vertical axes anterior segment data. A paired sample t-test was used to test the differences in each parameter across the six axes, the potential difference between each pair of parameters in a given axis, and the artificial lens size difference between the horizontal and vertical directions. Pearson's correlation analysis was used to determine the potential correlation between age and AL, WTW, STS, and ATA distances. Results: ATA and STS were the longest on the vertical and shortest on the horizontal axis, while WTW was similar on both axes. These three parameters differed only in the vertical axis (F = 4.910, p = 0.008). ATA and STS were by 0.23 ± 0.08 mm (p = 0.005) and 0.21 ± 0.08 mm wider (p = 0.010) than WTW, respectively. ICL size was 0.27 ± 0.23 mm smaller when based on the horizontal than on the vertical axis parameters (p < 0.001), while ACIOL remained similar (p = 0.709). Age correlated negatively and axial length positively with all measured values. ATA, STS, and WTW correlated positively in the same axis (all p < 0.001). Conclusions: ATA and STS were longer in the vertical than in the horizontal direction, while WTW measurements remained similar. ATA and STS diameters more accurately depicted anatomic relationships for phakic IOL sizing than WTW.

Efficacy and safety of UT-DSAEK combined with Carlevale's sutureless scleral fixation IOL.

To evaluate a novel surgical combination of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and sutureless scleral fixation for Carlevale intraocular lens (SSF-Carlevale IOL) implantation to manage corneal endothelial decompensation when there is a concomitant need for secondary IOL fixation. Clinical data collected from 10 eyes of 9 patients with bullous keratopathy (BK) who underwent combined UT-DSAEK and SSF-Carlevale IOL implantation in a single procedure were retrospectively analyzed. Anterior chamber IOL (4 cases), aphakia (4 cases, 1 of which associated with PEX), and previous trauma (2 cases) were the conditions responsible for BK. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), graft thickness (GT) and complications were recorded over a 12-month follow-up period. In 90% (9/10) of eyes graft clarity was maintained during follow-up. The mean CDVA improved significantly (p < 0.0001) from 1.78 ± 0.76 logMAR preoperatively to 0.53 ± 0.3 logMAR at 12 months. ECD on average decreased from 2575 ± 125.3 cells/mm2 (donor tissue) to 1697 ± 133.3 cells/mm2 in 12 months. The mean CCT decreased from 870 ± 200 µm to 650 µm ± 9 at 12 months (ANOVA, p = 0.0005). Combined UT-DSAEK and SSF-Carlevale IOL implantation was associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a practical option for patients requiring both treatment for corneal endothelial dysfunction and secondary IOL implantation.

COMPARISON OF SECONDARY AC-IOL IMPLANTATION ON APHAKIA PATIENTS WITHOUT CAPSULAR SUPPORT AFTER PARS PLANA VITRECTOMY VERSUS COMPLICATED CATARACT SURGERY

Introduction and objectiv: Capsular support is often absent in cases of aphakia secondary to ocular trauma or previous complicated intraocular surgery. This study aims to compare the short-term efficacy and safety of secondary AC IOL implantation for aphakia patients who underwent pars plana vitrectomy and complicated cataract surgery Method: Retrospective, comparative, case series of 72 aphakic eyes without capsular support after pars plana vitrectomy (Group 1 =37 eyes) and complicated cataract surgery (Group 2=35 eyes) who underwent secondary AC-IOL implantation (Iris Claw and Anterior Chamber) in Yap Eye Hospital and Air Force Central Hospital Hardjolukito. Basic characteristics such as age, sex, laterality, visual acuity, intraocular pressure (IOP), central corneal thickness, endothelial count, axial length, anterior chamber depth and keratometry were recorded Results: There were no statistically differences at baseline characteristics between the two groups. Despite the proportion difference of lens type used in both group (p=0.04), the mean visual acuity outcome at day 1 and month 3 were found similar. However, on day 7 and month 1 the difference of postoperative visual acuity showed a trend. The difference of postoperative mean IOP was also not significant at day 1, month 1 and month 3, but showed a trend in day 7 (p=0.06). The proportion of complication cases were found different in both group (p=0.01), with secondary glaucoma was found highest (18%). Conclusion: The outcomes of secondary anterior chamber IOL implantation after pars plana vitrectomy and complicated cataract surgery were found similar, although there was a significant difference in the proportion of complication in both groups

Trans-Scleral Plugs Fixated FIL SSF IOL: A Review of the Literature and Comparison with Other Secondary IOL Implants

Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications.

