The Foldable Capsular Vitreous Bag (FCVB) implant is useful in maintaining an ocular structure in cases of chronic hypotony secondary to trauma or repeated surgery. There are a few published reports of long-term outcomes and no indication of the chronic cellular changes of the adjacent tissues associated with FCVB implantation. We describe one of the few FCVB cases in the United Kingdom and present histological findings associated with it following secondary enucleation. A 33-year-old man underwent a left primary globe repair following a left penetrating injury and intraocular metal foreign body secondary to a close-range blast injury. Postoperatively, a retinal detachment was detected, and a left vitrectomy with lensectomy, retinectomy, and silicone oil insertion was performed. Subsequently, pupillary prolene sutures were used to create a two-chamber eye. Despite this, hypotony, silicone oil in the anterior chamber, and upper limb deep vein thromboses occurred postoperatively. He had a complex history of Factor V Leiden with renal thrombosis in childhood. After warfarinisation, his FCVB procedure was uneventful with a good bag silicone oil fill. Postoperative outcomes were initially favorable; however, enucleation was necessary almost 3 years postimplantation due to spontaneous left hyphema and intractable raised intraocular pressure. Histology revealed extensive intraretinal fibrotic pannus membranes, loss of photoreceptor architecture, and focal foreign body-cell reaction. A complex case of FCVB implantation following ocular trauma with postoperative complications years later. Long-term outcomes of FCVBs are poorly understood; this case was complicated by the patient's systemic coagulopathy.

Introduction. Cataract remains the leading cause of visual impairment worldwide. The only effective treatment is surgical removal of the opacified lens, followed by intraocular lens (IOL) implantation. Different types of IOLs, monofocal, multifocal, and extended depth of focus (EDOF), offer varying levels of visual acuity at different distances and impact postoperative quality of life. Assessing the effectiveness of surgical outcomes based on IOL type is important for a personalized, patient-centered approach. Objective. To analyze the functional outcomes of cataract surgery depending on the type of implanted IOL and to determine their impact on postoperative visual quality. Participants and methods. The study included 85 patients (85 eyes) with age-related cataract who underwent phacoemulsification with intraocular lens implantation. Patients were divided into three groups: Group I – monofocal intraocular lenses (n=25); Group II – multifocal intraocular lenses (n=31); Group III – EDOF- intraocular lenses (n=29). All surgeries were performed by the same surgeon using a standardized ultrasound-guided technique with capsular bag IOL implantation. Outcomes evaluated included uncorrected and corrected visual acuity for distance and near, contrast sensitivity, and subjective patient satisfaction. Assessments were conducted preoperatively, on postoperative day 1, and at 1, 3, and 6 months. Results. All groups demonstrated improved visual acuity postoperatively. Group I had the highest uncorrected distance visual acuity, while Groups II and III showed better near and intermediate visual acuity. The EDOF group provided the best balance across visual ranges and reported the highest subjective satisfaction, with fewer complaints of glare and halos.

In patients with iris deficiencies, surgical placement of a custom, artificial iris improves cosmesis and photic symptoms. When patients have existing intraocular lenses (IOLs) within the capsular bag, iris devices also placed within the capsular bag might change the IOL's effectivity; previous reports suggest a hyperopic shift, but data is limited. This retrospective chart review studied 13 eyes receiving a custom, flexible iris prosthesis fixated into an existing intact capsular bag, separate from prior phacoemulsification. Biometry, IOL data, and pre- and post-operative refraction were collected. For iris prosthesis placement without concomitant procedures, the average change in spherical equivalent was +0.49D; For an aphakic eye receiving a secondary IOL, post-operative refraction was +0.79D more hyperopic than expected. For eyes undergoing concomitant IOL exchange, average post-operative refraction was 1.22D less myopic than predicted. This study confirms a hyperopic refractive shift when both IOLs and iris prostheses are placed into the capsular bag.

Capsular Tension Ring Use in High Myopic Eyes Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis.

Cataract Surgery with IOL Implantation in Children with Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis (JIA) or Antinuclear Antibody (ANA)-Positive Uveitis: Mid-term Results and Predictors for Outcome.

