Corneoscleral Incision Research Articles

Клинический случай хирургической реконструкции зрачка у молодого пациента с аномалией Петерса

Purpose. A clinical case demonstrating surgical reconstruction of the pupil for bilateral Peters anomaly. Material and methods. Patient F., 20 years old. Complaints of vision problems in the left eye. Left eye: microcornea (up to 7–8 mm), the anterior chamber is small, uneven, multiple iridocorneal adhesions at 2.5 and 7 o’clock. The pupil is narrow – 1.0 mm, round, ectopic 2.2 mm upward from the optical center of the cornea, posterior stromal circular synechia, no pupillary reaction to light and mydriatics. Results. A tunnel corneoscleral incision with a width of 2.0 mm was formed at 9 o’clock, as well as 2 paracenteses: at 2 and 6 o’clock. Through the local zone of absence of posterior synechiae and residual native pupillary opening (1.0 mm), a 0.6 mm spatula was placed under the plane of the iris, and a posterior synechiotomy was performed. Then, using 25G scissors, the existing pupillary opening was expanded to 4.2 mm in the area of its planned localization. At the end of the operation, the viscoelastic was washed out of the anterior chamber and standard sealing of surgical approaches was performed. The next day the patient noted an improvement in the brightness of the visual image perceived by the eye, and the visual field expanded. Conclusion. The presented clinical case demonstrated the possibilities of surgical dilation of the pupil when it tends to be completely closed in an eye with congenital Peters anomaly. Key words:: Peters anomaly, pupil formation, pupillary fusion, surgical reconstruction

Global preferred practice patterns in manual small incision cataract surgery

Objectives: Manual small incision cataract surgery (MSICS) has become the surgery of choice in developing countries and setups with a high cataract load; being non-inferior to phacoemulsification, with minimum dependency on technology, and a shorter learning curve. There exist high variability and multiple differing personal preferences in its instrumentation and techniques. Through our study, we aimed to analyse different MSICS practice patterns across the globe to be able to summarise the commonly performed variations and carve a path for MSICS training programmes and help novice surgeons learn the state-of-the-art methods. Materials and Methods: Ours was an online, questionnaire-based cross-sectional observational study. The Google form was floated among ophthalmologists through social media, globally. The preferences for each step of MSICS from the type of anaesthesia used to post-operative advice were asked and responses analysed. Results: Out of 278 respondents, 234 (84.17%) ophthalmologists used peribulbar anesthesia; 214 (77.3%) preferred to do capsulorrhexis first followed by corneoscleral tunnel incision; 145 (52.15%) preferred frown incision; and 152 (54.7%) considered astigmatism management important during tunnel-making. The majority (226 [81.3%]) surgeons used anterior chamber maintainer. Viscoexpression, wire-Vectis, and irrigating Vectis were practiced by 122 (43.9%), 96 (34.5%), and 64 (23%), respectively. As for the intraocular lenses, 175 (62.9%) surgeons preferred non-foldable and non-premium while 65 (23.4%) used multifocal. Viscoimplantation was preferred by 256 (92.1%) surgeons. Only 13 (4.7%) surgeons sutured the tunnel at the end while a subconjunctival antibiotic-steroid injection was used by 166 (59.7%) surgeons. Conclusion: Studying the variability in MSICS can help to carve future MSICS training programs and help novice surgeons to better perform the surgery.

Modified Yamane technique with a 26-gauge needle: single corneal incision and simplified haptic insertion.

A modified Yamane technique with a 26-gauge needle for aphakia correction is described. Single corneal or corneoscleral incision is set at 12 o'clock. The 26-gauge needles are used to make 2 angled incisions parallel to the limbus to fix the haptics of a 3-piece intraocular lens. The modifications provide an easier and safer way of haptic insertion into the needle tip and decreases the possibility of bending or breaking the haptic.

The Clinical Guiding Role of the Distribution of Corneal Nerves in the Selection of Incision for Penetrating Corneal Surgery in Canines.

