Artificial Intraocular Lens Research Articles

CHANGES IN THE VISION OF ADULT AMBLYOPIC PATIENTS FOLLOWING CLEAR LENS EXTRACTION.

The aim of the study was to retrospectively evaluate changes in vision after the implantation of trifocal (tIOL) or rotationally asymmetric multifocal artificial intraocular lenses (mIOL) in patients undergoing clear lens extraction. The main goal was to determine whether changes to central visual acuity occur after the implantation of an IOL at a follow-up examination after one year. Other objectives were to determine the difference between the groups with implanted diffractive and rotationally asymmetric artificial intraocular lenses, as well as to evaluate the risk of accurate correction in patients who had lived most of their lives "undercorrected". In our study, we present a retrospective longitudinal evaluation of results in patients after the implantation of an artificial intraocular lens. In the period from 2013 to 2020, we evaluated changes in the vision of 22 patients aged 39-59 years, of whom 18 were women and 5 were men. The average preoperative refraction of myopic eyes was +5.7 ±2.13 Dsf and +1.24 ±0.86 Dcyl. In amblyopic eyes, 7 diffractive lenses and 15 rotationally asymmetric lenses were used. Uncorrected distance visual acuity before surgery and one year (1Y) after was 0.13 ±0.09 vs. 0.57 ±0.28 (p < 0.001); the best corrected distance visual acuity before and 1Y after was 0.53 ±0.22 vs. 0.62 ±0.29 (p = 0.024); uncorrected near visual acuity before and 1Y after was 0.06 ±0.06 vs. 0.48 ±0.32 (p < 0.001); the best corrected near visual acuity before and afér the surgical procedure was 0.45 ±0.27vs. 0.55 ±0.35 (p = 0.014). Implantation of tIOL and mIOL lenses was effective in our group of patients with amblyopia, thus improving uncorrected distance and near visual acuity and without serious adverse effects. At the same time, we evaluate that the change in refraction and the removal of anisometropia lead to a significant change in the best corrected visual acuity for distance or near vision at the one-year follow-up examination.

Assessment of the Effectiveness of Glaucoma Treatment Using MicroPulse Transscleral Cyclophotocoagulation in Patients with Glaucoma Who Have Previously Undergone Vitreoretinal Surgery.

This retrospective study aimed to assess the effectiveness of using MicroPulse transscleral cyclophotocoagulation (µP-TSCPC) in patients who had previously undergone pars plana vitrectomy (PPV), depending on the endotamponade used. For the study, a total of 60 patients were enrolled who underwent PPV followed by tμP-TSCPC as a result of an increase in intraocular pressure (IOP) over the norm of 21mmHg. In this group of patients, 20 received silicone oil endotamponade during PPV, 20 received sulfur hexafluoride gas SF6, and in another 20 a differentiated balanced salt solution (BSS) was used. The main indications for conducting PPV were (1) retinal detachment (silicone oil endotamponade was used; n = 12); (2) dislocation/subluxation of the patient's own or artificial intraocular lens (balanced salt solution (BSS) endotamponade was used; n = 11); (3) the presence of an epiretinal membrane and/or a macular hole (BSS endotamponade was used; n = 9, or SF6; n = 20); and (4) hemorrhage into the vitreous chamber (silicone oil endotamponade was used; n = 8). The choice of endotamponade used during PPV was not found to determine the effectiveness of µP-TSCPC treatment. The effectiveness of µP-TSCPC in patients after PPV depended, above all, on the etiology of the disease, for which PPV was previously performed. The lowest effectiveness of µP-TSCPC was noted in cases where the reason for conducting PPV was hemorrhage into the vitreous chamber and silicone oil endotamponade was used, while the highest effectiveness was noted in cases where PPV was conducted owing to the presence of an epiretinal membrane and/or a macular hole and SF6 endotamponade was used.

Spectral transmittance of animal intraocular lenses in comparison with the spectral properties of their biological lenses.

