Complicated Cataract Research Articles

A novel 4-point scleral fixation technique with a hydrophobic IOL: The LOTO technique.

to describe a new surgical technique that combines 4-point, flanged polypropylene scleral fixation with a hydrophobic IOL. Using the Envista MX60 and 6.0 polypropylene, scleral 4-point fixation was achieved using a flanged-suture technique 5 times in a model eye and in a case series of 8 patients, retrospectively reviewed. The polypropylene is passed through each eyelet in a novel configuration (LOTO: Loop to Optic and Trailing ends to Outside). Conjunctival peritomies, scleral flaps/pockets, glue, and suture knots are avoided. The load needed for haptic fracture and scanning electron microscopy (SEM) at fracture sites were studied. Haptic fracture occurred once following the first model eye implantation due to excessive suture tension. The fracture load was similar between the LOTO and the simple-pass technique (1.08 ± 0.52 N vs 1.09 ± 0.32 N), suggesting no safety compromise. SEM did not disclose cheese-wiring effect. Over a mean follow-up of 10.8 months (range: 3 to 19; median 11.5 months), all cases experienced visual improvement with best-achieved-postoperative uncorrected visual acuity (BAPUCVA) of 20/25-20/200, and the IOL was well-centered. Postoperative IOL tilt averaged 2.9 degrees (range: 0 to 9.6; median: 2.9 degrees). Two patients developed post-operative CME treated topically. The first case developed flange extrusion that was readily repaired in clinic. This novel technique adds 2 main advantages to previously described flanged-suture techniques: 1) 4-point fixation of a hydrophobic IOL and 2) immediate application at the time of initial complicated cataract surgery since it requires no additional supply, IOL, or instrumentation.

Outcome of Phacoemulsification Cataract Surgery in Complicated Cataract Due to Uveitis

Background: Surgical removal of cataractous lens is the only of treatment of cataract irrespective of etiology. Phacoemulsification is a modern cataract surgery in which the eyes internal lens is emulsified with an ultrasonic hand-piece and aspirated from the eye. Complicated cataract due to anterior uveitis has difference in morphology and outcome from that of age-related cataract variety. Aim of the study: The purpose of this study was to evaluate the outcome of phacoemulsification in complicated cataract due to uveitis. Methods: This prospective observational cross-sectional study conducted in cataract clinic of National Institute of Ophthalmology & Hospital, Dhaka, Bangladesh, from September 2018 to March 2019. Sample was selected by purposive sampling technique. Total 50 patients suffering from complicated cataract due to uveitis were included according to selection criteria. Data were gathered from the informant and recorded in a structured case report format. Clinical examination and relevant investigation were done meticulously. All acquired data was entered into a Microsoft Excel Work Sheet and analyzed using descriptive statistics in SPSS 24.0. Results: In this study, the maximum number of patients 18(36.0%) were 51-60 years age group, mean age of the patient was 52.7±6.37 years. Male to female ratio was 1:1.17. Postoperative best corrected visual acuity (BCVA) was better progressively and reached significance difference (P<0.05). Astigmatism was measured in different follow up time. There was significant difference (p< 0.05) present in all post-operative days. In time wise comparison revealed, there was also significant difference in between 1st postoperative day and 30th postoperative day but no significance was present between 30th postoperative day and 180th postoperative day (P= 0.161). In this study postoperative complications included posterior capsule opacification (55.5%), posterior synechiae (11.1%), cystoid macular edema (22.2%) & glaucoma (11.1%). Conclusion: Present study concluded that phacoemulsification is safer for the uveitic cataract as less inflammation is induced than that by a manual extracapsular cataract extraction. In order to optimize the postoperative outcome of uveitic cataract surgery, it is necessary to be meticulous and thorough.