The cornea is one of the regions with the highest density of nerve terminals in the animal body and it bears such functions as nourishing the cornea and maintaining corneal sensation. In veterinary clinical practice, the corneoscleral limbus incision is frequently applied in cataract surgery, peripheral iridectomy, and other procedures for glaucoma. Inevitably, it would cause damage to the nerve roots that enter the cornea from the corneal limbus, thus inducing a series of complications. In this paper, the in vitro cornea (39 corneas from 23 canines, with ages ranging from 8 months old to 3 years old, including 12 male canines and 11 female canines) was divided into 6 zones, and the whole cornea was stained with gold chloride. After staining, corneal nerves formed neural networks at different levels of cornea. There was no significant difference in the number of nerve roots at the corneoscleral limbus between different zones (F = 1.983, p = 0.082), and the nerve roots at the corneoscleral limbus (mean value, 24.43; 95% CI, 23.43–25.42) were evenly distributed. Additionally, there was no significant difference in the number of corneal nerve roots between male and female canines (p = 0.143). There was also no significant difference in the number of corneal nerve roots between adult canines and puppies (p = 0.324). The results of the above analysis will provide a reasonable anatomical basis for selecting the incision location and orientation of penetrating surgery for the canine cornea in veterinary practice.

A Modified Intrascleral Intraocular Lens Fixation Technique Using 27-Gauge Blunted Needles with Fewer Intraocular Manipulations.

A new method for intraocular lens (IOL) fixation in the scleral tunnel using two common 27G blunted needles and an ultrathin 30G needle with fewer intraocular manipulations was developed. Half-depth scleral flaps were prepared, and vertically angled sclerotomies were performed under each scleral flap, 2 mm from the limbs with a 20G microblade or a 26G needle. Two bent 27G blunted needles connected the sclerotomy and corneoscleral incisions. One haptic was inserted into this bent 27G blunted needle extraocularly and extruded through the sclerotomy site. Each haptic was inserted into the lumen of the preplaced ultrathin 30G needle and buried into the scleral tunnel. In this retrospective study, we reviewed the outcomes of this new technique in patients with at least 3 months' follow-up data. Iris capture of the IOL was not observed in any case, and IOL repositioning was not performed either. Astigmatism induced by intraocular aberration was almost as same as that with other methods. Our technique can be performed in any operation room without any extra instruments. This trial is registered with UMIN000044350.

A Device for Preloaded, Trifolded Grafts to Facilitate Descemet Membrane Endothelial Keratoplasty

Abstract Descemet membrane endothelial keratoplasty (DMEK) is the most efficacious partial endothelial keratoplasty, offering the highest likelihood of 20/20 vision and the shortest recovery times. However, current devices do not effectively address the difficult step of unrolling the corneal graft within the eye which is the greatest barrier to DMEK adoption. Here, we present the design, development, and testing of a novel device that simplifies and standardizes DMEK graft transplantation. The patent-pending cartridge facilitates the trifold technique, a graft preparation method that allows the graft to naturally unroll in the eye and reduces time-consuming manipulation steps required in alternative techniques. Injection molding was used to manufacture devices which were tested with research-grade corneal grafts. The cartridge's design allows it to fit into a typical corneoscleral incision, maintains trifolded grafts (p = 0.006), and reduces endothelial cell loss (ECL) (p = 0.049). These results demonstrate that the device introduced here is suitable for DMEK and may simplify this procedure for corneal surgeons.

Analysis of Changes in Corneal Topography after 27-Gauge Transconjunctival Microincision Vitrectomy Combined with Cataract Surgery.

