Anterior Subcapsular Opacities Research Articles

Ocular effects of Rho kinase (ROCK) inhibition: a systematic review.

Topical therapies targeting Rho-associated protein kinase (ROCK) signalling, including netarsudil (Rhopressa®) and ripasudil (Glanatec®), have become widely adopted as part of standard clinical practice to lower intraocular pressure (IOP) in patients with ocular hypertension or glaucoma. Given the pleiotropic roles of ROCK signalling, ROCK inhibition has the potential to cause unintended ocular side effects beyond IOP lowering in other substructures of the eye, both beneficial and deleterious. Additional experience and observation of patients treated with this class of medications have uncovered both new side effects not reported in the initial clinical trials, as well as potential benefits that have inspired off-label uses and that have been the topic of numerous clinical studies, case series, case reports, and translational studies. Here, we performed a comprehensive systematic review and identified 170 studies describing ocular effects of ROCK inhibition. In addition to describing well-established ocular effects associated with inhibition of ROCK signalling, such asconjunctival hyperaemia, corneal verticillata, and reticular corneal epithelial oedema, we also highlight other effects, such as corneal haemorrhages, changes in corneal contour, anterior subcapsular opacities, contact dermatitis, punctal stenosis, and eyelid wound dehiscence, which have been described in case series and case reports. Finally, we evaluated studies describing potential novel applications of ROCK inhibition for treating disorders affecting the cornea, the retina, and the optic nerve, finding strong evidence in support of a beneficial effect of ROCK inhibitors on corneal oedema due to corneal endothelial cell dysfunction. The other potential applications require further research.

Three-year outcomes of a novel toric intraocular lens implantation for moderate-high myopic astigmatism in phakic eyes

PurposeTo investigate the three-year visual, refractive outcomes and adverse events of the Eyecryl toric phakic IOL (pIOL) for moderate-to-high myopic astigmatism.MethodsThis retrospective study included eligible patients who underwent refractive surgery in one or both eyes with Eyecryl toric pIOL for myopic astigmatism. The efficacy, safety, predictability, rotational stability, vector analysis, and adverse events were evaluated in patients with spherical refraction from − 4.50 to -17.00 diopters (D) and cylindrical refraction from − 0.75 to -5.50 D.ResultsFifty-two eyes of 28 patients were included in the study. The mean efficacy and safety index were 1.12 ± 0.35 and 1.38 ± 0.42, respectively. The mean manifest refraction spherical equivalent was − 10.06 ± 2.69 D and − 0.64 ± 0.61 D preoperatively and postoperatively at 36 months, respectively. The mean manifest astigmatism was − 2.06 ± 1.16 D and − 0.44 ± 0.48 D preoperatively and 36 months postoperative, respectively. During the final examination, 70% of the eyes showed an increase in CDVA of one or more lines compared to their preoperative state. There was a cumulative endothelial cell loss of 3.1% at 36 months postoperatively. One eye developed visually significant anterior subcapsular opacity, whereas another eye experienced pIOL opacification.ConclusionThe Eyecryl toric pIOL demonstrated satisfactory visual acuity and refractive outcomes, as assessed by efficacy, safety and stability over a three-year period.

Transient anterior subcapsular vacuolar lens opacities after Tanito microhook trabeculotomy: report of six cases

ObjectiveTo present six cases exhibiting transient anterior subcapsular vacuolar lens opacities following early postoperative Tanito microhook trabeculotomy (TMH) performed by the same surgeon.MethodsSix patients who underwent lens-sparing TMH at Meizankai Shimizu Eye Clinic from November 2021 to May 2023, and developed anterior subcapsular vacuolar lens opacities postoperatively were reviewed. Detailed records of surgeries, follow-up findings were collected and reported.ResultsIn all six cases, anterior vacuolar subcapsular lens opacities were observed on the day after surgery, gradually decreasing without affecting visual acuity or contrast sensitivity. In all cases, without any specific interventions, the opacities disappeared by 21 months postoperatively.ConclusionAnterior subcapsular cataracts, characterized by a vacuolar appearance and transient existence, should be recognized as an early complication of ab interno glaucoma surgery, possibly linked to use of distributed ophthalmic viscosurgical devices and excessive anterior chamber irrigation leading to traumatic cataracts on the lens surface.

