Diaphragm Intraocular Lens Implantation Research Articles

This issue of ACTA

This issue of ACTA

Over 10-year follow-up outcomes and failure analysis of black diaphragm intraocular lens implantation in traumatic Aniridia.

To determine the over 10-year follow-up outcomes and analyse the reason for failure in patients who underwent black diaphragm intraocular lens (IOL) implantation for the management of traumatic aniridia. Fifty-three patients underwent black diaphragm IOL implantation for the treatment of traumatic aniridia from September 1998 to August 2007. 33 eyes of 33 patients were enrolled in our study, and the mean follow-up period was 185.6±36.2months (range: 126-247months). The primary methods employed for assessment of the safety of the IOL and the causes of failure were the ultrasound biomicroscopy (UBM) and observation during reoperation. In the current study, 13 patients (39.4%) who underwent IOL implantation by means of trans-scleral fixation were observed to maintain a transparent cornea and normal intraocular pressure. 20 patients (60.6%) developed corneal endothelial decompensation, and 14 patients (42.4%) developed secondary glaucoma. 27 patients were examined by means of UBM or reoperation and the position of black diaphragm IOL in 18 patients was observed to be abnormal; the IOL had shifted forward and directly contacted with the anterior chamber and even the corneal endothelium. The forward displacement of black diaphragm IOL is a direct cause of treatment failure. Although the implantation of black diaphragm IOL is an effective method of management of traumatic aniridia, the treatment should be guarded and performed in an appropriate manner. Patients should be informed regarding the need for life-long follow-up, so that the complications can be identified in a timely manner.

Safety and efficacy of black iris diaphragm intraocular lens implantation in eyes with large iris defects: Report 4

To assess the safety and efficacy of Morcher 67B black iris diaphragm intraocular lens (IOL) implantation for managing large iris defects and aphakia. Stein Eye Institute, UCLA, Los Angeles, California, USA. Prospective case series. The demographic, preoperative, and postoperative data on patients implanted with a black iris diaphragm IOL and followed to 1year were reviewed. Safety measures included loss of corrected distance visual acuity (CDVA), perioperative complications, adverse events, and secondary surgical interventions. Efficacy measures included CDVA with glare, daytime and nighttime glare symptom scores, and subjective cosmesis scores. Thirty-one eyes of 31 patients were implanted. There was a 7-line improvement in median Snellen CDVA (P<.001). Four eyes worsened more than 1 line. There was 1 minor intraoperative complication. Twenty-one eyes experienced postoperative complications, most of which were related to preexisting ocular comorbidities. Three adverse events included cystoid macular edema, corneal graft dehiscence, and uveitis with ocular hypertension. There were 12 secondary surgical interventions. The CDVA with glare improved 6 Snellen lines (P<.0001). The mean subjective glare symptoms improved 4.94 points on a 0 to 10 scale during the day (P<.0001) and 3.61 points at night (P<.0001). The mean cosmesis score improved 2.23 points (P<.0001) on the same scale. Black iris diaphragm IOL implantation in aphakic eyes with large iris defects and significant ocular comorbidity was found to be relatively safe and very effective at improving CDVA and reducing light and glare sensitivity.

The efficacy and complications of black diaphragm intra-ocular lens implantation in patients with congenital aniridia.

To evaluate the efficacy and complications of black diaphragm intra-ocular (BDI) lens implantation in patients with congenital aniridia. Twenty patients underwent BDI lens implantation for the treatment of congenital aniridia from January 1999 to December 2012. Fifteen patients (23 eyes) were enrolled in our study, and the mean follow-up period was 26months. Patient demographics, clinical evaluations [visual acuity (VA), best-corrected visual acuity (BCVA), intra-ocular pressure measurement (IOP), corneal endothelial cell density (ECD) and ultrasound biomicroscopy (UBM)], complications and treatments were analysed for each patient. Sixteen eyes (70.1%) had a BCVA better than 20/200 after BDI lens implantation, and photophobia obviously decreased in all patients. Six eyes (26.09%) developed secondary glaucoma after BDI lens implantation, and one eye underwent glaucoma surgery. Corneal decompensation occurred in two eyes (8.70%), one of which was complicated by glaucoma. Two eyes (8.70%) developed visual axis opacity (VAO) after surgery. One patient (4.35%) had limbal stem cell failure, and another patient (4.35%) had an eccentric BDI lens. Intra-ocular pressure measurement elevation and ECD reduction were found after BDI lens implantation. Black diaphragm intra-ocular lens implantation can effectively improve VA, decrease photophobia and resolve cosmetic issues in most congenital aniridia eyes. Glaucoma, corneal decompensation and VAO were the major long-term complications of BDI lens implantation in patients with congenital aniridia. All patients should be managed attentively because of high risk of complications and followed long term to achieve favourable outcomes.