To determine the spectral transmittance of artificial intraocular lenses (IOLs) designed for various species (dog, cat, chinchilla, eagle, tiger) and compare them to the spectral properties of the biological lenses of these species. Twenty-seven IOLs were scanned with a spectrophotometer fitted with an integrating sphere. All IOLs transmitted long wavelengths well before cutting off sharply at short wavelengths, with insignificant transmission below ca. 340 nm. In comparison with the IOLs, the biological lenses of the cat, dog, and probably the chinchilla transmitted significantly more short wavelengths. The spectral properties of the biological lenses of eagles and tigers, while uncertain, may be a closer match to the IOLs made for these species. It is not known if there are any visual or behavioral consequences for animals caused by a mismatch between the spectral properties of their biological lenses and IOLs. However, following IOL implantation there might be a change in the perceived hue of objects due to the removal of UV wavelengths which form a normal part of the visible spectrum for these species and/or a decrease in sensitivity.

Physics-aware learning and domain-specific loss design in ophthalmology.

The human cataract, a developing opacification of the human eye lens, currently constitutes the world's most frequent cause for blindness. As a result, cataract surgery has become the most frequently performed ophthalmic surgery in the world. By removing the human lens and replacing it with an artificial intraocular lens (IOL), the optical system of the eye is restored. In order to receive a good refractive result, the IOL specifications, especially the refractive power, have to be determined precisely prior to surgery. In the last years, there has been a body of work to perform this prediction by using biometric information extracted from OCT imaging data, recently also by machine learning (ML) methods. Approaches so far consider only biometric information or physical modelling, but provide no effective combination, while often also neglecting IOL geometry. Additionally, ML on small data sets without sufficient domain coverage can be challenging. To solve these issues, we propose OpticNet, a novel optical refraction network based on an unsupervised, domain-specific loss function that explicitly incorporates physical information into the network. By providing a precise and differentiable light propagation eye model, physical gradients following the eye optics are backpropagated into the network. We further propose a new transfer learning procedure, which allows the unsupervised pre-training on the optical model and fine-tuning of the network on small amounts of surgical patient data. We show that our method outperforms the current state of the art on five OCT-image based data sets, provides better domain coverage within its predictions, and achieves better physical consistency.

Freeform Surface Lens Design Using Genetic Algorithm with Acrylic Material for Reducing Aberrations in Multifocal Artificial Intraocular Lens to Enhance Image Sensing Quality

Freeform Surface Lens Design Using Genetic Algorithm with Acrylic Material for Reducing Aberrations in Multifocal Artificial Intraocular Lens to Enhance Image Sensing Quality

USE OF A FEMTOSECOND LASER IN CATARACT SURGERY.

Cataracts continue to be the leading cause of blindness worldwide. Phacoemulsification is the gold standard in the treatment of cataracts. The aim of the study was to compare the postoperative results of the phacoemulsification technique in comparison with femtosecond laser-assisted cataract surgery (FLACS). Our work retrospectively evaluates the results of patients after implantation of an artificial intraocular lens for cataract from May 2017 to March 2019. The study evaluated a total of 80 implanted lenses in 47 patients operated on by two surgeons. Of the 47 patients, 28 were women. The mean age in the group at the time of surgery was 63.7 years, ranging from 34-79 years. Patients could choose FLACS (n = 45) surgery or standard phacoemulsification procedure (n = 35). Upon a comparison of the group regarding uncorrected distal visual acuity (UCDVA) up to 12 months after surgery, the group FAKO CATARACTS recorded 0.85 ±0.18 vs. 0.93 ±0.12 in the FEMTO CATARACTS group (p = 0.021), comparably uncorrected near visual acuity (UCNVA) was 0.77 ±0.18 vs. 0.84 ±0.17 (p = 0.034) respectively. A difference in the use of phacoemulsification energy (OZIL) was measured in patients with phacoemulsification 3.5 ±3.1 and in the use of femtosecond laser 2.2 ±3.1, (p = 0.005). In all cases, an AT LISA 839 trifocal lens (Carl Zeiss Meditec, Germany) was implanted. The femtosecond platform assists the surgeon in cataract surgery with capsulorhexis and pre-fragmentation of the lens nucleus, which can be advantageous especially for complicated cataracts. We recorded significantly higher uncorrected distance and near visual acuity in the FLACS group, and also a significantly lower value of the phacoemulsification energy used.