A neglected ocular tuberculosis without antitubercular therapy: A case report

Ocular tuberculosis (TB) is one of the causes of uveitis, but there is often a skepticism and lack of acceptance regarding this diagnosis. We present a case of a-62-year-old female patient who complained of blurred vision, pain, and redness in her right eye. These symptoms had persisted for the past 16 months. The latest visual acuity in the right eye was 0.0167, and in the left eye was 0.63. Upon examination, keratic precipitates were found in the right eye, along with flare and cells +1/+1, pupil seclusion, a cloudy lens, and opacity in the posterior segment. The left eye was within normal limits. The patient was diagnosed with panuveitis of the right eye due to ocular TB and a complicated cataract. She had been referred by the local general hospital with complaints of blurred vision and was initially diagnosed with anterior uveitis due to ocular TB based on clinical presentation and positive Interferon-Gamma Release Assay (IGRA) test results. The patient was then referred back to the Internal Medicine Department of the local general hospital and the community health centre to start the anti-tuberculosis therapy (ATT). However, the patient refused treatment and, as a result, did not receive anti-tuberculosis drugs. Panuveitis TB, without adequate treatment, can lead to a poor prognosis.

Paenibacillus lautus: A new foe in endogenous endophthalmitis.

To discuss the diagnosis and management of a rare case of endogenous endophthalmitis (EE) caused by Paenibacillus lautus mimicking granulomatous uveitis in a child, highlighting the use of 16S rRNA gene amplicon sequencing as an accurate method to identify rare pathogens. A retrospective chart review of the clinical presentation, microbiologic workup-including microscopy, culture, antibiotic susceptibility, and polymerase chain reaction for pathogen DNA of clinical samples-and the clinical management of the case were recorded. A 13-year-old boy presented with decreased vision in the right eye for one month. On examination, he had uveitis with hypopyon and complicated cataract. The case underwent an anterior chamber tap followed by vitrectomy and lensectomy. The culture of the vitreous aspirate grew Gram-variable bacilli that could not be identified by conventional microbiological techniques. However, PCR-based sequencing of the 16S rRNA gene was performed, and the bacterium was identified as P. lautus. The patient subsequently developed rhegmatogenous retinal detachment, for which he underwent endo laser photocoagulation and oil tamponade. Four months later, silicone oil was removed, and an intraocular lens was implanted. At six weeks follow-up, the retina remained well attached, and intraocular pressure was maintained. P. lautus can cause EE and mimic granulomatous uveitis. Techniques such as 16S rRNA gene sequencing can significantly facilitate aetiological diagnosis in cases where conventional methods fail.

Surgical treatment of traumatic iridodialysis with simultaneous implantation of a toric intraocular lens in a patient with aphakia. A clinical case study

Introduction. Iridodialysis refers to a localized detachment occurring at the attachment site of the iris to the ciliary body. This condition is often the most severe consequence of ocular trauma, leading to discomfort, decreased visual quality, and diplopia. Conventional corrective approaches typically induce astigmatism, thereby compromising the functional results of the operation.Purpose: to assess the effectiveness of an innovative surgical approach for traumatic iridodialysis that incorporates the one-time implantation of a toric intraocular lens in patients with prior unsuccessful cataract surgeries.Case description. A patient reported significant cosmetic and visual disturbances including reduced visual acuity, photophobia, and visual discomfort in the right eye, following an earlier complicated cataract surgery that did not involve an intraocular lens implant. Our treatment strategy utilized a minimally invasive technique for the simultaneous implantation of the intraocular lens and closed iridoplasty.Conclusions. The surgical approach provided rapid and complete rehabilitation, yielding high clinical and functional outcomes, including the restoration of visual acuity and the resolution of the patient’s cosmetic concerns.

A New Technique with Scleral Grooves for Sutureless Scleral Fixation of the Carlevale Intraocular Lens.

