Anterior Chamber Intraocular Lens Research Articles

Comparative long-term outcomes of vitrectomy combined with anterior chamber intraocular lens to intra-scleral haptic fixation of posterior chamber intraocular lens

PurposeTo evaluate the long-term clinical outcomes in patients with combined pars plana vitrectomy (PPV) with anterior chamber intraocular lens (ACIOL) to intrascleral haptic fixation (ISHF) using the Agarwal technique with fibrin glue to secure the scleral flap of a posterior chamber intraocular lens.MethodsRetrospective, consecutive, single-center, comparative case series. 83 eyes were studied. Patients with < 8 months of follow-up were excluded. Detailed pre-, intra-, and post-operative complications were analyzed using mixed model univariate analysis and t-test. Pre- and post-operative best corrected visual acuity (BCVA) was analyzed.ResultsTwenty-five subjects met entry criteria. Mean age at time of surgery was 70.4 ± 17.7 years in the ACIOL group (n = 12) and 54.6 ± 21.1 years in the ISHF group (n = 13; p = 0.03). Mean follow-up was 38.2 months. Incidence of corneal decompensation was similar in the ACIOL and ISHF lens group (p = 0.93). There was no difference in the BCVA mean change or cystoid macular edema (CME) at the final visit between the groups (p = 0.47; p = 0.08), but there was a trend toward increased CME in the ACIOL group.ConclusionsPPV with concomitant placement of either ACIOL or ISHF lens result in improvement in BCVA. Both procedures are well tolerated and result in favorable outcomes with long-term follow-up though varying patient populations do not allow precise comparison between the two groups.

Anterior Chamber Intraocular Lens Implantation Versus Four-Flanged Scleral Fixation Technique for Patients With Loss of Capsular Support During Routine Cataract Surgery.

To compare the outcomes of anterior chamber intraocular lens (AC-IOL) implantation versus the four-flanged scleral fixation technique in eyes with loss of capsular support during routine cataract surgery. This was a retrospective cohort study of all patients in whom an IOL was implanted either during or after short-term aphakia due to loss of capsular and sulcus support in a routine cataract surgery with at least 6 months of follow-up time between 2015 and 2023 in a tertiary medical center in Israel. Two different IOL implantation techniques were compared: the implantation of an angle-supported ACIOL and four-flanged scleral fixation. Main outcome measures included postoperative complications such as pseudophakic bullous keratopathy, loss of intraocular pressure control and glaucoma, IOL subluxation, and retinal detachment. Sixty-five eyes of 65 patients were included in the study, 33 eyes in the AC-IOL group and 32 eyes in the flange group. Follow-up time was 29.92 ± 20.02 months in the AC-IOL group and 20.17 ± 15.56 months in the flange group (P = .087). Pseudophakic bullous keratopathy was observed in 10 (30.3%) patients in the AC-IOL group and in 1 (3.1%) patient in the flange group (P = .04). This association remained significant using survival analysis (P = .006). In 4 (12.1%) patients in the AC-IOL group, a glaucoma filtering procedure was performed to control the intraocular pressure compared with none in the flange group (P = .042). In the setting of loss of capsular support during routine cataract surgery, four-flanged scleral fixation showed an overall lower rate of complications and significantly reduced rate of subsequent surgical interventions. [J Refract Surg. 2024;40(8):e520-e526.].

Contact Lens-Assisted DMEK for Corneal Decompensation With an Anterior Chamber Intraocular Lens: A Novel Technique.

To describe a novel technique in which a contact lens was used to facilitate Descemet membrane endothelial keratoplasty (DMEK) in an eye with an anterior chamber intraocular lens (ACIOL). A 71-year-old man with a long-standing ACIOL developed bullous keratopathy. As the patient was at high risk of complications due to multiple ocular comorbidities, DMEK was performed with the ACIOL left in the anterior chamber. An inserted cosmetic contact lens was used as a platform for the graft unfolding. Partial graft detachment on the third postoperative day required rebubbling. This successfully cleared up the cornea after a few weeks. At the one-month follow-up, the uncorrected distance visual acuity improved to 20/50, with an endothelial cell loss of 35.2%. Steroid-induced ocular hypertension necessitated a trabeculectomy by the fifth postoperative month. At the sixth follow-up month, endothelial cell loss was 64%. Contact lens-assisted DMEK is a safe procedure for eyes with an ACIOL. However, good foresight is needed regarding whether the ACIOL should be kept or exchanged.

