Anterior Chamber Intraocular Lens Implantation Research Articles

Intraocular Lens Implantation in the Absence of Zonular Support: An Outcomes and Safety Update: A Report by the American Academy of Ophthalmology

To review the published literature on the visual acuity results and complications of different surgical techniques for intraocular lens (IOL) implantation in the absence of zonular support. Peer-reviewed literature searches were conducted last in PubMed and the Cochrane Library in July 2019. The searches yielded 734 citations of articles published in English. The panel reviewed the abstracts of these mostly retrospective case series studies, and 45 were determined to be relevant to the assessment objectives. Three articles were rated as level II evidence, and 42 articles were rated as level III evidence. Eight different types of IOL fixation techniques with at least 6-month follow-up were evaluated: anterior chamber IOL (ACIOL), iris-claw IOL, retropupillary iris-claw IOL, 10-0 polypropylene iris-sutured posterior chamber IOL (PCIOL), 10-0 polypropylene scleral-sutured PCIOL, 8-0 polypropylene scleral-sutured PCIOL, CV-8 polytetrafluoroethylene, and intrascleral haptic fixation (ISHF). Eight articles reported data comparing 2 techniques. The 45 studies had insufficient statistical power to compare the techniques conclusively. A qualitative analysis of similar types showed that trends in visual acuity outcomes were not inferior to those of ACIOL implantation, but the severity of preoperative pathologic features was not controlled for. Compared with ACIOL, complications of cystoid macular edema were higher in 10-0 polypropylene iris-sutured PCIOL and 8-0 polypropylene scleral-sutured PCIOL. Non-anterior chamber IOL techniques were less likely to report chronic uveitis. Chronic glaucoma was highest in the 8-0 polypropylene scleral-sutured PCIOL group. Although retinal detachment was infrequent overall, it was twice as common in both iris- and scleral-sutured PCIOLs (except CV-8 polytetrafluoroethylene suture) compared with nonsutured methods: ACIOL, iris-clipped IOL, and ISHF PCIOL. The evidence reviewed shows no superiority of any single IOL implantation technique in the absence of zonular support. The various techniques seem to have equivalent visual acuity outcomes and safety profiles. Each technique has its own profile of inherent risk of postoperative complications. Surgeons must educate patients on the importance of close, long-term follow-up as a result of the uncertain nature of these techniques. Large prospective studies are needed to confirm the long-term complication profiles of these various IOL implantation techniques.

Caractéristiques et prise en charge du syndrome Uvéite-Glaucome-Hyphéma

Uveitis-Glaucoma-Hyphema syndrome (UGH) is caused by mechanical chafing of anterior segment structures by an intraocular lens, especially an anterior chamber lens. The objective of this study was to characterise the clinical course and risk factors of UGH syndrome at a time when posterior chamber implantation is the gold standard. This was a retrospective study of 30 cases of UGH syndrome managed between January 2014 and September 2018. Data from the initial clinical examination, the type of implant involved and the clinical management were analysed. Thirty eyes of 28 patients were included. Intra ocular lenses were iris-sutured (15/30, 50%), in the bag (6/30, 20%), scleral-fixated (4/30, 13.3%), in the ciliary sulcus (3/30,10%) or "in and out" (2/30, 6.7%). Initial management was medical (18 eyes) or surgical (12 eyes). Surgical procedures were explantation (n=4), IOL repositioning (n=7) or trabeculectomy (n=1). Recurrences occurred with medical treatment (9/18), but not in the surgical group (p=0.02). Ocular hypertension became chronic in 19 cases out of 30 (63.3%). UGH syndrome can be caused by any type of pseudophakic lens. An intraocular lens in the bag should not rule out the diagnosis. Despite the decreasing popularity of anterior chamber intraocular lens implantation, UGH syndrome remains a current condition and must be recognised in order to adapt therapeutic management.

