Capsule Bag Research Articles

Зависимость частоты спонтанной люксации комплекса капсульный мешок-ИОЛ от материала и массы линзы

Abstract Spontaneous luxation frequency dependence of the «capsule bag-IOL» complex on the material and weight of the lens A.A. Ivanov , O.P. Mishchenko , T.N. Iureva S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk Branch, Irkutsk, Russian Federation Irkutsk State Medical Academy of Postgraduate Education – branch of the FSBEI APE RMACPE, Irkutsk, Russian Federation Irkutsk State Medical University, Irkutsk, Russian Federation Relevance.Spontaneous luxation of the «capsule bag – IOL» complex in the long-term postoperative period is a serious complication. The search for regulated risk factors, the limitation of which will reduce the frequency of this complication, is relevant. Purpose. To evaluate association between frequency of spontaneous luxation of the «capsule bag – IOL» complex and the number of surgeries, taking into account the characteristics of the lens. Material and methods. 69 IOLs from 14 medical companies and 2 capsule rings were examined. The weight was determined using trusted torsion scales (accuracy ± 1 mg) under hydration conditions. IOLs were divided into 3 groups: ≤18 D; 18.5–24.0 D; ≥24.5 D. A retrospective analysis of 159 cases of spontaneous IOL luxation into the vitreous body over 13 years (2007–2020) was carried out. Comparison of IOL implantation results/luxation was carried out from 2006 to 2010, taking into account luxations from 2007 to 2020. Additionally, the number of years from IOL implantation to spontaneous luxation, the axial length of the eye, and the presence of pseudoexfoliation syndrome were evaluated. Results. A multiple excess of the weight of hydrophilic compared with hydrophobic IOLs was found in three comparison groups with a comparable refractive power (p=0.0001). Hydrophilic lenses in various groups were 1.5–1.82 times heavier than hydrophobic lenses. Spontaneous luxation of hydrophobic IOLs occurred less frequently by 11.86–49.22% compared to lenses made of hydrophilic materials. Conclusion.The weight of the IOL may play an important role in the pathogenesis of dislocation of the artificial lens. In the future, it is possible to develop recommendations to reduce the risk of luxation of the «capsule bag – IOL» complex in the long term for patients with an initial combination of non-correctable risk factors complicating the condition of the ligamentous apparatus of the lens. Key words: IOL luxation, IOL weight, lens material, hydrophilic or hydrophobic IOLs

Транссклеральная фиксация ИОЛ как оптимальный барьер между камерами глаза при витреальной патологии

In case of regmatogenic retinal detachment, the main point is the formation of a strong barrier between the chambers of the eye using intraocular lenses, including in case of combined pathology, and in particular in the absence of the possibility of implanting a lens into the capsular bag. The distinctive features of the lens location relative to the limb and cornea were identified during a comparative analysis of the position of intraocular lenses in patients with articulation and transcleral fixation using optical coherence tomography. The purpose of the study was to conduct a comparative analysis of the position of intraocular lenses in patients with transcleral fixation and in patients with artificial in the conditions of silicone tamponade of the vitreal cavity. Material and methods. The studies were carried out on 64 eyes of patients aged 56 to 75 years with transcleral fixation and artifaction with silicone tamponade of the vitreal cavity. Results. In patients with transcleral fixation, the distance from the limb to the optical edge of the lens was equal to 4.31 ± 0.82 mm, in the group with articulation 4.11 ± 1.03 mm. The absence of a statistically significant difference indicates the position of the intraocular lens when performing transcleral fixation identical to the location of the lens in the capsule bag. The indicator of the distance from the cornea to the edge of the intraocular lens in patients with transcleral fixation corresponded to 3.72 ± 1.54 mm, in patients with articulation corresponded to 3.21 ± 1.48 mm, while this indicator in the group with transcleral fixation was more variable. Conclusion. In the conditions of silicone tamponade of the vitreal cavity, the technique of transcleral fixation of intraocular lenses provides a single-format position of the lens with artificial patients. Keywords: intraocular lens, transcleral fixation, silicone tamponade

Результаты имплантации монофокальной интраокулярной линзы Clareon с автоматизированной системой доставки AutonoMe (один год наблюдений)

