Cortical Lens Material Research Articles

Capsular bag distension syndrome after uneventful DMEK for Fuchs corneal endothelial dystrophy

AbstractPurpose: Capsular bag distension syndrome or capsular block syndrome is a rare complication of cataract surgery characterized by accumulation of fluid between the intraocular lens and the posterior lens capsule, leading to visual deterioration. A small continuous curvilinear capsulorhexis, residual cortical lens material, as well as residual viscoelastic material behind the intraocular lens are associated with increased risk of fluid entrapment. Capsular bag syndrome usually occurs in the early postoperative period, but it has also been described as late as 14 years after cataract surgery. Nd‐YAG laser posterior capsulotomy is the treatment of choice in most cases, facilitating the drainage of the fluid in the vitreous cavity. Late‐onset capsular block syndrome is often associated with Propionibacterium acnes, requiring surgical management.Methods: Hereby we report a case of a 72‐year‐old female patient with Fuchs corneal endothelial dystrophy, who developed a capsular block syndrome after an uneventful endothelial keratoplasty (DMEK).Results: In the early postoperative period after the DMEK, we observed the development of capsular block syndrome OS. The patient was subjected to bilateral cataract surgery 6 years ago. After intensive follow‐up examination for excluding Propionibacterium acnes‐related endophthalmitis, we proceeded with Nd‐YAG capsulotomy, which resulted in drainage of the fluid in the vitreous cavity and immediate visual recovery.Conclusions: To our knowledge this is the first report of capsular bag syndrome after DMEK and therefore anterior segment surgeons should be aware of this rare complication.

A Case of Malignant Glaucoma in a Vitrectomized Eye

Purpose: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. Case summary: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient’s symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. Conclusions: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation. J Korean Ophthalmol Soc 2015;56(4):638-642

23-Gauge Vitrectomy for Retained Lens Material

A technique for removal of retained lens material is described with a three-port 23-gauge vitrectomy system. Removal of the core vitreous is first performed, followed by removal of the cortical vitreous. All vitreous adhesions to the lens are cleared. The cut rate is then decreased to 1,500 cuts per minute, and vacuum increased to 600 mm Hg. The cortical lens material is cleared first, and then the nuclear material is taken with the same vitrectomy probe using the light pipe to assist in crushing the nuclear fragments. With this technique, even large dense nuclear and cortical retained lens material can be removed from the vitreous chamber without the need for a fragmatome.

Auto-cortex of crystalline lens-induced iris neovascularization.

To investigate auto-cortex of crystalline lens induced iris neovascularization (INV). Thirty-six eyes of 36 guinea-pigs were included and divided into three groups randomly in this cohort study. Group A: the right lens nucleus was extracted and the remaining cortical lens material was aspirated thoroughly. Group B: the lens was removed and 30µL precipitated lens cortex was injected into the anterior chamber again. Group C: aspirated the lens cortex of the left eyes and inject them into the right anterior chambers about 10µL. Clinical changes were followed by slit-lamp examination and photograph. The eye balls were enucleated at the day of 2, 4, 7, 11, 13, 17 after operation. HE was used to detect the pathological changes. INV had not been observed until the end of empirical study. The stromal layer contained thick wall vessels, without expansion. Group B: All eyes developed INV. Postoperative (po) 7 days; the eyes developed intense and extensive INV. The vessels of iris expanded remarkably and neovascularization was observed erupting from it's lateral wall and stretching towards the anterior surface. Po11 days, INV regressed gradually after lens cortex had been absorbed. Group C: Po four (4) days, new blood vessels liking red line were presented on the anterior surface of the iris and they were not obvious. Anterior chamber inside lens coriaceous can induce iris new blood vessels.

Simple method to evaluate adequacy of capsule for foldable intraocular lens implantation in the sulcus

We describe a simple method for evaluating the adequacy of the capsule for implantation of a foldable intraocular lens (IOL) during phacoemulsification complicated by a posterior capsule tear. After cortical lens material clean-up and anterior vitrectomy (if required), 3 knots of 10-0 nylon are tied to the trailing haptic of the IOL using a 3/1/1 configuration. Then, the IOL is inserted into the sulcus. If it is unstable when the surgeon tries to deepen or shallow the anterior chamber, gently pulling the nylon thread will prevent posterior IOL dislocation. Two further attempts to implant the IOL in the other meridians of the capsule are made. The results of using this technique in 10 eyes of 10 patients are reported. Optic decentration occurred in 1 case (10%). No postoperative dislocation was observed, and no patient required surgery for IOL decentration during the follow-up.

