Complicated Phacoemulsification Research Articles

Retinal Detachment Rates After Uncomplicated DMEK Versus Cataract Surgery Combined (Triple-)DMEK.

To evaluate the rate of and risk factors for rhegmatogenous retinal detachment (RRD) after Descemet membrane endothelial keratoplasty (DMEK) either alone or in combination with cataract surgery. Retrospective analysis of prospective database. Consecutive eyes with Fuchs endothelial corneal dystrophy (FECD) that received DMEK surgery with a minimum follow-up of 1 year between July 2011 and January 2021 at the Department of Ophthalmology at the University of Cologne were analyzed. Exclusion criteria were complicated history including repeat DMEK within 1-year, previous retinal or glaucoma surgery, complicated phacoemulsification, congenital cataract, history of trauma. From 3858 consecutive DMEKs, 1961 patients were identified suitable for analysis. 846 (43.1%) were pseudophakic DMEK, 91 (4.6%) phakic DMEK and 1,024 (52.2%) combined with cataract surgery. RRD occurred in 13 eyes (12 patients). Within two years after DMEK RRD occurred in 0.49% and 0.47% after DMEK and DMEK with cataract surgery, respectively. Mean age of 59.24 ± 8.42 years with subsequent RRD was significantly lower than overall 68.81 ± 9.89 years (t-test two-tailed; p < 0.001). The spherical equivalent was -4.69 ± 3.98 D (range -9.00 to 0.5) in RRD after pseudophakic DMEK compared to -2.79 ± 3.54 D (range -7.5 to 0.75) in combined procedures. Re-bubbling had no influence on RRD rate. DMEK alone or in combination with cataract surgery showed similar postoperative RRD rates in the first two years, generally in the range of pseudophakic RRDs. Risk factors such as myopia and younger age could be identified. Re-bubbling has no influence on RRD rates.

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M &amp; J Western Regional Institute of Ophthalmology (M&amp;J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M &amp; J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value &amp;#60;0.05 was taken as significant.: MSICS &amp; phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS &amp; phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

Exploring the Distinct Characteristic of Two Procedures for Sulcus Implementation following Posterior Capsular Rupture during Phacoemulsification: Single-piece Foldable IOLs and Polymethylmethacrylate IOLs

Introduction : Posterior capsular rupture (PCR) is one of the most feared complications of phacoemulsification. In? the?bag implantation of the lens becomes difficult if the PCR was large. Implantation of rigid polymethylmethacrylate (PMMA) or single?piece foldable IOL is implanted in the sulcus&#x0D; Case Illustration : After noting the PCR on both patients, single?piece foldable IOL of the same power was implanted in the ciliary sulcus. Same action was implemented to PMMA IOLs by enlarging the main port twice. Intracameral pilocarpine was injected and vitrectomy anterior was performed. The wound was closed with hydration on single-piece foldable IOL, meanwhile on PMMA IOLs, one hecting is required in the middle of mainport wound. The postoperative VA on day 1 from 0.12 on single-piece foldable IOLs and 0.25 on PMMA IOLs. Corneal edema, increased anterior chamber reaction was seen on single-piece foldable IOLs. Raised IOP was not found on both patients&#x0D; Discussion : Complications implantation single?piece foldable IOLs such as pigment dispersion syndrome, increased IOP. A surgical peripheral iridectomy can be created as a solution. Complication less likely occurred on the patient with longer axial length. The AL on this patient is AL 23.33 mm (single?piece foldable IOLs) and 24.08 mm (PMMA IOLs). The weakness of single piece foldable acrylic lenses are poor choice for ciliary sulcus placement and PMMA IOLs can induce astigmatism.&#x0D; Conclusion : Single-piece foldable IOLs are not designed for sulcus implantation. PMMA IOLs implantation can induce astigmatism.

Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus

Objective: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).&#x0D; Materials and Methods: A retrospective study was conducted at the Ophthalmology Department of Lahore General Hospital, Lahore between 2017 and 2022. The study included 51 patients (33 males and 18 females) between the age 35 to 85 years who were referred after a complicated phacoemulsification with dropped nucleus.&#x0D; Results: This study included 51 patients in which 33 were males (64.71%) and 18 were females (35.29%). All patients underwent 23-gauge pars plana vitrectomy. Posterior chamber phacofragmentation was carried out in 32 (62.75%) eyes while in remaining 19 (37.25%) patients vitrectomy cutter was used for the dropped nucleus. Out of 51, 06 (11.76%) patients received an anterior chamber IOL at the time of cataract surgery, 21 (41.18%) eyes had IOL in the ciliary sulcus, 07 (13.73%) had a posterior chamber IOL, and the remaining 17 (33.33%) patients were aphakic. Of these 17 aphakic patients, an anterior chamber IOL was placed at the time of vitrectomy in 07 (41.18%) patients who were judged to have inadequate capsular support for a posterior chamber lens. In the remaining 10 (58.82%) eyes, where capsular support was deemed adequate, a posterior chamber IOL was inserted. Final visual acuity was 20/40 or better in 34 (66.67%) eyes and 20/50 in 06 (11.76%) patients.&#x0D; Conclusion: Poor visual outcome after dropped nucleus at phacoemulsification cataract extraction can be avoided if managed by prompt pars plana vitrectomy as it offers the advantages of a closed system for vitrectomy and manipulation of the nucleus, an improved view of the posterior segment and facilitated recognition and management of intraoperative complications with better visual and anatomical outcomes with low rate of postoperative complications.

The Precision of Calculating the Optical Power of the IOL in Various Methods of Out-Bag IOL Fixation

The calculation of the optical power of the IOl for out-bag implantation remains one of the actual problems of cataract surgery. Purpose. Comparative study of the precision of calculating the optical power of the IOL for retropupillary fixation of an iris-claw lens, transscleral fixation of a rigid IOL with two flexible haptic elements and transscleral fixation of an soft hydrophobic IOL with two open haptic elements. Patients and methods. The study included 105 patients (108 eyes) with complicated phacoemulsification in combination with lens subluxation. First group included 39 patients (42 eyes) with complicated phacoemulsification and retropupillary implantation of an iris-claw lens. Second group included 29 patients (29 eyes) with complicated phacoemulsification and transscleral suture fixation of rigid PMMA IOL. Third group included 37 patients (37 eyes) with complicated phacoemulsification and transscleral suture fixation of an soft hydrophobic IOL with two open haptic elements. In the postoperative period we performed a comparative evaluation of visual acuity without correction and best corrected visual acuity, IOL optical power calculation precision within ±0.5 diopters, the average absolute error of IOL optical power calculation. Results. Three months after the operation the visual acuity of 0.8–1.0 without correction was obtained in 35,7 % of cases in the 1st group, 17.2 % in the 2nd group, 16.2 % in the 3rd group. The precision of postoperative refraction within ±0.5 diopters was 95.2 % in the 1st group, 86.2 % in the 2nd group 83.7 % in the 3rd group. The average absolute error of IOL optical power calculation was 0.33 ± 0.07 diopters in the 1st group, 0.57 ± 0.18 diopters in the 2nd group, 0.62 ± 0.19 diopters in the 3rd group (р &lt; 0.05). Three months after surgery there were no significant differences in best corrected visual acuity and the degree of induced astigmatism. Conclusion. Retropupillary implantation of an iris-claw lens during complicated phacoemulsification significantly increases visual acuity without correction, frequency calculation precision within ±0.5 diopters, significantly reduces the average absolute calculation error compared to transscleral suture fixation of the IOL.

