Capsular Bag Research Articles

Novel nucleus management technique in hypermature morgagnian cataracts with liquified cortex during phacoemulsification.

To describe a novel nucleus management technique of variable size mobile nucleus in Hypermature Morgagnian cataracts. In this technique, under topical anesthesia, temporal tunnel incision and capsulorhexis were performed, and the capsular bag was inflated with 2% w/v hydroxypropylmethylcellulose. A chopper and phacoemulsification probe were used to consciously nudge the nucleus towards the capsular periphery (fornix) to immobilize the floating nucleus against the capsular bag recess. Firm nuclear impaling was achieved using longitudinal power in linear mode (range 0-70%), 650 mmHg vacuum, and aspiration flow rate of 42 ml/min. The nucleus was chopped by direct chop technique, total separation achieved, and fragments emulsified. Primary outcome measures included ease of nuclear holding, iatrogenic zonular stress/damage, posterior capsule tear, and endothelial cell loss. This technique was performed in 29 consecutive cases from June 2019 - December 2021, and no intraoperative or postoperative complications were noted. The average phacoemulsification time and cumulative dissipated energy (CDE) were nearly similar in all cases. This technique would make phacoemulsification much safer in eyes with hypermature cataract and liquified cortex with lower complication rates and maintenance of better endothelial integrity.

Comparison of Capsular Tension Ring Implantation before vs. after Toric Intraocular Lens for Rotational Stability.

To compare the effect of implanting the capsular tension ring (CTR) before or after a toric intraocular lens (IOL) on rotational stability in patients with cataract and astigmatism. This is a randomized retrospective study. Patients who underwent phacoemulsification combined with toric IOL implantation due to cataract and astigmatism between February 2018 and October 2019 were enrolled in the study. Group 1 consisted of 53 eyes of 53 patients in whom the CTR was placed into the capsular bag after the implantation of the toric IOL. On the other hand, group 2 consisted of 55 eyes of 55 patients in whom the CTR was placed into the capsular bag before implantation of the toric IOL. The two groups were compared in terms of preoperative and postoperative astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and postoperative IOL rotation degree. There were no significant differences between the two groups related to age and sex (p > 0.05) or the mean preoperative spherical value, UCVA, BCVA, and corneal astigmatism (p > 0.05). Although the mean postoperative residual astigmatism of the first group (- 0.29 ± 0.26) was lower than that of the second (- 0.43 ± 0.31), the difference was not statistically significant (p = 0.16). The mean degree of rotation was 0.75 ± 2.66° in group 1 and 2.90 ± 6.57° in group 2, which was found to be statistically significant (p = 0.02). The implantation of CTR after a toric IOL provides further rotational stability and more effective astigmatic correction.

Extracellular HSP90 promotes differentiation of lens epithelial cells to fiber cells by activating LRP1-YAP-PROX1 axis.

Capsular residual lens epithelial cells (CRLEC) undergo differentiation to fiber cells for lens regeneration or tansdifferentiation to myofibroblasts leading to posterior capsular opacification (PCO) after cataract surgery. The underlying regulatory mechanism remains unclear. Using human lens epithelial cell lines and the ex vivo cultured rat lens capsular bag model, we found that the lens epithelial cells secrete HSP90α extracellularly (eHSP90) through an autophagy-associated pathway. Administration of recombinant GST-HSP90α protein or its M-domain induces the elongation of rat CRLEC cells with concomitant upregulation of the crucial fiber cell transcriptional factor PROX1and its downstream targets, β- and γ-crystallins and structure proteins. This regulation is abolished by PROX1 siRNA. GST-HSP90α upregulates PROX1 by binding to LRP1 and activating LRP1-AKT mediated YAP degradation. The upregulation of GST-HSP90α on PROX1 expression and CRLEC cell elongation is inhibited by LRP1 and AKT inhibitors, but activated by YAP-1 inhibitor (VP). These data demonstrated that the capsular residue epithelial cells upregulate and secrete eHSP90α, which in turn drive the differentiation of lens epithelial cell to fiber cells. The recombinant HSP90α protein is a potential novel differentiation regulator during lens regeneration.