The pattern of increasing intraocular pressure after phakic anterior chamber intraocular Lens Implantation


 
 
 Background: Phakic intraocular lenses (IOL) are being used to correct refractive errors. We studied the pattern of increasing Intraocular Pressure (IOP) after Phakic Anterior chamber intraocular lens implantation as the risk after surgery. Methods: Sixty eyes of 30 patients were enrolled. All eyes underwent the same protocol with IOP examination before surgical procedure, and during follow up (one day after, 2 weeks, 1 month, 2 months and 3 months) after implantation of phakic IOL anterior chamber. All results were analyzed statistically using SPSS 16 statistics software. Correlation between parameter were analyzed using the wilcoxon test. 
 Results: Median IOP before surgery were 14.00 mmHg (IOP), during follow up 17.00 mmHg (IOP I), 16.00 mmHg (IOP II) , 17.00 mmHg (IOP III), 15.00 mmHg (IOP IV), 15.00 mmHg (IOP V). The increasing of IOP between pre surgery and follow up a day after was found to correlate significantly (p=0.03), there were increasing of IOP after 2 weeks, a month, 2 and 3 months but no significant difference. 
 Conclusion: There were significant of increasing IOP before surgery compare to a day after surgery,then the pattern of increasing IOP tend to be stable. There were no significant increasing of IOP during 3 months follow up. 
 
 

Descemet Stripping Automated Endothelial Keratoplasty With a Retention Suture: Description of a Technique for Patients at High Risk of Graft Detachment.

To evaluate the utility, safety, and efficacy of a parallel or cloverleaf retention suture in Descemet stripping automated endothelial keratoplasty that does not penetrate donor tissue and can be removed at the slit lamp for patients at high risk of graft detachment. Data were prospectively collected over 9 years from patients who received a retention suture. Indications for use of a retention suture included difficulty with postoperative positioning, abnormal intraocular anatomy including glaucoma tube shunts, trabeculectomies, anterior chamber intraocular lens implants, previous vitrectomy, aniridia, and aphakia, or history of previous graft detachment. Of 128 surgeries, 12 (9.4%) required additional intervention for graft reattachment (rebubble). Overall, 120 grafts (93.8%) remained clear and attached either after surgery with a retention suture or after rebubble procedures. Mean endothelial cell density at 1 year was 1840 cells/mm, and mean endothelial cell density loss was 37.3%. A cloverleaf or parallel retention suture in conjunction with Descemet stripping automated endothelial keratoplasty seems to reduce the risk of detachment in high-risk patients, while maintaining adequate cell density and graft clarity at 1 year.

Descemet membrane endothelial keratoplasty and refractive surgery.

Descemet membrane endothelial keratoplasty (DMEK) has become a first-line treatment in corneal endothelial diseases because of its exceptional clinical outcomes and low complication rates. Because of its improved refractive predictability, DMEK is now also considered for managing cases with endothelial decompensation following previous refractive procedures, or in combination with those. This article reviews the clinical outcomes in these cases and discusses the possibility of refractive interventions following DMEK. DMEK has been successfully performed in eyes after laser in-situ keratomileusis, eyes after anterior chamber intraocular lens (IOL) implantation and aphakic eyes. Often, DMEK is combined with cataract surgery (triple-DMEK). Initial reports on reducing the refractive cylinder by toric IOL implantation are available. Although there are some reports on phacoemulsification and IOL implantation after phakic DMEK, reports on laser refractive procedures following DMEK are lacking. In contrast to earlier keratoplasty techniques, DMEK induces on average only mild refractive shifts owing to the 'natural' restoration of the cornea. As such, DMEK may be ideal in managing corneal decompensation in refractive patients. However, further studies are required to assess the safety and efficacy of DMEK after refractive treatment and of refractive procedures following DMEK.

Spontaneous Late Intraocular Lens and Capsule Tension Ring Dislocation.

In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.