Intraocular Lens Exchange: Indications, Comparative Outcomes by Technique, and Complications.

To describe the indications, outcomes, and complications associated with intraocular lens (IOL) exchange. To determine the relative frequency of postoperative complications between techniques for all patients undergoing IOL exchange from May 1, 2014 through August 31, 2020. IOL exchange was performed in 511 eyes of 489 patients (59.7% men; mean age: 67.0 ± 13.9 years, median time from cataract procedure to IOL exchange: 47.5 months). Mean uncorrected visual acuity significantly improved from 20/192 Snellen equivalent (logMAR 0.981) preoperatively to 20/61 (logMAR 0.487) at last follow-up (P < 0.001). Overall, 384 eyes (78.7%) met their desired refractive outcome within ±1.0 diopter (D). The most frequent complication was cystoid macular edema (CME) (n=39, 7.6%). Iris-sutured technique was associated with significantly greater frequency of subsequent IOL dislocation (10.3%) than 4-point scleral sutured (0%, P = 0.002), anterior chamber IOL (ACIOL, 1.5%, P = 0.01), and 2-point scleral sutured (0%, P = 0.03) techniques. Yamane scleral-fixation technique was associated with significantly greater frequency of developing IOL tilt (11.8%) than ACIOL (0%, P = 0.002), 4-point scleral sutured (1.1%, P = 0.01), 2-point scleral sutured (0%, P = 0.04), and iris-sutured (0%, P = 0.04) techniques. IOL exchange significantly improved uncorrected visual acuity and more than three-quarters of eyes met the refractive goal. Certain techniques were associated with complications, including subsequent dislocation associated with iris-sutured technique and IOL tilt associated with Yamane scleral-fixation technique. This information may help guide surgeons in deciding between procedural techniques for individual patients during IOL exchange preoperative planning.

Visual outcome and complications after sutureless scleral fixation intraocular lens implantation

Context:In case of weak, inadequate, or total absence of posterior capsule following trauma or surgical complication, a sutureless scleral fixation (SFIOL) technique has been studied to secure good vision with minimal postoperative complications. It remains as a good alternative against anterior chamber intraocular lens (ACIOL), iris claw lens, and sutured scleral fixated intraocular lens.Aims:Visual outcomes after SFIOL implantation. Complications of SFIOL implantation.Settings and Design:A retrospective hospital-based study.Methods and Material:The study was undertaken depending on the data available of the patients who were diagnosed to have postoperative or post-traumatic aphakia and underwent pars plana vitrectomy ± lens explantation ± phacofragmentation with SFIOL implantation from the month of May 2021 to October 2021 and came for regular follow-up for 6 months. The study included patients with total absence of capsular bag or history of eye trauma or complicated cataract surgery causing aphakia. Patients with retinal detachment were excluded from the study. Indication for surgery, best corrected visual acuity, and other complications were studied.Results:Of 25 eyes of 25 patients who completed 6 months of follow-up, 16 (64%) were men and 9 (36%) were women. Mean visual outcome preoperatively and postoperatively were 1.56 ± 0.7 logMAR and 0.46 ± 0.1 logMAR units, respectively. Mild vitreous hemorrhage was found in 8 eyes (32%) which was the most common postoperative complication noted followed by postoperative hypotony in 6 eyes (24%). Transient rise in intraocular pressure, corneal edema, and choroidal detachment were other complications seen postoperatively.Conclusions:A technique of sutureless SFIOL implantation was found to be a cost-effective method of providing a good visual outcome without serious postoperative complications in eyes with aphakia following post-trauma or surgical complications.

