Capsular Bag Research Articles

Clinical Observation of Non-Staining Circular Capsulorhexis for Hypermature Cataract

Objective: To explore the circular capsulorhexis method and its clinical effect in phacoemulsification of hypermature cataract without staining. Methods: In this prospective randomized case-control study, 22 patients (22 eyes) with hypermature cataract were randomly divided into a staining agent group (10 cases, 10 eyes) and a non-staining agent group (12 cases, 12 eyes). Both groups underwent phacoemulsification with foldable intraocular lens implantation under topical anesthesia. In the staining agent group, 0.5% indocyanine green was used to stain the anterior lens capsule to assist in circular capsulorhexis; in the non-staining agent group, after puncturing the anterior lens capsule and aspirating the liquefied cortical material, the capsular bag was filled with viscoelastic agent to increase the contrast prior to circular capsulorhexis. The operability of the anterior capsule without staining in capsulorhexis was observed, and the effect of capsulorhexis, diameter of capsulorhexis opening, and operative time were compared and analyzed between the two groups. Results: Both groups successfully underwent circular capsulorhexis, with a success rate of 100%. The diameters of capsulorhexis opening in the staining agent group and non-staining agent group were 5.68 ± 0.15 mm and 5.54 ± 0.16 mm, respectively, without any statistical difference between the groups (P > 0.05); the operative time of the staining agent group (40.40 ± 5.42 s) was shorter than that of the non-staining agent group (50.92 ± 3.97 s), and the difference was statistically significant (P < 0.001). In both groups, phacoemulsification was successful, and intraocular lens were implanted into the capsular bags; their visual acuity showed significant improvement during the 1-month follow-up period after surgery, without any surgical complications. Conclusion: In hypermature cataract, injecting viscoelastic agent into the capsular bag for volume replacement, given a lack of capsule staining agent, can increase the contrast for capsulorhexis and reduce the risk of large capsular bag collapse on the zonular ligament. Thus, it is considered safe and effective. Circular capsulorhexis is conducive to a smooth phacoemulsification procedure.

Phacoemulsification associated with loss of endothelial cells in cataract surgery: a systematic review of main surgical techniques

Introduction: Phacoemulsification (PE) cataract surgery is the gold standard in ophthalmology, being effective in improving vision in more than 90.0% of patients. In this context, authors found that PE was associated with 16.67% of endothelial cell loss, which correlated with the degree of trauma during surgery. Endothelial changes are considered an important parameter for assessing trauma and for estimating the safety of a surgical technique. In this sense, more modern PE machines are capable of removing cataracts using optimized parameters such as high vacuum, aspiration flow, and low amount of ultrasonic energy. Objective: It was to present and discuss the main phacoemulsification techniques for optimizing the treatment of cataracts, in an attempt to reduce the loss of corneal endothelial cells. Methods: Experimental and clinical studies were included (case reports, retrospective, prospective, and randomized studies) with qualitative and/or quantitative analysis. Initially, the keywords were determined by searching the DeCS tool (Descriptors in Health Sciences, BIREME base) and later verified and validated by MeSH Terms. The search literature was carried out from January to April 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Results: A total of 122 articles involving phacoemulsification and endothelial cells were found. Initially, the existing title and duplications were excluded according to the interest described in this work. After this process, the abstracts were evaluated and a new exclusion was performed. A total of 80 articles were evaluated in full and 59 were included and discussed in this study. At the beginning of treatment with PE, without the endothelial protection of viscoelastic agents and the use of ultrasound in the anterior chamber, the endothelial loss was greater than in extracapsular cataract extraction. With the modernization of PE, the use of viscoelastic agents, the emergence of techniques for fracture of the nucleus within the capsular bag, and the use of ultrasound in the posterior chamber, the loss of endothelial cells reduced from 7 to 12% on average. Conclusion: Endothelial changes are considered an important parameter to assess trauma and estimate the safety of a surgical technique. Highlighted, the main predictors associated with the loss of corneal endothelial cells are the duration of the ultrasound used in the surgery, the turbulence of the liquid in the anterior chamber, and the mechanical trauma.