Dislocated Posterior Chamber Intraocular Lens (PCIOL) in Patients with Retinitis Pigmentosa (RP)

Subluxation or dislocation of PCIOL is one of the complications of cataract operation in RP patients. This paper reports the presentation of PCIOL dislocation and subluxation and the management and outcome in 3 eyes of 2 RP patients. Two medical records of patients with RP who developed dislocated or subluxated PCIOL and subsequently underwent explantation of the dropped IOL were evaluated. Two patients had bilateral eye cataract operation done and had PCIOL implanted. Patient 1 developed left eye subluxated PCIOL inferiorly after 2 years of the cataract operation and right eye dislocated PCIOL anteriorly 4 years after cataract operation. Patient 2 develop right eye subluxated PCIOL inferiorly after 12 years of the cataract operation. Patient 1 with right eye dislocated PCIOL underwent intraocular lens (IOL) explantation and was left aphakic as her visual prognosis was poor due to advanced RP. The left IOL remained within the visual axis despite subluxation and no intervention has been done. Patient 2 with right eye subluxated PCIOL underwent IOL explantation and anterior chamber intraocular lens (ACIOL) implantation. ACIOL remained stable and visual acuity improved post-operation. Both the operations were uneventful. Post-operatively, there was no elevated intraocular pressure and no prolonged ocular inflammation, which required prolonged anti-inflammatory and no retinal detachment was seen. Both patient and surgeon should be aware of potential PCIOL subluxation or dislocation in RP. The presentation may be as late as more than a decade after the cataract operation.

Trocar-Assisted, Sutureless, Scleral-Fixated Intraocular Lens Implantation Combined With Penetrating Keratoplasty.

To evaluate the results of trocar-assisted, sutureless, scleral-fixated (SSF) intraocular lens (IOL) implantation combined with penetrating keratoplasty (PKP). This study comprised 4 eyes (4 patients) undergoing trocar-assisted SSF-IOL implantation during PKP. The combined technique was performed in 3 eyes of 3 patients with bullous keratopathy and in 1 eye with central corneal opacity. Two eyes had anterior chamber IOL implants, and 2 were aphakic. All eyes had inadequate capsular support. Evaluated parameters were biomicroscopy, corrected distance visual acuity, intraocular pressure, IOL position, and corneal graft status. Intraoperative and postoperative complications and additional surgeries were recorded. The mean follow-up period was 28.3 ± 3.5 months. Trocar-assisted SSF-IOL implantation with PKP was successfully performed in all eyes. Visual acuity improved in all patients. During the follow-up period, a well-stabilized IOL without any IOL-related complication was obtained in all eyes. In one eye with corneal scarring and aphakic glaucoma caused by trauma, drug-resistant glaucoma developed 6 months after surgery requiring Express glaucoma shunt surgery. In one eye with a history of central retinal vein occlusion, repeat keratoplasty was performed after 10 months because of graft rejection. Trocar-assisted SSF-IOL implantation combined with PKP is an alternative method for visual rehabilitation in the eyes with bullous keratopathy and corneal scarring without sufficient capsular support.

Pars Plana Vitrectomy Combined With Either Secondary Scleral-Fixated or Anterior Chamber Intraocular Lens Implantation

To compare visual outcomes among eyes that underwent pars plana vitrectomy (PPV) in combination with either anterior chamber intraocular lens implantation (ACIOL) or scleral suturing of posterior chamber lens (PCIOL). Retrospective comparative case series. All eyes presented with aphakia or luxated or subluxated posterior chamber intraocular lens (IOL) following complicated cataract surgery, trauma, or spontaneous dislocation. Eyes involving visually significant macular pathology, past retinal detachment, follow-up of less than 6months, and surgeries requiring the removal of an ACIOL were excluded. The main outcomes measured were final best-corrected visual acuity (BCVA) and surgical complication rates. Fifty-seven eyes met inclusion criteria; median follow-up was 13.2months. Initial median BCVA for ACIOL patients was logMAR 1.301 (Snellen equivalent 20/400, range 20/20 to light perception); final median BCVA was logMAR 0.477 (Snellen equivalent 20/60, range 20/20 to light perception, P < .001). Initial median BCVA for PCIOL patients was logMAR 1.239 (Snellen equivalent 20/347, range 20/60 to light perception); final median BCVA was logMAR 0.301 (Snellen equivalent 20/40, range 20/20 to hand motions, P < .001). The change in BCVA between the 2 groups over the course of the study was similar (P > .05). More epiretinal membrane (ERM) formations occurred postoperatively in the ACIOL group (P= .011). Other complication rates were similar between both groups. PPV with secondary IOL placement is safe and effective, resulting in improved visual outcomes regardless of the technique used. Patients undergoing ACIOL placement have a higher incidence of ERM formation.