Visual Outcomes and Complications of Intraocular Lens Placement in the Absence of Capsular Support in a Philippine Tertiary Hospital.

Surgical correction of aphakia without capsular support continues to be a challenge. Improvements in the technology of cataract surgery have provided advancements in techniques in surgical management of aphakia. Locally, we have limited data on the outcomes of the different intraocular lenses used in aphakia. This study aimed to determine visual outcomes and complications associated with different techniques of intraocular lens implantation in the absence of capsular support. We reviewed the medical charts of 207 patients who underwent intraocular lens implantation without capsular support. Excluded were patients with incomplete follow up, pediatric patients, and lost records. Best corrected visual acuity at day 1, 1st month, 3rd month and 6th month postoperatively, and the complications were noted. Mean age was 60 and 51% (n=105) were females. The mean follow-up time was 9.33 ± 0.71 months. Loss of capsular support was most frequently caused by intraoperative complication (n=146, 70%) and trauma. Retropupillary fixation iris claw intraocular lens was frequently used (n=93, 44.9%). Across all patients, visual acuities showed excellent outcomes with 20/50 or better. Across IOL types, the most frequent postoperative complication was increase in IOP. Statistically significant results were set at P <0.05. There is a notable preference towards iris claw retropupillary lenses through time. Iris claw lenses showed the shortest operative time. All intraocular lenses used in aphakia showed comparably good postoperative visual acuities, except for the superior visual acuity trend seen among retropupillary iris claw and anterior chamber IOL groups. Complications included elevated intraocular pressures, corneal edema, and pigment dispersion.

Phacoemulsification of cataract in the case of capsular bag damage

Purpose: to analyze the results of complicated cataract phacoemulsification with implantation of various types of intraocular lenses and fixation techniques. Material and methods. 48 patients (51 eyes) with complicated cataracts and weakened ligamentous apparatus of the lens or intraoperative rupture of the posterior lens capsule were divided into two groups: the study group I consisted of 21 patients (23 eyes, aged 71.4 ± 4.5 years) who had cataract phacoemulsification with an implantation of RSP-III IOL which was performed through a 2.4 mm small self-sealing incision using an injector and the control group II consisting of 27 patients (28 eyes, aged 73.6 ± 4.1 years) who had. Cataract phacoemulsification with an anterior chamber IOL implantation using an incision widened to 6.0 mm. Results. By the end of 1-year follow-up period, uncorrected visual acuity was 0.8 ± 0.1 in group 1 and 0.5 ± 0.1 in group II. In 100% of the patients of group 1 the correct position of the IOL was achieved in the early postoperative period (1–3 days) and maintained in the late period (1 year), whereas in group II, two eyes of 28 operated (7.14 %) showed a forward displacement of the anterior chamber IOL, which involved a contact with corneal endothelium. IOP stayed within the normal range in 21 eyes of group I patients (91.3 %), albeit two eyes (8.7 %) revealed transitory hypertension. In group II, 21 eyes (75 %) had normal IOP in the first three postoperative days, while 7 eyes (25 %) revealed an IOP increased to 29–30 mm Hg. In contrast to group I, group II patients showed induced corneal astigmatism which was decreasing during the follow-up period. Conclusion. In the case of a rupture of the posterior capsule during cataract phacoemulsification, or failure of the ligamentous apparatus of the lens of various origins, the implantation of the RSP-III IOL through a small self-sealing incision using an injector is the method of choice, which allows achieving a stable position of the IOL in the early and long-term follow-up periods, and high visual acuity with the minimal values of corneal astigmatism.