Ten-year follow-up of posterior chamber phakic intraocular lens with central port design in patients with low and normal vault.

To assess the clinical outcomes and postoperative complications of the implantable collamer lens (ICL) with a central port throughout 10 years of follow-up in patients with low and normal vault. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Retrospective and comparative case series. This study included eyes that underwent a V4c ICL implantation with 10 years of follow-up. The eyes were divided into 2 groups according to the vault at 1 year postoperatively: vault <250 μm and between 250 μm and 800 μm. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), vault, complications, and secondary surgeries were analyzed. 37 and 90 eyes were enrolled in the low and normal-vault groups, respectively. No differences in UDVA, CDVA, and refraction were found between the groups over 10 years of follow-up. No cases developed ICL-induced anterior subcapsular opacity over the follow-up period. 2 (5.4%) and 8 (8.9%) eyes in the low and normal-vault groups, respectively, required ICL exchange. 1 (2.8%) and 2 (2.2%) eyes in the low and normal-vault groups, respectively, required excimer laser to correct residual refractive error. The IOP remained stable throughout the 10-year follow-up. The loss in ECD from that preoperatively to 10 years postoperatively was 3.8% and 4.5% in the low and normal-vault groups, respectively ( P = .4). No pigment dispersion glaucoma or other vision-threatening complications were reported. This study shows good long-term outcomes of the V4c ICL, supporting that the central hole provides safety to the procedure and prevents the potential risk associated with low vault.

Lens Thickness in Atopic Cataract: A Case-Control Study.

To examine whether atopic cataracts are associated with thinner lenses. Department of Ophthalmology, Jikei University Hospital, Tokyo, Japan. Retrospective matched case-control study. A total of 31 eyes with atopic cataracts, 62 with non-atopic cataracts, and 31 without cataracts were analyzed. Each group was matched for age (± 4 years) and sex. The mean lens thickness (LT) was 3.76 ± 0.40, 3.94 ± 0.49, and 4.11 ± 0.40 mm in eyes with atopic cataracts, non-atopic cataracts, and normal lenses, respectively. Repeated-measures analysis of variance showed that the LT in the atopic cataract group was significantly thinner than that in the non-atopic cataract (P = 0.036) and normal lens (P < 0.001) groups. In multivariate logistic regression analysis, a thinner LT was negatively correlated with age (OR 0.91, 95% CI 0.86-0.96) and positively correlated with anterior subcapsular cataract (ASC) (OR 5.61, 95% CI 1.97-15.99). Atopy was not a significant factor. Twenty-four of the 62 eyes (38.7%) with non-atopic cataracts and 24 of the 31 eyes (77.4%) with atopic cataracts had ASC. The lenses of eyes with atopic cataracts were thinner than those of controls. Atopic cataracts frequently present with anterior subcapsular opacity, which is associated with lens thinning.

Lenticular hydrops in lenticonus: a new concept

A 25-year-old male patient presented with biopsy-proven Alport's syndrome with bilateral cataracts (history of unstable refractive error over past 6 years with recent-onset diminution of vision in either eye for the past 1 year; best-corrected visual acuities of 20/100 OD and 20/200 OS; (Fig. 1A, B). On optical coherence tomography the patient showed right eye lenticonus (Fig. 1C) with a communicating hyperreflectivity (fibrosed hydration track) between the anterior capsular and subcapsular opacities (Fig. 2A). The left eye showed a flatter anterior curvature with hyperreflective dots in the anterior chamber suggestive of leaked lens matter or low-grade inflammation (Fig. 1D) with volume loss in the anterior subcapsular region (Fig. 2B) and a localized area of capsular thinning (Fig. 2C). It was hypothesized that microruptures in the anterior capsule (secondary to thinning in the lenticonus) with aqueous hydration could have caused the bilateral cataract and lenticular volume loss in the left eye, thus called hydrops.