Retrospective Analysis of Negative Dysphotopsia After Cataract Surgery

&amp;lt;i&amp;gt;Purpose&amp;lt;/i&amp;gt;: To describe the incidence and characteristics of negative dysphotopsia (ND) as well as the risk factors contributing to it. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: For this retrospective study, data from patients who underwent cataract surgery between January 2018 and December 2019 at our department (Department of Ophthalmology, Hietzing Hospital, Vienna, Austria) was analyzed. A total of 8122 eyes had cataract surgery performed. Three different intraocular lenses (IOLs) have been used (EyeCee® One by Bausch + Lomb, TECNIS® by Johnson &amp; Johnson, HOYA Vivienx ™ by HOYA). Data from patients who postoperatively complained about ND as well as data from a gender and age-matched control group (34 eyes in each) was further analyzed: pupil size, axial length, anterior chamber depth, angle kappa, IOL power and other biometrical factors. The scotomas were depicted on a Harms tangent screen. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: An incidence of 1.99% of ND was found, of which 1.58% was transient and 0.42% persistent. The average duration of the symptoms was 5.40 (±6.15) weeks in the transient ND group. In the total cohort of 8122 eyes, there was no difference in the distribution of implanted IOL types or IOL power; neither played the surgeon a significant role in the development of ND. There was no significant difference between ND and control eyes regarding pupil size, axial length, and angle kappa. The anterior chamber was significantly shallower in the ND group: 5.1±0.58mm vs. 5.41±0.61mm (p=0.03). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: According to our findings, a shallower anterior chamber poses a risk to the development of ND.

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine &amp; quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients &amp; Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery &amp; had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary &amp; secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye &amp; PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size &amp; percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

VITREORETINAL OUTCOMES FOLLOWING SECONDARY INTRAOCULAR LENS IMPLANTATION WITH PARS PLANA VITRECTOMY.

Retrospective cohort study of 561 adult patients undergoing secondary intraocular lens (IOL) implantation by vitreoretinal surgeons at a single institution from April 2015 to December 2020. Patient historical factors, intraoperative/postoperative complications, and outcomes of IOL type (anterior chamber IOL versus scleral sutured IOL versus scleral fixated IOL versus. sulcus) were assessed. Primary outcomes were rates of postoperative retinal tears and rhegmatogenous retinal detachment. Secondary outcomes were rates of intraoperative endolaser, intraoperative retinal tear, and further IOL surgery. The incidence of intraoperative retinal tears was 7.3% and not significantly different between techniques. Rates of intraoperative endolaser use were 17.5% among all techniques and not significantly different between techniques. Rates of postoperative retinal tear were low (0%-2.7%). Rates of postoperative rhegmatogenous retinal detachment were not significantly different between techniques (anterior chamber IOL 9/198 [4.5%], SFIOL 1/54 [1.9%], scleral sutured IOL 14/274 [5.1%], sulcus 2/35 [5.7%], total 26/561 [4.6%], P = 0.79). Rates of repeat IOL surgery trended higher in sulcus lenses (anterior chamber IOL 5/198 [2.5%], SFIOL 4/54 [7.4%], scleral sutured IOL 16/274 [5.8%], sulcus 5/35 [14.3%], total 30/561 [5.3%], P = 0.12). Intraoperative endolaser use and intraoperative retinal tear are not uncommon in secondary IOL surgery and underscore the importance of careful vitreoretinal management among these patients.

Efficacy and safety analysis of scleral fixation intraocular lens implantation using the Yamane technique