Vitrectomy in Lens and Glaucoma Pathologies

Pars plana vitrectomy (PPV) is currently used as an effective method in many posterior segment pathologies. Although the most common indication is retina and vitreous pathologies, PPV is also preferred in some cases associated with lens and glaucoma. In case the crystalline lens or artificial intraocular lens, which is a product of industrial development, falls into the vitreous, it is essential to remove it mostly with the PPV approach. In some types of secondary glaucoma, especially malignant glaucoma, successful results are obtained in terms of visual prognosis and complications with vitreoretinal surgery techniques.

Complications of Cataract Surgeries and Implantation of Intraocular Lens

A cataract is described as the opacification of the lens. A cataract is the clouding of the lens. A cataract is also described as any opacification in the lens. Because of this, there's lower withinside the imaginative and prescient. Cataract surgical procedure is the maximum conventional surgery in evolved countries. Cataract maximum not unusual place motive of blindness in growing countries. In the presence of suitable capsular aid, cataract surgical procedure with phacoemulsification with intraocular lens (IOL) insertion withinside the capsular bag is the gold standard. Cataract surgical treatment is one of the most customarily carried out surgical procedures withinside the globe. It's additionally one of the maximum historic. Improvements in intraocular lens alternative technology have followed breakthroughs in cataract surgical techniques. Cataract surgical treatment is one of the best remedies in medicine. Cataract surgical operation has an extended record courting returned lots of years. Initially, the surgical procedure changed into done with crude running skills, resulting in a lack of a huge range of eyeballs. With the development of running tactics and devices throughout the mid-20th century, numerous intracapsular cataract extraction remedies have become used. From the second 1/2 of the 20th century, artificial intraocular lenses' advent and significant utilization caused the rediscovery and refinement of the extracapsular cataract extraction method. Modern cataract surgical procedure has stepped forward to refractive cataract surgical procedure, which lets the doctorate alter the final refractive results for every patient. Postoperative refractive mistakes have reduced dramatically due to advances in optical biometry and contemporary intraocular lens (IOL) calculation algorithms, but residual astigmatism is difficult for each surgeon and sufferer and might bring about symptomatic impaired visual performance. Cataracts are not typically because of aging. The signs of cataracts range primarily based on the kind of cataracts and the patient's way of life and visible needs. In the industrialized global, cataract surgical procedure is accomplished while the advantage of putting off signs and symptoms overcomes the little dangers related to a modern-day surgical operation. After the surgical procedure, 85-ninety percent of sufferers have to see simply sufficient to conform with maximum riding necessities in maximum nations. Cataracts usually expand over time, resulting in innovative, imaginative, and prescient loss that cannot be corrected with glasses. Blurry imaginative and prescient, issue studying in low mild, night time imaginative and prescient impairment, glare and halos round lights, or even double imaginative and prescient are all symptoms to appear out for. Other symptoms and symptoms of cataracts in adults over fifty-five are common modifications in eyeglass prescriptions and the capacity to study without analyzing glasses.