Zonulopathy Identified During Cataract Extraction in Patients With Primary Angle Closure Disease.

The proportion, clinical characteristics, and risk factors of zonulopathy in Primary Angle Closure Disease (PACD) were analyzed. Zonulopathy is an under-recognized common finding in PACD, especially in acute angle closure patients. To examine the proportion and risk factors associated with intraoperative zonulopathy in primary angle closure disease (PACD). This is a retrospective analysis of 88 consecutive PACD patients who underwent bilateral cataract extraction at Beijing Tongren Hospital from August 1, 2020 to August 1, 2022. Zonulopathy was diagnosed based on intraoperative findings including the presence of lens equator, radial folds of the anterior capsule while making capsulorhexis, and other signs of unstable capsular bag. The subjects were grouped based on their PACD subtype diagnoses: acute angle closure (AAC), primary angle closure glaucoma (PACG), primary angle closure (PAC), or primary angle closure suspect (PACS). Multivariate logistic regression was performed to identify risk factors associated with zonulopathy. The proportion and the risk factors of zonulopathy were estimated in PACD patients and in PACD subtypes. Of 88 PACD patients (67.3±6.9y old, 19 male, 69 female), the overall proportion of zonulopathy was 45.5% of patients (40/88) and 30.1% of eyes (53/176). Among the PACD subtypes, the proportion of zonulopathy was highest (69.0%) in AAC, followed by 39.1% in PACG, and 15.3% in PAC and PACS combined. AAC was an independent risk factor associated with zonulopathy (P= 0.015, AAC vs PACG, PAC and PACS combined, OR 0.340, CI 0.142-0.814). Shallower anterior chamber depth (P=0.031) and greater lens thickness (P= 0.036), but not laser iridotomy, were associated with increased proportion of zonulopathy. Zonulopathy is common in PACD, especially in AAC patients. Shallow ACD and thick LT were associated with increased proportion of zonulopathy.

Nano-Indentation to Determine Mechanical Properties of Intraocular Lenses: Evaluating Penetration Depth, Material Stiffness, and Elastic Moduli.

Intraocular lenses (IOL) should remain in the eye for life after implantation into the capsular bag during cataract surgery. The material must meet various requirements. It is crucial that the material has the best biocompatibility, and it should be flexible and soft for best possible implantation process but also sufficiently stable and stiff for good centering in the eye and posterior capsule opacification prevention. In this laboratory experiment, we used nano-indentation for the mechanical assessment of three hydrophobic acrylic (A, B, C), three hydrophilic acrylic (D, E, F), and one silicone (G) intraocular lens. We wanted to determine whether some react more sensitively to touching/handling than others. The indentation elastic modulus and the creep were obtained from the force displacement curve. For measuring penetration depth and testing of possible damage to the intraocular lenses, the samples were measured at room temperature. A 200-µm-diameter ruby spherical tipped indenter was used for all the tests. Indentations were made to three different maximum loads, namely 5mN (milli Newton), 15mN, and 30mN and repeated three times. The lowest penetration depth (12µm) was observed with IOL B. However, IOL A, D, and F showed similar low penetration depths (20, 18, and 23µm, respectively). Lenses C and E showed slightly higher penetration depths of 36 and 39µm, respectively. The silicone lens (G) showed the greatest penetration depth of 54.6µm at a maximum load of 5mN. With higher maximal loads (15 and 30mN) the penetration depth increased significantly. Lens C, however, showed the same results at both 15 and 30mN with no increase of penetration depth. This seems to fit well with the material and manufacturing process of the lens (lathe-cut). During the holding time of 30s at constant force all six acrylic lenses showed a significant increase of the creep (CIT 21-43%). Lens G showed the smallest creep with 14%. The mean indentation modulus (EIT) values ranged from 1 to 37MPa. IOL B had the largest EIT of 37MPa, which could be caused by the low water content. It was found that results correlate very well with the water content of the material in the first place. The manufacturing process (molded versus lathe-cut) seems to play another important role. Since all included acrylic lenses are very similar, it was not surprising that the measured differences are marginal. Even though hydrophobic materials with lower water content showed higher relative stiffness, penetration and defects can also occur with these. The surgeon and scrub nurse should always be aware that macroscopic changes are difficult to detect but that defects could theoretically lead to clinical effects. The principle of not touching the center of the IOL optic at any time should be taken seriously.