A novel technique is described employing scleral grooves to facilitate sutureless scleral fixation of the Carlevale intraocular lens (CIL). We describe its use in a series of 47 patients with aphakia. A retrospective study of all patients with aphakia who underwent CIL implantation with the new technique by a single surgeon during 1year. The novelty of this technique consists in the creation of two partial-thickness linear sclerotomies (grooves), 180° apart, 2mm from and parallel to the limbus. In the middle of each groove a full-thickness sclerotomy is performed to facilitate externalization of the CIL anchors. The groove allows the anchor to plug the full-thickness sclerotomy and to rest within the sclera without protrusion. Reported outcomes include pre-operative/post-operative visual acuity, post-operative spherical equivalent and surgical complications. Follow-up was a minimum of 6months. Forty-eight eyes of 47 patients with aphakia with a mean age of 74years (range 31-90years) are included. The commonest causes of aphakia were intraocular lens (IOL) subluxation,with or without exfoliation (54.2%), complicated cataract surgery (29.2%), crystalline lens luxation (6.3%) and trauma (4.1%). All CILs inserted with the new technique stayed successfully in situ during follow-up. Median pre-operative best-corrected visual acuity (0.75 logMAR; range 0.1-2.7) significantly improved to 0.5 logMAR post-operatively (p < 0.001). Moreover, 78% and 65% of the operated cases were within 1.0 and 0.5 diopters, respectively, from intended refraction. The most common complications were transient cystoid macular oedema (8.3%) and transient intraocular pressure rise (8.3%), all of which resolved within 2months. The proposed modification of sutureless scleral fixation of the CIL appears safe and effective. In our experience it is less time consuming and easier to perform than previous techniques and may therefore offer a useful future option.

TO EVALUATE THE SELECTION PROTOCOL OF CATARACT PATIENTS ADMITTED THROUGH OUTREACH PROGRAMS (EYE CAMPS) UNDERGOING SURGERY IN A TERTIARY CARE CENTER OF CENTRAL INDIA

Aim: To evaluate the selection protocol of Cataract patients admitted through outreach programs (EYE CAMPS) undergoing surgery in a tertiary care center of Central India Study design: It is a prospective descriptive study conducted on camp patients at a charitable tertiary eye care hospital (Central India) from January 2023 to june2023. Wirtten informed consent was taken from patients for participation in this study. Setting:A prospective observational study was performed of all cataract patients admitted through outreach program (EYE Camp) for small incision cataract surgery in the department of Ophthalmology, Sri Aurobindo institute of medical sciences, Indore from January 2023 to june2023. Material and Methods: During the study period 332 patients were screened ..all patients above 40 years of age having senile cataract were included and Patients with age less than 40 years of age, Congenital cataract, complicated cataracts like traumatic, uveitic, subluxated or dislocated cataracts, patients having undergone previously any ocular surgery in the selected eye, patients not giving written informed consent were excluded from the study. Results: Out of 332 camp patients 306 (92%) patients under went small incision cataract surgery and the surgeries of 26 patients (8%) were postponed, as the patients were unfit due to ocular and systemic reasons out of 26 patients, 5 patients had uncontrolled blood sugar, 7 patients had uncontrolled blood pressure, 2 patients had cardiac problems, 1 patient was asthmatic. Conclusion:In our study, increasing age and female gender were commonly associated with cataract. Most of the patients had bilateral cataract and low vision at presentation. Hypertension and type 2 diabetes mellitus were commonly associated systemic disorders with cataract. This study highlights that high quality cataract surgery with a low intra-operative complication rate and good visual outcome can be attained even in camp patients operated in the base hospitals with standard protocols.

Challenges in cataract surgery after penetrating keratoplasty managed using femtosecond laser: A series of 3 case reports.