Cataract inhibitors: Present needs and future challenges

Cataracts result from opacification of the ocular lens and represent the leading cause of blindness worldwide. After surgical removal of the diseased lens material and implantation of an artificial intraocular lens, up to 50% of cataract patients develop a secondary lens defect called posterior capsular opacification (PCO). While vision can be restored in PCO patients by a laser-mediated capsulotomy, novel therapies involving inhibition of aldose reductase are now being developed to prevent PCO development and complications of laser capsulotomy. A question we wished to address was whether cataract surgeons believe there is an unmet need for a preventative PCO therapy, whether they would prescribe such a therapy were it available, and to assess their perceptions regarding the benefits of and obstacles to adopting novel PCO therapies in the place of laser capsulotomy. We gathered perspectives from adult, pediatric, and veterinary cataract surgeons using an online questionnaire. From 161 surgeon responses, we found that the majority of adult, pediatric, and veterinary cataract surgeons (78% n = 35, 88% n = 37, and 96% n = 71 respectively) believed there is an unmet need for preventative PCO therapy, with more than 95% expressing interest in incorporating such therapy into surgical protocols. Perceived benefits included optimizing visual outcomes, avoiding the need for additional procedures, eliminating complications related to neodymium:yttrium-aluminum-garnet laser, preserving the posterior capsule particularly in patients receiving multifocal intraocular lens implants, providing a viable solution for PCO in animals, and using it in developing countries that lack access to neodymium:yttrium-aluminum-garnet lasers. Perceived obstacles included potential lack of reimbursement by insurance companies, and the need for strong efficacy and safety profiles. Among adult surgeons, 70% (n = 31) indicated that preventative PCO therapy could add value to premium intraocular lens packages. Our studies revealed that cataract surgeons overwhelmingly support the development of preventative PCO therapy, and that clinical trials will play a critical role to test the safety and efficacy of specific therapeutic agents.

The Role of Trace Elements in Retinal Diseases

Background: The role of serum zinc, and magnesium concentration activities in association with the Blood sugar level, and their link as biochemical marker risk for lens damage, inflammation, for the Retinal disease patients with diabetes beside lens replacement surgery, and in control individuals for both genders. Our purpose for the current study is to investigate serum concentration levels of blood sugar, zinc, and magnesium, as trace elements for patients with retinal diseases with diabetes in correlation with healthy subjects, and their effect on eye function, lens damage, inflammation, and bacterial or viral infections, or even undergo artificial intraocular lens surgery. Also to find a diagnostic prediction for blood sugar, magnesemia and zinc levels may induce causing diabetes retinopathy, cataract, or even glaucoma. Materials and methods: Total of forty six diabetic retinopathy patients their mean is (53.36±16.3), and thirty four healthy controls with mean of (49.91±21.72) have been studied. The age has non-significantly (P>0.05) differ in diabetic retinopathy patients (53.36±16.31 year) from normal subjects (49.91±21.72 year). Retinal disease patients are diagnosed on the basis of pathological condition into diabetic retinopathy patients. Results: Assessment, of serum zinc, and magnesium, and blood glucose levels were done for all groups. The concentricity of serum zinc levels are depressed, and non-significantly differ for diabetic retinopathy patients, higher in (33±19.48 ng/L with P= 0.122), from that of normal subjects. Whilst the level of magnesium was exhibited to be decreased for diabetic retinopathy patients, they showed (1.74±0.34 ng/L with P = 0.390) from that of normal subjects. Moreover, blood sugar levels are increased in diabetes than control (10.27±4.62 μmol/L versus 5.23±0.40 μmol/L with P = 0.0001). All parameters has are correlated non-significantly association with each other for diabetic retinopathy patients.

Biochemical Parameters Determination for Prognosis of Retinal Diseases and their Relationship to Cataract, Diabetes and Hypertension Patients in Ibn Al-Haytham Hospital in Baghdad-Iraq