The Incidence of Optic Cracks or Fractures During a Foldable AcrySof or Acriva BB Acrylic Monofocal Intraocular Lens Implantation via the Manual Monarch Injector System With the Cartridge in Phacoemulsification Surgery.

To evaluate the incidence of optic cracks and/or fractures during foldable acrylic intraocular lens (IOL) implantation via the manual Monarch delivery system with the cartridge and to determine factors that help to avoid such complications. Small-incision phacoemulsification surgery was performed in 702 eyes with visually significant cataract formation. A foldable acrylic soft IOL (AcrySofâMA60BM/MA30BA, Alcon, Fort Worth, TX, USA) or a single-piece acrylic soft IOL (Acriva BBâ, VSY Biotechnology, Amsterdam, The Netherlands) was inserted in all eyes using a cartridge and viscoelastic agents (sodium hyaluronate, Healon®, Advanced Medical Optics, Santa Ana, CA, USA). Postoperative central, paracentral, or peripheral optic cracks or fractures were encountered in a total of six of 702 eyes (0.85%). Four of six lenses (0.57%) had optic cracks within the IOL substance, whereas two of 702 cases (0.28%) had full-thickness IOL fractures in the substance in multiple locations. Three of the four lenses with optic cracks were noted to be handled by tying forceps during the cartridge insertion, and one of them was the complication of holding forceps. Two IOLs with full-thickness optic fractures were encountered during the insertion of the IOLs in the capsular bag as a result of direct trauma to the lens optic by the plunger of the injector system overriding the lens optic during cartridge passage. None of the patients suffered from glare or other visual disturbances postoperatively, and, therefore, none of the six eyes required lens replacement. The unintentional extensive pressure effect of the forceps during the holding process of the IOL or the direct trauma to the lens optic by the plunger of injector systems may cause optic cracks or fractures. Physicians should continue to monitor the eyes postoperatively regularly and must determine the benefits and risks to be derived from lens replacement, if such patients complain of significant glare, image degradation, and visual disturbances. We recommend the use of preloaded lenses, which have their own delivery systems and cartridges, to minimize the risk of such complications.

Оценка эффективности интраоперационной периферической капсулотомии при цилиокапсульной фиксации трехчастной интраокулярной линзы с помощью оптической когерентной томографии

Purpose. To evaluate the clinical efficacy of intraoperative peripheral capsulotomy of the anterior leaf of the preserved capsular bag for the prevention of capsular block during cilio-capsular IOL fixation using optical coherence tomography Material and methods. Clinical results of phacoemulsification of complicated cataract with femtosecond laser accompaniment against the background of pseudoexfoliation syndrome, grade I subluxation in a 58-year-old patient in the early postoperative period. In addition to standard examination methods, optical coherence tomography of the anterior segment of the eye was used. During the operation, after filling the haptic elements of the three-part IOL into the ciliary sulcus, and the optics into the anterior capsulorhexis, 0.3 mm to the periphery from the edge of the IOL optics with a spear knife, two peripheral capsulotomies of the anterior capsule were performed opposite to each other. Results. On the 2nd day after the operation, the maximum corrected visual acuity increased and amounted to 0.8, IOP – 11 mm Hg. Art.; before surgery – 0.6 and 22, respectively. According to optical coherence tomography, a sufficient distance between the edge of the iris and the anterior surface of the IOL for free circulation of intraocular fluid was determined, and there were no signs of a capsular block. Conclusion. In the course of the study, it was found that intraoperative peripheral capsulotomy of the anterior leaf of the capsular bag provided natural leaching of viscoelastic from the capsular bag during implantation of a three-part IOL into the ciliary sulcus with infringement of the optic part in the anterior capsulorhexis on the second day after the operation. Key words: capsular block, capsulotomy, capsular-ciliary fixation, three-part intraocular lens, pseudoexfoliative syndrome