Introduction: Cataract surgery technologies continue to manage complications. Current surgical methods for secondary Intra Ocular Lens (IOL) include Anterior Chamber IOL, Iris Claw IOL, and sutured and sutureless techniques of Scleral Fixation IOL (SFIOL). The Yamane technique of SFIOL is a novel, relatively safe, and easy method of sutureless SFIOL. This study aims to describe and analyze the surgical outcomes and complications of the Yamane IOL implantation technique. Methods: A retrospective study of 21 eyes of 21 patients that underwent scleral fixation of IOL by the Yamane technique was observed. Demographic data, primary indications for surgery, best corrected visual acuity (BCVA), intraocular pressure (IOP) pre-operative and post-operative during follow-up, and complications were also analyzed. Results: Twenty-one patients were included, with an average age of 52.57±23.41 years old. Eleven eyes with lens subluxation (52.4%), 9 eyes with aphakia (42.9%), and 1 eye with phacodonesis (4.8%) were indicated for the Yamane technique of SFIOL in this study. The preoperative mean BCVA was 2.2±0.9 LogMAR, while the 1-month postoperative BCVA was 1.1±0.9 LogMAR. The mean preoperative IOP was 15.81±6.7 mmHg, and the 1-month postoperative IOP was 16.00±7.7 mmHg. This study found that there was a significant improvement in BCVA with p=0.00 (p&lt;0.05), and there was no significant postoperative IOP spike with p=0.88 (p&lt;0.05). The main complications observed in this study were corneal edema (23.8%) and postoperative IOP spike (14,3%). Conclusion: The Yamane SFIOL technique is a relatively safe approach for the surgical management of patients who need secondary IOL implantation with significantly improved visual function without significant complications.

Comparative Analysis of Iris Claw Anterior Chamber Fixation Versus Suture less Intrascleral Intraocular Lens Implantation in the Management of Aphakia

Purpose: To determine the efficacy of iris claw anterior chamber fixation versus suture less intrascleral intraocular lens implantation in terms of visual recovery and complications during and after surgery. Method: The present prospective observational study was conducted in the Postgraduate Department of Ophthalmology at SMHS Hospital, Govt. Medical College, Srinagar over a period of one and half year. Results: A total of 30 patients were studied and divided equally into two groups with patients age ranging between 19-70 years with mean age of 49.5+17.41 years in iris claw anterior chamber IOL group and in suture less intrascleral fixated IOL group with age ranging between 24-70 years with a mean age of 51.9+15.94 years. Primary fixation of IOL was implanted in 8 (26.7%) patients, out of which 5 (33.3%) underwent iris claw anterior chamber IOL fixation and 3 (20%) patients underwent suture less intrascleral fixated IOL while the remaining 22 (73.3%) underwent secondary IOL.Mean preoperative BCVA improved from log MAR 0.78+0.251 in iris claw anterior chamber IOL to log MAR 0.85±0.241 in suture less intrascleral fixated IOL to log MAR {0.23±0.206 &amp; 0.18±0.191} in two study groups respectively. Eyes with iris claw IOLexperienced pigment precipates (73.3%) followed by ovalisation of pupil (26.7%) while as intraocular pressure (33.3%) followed by corneal edema (13.3%) and transient hypotony (6.7%) were seen in suture less intrascleral fixation of IOL. Conclusion: It was concluded that both irises claw anterior chamber IOL fixation and suture less SFIOL using flange are viable options for surgical correction of aphakia.

Pseudophakic Pupillary Block Following Cataract Extraction with Anterior Chamber Lens Implantation : A Case Report

Inteoduction : Pupillary block occurs when aqueous humor flow from posterior chamber to anterior chamber is obstructed by functional block between pupillary portion of iris and lens. It is relatively common when pupil is occluded by anterior chamber intraocular lens (IOL). This condition can lead to iris bombe, iridocorneal adhesion formation, increasing intraocular pressure (IOP), and optic nerve damage.&#x0D; Case Illustration : A 65-year-old woman came to local hospital with complaints of blurred left eye five days prior presentation. She had history of bilateral cataract surgery in 2013. On physical examination, BCVA was 6/6 on right eye and 1/300 on left eye. The IOP was 15. 3 on right eye and 31.5 on left eye. Slit lamp examination showed anterior chamber IOL on left eye, shallow camera oculi anterior (COA), no flare/cell, pupillary block was present, and no surgical iridectomy was found. She was previously given timolol 0.5% eye drop and added latanoprost 50 mcg eye drop, sodium chloride 4.4 mg- potassium chloride 0.8 mg eye drop for current therapy.&#x0D; Discussion : Pupillary block is a frequent complication of anterior chamber IOL implantation after cataract surgery. The anterior chamber in this patient was shallow, which indicates partial/total blocked aqueous flow from posterior chamber, causing an elevated IOP, and may disrupt optic nerve that cause decreased vision. Surgical iridectomy is suggested in high-risk procedures such as implantation of an anterior chamber IOL.&#x0D; Conclusion : Elevated IOP may cause visual dysfunction and damage to optic nerve. In cases of high-risk postoperative pupillary block, surgical iridectomy is suggested to prevent further complications

Chamber shallowing technique for challenging DMEK cases: Tucking cellulose spears under the speculum to augment posterior pressure.