Purpose To investigate changes in the corneal shape before and after vitrectomy, over a period of time, using a 27-gauge system. Methods Forty-five eyes underwent a combination of cataract surgery and vitrectomy. The surgeries were performed using a 27-gauge transconjunctival vitrectomy system, in which the corneal topography could be performed up to three months after the surgery. The surgeries were performed for an epiretinal membrane in 11 eyes, a macular hole in 14 eyes, and rhegmatogenous retinal detachment in 20 eyes. All of the surgeries were performed by the same surgeon, and in all cases, a 4-port 27-gauge vitrectomy device was used. Cataract surgery in all patients was performed with a 2.4 mm corneoscleral incision at 11 o'clock. The surgeries were performed without suturing the operative wound in all cases. Corneal topography was performed using a TMS-4 topographer (Tomey Corporation, Tokyo, Japan). The examinations were performed the day before and 1 day, 1 week, 1 month, and 3 months after the surgery. The results of corneal topography for the spherical, regular astigmatic, asymmetric, and high-order irregular astigmatic components were compared before and after surgery. Results No significant differences were seen in any of the components in the epiretinal membrane group, but significant differences were seen in the asymmetric components and the high-order irregular astigmatic components between the macular hole and rhegmatogenous retinal detachment groups (p < 0.05). There were no significant changes in intraocular pressure on any measurement time in the postoperative period compared to preoperative intraocular pressure. Conclusion Irregular astigmatism was seen after surgery when 27-gauge vitrectomy with a 4-port system was performed together with cataract surgery with a 2.4 mm incision.

A novel technique for the surgical management of intraocular lens-capsular bag-capsular tension ring complex dislocation.

The present study describes a surgical technique for the management of complex dislocation and subluxation of the intraocular lens (IOL)-capsular bag (CB)-capsular tension ring (CTR) complex. During the procedure, one double-curved suture was inserted through the sclera into the posterior chamber, passing through the anterior capsules and then into the anterior chamber. The suture lines were pulled out from above and below the IOL-CB-CTR complex and a knot was tied 1 mm away from the corneoscleral incision. The IOL-CB-CTR complex was repositioned by adjusting the suture length. This novel method does not require explanting of the original IOL, allowing the IOL-CB-CTR complex to be immobilized in a simple and effective way.

Managing dislocated hard lens nuclei: 23-gauge vitrectomy and lens extraction via a corneoscleral limbal incision versus 23-gauge vitrectomy and phacofragmentation

To compare 23-gauge vitrectomy and lens extraction viaa corneoscleral limbal incision (CSLI) with 23-gauge vitrectomy and phacofragmentation to treat dislocation of hard lens nuclei. Ningbo Eye Hospital, Zhejiang, China. Retrospective case series. The study included consecutive patients with complete posterior dislocation of a hard nucleus (grade≥IV) into the vitreous cavity. All patients received 23-gauge 3-channel vitrectomy. Some patients also had phacofragmentation and others had lens extraction through a CSLI. The CSLI group comprised 21 eyes of 21 patients and the phacofragmentation group, 22 eyes of 22 patients. The median follow-up was 10.8 months (range 6 to 24months)and 11.3months (range 5 to 18months), respectively. Demographic characteristics, reason for lens dislocation, preoperative corrected distance visual acuity (CDVA), preoperative intraocular pressure (IOP), lens nucleus grade, and comorbidities were similar between groups. The CSLI group had a shorter meansurgical time than thephacofragmentation group (42.5±7.2minutes versus 68.2±16.5minutes); less frequent use of perfluorocarbon liquid, octafluoropropane, or air tamponade; lower incidence of retinal tears (9.5% versus 31.8%); and better CDVA but worse astigmatism 1day and 1week postoperatively (P<.05). The postoperative IOP did not differ between groups. Corneal edema and recurrent retinal detachment were less common in the CSLI group than in the phacofragmentation group. The 23-gauge vitrectomy with lens extraction through a CSLI might have advantages over 23-gauge vitrectomy with phacofragmentation for management of dislocated hard lensnuclei.

A Prospective study of Dry Eye after manual Small Incision Cataract Surgery in rural population of Bagalkot

Aim: To find the occurrence of ‘Dry Eye’ and to assess the severity of the dry eye after manual small incision cataract surgery with corneoscleral tunnel incision. Material and Method: A total of 81 patients were selected who came for manual small incision cataract surgery. Each patient was questioned pre-operatively about ‘dry eye’ symptoms and examined with Schirmer’s test 1 and tear film break up time.

Small incision guarded hydroaspiration of iris lesions

AimTo describe the technique and results of a minimally invasive surgical technique for resection of small iris lesions.MethodsConsecutive case series of 22 patients with localised, small iris lesions that were...