Интраоперационная периферическая капсулотомия при цилиокапсулярной фиксации: да или нет?

Purpose. To obtain clinical confirmation of the need for intraoperative peripheral capsulotomy with cilio-capsular fixation. Material and methods. Clinical results of phacoemulsification of complicated cataract with femtosecond laser accompaniment against the background of pseudoexfoliation syndrome, grade I subluxation in a 65-year-old patient in the early postoperative period.In addition to standard examination methods, optical coherence tomography of the anterior segment of the eye was used. During the operation, cilio-capsular fixation of a three-part IOL was used without peripheral capsulotomy of the anterior capsule. In the early postoperative period, due to the developed capsular block, YAG laser dissection of the posterior lens capsule was used. Results. On the 3rd day after the operation, the maximum corrected visual acuity increased and amounted to 0.7, IOP – 12 mm Hg. Art.; before surgery – 0.3 and 22 mm Hg, respectively. According to optical coherence tomography after YAG laser discission, a sufficient decrease in the depth of the retrooptic space was determined, which indicates the absence of signs of a capsular block. Conclusion. During the study, it was found that in the absence of communication between the capsular bag with the anterior chamber, a capsular block is formed during cilio-capsular fixation. This necessitates intraoperative peripheral capsulotomy. Key words: capsular block, capsulotomy, capsular-ciliary fixation, three-part intraocular lens, pseudoexfoliative syndrome

Risk Factor of Cataract Formation after Penetrating Keratoplasty

Introduction: Post-corneal graft cataract is a not negligible complication. Its occurrence rate varies from 0.4% (2) to 32% (3) according to series, it can present itself in the form of nuclear, cortical and posterior capsular opacities. Its treatment corresponds to a usual cataract surgery by phacoemulsification with implantation in the capsular bag. Our work aims to identify and analyze the risk factors for the development of cataract after keratoplasty. Materials and Methods: This is an analytical study conducted within the Ophthalmology Service B at the Rabat Specialty Hospital on 58 patients who underwent penetrating keratoplasty. The main criteria studied were: age; sex; indication for surgery and average dose of corticosteroids. Statistical calculations were made using the SPSS 10.0 software for Windows. A p value <0.05 was considered significant. The average follow-up was 24 months. Results: Cataract after corneal transplantation was observed in 10 cases (17.2%). The mean age at the time of cataract diagnosis was 55 years, with extremes ranging from 40 to 70 years? It developed in 7 of the 33 female cases (21%), and in 3 of the 25 male cases (12%). The onset delay ranged between 16 and 24 months, with a mean delay of 18 months after the penetrating keratoplasty. The most frequent type was nuclear cataract (8 of 10 eyes, 80%), posterior subcapsular cataract developed in one eye (10%) and cortical-nuclear cataract in one eye (10%). It developed in 4 of the 9 cases operated for corneal dystrophies (44.4%), in 3 of the 11 cases operated for sequelae of infectious keratitis (27.2%), in 2 of the 13 cases operated for posttraumatic opacity (15%) and in 1 of the 20 cases operated for keratoconus (5%). In our study, only age and operative indication of the graft were considered as risk factors for the development of cataract after corneal transplantation (p<0.05). The preoperative visual acuity, the patient’s sex.

30G needle aspiration - A modified technique of capsulorhexis in pediatric cataract with high intra-lenticular pressure.