DSAEK in corneal decompensation by Baikoff lens implant after traumatic cataract and superior iridodialysis

AbstractPurpose: To present the assessment and surgical approach to late pseudophakic bullous keratopathy in a case of pseudophakia with Baikoff type anterior chamber (AC) IOL implantation with haptics synechiated to the iridian stroma. We opted for Descemet Stripping with Automated Endothelial Keratoplasty (DSAEK), which allowed us to solve the corneal decompensation.Methods: We present the case of a 72‐year‐old male with a history of traumatic cataract and superior iridodialysis, who was surgically treated with lens extraction and implantation of a three‐haptic Baikoff‐type AC IOL. During the 30 years after surgery, the patient remained stable. However, in 2021, he went for a revision with a decrease in visual acuity. During the slit‐lamp biomicroscopic examination and the images obtained, the presence of synechiae of the three haptics of the lens to the peripheral iridian stroma was evidenced, as well as the presence of generalized edema with increased thickness and loss of corneal transparency, which did not subside with medical treatment.Results: Given the need for surgical intervention, the risk–benefit of performing a lens explant was studied. It was decided to perform a DSAEK endothelial transplantation keeping the IOL in its position, given the existence of a wide iridian dialysis and a wide anterior chamber. During the operation, the implanted gas bubble allowed the graft to adhere properly, although it did not remain in the anterior chamber, due to the presence of the traumatic superior iridodialysis. However, in the immediate postoperative period, the graft of the posterior corneal layers remained adhered without the need of the gas bubble, resolving the previous bullous keratopathy.Conclusions: Late corneal decompensation is a complication to be taken into account in eyes with AC IOL. On the other hand, DSAEK offers advantages in the ease of positioning and maintenance of the graft compared to DMEK in cases with iridodialysis, obtaining a prompt recovery with good refractive results.

History of diagnosis and treatment of cystoid macular edema

AbstractFollowing the introduction of the ophthalmoscope by Helmholtz in 1851, very early descriptions of macular edema were reported by Jaeger in 1856 and Nettleship in 1872. Macular disease following cataract surgery was described by Hruby in 1950, Irvine in 1953, Chandler in 1954, Nicholls in 1954, and Maumenee in 1957, among others. The introduction of fluorescein angiography by Novotny and Alvis in 1961, with subsequent modifications by David, Sever and Justice, greatly facilitated the diagnosis of this condition. Using fluorescein angiography, Gass and Norton reported 44 patients with “cystoid macular edema” (CME) in 1966, which appears to be the first use of this term. The eponym “Irvine‐Gass syndrome” appears to have been published first in 1971. In 1991, Puliafito and colleagues reported the first use of optical coherence tomography, and published one case of postoperative CME in 1995.Treatments for CME developed as the pathophysiology became better understood. Early reported treatments included oral vasodilators (Laws, 1964), oral prednisone (Gehring, 1968), and pulsed ruby photocoagulation (Zweng and colleagues, 1968). Alternatively, other investigators recommended observation for at least 12 months, including Gass and Norton in 1969 and Jacobson and Dellaporta in 1974. Miyake reported good results with topical indomethacin prophylaxis in 1977; other investigators subsequently reported benefit with topical or oral indomethacin, including Yannuzzi and colleagues in 1979 and Kraff and colleagues in 1982. Various surgical factors, including posterior (rather than anterior) chamber intraocular lenses, were found to be beneficial during the 1980s. Multiple topical medications, including prednisolone acetate, flurbiprofen, ketorolac, diclofenac, and others, were investigated in the 1990s and 2000s. Gaudric and colleagues published treatment of CME with intravitreal triamcinolone acetonide in 2003.At the present time, the use of topical corticosteroids and nonsteroidal anti‐inflammatory agents is widely used in the prophylaxis and treatment of CME, but there is relatively little evidence from randomized clinical trials to support this practice. In both the US and Europe, no agent has achieved regulatory approval for the treatment of postoperative CME; all agents are used “off‐label”.