Anterior Subcapsular Cataract Formation With Long-term Topical Netarsudil Treatment for Glaucoma.

The purpose of this study was to describe anterior subcapsular cataract development in patients on long-term topical netarsudil use. This clinical observational study summarizes a similar cataract pattern demonstrated in a series of patients from a single physician practice and a university-based outpatient clinic during their routine clinical follow-up visits from October 2020 to August 2021. All patients have been using topical netarsudil once daily for at least 15 months. No anterior capsular changes have been observed in any patient at the time when netarsudil was initiated. Five eyes from 4 patients between the ages of 41 and 61 and 1 eye from a patient aged 84 were found to develop anterior subcapsular opacities 15 to 37 months after beginning netarsudil. These cataracts were overall small, 1 to 3 mm, round, oval or ring-shaped, central or paracentral with mild density. No other risk factors for cataract development apart from age were found in these patients. Patients on long-term netarsudil should be monitored for potential development of anterior subcapsular cataracts.

Long-term assessment of crystalline lens transparency in eyes implanted with a central-hole phakic collamer lens developing low postoperative vault.

To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia. Clinica Baviera, Madrid, Spain. Retrospective cross-sectional single-center study. Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 μm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation. The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 μm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 μm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group. Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Bilateral phacoemulsification and toric extended depth of focus intraocular lens implantation in Alport's syndromes

Alport syndrome is a hereditary disorder characterized by sensorineural deafness, renal disease, and ocular abnormalities, including anterior lenticonus with high refractive errors. We report a case of Alport's syndrome with bilateral anterior lenticonus that was submitted to phacoemulsification and toric extended depth of focus (EDOF) intraocular lens (IOL) implantation. A 49-year-old male patient presented with progressive bilateral visual loss for 10 years. His past medical history included a diagnosis of Alport's syndrome, with renal transplantation 20 years ago. The best-corrected visual acuity was 20/80 in the right eye and 20/63 in the left eye. Examination showed anterior lenticonus and anterior subcapsular opacities. Phacoemulsification and toric EDOF-IOL implantation were performed in both eyes. Capsulorhexis was challenging because of a highly elastic anterior capsule, which was aided by the use of a viscoadaptive ophthalmic viscosurgical device. The postoperative period was uneventful, with good refractive and visual outcomes.

Precision pulse capsulotomy in challenging cataract surgery cases.

PurposeTo evaluate the use of the precision pulse capsulotomy (PPC) device for challenging cataract surgery cases.Patients and methodsThis single-center retrospective case series study comprised of 43 eyes (from 35 patients) that were challenging cataract surgery cases with poorly dilated pupils, anterior subcapsular opacity, white cataract, brunescent cataract, and corneal opacity. This was conducted at the Busan Sungmo Eye Hospital (Busan, Republic of Korea) to assess the performance of the PPC device through a 2.2-mm clear corneal incision width, followed by the phacoemulsification technique and intracapsular intraocular lens fixation. The main outcome measurement was the anterior capsulotomy performance of the PPC device and the development of intraoperative complications. At postoperative 2 months, visual acuity, endothelial cell count, and refractive error were measured.ResultsNo cases of anterior capsule tears or tags occurred. All 43 eyes received circular, 360-degree, free-floating, and appropriately sized anterior capsulotomies. During 2 months of follow up, no postoperative complications occurred in association with the PPC device.ConclusionThe PPC device facilitated the creation of a precise, round, appropriately sized anterior capsulotomy in challenging cataract surgery cases. Further investigations are required to understand the long-term safety and efficacy of the PPC device.