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

Influence of design parameters and capsulorhexis on intraocular lens stabilities: A 3D finite element analysis

BackgroundCurrent treatment of cataract widely used in clinics is by removal of the opacified content from the lens capsule which is followed by insertion of an artificial intraocular lens (IOL). The IOL needs to remain stabilized in the capsular bag for the eye to achieve desired optical quality. The present study aims to investigate how different design parameters of the IOL can influence the axial and rotational stabilities of IOLs using Finite Element Analysis. MethodsEight designs of IOL with variations in types of optics surface, types of haptics and haptic angulation were constructed using parameters obtained from an online IOL databank (IOLs.eu). Each IOL was subjected to compressional simulations both by two clamps and by a collapsed natural lens capsule with an anterior rhexis. Comparisons were made between the two scenarios on axial displacement, rotation, and distribution of stresses. ResultsThe clamps compression method set out by ISO does not always produce the same outcome as the in-the-bag analysis. The open-loop IOLs show better axial stability while the closed-loop IOLs show better rotational stability when compressed by two clamps. Simulations of IOL in the capsular bag only demonstrate better rotational stability for closed-loop designs. ConclusionsThe rotational stability of an IOL is largely dependent on its haptic design whilst the axial stability is affected by the appearance of the rhexis to the anterior capsule which has a major influence on designs with a haptic angulation.

Cascade reaction triggering and photothermal AuNPs@MIL MOFs doped intraocular lens for enhanced posterior capsular opacification prevention

Posterior capsular opacification (PCO) is the most common complication after cataract surgery. Present strategies can’t meet the clinical needs of long-term prevention. This research reports a novel intraocular lens (IOL) bulk material with high biocompatibility and synergistic therapy. Gold nanoparticles (AuNPs) doped MIL-101-NH2 metal–organic frameworks (MOFs) (AuNPs@MIL) was firstly fabricated via in situ reductions. Then the functionalized MOFs were uniformly mixed with glycidyl methacrylate (GMA) and 2-(2-ethoxyethoxy) ethyl acrylate (EA) to form the nanoparticle doped polymer (AuNPs@MIL-PGE), and which was used to fabricate IOL bulk materials. The materials’ optical and mechanical properties with different mass contents of nanoparticles are investigated. Such bulk functionalized IOL material could efficiently remove residual human lens epithelial cells (HLECs) in the capsular bag in the short term, and can prevent PCO on demand in the long run by near-infrared illumination (NIR) action. In vivo and in vitro experiments demonstrate the biosafety of the material. The AuNPs@MIL-PGE exhibits excellent photothermal effects, which could inhibit cell proliferation under NIR and doesn’t cause pathological effects on the surrounding tissues. Such functionalized IOL can not only avoid the side effects of the antiproliferative drugs but also realize the enhanced PCO prevention in clinical practice.

Plasmin-Induced Lens Epithelial Cells Detachment for the Reduction of Posterior Capsular Opacification.

We sought to evaluate the efficacy and safety of plasmin injection in the capsular bag during the cataract operation for the prevention of posterior capsule opacification. Thirty-seven anterior capsular flaps taken from phacoemulsification surgery were immersed in either 1 µg/mL plasmin (plasmin group, n = 27) or phosphate-buffered saline (control group, n = 10) for 2 minutes and photographed after fixation and nuclear staining to compare the numbers of residual lens epithelial cells. In the animal experiments, the plasmin solution was injected into the capsular bag and remained for 5 minutes during hydrodissection or after lens extraction. The degree of posterior capsular opacity of the rabbits at 2 months were photographed by slit lamp biomicroscopy. In HLE-B3 cell culture, the cell detachment rate, proliferation, and apoptosis after the plasmin digestion were analyzed. The residual lens epithelial cell numbers on the capsule after plasmin treatment were 168 ± 190.7/mm2 in the 1 µg/mL plasmin group, which was significantly lower than that of the control (1012 ± 798.8/mm2; P < 0.0001). In a rabbit model, the treatment of plasmin resulted in a significantly clearer posterior capsule compared with that of the control group at 2 months postoperatively. This study suggested that plasmin injection can induce effective lens epithelial cell detachment, which could be a promising adjunctive treatment to further improve the success rate in posterior capsule opacification prevention. Plasmin injection for lens epithelial cell detachment could significantly decrease the number of residual lens epithelial cells. This approach could be a promising treatment incorporating the current treatment approach to further improve the success rate in posterior capsule opacification prevention.