Multimodal imaging features in chorioretinitis sclopetaria

AbstractPurpose: To describe the multimodal imaging findings in a case of chorioretinitis sclopetaria (CS).Methods: Single case report.Results: A 26‐year‐old male reported a history of ocular injury to the right eye (OD) in childhood caused by a palm tree branch after which he underwent cataract surgery. On examination, his best‐corrected visual acuity was light perception in OD. Anterior segment examination revealed the presence of an anterior chamber intraocular lens. Intraocular pressure was within the normal range. Dilated funduscopy showed an area of bare sclera in the inferonasal quadrant adjacent to a white fibroglial proliferation that extended to the nasal and temporal periphery consistent with CS. A large area of chorioretinal atrophy involving the macular region with a nasal demarcation line and scattered hyperpigmented patches was also noted. The left eye examination was unremarkable. Fundus autofluorescence showed hypoautofluorescence of the scar tissue and in the posterior pole. Swept‐source optical coherence tomography scans confirmed the rupture of the choroid underneath a full‐thickness hyperreflectivity in the inferonasal quadrant and revealed disruptions in the macular RPE and outer retinal layers.Conclusions: CS is caused by a shock wave from a high‐velocity projectile resulting in the tearing of the choroid, retinal pigment epithelium (RPE), and neurosensory retina which later induces fibrous scarring, RPE hyperplasia, and photoreceptor loss. Multimodal imaging findings of CS are consistent with these features.

Comparative evaluation of “in-the-bag” intraocular lens implantation with cionni ring versus pars plana lensectomy–vitrectomy with anterior chamber IOL implantation in subluxated lenses in pediatric eyes

Background: Subluxation of the crystalline lens has various surgical management options. In moderate zonular dialysis, the capsular bag may be preserved and used for intraocular lens (IOL) implantation using a capsular tension ring or Cionni ring or Capsular tension segment. It is technically demanding and associated with high incidence of complications such as IOL decentration, dislocation, and posterior capsular opacification (PCO). Advantages of the combined pars plana lensectomy–vitrectomy (PPL/PPV) with anterior chamber IOL (ACIOL) approach include a closed ocular surgical system, minimal corneal trauma, limited iris trauma, and good vitreous control. Therefore, in this study, we aim to study the outcomes of inthe-bag IOL implantation with Cionni ring versus PPL/PPV with ACIOL in subluxated lenses in children. Aims and Objectives: The aims of this study were to compare “in-the-bag” IOL implantation with Cionni ring versus PPL/PPV with ACIOL implantation in subluxated lenses in children. Materials and Methods: In this prospective, comparative, and interventional case series, 20 eyes (18 children, 8–18 years) with 90–210° subluxation were randomly allocated into two groups (ten eyes each). Group A underwent single eyelet Cionni Ring with in-the-bag PCIOL implantation and Group B underwent PPL/PPV with ACIOL. Outcome measures included best-corrected visual acuity (BCVA), endothelial cell count (ECC), intraocular pressure, fundus evaluation, and intraoperative/post-operative complications. Results: The etiology of subluxation included trauma (40%), Marfan’s syndrome (20%), myopia (20%), and others (20%). In Group A, intraoperative difficulties were encountered in capsulorrhexis, irrigationaspiration, and increased duration of surgery. Two eyes in Group B had intraoperative lens fragment drop in vitreous. At 3 months, no statistically significant difference in BCVA was noted. About 90% eyes in Group A and 80% eyes in Group B had final BCVA of ≥6/18. ECC and PCO were significantly higher in Group A at 3 months. Conclusion: Implantation of planned open-loop ACIOL is viable surgical alternative to Cionni ring with PCIOL implantation in large lens subluxation and good pre-operative ECC.

Risk factors affecting cataract surgery outcome: The Malaysian cataract surgery registry