The effect of pupil dilation on AL-Scan biometric parameters

The purpose of this study was to investigate the effects of pupil dilation on the parameters of the AL-Scan (Nidek Co., Ltd, Gamagori, Japan). We compared the measurements of axial length (AL), anterior chamber depth (ACD), central corneal keratometry reading, pupil diameter, and intraocular lens (IOL) power of 72 eyes of 72 healthy volunteers and patients scheduled for cataract surgery before and 45min after instillation of cyclopentolate hydrochloride 1% using the AL-Scan. Intraobserver repeatability was assessed by taking three consecutive recordings of ACD and AL. Only ACD readings were significantly different between predilation and postdilation (P<0.001). The difference of the other measurements between two sessions was not statistically significant (P>0.001). Only two cases in the study demonstrated changes in IOL power higher than 0.5D. The intraobserver repeatability of both devices was good (CV values for ACD and AL were 0.16 and 0.20%, respectively). Dilated pupil size did not affect the measurement of IOL power using the A-Scan optical biometer, but increase in ACD after dilation should be taken into account when performing refractive surgeries in which ACD is very important such as phakic anterior chamber IOL implantation.

Outcome of Capsular Tension Ring (CTR) Implant in Complicated Cataracts.

Surgery in the presence of zonular weakness or subluxated lens was a great surgical challenge and included intracapsular cataract extraction with anterior chamber IOL implantation or pars plana lensectomy and vitrectomy with a sutured (IOL). Modern surgical approache involves placement of endocapsular flexible PMMA ring that prevents iatrogenic loss of zonular support, minimizing vitreous loss and enables placement of in the bag IOL. To evaluate frequency and indications of capsular tension ring (CTR) implant and analyse the visual and anatomical outcome in various complicated cataract surgeries. Retrospective screening of database of 6000 consecutive cataract surgeries was done. BCVA, complete ocular examination with SLEx, intraocular pressure, direct ophthalmoscope, fundus examination with +78/+90D were noted. CTR was implanted in cases where Zonular dialysis of > 3 clock hours was present or capsular bag instability was detected during capsulorhexis or subsequent intraoperative maneuvers. In cases with capsulorrhexis extension, CTR was not implanted. Records were analysed for indication of CTR implant and clinical outcome on Day 1, 1 month and 6 month follow up. In this series CTR implant was done in 45 cases. The indications were hypermature senile cataract in 9 cases, hypermature senile cataract with lens induced glaucoma in 9 cases, pseudoexfoliation syndrome in 9 cases, post blunt injury traumatic cataract in 6 cases, iridochoroidal coloboma in 6 cases, hypermature cataract with pseudoexfoliation and marfan syndrome in 3 cases respectively. Decision of CTR implant was intraoperative in 42 patients. At 6 month follow up, 39 patients had best corrected visual acuity ≥6/12. IOL decentration was detected in only 3 cases, but without any subjective visual complaints. As per the results CTR was used very infrequently (0.75%) but remains useful in cataract surgeries with difficult pre and intraoperative conditions. It gives good postoperative result and creates satisfied patients.