Comparison of safety and effectiveness between phacoemulsification and suture less small incision procedures in Cataract surgery

BACKGROUND &amp; OBJECTIVE: Cataract is major cause of preventable blindness, worldwide. Phacoemulsification and manual small incision are most common surgical methods of cataract. The objective of our study was to compare surgical outcomes and complications in phacoemulsification (Phaco) and manual small incision cataract surgery (MSICS) patients&#x0D; METHODOLOGY: A Prospective Observational study was conducted at Ophthalmology department of POF Hospital Wah Cantt, Pakistan. Study duration was 6 months (January 2020-June 2020). We calculated sample size of 30 cataract patients. Selection of cataract patients in OPD was done through non probability consecutive sampling technique. Afterwards, they were divided randomly into two different groups using lottery method; Group A patients cataract extraction was done with Phacoemulsification while in group B patients cataract extraction was done with small incision cataract surgery. Patients were followed for 5 weeks. Fisher-exact test and independent and paired T-test was applied to get statistically significant results. P value ≤0.05 was considered significant.&#x0D; RESULTS: Total 30 patients were included in study. There were 19(64.5%) male and 11(35.5%) female. Mean age of patients was 48.3±7.5SD. There was a significant change in pre and post operative visual acuity in both groups (Group A p=0.000 and Group B p=0.000). MSICS showed high surgery duration as compared to phacoemulsification (29.6±1.5 vs 22.2±2.1, p=0.000).&#x0D; CONCLUSION: Phacoemulsification and Manual small incision cataract surgery are safe and clinically effective surgical techniques that did not show any difference in surgical outcomes. However, Phacoemulsification is associated with less post-operative complications as compared to MSICS.

"Capsule drape wrap"-a new technology for iridoschisis management during phacoemulsification.

To introduce a new technique for iridoschisis management during phacoemulsification: "capsule drape wrap". "Capsule drape wrap" technique was used for an 80-year-old man with idiopathic iridoschisis in the right eye during phacoemulsification. The inserted flexible nylon iris hooks to hold anterior capsule in place, the margin of the anterior capsule could act as drape wrap, tracking the fibrillary iris strands firmly from free floating and stabilizing the capsular bags simultaneously. The eye with iridoschisis was successfully treated. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there were no intraoperative complications such as tear of the iris, hyphema, iris prolapse, loss of mydriasis, or rupture of the posterior lens capsule during phacoemulsification. The best-corrected visual acuity was increased by 0.1 (logMAR) 6mo after the surgery. "Capsule drape wrap" for iridoschisis is easily manageable, prevents further disruption to the loose iris fibers and ensures the stability of capsule-iris complex simultaneously, consequently minimizing the risk of surgical complications in phacoemulsification.

Глаукома псевдофакичного глаза

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

Corneal endothelial cells and acoustic cavitation in phacoemulsification.

Postoperative complications of phacoemulsification, such as corneal edema caused by human corneal endothelial cell (CEC) injury, are still a matter of concern. Although several factors are known to cause CEC damage, the influence of ultrasound on the formation of free radicals during surgery should be considered. Ultrasound in aqueous humor induces cavitation and promotes the formation of hydroxyl radicals or reactive oxygen species (ROS). ROS-induced apoptosis and autophagy in phacoemulsification have been suggested to significantly promote CEC injury. CEC cannot regenerate after injury, and measures must be taken to prevent the loss of CEC after phacoemulsification or other CEC injuries. Antioxidants can reduce the oxidative stress injury of CEC during phacoemulsification. Evidence from rabbit eye studies shows that ascorbic acid infusion during operation or local application of ascorbic acid during phacoemulsification has a protective effect by scavenging free radicals or reducing oxidative stress. Both in experiments and clinical practice, hydrogen dissolved in the irrigating solution can also prevent CEC damage during phacoemulsification surgery. Astaxanthin (AST) can inhibit oxidative damage, thereby protecting different cells from most pathological conditions, such as myocardial cells, luteinized granulosa cells of the ovary, umbilical vascular endothelial cells, and human retina pigment epithelium cell line (ARPE-19). However, existing research has not focused on the application of AST to prevent oxidative stress during phacoemulsification, and the related mechanisms need to be studied. The Rho related helical coil kinase inhibitor Y-27632 can inhibit CEC apoptosis after phacoemulsification. Rigorous experiments are required to confirm whether its effect is realized through improving the ROS clearance ability of CEC.

Resident-Performed Phacoemulsification Cataract Surgery: Impact of Resident-Level Characteristics.