This is a 5 years multicentre database study that recruited subjects from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR), aimed to determine risk factors that affect cataract surgery visual outcome and evaluates post-cataract surgery vision. All age-related cataract surgeries with primary intraocular lens (IOL) implantation were included. Cases with secondary cataract, previous ocular surgeries and incomplete data were excluded. A total of 131425 cases were included in the study. Amongst all types of cataract surgery, 92.9% attained post-operative best-corrected visual acuity better than 6/18 and the outcome improved to 97.1% when ocular comorbidities were excluded. Factors with Odds Ratio (OR) >1.5 associated with an impaired visual outcome included: elderly patients of 80 years old and above; systemic disease such as renal failure; ocular co-morbidities; pre-operative vision worse than 6/60; general anaesthesia, retrobulbar anaesthesia or subconjunctival anaesthesia; extracapsular cataract extraction (ECCE), intracapsular cataract extraction (ICCE), anterior chamber intraocular lens (ACIOL) implantation or combined cataract surgery; the presence of intra- and post-operative complications. In conclusion, a good visual outcome was achieved after cataract surgery in most cases. This large multicentre study provides information about risk factors for poor visual outcome post-cataract surgery and may serve as a basis for evidence-based guidelines.

The Descemet Membrane Endothelial Keratoplasty (DMEK) "Wave Maneuver".

A novel technique for Descemet membrane endothelial keratoplasty (DMEK) graft handling and centration without the endothelium touching the posterior part of the anterior chamber (AC), is presented here. It is particularly suitable for vitrectomized eyes, deep AC, and AC intraocular lenses (ACIOLs), potentially reducing surgery time and endothelial cell loss during surgery. This retrospective interventional case series includes 27 eyes with complex ocular pathology. All utilized a “Wave maneuver” to center an early elevated graft without completing graft centration on the bottom of the AC. Successful graft attachment and centration were evaluated intra and post-operatively. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), and donor endothelial cell density (ECD) were measured pre-operatively, and three and six months post-operatively. DMEK grafts were successfully attached and centered in all cases. No maneuver-related complications were observed intraoperatively. BCVA improved from a pre-operative 0.2 ± 0.63, to 0.43 ± 0.49 and 0.76 ± 0.51 at the three- and six-month follow-ups, respectively (p < 0.01). CCT decreased from a pre-operative 742 ± 118, to 546 ± 87 and 512 ± 67 at three and six months, respectively (p < 0.01). ECD decreased from 2878 ± 419 cells/mm2 to 1153 ± 466 cells/mm2 at three and six months, respectively (p < 0.01). The “Wave maneuver” may be very beneficial in DMEK cases where the AC is either very deep or the bottom of the AC is compromised. The “Wave maneuver” learning curve was brief.

Commentary: Decision-making in the management of surgical aphakia.