Implantation of posterior chamber phakic intraocular lens for myopia and hyperopia – long-term clinical outcomes

To evaluate long-term refractive outcomes of implantable collamer lens (ICL) implantation and late postoperative complications. We assessed outcomes of patients who underwent ICL implantation (type ICM V4 for myopia, ICH V3 for hyperopia, TICM V4 for astigmatism) in our department between 1998 and 2013. It comprised 62 eyes (40 myopic and 22 hyperopic). The average follow-up period was 10.5 years. We evaluated: uncorrected and best-corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), ICL vault, endothelial cell density and late postoperative complications. In myopes, the average UCVA was 1.0±0.37 and BCVA 1.18±0.38, in hyperopes 0.78±0.19 and 1.14±0.18, respectively. The average SE in myopes, whose target refraction was emmetropia, was -0.6±0.83 Dsf, in hyperopes +0.73±0.93. Central ICL vault was 206.16μm±105.94, (range 10-427) in myopes, 195.5μm±109.09, (range 20-404) in hyperopes. The most common late postoperative complication was cataract formation. Three myopic eyes (7.5%) developed symptomatic anterior subcapsular opacities with loss of at least two lines of BCVA. Cataract significantly affecting visual acuity occurred in 5 myopic eyes (12.5%) and 2 hyperopic eyes (9.09%). In these eyes, ICL removal and cataract surgery was performed. In our experience, ICL implantation in moderate and high ametropia was effective and relatively safe. The most common late complication was cataract formation. This complication can be managed effectively surgically with good refractive outcomes without loss of BCVA.

The safety and stability of implantable collamer lens implantation for treatment of high myopia

Objective To evaluate the safety and stability of implantable collamer lens/toric implantable collamer lens(ICL/TICL)implantation for the treatment of high myopia by observing the intraocular pressure, corneal endothelial count, central vault, crystalline lens and retina of high myopia after implanting ICL/TICL. Methods By using prospective self-controlled comparison, 40 cases (80 eyes) with high myopia received ICL/TICL implantation in our hospital from January 2013 to February 2016 were enrolled. The intraocular pressure, corneal endothelial cells, central vault, crystalline and retina were observed before operation and 2 years after operation. All data were statistically analyzed. Results ⑴ Before operation and 2-hour, 1-day, 1-week, 1-month, 3-month and 6-month after operation, the average intraocular pressure were (16.2±2.4)mmHg, (21.1±3.5)mmHg, (19.7±2.7)mmHg, (17.5±1.9)mmHg, (16.9±3.1)mmHg, (16.0±2.8)mmHg, and (16.1±1.6)mmHg, respectively. There was no statistically significant difference (P>0.05). ⑵ Before operation and 1-month, 1-year and 2-year after operation, the corneal endothelial cells were (2 826.4±163.3)/mm2, (2 775.3±192.7)/mm2, (2 803.5±177.4)/mm2, and (2 783.2±169.8)/mm2, respectively. There was no statistically significant difference (P>0.05). ⑶ Before operation and 1-month, 3-month, 6-month, 1-year and 2-year after operation, the average central vault value were (0.56±0.19)mm, (0.57±0.16)mm, (0.53±0.12)mm, (0.55±0.15)mm, and (0.51±0.18)mm, respectively. There was no statistically significant difference (P>0.05). ⑷ Anterior subcapsular opacity in 1 eye at postoperative 6-month was observed, and did not develop thereafter. ⑸ There were no severe retinopathy in all eyes after operation. Conclusions ICL/TICL implantation is a good choice for the treatment of high myopia without any serious complications, and also maintain stable long term clinical effect. Key words: Myopia/SU; Phakic intraocular lenses

Urrets-Zavalia syndrome in different methods of keratoplasty.

Urrets-Zavalia was first described as a syndrome consisting of a fixed, dilated pupil with iris atrophy following penetrating keratoplasty (PKP) in 1963 and back then it was thought that this syndrome was only related to keratoconus patients[1]. Other findings that were not essential for the diagnosis were posterior synechiae, ectropion uvea, pigment dispersion, anterior subcapsular lens opacities and secondary glaucoma syndrome[1]. Subsequently, this syndrome was described after PKP for corneal dystrophy, deep anterior lamellar keratoplasty (DALK), descemet stripping endothelial keratoplasty (DSEK), goniotomy, laser iridoplasty, iatrogenic mydriasis and after implantation of phakic intraocular lenses[2]–[8]. The present study was undertaken to report the prevalence of Urrets-Zavalia syndrome in different methods of keratoplasty.