Material and methods. The short- and long-term results of phacoemulsification with implantation of 700 Clareon intraocular lenses (IOL) preloaded into disposable pneumatic AutonoMe delivery systems were studied. The optical power of the IOL was calculated using the Verion system using modern formulas for emmetropia. Functional and refractive results, surgical and postoperative complications were assessed. Results. Of the 700 Clareon IOL implantations performed, 693 (99.0%) were without complications; complications occurred in 7 (1.0%) eyes. By 12 months of observation, BCDVA and UCDVA increased from 0.15±0.03 to 0.65±0.09 and from 0.31±0.04 to 0.76±0.12 (p<0.05), respectively. Refraction of the target was achieved in 90% of patients. The loss of endothelial cells from the baseline level was 4.8%. In all patients, the optical part of the IOL remained stably transparent, no glistening phenomena were observed in any case; the haptic component of the IOL provided a stable correct central position of the IOL in the capsule bag. Secondary cataract developed in 22/605 (3.6%) eyes, which required dissection in 19/605 (3.1%) eyes. Conclusion. The new monofocal intraocular lens Clareon is high-tech and can be widely used in clinical practice. The new automated pneumatic delivery system AutonoMe is efficient and safe. Key words: phacoemulsification, Clareon, automatic IOL delivery system, glistening, secondary cataract

Предварительные результаты превентивной фланцевой склерокорнеальной монофиксации комплекса внутрикапсульное кольцо – интраокулярная линза в хирургии катаракты при подвывихе хрусталика

Pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery and is associated with possible intra- and postoperative complications. To prevent further dislocation of the intraocular lens (IOL) in the postoperative period, IOL suturing with polypropylene thread is used for one or both supporting elements to the iris, or with sclerocorneal or scleral fixation. Purpose. Development of preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree and evaluation of its effectiveness. Material and methods. Preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree was performed in 15 patients aged 74.4 ± 11.4 years. The lens was fixed by the edge of the capsulorexis with four iris retractors, an intracapsular ring of the SK-2 type (Reper, Russia) was implanted into the capsule bag, an 8/0 polypropylene monofilament was attached to the inner curl of which, the second end of the thread was ab interno transclerally-transcorneally with the formation of a flange, the IOL was implanted into the capsule bag. Results. In all cases, the capsule bag was preserved and intra-capsule implantation of the IOL was performed. Complications during operations and in the postoperative period were not received in any case. The maximum corrected visual acuity (MCVA) during treatment rose from 0.2 ± 0.15 to 0.85 ± 0.14 6 months after surgery (p < 0.01; t-criterion). The loss of endothelial cells 3 months after surgery was 8,9 ± 1,4%. Conclusions. The use of preventive flanged sclerocorneal monofixation of the intracapsular ring – intraocular lens complex in cataract surgery with lens subluxation of II–III degree made it possible to preserve the capsular bag in all patients and perform the most physiological intracapsular implantation of IOL. Keywords: cataract, lens subluxation, phacoemulsification, intraocular lens.

Phacoemulsification Complicated Subluxation of the Crystalline Lens, Anterior Megalophthalmos, Central Cloudy Corneal Dystrophy of Francois and High Myopia

A case is described of a 47-old man with anterior megalophthalmos, high myopia (>31.0 mm) and who underwent bilateral consecutive phacoemulsification. In addition a bilateral dislike corneal opacity was present which was classified as central cloudy corneal dystrophy of Francois. Special attention must be paid to both surgical technique and IOL selection. In the first eye a single-piece foldable IOL was implanted into a capsule bag, in the second eye three-piece foldable IOL were sutured fixed to the iris. In the meantime, phacoemulsification in patients with dystrophy of Francois safe and does not lead to progression. We calculated the IOL power for our case with the Haigis and Barret II Universal formula retrospectively.

Возможности хирургической коррекции спонтанной дислокации комплекса «интраокулярная линза – капсульный мешок», развившейся в различные сроки после факоэмульсификации возрастной катаракты

Purpose. Substantiation of surgical correction method of spontaneous dislocation of the complex «intraocular lens – capsular bag» (CICB), that developed after phacoemulsification (PE), in relation to its severity. Material and methods. The clinical material consisted of 28 patients (28 eyes) aged 61 to 89 years. The terms of spontaneous dislocation of CICB after PE performed widely varied from 3 months to 11 years, averaging 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 correction was performed in all cases dislocation of CICB 2nd or more degrees, the volume of which was commensurate with the initial severity of the eye condition. Results. All operations were carried out as planned, without complications. The postoperative response of the eyes was assessed on the 1st and next days of the postoperative period. In all cases, it corresponded to the volume 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 8 eyes (29 %) we achieved indexes like they were immediately after PE. Conclusion. Thus, in our experience, the surgical correction of spontaneous dislocations of CICB of the 2–4th degrees has shown itself to be effective in all of these cases. Keywords: phacoemulsification, spontaneous dislocation of the «intraocular lens – capsule bag» complex, surgical treatment