According to the 2015–2019 survey by the National Programme for Control of Blindness and Visual Impairment, uncorrected aphakia accounts for 1.7% of blindness and vision impairment in adults aged >50 years in India.[1] Anisometropia, aniseikonia, prismatic distortion of images (jack-in-the-box phenomenon) and the weight of high hyperopic spectacles demands rehabilitation in surgical aphakia with an intraocular lens (IOL) implantation. IOLs provide a better field of vision and less image disparity, and are more acceptable cosmetically. The standard of care of in-the-bag implantation of an IOL, may not be feasible in circumstances where there is a lack of posterior capsular support. Such instances are not uncommon in a regular cataract surgeon’s practice. Further recourse depends on the presence or absence of sulcus support. While, in the presence of an adequate sulcus support, a foldable 3-piece or a rigid polymethyl methacrylate (PMMA) IOL is preferred, in its absence, the choice of IOL fixation depends on the surgeon’s expertise. We congratulate the authors for summarizing the desired options for aphakia management by the anterior and posterior segment surgeons, in their study “Preferred practice patterns in Aphakia management in adults in India - A Survey”.[2] Although this study elaborates on the preferred site of IOL fixation being the iris and scleral-fixated IOLs by anterior and posterior segment surgeons, respectively, the results cannot be extrapolated to a larger population, considering the minimal response rate (4.8%). The primary indication for secondary IOL, age of the patient at surgery, associated ocular and systemic conditions, level of training of surgeons, and the availability of different types of IOLs should also be considered when such a survey is being conducted. Optical correction is a critical component of visual rehabilitation in aphakia. There are pros and cons to each of the modalities of IOL fixation. Owing to the higher risk of hyphema, secondary glaucoma and corneal endothelium decompensation, either scleral-fixated or iris-fixated IOLs are being preferred over the use of angle-fixated anterior chamber IOLs nowadays.[3] The decision to use iris-fixated or scleral-fixated IOLs depends on the expertise of the surgeon.[45] The visual outcome in both types of IOL fixation are comparable at variable follow-up periods, although long-term prospective studies are required to confirm the same.[5678] Each of these methods have inherent complications associated with them. Iris-fixated IOLs, either anteriorly or posteriorly, are associated with iris erosion, pigment dispersion, corectopia, hyphema, IOL subluxation, cystoid macular edema, chronic uveitis and secondary glaucoma.[58] In addition to the aforementioned complications, scleral-fixated IOLs, either sutured or suture-less, are associated with vitreous hemorrhage, haptic exposure, retinal detachment, scleral thinning and IOL tilting and/or dislocation.[59] As opposed to the in-the-bag IOL and angle-fixated anterior chamber IOL (ACIOL), the procedure for iris-fixated and scleral-fixated IOLs is technically challenging, has a steep learning curve and needs expertise. The long-term stability of the these IOLs as well as complications are yet to be studied prospectively. Nevertheless, these results cannot be extrapolated to the pediatric aphakic population. Age, size of the eyeball, corneal diameter, primary indication of aphakia, eye growth, systemic associations, and high prediction errors are factors to be considered while planning IOL implantation in children. Primary IOL implantation is usually discouraged in children with small eyes (short axial length/microcornea) and those with associated anterior and posterior segment pathologies. When children reach the appropriate age, and their eyes are of the adequate size with open angles on gonioscopy and have no contraindications, a secondary three-piece IOL or a PMMA IOL in-the-sulcus/in-the-bag can be planned.[10] When sulcus examination becomes difficult clinically, ultrasound biomicroscopy of the anterior segment can be done. This provides the surgeon with information on the status of ciliary sulcus and its surrounding tissue preoperatively.[10] The vigilance on the postoperative course in children should be high as they are at a risk of excessive postoperative inflammation and rise in intraocular pressure. In specific cases such as ectopia lentis caused by Marfan syndrome, it is preferrable to leave the children aphakic and rehabilitate them with contact lenses or spectacles. Thus, for a customized approach to manage a case of aphakia, weighing the risks and benefits of the procedure is encouraged. Various factors to be considered are age, indications, contraindications, site of IOL fixation, IOL POWER calculation formula, IOL material/designs and expertise in the procedure. The historic Latin phrase, Primum non nocere, meaning, “First, do no harm,” should be respected, and selected cases should be left aphakic and rehabilitated with contact lenses or spectacles, rather than implant an IOL and cause irreversible damage due to glaucoma, corneal decompensation and retinal detachment.

Comparison of Iris Calved IOL and LASIK Surgery Outcome in Mongolian Patients

Objective: There are significantly few studies which have introduced the comparison intra ocular lens (IOL) outcome with conventional phacoemulsification surgery. Thus, in the present study, we aimed to compare anterior chamber intra ocular lens (AC IOL) and LASIK surgery in Mongolian patients. Methods: This study was conducted on 67 participants. Females comprised 58.8 % in the IOL patients and 72.0 % in the LASIK groups. The mean age of the participants was 32.06 ± 9.29 in IOL and 29.4 ± 6.59 in the LASIK group. Results: Pre operative uncorrected visual activity (UCVA) was 7.94 ± 6.56 in IOL patients, and 2 weeks after surgery, UCVA had increased to 61.18 ± 21.18. In the case of LASIK, pre-operative UCVA was 20.56 ± 17.20, and the value was 86.8 ± 18.23 after surgery. Pre-operative best-corrected visual acuity (BCVA) IOL and LASIK group were 37.65 ± 18.38 and 97.6 ± 4.31, respectively. However, only IOL patients had significantly improved BCVA after surgery (71.76 ± 22.97 at post-operative 2nd week). Conclusions: The best-corrected visual acuity and was better for AC IOL than LASIK surgery.