Outcomes of implantable collamer lens V4 and V4c for correction of high myopia - a case series.

To evaluate the visual outcomes and intraocular pressure changes after Visian Implantable Collamer Lens (ICL) implantation V4b and V4c (with centraflow technology) for correction of myopia. A prospective, consecutive, comparative interventional case series of V4b and V4c ICL implantation done for correction of high myopia (>-6 diopter D) in patients unsuitable for laser vision correction. The outcome measures that were evaluated included preoperative and postoperative uncorrected distant visual acuity (UDVA), best spectacle corrected distant visual acuity (CDVA), endothelial cell count (ECC), presence of lens opacification, intraocular pressure (IOP) and ICL vaulting. A follow-up of upto 1 year was done. A questionnaire was given at the end of follow-up period. A total of 30 eyes (24.56±4.8 years) underwent V4b ICL implantation (10 non-toric, 20 toric ICL-TICL) with intraoperative peripheral iridectomy (PI) and 34 eyes (26.13±3.8 years) had implantation of V4c ICL with centraflow (12 non-toric, 22 TICL). The mean preoperative manifest spherical equivalent (MSE) was 8.98±2.8 D and 9.24±2.4 D in the V4b and V4c groups respectively which reduced to postoperative values of -0.28±1.3 D and -0.19±1.18 D respectively. The mean preoperative astigmatism was -1.8±1.2 diopter cylinder (Dcyl) and -1.9±1.6 Dcyl which respectively reduced to -0.8±0.8 Dcyl and -0.9±0.3 Dcyl. At the end of 1 year follow up, mean ECC loss was 7.6% and 7.1%, mean vault was 583.12±231.12 μ and 602±241.24μ respectively in the V4b and V4c groups. Anterior subcapsular opacities were present in 6.66% and 2.94% of eyes with V4b and V4c groups respectively. Two eyes from both V4b (10%) and V4c (8.33%) had rotation of more than 30 degrees and required re-rotation surgery done successfully. Two eyes (6.66%) with V4b ICL implantation had high postoperative IOP (>35 mm Hg) and required Nd:Yag laser iridotomy later done with successful control of IOP. The safety indices were 1.12 and 1.15 and efficacy indices were 1.5 and 1.6 in the V4b and V4c groups respectively at the end of 1 year. The most common visual complaint was glare and haloes in 24% and 27% in the two groups respectively. However, they were not annoying enough to cause visual disability. Both V4b and V4c Visian ICL implantations are comparable in terms of visual outcome and safety profile for correction of high myopia. However, V4c ICL offers these advantages without the requirement of an additional PI.

Electric cataract: a report of two cases and a review of the literature

We report two cases of electrical cataract developing after a high-voltage electric shock. Both patients had undergone cataract extraction and posterior chamber intraocular lens implantation, both of them achieved visual acuity of 6/6. Most of the times outcomes after the cataract surgeries are excellent provided that other ocular structures are undamaged. Anterior subcapsular opacity may hamper the lens nutrition and lead to cataract formation.

Long-term visual outcome of congenital cataract at a Tertiary Referral Center from 2004 to 2014