Two-Year Follow-Up of Artisan Iris-Supported Phakic Anterior Chamber Intraocular Lens for Correction of High Myopia

ABSTRACTPurpose: To evaluate the results of Artisan iris-supported phakic anterior chamber intraocular lens (pIOL) implantation in patients with high myopia. Methods: Medical records of patients who underwent Artisan pIOL implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a two- year follow-up were included. Spherical equivalent of manifest refractive error (SE), uncorrected visual acuity (UDVA), distance corrected visual acuity (CDVA), and endothelial cell density (ECD) were analyzed at six months, one year, and two years after surgery. Results: Sixty-two eyes of 42 patients were included in the study. All patients had a minimum anterior chamber depth of 3.0 mm from the endothelium. At two years, 68% of the patients were within ±0.50 D. Mean ECD was 2723 ± 311 cells/mm2 preoperatively and 2630 ± 291 cells/mm2 at six months postoperatively (3.4% loss, p = 0.001). ECD loss from six months postoperatively to two years postoperatively was not statistically significantly different. In three eyes (4.8%) of two patients, a temporary, steroid-induced increase in intraocular pressure (IOP) was detected. Conclusion: Artisan pIOL implantation is a safe and highly effective procedure for surgical correction of high myopia. ECD loss stabilizes in the early postoperative period.

Comparison of Outcomes of Primary Anterior Chamber Versus Secondary Scleral-Fixated Intraocular Lens Implantation in Complicated Cataract Surgeries

To compare the outcome of primary anterior chamber vs secondary scleral-fixated intraocular lens (IOL) implantation in complicated cataract surgeries. Retrospective, comparative study. A consecutive series of complicated cataract surgeries with primary anterior chamber (ACIOL) or secondary scleral-fixated IOL implantation from January 1, 2004 to December 31, 2009 was analyzed. Main outcome measures included the postoperative best-corrected visual acuity (BCVA) and postoperative complications. There were 89 eyes in the primary ACIOL group and 74 eyes in the secondary scleral-fixated IOL group. The mean follow-up duration was 64.1 ± 36.7 months. The mean postoperative logarithm of minimal angle of resolution (logMAR) BCVA at 1 year was 0.32 ± 0.54 and 0.34 ± 0.21 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .734). The mean latest logMAR BCVA was 0.68 ± 0.54 and 0.61 ± 0.47 in the primary ACIOL group and the secondary scleral-fixated IOL group, respectively (P = .336). The primary ACIOL group had more early postoperative complications (P < .001). No difference in late postoperative complications was observed between the 2 groups (P = .100). Regression analysis showed that primary ACIOL and secondary scleral-fixated IOL implantation had similar latest postoperative logMAR BCVA (P = .927), while the presence of late complications was associated with a worse final visual outcome (P = .000). This study shows that there are no long-term differences in the visual outcomes and complication profiles after primary ACIOL or secondary scleral-fixated IOL implantation in a complicated cataract operation when capsular support is inadequate.

Anterior chamber intraocular lens implantation in patients with a history of chronic uveitis: Five-year follow-up

To compare the incidence of long-term complications after cataract surgery with primary anterior chamber intraocular lens (AC IOL) implantation in uveitic patients and patients without a history of intraocular inflammation (control group). Single-center private practice. Retrospective clinical study. The study comprised patients who between November 2005 and August 2010 had cataract extraction followed by AC IOL implantation because conventional placement was not possible. Outcome measures were the incidence of intraoperative and postoperative complications, preoperative corrected distance visual acuity (CDVA), and CDVA after 1 year. Of the 39 patients identified through electronic medical records, 17 (17 eyes) had a history of chronic uveitis and 22 (23 eyes) had no intraocular inflammatory disease. There were no significant differences in the incidence of intraoperative and postoperative complications between the 2 groups during follow-up (range 12 to 68 months) (P=.702). Although uveitic eyes had a greater risk for epiretinal membrane formation, the incidence of uveitis flareups attributed to the IOL and deposits on IOL surfaces was comparable to that in the control group (P<.001). The CDVA improved significantly in both groups 1 year after surgery (P<.01 and P<.001, respectively). In uveitic eyes with inadequate capsule support, AC IOL implantation restored visual function without a significant increase in long-term postoperative complications compared with eyes that had no history of uveitis.