Cataract surgery in patients after penetrating keratoplasty (PKP) is often challenging because of changes in corneal structure induced by PKP and primary corneal disease. Femtosecond laser-assisted cataract surgery offers several advantages over conventional phacoemulsification, and has been widely used in complicated cataract surgery. We report the use of femtosecond laser-assisted cataract surgery in 3 challenging cases after penetrating keratoplasty. Case 1 involved a patient with hard nuclear grade IV° cataract. After surgery, his corrected distance visual acuity (CDVA) improved from 20/400 to 20/25, and the endothelial cell loss (ECL) % was 12.05 % at 3 months postoperatively. The rotation of the toric IOL in Case 1 was 2°. Case 2 involved a patient with severe nuclear cataract and an endothelial cell density of 837 cells/mm2. After surgery, the CDVA improved from 20/100 to 20/40. The ECL% was 4.06% at 1 week postoperatively. Case 3 was a 91-year-old woman with a short axis length of 21.35 mm and an endothelial cell density number of 1238 cells/mm2. After surgery, the CDVA improved from light perception to 20/133, and the ECL% was 26.09% at 1 week postoperatively; ECL% was 2.67% at 1 month post-operation. The corneal grafts were transparent. Femtosecond laser-assisted cataract surgery seems to be an effective, predictable, and safe approach for challenging patients after PKP, and improves visual recovery and optimal refractive outcomes.

Двухэтапное хирургическое лечение регматогенной отслойки сетчатки, осложненной выраженной пролиферативной витреоретинопатией, с применением первичной круговой ретинотомии и отсроченной эндолазеркоагуляцией сетчатки в уменьшенном объеме

Abstrakt Primary retinotomy in the surgical treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy D.O. Shkvorchenko, B.E. Malyugin, A.Yu. Kornienko, E.S. Khrisanfova, O.B. Klepinina S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Purpose. To develop a method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy (stage C) using primary circumferential retinotomy, short-term perfluorocarbon liquid (PFCL) endotamponade and deferred laser endophotocoagulation in a reduced volume. To evaluate the effectiveness of the developed method in the treatment of complicated rhegmatogenous retinal detachment with severe proliferative vitreoretinopathy. Material and methods. 12 patients (12 eyes) with the diagnosis of rhegmatogenous retinal detachment with severe proliferative retinopathy were operated using developed method of two-stage surgical treatment with a reduced volume of laser endophotocoagulation. All 12 patients had a concomitant diagnosis of complicated cataract. Results. A new method of two-stage surgical treatment with reduced volume of laser endophotocoagulation was developed in the S. Fyodorov Eye Microsurgery Federal State Institution. After the follow-up period of 12 months retina was attached in all 12 cases, best corrected visual acuity (BCVA) was 0.38±0.08; 5 eyes had silicone oil endotamponade, in 7 cases silicone oil was removed. Conclusion. Primary 360-degree retinotomy is an effective method of surgical treatment of rhegmatogenous retinal detachment with severe proliferative retinopathy. The most preferable in these cases is to carry out surgical treatment in several stages with short-term PFCL tamponade, which allows to achieve maximum adaptation of the retina. Laser retinopexy in the PFCL environment during the second stage of surgery allows it to be carried out fully and at the same time in a minimal volume. Key words: retinal detachment, proliferative vitreoretinopathy, primary retinotomy, circumferential retinotomy, perfluorocarbon liquid, laser endophotocoagulation

Phacoemulsification Plus Intraocular Lens Implantation with Gold Nanoparticles for Complicated Cataract Secondary to Uveitis: Efficacy Analysis

This study analyzes the efficacy of phacoemulsification (PE) plus intraocular lens implantation (IOLI) in patients with complicated cataracts secondary to uveitis. Nanostructured photothermal ring integrated (nano)-intraocular lens (IOLs) were developed to improve the biocompatibility and optical properties of IOLs. However, data on the safety profile and effectiveness of IOLI for patients with complicated cataracts secondary to uveitis are scarce, and studies have questioned the safety of PE in patients undergoing cataract surgery. We used gold nanoparticle (AuNP)-modified commercially available intraocular IOLs combined with PE technology to treat patients with complicated cataracts secondary to uveitis. First, we found that AuNP-modified IOLs were effective in reducing macrophage and bacterial adhesion and were biocompatible with the organism. Then, 64 patients with complicated cataracts secondary to uveitis were totally selected from February 2019 to February 2022, of which 33 cases were treated with PE+IOLI (test group) and 31 with conventional small-incision extracapsular cataract extraction (SIECCE) and IOLI (control group). Intergroup comparisons based on efficacy, safety, visual acuity (VA), aqueous humor protein levels before and after treatment, and quality of life (assessed with the Generic Quality of Life Inventory-74, GQOLI-74) revealed higher overall treatment efficacy and postoperative VA, as well as lower complication rate and postoperative aqueous humor protein levels, in the test group than the control group. Moreover, the test group had higher GQOLI-74 scores in the dimensions of physical function, mental health, psychological health, and social competence than the control group. Thus, PE+IOLI is more suitable for patients with complicated cataracts secondary to uveitis than conventional SIECCE+IOLI. PE+IOLI can improve treatment efficacy and safety, as well as patient VA and quality of life.