Scheimpflug Imaging of Late-onset Capsular Bag Distention Syndrome Treated with Nd: YAG Laser: A Case Report

Aims: To report a case of very late-onset capsular bag distention syndrome (CBDS) 8 years after uncomplicated cataract surgery treated with Neodymium: Yag (Nd: Yag) laser posterior capsulotomy.
 Presentation of the Case: A 76-year-old female patient without any systemic or ocular disorders, presented with progressive blurry vision in her right eye (RE) over the last 1 year. Best-corrected visual acuity (BCVA) was 6/9 in the right eye and 6/6 in the left eye. Manifest refraction revealed a 0.5 diopters myopic shift in her RE compared to her last ocular examination 2 years ago. Scheimpflug photograpgy and slit-lamp examination were utilized to make the diagnosis of CBDS, which was successfully treated with Nd: Yag laser posterior capsulotomy. At day 1 post-capsulotomy the BCVA of her RE improved to 6/6 with a 0.5 diopters hyperopic shift which was consistent with a 0.13 mm post-capsulotomy increase in the anterior chamber depth, as documented by the Scheimpflug images.
 Discussion and Conclusion: Late-onset CBDS can manifest after a considerable time period following cataract surgery and Scheimpflug imaging can be a useful aid for a precise diagnosis and documentation of the treatment.

Comparison of Primary Duet Lens Procedures: In-The-Bag Monofocal with Sulcus Multifocal, and Standard Single Multifocal Lens for Cataract Surgery

To assess the safety and efficacy of primary duet intraocular lens (IOL) procedure using an in-The-bag monofocal IOL and a sulcus-based multifocal reversible platform for cataract surgery. The visual outcomes were compared with a single in-The-bag multifocal IOL. Retrospective cohort study. Consecutive patients who underwent primary duet IOL procedures were compared with consecutive patients who underwent single multifocal IOL surgery. Primary outcomes were uncorrected distance and near visual acuities (UDVA and UNVA), refraction and spherical equivalent data. Secondary outcomes included surgical complications. The study group consisted of 32 eyes (22 toric IOLs) whilst the control group had 57 eyes (29 toric IOLs). There were no statistically significant differences between the two groups on post-operative 1-month and 1-year UDVA (p=0.1522 and 0.4926, respectively) and UNVA (p=0.1248 and 0.2738, respectively). There were no statistically significant differences in the postoperative 1-month spherical equivalent within ± 0.5 diopter (p=0.1891). Postoperative intraocular pressure spikes were observed on day-1 in both groups, with most returned to their baseline at 1-month and all were normal at 1-year post surgery. There were no statistically significant differences in intraocular pressure between the two groups on day-1, 1-month and 1-year after surgery (p=0.6421). There were no statistically significant differences in the IOL axis deviation from the intended axis in the toric subgroup analysis (p=0.5843). Primary duet IOL procedure is equally effective and safe in correcting distance and near vision when compared with single multifocal IOL in the capsular bag.

Optical Quality Variation of Different Intraocular Lens Designs in a Model Eye: Lens Placed Correctly and in an Upside-Down Position

Introduction: Intraocular lenses (IOLs) may lose their optical quality if they are not correctly placed inside the capsular bag once implanted. One possible malpositioning of the IOL could be the implantation in an upside-down position. In this work, three aspheric IOLs with different spherical aberration (SA) have been designed and numerically tested to analyse the optical quality variation with the IOL flip, and misalignments, using a theoretical model eye. Methods: Using the commercial optical design software OSLO, the effect of decentration and tilt was evaluated by numerical ray tracing in two conditions: in their designed position and flipped with respect to the planned position (IOL is implanted upside down). The theoretical model eye used was the Atchison model eye. Seven IOL designs of +27.00 diopters were used: a lens with negative SA to correct the corneal SA, a lens to partially correct the corneal SA, and a lens to not add any SA to the cornea (aberration-free IOL). These lenses were designed with the aspherical surface located on the anterior and posterior IOL surface. A lens with no aspherical surfaces was also included. For the optical quality analysis, the modulation transfer function (MTF) was used, together with the Zernike wavefront aberration coefficients of defocus, astigmatism, and primary coma. Results: Off-centring and tilting the IOL reduced overall MTF values and increased wavefront aberration errors. With the IOL correctly positioned within the capsular bag, an aberration-free IOL is the best choice for maintaining optical quality. When the IOL is flipped inside the capsular bag, the optical quality changes, with the aberration-free IOL and the IOL without aspheric surfaces providing the worst results. With the lens in an upside-down position, an IOL design to partially correct corneal SA shows the best optical quality results in decentration and tilt, in terms of MTF and wavefront aberrations. Conclusion: The aberration-free IOL is the best choice when minimal postoperative errors of decentration or tilt are predicted. With IOL flip, the negative SA lens design is the best choice, regarding the root mean square wavefront aberrations. However, in a proper IOL implantation, the IOL designed to partially compensate the corneal SA including asphericity on its posterior surface is the better possible option, even in the presence of decentration or tilt.