Анализ положения интраокулярных линз у пациентов с транссклеральной фиксацией и силиконовой тампонадой витреальной полости при регматогенной отслойке сетчатки

Purpose. To conduct a comparative analysis of the position of intraocular lenses (IOL) in patients with transscleral fixation and in patients with artifacia in the conditions of silicone tamponade of the vitreal cavity. Material and methods. The studies were carried out on 64 eyes of patients aged 56 to 75 years with transscleral fixation and artifaction with silicone tamponade of the vitreal cavity. Results. In patients with transscleral fixation, the distance from the limb to the optical edge of the lens was equal to 4.31 ± 0.82 mm, in the group with articulation – 4.11 ± 1.03 mm. The absence of a statistically significant difference indicates the position of IOL when performing transscleral fixation identical to the location of the lens in the capsule bag. The indicator of the distance from the cornea to the edge of IOL in patients with transscleral fixation corresponded to 3.72 ± 1.54 mm, in patients with articulation corresponded to 3.21 ± 1.48 mm, while this indicator in the group with transscleral fixation was more variable. Conclusion. In the conditions of silicone tamponade of the vitreal cavity, the technique of transscleral fixation of IOL provides a single-format position of the lens with artificial patients. Keywords: intraocular lens, transscleral fixation, silicone tamponade

Inhibition of Posterior Capsule Opacification by Adenovirus-Mediated Delivery of Short Hairpin RNAs Targeting TERT in a Rabbit Model

Purpose Posterior capsule opacification (PCO) is the most common postoperative complication after cataract surgery and cannot yet be eliminated. Here, we investigated the inhibitory effects of telomerase reverse transcriptase (TERT) gene silencing on PCO in a rabbit model. Methods After rabbit lens epithelial cells (LECs) were treated with adenovirus containing short hairpin RNAs (shRNA) targeting TERT (shTERT group), adenovirus containing scramble nonsense control shRNA (shNC group) or PBS (control group), quantitative real-time polymerase chain reaction and Western blotting were used to measure the expression levels of TERT, and a scratch assay was performed to assess the LEC migration. New Zealand white rabbits underwent sham cataract surgery followed by an injection of adenovirus carrying shTERT into their capsule bag. The intraocular pressure and anterior segment inflammation were evaluated on certain days, and EMT markers (α-SMA and E-cadherin) were evaluated by Western blotting and immunofluorescence. The telomerase activity of the capsule bag was detected by ELISA. At 28 d postoperatively, hematoxylin and eosin staining of the cornea and iris and electron microscopy of the posterior capsule were performed. Results Application of shTERT to LECs downregulated the expression levels of TERT mRNA and protein. The scratch assay results showed a decrease in the migration of LECs in the shTERT group. In vivo, shTERT decreased PCO formation after cataract surgery in rabbits and downregulated the expression of EMT markers, as determined by Western blotting and immunofluorescence. In addition, telomerase activity was suppressed in the capsule bag. Despite slight inflammation in the iris, histologic results revealed no toxic effects in the cornea and iris. Conclusion TERT silencing effectively reduces the migration and proliferation of LECs and the formation of PCO. Our findings suggest that TERT silencing may be a potential preventive strategy for PCO.

Surgical decisions in the setting of zonulopathy.