Evaluation of endothelial cell loss after cataract surgery in patients with pseudoexfoliative syndrome

Introduction: Despite modern techniques and technologies for cataract surgery, pseudoexfoliative syndrome poses a challenge to surgeons due to weakness of the zonular apparatus and limited pupillary dilation. Quantitative and qualitative morphological changes in the corneal endothelium have been demonstrated by several studies. An accumulated risk of endothelial cell loss can be expected in these patients following more complicated and prolonged surgery, often requiring complex manipulation of the cataract, iris, and IOL. Our present work aims to compare the loss of endothelial cells after uncomplicated phacoemulsification in patients without and with pseudoexfoliative syndrome. Materials and methods: We conducted a prospective comparative study collected at the Rabat specialty hospital, spanning from August to December 2023. Were included in this study 60 candidates for cataract surgery: - 30 patients with pseudoexfoliation syndrome (PXF) and - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. Discussion: In our series, we did not find a statistically significant difference in the density of preoperative endothelial cells between the 2 groups, this result is similar to that obtained by KALJURAND et al, on the other hand for ken hayashi et al, and wirbelauer et al, the difference between the 2 groups was statistically significant. Regarding postoperative cell loss, our results agreed with those obtained by Ken Hayashi et al, who also reported greater endothelial cell loss in the PXF group compared to the control, unlike Wirbelauer et al, for whom the loss of endothelial cells was similar between the 2 groups. In the study by Kaljurand et al, the average percentage loss was 18% in the PXF group versus 11.6 in the control group, this difference had a statistically low significance. Conclusion: The loss of corneal endothelial cells after phacoemulsification in eyes with capsular pseudoexfoliation was significantly greater than in eyes without PXF, these results suggest that corneal endothelial cells of patients with pseudoexfoliation syndrome are more vulnerable to cataract surgery than healthy endothelial cells. To prevent serious endothelial lesions, a precise preoperative evaluation of the corneal endothelial state by specular microscopy seems necessary in these patients, with more precision and precautions during the procedure.

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine &amp; quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients &amp; Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery &amp; had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary &amp; secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye &amp; PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size &amp; percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

ВЛИЯНИЕ ГИПОТЕНЗИВНЫХ ПРЕПАРАТОВ В ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ У ПАЦИЕНТОВ С ПСЕВДОЭКСФОЛИАТИВНЫМ СИНДРОМОМ НА ФОНЕ ОСЛОЖНЕННОЙ КАТАРАКТЫ

In modern surgery of complicated cataracts, an important factor is the preservation of visual functions with minimal costs. The surgeon’s experience and modern technology, which makes it possible to identify hidden symptoms of certain pathologies at the diagnostic stage, allows for a favorable completion of surgery with minimal intraoperative complications. This article shows the approach and observations of patients at risk of increasing eye pressure in the postoperative period due to the anatomical structures of the eye (in these cases, patients with open-angle glaucoma) to antihypertensive drugs. 131 patients (134 eyes) with various signs of pseudoexfoliation syndrome participated in the observation. Before planned surgery for complicated cataracts, all patients underwent ophthalmological diagnostics, medical history, and laboratory tests according to generally accepted methods. All operations were performed by the same surgeon. Cataract surgery was performed according to the standard technique (Phaco + intraocular lens) through a 2.2 mm incision, two 1.2 mm paracentesis, but for some patients other components of surgical interventions were added. In the observation groups, for better fixation and a lower percentage of complications in long-term follow-up periods, RPR, T-19, Myol were implanted in 27.7%. A large percentage of 34% were implanted with the HO Acrylic IOL model lens, which requires a 2.2 mm corneal incision. In observation groups 2 and 3, 32.5 and 31.8% preferred lenses to the Acrysoft IQ model. And in 32.5% and 13.6%, respectively, the AFY model. The choice of the method of surgical intervention, as well as the model of intraocular lenses, made it possible to predict the long-term postoperative period with less toxicity for the patient’s condition. No intraoperative complications were observed; the administration of antihypertensive drops, both in combination and in monotherapy in the early stages of the postoperative period, allowed maintaining eye pressure within normal limits in all observation groups.