The role of serum retinol activity in association with the Blood sugar level, and their link as biochemical marker risk for lens inflammation and damage stage under pandemic, for the Retinal disease patients with cataract, hypertension, and diabetes, and in healthy for both genders. Total of seventy-five patients and thirty healthy control have been studied. Retinal disease patients were subdivided on the basis of pathological condition into three subgroups (First group was cataract, second was hypertension, and the third group was diabetes. Assessment, of serum retinol activity, and blood glucose levels were done for all groups. The concentricity of serum retinol levels is decreased in diabetic patients than control (13.147±7.195 (μmol/L) with 21.930±16.241 (μmol/L) versus P = 0.011)), while for cataract patients, they showed extremely similar concentricity of serum retinol levels to healthy (20.760±15.941 (μmol/L) with P = 0.790), whilst the retinol-activity was exhibited to be higher in hypertension patients (24.190±21.972 (μmol/L) versus P = 0.663). retinol activity is correlated significantly negatively with both diabetic patients and cataract. Moreover, blood sugar levels are increased in diabetes than control (10.256±4.119 (μmol/L) versus 5.365±1.084 (μmol/L) with P = 0.0001), in comparison with cataract (5.288±0.9560 (μmol/L) with P = 782). The retinol levels are correlated significantly negatively for diabetic and cataract patients. The purpose of this work: is to investigate association between retinal diseases with cataract hypertension & diabetes for risk of fasting at least eight hours in Ramadan and out of Ramadan time, and directly pre surgery gets started by artificial intraocular lens, and by estimation of retinol and blood sugar concentrations.

Predicting Spatial Displacement Based on Intraocular Image Design Using Convolution Neural Network – Preliminary Findings

The main global cause for blindness is due to cataract. The common treatment for cataract is to have the cloudy natural lens to be removed and replace with an artificial intraocular lens (IOL). Success in the post cataract surgery depends on the design and quality of the IOL implanted on the eye. ISO11979-3 is the standard adhered to by many lens manufacturers, to test the mechanical stability of their lenses that were produced. This compression test experiments on the lab are very costly and time consuming. Alternatively, we propose to use the convolution neural network (CNN) to predict the spatial displacement response based on the intraocular image designs. Due to limited number of images in the datasets, data augmentation was performed to tranform these images and increase the sample size to 240. On top of this, the ResNet-50 deep learning network architecture was utilized to transfer the learning done on over millions of images. The final RMSE value for the training set, validation set and testing set were at 0.47mm, 2.93mm and 2.92mm respectively. The model predictabillity is well within the range recommended by the standard between 0.15 to 1.98 mm.

In vivo study on the performance of therapeutic intraocular lens loaded with an antibiotic and an anti-inflammatory

Introduction Cataract treatment usually involves surgery for substitution of the opacified eye lens by an artificial intraocular lens (IOL). In the post-operatory period, antibiotics and anti-inflammatories eye drops are prescribed to prevent endophthalmitis that may occur due to bacterial infection and results in serious complications [1,2]. This drug delivery method leads to a low bioavailability of the drugs due to the ocular clearance and absorption mechanisms. Furthermore, since it requires frequent administrations, it is uncomfortable for patients and it may lead to a low compliance. Drug-loaded intraocular lenses (IOL) have been explored as potential drug release vehicles due to their prolonged time of contact with the eye and constitute a promising alternative to eye drops [3]. The main goal of this work is to evaluate the in vivo performance of dual drug-loaded IOLs containing an antibiotic and an anti-inflammatory. Materials and methods An antibiotic, moxifloxacin (MXF), and an anti-inflammatory, ketorolac (KTL) were loaded in commercial acrylic IOLs by soaking in drug solution containing the two drugs (5 mg/mL each drug) at 60 °C for 2 weeks. The effect of the drug loading on lenses properties such as the swelling capacity, optical properties (transmittance) and mechanical properties (Young’s modulus) was evaluated. After sterilisation, the drug loaded lenses were used for in vitro drug release tests, carried out in sink conditions (PBS, 3 mL, 36 °C, 180 rpm) and in vivo experiments with rabbits. A mathematical model was applied to the in vitro results to predict the in vivo concentrations. In the in vivo tests, the lenses were implanted into the right eye of 5 Japanese rabbits. No eye drops were administered in the post-operatory period. To evaluate ocular inflammation, slit-lamp examinations were done on the days 1, 3, 7, 14 and 21. On the day 21 the animals were anaesthetised and killed humanely with air embolism. The eyes were enucleated for histological investigation, in particular the cornea and the iris were separated, sectioned with a cryostat and stained following the haematoxylin and eosin staining. Results and discussion It was found that the presence of drugs increases the swelling capacity of the lenses, slightly decreases the Young’s modulus and does not affect the transmittance in the range 500–700 nm. In vitro tests show that the lenses are able to release both drugs in a sustained way. The mathematical model indicates that the in vivo concentration of MXF should be higher than the minimal inhibitory concentration (MIC) of Staphylococcus aureus and Staphylococcus epidermidis (two of the most common bacteria responsible for endophthalmitis), for at least 15 days and that the concentration of KTL stays above half maximal inhibitory concentration (IC50) of cyclooxygenase 1 (and cyclooxygenase 2 (2 enzymes responsible for inflammation) for 16 days. In the in vivo tests, the slit-lamp examinations demonstrated that after 7 days no inflammation was present on the eyes of the rabbits. The histological evaluation proved good biocompatibility of the double loaded lenses. Conclusions The double loaded lenses revealed to be promising devices for the post-cataract surgery prophylaxis, complying with both antibiotic and anti-inflammatory therapeutic needs.