An 85-year-old man with a history of type 2 diabetes, pseudoexfoliation (PXF) in both eyes, and tamsulosin use was referred for the evaluation of a dense cataract in the right eye and a subluxated intraocular lens (IOL) in the left eye. Unfortunately, his surgery in the left eye was complicated by diffuse zonulopathy. The referring surgeon placed a 3-piece IOL in the sulcus. However, the passively fixated 3-piece IOL moved inferiorly causing monocular diplopia for over a year. Because the patient was pleased with the IOL immediately postoperatively, a refixation procedure was performed in the form of sulcus placement with iris suture fixation in the left eye. Fortunately, the iris-fixated IOL in the left eye has remained well centered and stable without cystoid macular edema (CME) or chronic inflammation for over 8 months. The patient is on no ocular medications and has no family history of glaucoma. He now needs cataract surgery in the right eye and is extremely apprehensive because of his difficult course in the left eye. The corrected distance visual acuity is 20/70 in the right eye and 20/25 in the left eye. Intraocular pressures (IOPs) measure 20 mm Hg in the right eye and 14 mm Hg in the left eye by Goldmann tonometry. Pachymetry is 536 µm in the right eye and 543 µm in the left eye. Pupils are round with minimal reactivity and without a relative afferent pupillary defect. Extraocular motility is normal in both eyes, and confrontation visual fields is full in both eyes. Gonioscopy reveals an angle open to the pigmented trabecular meshwork (PTM) in the right eye and the ciliary body in the left eye with 1+ PTM and without peripheral anterior synechia in both eyes. The retinal nerve fiber layer and macular optical coherence tomography are normal in both eyes. On slitlamp examination, pertinent findings include pseudoexfoliative changes at the pupillary margin with poor dilation of 3.5 mm in both eyes; the anterior chamber (AC) is shallow but adequate in the right eye and deep and quiet with rare pigmented cells in the left eye. There is a 5+ nuclear sclerotic cataract with pseudoexfoliative changes on the anterior capsule and no obvious phacodonesis in the right eye and a 3-piece posterior chamber IOL in the sulcus fixated to the iris with 10-0 polypropylene sutures at 6 and 12 o'clock without pseudophacodonesis in the left eye. Dilated fundus examination reveals a cup-to-disc ratio of 0.4 with healthy neuroretinal rims in both eyes, posterior vitreous detachments in both eyes, and no evidence of diabetic retinopathy in both eyes. All other findings are unremarkable. How would you counsel this patient regarding his risk factors for surgery in the right eye? What surgical maneuvers would you use to remove the cataract safely? How would you stabilize the IOL if the capsule bag becomes compromised due to zonulopathy?

Non-viral gene coating modified IOL delivering PDGFR-α shRNA interferes with the fibrogenic process to prevent posterior capsular opacification.

Posterior capsule opacification (PCO), the most common complication after cataract surgery, is caused by the proliferation, migration and epithelial-mesenchymal transition (EMT) of residual lens epithelial cells in the capsule bag. Although the surface modification and drug loading of intraocular lens (IOLs) have been effective in preventing PCO to some extent, the intraocular safety of anti-proliferative drug application is still a major limitation in clinical application. In this study, we used non-viral gene delivery systems in combination with layer-by-layer (LBL) self-assembly technology, and the modified IOL could effectively prevent the development of PCO by interfering with the EMT process mediated by the platelet-derived growth factor receptor-α (PDGFR-α). Herein, the gene fragments were wrapped by electrostatic conjugation using polyethyleneimine-graft-poly(ethylene glycol) to form gene complexes. Gene complexes were characterized by dynamic light scattering, transmission electron microscopy (TEM) and agarose gel electrophoresis, and evaluated for storage and serum stability. The layer assembly behavior of the IOL surface, changes in optical properties and the release behavior of the gene complexes were characterized using quartz crystal microbalance, UV-vis, contact angle and TEM. In vitro experiments showed that the IOL coating has good bio-compatibility and can achieve the corresponding transfection effect, and the released gene complexes exhibited excellent cell internalization and lysosomal escape behaviors, as well as effective inhibition of PDGFR-α expression and its mediated EMT process. The early PCO prevention effect and bio-compatibility evaluation of the modified IOL in vivo were evaluated by implantation into animal eyes. This study provides a new strategy for the development of surface modifications of small nucleic acid drugs and non-toxic EMT interference therapies for PCO.

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.

Surgical Treatment of Patients with Dislocation of IOL — Fibrosed Capsule Bag Complexes