Некоторые факторы риска воспаления переднего отрезка глаза после хирургии катаракты у пациентов с глаукомой (серия клинических случаев)

Purpose. The study purpose was to identify risk factors that increase anterior segment inflammation after cataract surgery in patients with glaucoma. Material and method. We present 3 clinical cases in which anterior segment inflammation was observed after phacoemulsification in patients with combined cataract and glaucoma (with failure of the ligamentous apparatus of the lens, a history of anti-glaucoma surgery and the presence of a complete complicated cataract against the background of a narrow pupil). Results. In the first clinical case, descemetite was biomicroscopically observed on the next postoperative day; the intraocular fluid’s opalescence of the anterior eye chamber. This condition was the result of excessive manipulation during surgery (use of iris retractors and intracapsular ring). The vision on the first day was 0.4 does not correct (n/c), after 7 days it was 0.6 n/c. In the second clinical case, excessive contact with the iris (rupture of synechiae and action of instruments dilating the pupil) resulted in postoperative descemetis, dispersion of iris pigment in the anterior chamber moisture, residual viscoelastic on the endothelium. Vision on the first day after surgery was 0.2 n/c, on the 7th – 0.4 n/c. In the third clinical case, the descemetal folds were a consequence of increased ultrasound activity in a mature cataract as well as of manipulations that dilated the pupil. The day after surgery, visual acuity was 0.5 n/c. Conclusion. These clinical cases demonstrate risk factors of increased anterior segment inflammatory response after phacoemulsification for patients with combined cataract and glaucoma. They are: lens subluxation, previous trabeculectomy, complete complicated cataract and narrow rigid pupil. Key words: cataract, glaucoma, phacoemulsification, intraocular lens, cataract extraction, inflammation

GIANT INTRAOPERATIVE CORNEAL BULLA MANAGED WITH BANDAGE LENS TECHNIQUE DURING VITRECTOMY SURGERY.

To report a case of giant intraoperative corneal bulla formation in a patient with a history of recent phacoemulsification with clear corneal incision that was managed with a bandage contact lens intraoperatively. Retrospective case report with anterior segment optical coherence tomography. A 77-year-old woman with a history of recent complicated cataract surgery with retained lens fragments underwent pars plana vitrectomy and scleral-fixated intraocular lens placement. During pars plana vitrectomy, a large corneal bulla formed at the site of the main corneal incision, confirmed with anterior segment optical coherence tomography. A bandage contact lens with viscoelastic was used to overcome visualization challenges and safely proceed with the surgery. This is the first report of corneal bullae formation during pars plana vitrectomy that is confirmed by anterior segment optical coherence tomography and successfully managed with a bandage contact lens intraoperatively.

Management of macula-on giant retinal tear detachments– outcome of pars-plana-vitrectomy with silicone oil versus gas tamponade

BackgroundTo compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade.MethodsAll consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded.ResultsOverall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).ConclusionsSurgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.Trial registrationThe trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).