Late Spontaneous Dislocation of a Posterior Chamber Intraocular Lens into Anterior Chamber: A Case Report

Abstract Introduction: Lens luxation generally happens secondary to trauma and hereditary disorders into the vitreous body. However, spontaneous dislocation especially into the anterior chamber occurs rarely. We report an unusual case with spontaneous anterior dislocation of a posterior chamber intraocular lens (IOL) 4 years after cataract surgery. Case Presentation: A 42-year-old woman was referred to ophthalmology department with complaint of sudden onset blurring of vision in the left eye 4 years after cataract surgery. No history of trauma and systemic disorder was reported and no capsular fibrosis was found during eye examination. The patient underwent corneoscleral incision under general anesthesia and the IOL was extracted using a viscoelastic material. Conclusions: To our knowledge, this is the first reported case in the literature. This report may imply that IOL related factors could be considered for spontaneous dislocation of intraocular lenses.

Influence of Patient Age at Surgery on Long-Term Corneal Astigmatic Change Subsequent to Cataract Surgery

To examine whether long-term corneal astigmatic change with age after cataract surgery depends on patient age at the time of surgery, and to evaluate whether this change is different from that in eyes that did not undergo surgery. Retrospective cohort study. A total of 437 eyes that underwent phacoemulsification with a 4.1-mm horizontal corneoscleral incision more than 11 years ago and 600 control eyes without surgery were divided into 4 age groups: (1) 60 years or younger, (2) 61-65 years, (3) 66-70 years, and (4) 71 years or older. The corneal astigmatic change between baseline and 5 years after baseline, between 5 and 10 years, and between baseline and 10 years, as calculated using the polar (x-y) coordinate analysis, were compared among the age groups and between eyes with and without surgery. Corneal astigmatic change, expressed as x- and y-coordinates, showed an against-the-rule change of 0.2-0.4 diopter during the 10 years in all age groups of the surgery and nonsurgery groups. Using multivariate analysis of variance, the mean x- and y-coordinates did not differ significantly among the age groups in either the surgery or nonsurgery groups (P ≥ .4112). Furthermore, the mean x- and y-coordinates did not differ significantly between the surgery and nonsurgery groups in any age group (P ≥ .1359). Long-term corneal astigmatic change with age after cataract surgery does not differ significantly depending on patient age at the time of surgery, and is comparable to that of eyes without surgery.

Influence of the combined surgery of phacoemulsification and intraocular lens implantation through different incisions on tear film stability

Objective To explore the changes of tear film after the combined surgery of phacoemulsification and intraocular lens (IOL) implantation through two different incisions.Methods Preoperatively,74 age-related cataract cases (74 eyes) without dry eye syndrome were randomly divided into two groups.Thirty-seven eyes of 37 cases were enrolled in group A,they were treated with corneoscleral incision,and 37 cases (37 eyes) in group B treated with clear corneal incision.Subjective score for dryness,Schirmer I test(SIt),tear film break-up time (BUT) and corneal fluorescein staining were evaluated preoperatively and 1,7,14,30 and 90 days postoperatively.Results Decline of BUT and increase of SIt,corneal fluorescein staining and subjective score for dryness were observed postoperatively,which showed statistically significant difference when compared with the preoperative (P ＜ 0.05),and there was significant difference between two groups after surgery (P ＜ 0.05).Conclusion The short-term stability of tear film was worse after the combined surgery with phacoemulsification and IOL implantation through clear corneal incision than that through corneoscleral incision. Key words: Phacoemulsification; Clear corneal incision ; Corneoscleral incision; Tear film

Artificial iris–intraocular lens implantation for traumatic aniridia and aphakia assisted by silicone oil retention sutures

An 83-year-old pseudophakic woman fell and sustained an open-globe injury to her left eye with traumatic aniridia, aphakia, and a total retinal detachment. Visual acuity was light perception. After primary repair of the ruptured globe, the retina was reattached using silicone oil tamponade with placement of silicone oil retention sutures to prevent the oil from touching the corneal endothelium. Three months later, the oil was removed and with glare, aphakic correction improved the patient's visual acuity to 20/80(-1). A scleral-fixated artificial iris-intraocular lens (IOL) was subsequently implanted. During placement of the IOL through a temporal corneoscleral beveled incision into the anterior chamber, the silicone oil retention sutures supported the optic as it wasscleral fixated. The retention sutures aided in the placement of the IOL and prevented it from subluxating and/or dislocating during surgery. Postoperatively, the corrected visual acuity was 20/50(-2). Dr. Rosenthal is a consultant to and clinical investigator for Ophtec USA, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Development of surgical techniques for implantation of a wireless intraocular epiretinal retina implant in Göttingen minipigs