Management and Outcomes of Descemet Stripping Automated Endothelial Keratoplasty With Intraocular Lens Exchange, Aphakia, and Anterior Chamber Intraocular Lens

To compare outcomes and complications of Descemet stripping automated endothelial keratoplasty (DSAEK) in complicated cases with intraocular lens (IOL) exchange, aphakia, or anterior chamber intraocular lens (ACIOL) implants with a group of noncomplicated DSAEK cases. Of the 30 complicated DSAEK cases, 14 eyes underwent concurrent IOL exchange, 5 ACIOLs were not removed, 5 eyes remained aphakic, and 5 eyes had IOL exchange done before or after DSAEK. One eye had an iris-supported phakic IOL removed, followed by cataract extraction with IOL implantation at the time of DSAEK. The comparison group included 109 consecutive DSAEK cases with a history of Fuchs dystrophy or pseudophakic bullous keratopathy. In the complicated group with significant ocular comorbidities, 27.6% achieved best-corrected visual acuity (BCVA) ≥20/40 and 60% had a final BCVA ≥20/70. In the comparison group of patients without visually significant comorbidities, 94.4% of eyes achieved BCVA ≥20/40 with no complication of graft detachments. Of the 30 complicated eyes, 5 (16.7%) had graft detachments and 5 (16.7%) developed IOL dislocations. All grafts remained clear at the last follow-up visit, except 3 cases (10%) in the complicated group, 2 of which were because of primary graft failure and required penetrating keratoplasty. In comparison with uncomplicated DSAEK cases, higher graft and IOL dislocations were observed in cases involving IOL exchanges, ACIOLs, or aphakia.

The role of phakic intraocular lens implants in treatment of high-refractive errors and amblyopia in children.

IntroductionThis article aims to evaluate the role of phakic intraocular lens (pIOL) implants in the treatment of high-refractive errors and amblyopia in the pediatric setting.MethodsA literature search of the PubMed database was conducted in December 2012 using the keywords: pIOL implants, amblyopia, pediatric refractive surgery and ametropia, and articles of high or medium clinical relevance were selected for review. Inclusion criteria were children aged 0–17 years who had undergone pIOL implantation for the treatment of refractive errors and/or amblyopia.ResultsMultiple studies have shown the relevancy and effectiveness of pIOL implantation as an alternative surgical management for highly significant pediatric ametropia in selective patients who are noncompliant with medical treatment.ConclusionsIn the management of clinically significant severe pediatric ametropic and/or anisometropic myopia or hyperopia and in the event of nonadherence to traditional medical treatment, phakic anterior chamber IOL implantation is currently considered an effective modality of treatment. Long-term follow-up of pediatric patients following pIOL implantation is necessary. Future clinical trials are needed to address the safety and efficacy of the type of and the best time for pIOL implantation in treatment and/or prevention of amblyopia in children.

Evolution of cataract surgery: Barraquer experience

AbstractPurpose To describe the evolution of cataract surgery at the Barraquer Eye CenterMethods Several videos are presented showing the different techniques of cataract surgery over the last centuryResults Intracapsular cataract extraction using the eysiphake was first developed by Prof. Ignacio Barraquer and the surgery was done with topical anesthesia, sutureless technique. This technique was later on enhanced with zonulolysis using alpha‐chymotrypsis as discovered by Prof. Joaquin Barraquer. Anterior chamber intraocular lens implantation using the Strampelli lens thru a small corneal incision is also shown. Finally we show the present day technique femtosecond laser assisted phacoemulsification thru a 2 mm incision with implantation of foldable intraocular posterior chamber lens.Conclusion Several changes have taken place thru the last century in cataract surgery. Techniques have been developed for less intra operative and postoperative complications, faster visual rehabilitation and excellent refractive results.