Some anterior chambers do not readily shallow because of insufficient posterior pressure and/or very deep anterior chamber anatomy, which can make unscrolling descemet membrane endothelial keratoplasty (DMEK) tissue more challenging with an unmodified tap technique. We present a hands-free method for augmenting posterior pressure by temporarily tucking cellulose sponges under the blades of the eyelid speculum. The sponges transfer some of the eyelid speculum's weight onto the bulbar surface posterior to the iris, thereby indenting the sclera and causing the iris diaphragm to bulge further forward. This hands-free technique can transform a potentially challenging DMEK case into a more straightforward one by facilitating both a shallow anterior chamber and a bimanual unscrolling technique. However, it only works in bicameral eyes with a vitreous body (e.g., an eye with penetrating keratoplasty, vitreous syneresis, and axial myopia) and will not work in unicameral eyes after vitrectomy (e.g., an eye with an Anterior Chamber Intraocular Lens (ACIOL)).

Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus

Objective: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).&#x0D; Materials and Methods: A retrospective study was conducted at the Ophthalmology Department of Lahore General Hospital, Lahore between 2017 and 2022. The study included 51 patients (33 males and 18 females) between the age 35 to 85 years who were referred after a complicated phacoemulsification with dropped nucleus.&#x0D; Results: This study included 51 patients in which 33 were males (64.71%) and 18 were females (35.29%). All patients underwent 23-gauge pars plana vitrectomy. Posterior chamber phacofragmentation was carried out in 32 (62.75%) eyes while in remaining 19 (37.25%) patients vitrectomy cutter was used for the dropped nucleus. Out of 51, 06 (11.76%) patients received an anterior chamber IOL at the time of cataract surgery, 21 (41.18%) eyes had IOL in the ciliary sulcus, 07 (13.73%) had a posterior chamber IOL, and the remaining 17 (33.33%) patients were aphakic. Of these 17 aphakic patients, an anterior chamber IOL was placed at the time of vitrectomy in 07 (41.18%) patients who were judged to have inadequate capsular support for a posterior chamber lens. In the remaining 10 (58.82%) eyes, where capsular support was deemed adequate, a posterior chamber IOL was inserted. Final visual acuity was 20/40 or better in 34 (66.67%) eyes and 20/50 in 06 (11.76%) patients.&#x0D; Conclusion: Poor visual outcome after dropped nucleus at phacoemulsification cataract extraction can be avoided if managed by prompt pars plana vitrectomy as it offers the advantages of a closed system for vitrectomy and manipulation of the nucleus, an improved view of the posterior segment and facilitated recognition and management of intraoperative complications with better visual and anatomical outcomes with low rate of postoperative complications.

Comparison of 20% SF6 and 6% C3F8 Gas for Anterior Chamber Tamponade in Endothelial Keratoplasty.

The aim of this study was to compare the rates of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) between patients who had anterior chamber (AC) graft tamponade with 20% sulfur hexafluoride gas (SF6) and 6% perfluoropropane gas (C3F8). The charts of 431 patients undergoing EK from June 8, 2010, to April 16, 2023, were reviewed. Patients undergoing EK alone as well as combined procedures with cataract extraction and intraocular lens implantation were included. Eyes with tube shunts, anterior chamber intraocular lenses, and large peripheral iridotomy with posterior loss of bubble, and patients undergoing cyclophotocoagulation or synechialysis were excluded. All rebubble procedures were performed within 1 month after initial surgery. A total of 346 eyes using SF6 and 167 eyes using C3F8 were analyzed. Overall, 46 eyes (9%) required rebubbling; 33 eyes (10%) in the SF6 group and 13 eyes (8%) in the C3F8 group. For those patients undergoing DMEK, the odds of requiring rebubbling in the C3F8 group were about 22% lower than that of patients in the SF6 group (operating room [OR]: 0.782; P < 0.001). For patients undergoing DSEK, however, the gas type did not significantly affect rebubbling rates ( P = 0.99). For DMEK, utilization of 6% C3F8 as an AC tamponade was associated with a significantly lower odds of graft rebubbling compared with 20% SF6. Gas type did not result in a significant difference for DSEK. Utilization of 6% C3F8 for graft tamponade could be considered to reduce graft detachment rates in DMEK.