Scharioth Macula Lens for patients with high myopia: a novel approach to achieve spectacle independence (binocular trifocal monovision).

We aimed to test a novel concept based on multiple IOL-implantation, targeting spectacle independence for patients with high and excessive myopia (26.0 mm < axial length; 6.0 D < refractive error). Therefore, we introduced the first results of five patients with high myopia. After clear lens extraction, one eye was targeted to emmetropia, and the other to mild myopia by implanting monofocal capsular bag IOLs with appropriate refractive powers in each case. The emmetropic eye was aimed to result in magnification and improved distance vision, while the mild myopic eye was supposed to ensure good intermediate vision. Thereafter, a Scharioth Macula Lens (SML) was implanted into the emmetropic eye in order to achieve sharp near vision. Visual acuity curves and defocus curves were plotted postoperatively. According to our results, this new concept seems to be an efficient approach of achieving appropriate uncorrected vision at all distances, by creating binocular trifocal monovision.

Capsular Bag Distension Syndrome after Uneventful DMEK for Fuchs Corneal Endothelial Dystrophy

Capsular bag distension syndrome (CBDS), or capsular block syndrome, is a rare complication (< 1%) following cataract surgery with continuous curvilinear capsulorhexis, phacoemulsification, and intraocular lens (IOL) implantation in the capsular bag. It is characterized by accumulation of cloudy fluid between the IOL and the posterior lens capsule. The signs or symptoms can develop in the early or late postoperative period and have been reported even 20 years after cataract surgery [1]. The entrapped fluid leads to poor visual acuity. A myopic refractive shift in 80% of patients and hyperopic shift in 20% of patients have been reported [2]. In some cases, elevation of intraocular pressure (IOP) has been described.

Clinical and laboratory studies on the effects of capsular tension ring on surgical outcomes of trifocal intraocular lens implantation

To assess the influence of capsular tension ring (CTR) on surgical outcomes of trifocal intraocular lens (IOL) implantation in femtosecond laser-assisted cataract surgery. Sugita Eye Clinic, Tokyo, and University of Tsukuba, Ibaraki, Japan. Prospective, randomized, paired-eye clinical study and laboratory study. In the clinical study involving 44 eyes of 22 patients with no risk of zonular instability, 1 eye received IOL alone and the contralateral eye received IOL with CTR. Preoperative capsular bag diameter and postoperative IOL tilt/decentration were measured using anterior segment optical coherence tomography. In the laboratory study, IOL and CTR were implanted into an artificial capsular bag of 10 mm in diameter, and IOL centration was evaluated. Throughout the 12-month follow-up period, there was no significant difference in refractive and visual outcomes between groups. The amount of IOL decentration was significantly larger in eyes with CTR than in eyes without CTR at 12 months postoperatively (P = .037). There was a significant negative correlation between capsular bag diameter and the amount of IOL decentration in eyes with CTR (P = .038), but not in eyes without CTR (P = .873). The laboratory study indicated that interference between CTR eyelets and IOL haptics significantly increased IOL decentration (P < .001). The use of CTR did not affect refractive and visual outcomes of trifocal IOL implantation in eyes without the risk of zonular weakness. CTR coimplantation increased IOL decentration possibly due to the interference between CTR eyelets and IOL haptics.