Multimodality imaging technique for capsular bag distension syndrome

Multimodality imaging technique for capsular bag distension syndrome

Retropupillary iris-claw lens

Aim: To evaluate the preoperative and intraoperative indications, postoperative complications, incidence of secondary glaucoma, and visual outcome in patient who underwent iris-claw implantation during cataract surgery and effect of vitrectomy on postoperative intraocular pressure (IOP). Material and Methods: A retrospective study was conducted from January 2016 to February 2020. One hundred eighty-seven eyes of 187 patients who underwent iris-claw lens implantation, with minimum 1 month follow-up, were included in the study. Analysis of records was done for preoperative, intraoperative findings and was recorded and postoperative best corrected visual acuity (BCVA) and IOP were noted in each follow-up. Results: Mean preoperative BCVA of 187 eyes was 1.78 logMAR (SD 0.68), which increased to 0.61 ± 0.50, 0.36 ± 0.26, 0.21 ± 0.16 logMAR at postoperative day 1, day 7, and 1 month, respectively. Most common indications included phacodonesis (17.65%), small dilating and nondilating pupil (11.22%), zonular dialysis (6.41%), and pseudoexfoliation in (4.81%). Few patients (6.94%) had preexisting corneal pathologies which lend up in intraoperative complications that lead to iris-claw implantation. Mean IOP in vitrectomized eye after 1 month was 15.53 (SD 2.16) mm Hg and those of nonvitrectomized was 16 (SD 1.90) mm Hg. Posterior capsular rent and whole capsular bag loss were the most common intraoperative indications. Incidence of secondary glaucoma was 2.13%. Irregular pupil was the most common anterior segment finding at 1 month postoperatively. Conclusion: Retropupillary iris-claw implantation is one of the safe and least complicated methods of managing intraoperative complications which gives good visual acuity and prevent patient from the trauma of multiple surgeries.

Visual outcome and complications after sutureless scleral fixation intraocular lens implantation

Context:In case of weak, inadequate, or total absence of posterior capsule following trauma or surgical complication, a sutureless scleral fixation (SFIOL) technique has been studied to secure good vision with minimal postoperative complications. It remains as a good alternative against anterior chamber intraocular lens (ACIOL), iris claw lens, and sutured scleral fixated intraocular lens.Aims:Visual outcomes after SFIOL implantation. Complications of SFIOL implantation.Settings and Design:A retrospective hospital-based study.Methods and Material:The study was undertaken depending on the data available of the patients who were diagnosed to have postoperative or post-traumatic aphakia and underwent pars plana vitrectomy ± lens explantation ± phacofragmentation with SFIOL implantation from the month of May 2021 to October 2021 and came for regular follow-up for 6 months. The study included patients with total absence of capsular bag or history of eye trauma or complicated cataract surgery causing aphakia. Patients with retinal detachment were excluded from the study. Indication for surgery, best corrected visual acuity, and other complications were studied.Results:Of 25 eyes of 25 patients who completed 6 months of follow-up, 16 (64%) were men and 9 (36%) were women. Mean visual outcome preoperatively and postoperatively were 1.56 ± 0.7 logMAR and 0.46 ± 0.1 logMAR units, respectively. Mild vitreous hemorrhage was found in 8 eyes (32%) which was the most common postoperative complication noted followed by postoperative hypotony in 6 eyes (24%). Transient rise in intraocular pressure, corneal edema, and choroidal detachment were other complications seen postoperatively.Conclusions:A technique of sutureless SFIOL implantation was found to be a cost-effective method of providing a good visual outcome without serious postoperative complications in eyes with aphakia following post-trauma or surgical complications.