PurposeTo assess the long-term visual acuity (VA) outcome after congenital cataract surgery at Imam Hossein Medical Center (Tertiary Referral Center) (2004–2014). MethodsIn this descriptive study, records of 120 patients with a history of congenital cataract surgery were studied. Those with traumatic, metabolic cataract, aged <5 years at the last visit who were not able to respond VA testing accurately and follow-up < 6 months were excluded. Cases with incomplete files were recalled and reexamined. Finally, the records of 42 patients (71 eyes) were included. ResultsIn this study, 20 males and 22 females with a mean age of 11.80 ± 6 years at their last visit were studied. Bilateral and unilateral cataract was seen in 69% and 31% of cases, respectively. Posterior and anterior subcapsular opacity was the most common (53.70%) and rarest (1.90%) type of congenital cataract, respectively. The mean age at the time of operation and surgical interval was 65 ± 66.6 (range: 1–200) and 12.9 ± 23.5 (range: 0–96) months, respectively. The most common method of refractive error correction was pseudophakia plus glasses (56.3%) with the mean best corrected visual acuity (BCVA) of 0.29 ± 0.28 LogMAR., The mean BCVA was 0.7 ± 0.53 LogMAR for aphakic patients correcting by glasses. In our study, amblyopia (56%), glaucoma (23.90%), and posterior capsular opacity (16.40%) were observed during their follow-ups on an average of 76 ± 65 months (median: 60, range: 6–240). Unilateral cataract, aphakia, nystagmus, female gender, and strabismus were risk factors of VA loss. ConclusionBased on our results, 56% of cases showed amblyopia. It could be due to late operation (especially in unilateral cases), longer surgical interval between two eyes, and no compliance of amblyopia therapy. Early detection through screening may reduce the rate of amblyopia. Refractive errors, visual acuity, amblyopia, glaucoma, posterior capsular opacity, and compliance of amblyopia therapy should be checked regularly at follow-up visits.

Implantable collamer lens V4b and V4c for correction of high myopia

PurposeTo evaluate the visual outcome and intraocular pressure changes after Visian Implantable Collamer Lens (ICL) implantation V4b and V4c (with central hole) for correction of high myopia. MethodsA prospective, consecutive, interventional comparative case series of V4b and V4c ICL implantation was done in high myopic patients who were unsuitable for laser vision. The main outcome measures studied were uncorrected and corrected distant visual acuity (UDVA, CDVA), ICL vault, intraocular pressure (IOP), endothelial cell count (ECC), and development of subcapsular lens opacities. The patients were evaluated at postoperative 1,3,6, and 9 months. ResultsA total of 62 eyes of 32 patients (24.56 ± 4.8 years) underwent V4b ICL implantation (21 non-toric, 41 toric ICL-TICL) with intraoperative peripheral iridectomy (PI), and 10 eyes of 5 patients (26.13 ± 3.8 years) had implantation of V4c ICL (4 non-toric, 6 TICL). The mean preoperative manifest spherical equivalent (MSE) was −9.98 ± 2.8 D and −9.14 ± 2.4 D in the V4b and V4c groups, respectively, which reduced to postoperative values of −0.24 ± 1.3 D and −0.2 ± 1.18 D, respectively. At the end of 9 months follow-up, mean ECC loss was 6.4% and 6.1%, mean vault was 573.13 ± 241.13 μ, and 612 ± 251.14 μ, respectively, in the V4b and V4c groups. Anterior subcapsular opacities were present in 6.9% and 3.14% of eyes with V4b and V4c groups, respectively. Four eyes from V4b (9.75%) and 1 eye from V4c (16.66%) had rotation of more than 30° and required realignment surgery, which was done successfully. Two eyes (3.22%) with V4b ICL implantation had high postoperative IOP (>35 mm Hg) due to blocked PI and required Nd:Yag laser iridotomy, which was done with successful control of IOP. The safety indices were 1.11 and 1.14, and efficacy indices were 1.4 and 1.5 in the V4b and V4c groups, respectively, at the end of 9 months. ConclusionICL implantation is a safe and effective surgery for correction of high myopia. Implantation of ICL with a central hole showed negligible postoperative IOP fluctuations without a peripheral iridectomy.

Correction of moderate to high hyperopia with an implantable collamer lens: medium-term results.