Purpose: The aim of this study was to evaluate the treatment of patients with keratoconus and cataract with cataract extraction and insertion of dual intraocular lenses with fixed-aperture intraocular lens (IOL) and toric sulcus piggyback IOL. Methods: This study is a retrospective case series from a private practice on the Gold Coast, Queensland, Australia. All patients with keratoconus and cataract treated with cataract extraction and simultaneous insertion of fixed-aperture IOL inserted into the capsular bag with a capsular tension ring and a toric sulcus piggyback IOL were included. Preoperative patient demographics, uncorrected visual acuity (UCVA), corrected distance visual acuity, refraction, and corneal tomography results were recorded. Postoperative UCVA, corrected distance visual acuity, and refraction were recorded after surgery. Adverse outcomes were recorded. Results: There were 12 eyes of 9 patients (average age 65 years, 8 female) included in this study. Patients gained 4 lines of UCVA on average (ranging from 0 to 9 lines). Postoperatively, patients had significant reduction in spherical equivalent from average of −2.39D to average of −0.783D ( P = 0.03), astigmatism from −4.04D to −1.27D on average ( P < 0.001), and higher-order aberrations in both mesopic and photopic conditions. One patient developed toxic anterior segment syndrome but recovered to vision 6/7.5 at 3 months of follow-up. Conclusions: The technique described significantly improved vision, while also providing an accurate refractive result and improved higher-order aberration in the patients treated. This was safe and effective with minimal adverse outcomes.

Capsular bag folding associated with in-the-bag intraocular lens displacement in pseudoexfoliation syndrome

Purpose:To examine the long-term outcome in terms of visual performance and positional stability of a minimally invasive in situ fixation technique for repositioning of subluxated capsular bag-intraocular lens complex.Setting:Tertiary eye care and postgraduate training institute.Design:Single-center retrospective study.Methods:The medical records of 13 pseudophakic patients who presented with Subluxated capsular bag - intraocular lens complexes operated by a single surgeon with a minimally invasive in situ fixation technique from January 2014 to February 2020 were retrospectively reviewed. This technique employs creation of a scleral pocket and an opposing paracentesis to pass the nonabsorbable suture to engage the subluxated capsular bag-intraocular lens complex followed by centration and tying of suture ends and burying the knot. The uncorrected and best-corrected visual acuity and centration and stability of the repositioned complex were analyzed at baseline, 3 weeks, and final visit. The refractive status and ocular residual astigmatism were also analyzed.Results:On comparing the best corrected visual acuity at baseline with that at final visit mean follow-up 53 months, 92.3% had successful visual outcome as defined in this study. Centration was achieved in 12 patients on follow-up visits except in one patient who had inferior iris coloboma. The measured ocular residual astigmatism ranged between J0 -0.55 and J45 -0.17. Three patients had posterior capsule opacification as the only late complication that would occur even otherwise.Conclusion:The minimized surgical manoeuvring and long term satisfactory visual outcomes suggest that this technique can be performed as a primary repositioning surgery for subluxated capsular bag - intraocular lens complex.

To compare two dispersive ophthalmic viscosurgical devices (OVD), Z-HYALCOAT (investigational) and HEALON EndoCoat (control), with a 3-month postoperative follow-up. Multicenter study conducted in 11 sites across Europe. Prospective, randomized, masked, multicenter post market study. Adult subjects having clear intraocular media excluding the presence of cataract and scheduled for uncomplicated age-related cataract removal by phacoemulsification and IOL implantation in the capsular bag with sole administration of either investigational or control device as per randomization scheme were included in this study. Primary endpoint was the incidence of IOP ≥ 30 mmHg. Other endpoints included slit lamp observations, corneal endothelial cell density (ECD), surgeon-reported device functionality, and rate of adverse events (AEs) and device deficiencies (DDs). In total, 242 subjects were treated in this study (123 with the investigational OVD and 119 with the control OVD). In per-protocol population, 13 eyes (11.2%) from the investigational group and 19 (17.0%) from the control group reached an IOP equal to or higher than 30 mmHg at 8 hours following device use. Slit lamp examinations performed up to 3 months did not reveal any relevant differences between the groups. ECD loss was also similar between the groups. Surgeon-reported OVD functionality was generally favorable and comparable for both devices. This investigation proved the non-inferiority of Z-HYALCOAT to HEALON EndoCoat in terms of IOP spikes and showed the two devices to be highly similar in all evaluated aspects.