Violation of the correct location of the complex IOL capsule bag (CICB) in the delayed postoperative period occurs with a frequency of 0.2 to 2.8 %. The basis of the pathogenesis of this complication is the destruction of the zonal ligament due to progressive pseudoexfoliative syndrome, as well as the process of fibrosing the capsule bag. The stage of the flow and the different degree of severity of each mechanisms determines the variety of clinical manifestations. CICB dislocation in combination of these two mechanisms requires a special approach to treatment.Objective: to develop a system of surgical treatment of IOL dislocations in contract capsule syndrome, with varying degrees of severity, combined with the weakness of the ligament apparatus of the lens, and to present the results of its use.Patients and methods. Retrospective analysis of 55 cases of CICB dislocations with the observation period of more than 4 years operated in 2014-2016. Number of dislocations with certain IOL type: Hydrophilic monolithic — 27, Hydrophilic monolithic — 11, Hydrophilic three-part — 10, Hard — 7. The selection criterion was the presence of CICB dislocation in the combination of weakness of the ligament apparatus (II–III st. of severity) and contraction capsule syndrome, with varying degrees of severity. A system is proposed to allow a low-invasive repositioning of intraocular lenses dislocated with a fibrous capsule bag with subsequent suture fixation to the iris. Signs used for choice of surgical technique: localization of capsule bag fibrosis, contract effect of capsule bag fibrosis on IOL position and correct location of haptic elements, size, and severity of equatorial lens masses (Semmering ring). In cases when insufficiency of the ligament apparatus prevails, with insignificant fibrosis of the capsule bag, without contractional influence, fixation of KIKM to iris is carried out without cutting of the capsule bag (method 1). As the fibrous changes of the front or back leaf of the capsule progress without changing the position of IOL inside the capsule bag due to contraction, along with fixation of KIKM, the fibrous front/back capsule is excised (method 2). The variant of complete removal of the fibrous capsule bag is used in faraway stages of CCS with further fixation of IOL to the iris (method 3).Results. The data of BCVA and IOP of patients treated by a certain method (before the operation, early postoperative period (2–5 days), delayed period (more than 4 years)) are presented.Conclusion. Surgical treatment of patients with CICB dislocation combining manifestations of Capsule contraction syndrome and weakness of the lens ligament apparatus can now be standardized using a proper approach and certain methods of treatment, but requires a comprehensive assessment of such parameters as the safety of the ligament apparatus, the localization and degree of fibrous changes of the anterior / posterior capsule, the contractional effect of the capsule bag fibrosis on the front position of the IOL optics and the correct location of the haptic elements, the severity of the ring.

Capsular Contraction Syndrome. Review. Methods of Prevention and Treatment. Part 2

The article describes the existing methods of preventing the occurrence and progression of capsule bag fibrosis. The types of used treatment are listed and structured. Key aspects of the principles of surgical treatment are highlighted. They are aimed to eliminate the dislocation of the IOL-fibrous capsular bag complex. Special attention is paid to the methods of suture and sutureless fixation of the IOL to the sclera or iris. The author’s techniques are given. Variants of fixing devices were used. The risks of possible complications were analyzed. Conclusion: capsular syndrome is an actual problem that requires attention and search for optimal treatment methods, depending on comprehensive assessment of the initial condition.

К вопросу профилактики капсульного блока после факоэмульсификации катаракты с имплантацией заднекамерной интраокулярной линзы

Purpose. Method for the formation of anterior capsulorhexis for the prevention of capsular block in cataract phacoemulsification with implantation of a posterior chamber IOL was suggested. Material and methods. 67 patients (67 eyes) were operated on, for whom capsulorhexis was performed according to the method proposed by the authors in the form of an ellipse with a large axis of 7.0–7.5 mm along the tunnel incision and a small axis of 4.0–5.0 mm. Results. We did not observe any complications during the operation, as well as in the early and late postoperative period (damage to the anterior capsulorhexis, capsule block, bullous keratopathy, etc.). Only 2 patients (3%) were diagnosed intraoperatively with posterior capsule fibrosis, which required posterior capsulorhexis, which was performed after IOL implantation. At the same time, it should be noted that capsulorhexis was technically easier to carry out, since access to the posterior capsule was increased due to the previously performed oval anterior capsulorhexis. It was noted that the proposed method of forming the anterior capsulorhexis facilitates the insertion of the working part of the chopper over the edge of the lens when using the core fracture technique, reduces the risk of damage to the lens capsules, ensures reliable fixation of the IOL in the capsule bag and increases access for carrying out the posterior capsulorhexis, if necessary. After the operation UCVA and BCVA showed statistically significant increase, as much as possible after a month, but the difference with the data at the hospital discharge is statistically unreliable. After 1 year, visual functions remained stable, IOP was normalized. Conclusion. The proposed method for the formation of anterior capsulorhexis in cataract phacoemulsification with implantation of a posterior chamber IOL reliably eliminates the possibility of a capsule block due to the formation of an oval shape of the capsule hole. In addition, during the operation, it facilitates the insertion of the working part of the chopper over the edge of the lens when using the core fracture technique, reduces the risk of damage to the lens capsules, ensures reliable fixation of the IOL in the capsule bag by preserving sufficient peripheral flaps of the anterior capsule, and also increases access for posterior capsulorhexis under the IOL, if necessary. Keywords: cataract phacoemulsification, posterior chamber IOL, capsule block, oval capsulorhexis.