Recurrent Uveitis-Glaucoma-Hyphema Syndrome Due to Positional Pupillary Capture after Sutureless Scleral-Fixated Secondary Intraocular Lens Placement

Here, we present a case of floppy iris leading to positional pupillary capture by a sutureless, scleral-fixated intraocular lens (IOL) causing recurrent uveitis-glaucoma-hyphema (UGH) syndrome. The patient developed recurrent episodes of UGH syndrome after dislocated IOL removal and the placement of sutureless, scleral-fixated IOL. Gravitationally dependent pupillary capture was noted with the superior iris moving in front of and behind the IOL, depending on head positioning. Ultrasonography showed a floppy iris that moved with shifting gaze. The lack of the capsular bag may have contributed to extreme iris movements. This finding may be secondary to a combination of a lack of zonular support and capsular bag support as well as the lack of vitreous support following vitrectomy. When possible, secondary IOL placement behind a peripherally preserved capsular bag may reduce the risk of UGH.

Simulated zonular tension analysis in the presence of zonular disinsertion

Purpose: To analyze and understand the zonular tension and distribution of forces in the presence of zonular disinsertion in a model simulation with and without a capsular tension ring (CTR). Methods: This study was conducted at Complejo Hospitalario Universitario Albacete, University of Castilla La Mancha, Spain. Twelve load cells were arranged in a circular fashion to simulate the 360 degrees of zonulae in the eye. An elastic band was prestretched in a uniform and radial manner in 12 directions. Force measurements were taken using 12 load cells, uniformly arranged at 30° spacing around the elastic band. Tension was measured at each cell, before and after the simulated zonulardisinsertion. Every clock hour of zonular disinsertion was cycled through all 12 load cells. The tension was evaluated for zonular disinsertion ranging from 0 to 5 clock hours (0° to 150°) with and without a CTR. Results: An increase in zonular tension was recorded in the load cells adjacent to the segments of zonular disinsertion. As the zonular disinsertion progressed, opposing forces could no longer cancel each other out, leading to a displacement of thecomplex. The use of a CTR redistributed the forces, providing better centration in the presence of zonulolysis. Conclusion: This study visualizes the distribution of forces and displacement of the capsular bag complex in the presence of zonular disinsertion and demonstrates a significant increase in zonular tension in the areas adjacent to the segment of zonular disinsertion. The use of a CTR managed to redistribute the tension over the remaining zonulae, maintaining better centration in the presence of zonulolysis. The knowledge of this behavior can help surgeons tackle clinically significant zonular disinsertion.

Эффективность хирургического лечения спонтанной дислокации комплекса «интраокулярная линза – капсульный мешок», развившейся после факоэмульсификации возрастной катаракты

Purpose. To evaluate method for spontaneous dislocation of «intraocular lens – capsular bag» complex (CICB) surgical treatment, that developed after phacoemulsification (PE), in relation to its severity. Material and methods. Clinical material included 36 patients (36 eyes) aged 61 to 89 years. Spontaneous dislocation of CICB after PE performed varied from 3 months to 11 years after surgery, average 5±2 years. According to our proposed classification degrees of severity spontaneous dislocation of CICB, its 1st degree took place in 8 eyes; 2nd – in 9 eyes; 3rd – in 16 eyes; 4th – in 3 eyes. Surgical treatment was not performed in patients with the 1st degree of CICB dislocation. At the 2nd degree of CICB dislocation and more severe, patients underwent its surgical correction, according to severity of the eye condition. Results. All surgical intervensions were carried out as planned, without complications. The postoperative response of the eyes was evaluated on the 1st and next days of the postoperative period (SN Fedorov, EV Egorova, 1992). In all cases, it corresponded to the amount of performed surgical intervention. So, in 19 eyes, it corresponded to the 1st degree; in 6 eyes – 2nd degree; 3 eyes developed 3rd degree postoperative response of the eyes (postoperative uveitis). Indexes of uncorrected visual acuity on days 3–5 in 14 eyes (50%) ranged from 0.05 to 0.4; in 6 eyes (21%) – did not change significantly; in 8 eyes (29%) we reached the indexes that took place immediately after PE. Conclusion. Thus, in our experience, the surgical correction of spontaneous dislocations of CICB of the 2–4 degrees have shown itself to be effective in all of these cases. Key words: phacoemulsification, spontaneous dislocation of the «intraocular lens – capsule bag» complex, surgical treatment.