The aim of this study was to develop surgical methods for the implantation of a wireless intraocular epiretinal retina implant (EPI RET3) in Göttingen minipigs. This animal model resembles closely the anatomical conditions in humans, and is thus suitable for investigating the EPI RET3 implant as designed for the application in humans. Phacoemulsification and vitrectomy was performed on the right eye of 16 Göttingen minipigs under general anesthesia. The implants, consisting of a receiver module and an electrode array connected via a flexible micro cable, were inserted through a corneoscleral incision. The receiver module was placed into the sulcus ciliaris and the electrode array was fixed onto the retina temporal to the optic disc with a retinal tack. Minipigs were monitored for intra- and postoperative ocular complications. Follow-up times were 3 (seven minipigs) and 12 weeks (nine minipigs). Implantation was successfully performed in all 16 minipigs. The complete implantation surgery required on average 2 hours. Intraoperative findings were a minor hemorrhage of the anterior chamber angle in two eyes, one minor iris hemorrhage, and one minor punctiform retinal hemorrhage, which were all reversible. Postoperatively, the corneoscleral incision showed good wound healing in all eyes. Intraocular reactions included mainly fibrin exudation (six eyes) and formation of iris synechiae with the receiver module of the implants (three eyes). The performed implantation procedures of the intraocular EPI RET3 implant are feasible and reproducible within an acceptable surgical time. The development of inflammatory responses is a specific predisposition of the minipig following any intraocular intervention; nevertheless, the surgical techniques should be further improved to minimize procedure-related reactions. Our results provide a step towards the application of the EPI RET3 system in clinical studies.

Influence of corneoscleral limbus incision on tear film stability after phacoemulsification

目的 探讨角巩膜缘切口对白内障超声乳化术后泪膜变化的影响.方法 研究为临床疗效评价的病例对照研究.收集2006年7月-2008年12月行小切口白内障超声乳化及人工晶状体(IOL)植入术的年龄相关性白内障患者128例219眼;年龄61～87岁,平均年龄(66.1±12.1)岁.按信封法随机将患者分为3组,其中角巩膜缘切口组42例69眼,透明角膜切口组45例70眼,巩膜隧道切口组41例80眼.各组资料的人口统计学特征差异无统计学意义(P>0.05).在术前第1天,术后第1、2、7、30、90天对各组患者进行干眼症状评分、Schirmer试验(SIt)、泪膜破裂时间(BUT)和角膜荧光素染色(FLS)4项指标的检测.结果 角巩膜缘切口组、透明角膜切口组和巩膜隧道切口组在检测的各时间点(F=110.51,P=0.00)干眼症各组临床评分(F=99.45,P=0.01)的差异均有统计学意义.角巩膜缘切口组干眼症临床评分在手术后14d逐渐下降,各时间点的临床评分与术前相比差异均有统计学意义(P 0.05),而透明角膜切口组手术后14d的BUT值最低.手术后1d角巩膜缘切口组的SIt值达高峰,第1～14天逐渐降低,各组间的差异均有统计学意义(P 0.05).结论 角巩膜缘切口对泪膜的稳定性影响小,是干眼症高危患者白内障超声乳化术较为理想的选择。

Spontaneous dislocation of a transparent lens to the anterior chamber: A case report