Клинический случай лечения ребенка с врожденной патологией радужки и хрусталика

Relevance. Congenital aniridia is a rare ocular malformation. Its occurrence in the world ranges from 1: 40,000 to 1: 96,000. Purpose. To study clinical and functional characteristics of both eyes and the effectiveness of treatment in a child with congenital aniridia, congenital cataract and lens subluxation. Material and methods. The article presents the results of the clinical case of the child T., born in 2006, diagnosed with: OU – Subluxation of the lens congenital III degree. Cataract congenital intrauterine polymorphic. Aniridia is congenital hereditary. Glaucoma congenital intrauterine initial subcompensated (m). Myopia congenital high with astigmatism. Nystagmus horizontal fine-caliber constant. Surgery was performed on both eyes – FAC + IOL + ICR with implantation of the complex «Artificial iris» + Anterior vitrectomy. The article presents an analysis of a clinical case with familial congenital aniridia in a child in order to increase the awareness of treating ophthalmologists about the complexity and systemic manifestations of this congenital malformation and the need for a systematic approach to its treatment. Results. Surgery and postoperative period without complications. Visual acuity after surgery was – OD – 0.08 w/c cyl (+) 1.0 D = 0.2; OS – 0.1 N/c. The position of the Artificial Iris complex is correct. IOL in the back chamber, in the capsule bag. A month after the operation, the visual functions are preserved, the IOP is compensated, the horizontal nystagmus has decreased Conclusion: • The use of the «Artificial iris» complex with a one-stage IOL implantation to correct the elimination of congenital aniridia makes it possible to achieve high cosmetic and functional results. • The child and the child’s parents are satisfied with the cosmetic effect after the operation. • A child after undergoing correction of aniridia with the «Artificial Iris» unit requires constant dynamic observation by an ophthalmologist. • It is necessary to take into account the high risk of postoperative ophthalmic hypertension in the child and the possibility of repeated interventions. Key words: congenital aniridia, congenital cataract, lens subluxation, cataract phacoaspiration with IOL implantation, intracapsular ring, Artificial iris complex

Transscleral Fixation of the Dislocated IOL-Capsular Bag Complex in Contraction Capsular Syndrome

Contraction capsule syndrome is a serious complication accompanied by structural changes of the capsule bag. Fibrous changes of the lens capsule are found in the postoperative period, even in cases of uncomplicated primary cataract surgery. A certain influence has both general systemic state of the patient and local predisposing factors: the presence of pseudoexfoliative syndrome, the material and design of IOL, the size and shape of the anterior capsulorexis. The far-reaching pathological process leads to pronounced anatomical disorders. Excessive, asymmetrical fibrosis of the anterior capsule in combination with the capsulorexis phimosis leads to IOL decentration and frontal inclination, as well as to the dislocation of the entire IOL capsule complex due to local defects of the zinc ligament. The article presents the method of transscleral-suture fixation of the dislocated IOL-Capsular bag complex developed as a result of contraction capsule syndrome on clinical examples. Its distinctive advantages are described. Reduction of invasiveness is achieved due to the “one puncture” technique — ab externo, needle 30G. The proposed method is technically simple and reliable due to absence of conjunctiva peritomy, low probability of polypropylene 9-0 biodegradation, and possibility of its application with different IOL models allows to speak about its universality.

Surgical Correction for Late Postoperative Subluxation of a Diffractive Optic Multifocal IOL, Capsule Bag and Capsule Tension Ring Complex: Case Report.

Diffractive optic intraocular lenses (IOLs) require near perfect centration for best performance. A patient with a multifocal IOL and pseudoexfoliation developed late marked subluxation of the capsule bag, capsule tension ring and multifocal IOL complex. The surgical challenge was to fixate and recenter the diffractive optic IOL in order to restore normal quality vision; traditional surgical methods are not adequate for repositioning IOLs of this nature. A unique surgical plan that included three-point radially oriented suture fixation of an existing standard capsule tension ring (CTR) was conceived and was successful in achieving the patient’s goal of maintaining spectacle independence by returning his vision to previous levels with a well-centered multifocal IOL.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00478-y.