Migration of dexamethasone implant (OZURDEX®) into the anterior chamber in a pseudophakic eye with an intact capsular bag

Ozurdex® (Allergan, Inc., Irvine, CA, USA) is an intravitreal sustained-release drug delivery system containing dexamethasone, mainly used for the treatment of macular edema in diabetes, retinal vein occlusions or treatment of non-infectious posterior uveitis, as approved by the US FDA. It can be implanted into the vitreous cavity via the pars plana route. Migration of this implant into the anterior chamber may occur in cases of aphakia, pseudophakia with defective lens capsule, zonular dehiscence, iatrogenic, or as in pseudoexfoliation syndrome. We report a case of a pseudophakic patient with intact posterior capsule and no significant history suggesting a zonular weakness, who presented with diminution of vision due to anterior migration of the dexamethasone implant and its effects on the cornea. Measurements of specular microscopy provide useful information which may aid in management pre- and post-removal of migrated implant.

Глаукома псевдофакичного глаза

Relevance. Currently, there is a steady increase in the age-associated eye diseases worldwide. First of all, this applies to such ocular diseases as age-related maculodegeneration (AMD), glaucoma and cataracts. Despite the development and standardization of surgical techniques, the widespread introduction of cataract phacoemulsification, appearance of many modifications of anti-glaucomatous surgery, and the active use of angiogenesis inhibitors used to treat AMD, these diseases continue to occupy a leading position in the causes of low vision and blindness. Purpose. To reveal the problem of the development of pseudophakic glaucoma in patients who underwent surgical treatment for cataracts. Material and methods.To complete this review, we searched for literature sources on the PubMed and Scopus abstract databases for the period up to 2021 inclusive. In total, 53 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 1963. Results. At risk are patients with pseudoexfoliative syndrome, high-grade myopia, traumatic, diabetic and uveal cataracts. Pseudophakic glaucoma can also be caused by intraoperative (iris damage, vitreous prolapse, implantation of an intraocular lens outside the capsular bag, incomplete viscoelastic washout) and postoperative complications (inflammatory process, hyphema, dislocation of the artificial lens, pupillary block or Ellingson syndrome). Conclusion. Pseudophakic glaucoma, although rare, is quite formidable, which can reduce result of cataract surgery. Key words: pseudophakic glaucoma, glaucoma, cataract, ophthalmohypertension, complications of phacoemulsification

Clinical and anatomic correlates of objectively measured zonular dehiscence in 427 postmortem pseudophakic eyes

ObjectifLa présente étude vise à mesurer de manière objective le degré de déhiscence zonulaire dans des yeux de donneurs cadavériques et à évaluer les corrélations cliniques et anatomiques. NatureÉtude transversale. MatérielQuatre cent vingt-sept yeux pseudophaques de donneurs cadavériques humains. MéthodesLes yeux provenaient de la banque d'yeux Lions Gift of Sight. Les photographies des yeux au microscope consistaient en une vue postérieure de segment antérieur (Miyake–Apple view); on a eu recours au logiciel ImageJ pour réaliser l'analyse de la zone visée afin de mesurer l'aire, la circonférence et le diamètre du sac capsulaire, de l'anneau ciliaire et du capsulorhexis. Les paramètres cliniques et anatomiques ont été évalués grâce à une analyse de régression linéaire simple et à une analyse de la variance à un facteur s'accompagnant d'un test de Bonferroni. On s'est servi de 2 paramètres de substitution pour mesurer la déhiscence zonulaire : le rapport de l'aire de la capsule sur l'aire de l'anneau ciliaire (CCR, pour capsule area over ciliary ring area ratio) et la décentration de la capsule par rapport à l'anneau ciliaire (CCD, pour capsule-ciliary ring decentration). Un CCR faible et une CCD élevée correspondent à une déhiscence zonulaire plus prononcée. RésultatsOn a noté une corrélation inverse significative entre le CCR et un capsulorhexis de plus petite taille (p = 0,012), une lentille intraoculaire de plus faible puissance (p < 0,00001), un âge moins avancé lors du décès (p = 0,00002) et un délai plus long entre l'apparition des cataractes et le décès (p = 0,00786). Le CCR était en outre significativement plus faible en présence de glaucome (p = 0,0291). Par ailleurs, la CCD était en corrélation significative avec un délai plus long entre l'apparition des cataractes et le décès (p = 0,000864), une plus grande aire de l'anneau ciliaire (p = 0,001), une opacification plus prononcée de la capsule postérieure (p = 0,0234) et une opacité plus prononcée de l'anneau de Soemmering (p = 0,0003). Enfin, on a enregistré significativement plus de décentration dans les yeux d'hommes que dans les yeux de femmes (p = 0,00852). ConclusionsLe CCR et la CCD constituent de nouvelles façons de mesurer la déhiscence zonulaire dans des yeux de donneurs cadavériques et permettent de mettre au jour de nombreuses corrélations intéressantes. Un élargissement de l'aire de l'anneau ciliaire pourrait être associé à une déhiscence zonulaire dans des yeux pseudophaques et peut vraisemblablement servir de variable de substitution quantifiable in vivo.