To evaluate the rate of complications in resident-performed phacoemulsification and influencing factors. In this retrospective cohort study, the outcomes of cataract surgeries performed by 18 ophthalmology residents were analyzed. The outcome of first 80 phacoemulsification cataract surgeries (1440 cataract surgeries) performed by each resident were analyzed. Outcome measures included the rate of intraoperative capsular rupture requiring anterior vitrectomy, nucleus drop, and incomplete attempts at uncomplicated procedures. Changes in the rate of complications over the surgical training course were also assessed. The most common surgical complications were capsular rupture (7.5%), followed by incomplete attempt(s) (5.9%), and nucleus drop (1.1%). Comparing the first 40 and second 40 surgeries, the rate of complications decreased as a function of surgeon experience in all resident cohorts. Greater theoretical skills and younger surgeon age were associated with a lower rate of intraoperative capsular rupture (hazard ratios = 1.421 and 1.481, respectively; P = 0.047 and P = 0.041, respectively). The use of antianxiety drugs and number of surgeries in the first 6 months demonstrated no predictive value for a lower rate of intraoperative complications (hazard ratios = 0.929 and 1.002; P = 0.711 and P = 0.745, respectively). The use of antianxiety medication and more surgeries in the first 6 months did not decrease the rate of intraoperative complications of phacoemulsification, while improvement of theoretical skills may have increased the safety of resident-performed cataract surgery.

Retrospective study of postoperative intraocular pressure and complications in phacoemulsification combined with endoscopic cyclophotocoagulation and phacoemulsification alone in dogs.

Long-term comparative data of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) versus phacoemulsification (phaco) alone in dogs are rare. To investigate the effects of ECP on postoperative intraocular pressure (IOP) and complications after phaco in dogs with normal IOP. Medical records of IOP, conjunctival hyperemia, corneal edema, aqueous flare, posterior synechia, intraocular fibrin, and posterior capsule opacification (PCO) formation in 15 canine eyes that underwent phaco-ECP and 36 eyes that underwent phaco alone were evaluated retrospectively. ECP was applied when either the iridocorneal angle or the ciliary cleft was narrow or closed. The IOP of the phaco-ECP group persisted within the normal range postoperatively. The phaco-ECP group had a shorter period of dorzolamide use than did the phaco group. PCO was formed earlier in the phaco-ECP group than in the phaco group. The phaco-ECP group showed more severe corneal edema than the phaco group at every follow-up visit. Posterior synechia was more severe in the phaco-ECP group than in the phaco group from two weeks until the last follow-up. Although ECP might cause more postoperative complications such as corneal edema and posterior synechia, it could effectively reduce the incidence of IOP increase after phaco in dogs with a high risk of postoperative glaucoma.

Predictive factors and visual outcomes after immediate pars plana vitrectomy for posteriorly dislocated lens fragments during complicated phacoemulsification surgery.

To investigate the prognostic factors for visual outcome in patients undergoing immediate pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments during phacoemulsification surgery. This was a single-center, retrospective, cross-sectional study of 37 eyes of 37 patients undergoing immediate PPV for posteriorly dislocated lens fragments from 2015 to 2021. The primary outcome measure was changes in the best-corrected visual acuity (BCVA). Additionally, we analyzed the predictive factors for poor visual outcomes (BCVA <20/40) and perioperative complications. The mean (±standard deviation [SD]) age of the patients was 66.57 (±10.86) years, with an almost identical gender profile (M: F = 18/19 [48.64%:51.36%]). The median (interquartile range [IQR]) log of minimum angle of resolution (logMAR) BCVA improved significantly from the baseline (1 [0.6-1.48], ~20/200) to the final visit (0.3 [0.2-0.6], ~20/40) (P < 0.0001) after a mean (±SD) follow-up of 6.35 (±6.32) months. The final BCVA was 20/40 or better in 59.5% of the eyes. Poor final BCVA (<20/40) was associated with small preoperative pupillary size (P = 0.02), presence of preoperative ocular pathology (P = 0.02) including uveitis, glaucoma, and clinically significant macular edema (CSME), intraoperative displacement of >50% of lens matter into the vitreous (P < 0.001), use of iris-claw lens (P < 0.001), and postoperative cystoid macular edema (CME; P = 0.007). The postoperative complications included CME (13.51%), retinal detachment (10.81%), chronic uveitis (8.11%), glaucoma (8.11%), iritis (2.7%), posterior chamber IOL (PCIOL) dislocation (2.7%), and vitreous hemorrhage (2.7%). For retained lens fragments in complicated phacoemulsification surgery, immediate PPV is a viable approach with the potential for a good visual outcome. The important predictors for poor visual outcomes include a small preoperative pupil size, preexisting ocular pathology, displacement of significant volume of lens matter (>50%), use of an iris-claw lens, and CME.