Method of surgical treatment of patients with oculocutaneous albinism using artificial iris

To study the results of surgical treatment with implantation of an artificial iris as a diaphragm element in patients with albinism. This article was based on the examination and treatment of 2 patients suffering from oculocutaneous albinism, which is characterized by hypopigmentation of the iris and retinal pigment epithelium of the retina, foveolar hypoplasia, low visual acuity, nystagmus, strabismus and excruciating photophobia. The patients were implanted an artificial iris in both eyes with fixation in the capsular bag in the first patient, and in the ciliary sulcus in the second. In both patients, complaints of photophobia and optical phenomena have ceased. Visual acuity increased to 0.2 and remained without regression throughout the entire period of observation. Intraocular pressure and hydrodynamic parameters also remained stable throughout the observation period. The artificial irises were observed by ultrabiomicroscopy to remain in a stable position both when it was implanted in the capsule bag, and when it was seamlessly fixed in the ciliary sulcus. The surgical interventions relieved patients from glare, at the same time improving visual acuity without correction, as well as achieving a pronounced cosmetic effect and visual rehabilitation. Artificial irises have proven to be a safe and effective way to treat patients with oculocutaneous albinism.

Evaluation of flow field in the anterior segment during irrigation and aspiration in cataract surgery with three-dimensional computational simulation

IntroductionTo quantitatively analyze the flow field and fluid pressure contour in the anterior segment during the irrigation and aspiration (I/A) procedure by means of computational fluid dynamics (CFD) simulation. MethodsFour different models were established combining the irrigation sleeve, aspiration cannula, anterior chamber, and capsule to simulate various scenarios during the coaxial I/A procedure. Commercial CFX software was applied to perform the steady-state simulation with the k-ε turbulence model. The inlet boundary condition was a balanced salt solution with a 100 cm height of pressure, and the mass flow rate boundary condition set at 40 cc/min was applied at the outlet. ResultsThe four models included the I/A tip located in the middle of the pupillary plane, the capsule equator, and the middle of the posterior capsule. The inlet/outlet pressure at the tip of the I/A cannula was almost the same in the four models. Following ejection into the anterior chamber and capsule bag, the streamline speed rapidly decreased. The pressure in the anterior chamber and capsule bag was approximately 60–70 mmHg. The area on the cornea and capsule closer to the initial streamline of the inlet irrigation possessed larger pressure. The differential pressure on the cornea and capsule was greater when the irrigation orifice directly facing the wall. ConclusionThe pressure varies at different positions in the anterior segment during the I/A procedure. The study suggests that specific precautions are required when the tip moves closer to the wall and the irrigation orifice is directed toward the opposite wall.

Особенности выполнения переднего капсулорексиса для профилактики капсульного блока после факоэмульсификации катаракты с имплантацией заднекамерной ИОЛ

Purpose. Тo develop a method for the formation of anterior capsulorexis for the prevention of capsule block in cataract phacoemulsification with the implantation of a posterior chamber IOL. Material and methods. 135 people were studied, who were divided into two groups depending on the diameter of the performed anterior capsulorexis (CR). Group I (main) included 67 patients (67 eyes), who underwent CR according to the method proposed by the authors-in the form of an ellipse with a large axis of 7,0-7,5 mm along the tunnel incision and a small axis of 4.0-5.0 mm. Group 2 -68 patients (68 eyes), capsulorexis was produced in a round shape- 5-5.5 mm. Results. Complications during surgery – in patients of group 2, a capsule block and a tear in the anterior capsulorhexis were noted in 2.9% of cases, in 3% of cases posterior capsular fibrosis was diagnosed in each group, which required the performance of posterior capsulorhexis. In the late period in one patient of group 2 endothelial-epithelial dystrophy (EED) of the cornea developed, which required ultraviolet corneal crosslinking followed by keratoplasty. Conclusion. The proposed method for the creation of anterior capsulorexis in cataract phacoemulsification with the implantation of a posterior chamber IOL reliably eliminates the possibility of a capsule block due to the formation an oval shaped capsule hole. In addition, it reduces the risk of damage to the lens capsules, ensures reliable fixation of IOLs in the capsule bag and increases access for posterior capsulorhexis, if necessary. Key words: cataract phacoemulsification, posterior chamber IOL, oval capsulorexis, capsule block.