Синдром девиации инфузионных потоков: современное состояние вопроса

Relevance. Description of the infusion misdirection syndrome (IMS) was first published by R. Mackool in 1993. Nowadays many definitions of this syndrome are used by different authors that sometimes leads to confusion in understanding of clinical situations. Purpose. To summarize current understanding of the etiological factors, the specific pathogenic mechanisms of the infusion misdirection syndrome and possible treatment and prophylaxis methods of this condition. Material and methods. The PubMed web platform was used to find relevant studies since 1992 until 2022 using the following keywords: infusion misdirection syndrome, aqueous misdirection syndrome, intraoperative fluid misdirection syndrome, subcapsular fluid entrapment, acute intraoperative rock-hard eye syndrome. Search query found 167 papers, only 10 papers were relevant for the topic of search. Other publications were also considered as a potential source of information when referenced in relevant articles. Results. Authors of this article support the opinion that IMS etiologically relates to irido-zonular dehiscence and disturbance of the vitreolenticular interface barrier. Manifestations of the IMS include retrocapsular lens fragments migration after uneventful phacoemulsification with intact capsular bag and vitreous hydration. The most severe IMS consequence is the acute intraoperative rock-hard eye syndrome. In intact capsules the zonular dehiscence may enable fluid to flow in an unusual pattern, facilitating its penetration to the posterior chamber. The role of vitreolenticular interface should be mentioned in the aspect of the IMS. Anterior hyaloid membrane detachment or Wieger's ligament destruction are risk factors for IMS development during phacoemulsification. Conclusion. IMS is the object of insufficient research in ophthalmology nowadays. There are many descriptions of IMS in literature, but no solutions to avoid this hidden complication of cataract surgery are proposed. Key words: infusion misdirection syndrome, phacoemulsification, irido-zonular dehiscence, vitreolenticular interface.

Complications and visual outcome of cataract surgery in pseudoexfoliation patients

Pseudoexfoliation syndrome is a multifactorial diffuse disease and is diagnosed clinically on slit lamp examination of the eye by the deposition of white, dandruff like material on different structures in anterior segment i:e corneal endothelium, iris, pupillary margin, anterior lens capsule, zonules and trabecular meshwork. The aim of study was to study demographic features, intraoperative and postoperative complications and the visual outcome of cataract surgery in pseudoexfoliation patients. 93 eyes of 93 patients with pseudoexfoliation posted for cataract surgery were included in the study. 79.56% patients were of more than 60 years of age group.43 patients were male and 50 patients were female. 44 patients had pseudoexfoliation syndrome in both eyes and 49 patients had either right eye or left eye involvement. Intraoperative problems encountered were poor pupillary dilatation, capsular bag prolapse, zonular dehiscence, posterior capsular rent, residual cortical matter and positive vitreous pressure. Postoperative complications reported were corneal edema, raised intraocular pressure, significant anterior chamber cell reaction, left cortical matter and exudative membrane. Best corrected visual acuity was more than 6/18 in 67 eyes, between 6/60-6/24 in 16 eyes, and less than 6/60 in 10 eyes. At 1 month, best corrected visual acuity was more than 6/18 in 92 eyes. Cataract surgery in pseudoexfoliation patients is associated with high risk of complications. Use of iris hooks and capsule tension rings where required during the surgery can decrease the intraoperative complications and thus will give better visual outcome.