A 10-year review of the visual outcomes of early versus late pars plana vitrectomy in eyes with dropped lens fragment or nucleus during phacoemulsification

Background: Pars plana vitrectomy (PPV) is a routine surgical option for the removal of dropped lens fragment or nucleus in the vitreous cavity due to complicated cataract surgery; however, its optimal timing is controversial. Therefore, we aimed to determine the visual outcomes of early versus late PPV in eyes with dropped lens fragment or nucleus due to complicated phacoemulsification cataract surgery.&#x0D; Methods: This descriptive-analytical retrospective study collected data of patients who underwent early (less than or equal to 1 week) versus late (&gt; 1 week) PPV for the management of dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery over a 10-year period at Imam Khomeini Tertiary Referral Hospital, Ahvaz, Iran. Demographic characteristics, the interval between complicated phacoemulsification and PPV, pre- and postoperative intraocular pressures, best-corrected distance visual acuity (BCDVA), and postoperative complications were extracted from each patient’s record.&#x0D; Results: Fifty-one eyes of 51 patients with a mean (standard deviation [SD]) age of 64.66 (6.54) years and a male-to-female ratio of 33 (64.7%) to 18 (35.3%) were included over 10 years. The mean (SD) BCDVA before PPV was 1.87 (0.53) logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.54 (0.46) logMAR at the final postoperative visit (P &lt; 0.001). The mean (SD) BCDVA was significantly better after early PPV than after late PPV (0.41 [0.30] versus 0.62 [0.52] logMAR; P &lt; 0.05). There was no significant difference in the final BCDVAs among the three methods of lens fragment removal (P &gt; 0.05). The rates of post-PPV complications were as follows: 29 (56.9%) eyes with corneal edema, 16 (31.4%) eyes with uveitis, 10 (19.6%) eyes with cystoid macular edema, 8 (15.7%) eyes with rhegmatogenous retinal detachment, and 8 (15.7%) eyes with other complications (optic nerve atrophy, choroidal neovascularization, vitreous hemorrhage, or epiretinal membrane formation). No significant differences were observed in the rates of complications according to the time interval between complicated phacoemulsification and PPV (all P &gt; 0.05). The frequency of corneal edema was significantly higher when removing lens fragments using the trans-limbal method than using the other methods (P &lt; 0.05), yet the rates of other complications were comparable among the three methods of lens fragment removal (all P &gt; 0.05).&#x0D; Conclusions: Early PPV and removal of a dropped lens fragment or nucleus resulting from complicated phacoemulsification cataract surgery are recommended to achieve better visual outcomes. Future studies with longer follow-up, greater sample sizes, and analysis of other parameters of visual function, such as contrast sensitivity, visual field, color vision, and stereopsis, could provide more conclusive results and help verify our preliminary findings.

Treatment approaches to postoperative fibrinoid syndrome after phacoemulsification