Jagat and Bala intraocular lens supporting system: An artificial platform for intraocular lens implantation in an aphakic patient with inadequate capsular support.

We describe a novel device, Jagat and Bala Intraocular lens Supporting System (JBISS), an artificial Intraocular lens (IOL) platform that facilitates IOL fixation in an aphakic patient with poor capsular support and also facilitates IOL exchange in case of myopic shift or refractive surprise. Implantation of JBISS along with IOL was carried out in four patients and results are promising without any adverse events.

Uncommon severe blunt ocular injury associated with large retinal dialysis caused by a fishing sinker

Introduction. Severe ocular injuries caused by fishing equipment are relatively rare. The visual prognosis for fishing-related injuries depends on the involved ocular structures, the presence of complications, and surgical techniques applied. Case outline. A 40-year-old man reported a sudden severe sharp pain and a loss of vision in his left eye while he was pulling the fishing rod during recreational fishing. At admission, his best corrected visual acuity (BCVA) of the left eye was 1/60. Clinical examination revealed a laceration in the temporal quadrant of the bulbar conjunctiva 0.2?0.3 mm in size and a dark tumefaction under the conjunctiva in the same region. It was identified during primary surgical exploration as a fishing sinker 1 cm in size lodged under the lateral rectus muscle. The bulbar wall was intact and the fishing sinker was safely removed. Phacoemulsification with the implantation of an artificial foldable intraocular lens and 23G pars plana vitrectomy were performed. During vitrectomy, subretinal hemorrhage in the macular region and large retinal dialysis in the temporal segment were revealed. Vitrectomy was finished with silicone oil tamponade. One week later, the patient?s BCVA of the left eye was 2/60. Eight months after surgery, spontaneous resorption of subretinal hemorrhage in the macular region and the attached retina was observed. The patient?s BCVA was 3/60 due to the destruction of photoreceptors and retinal pigment epithelium and the formation of epiretinal membrane. Conclusion. To our knowledge, this is the first case report of a severe blunt ocular injury associated with large retinal dialysis caused by a fishing sinker.

Enhanced PCO prevention of drug eluting IOLs via endocytosis and autophagy effects of a PAMAM dendrimer.

Drug-loaded intraocular lenses (IOLs) have received considerable attention in treating complications that arise after cataract surgery, especially posterior capsular opacification (PCO). However, for a better therapeutic effect, the drug concentration in IOLs usually needs to be increased. Herein, we developed multilayer (doxorubicin (DOX)@polyaminoamide (PAMAM) (D@P)/heparin sodium (HEP))5 modified IOLs, which efficiently enhance the inhibitory effect on PCO using the enhanced autophagy effect of a cationic PAMAM. The chemotherapeutic drug DOX was encapsulated in PAMAM to formulate cationic DOX@PAMAM nanoparticles. Subsequently, negatively charged HEP and D@P nanoparticles (NPs) were assembled on the aminated artificial IOL surface using the layer-by-layer (LBL) assembly technique. The (D@P/HEP)5 IOLs were implanted into rabbit eyes to evaluate the prevention of PCO. In vitro and in vivo research studies showed that the D@P NPs exhibited enhanced cellular uptake owing to the cell-penetrating cationic characteristics, while demonstrating enhanced autophagy. D@P NPs are more effective at the same DOX concentration when compared to free DOX. Multilayer-modified (D@P/HEP)5 IOLs can efficiently inhibit PCO after cataract surgery. This study provides a strategy for improving the therapeutic effect of antiproliferative drug DOX by using a cationic dendrimer, which, in turn, increases the level of autophagy of cells. These LBL-based multilayer IOLs have broad application prospects in the treatment of complications after cataract surgery.