Optical and reconstructive surgery of a patient with a contusion damage of the eyeball and iridodialysis of 180 degrees: a clinical case

Traumatic eyeball damages is a topical issue in present-day ophthalmology as they constitute one of the main causes of vision loss in people of working age. Purpose: to assess the feasibilty, effectiveness and safety of one-time early-stage microinvasive optical reconstructive surgery of a patient with traumatic eyeball damage consequences: a swelling cataract, lens ligamentous apparatus defect, iridodialysis, and traumatic mydriasis. Material and methods. Patient V., 27, was under observation with the following diagnosis: “OS — condition after a contusion damage to the eyeball: traumatic swelling cataract; stage II subluxation of the lens; traumatic mydriasis, iridodialysis of 180 degrees”. OS visual acuity — correct light projection. The patient underwent an ORO of the left eye: phacoaspiration of a swelling cataract with implantation of an intracapsular ring and an intraocular lens in combination with closed iridoplasty. Results. No intraoperative complications took place. In the postoperative period, the best corrected visual acuity was 0.6, IOP remained stable, the lens was centered in the capsular bag, the iris sutures were consistent, the pupil rounded, centered, 4 mm in diameter. The patient felt satisfied with the cosmetic and functional result of surgery. Conclusion. One-time iridoplasty in combination with cataract surgery is an effective and safe method of surgical treatment of traumatically damaged iris and lens.

Phacoemulsification of cataract in the case of capsular bag damage

Purpose: to analyze the results of complicated cataract phacoemulsification with implantation of various types of intraocular lenses and fixation techniques. Material and methods. 48 patients (51 eyes) with complicated cataracts and weakened ligamentous apparatus of the lens or intraoperative rupture of the posterior lens capsule were divided into two groups: the study group I consisted of 21 patients (23 eyes, aged 71.4 ± 4.5 years) who had cataract phacoemulsification with an implantation of RSP-III IOL which was performed through a 2.4 mm small self-sealing incision using an injector and the control group II consisting of 27 patients (28 eyes, aged 73.6 ± 4.1 years) who had. Cataract phacoemulsification with an anterior chamber IOL implantation using an incision widened to 6.0 mm. Results. By the end of 1-year follow-up period, uncorrected visual acuity was 0.8 ± 0.1 in group 1 and 0.5 ± 0.1 in group II. In 100% of the patients of group 1 the correct position of the IOL was achieved in the early postoperative period (1–3 days) and maintained in the late period (1 year), whereas in group II, two eyes of 28 operated (7.14 %) showed a forward displacement of the anterior chamber IOL, which involved a contact with corneal endothelium. IOP stayed within the normal range in 21 eyes of group I patients (91.3 %), albeit two eyes (8.7 %) revealed transitory hypertension. In group II, 21 eyes (75 %) had normal IOP in the first three postoperative days, while 7 eyes (25 %) revealed an IOP increased to 29–30 mm Hg. In contrast to group I, group II patients showed induced corneal astigmatism which was decreasing during the follow-up period. Conclusion. In the case of a rupture of the posterior capsule during cataract phacoemulsification, or failure of the ligamentous apparatus of the lens of various origins, the implantation of the RSP-III IOL through a small self-sealing incision using an injector is the method of choice, which allows achieving a stable position of the IOL in the early and long-term follow-up periods, and high visual acuity with the minimal values of corneal astigmatism.

IOL scaffolding technique in Hypermature/ Morgagnian cataract in Manual Small Incision Cataract Surgery.

To describe surgical technique of IOL scaffolding in hypermature / Morgagnian cataract in manual small incision cataract surgery.Setting: charitable section of the hospital through direct availed services at free /subsidised cost. Interventional study. This study included 38 eyes of 38 patients operated at charitable section of the hospital through direct availed services at free /subsidised cost. IOL scaffolding in manual small incision cataract surgery was executed in 38 patients out of which 25 patients were diagnosed as hypermature cataract, pseudoexfoliation syndrome with mature cataract in 5 patients, 5 patients had phacolytic glaucoma and 3 patients had lens induced uveitis. This technique was successful in 35 out of 38 patients and was not successful in three patients in whom traditional SICS was performed in 2 patients and retro haptic iris fixation in one patient. We describe a technique which uses IOL as a scaffold in hypermature cataract in MSICS that provides a stable barrier by stretching the capsular bag in order to prevent the crumpling of the bag or whole bag removal following nucleus delivery.

