Capsule Contraction Research Articles

Long-term Insights: Histopathological Assessment of Polyurethane Implant Capsules Over 24 Years.

Polyurethane (PU)-coated breast implants are known for their strong integration into breast tissue and the formation of capsules around them. However, capsular contracture can pose both aesthetic and clinical challenges. The objectives of this study were to analyze the biological and morphological characteristics of the capsular tissue surrounding PU-coated implants, irrespective of their contracture status, and to assess their potential suitability as a flap in revisional breast surgery for capsular contracture. A total of 23 tissue samples were harvested from the capsules surrounding PU-coated breast implants in 12 female patients during replacement or revisional surgery. We evaluated collagen abundance, cellular and vascular density, inflammation, collagen band types and alignment, synovial metaplasia, capsule thickness, and the expression of inflammatory biomarkers and myofibroblasts with immunohistochemical techniques. Scanning electron microscopy was employed to assess implant surface characteristics over time. We found a significant association of capsule contraction with longer implantation durations and greater implant surface roughness (P = .018 and P = .033, respectively). Synovial metaplasia was significantly more frequent in noncontracted capsules (P = .0049). Both capsule types consisted of paucicellular, type I collagen-rich compact fibrous tissue with low vascularization. There was a marked reduction in inflammatory cells within the foreign body granuloma. The expression of inflammatory biomarkers in the capsular tissue was negligible. Given the reduced levels of inflammatory and vascular components within the dense, fibrous capsular tissue, we consider them to be viable alternatives for capsular flaps in revisional surgery. This strategy has the potential to mimic the reconstruction achieved with acellular dermal matrix.

ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome.

We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.

CARD9-Mediated Macrophage Responses and Collagen Fiber Capsule Formation Caused by Textured Breast Implants.

An increasing number of women are undergoing breast implantation for cosmetic purposes or for reconstructive purposes after breast excision. The surface morphology of the breast implant is a key factor associated with the induction of capsule contraction. The effect of surface morphology on the inflammatory response after implant insertion remains unclear, however. The authors conducted comparative analyses to determine the effect of the textured and smooth surface morphology of silicone sheets. Each type of silicone sheet was inserted into the subcutaneous pocket below the panniculus carnosus in C57BL/6 mice and mice with genetic disruption of CARD9 , Dectin-1 , Dectin-2 , or Mincle . The authors analyzed collagen fiber capsule thickness, histologic findings, and macrophage inflammatory response, including transforming growth factor (TGF)-β synthesis. The authors found that textured surface morphology contributed to the formation of collagen fiber capsules and the accumulation of fibroblasts and myofibroblasts, and was accompanied by the accumulation of TGF-β-expressing macrophages and foreign-body giant cells. CARD9 deficiency attenuated collagen fiber capsule formation, macrophage responses, and TGF-β synthesis, although the responsible C-type lectin receptors remain to be clarified. These results suggest that CARD9 may have a strong impact on silicone sheet morphology through the regulation of macrophage responses. Silicone breast implants have been widely used for postmastectomy and cosmetic augmentation mammaplasty breast reconstruction. The authors sought to elucidate the surface morphology of the breast implant as one of the key factors associated with the formation of collagen fiber capsules. Therapeutic, V.

Effect of intraocular lens material and haptic design on anterior capsule contraction after cataract surgery: A systematic review and meta-analysis.

To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs. We searched three electronic databases for relevant studies published up to January 1, 2023. Five randomized controlled trails (RCTs) and three cohort studies involving 1,221 eyes were included in quantitative synthesis. We extracted data, assessed their quality independently, and calculated standard mean difference (SMD) using a random-effects model. Six RCTs and one retrospective cohort were included in information summary. The contraction of the anterior capsule opening area in the hydrophilic group was larger than that of the hydrophobic group from one month to one year postoperatively (P < 0.001 and P < 0.001, respectively). Specifically, the hydrophilic group showed greater contraction of the anterior capsule opening area at one month postoperatively (Standardized mean difference [SMD] = -0.73, 95% confidence interval [CI] = -0.93 to -0.52), three months (SMD = -1.04, 95% CI = -1.32 to -0.75), six months (SMD = -0.99, 95% CI = -1.24 to -0.74) and one year (SMD = -1.33, 95% CI = -2.50 to -0.16). As of one year postoperatively, the anterior capsular opening area showed a trend of decreasing over time in both groups (P = 0.046 and P = 0.050, respectively). In information summary, three studies indicated no relationship between haptic design and ACC, while the other four studies reported that the number and shape of haptic would affect ACC. This meta-analysis suggested that the postoperative ACC after the implantation of hydrophobic IOLs was less than that induced by hydrophilic IOLs. Haptic design may also affect the degree of ACC.