Use of bipolar diathermy to prevent posterior capsule opacification

Purpose: To determine the feasibility of using directed bipolar diathermy to eliminate or reduce the formation of new cortical lens material following phacoemulsification in a rabbit model.Setting: Department of Research & Development, Bausch & Lomb Surgical, and Department of Ophthalmology, St. Louis University, St. Louis, Missouri, USA.Methods: A rabbit model for posterior capsule opacification (PCO) was used. A continuous curvilinear capsulorhexis was performed followed by phacoemulsification to remove cortical lens material. In 2 experimental groups, modified bipolar instruments were used to apply diathermy to residual lens epithelial cells using an intracapsular or extracapsular method of application. Postoperative clinical examinations were at 1, 3, and 7 days and then weekly up to 60 days. Selected animals were followed for a longer period. Capsule integrity was evaluated by measuring the pressure required to rupture the capsule in similarly treated porcine eyes.Results: Diathermy prevented PCO in 4 of 4 eyes in the intracapsular treatment group and 4 of 5 in the extracapsular group. Eyes remained free of new lens cortex for the life of the animal, which was as long as 18 months. New cortical material was detected after 35 days in 1 animal in the extracapsular group. Mean time for the formation of observable cortical material was 29 days ± 5 (SD) in the control animals. Physical measurements did not detect a reduction in capsule integrity with diathermy treatment. The extracapsular treatment method resulted in fewer iris complications.Conclusions: Directed diathermy has the potential to eliminate secondary cataract formation with minimal damage to collateral tissues.

Lens particle glaucoma occurring 15 years after cataract surgery

A 60-year-old man visited our clinic with a sudden blurred vision and ocular pain in his right eye occurring 15 years after cataract surgery. The intraocular pressure (IOP) was 55 mmHg in the right eye and gonioscopy revealed a wide open angle with white cortical lens material in the inferior angle. Since the IOP was unable to be controlled with medical therapy, removal of the lens material was performed by irrigation and aspiration. Following surgery, the IOP was decreased to 18 mmHg without medication and the patient's vision recovered to 20/20. The pathology of the aqueous humor showed macrophages with engulfed lens particles.

Indocyanine green staining in traumatic cataract

We report the first case of indocyanine green (ICG) being used in an eye with an anterior capsule that was not completely intact. We found that ICG seems to have a selective affinity for the anterior capsule over cortical lens material. The patient had a corneal perforation with a wire and developed endophthalmitis requiring pars plana vitrectomy with intravitreal antibiotics. He subsequently developed a white traumatic cataract with an anterior capsule tear. Five months after the injury, he had cataract extraction. Indocyanine green was used to better visualize the anterior capsule before capsulotomy. The anterior capsule stained green, but the cortical material exposed to ICG did not stain.

Intraocular contamination during extracapsular cataract extraction with intraocular lens implantation

Ocular bacterial contamination has been studied in 45 eyes that underwent cataract surgery. The following samples were taken: (1) eyelid margin swab; (2) conjunctival swab; (3) aqueous humor after initial anterior chamber penetration; (4) anterior capsule fragment after capsulorrhexis or capsulotomy; (5) cortical lens material; (6) anterior chamber fluid after lens implantation. The percentages of contaminated samples were 15.5, 13.3, 0.0, 11.1, 13.3 and 6.6, respectively. There was a significant difference between the incidence of positive cultures in the aqueous humor at the time of incision and in subsequent intraocular samples. Positive cultures were found in 13 out of 45 eyes, only gram-positive organisms were recovered and coagulase-negative staphylococci were the most common (78.5% of the isolates). These results confirm previous reports on intraocular contamination during cataract surgery.

Needle Aspiration of Cortical Lens Material : Subsequent to Extracapsular Cataract Extraction

Needle Aspiration of Cortical Lens Material : Subsequent to Extracapsular Cataract Extraction

The mechanism of Senile Cataract

The features of senile cortical cataract are produced by colloidal fluid which has been extruded from its combination with the lens protein or has been attracted through the capsule which has been changed in its permeability. In the incipient stage, this fluid may produce an ill-defined cortical haze or may diffuse along interfibrillar spaces to reach the capsule where it collects in the form of the so-called vacuoles or globules, or it may distend the sutures or interlamellar spaces to form the familiar water-split sutures or separated lamellae. Senile nuclear cataract represents an excessive sclerosis and dehydration of the nuclear and later of the cortical lens material. Study of the formation of cataract in tetany led to the opinion that a disturbance of the inorganic ions takes place, which is sufficient to affect the transparency of the labile colloidal solution of the lens protein. Cataracts in diabetics present features similar to those of the senile cortical form. The hypothesis is expressed that the various phenomena exhibited in the mechanism of senile cataract are those of disturbances of permeability. The structures affected in the eye are the blood vessels and the tissues of the semi-permeable ciliary epithelial membrane, the lens capsule, the lens fibers and the interfibrillar diffusion spaces. The cause of these disturbances in permeability may be chemical, physical or dependent on metabolic changes in the general system. The material for this thesis was gathered while the author was Research Fellow for the American Academy of Ophthalmology and Oto-Laryngology. From the Department of Ophthalmology, College of Physicians and Surgeons, Columbia University. Read before the Association for Research in Ophthalmology, in Milwaukee, June 13, 1933.