Морфофункциональные параметры переднего отдела глазного яблока с дефектом капсуло-связочного аппарата при регматогенной отслойке сетчатки

To determine the changes in the morphofunctional parameters of the aphakic eye in RRD, the following goals were set. Purpose. To determine the features of the structural parameters of the anterior eye, namely the angle of the anterior chamber and the depth of the anterior chamber. Material and methods. Depending on the method of correction of the defect in the capsular-ligamentous apparatus of the lens against the background of silicone tamponade of the vitreal cavity, the patients were divided into 4 groups: group 1 – patients with anterior chamber IOLs, group 2 – patients with transsclerally fixed IOLs, group 3 – patients with aphakia, group 4 artifakia (control). For a detailed study of the change in indicators from the anterior chamber, emphasis was placed on two indicators, namely the angle of the anterior chamber and the depth of the anterior chamber. The depth of the anterior chamber was measured from the iris to the corneal endothelium at 2 mm from the anterior chamber angle point. Results. When examining the features of changes in the APC in different groups, a tendency for this indicator to change when using an anterior chamber IOL, relative to the control group, is revealed, in particular, this parameter is significantly lower in the temporal sector: APC 3(T) in the 1st group is less than in the 4th group by 7.73 (p = 0.036) degrees. A similar trend in this sector was found in patients with transscleral fixation of the IOL: AEC 3(T) in the 3rd group was less than in the 4th group by 8.73 (p = 0.028) degrees. Conclusion. In a general analysis of the dynamics of the HPC indicators, depending on the correction of the CCA defect, general trends are identified that characterize each group. In particular, in patients using the anterior chamber IOL (group 1), a decrease in this parameter in sector S is detected, relative to the indicators of the control group (group 4) and the group using transscleral fixation of the IOL (group 3). When using the anterior chamber IOL, a change in the position of the iris is observed due to the pressure of the silicone bubble from the vitreous cavity. Keywords: retinal detachment, intraocular lens, anterior chamber.

Visual outcome of cataract surgery from a free outreach camp among rural areas of Southern-Kaduna, Nigeria

Objectives: The objectives of the study were to assess the visual outcome of those who underwent free cataract surgery in southern senatorial zone of Kaduna State between September and November 2018, and to identify the causes of poor visual outcome (Visual acuity [VA] &lt;6/60 Post op), suggest ways of improving it and comparing findings of this study with other studies. Materials and Methods: An observational study of consecutive patients with dense cataracts and VA &gt;6/60 who underwent manual small incision cataract surgery (MSICS) with intraocular lens implant (IOL). All patients had posterior chamber intraocular lens (PCIOL) implant after cataract extraction except 6 who had anterior chamber intraocular lens. A total of 116 eyes of 116 patients who met the inclusion criteria were recruited for the study but only 109 were followed up for 8 weeks postoperatively. Their VA pre-operative was noted. Postoperatively, 1st day, 1,and 8 weeks presenting VA were noted while best corrected VA (BCVA) at 1 week and 8 weeks were also noted. Information collected was analyzed with Statistical Package for the Social Sciences version 19. A 95% significant confidence interval was used, that is, P &lt; 0.05. Results: Age range of patients in this study was 40–80 years with a male to female ratio of 1.02:1. All patients presented pre-operatively with poor vision (VA &gt;6/60) but after surgery 27.3%, 42.2%, and 56.6% of patients had good vision (VA 6/6–6/18) on 1st day, 1 week, and 8 weeks post-operatively, respectively, with a BCVA in 75.6% of study population. Complications such as corneal edema, posterior capsule rent, iris tear, cortical remnants, and uncorrected residual refractive errors contributed to poor visual outcome (VA &lt;6/60) 8 weeks after surgery. Conclusion: MSICS was effective in restoring visual loss from cataract. Even though the WHO standard was not achieved in this study, provision of required technology for pre-operative preparation and post-operative follow-up along with improvement in surgical techniques will improve visual outcome after cataract surgery.