Complete resolution of hyperopic shift in anterior capsular contraction syndrome after Nd:YAG laser capsulotomy: a case report

Link of Video Abstract: https://youtu.be/UfCbUNzPIRE Background: Anterior capsular contraction syndrome (ACCS) is a disorder in which the anterior capsulectomy opening shrinks excessively. One of the many factors that have been discovered to aggravate the problem is a lack of zonular support for the lens capsule. The prognosis for non-progression of contractions after Nd:YAG anterior capsulotomy is quite excellent. This study aims to present a complete resolution of the hyperopic shift in an anterior capsular contraction syndrome (ACCS), a rare complication of cataract surgery. Case Illustration: This case report presented a 63-year-old female who developed ACCS in the right eye two years after uncomplicated cataract surgery and intraocular lens implantation. A moderate hyperopic shift of +3.00 D was noted in the affected eye at the initial presentation. Slit-lamp examination revealed an anterior capsule opacification and anterior capsular contraction with fibrosis surrounding the capsulorhexis opening. Ocular and systemic past medical history was unremarkable, and no known risk factors associated with contraction syndrome were found. Nd:YAG laser capsulotomy with six relaxing incisions was performed to release the anterior capsular contraction. Two weeks following capsulotomy, the patient’s visual acuity remarkably improved to LogMAR 0.00 without correction. The hyperopia was completely resolved, and a decrease in anterior chamber depth compared to pre-capsulotomy measurement was noted. ACCS is a possible complication following capsulorrhexis performed in uneventful cataract surgery, which may occur in patients with no known ocular or systemic risk factors. ACCS is commonly asymptomatic, and hyperopic shift is a rare manifestation of ACCS. The backward shift of the intraocular lens (IOL) induces hyperopia due to the anterior capsule contraction. The preferred treatment for ACCS is relaxing incisions using Nd:YAG laser capsulotomy. Conclusion: Hyperopic shift in ACCS is a rare complication of cataract surgery. However, prompt treatment of contraction release with Nd:YAG laser capsulotomy effectively restored visual function.

Inhibition of anterior capsule opacification and contraction by the elevated anterior rim of the intraocular lens optic.

To verify the anterior capsule opacification (ACO) and contraction (ACC) of the ZCB00V intraocular lens (IOL), made of the same material as the AR40e with a high ACC rate. Retrospective cohort study. We evaluated 35 patients at 1 week, 1, 3 and 6 months post phacoemulsification with either a ZCB00V (n = 35) or FY-60AD (n = 34) IOL implantation. The ACC rate was calculated using retroillumination images of the anterior segment, and the ACO was measured using anterior segment photographs and image analysis software. The contact grade between the IOL and anterior capsule was estimated from the Pentacam® images. The postoperative ACC rates (mean ± standard deviation) at 3 months were 1.03%±2.54% for the ZCB00V and, and 7.12%±9.47% for the FY-60AD. The ZCB00V-implanted eyes showed a significantly lower postoperative ACC at 1 week, 3 months, and 6 months (P < 0.01). On the other hand, the FY-60AD-implanted eyes had more pronounced ACO, and a significantly larger area of opacification (62.24%±21.32% vs. 16.90%±8.34%; P = 0.0005). Pentacam® analysis revealed a space between the anterior capsule and IOL surface in the ZCB00V-implanted eyes, whereas the anterior capsule firmly adhered to the IOL surface in the FY-60AD-implanted eyes. The ACC and ACO were significantly lower in eyes with ZCB00V IOLs compared to those with the FY-60AD. The anterior segment image analysis revealed that the elevated anterior rim of the ZCB00V IOL prevented adhesion between the anterior capsule and IOL optic surface, suggesting an open capsule effect.