BACKGROUND: Postoperative fibrinoid syndrome (PFS) is an early complication of phacoemulsification, manifested by fibrin deposition on the iris and the intraocular lens surface, which leads to visual acuity decrease.&#x0D; AIM: To assess the rate and the treatment efficacy (by YAG laser, enzymatic, medicalmentous) in PFS after phacoemulsification.&#x0D; MATERIALS AND METHODS: Retrospective analysis of 56,019 cataract surgery cases of 20172021. There were 49 patients with PFS divided into 3 groups according to treatment approaches: 1st group medicamentous treatment (MT) + YAG laser destruction of the fibrin film (n = 6); 2nd MT + prourokinase injection into the anterior chamber (n = 6); 3rd MT only (n = 37).&#x0D; RESULTS: There was no difference between groups in best-corrected visual acuity (BCVA) before the PFS development. There was a more rapid increase in BCVA in the 1st and the 2nd groups compared with the 3rd one on the third day (0.20 0.09 and 0.21 0.08 versus 0.09 0.08 for groups respectively, p = 0.001) and on the fifth day of treatment (0.25 0.10 and 0.27 0.13 versus 0.16 0.14, p = 0.029). Nevertheless, in one week, there was no difference in BCVA between groups. Unfortunately, BCVA did not return to baseline in any group.&#x0D; CONCLUSION: The incidence of PFS after phacoemulsification is relatively low and amounts to 0.093%. The most rapid BCVA recovery was observed in the 1st and the 2nd groups.

Yamane Scleral Haptic Fixation Combined with Single Pass Four Throw Technique (Case Report)

Purpose: This is a report of an aphakia case without posterior capsular support and iris support. We did a Yamane scleral fixation combined with single pass four throw pupilloplasty. Case report: A-56 year-old male with a history of complicated phacoemulsification and glaucoma came with a diagnosed of aphakia and angle closure glaucoma. There were no posterior capsular support and iris support so that in this case iris claw secondary IOL cannot be done. We performed Yamane scleral fixation secondary IOL in this case followed by single pass four throw technique pupilloplasty. Post operative uncorrected visual acuity was 0.5 without any complain of quality of vision including glare. Intraocular pressure was within normal limit with topical medication. Conclusion: Yamane scleralfixation secondary IOL implantation combinedwith single pass four throw pupillopasty can be considered on aphakia patient without both posterior capsular support and iris support.

Risk factors, complications, and outcomes of phacoemulsification cataract surgery complicated by retained lens fragments in Asian eyes: A 10-year retrospective study.

PURPOSE:To study the risk factors, visual outcomes, and sequelae of phacoemulsification surgery complicated by retained lens fragments (RLFs).METHODS:This single-center case–control study enrolled consecutive eyes complicated by RLF and compared them to age- and gender-matched uneventful cataract surgery cases at a tertiary care teaching hospital. Biometric, intraoperative, and postoperative data were collected. The primary outcome measures were risk factors, visual outcomes, and rate of postoperative complications.RESULTS:The study and control groups included 282 and 289 eyes, respectively. The estimated incidence of RLF was 1.47% during the study. We found a statistically higher risk of RLF among diabetics (P < 0.001), those with a history of intravitreal injections (P = 0.001), eyes with dense nuclear sclerosis, anterior capsular cataract (P < 0.001), and posterior polar cataract (P = 0.01). There was a statistically higher risk of RLF in eyes with a higher mean preoperative visual acuity (logarithm of the minimum angle of resolution) (P < 0.001) and in cases performed by trainees (P < 0.001). Most eyes in the RLF group (n = 207, 73.4%) retained their preoperative vision or experienced a one-line improvement in visual acuity and 14 eyes (5.3%) experienced more than one-line improvement in vision.CONCLUSION:Although RLFs are rare, they can affect the quality of postoperative vision and outcomes of complicated phacoemulsification surgery.

Early Postoperative Capsular Block Syndrome: Case Report

Objective: To report a case of capsular block syndrome (CBS) 24 hours after phacoemulsification plus intraocular lens (IOL) implantation without complications. Observations: 78-year-old male with blurred vision after cataract surgery. Narrow anterior chamber is found with anterior displacement of the iridolenticular complex, and retention of material in the capsular bag. Results: Visual acuity of 0.2 logMAR, intraocular pressure 14mmHg, wide anterior chamber, centered IOL, in good position. Conclusion: SBC is a rare complication of phacoemulsification. The diagnosis is fundamentally clinical and its treatment must be individualized.