Causes of IOL explantation in Spain

To study the reasons and the demography of pseudophakic intraocular lens (IOL) explantation in Spain. In this observational multicenter retrospective study, the cases studied correspond to the 15 centers that constitute the Nodo Calidad Visual y Cirugia Refractiva of the Red Tematica de Investigacion Cooperativa (RETICS) sponsored by the Spanish Ministry of Health. Clinical data from all the patients who underwent explantation were assessed. The different reasons that caused the decision of explantation were analyzed. A total of 257 explanted pseudophakic IOLs have been studied. Patients' mean age when explantation occurred was 67.5 years (SD 13.5 [22-99]) and 135 were female (52.5%). The main causes for explantation were dislocation/decentration in 145 cases (56.3%), incorrect lens power in 33 cases (12.8%), IOL opacification in 29 eyes (11.3%), neuroadaptation failure in 16 cases (6.2%), pseudophakic bullous keratopathy in 6 eyes (2.3%), endophthalmitis in 5 cases (1.9%), and "other causes" in 23 eyes (8.9%). Treatment after explantation was posterior chamber IOL implantation in 149 eyes (58%), anterior chamber IOL implantation in 49 eyes (19.1%), aphakia in 39 eyes (15.2%), and missing information in 20 cases (7.8%). Mean time from implantation to explantation was 3.97 (SD 4.68 [0.005-21.1]) years. Dislocation/decentration (most of the time with lens in the bag) is the main cause for explantation in Spain, followed by incorrect lens power (which decreased greatly over past years) and IOL opacification. Posterior chamber IOL implantation is the most elected treatment after explantation.

Bilateral spontaneous dislocation of posterior chamber intraocular lens in a patient with gyrate atrophy

We report a patient with gyrate atrophy, a rare metabolic disease, who had bilateral late spontaneous posterior dislocation of in-the-bag posterior chamber intraocular lens (PCIOL). He underwent pars plana vitrectomy, PCIOL retrieval and anterior chamber intraocular lens implantation in both eyes. This report may imply that patients with gyrate atrophy are at risk for spontaneous dislocation of intraocular lenses.

Comparison of clinical outcomes between iris‐fixated anterior chamber intraocular lenses and scleral‐fixated posterior chamber intraocular lenses in Marfan syndrome with lens subluxation

To compare the clinical outcomes in Marfan's with subluxated lens having phaco-emulsification with simultaneous scleral-fixated posterior chamber intraocular lens or iris-fixated anterior chamber intraocular lens implantation. Randomized case series in the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. Seventy-one eyes of 49 patients with Marfan syndrome with subluxated lens. This is a randomized case series of patients with Marfan syndrome and subluxated lenses who underwent phaco-emulsification combined with scleral-fixated posterior chamber intraocular lens or iris-fixated anterior chamber intraocular lens implantation. The evaluation indexes included the surgery time, best corrected visual acuity, intraocular pressure, aqueous flare and cells counts, corneal endothelium counts and complications. Increase in best corrected visual acuity in both groups was not significant. The aqueous flare and cells rose in both groups postoperatively. Significant difference between the two groups at 1 week postoperatively was found, whereas no statistically significant difference was found later. The loss rate of corneal endothelium cells in the scleral-fixated posterior chamber intraocular lens group was 13.2% and 19.5% at 3 months and 1 year postoperatively, which in the iris-fixated anterior chamber intraocular lens group was 13.3% and 19.3% (P > 0.05). Prolapse of vitreous was found in 21 cases intraoperatively. The posterior capsule opacification rate was 32% and 15%, respectively. The decentration of the intraocular lens was found in 19 eyes (48.7%) in the scleral-fixated posterior chamber intraocular lens group 1 year postoperatively, whereas none was found in the iris-fixated anterior chamber intraocular lens group. Iris-fixated anterior chamber intraocular lens after phaco-emulsification presented a safe, simple and efficient approach for managing subluxated lens in Marfan syndrome.