Rationale: open eye trauma with the presence of an intraocular foreign body continues to be among the leading causes of vision loss and disability globally. Objective: – to study the possibility of performing posterior femtocapsulorhexis in patients with open eyeball trauma and to evaluate its effectiveness in preserving the supporting function of the lens capsular bag during removal of an intraocular foreign body through the anterior chamber of the eye. Methods: in 2023-2024, 7 patients (7 eyes) were treated at the Kaluga branch of “Eye Microsurgery” with a diagnosis of open trauma to the eyeball with an intraocular foreign body. The age of patients ranged from 20 to 66 years. All patients underwent diagnostic examination. The patients were recommended surgical treatment in the following scope: phacoaspiration of the transparent lens (or phacoemulsification of traumatic cataract) with femtosecond laser accompaniment at the stage of posterior capsulorhexis + vitrectomy + removal of intraocular foreign body by a combined method + IOL implantation. Results: all surgical interventions were performed without intraoperative complications. In all patients, the intraocular foreign body was removed using a combined approach through the anterior chamber and corneoscleral tunnel incision. In all cases, the IOL was successfully implanted into the capsular bag. Conclusion: the developed technique for performing posterior femtocapsulorhexis in open eye trauma with an intraocular foreign body increases the functional and anatomical effectiveness of surgical treatment of patients with eyeball trauma during removal of an intraocular foreign body from the vitreous cavity through the anterior chamber.

Extracellular heat shock protein 90α (eHSP90α) regulates diverse cellular processes such as wound healing, tumor metastasis, angiogenesis and cell differentiation etc. Our previous data show that lens epithelial cells can secret eHSP90α, and administration of eHSP90α exerts a critical regulation for lens regeneration by promoting the differentiation of lens epithelial cells (ECs) to lens fiber cells. Autophagy is proposed to regulate the eHSP90α secretion from lens epithelial cells. However, the regulatory mechanism remains unclear. Lens ECs cell line SRA01/04, ex vivo cultured rat lens capsular bags and primary rat lens ECs were used in this study. The immunoblotting and qPCR were used for measuring the expression of proteins and mRNAs. The immunofluorescence staining assay was for testing the autophagosomes or protein co-localization. siRNA or CRISPR-Cas9 were used to knock down genes' expression in cells in vitro. The ChIP assay was used to study the interaction of transcriptional factor to the promoter of target genes. The nuclear and cytoplasmic extraction assay was for testing the nuclear translocation of TFEB and TFE3. eHSP90α is secreted through the secretory autophagy pathway in lens epithelial cells in vitro or in the residual anterior ECs of capsular bags ex vivo. HSP90α interacts with adaptor protein TRIM16, and was recruited to the R-SNARE protein SEC22B on the surface of secretory autophagosome membrane for secretion. Silencing autophagic ATG7 or components of secretory autophagy pathways, such as TRIM16, SEC22B and Q-SNARE STX3, STX4 and SNAP23 downregulates HSP90α secretion. TGF-β2 upregulates the eHSP90α secretion via upregulating secretory autophagy pathway. TGF-β2 treatment results in the upregulation of the expression of ATG7, Beclin1, LC3B at both protein and mRNA levels through activating p38 and ERK1/2. In addition, TGF-β2 increases SEC22B expression through ERK1/2-induced expression and nuclear translocation of transcriptional factors TFEB and TFE3, which form the heterodimer binding to the promoter of SEC22B. Functionally, the upregulated eHSP90α can trigger TGF-β2-induced differentiation of lens ECs to fiber cells. In lens cells, the eHSP90α's secretion undertakes secretory autophagy pathway through interacting with TRIM16 and SEC22B. TGF-β2 elevates eHSP90α secretion through upregulating secretory autophagy pathway, which in turn promote TGF-β2-induced lens epithelial cells' differentiation to lens fiber cells.

To describe a technique for implanting capsular hooks made from a 7-0 polypropylene sutures, used for sutureless scleral fixation of the capsular bag in cases of lens subluxation. A 26-G needle was used to guide the 7-0 polypropylene suture into the eye. The suture was then extracted and thermally shaped into a hook. A needle holder clamped the built-in suture needle, allowing it to pass through the superficial layer of the sclera at the puncture site. Both hands coordinated the subsequent procedure: The suture was pulled externally, while the hook was advanced internally to vertically engage with the capsular bag at the site of continuous curvilinear capsulorhexis. This technique was applied to 11 eyes of 11 patients. The best-corrected visual acuity improved from a preoperative mean of 1.15 ± 0.39 logarithm of the minimum angle of resolution [logMAR] (Snellen 20/206) to 0.18 ± 0.15 logMAR (Snellen 20/29) at the final follow-up. Throughout the follow-up period, the capsular hook exerted stable vertical traction on the capsular bag at the site of the continuous curvilinear capsulorhexis without slippage. The capsular hooks made from 7-0 polypropylene sutures provide an effective alternative method for stabilizing the capsular bag in cases of moderate to severe lens subluxation.