(102) Complications of the Penuma Penile Implant for Genital Enhancement

Abstract Introduction The Penuma penile implant (PPI) is a subcutaneous silicone implant intended to increase penile length and girth. Only one case report and one case series of four patients have been published on the complications of PPIs. Objective To report a single center experience treating complications of the PPI both prior to and after implant removal. Methods Patients with a prior history of PPI surgery treated at our center were identified between 2012 and 2022. Demographic data, implant date, complications leading to explant, postoperative course, and functional outcomes were recorded. Our protocol is to wait 6 months after explant prior to scar excision (SE)/revision should disabling capsular contraction develop. Results A total of 13 patients were evaluated at our institution. Median age at time of implant was 36 (26-54) years. The median duration of implant was 3 months (range 3 days-33 months). Mean follow-up was 21.6 months. The most common complication leading to explant was distal lateral protrusion of the implant at the coronal margin causing patient and partner discomfort which occurred in 8 patients. Other reasons for explant were skin erosion, infection, decreased sensation, ventral curvature, and penile shortening each occurring in 1 patient. Adverse sensation changes occurred in 2 patients after implant. Following explant 9 (69%) patients developed disabling dorsal curvature, 8 (62%) patients had penile shortening, 3 (23%) had infections, 2 (15%) had de novo sensation changes, 2 (15%) had erectile dysfunction, and 1 (8%) had right lateral curvature. Curvature occurred because of capsule contraction following explant. Of those with disabling curvature, 6 (67%) underwent scar excision (SE), 1 is awaiting scar maturation for SE, 1 more is considering SE for disabling curvature, and 1 has elected not to undergo further surgery. In patients who underwent SE, severe scarring was noted superficial to the neurovascular bundles. All patients who have undergone SE had improvement in curvature and were able to have functional erections. Conclusions PPI for cosmetic penile enhancement can be associated with a variety of complications leading to device removal. Subsequent to explant, capsular contraction can result in disabling curvature and penile shortening which can be managed successfully with SE. Disclosure No

Treatment of visual axis opacification and secondary membranes with Nd:YAG laser after pediatric cataract surgery under intranasal sedation.

To describe neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser treatment of visual axis opacification and secondary membranes in pediatric patients with cataracts under intranasal dexmedetomidine sedation. Twenty eyes of 17 patients with secondary membrane formation after cataract extraction were enrolled in this study. Intranasal dexmedetomidine sedation (3 ug/kg) was administered, and Nd:YAG laser (Ellex Super Q, Adelaide, Australia) procedures were performed with children in the sitting position with their chin supported on a laser delivery slit lamp. Preoperative and postoperative visual acuities were documented, and medical records were reviewed. The age of the patients ranged from 5 to 83 months (31.82 ± 27.73). Nineteen (95.0%) eyes had congenital cataracts and one (5.0%) had a traumatic cataract. Nd:YAG laser treatment of VAO with ten (50.0%) eyes, pupillary membranes with three (15.0%) eyes, pupillary cortical proliferation with six (30.0%) eyes, and anterior capsule contraction with one (5.0%) eye. Five (25.0%) eyes demonstrated visual acuity improvement, whereas six (30.0%) eyes remained unchanged after laser treatment. The recurrence rate was 30.0% and four eyes underwent a second Nd:YAG membranectomy. No side effects or tolerances due to sedative drugs were observed. Nd:YAG laser membranectomy under intranasal dexmedetomidine sedation was safely performed in children as young as 5 months old in a sitting position. This approach facilitates patient convenience, doctor proficiency, and cost reductions. Patients with recurrence can be treated by repeating the procedure.

The effect of human recombinant epidermal growth factor on capsule contraction in an irradiated rat model

The effect of human recombinant epidermal growth factor on capsule contraction in an irradiated rat model

Current possibilities of laser surgery on anterior eye segment

The article summarizes the experience of recent years in the development and implementation of novel original laser technologies used in surgery of the anterior segment of the eye. The presented technology of laser activation of scleral hydropermeability (LASH) in glaucoma is based on the effect of enhanced transscleral filtration and has been shown as effective and safe, which was confirmed by the results of a comprehensive clinical and experimental study. Development of another technique was associated with the need to improve the safety of laser interventions in anterior capsule contraction syndrome in pseudophakia, and resulted in a proposition to change the configuration of the anterior lens capsule incision from the usual linear-radial to T-shaped laser anterior capsulorhexis. The proposed technology of laser photomydriasis based on near-infrared radiation of the diode laser (0.810 μm) has shown its effectiveness and gentle nature (absence of atrophy of the iris stroma and post-burn pigmentation) in ectopias and pupil deformity.