Retrospective analysis of negative Dysphotopsia after cataract surgery

Purpose: To describe the incidence and characteristics of negative dysphotopsia (ND) as well as the risk factors contributing to it.Methods: In this retrospective study postoperative results of 8122 eyes after cataract surgery were analysed. Three different IOLs have been implanted (EyeCee® One by Bausch + Lomb, TECNIS® by Johnson &amp; Johnson, HOYA Vivienx™ by HOYA). Following parameters were studied: pupil size, axial length, anterior chamber depth, angle kappa, IOL power and other biometrical factors. The scotomas were depicted on a Harms tangent screen.Results: An incidence of 1.99% of ND was found, of which 1.58% was transient and 0.42% persistent. The average duration of the symptoms was 5.40 (±6.15) weeks in the transient ND group. In the total cohort of 8122 eyes, there was no difference in the distribution of implanted IOL types or IOL power; neither played the surgeon a significant role in the development of ND. There was no significant difference between ND and control eyes regarding pupil size, axial length, and angle kappa. The anterior chamber was significantly shallower in the ND group: 5.1 ± 0.58 mm vs. 5.41 ± 0.61 mm (p = 0.03).Conclusion: According to our findings, a shallower anterior chamber poses a risk to the development of ND.

Short-term Visual Outcome Following Anterior Chamber Intraocular Lens Implantation—The Experience of a Rural Teaching Hospital

Purpose: To report the indications, frequency and short-term visual outcome of anterior chamber intraocular lens implantation (ACIOL) in a rural tertiary hospital; as well as to describe the reasons for poor visual outcome following ACIOL implantation. Methods: This was a retrospective descriptive study of all patients aged at least 18 years who underwent cataract extraction and implantation of ACIOL between January 2004 and May 2023. Information retrieved from the case records included preoperative visual acuity, indication for ACIOL implantation, first-day postoperative visual acuity, and 6 weeks postoperative visual acuity. Results: A total of 133 eyes of 126 patients were reviewed in this study. The mean age was 60.9 years, with a male-to-female ratio of 1.7:1. The most common indication for ACIOL use was a posterior capsular rent (70.7%). The first-day postoperative visual acuity was 6/18 or better in 7 (5.3%) patients, and by the sixth postoperative week, this proportion had increased to 28.6% (38 patients). The most common complication on the first day post-op was striate keratopathy (72.9%), while the most common at 6 weeks was pseudophakic bullous keratopathy (21.1%). Conclusion: Although complications were noted with the use of ACIOLs, improvement in visual acuity was observed at 6 weeks. ACIOLs may still be relevant in settings where automated vitrectomy equipment is not readily available, but the availability of expertize is required for its implantation and the complication profile of ACIOLs must always be taken into consideration.

Transient band keratopathy associated with epithelial ingrowth treated with antimetabolites

Introduction: To report a case of visually significant band keratopathy associated with ocular inflammation in the setting of epithelial ingrowth, both of which resolved after repeated antimetabolite treatments. Patient and Clinical Findings: A 74-year-old woman with a history of uveitis–glaucoma–hyphema syndrome after complicated cataract surgery presented with epithelial ingrowth in the right eye and diffuse central band keratopathy after posterior chamber intraocular lens (IOL) removal and pars plana vitrectomy and anterior chamber IOL placement. Diagnosis, Intervention, and Outcomes: After multiple intraocular injections of antimetabolites, the epithelial ingrowth and visually significant band keratopathy resolved. Conclusions: Treating the underlying source of inflammation, such as epithelial ingrowth with antimetabolites, was associated with clearance of the band keratopathy without further intervention.

Evolution of Scleral Fixation, Haptic Externalization and Tucking Techniques

Phakic rehabilitation poses challenges for patients without capsular support, making traditional intraocular lens (IOL) implantation difficult. In such cases, an Anterior Chamber (AC) IOL or a scleral-fixated posterior chamber IOL (SF-PC IOL) can be considered as options. To ensure a well-centered IOL, haptics should be away from the ciliary processes, iris, and oraserrata, with sufficient distance from the iris to prevent capture. Delayed IOL dislocation can occur due to suture breakage, but it can be prevented by proper IOL size and snugly opposing the stitched haptics into the ciliary sulcus.

Phakic intraocular Lens implantation in keratoconus patients.

Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases. To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards). No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1. pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.

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.