To evaluate the medium-term results of phakic posterior chamber implantable collamer lens implantation to correct moderate and high hyperopia. In this retrospective study, patients were treated for hyperopia with the Visian Implantable Collamer Lens (ICH model V3; STAAR Surgical AG, Nidau, Switzerland). Examined parameters were manifest refraction spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, vault, anterior chamber depth, anterior chamber angle width, endothelial cell density, intraocular pressure, patient satisfaction, and complications. The mean age of 15 patients (28 eyes) was 28 years (range: 18 to 36 years), with a mean follow-up period of 3.6 years (range: 3 to 6 years). The mean manifest refraction spherical equivalent decreased from +6.30 ± 1.42 diopters (D) (range: +4.25 to +8.50 D) preoperatively to -0.37 ± 0.56 D (range: -1.25 to +1.00 D) at 3 years postoperatively. The mean uncorrected distance visual acuity improved from 0.77 ± 0.38 logMAR (range: 0.16 to 1.30 logMAR) to 0.20 ± 0.17 logMAR (range: 0.00 to 0.48 logMAR) at the 3-year follow-up. Postoperatively, 62% of eyes gained one line of corrected distance visual acuity or remained unchanged. The mean vault reduced from 367.1 ± 253.6 μm (range: 70.0 to 1,190.0 μm) at 1 month postoperatively to 283.6 ± 210.0 μm (range: 75.0 to 915.0 μm) at the last follow-up visit (P = .005). The mean preoperative anterior chamber depth and anterior chamber angle width also decreased at the last follow-up visit (P = .037 and < .0001, respectively). The mean endothelial cell loss was 4.91% (P = .089). No serious complications occurred. Thirteen (87%) patients were satisfied with the outcomes and no patient was dissatisfied. Implantation of a posterior chamber implantable collamer lens is a safe, effective, predictable, and stable method for the correction of moderate and high hyperopia in highly selected patients. No case of cataract or anterior subcapsular opacities formation was recorded in relation to the decrease of vault over the studied period and low vault in some eyes.

Spontaneous Resolution of Extensive Descemet Membrane Detachment Caused by Sodium Cyanide Injury to the Eye

To describe the clinical course, ultrasonographic and confocal microscopic findings in a patient who developed a large Descemet membrane (DM) detachment that resolved spontaneously after ocular sodium cyanide injury. Case report. The patient presented with severe corneal stroma edema, a large detachment of DM, iritis, and anterior subcapsular lens opacity in the left eye caused by contact with 5% sodium cyanide. The ultrasound biomicroscopic and in vivo confocal microscopic examination exhibited the configuration of the DM detachment and extensive damage of corneal cells. Although no viable endothelial cells were observed with in vivo confocal microscopy, the DM spontaneously reattached 11 days after injury, coincident with increased intraocular pressure. However, persistent corneal edema and iris atrophy were observed 6 months after DM reattached. Sodium cyanide can cause severe injuries to the cornea and the anterior segment. Extensive DM detachment may resolve spontaneously despite the absence of viable endothelial cells.

Straylight value depending on the location of lens opacity and utility of straylight measurement in deciding cataract surgery

Abstract Purpose To evaluate the difference of straylight value depending on the location of lens opacity and to study whether the straylight measurement is useful in deciding the surgery of early cataract. Methods 139 cataractous eyes were classified into posterior subcapsular opacity type, anterior subcapsular opacity type and diffuse nucleosclerosis type. Straylight values of each groups were measured. Straylight values of 28 patients(28 eyes) who complained visual disturbance despite good visual acuity were measured and compared with 28 control eyes. Postoperative straylight values and best corrected visual acuities of 28 patients were measured and compared with the preoperative values. Results Posterior subcapsular opacity group showed significantly high straylight values(p=0.000). Mean straylight values of 28 eyes(28 patients) and 28 control eyes were 2.04±0.91 and 1.56±0.29 respectively(p=0.002). This was well matched to the difference of self‐reported visual quality scores of each group(45.1 points and 29.8 points). Postoperative straylight values decreased significantly than preoperative straylight values(p=0.000) in 28 patients. Self‐reported visual quality was well related to the decrease of straylight values(from 45.1 points to 28.2 points). Conclusion Straylight value was significantly high in posterior subcapsular lens opacity. Straylight is found to have added value for visual quality assessment and it can be useful to determine the time of cataract surgery in early cataractous eyes.