Surgical Management for Silicone Oil Barrier of Traumatic Aniridia with Aphakia: Suturing of Temporary Iris-Diaphragm Prior to Final Iris-Lens-Diaphragm Implantation.

PurposePatients with traumatic aniridia, aphakia and retinal complications can require silicone oil endotamponade. In the absence of compartmentalization, there is a risk of silicone oil migrating to the anterior chamber which can cause long-term complications. We report a two-step procedure in trauma cases, using sutures for silicone oil retention in primary care and subsequently prior to secondary artificial iris (AI) and intraocular lens (IOL) implantation, to achieve a reconstruction of the anterior and posterior chamber.Material and MethodsSeven patients with loss of the iris-lens-diaphragm after an ocular trauma and the need for silicone oil endotamponade underwent a primary intervention including wound closure, placement of silicone oil retention sutures and silicone oil filling. Four of those underwent secondary reconstruction with silicone oil removal and AI and IOL implantation and could be included in this retrospective observational study. All main outcome measures were evaluated after the first and after the second surgery. The main outcome measures were morphological findings, subjective impairment from glare, subjective cosmetic disfigurement, patient satisfaction and intraocular pressure (IOP) as well as best-corrected distance visual acuity and objective refraction.ResultsThe retention sutures could effectively prevent silicone oil migration into the anterior chamber in the first surgery. Silicone oil emulsifications in the anterior chamber were observed in one patient. In two patients, pigment deposition at the sutures was seen. Subjective impairment from glare and subjective cosmetic disfigurement could be reduced after the second surgery compared to the evaluation after the first surgery. IOP and best-corrected distance visual acuity remained stable. No eye needed silicone oil refilling after the secondary reconstruction surgery.ConclusionOur two-step approach is viable and provides good functional and aesthetic results. We observed a high patient satisfaction.

Microscopic Characteristics of Late Intraocular Lens Opacifications

The increases in overall life expectancy and in lens surgeries performed on younger patients have resulted in a significant increase in the anticipated duration of artificial intraocular lenses (IOLs) in the eye. Thus, the physicochemical properties of the IOL become a critical issue, and several types of postoperative IOL opacifications have been reported. To describe the microscopic characteristics of opacified IOLs. Glistenings and subsurface nanoglistenings are fluid-related phenomena developing mainly in hydrophobic acrylic IOLs and are associated with aqueous influx into the IOL matrix. Calcification presents in hydrophilic acrylic or silicone IOLs as deposits of hydroxyapatite or other phases of calcium. Snowflake degeneration is less common, and it manifests in older polymethyl methacrylate IOLs. PubMed and ScienceDirect databases were searched for the following keywords: intraocular lens, IOL, cataract surgery, phacoemulsification, opacification, glistening, subsurface nanoglistenings, calcification, snowflake degeneration. English-language articles published up to October 15, 2019 were included in the study. The manuscript contains mainly a literature review; however, it was supplemented with original investigations from the David J. Apple International Laboratory for Ocular Pathology. Glistenings and subsurface nanoglistenings should be evaluated in a hydrated state and at room temperature; they manifest as microvacuoles sized from 1.0 to greater than 25.0 μm and less than 200 nm, respectively. Calcification deposits are situated on or underneath the surface of the IOL and can be stained with a 1% alizarin red solution or with the von Kossa method. Snowflake degeneration manifests as "particles" or "crystals," causing whitish IOL discoloration. Scanning electron microscopy or energy dispersive X-ray spectroscopy may improve the diagnostic accuracy.