The lens capsule significantly affects the viscoelastic properties of the lens as quantified by optical coherence elastography.

The crystalline lens is a transparent, biconvex structure that has its curvature and refractive power modulated to focus light onto the retina. This intrinsic morphological adjustment of the lens to fulfill changing visual demands is achieved by the coordinated interaction between the lens and its suspension system, which includes the lens capsule. Thus, characterizing the influence of the lens capsule on the whole lens's biomechanical properties is important for understanding the physiological process of accommodation and early diagnosis and treatment of lenticular diseases. In this study, we assessed the viscoelastic properties of the lens using phase-sensitive optical coherence elastography (PhS-OCE) coupled with acoustic radiation force (ARF) excitation. The elastic wave propagation induced by ARF excitation, which was focused on the surface of the lens, was tracked with phase-sensitive optical coherence tomography. Experiments were conducted on eight freshly excised porcine lenses before and after the capsular bag was dissected away. Results showed that the group velocity of the surface elastic wave, , in the lens with the capsule intact ( ) was significantly higher (p < 0.001) than after the capsule was removed ( ). Similarly, the viscoelastic assessment using a model that utilizes the dispersion of a surface wave showed that both Young's modulus, E, and shear viscosity coefficient, η, of the encapsulated lens ( ) were significantly higher than that of the decapsulated lens ( ). These findings, together with the geometrical change upon removal of the capsule, indicate that the capsule plays a critical role in determining the viscoelastic properties of the crystalline lens.

NEW, SIMPLE, AND SAFE SURGICAL TECHNIQUE FOR THE REMOVAL OF A DISLOCATED CAPSULAR TENSION RING-INTRAOCULAR LENS-CAPSULAR BAG COMPLEX.

To report a safe and simple surgical technique for the removal of a dislocated capsular tension ring (CTR)-intraocular lens (IOL)-capsular bag (CB) complex. We present an extraocular surgical removal technique for a dislocated CTR-IOL-CB complex. Although the entire complex is typically removed with a large incision, this approach applies a CTR injector and anterior capsule forceps in a less invasive manner. After vitrectomy, the complex was moved to the anterior chamber, where the tip of the CTR was separated from the IOL-CB using anterior capsule forceps and hooked onto the tip of the CTR injector. Subsequently, the CTR, as well as part of the CB, was gradually separated from the IOL-CB and stored in the CTR injector. This was completed while also supporting the IOL-CB complex using the forceps. Once the whole CTR and the part of CB were removed from the anterior chamber, the residual IOL and CB were then removed. Our methodology, using the CTR injector and anterior capsule forceps, enables the procedure to be completed with only a small corneal incision, thereby allowing for the safe and simple removal of a CTR-IOL-CB complex.