The causes leading to dislocation of the natural lenses are different involving injuries, hereditary diseases and spontaneous dislocation. Spontaneous dislocation of a transparent natural lens is extremely rare, especially dislocation of the anterior eye chamber. We report a case of spontaneous dislocation of the transparent natural lens to the anterior eye chamber in a patient who had no history of eye injuries. The patient was a 17-year-old boy. Lens dislocation was spontaneous, and the patient presented for ophthalmological consultation due to a sudden vision impairment of the left eye. Biomicroscopic examination verified that the transparent lens was in the anterior chamber, and it was spherophakia of lesser diameter; there were no signs of increased intraocular pressure, as typically expected in lens dislocation to the anterior chamber. The patient was operated on in general anaesthesia. Surgery involved intracapsular extraction of the dislocated lens through a corneoscleral incision. This case report shows that a spontaneous dislocation of the natural lens may occur in younger people. The dislocated spherophakic lens to the anterior eye chamber did not contribute to the rise of the intraocular pressure and development of acute glaucoma. The acute glaucoma resulted from the pilocarpine narrowing of the pupil due to pupillary block. The intracapsular instrumental extraction of the dislocated transparent lens from the anterior chamber was successfully completed through a corneoscleral incision.

Bilateral Spontaneous In-The-Bag Anterior Subluxation of PCIOL Managed With Glued IOL Technique: A Case Report

Management of in-the-bag spontaneous bilateral subluxation of posterior-chamber intraocular lens(PCIOL) with sutureless fibrin-glue-assisted PCIOL implantation. A patient of retinitis pigmentosa with spontaneous bilateral anterior in-the-bag subluxation of PCIOL was managed by IOL explantation followed by fibrin-glue-assisted sutureless PCIOL implantation. Two partial thickness limbal-based scleral flaps were created about 1.5 mm from the limbus under which sclerotomies were made. Intraocular lens explantation along with capsular bag was performed through the corneo-scleral tunnel incision. Single-piece rigid polymethylmethacrylate 6.5-mm optic IOL was introduced through the limbal wound with a McPherson forceps, both the IOL haptics were externalized under the scleral flap. The haptic ends were tucked in the scleral tunnel made with the 26G needle. Scleral flaps and the conjunctiva were closed with the fibrin glue. Preoperative best corrected visual acuity was 20/80 in the right and 20/120 in the left eye. Patient gained a best corrected visual acuity of 20/30 in both the eyes, with a bilateral stable PCIOL and clear cornea. Severe capsular contracture causing in-the-bag IOL subluxation in retinitis pigmentosa can be effectively managed with this new technique of sutureless fibrin-glue-assisted PCIOL implantation.

The technique and observation of closed stitching recovery for Iridodialysis

Objective Iridodialysis is a common complication of closed incarcerated ocular trauma. Re-covery by reduction is the most effective stitching method. There are two methods of stitching:corneoscleral edge incision method and closed stitching method. The author has achieved better results with closed stitching meth-od. Methods In the cases of Iridedialysis,there are various types of complications,e, g. hyphema and pigmen-ted retina inflammation. The surgery is better performed after treatment in (3-7 days after treatment). Perform stitching fixation beneath the sclera flap on the cornenscleral edge of Iridedialysis. Based on the length of separa-tion,determine the counts of stitching (1-4 stitches) ,bury the end of stitches under the selera flap,with the re-duction and recovery of conjunctival flap. Results Our hospital has treated 32 cases of Iridodialysis,with com-plete recovery in each case. After the surgeries,26 cases were found with centralised pupils,4 cases with cent-ralised pupils shghtly oval-shaped,2 cases with deviated pupils,2 cases with angle recession and ocular hyper-tension. After sugeries,21 cases are found with adjusted vision of 0.5-1.0 (65.6%),6 with 0.3-0.4,2 with 0.1-0.2 (6.2%),1 with below 0.1 (3.1%). The cases with poor eye visions suffer from ocular hypertension, angle recession,vitreous hemorrhage,and etc. Conclusion For the Iridedialysis caused by incarcerated closed ocular trauma, the stitching fixation beneath sclera flap can be performed at an appropriate time after treatment to achieve desirable results. Therefore, this surgery method can be applied. The closed stitching method can mini-mise the stimulation to eye balls with rapid recovery of eye vision, and formation of a centralised pupil in a satis-factory shape of round or near-round. However,recovery of eye vision is not as good for those cases with serious eye trauma resulting in vitreous hemorrhage, angle recession, retina mutation, and visual neuro trauma. Key words: Iridodialysis; Stitching fixation beneath sclera flap