Подходы к комбинированной хирургии катаракты и глаукомы в условиях слабости связочного аппарата хрусталика

Purpose. To demonstrate the effectiveness of single-step phacoemulsification of cataracts and antiglaucoma surgery in conditions of weakness of the zonular apparatus. Methods. Patient N., 67 years old, came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) with complaints of decreased vision, increased intraocular pressure (IOP), and narrowing of the fields of view of the right eye. The diagnoses: OD Primary open-angle glaucoma 3v, Subluxation of the lens grade 1 OS Primary open-angle glaucoma 1a, OU Complicated cataract, Pseudoexfoliation syndrome. Carried out: autorefractokeratometry, visual acuity testing, computerized perimetry, biomicroscopy, gonioscopy, pneumotonometry, tonometry according to Maklakov, optical biometry. Considering the weakness of the lens zonules, the method of fixation of the intraocular lens (IOL) by optic capture technique was used. Results. Examination and evaluation one week post-operation: Visus 0.6 unc, IOP (pneumotonometry) 11 mmHg without hypotensive therapy; biomicroscopy: a calm eye with a well-expressed filtration bleb at the 12 o’clock position, well-adapted sutures, a transparent cornea of average depth, clear aqueous humor, moderate iris atrophy, round 3 mm pupil with pseudophakia at the pupil’s edge, IOL located in the capsular bag with haptics in the iridociliary groove, stable positioning. Fundus examination shows a pale optic nerve head, excavated with 0.8 cup-to-disc ratio, well-defined borders, narrowed vessels. Macular region appears normal. Conclusion. Combined cataract and glaucoma surgery in a patient with subluxated crystalline lens using the «optic capture» technique and Non-penetrating Glaucoma Surgery allowed preserving the correct and stable position of the IOL with normalization of intraocular pressure without the need for hypotensive therapy during a 1-year follow-up period. Key words: one-stage surgery, primary angle-closure glaucoma complicated by cataract, «optic capture»

Efficacy and safety of the implantation of a single-piece angulated foldable IOL in the sulcus.

To study the visual results and tolerance of a Zeiss CT Lucia 601P intraocular lens (IOL) implanted in the sulcus after complicated cataract surgery or during IOL exchange for clouded IOL. In total, 64 patients who underwent sulcus implantation were recalled to the hospital to undergo subjective and objective refraction, best corrected visual acuity measurement, tonometry, optical coherence tomography, laser flare photometry, biometry, and wavefront aberrometry. In spite of a large variation in preoperative refraction, the target refraction was obtained within 1.5 diopters in approximately 97% of patients and within 0.5 diopter in 53% of patients. Average BCVA was high (Snellen 0.86) and related to concomitant (mostly retinal) pathologies in eyes with poorer visual performance. Wavefront aberrometry showed no evidence of IOL tilting or decentration after long-term implantation in the sulcus. Tonometry was not different from the fellow eye of the patient (p > 0.5). In 53 patients with bilateral pseudophakia, the laser flare photometry was not significantly different from the fellow eye (p < 0.05). This study demonstrates that this single-piece angulated foldable acrylic IOL can be considered for implantation in the sulcus. The visual results are favorable, and the IOL can be well-positioned and tolerated in the sulcus. Moreover, there were no safety issues found since there was no evidence of elevated IOP or chronic uveitis.

CHEMICAL OCULAR INJURY BY POTASSIUM PERMANGANATE

Abstract Introduction &amp; Objectives : Chemical ocular injury is an emergency case and commonly occured among children. Alkaline chemical ocular injury is more destructive especially due to saponification. One of the rare chemical ocular injury is alkaline trauma by Potassium Permanganate (KMNO4) Methods : A case of a three-year-old boy patient brought by his mother in emergency department at Cicendo Eye Hospital with severe pain, redness, and swelling of the left eye. Ten hours earlier, the patient was playing and accidentally exposed to KMNO4. Visual acuity of the right eye was 6/6 and the left eye was difficult to examine. Ophthalmological examination revealed superior and inferior palpebra are swelling, KMNO4 adhered tightly on conjunctival tarsal superior, inferior, and conjunctival bulbi inferior until fornix and temporal area. Cornea was hazed and iris shadow test positive so he was diagnosed with Chemical Trauma Ropper Hall grade II OS. Treatment begins with irrigation 2 litres of normal saline until pH 7 along with debridement of KMNO4 from conjunctival tarsal superior inferior and bulbi. The patient underwent installation of transplanted amniotic membrane and debridement under anasthesia Results : Management in the initial phase is irrigation. The definitive therapy requires surgery to speed up the healing process. Complications that often occur are corneal limbal cell deficiency, dry eye, symblepharon formation, secondary glaucoma, and complicated cataracts Conclusion : Alkali chemical injury is hazardous and can lead to severe vision threatening complications because of saponification. Prompt and aggressive management is required in such cases to give them the best chance of a more favourable outcome