Коррекция дислокации гаптического элемента торической ИОЛ у пациента после факоэмульсификации и склеральной фиксации модифицированного капсульного кольца при синдроме Марфана

Purpose. To propose a surgical technic for correcting the dislocation of the haptic element of the toric intraocular lens (IOL) in a patient after phacoemulsification and scleral fixation of the modified capsular ring in Marfan syndrome (MS). Material and methods. To report a case about dislocation one of the haptic elements of a toric IOL out of the capsular bag as a result of contraction of the capsular bag in a patient with MS in the presence of sutured modified capsular tension ring. The patient underwent a comprehensive ophthalmological examination, including refractometry, eye biometry, ophthalmoscopy, fundus examination for medical mydriasis, keratotopography, computed tomography of the cornea, and surgical treatment. Results. Removal and peeling of fibrous tissue, located under the anterior capsule with a reposition of the haptic of toric IOL resulted in significant astigmatism reduction and visual functions improvement. Conclusion. The proposed surgical technic for dissection of the anterior capsule fibrosis and reposition of the IOL haptics is effective for restoring the anatomically correct position of the IOL, and also allows to obtain a good functional result. To the best of our knowledge, successful treatment of late postoperative residual astigmatism with IOL tilt under conditions of transscleral fixed modified capsular tension ring (M-CTR) with haptic dislocation from the capsular bag and the presence of contraction capsular syndrome in SM has not been previously described in the literature. Key words: Marfan syndrome, capsule contraction syndrome, modified capsular tension ring, phacoemulsification, toric IOL result. To the best of our knowledge, successful treatment of late postoperative residual astigmatism with IOL tilt under conditions of transscleral fixed modified capsular tension ring (M-CTR) with haptic dislocation from the capsular bag and the presence of contraction capsular syndrome in SM has not been previously described in the literature.

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.

Comparison Study of Anterior Capsule Contraction of Hydrophilic and Hydrophobic Intraocular Lenses Under the Same Size Capsulotomy.

PurposeTo compare anterior capsule contraction of two kinds of hydrophilic and hydrophobic acrylic intraocular lenses (IOLs) under the same size capsulotomy with femtosecond laser-assisted cataract surgery (FLACS).MethodsA total of 320 eyes in 320 patients who underwent FLACS were included. The patients were scheduled to have hydrophilic acrylic IOLs (MI60, 509M) and hydrophobic acrylic IOLs (iSert250, ZCB00) implanted. Visual acuity and anterior segment photography using a slit lamp microscope were performed at postoperative one week, one month, three months, and one year.ResultsThe contraction of the anterior capsule opening area (mm2) and circumference (mm) in the hydrophilic group were larger than that of the hydrophobic group from postoperative one week to one year (P < 0.001, P < 0.001, respectively). The postoperative contraction of the capsule opening area in MI60 was larger than in 509M (P < 0.001) and larger in 509M than in iSert250 and ZCB00 (P = 0.008, P = 0.019, respectively), but no difference was observed between iSert250 and ZCB00 (P = 0.867). During postoperative one to three months, all groups had the maximum capsule contraction (P < 0.001).ConclusionsUnder the same size capsulotomy with FLACS, the postoperative anterior capsule contraction induced by hydrophobic IOLs was less than that induced by hydrophilic IOLs. Among the four IOLs, the capsule contraction was largest in MI60, followed by 509M, and least in iSert250 and ZCB00, which was time-dependent.Translational RelevanceOur findings implied that patients with a high risk of ACC should choose hydrophobic IOLs, as well as nonsteroidal anti-inflammatory drugs may be used for a longer period in patients with high risk of capsule contraction syndrome.

Clinical experience with an anti-dysphotopic intraocular lens.