Sutured Custom Foldable Silicone Artificial Iris Implantation Combined With Intraocular Lens Implantation and Penetrating Keratoplasty: Safety and Efficacy Outcomes.

Purpose:To assess safety and efficacy outcomes of sutured custom silicone artificial iris and intraocular lens implantation combined with penetrating keratoplasty (triple procedure).Methods:Prospective consecutive surgical case series of patients who underwent the triple procedure between 2010 and 2019 at Stein Eye Institute, UCLA, followed up for 1 year minimum. Safety outcomes were changes from preoperative to last follow-up in corrected distance visual acuity (CDVA), endothelial cell count, intraocular pressure (IOP), and postoperative complications. Efficacy outcomes included changes in subjective glare (none to severe), cosmetic appearance (worse to very much improved), and visual function as assessed by the Visual Function Questionnaire-25 at 1-year follow-up.Results:Among 82 eyes implanted with an artificial iris, 14 eyes (17.1%) underwent the triple procedure. The median follow-up was 18.1 months (range 12.0–54.9 months). The median CDVA improved from 2.0 log of minimum angle of resolution (logMAR) (range 0.9–2.3 logMAR) to 0.7 logMAR (range 0.2–2.6 logMAR) (P = 0.02). Average endothelial cell count decreased 57.6% (P < 0.01). Six eyes (42.9%) experienced IOP elevations, 13 eyes (92.3%) developed iritis, and 11 eyes (78.6%) underwent secondary surgery. Graft rejection or secondary graft failure occurred in 7 eyes each (50.0%). Cosmesis improved in 12 eyes (85.7%; P < 0.01). The Visual Function Questionnaire-25 score improved from 72 to 77 (P < 0.01). Glare symptoms did not change significantly.Conclusions:The triple procedure was effective at improving CDVA, cosmesis, and quality of life; however, it was associated with frequent postoperative complications, of which iritis, IOP elevation, and secondary graft failure were the most common.

Comparison of algorithms to suppress artifacts from the natural lens in fluorescence lifetime imaging ophthalmoscopy (FLIO).

Fluorescence lifetime imaging ophthalmoscopy (FLIO) has developed as a new diagnostic tool in ophthalmology. FLIO measurements are taken from 30° retinal fields in two spectral channels (short spectral channel (SSC): 498-560 nm, long spectral channel (LSC): 560-720 nm). Because of the layered structure of the eye, the detected signal is an interaction of the fluorescence decay of the anterior part and of the fundus. By comparing FLIO measurements before and after cataract surgery, the impact of the natural lens was proven, despite the application of a confocal laser scanning (cSLO) technique. The goal of this work was to determine the best algorithmic solution to isolate the sole fundus fluorescence lifetime from the measured signal, suppressing artifacts from the natural lens. Three principles based on a tri-exponential model were investigated: a tailfit, a layer-based approach with a temporally shifted component, and the inclusion of a separately measured fluorescence decay of the natural lens. The mean fluorescence lifetime τm,12 is calculated using only the shortest and the intermediate exponential component. τm,all is calculated using all three exponential components. The results of tri-exponential tailfit after cataract surgery were considered as a reference, because the implanted artificial lens can be assumed as non-fluorescent. In SSC, the best accordance of τm,all of the reference was determined with τm,12 of the tailfit before surgery. If high-quality natural lens measurements are available, the correspondence of τm,12 is best with τm,all of the reference. In LSC, there is a good accordance for all models between τm,12 before and after surgery. To study the pure fundus fluorescence decay in eyes with natural lenses, we advise to utilize fluorescence lifetime τm,12 of a triple-exponential tailfit, as it corresponds well with the mean fluorescence lifetime τm,all of eyes with fluorescence-less artificial intraocular lenses.