Refractive outcomes of out-of-the-bag intraocular lens implantation

To study and compare the refractive outcomes of retropupillary implantation of an iris-claw lens and transscleral suture fixation of IOL in complicated phacoemulsification. The study included 70 patients (73 eyes) after complicated phacoemulsification in combination with grade 2 lens subluxation. The first group included 36 patients (39 eyes) who underwent complicated phacoemulsification using torsional ultrasound and retropupillary implantation of an iris-claw lens. The second group included 34 patients (34 eyes) after complicated phacoemulsification using torsional ultrasound and transscleral suture fixation of an elastic hydrophobic IOL. In the postoperative period we performed a comparative evaluation of uncorrected visual acuity and best corrected visual acuity, the average absolute error of IOL optical power calculation, the precision of postoperative refraction within ±0.5 diopters, the degree of induced astigmatism, and the tilt of the IOL. At three months after surgery uncorrected visual acuity of 0.8-1.0 was achieved in 33.3% of cases in the first group and 17.6% in the second group, the average absolute error of IOL optical power calculation was 0.34±0.08 diopters in the first group and 0.63±0.19 diopters in the second group, the precision of postoperative refraction within ±0.5 diopters was 94.9% in the first group and 85.3% in the second group, the tilt of the IOL was 0.69±0.21° in the first group and 3.19±0.97° in the second group (p<0.05). There were no significant differences in best corrected visual acuity and the degree of induced astigmatism 3 months after surgery. Implantation of an iris-claw lens in the course of complicated phacoemulsification in lens subluxation significantly improves refractive outcomes of the implantation in comparison with transscleral IOL fixation.

Angle-supported intraocular lens versus scleral-sutured posterior chamber intraocular lens in post-cataract surgery aphakic patients: two-year follow-up cost-effectiveness analysis.

To compare visual, anatomical and economical outcomes of patients with secondary anterior chamber intraocular lens (AC-IOL) implantation and secondary scleral fixated intraocular lens (SF-IOL) implantation. In this retrospective observational study, 38 aphakic patients after complicated phacoemulsification divided in two groups, AC-IOL group (17 patients receiving AC-IOL implantation) and SF-IOL group (21 patients receiving SF-IOL implantation). Corrected distance visual acuity (CDVA), patient reported visual outcome (VF-14) and endothelial cell density (ECD) were measured at baseline and two-year follow-up. Complication rate was registered. The global cost of each procedure and the incremental cost-effectiveness ratio (ICER) were calculated. No statistically significant difference was found in CDVA (logMAR 0.24 ± 0.17 vs. 0.32 ± 0.26, p = 0.27), VF-14 (68 ± 18 vs. 61 ± 20, p = 0.24), ECD (1456.48 ± 525.15 vs. 1341.71 ± 374.33, p = 0.48) and overall complication rate (p = 0.79) postoperatively between the SF-IOL group and the AC-IOL group. The ECD loss rate was significantly higher in the AC-IOL group (15.5% vs. 3.5%, p = 0.004). The average global cost of the two procedures was higher in the SF-IOL group (p < 0.005) and ICER showed an additional payment of 693 € for each patient in SF-IOL group against a saving of 186 endothelial cells 2 years postoperatively. AC IOL and SF-IOL implantation showed similar outcomes in terms of visual function and safety profile. Higher ECD loss was found in AC-IOL group. The global cost of implantation was significantly lower for AC-IOL, but the ICER seems to justify the SF-IOL implantation in patients with low ECD.

Ceftazidime and Vancomycin Deposits after Intravitreal Injection in a Vitrectomized Eye

A 62-year-old man was referred on suspicion of exogenous endophthalmitis 3 weeks after pars plana vitrectomy to remove retained lens fragments, following a complicated phacoemulsification 2 months before presentation. Five days prior to his referral, endophthalmitis was suspected, and he underwent a vitreous tap and received intravitreal injections of ceftazidime and vancomycin. Left posterior segment examination showed multiple, diffuse, whitish, preretinal deposits, without chorioretinal lesions or vascular involvement (Fig A). OCT conducted through the lesions confirmed the preretinal location (Fig B). After 1 week, the deposits had reduced in size and number, and migrated inferiorly (Fig C). After 4 weeks, the deposits had resolved completely (Fig D). (Magnified version of Fig A-D is available online at www.aaojournal.org). Supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.