State of the microbial spectrum (microbiome) of the ocular surface of patients with cataracts and glaucoma in the early postoperative period

Background. The occurrence of infectious complications in the early postoperative period in patients undergoing ophthalmic surgery remains a persistent challenge in contemporary clinical practice. Typically the treatment regimen involves the administration of a combination of antibiotics and corticosteroids, often utilized in a fixed-dose combination for simplicity. Despite the prevalent use of these regimens, there’s a notable disregard for comprehensive microbiological diagnostics of the conjunctiva in surgical patients, attributed to various socio-economic factors. However, the significance of such diagnostics in forecasting postoperative outcomes is indisputable. Purpose of the study: to determine the medical and economic feasibility of prescribing individual antibacterial and anti-inflammatory medications in fixed combinations (FC) in postoperative treatment regimens for patients scheduled ophthalmic surgeries. Materials and methods. The study included data from 99 patients (65 males and 34 females, mean age 74 (70–77) years) admitted for elective surgery to address cataracts or glaucoma from May to September 2023. Patients were randomly divided to 2 observation groups. The division into groups was carried out according to the drugs (medicines) used in the postoperative treatment regimens, each of which was further divided into 2 subgroups in accordance with ophthalmopathology. The first group of patients received postoperative therapy with the levofloxacin/dexamethasone FC (L-dexopt, RK.O. Rompharm Company S.R.L., RU LP-007490), the second group was treated with a tobramycin/dexamethasone FC (Tobrazon, Kadila Pharmaceuticals, RU P№015176/01). All subjects underwent a comprehensive ophthalmological examination, as well as a microbiological examination of the conjunctival cavity before surgery and 8 days after surgical treatment. Additionally, all patients completed the Ocular Surface Disease Index (OSDI) questionnaire. Results. Analysis of microbial flora changes during therapy revealed an increase in cultures exhibiting a “zero” degree of growth by 29 and 11,1 % in the “cataract” and “glaucoma” subgroups of the fi rst observation group, respectively. The second group showed a similar increase. “zero” degree of growth (11,7 and 28,6 %, respectively). The treatment costs for patients undergoing cataract surgery and receiving the FC levofloxacin/ dexamethasone were 105.9 rubles per treatment course, compared to 40.5 rubles for those undergoing surgery for glaucoma or complicated cataracts. The cost-effectiveness for those treated with the FC tobramycin/dexamethasone in the early postoperative period was 21,6 and 51,9 rubles. respectively. The OSDI scores across in all subgroups ranged from 16,6 to 25,0 points indicating normal values. The administration of FC levofloxacin/dexamethasone and tobramycin/dexamethasone in the early postoperative period for patients with cataracts and glaucoma was clinically effectively in managing the inflammatory process by influencing the microbial spectrum (microbiome) of the ocular surface. No significant differences were observed in the degrees of microflora growth during the preoperative period between the “cataract” and “glaucoma” subgroups, which does not support the hypothesis regarding the antiseptic action of topical antiglaucoma medications in patients with glaucoma at this stage. Conclusions. The conducted medical and economic analysis proved the feasibility of using both drug combination with a slight preference FC levofloxacin/dexamethasone in patients undergoing surgery for glaucoma and FC tobramycin/dexamethasone for those with uncomplicated cataracts in the early postoperative period.