An intraocular lens coated with polycaprolactone and methotrexate as a slow-release system for prophylaxis of posterior capsule opacification in-vitro.

A 59-year-old male contact lens wearer was admitted to the intensive care unit for COVID-19 pneumonia. As contact lenses were not removed during admission, the patient developed bilateral corneal abscesses, leading to evisceration of the left eye. Complete corneal melting was observed in the right eye, which was preserved with a therapeutic scleral lens filled with moxifloxacin until donor tissue was available for a sclerokeratoplasty combined with amniotic membrane transplantation. In the second procedure consisting of phacoemulsification, capsular bag implantation of the intraocular lens was not possible, and flanged intrascleral fixation was performed. Long-term graft survival has been achieved with systemic and topical immunosuppression.

Lens dislocation is one of the major issues in cataract surgery. This condition is caused by progressive weakening of the zonular fibers, as well as the lack of adequate capsular bag support. Nowadays, surgeons increasingly rely on various intracapsular devices to achieve a stable “intraocular lens (IOL)—capsular bag” complex. The article outlines the primary methods of capsular bag fixation in cases of lens subluxation and different degrees of IOL dislocation. The authors describe an original technique based on the formation of anterior lens capsule flaps with subsequent fixation to the iris, limbus, or ciliary sulcus. A series of clinical cases is presented, along with a discussion of the advantages and limitations of each variation. Keywords: intraocular lens, phacoemulsification, capsular bag, pseudophakia.

One of the late complications of crystalline lens surgery is dislocation of the intraocular lens — capsular bag complex. Numerous techniques for correcting this complication have been described and used, including replacement of the intraocular lens and reposition with suturing to the iris or into the ciliary sulcus. The standard of modern cataract phacoemulsification is implantation of an intraocular lens through a tunnel incision in the cornea using various models of injectors. Pinching or detachment of haptic elements of the lens is rare, but any surgeon may encounter it. Objective: to evaluate the effectiveness of reimplantation in case of dislocation of an intraocular lens with defects of haptic elements using a clinical example. Patient S., 81 years old, complained of decreased visual acuity in the left eye. Diagnosis: OD — Pseudophakia. O / angle III a (on drops, operative) glaucoma. OS — Decentration of the intraocular lens with a defect of the haptic elements. O/angle III a (on drops, operative) glaucoma. Secondary cataract. The intraocular lens with a defect in the haptic elements was removed and the lens was implanted with suturing into the ciliary sulcus. As a result of our surgical treatment, we obtained an increase in visual functions and an increase in the patient's quality of life. In order to prevent dislocation of the "capsular bag — intraocular lens" complex, it is necessary to use capsular rings of the appropriate diameter and shape, depending on the situation. Errors in intraocular lens implantation must be corrected immediately, without allowing additional surgical interventions that can entail a number of additional complications. Keywords: eyeball, intraocular lens dislocation, defect in the haptic elements

Purpose: to determine the influence of morphometric parameters of the anterior segment of the eyes of different axial lengths on the position of the intraocular lens. Material and methods. The study included 250 patients aged 47 to 90 years, with 295 eyes examined using optical biometers. Results. The presence of a reliable increase in the depth of the anterior chamber of the pseudophakic eye, when moving from the group of “short” eyes to the group of “medium” and then to the group of “long” eyes, was confirmed by dispersion analysis. In all cases, the center of the implanted IOL was located anterior to the center of the native lens. Conclusions. Thereby, the anatomical parameters of the anterior chamber and capsular bag at the preoperative stage can serve as fairly good guidelines for assuming how the IOL will be positioned after implantation during phacoemulsification. Keywords: anterior chamber depth, lens, axial length of the eye.