PURPOSE:Report experience regarding an anterior capsulotomy fixated intraocular lens (IOL) designed to prevent negative dysphotopsia (ND).METHODS:A prospective, nonrandomized clinical study was done at Péterfy Sándor Street Hospital-Clinic, and Jenő Manninger National Trauma Institute, Budapest, Hungary. The Morcher (Masket) 90S IOL has a circumferential groove on the optic that captures the anterior capsulotomy. Thus, part of the optic projects over and anterior to the capsule edge, while the bulk of the IOL is fixated within the capsular bag. We implanted the first version of the 90S IOL into the 40 eyes of 38 patients. These 40 eyes made up the primary investigational cohort. An additional 22 eyes received a modified version of the 90S IOL. The main outcome measure was the presence of ND. There was also a control group of 40 patients who received a single-piece monofocal aspheric hydrophobic acrylic IOL (877 FAB, Medicontur, Budapest, Hungary).RESULTS:None of our 66 test patients experienced ND during the follow-up period. After specific questioning, six patients reported nondebilitating PD that improved or disappeared completely in 5 cases. For the 40 eyes of the control group, there were 10 cases of ND on the first postoperative day and in 2 cases ND persisted for more than 1 year postoperatively.CONCLUSION:The 90S IOL can be used successfully to prevent ND. Since it is fixated by the anterior capsulotomy, additional advantages such as prevention of anterior capsule contraction, limited tilt, stable toric axis, perfect centration on the visual axis, and a more predictable lens position, among others, may be expected, and are under investigation.

Enlargement of Phimotic Capsulorhexis Using Plasma Energy: A Case Series

Purpose: to evaluate the effectiveness and safety of the plasma ablation technique of Fugo blade system to enlarge phimotic capsulotomies in the management of anterior capsule contraction syndrome.Patients and methods. Results of the enlargement of phimotic capsulotomies using the plasma ablation technique in 17 patients with anterior capsule contraction syndrome (10 men and 7 women, 18 eyes; average age — 73.8 ± 9.6 years) were retrospectively analyzed. Surgically, after pupil dilation, the anterior chamber was irrigated with a viscoelastic device (1.4 % solution of hyaluronic acid), and the tip of the Fugo blade was inserted through a 2.0–2.2 mm wide corneal incision. After slightly touching the anterior capsule, the apparatus was activated, and its tip was moved in a concentric manner, excising the required size of the fibrosed anterior capsule in a resistance-free fashion. Finally, the viscoelastic material was aspirated, and the incisions were hydrated.Results. Phimotic capsulotomies were enlarged in all cases. Except for three cases where the bimanual technique was required to ablate the anterior capsule, all other cases were managed single-handedly. The use of cohesive viscoelastic device (1.4 % solution of hyaluronic acid) made it possible to perform this procedure with minimum trauma and under visual control. No serious complications were encountered during surgery or in the early postoperative period. Patients were discharged 1–2 days after surgery. Corneal edema, which was observed in six eyes, resolved within 3–4 days. Visual acuity improved in all cases, except for 2 patients with complete glaucomatous optic atrophy. IOP remained under control in all cases. No negative effect on the hypotensive results of previous glaucoma surgeries was observed.Conclusion. The plasma-generating Fugo blade system is an effective and safe tool to enlarge phimotic capsulorhexis in a resistance-free fashion. It is easy to use, mastering of new surgical skills is not required, surgical trauma is minimal, the surgical time is reduced, and the patient’s rehabilitation period is significantly shortened.

Femtosecond laser-assisted intraocular lens exchange.

Intraocular lens (IOL) exchange in patients with anterior capsule contraction resulting from phimosis can complicate IOL exchange as the fibrotic anterior capsule must be cut to gain access to the IOL. Maintaining curvilinear capsulotomy is particularly important when the desired outcome is bag-to-bag IOL exchange. Similarly, when the posterior capsule is open, properly sized curvilinear anterior capsulotomy will allow for optic capture and further stability of the exchanged IOL. Secondary capsulotomy size ranged from 4.9 to 5.0 mm, and the energy was set at 4 to 10 μJ depending on diffusiveness of the anterior capsule. The femtosecond laser was adapted to create a secondary anterior capsulotomy to facilitate IOL exchange.