Evaluation of Wang-Koch optimisation of axial length for intraocular lens power calculation in myopic eyes

Background: Refractive outcome has become more relevant in myopic patients. Refractive surprises are mainly caused by errors in axial length (AL) measurement.Aim: This study aimed to evaluate the accuracy of intraocular lens (IOL) power calculation in myopic eyes using the AL measured by optical biometry versus an optimised AL calculated by the Wang-Koch method.Setting: Ophthalmology Department, Cairo University and Ophthalmic Diagnostic and Laser Unit, Cairo University Hospitals, both in Cairo, Egypt.Methods: A prospective study of 30 eyes of 23 patients with ALs greater than 25.0 mm that underwent phacoemulsification with IOL implantation in the capsular bag. The LENSTAR was used for preoperative IOL power calculation using the Holladay 1 formula and the LENSTAR AL (group 1), and for back-calculation of the prediction error (PE) for the same 30 eyes using the Holladay 1 formula and the optimised AL (group 2). Postoperative PEs and mean absolute errors (MAEs) were calculated six weeks after surgery.Results: The postoperative spherical equivalent was within ± 1.00 dioptre (D) of predicted in 86.7% and 90.0% of eyes, respectively, (p = 0.69). However, 66.7% of eyes had a hyperopic outcome in group 1, in comparison to 20.0% that would be left hyperopic using the optimised AL in group 2 (p 0.05).Conclusion: The Wang-Koch method of optimising the AL would have significantly reduced the percentage of eyes rendered hyperopic using the LENSTAR AL from 66.7% to 20.0%. This difference represents a clinically significant improvement in IOL power prediction in these eyes.

An improved two-steps method for secondary in-the-bag intraocular lens implantation in aphakia eye.

To describe an improved technique for secondary IOL implantation in constricted capsular bag in aphakic eyes. This study was designed and carried out in the department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital). This is a retrospective study which evaluate the post-operative effect of the two-steps secondary IOL implantation. 21 eyes of 21 patients who underwent primary cataract surgery from June 2020 to September 2020 were enrolled. Two-steps IOL implantation was performed. Patients were followed up with ophthalmic examinations. Of all 21 eyes, the capsular bags were reopened and the IOL were implanted into the bag. During follow-up, the mean age was 62.3 ± 7.3 (range, 44-81) years and mean interval between the primary surgery and secondary IOL implantation was 23.5 ± 9.6 (range, 4.1-78.3) weeks. A marked improvement of postoperative mean BCVA was noticed (pre 20/84 Snellen, 0.62 ± 0.26 logMAR equivalent, and post 20/44 Snellen, 0.34 ± 0.33 logMAR equivalent; p = 0.001). The mean SE also improved from + 10.32 ± 5.05D at baseline to -2.68 ± 1.36D at the last follow-up time (p < 0.001). The mean IOP showed no significant difference (pre 17.62 ± 4.66 mmHg, post16.84 ± 4.73 mmHg; p = 0.6860) and the corneal endothelial cell density decreased about 11.04 ± 10.84% (from 2483 ± 218.43 cells/mm2 to 2190 ± 361.36 cells/mm2 p = 0.0029). The two-steps capsular bag reopening method can be achieved in majority of cases with stable IOL position and better visual outcome.

Capsular bag transplantation

AbstractPurpose: To describe the surgical process of extraction of the capsular bag of the crystalline lens from the cadaveric donor and its posterior implant in aniridia and aphakia cases.Methods: This surgical procedure was used in three posttraumatic aniridia and aphakia patients, and in a aphakic case with uveitis‐glaucoma‐ hyphema (UGH) syndrome. In a case was implanted a capsular bag, an intraocular lens (IOL) and an aniridia ring. In two cases in addition was implanted an artificial iris prothesis. In three surgeries, the capsular bag was preserved by freezing prior to the operation. A pars plana vitrectomy was performed in each case. The in‐the‐bag IOL complex was fixed using a cow hitch knot technique.Results: The pseudophakic capsular bags complex remained stable and well positioned in all cases without any rejection phenomena. In the UGH syndrome, the capsular bag transplant avoided the mechanical trauma of the IOL over adjacent anatomical structures.Conclusions: Capsular bag transplant could be a good option in posttraumatic aniridia with aphakia and in UGH syndrome, to resolve these conditions in only one‐stage surgery. This new surgical technique could be the best way to recuperate the anatomical compartmentalization of the eyeball in such cases.