Phacoemulsification in modern ophthalmic surgery is the gold standard for the treatment of lens pathology. However, extensive damage to the ligamentous apparatus makes phacoemulsification more difficult, and, according to some surgeons, forces them to abandon this method of surgical treatment. In case of lens dislocation into the posterior vitreous body, there is virtually no alternative to vitreectomy with the introduction of a perfluoroorganic compound and subsequent phacoemulsification from the anterior segment of the eyeball. This requires a certain level of qualification from the surgeon and also entails risks of postoperative complications such as hemophthalmos, secondary glaucoma, partial atrophy of the optic nerve, and others. However, in case of lens dislocations in the anterior parts of the vitreous body, surgical treatment is possible without performing posterior closed subtotal vitreectomy and the introduction of perfluoroorganic compound. We analyzed 2 clinical cases of traumatic dislocation of the lens into the anterior vitreous body, treated at the ophthalmology department of the V. I. Voynov Regional Clinical Hospital. During the surgical treatment, posterior closed subtotal vitreectomy was not used, perfluoroorganic compounds were not administered, and high functional results were achieved on the first day after the operation. In addition, the capsular bag is preserved, which functions as a natural anatomical barrier between the anterior and posterior segments of the eyeball. Based on this, we can conclude that the method of phacoemulsification of the lens dislocated into the anterior parts of the vitreous body has proven its effectiveness and can be an alternative to more radical methods of surgical treatment of this pathology. Keywords: dislocated lens, phacoemulsification, vitrectomy

A rare side effect of cataract phacoemulsification (CPE) with monofocal intraocular lens (IOL) implantation is positive dysphotopsia described by the patient as glare or rays diverging from light sources. A clinical case of bilateral dysphotopsia in a patient after surgical treatment of cataracts in both eyes is analyzed. Presumptive causes of these light phenomena are established: intraocular – implantation of acrylic lenses with a square edge of optics in combination with a dilated pupil in mesopic conditions, probably caused by a general disease (systemic scleroderma), extraocular – hysteroid type of accentuation of the patient's character. Probable solutions to this problem are considered: «wait and watch» tactics, pharmacological miosis, surgical tactics with replacement of the acrylic IOL with a lens made of another material (silicone, collagen copolymer, polymethyl methacrylate) or having a different shape. In our clinical case, the most acceptable tactic was a «wait and watch» approach: over time, the peripheral part of the capsular bag became cloudy, and opaque zones reduced the reflection of light from the square edge of the IOL. In addition, the process of neuroadaptation to the artificial lens also takes long time. The use of 1% pilocarpine did not have a significant effect on the severity of optical symptoms. Surgical tactics were rejected, given the high functional outcome of CPE with IOL implantation in both eyes, although the patient periodically asked to replace the artificial lenses with another models. Besides, a refusal to replace IOL was due to difficulties of finding of «ideal» flexible lenses made of other materials. Thus, when selecting patients for cataract surgery, special attention should be paid to the pupil size in mesopic conditions and the general psychoemotional status of the patient. For patients with dysphotopsia in the pseudophakic eye, before surgery of the fellow eye, it is possible to recommend models of IOLs in which only the posterior edge of the optical part is square, and the edges of the lens are matte. Key words: positive dysphotopsia, glare, cataract phacoemulsification, monofocal intraocular lens implantation.

Relevance. After vitrectomy and silicone oil tamponade, the accuracy of intraocular lens (IOL) power calculation decreases due to changes in the axial length of the eye, anterior chamber depth, capsular bag instability, and macular zone deformations, which increase the risk of significant refractive errors. Additional challenges are caused by irregular astigmatism and displacement of foveal fixation, which distort biometry results. Purpose of the study. To analyze existing approaches and present our own clinical experience in IOL power calculation and surgical strategy selection in patients with cataract after vitreoretinal surgery for rhegmatogenous retinal detachment combined with macular hole. Materials and methods. The study included 28 patients (28 eyes), divided into two groups: in the first group, IOL power was calculated using standard formulas (Barrett, Haigis, SRK/T), while in the second group, a corrective adjustment was applied to compensate for the tendency of the IOL to be positioned more anteriorly in postvitrectomy eyes and high myopia. Results. In the first group, the mean deviation from the target refraction was –0.95 D with a pronounced myopic shift, whereas in the second group it was only –0.18 D, with no deviations exceeding 1.0 D. Conclusions. To prevent residual myopia in patients with avitreal status of the eye, it is recommended to shift the target refraction toward hypermetropia by +0.5 to +1.5 D depending on the axial length of the eye. Keywords: Cataract phacoemulsification, intraocular lens, macular hole, retinal detachment, clinical refraction, IOL calculation.