Case series: \u201cDouble arch\u201d changes caused by capsule contraction syndrome after cataract surgery in highly myopic eyes

BackgroundCapsule contraction syndrome (CCS) after cataract surgery causes intraocular lens (IOL) haptic flexion and IOL optic displacement in most former reports. However, there are few reports on CCS-induced deformation of the IOL optic. We report two cases of CCS after cataract surgery in highly myopic eyes and describe a previously unreported “double arch” complication.Case presentationTwo patients with history of high myopia had cataract surgery with hydrophilic acrylic plate haptic IOLs implanted in their eyes. CCS with arch shape deformation of the pupil as well as the optic of the IOL were noticed in both cases after three months, which induced refractive changes and corrected distance visual acuity (CDVA) deterioration. Visual acuity of the patients was restored by replacing the IOL from the capsular bag to the ciliary sulcus and the following neodymium: YAG (Nd:YAG) laser capsulotomy. We propose that such “double arch” change brought by CCS is related to the plate-haptic design of the IOL and the incomplete overlap between the capsular opening and the IOL optic.ConclusionsWe recommend careful IOL selection and proper capsulorhexis in patients with high myopia or with other risk factors of CCS. Early diagnosis and timely treatment of CCS are critical to prevent visual symptoms and further ocular complications.

Effect of lens capsular tension ring on preventing capsular contraction syndrome in the surgery of retinitis pigmentosa combined with cataract: Retrospective case series.

To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. Retrospective cases series study. Sixty-three cases (84 eyes) of RP with cataract were collected, including 30 males and 33 females. Phacoemulsification with 3.0mm clear corneal incision was performed in all the patients. IOL and CTR implantation were performed in 44 eyes, and IOL implantation alone was performed in 40 eyes. All cases were followed up at 1day, 1week and 1, 3, 6,12months after the surgery to compare the best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count (ECC) and complications before and after the surgery. All surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6months after surgery was 0.91±0.88 LogMAR, showing an improvement compared with the BCVA(1.3±0.7LogMAR) before surgery and there was a statistically significant difference (P=.003). Four cases of capsule contraction syndrome (CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was a statistically significant difference in the incidence of CCS between two groups (P=.047). Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is conducive to reducing the complications caused by capsule contraction.

A Modified Femtosecond Laser Technique for Anterior Capsule Contraction Syndrome.

Anterior capsule contraction syndrome (ACCS) is a rare, late complication of cataract surgery, associated with impairment of visual function. In this paper, we describe a new surgical technique to treat ACCS by femtosecond laser procedure. The femtosecond laser was used to perform an anterior capsulotomy with a customized size, in order to avoid IOL damage. After ophthalmic viscosurgical device injection in the anterior chamber, the anterior capsule flap was separated from the IOL surface by gentle hydrodissection. This manoeuvre enabled an easy and safe removal of the fibrotic material by vitreal microscissors. Our technique allowed a complete removal of the fibrotic material and opening of the capsule, with immediate complete visual acuity recovery without IOL damage. In conclusion, femtosecond laser appears to be safe and effective for treatment of ACCS with long-lasting efficacy.

Three-Year Outcomes of Cionni-Modified Capsular Tension Ring Implantation in Children Under 8 Years Old With Ectopia Lentis

This study evaluated visual outcomes and complications at 3 years post-implantation of a Cionni-modified capsular tension ring (MCTR) with an intraocular lens (IOL) in ectopia lentis patients ≤8 years old. Prospective clinical cohort study. Included were 101 eyes from 57 patients <8 years of age, who underwent surgery for nontraumatic ectopia lentis between November 2015 and December 2016. Exclusion criteria were planned IOL fixation in the ciliary sulcus, severe intraoperative complications, and incomplete follow-up. All eyes received in-the-bag implantation of a posterior IOL and Cionni-MCTR. Posterior capsulectomy and anterior vitrectomy were performed through the pars plana in 23 eyes of children <5 years of age. Patients were examined at 1day, and 1, 6, and 12months, and at 2 and 3 years postoperatively. Outcome; measurements included best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and posterior capsule opacification (PCO). In all eyes, BCVA improved significantly after surgery, especially during the first 12months (P < .05). Three years post-operatively, 44 eyes had BCVA 0.9 or better. Prophylactic Nd:YAG laser capsulotomy was performed 3months post-surgery in 24 eyes; 34 eyes underwent this; procedure 6months post-surgery because of PCO. A second surgery was; warranted in 4 eyes because of severe IOL decentration and combined anterior capsule contraction. No severe postoperative complications, such as retinal detachment or endophthalmitis, occurred. Implantation of in-the-bag IOL with Cionni MCTR is effective for visual rehabilitation in young children with ectopia lentis. A close follow-up of these patients is necessary to monitor IOL centration and stability.