Long-term efficacy and complications of black diaphragm intraocular lens implantation in patients with traumatic aniridia

AimsTo determine the efficacy and complications of long-term black diaphragm intraocular (BDI) lens implantation in patients with traumatic aniridia.MethodsThis study analysed the demographics, clinical evaluations and treatments of 95 patients...

Modified implantation of black diaphragm intraocular lens in traumatic aniridia

We describe a modified technique of black diaphragm intraocular lens (IOL) implantation in eyes with traumatic aniridia, aphakia, and previous vitrectomy. During black diaphragm IOL implantation, a double-armed 10-0 polypropylene suture is used to fixate the IOL in the ciliary sulcus. Two 10-0 polypropylene sutures are subsequently placed in front of the IOL to block its forward displacement and thus prevent its contact with the anterior chamber angle and corneal endothelium. This modified implantation technique reduces long-term complications following black diaphragm IOL implantation in patients with traumatic aniridia. No author has a financial or proprietary interest in any material or method mentioned.

Three Cases of Corneal Tattooing for the Treatment of Traumatic Iris Defect

Purpose: To investigate the effects of corneal tattooing on patients with a traumatic iris defect. Case Summary: Corneal tattooing operation was performed on three patients (3 cases) with a traumatic iris defect. In case 1, the cornea was dyed with Davidson marking dyes (Bradley Products Inc., MN, US) and the amniotic membrane with the central incision was permanently transplanted. In case 2, both corneal dyeing and permanent amniotic membrane transplantation were performed on the area of partial iris loss. In case 3, corneal dyeing was performed after the intrastromal cornea was dissected. Corneal reepithelization was found in the first 2 cases 12 and 9 days after amniotic membrane transplantation, respectively. Three months after the transplantation, all three cases showed an improvement in best corrected visual acuity (BCVA), with an increase of one or more lines on the Snellen Chart. Simultaneously, preoperative monocular contrast and glare were also found to beimproved in all three cases. In both cases 1 and 2, 60% of the initially used dyes still remained in the cornea 6 months after the surgery, and in case 3, 90% of the initial dye remained. Except for the moderate astigmatism found earlier after the surgery in case 3, no serious complications developed. Conclusions: Corneal tattooing can improve the visual acuity and reduce glare in eyes with a traumatic iris defect and is cosmetically pleasing. Furthermore, corneal tattooing can be performed more easily and repeatedly than black diaphragm intraocular lens implantation.

Black Diaphragm Intraocular Lens for Traumatic Aniridia: Long-term Follow-up

Purpose: This is a report on the long-term follow-up of patients who had received black diaphragm intraocular lens implantation after traumatic aniridia. Methods: This is a retrospective study on the long-term follow-up for more than 50 months of six patients who had received black diaphragm intraocular lens implantation after traumatic aniridia. Results: An improvement in visual acuity of more than two letters, according to the Snellan chart, occurred in three out of six eyes that were available for follow-up studies after an average period of 7 years and 8 months (50-115 months) after the operation, and no visual acuity decline groups were present. Early complications of black diaphragm intraocular lens implantation consisted of cystoid macular edema and transient intraocular pressure rise. The complications late occurred included bullous keratopathy in four eyes, glaucoma in three eyes, and exotropia in three eyes. We performed penetrating keratoplasty in two of the four eyes suffering from bullous keratopathy, and an Ahmed valve implantation in two of the three eyes suffering from glaucoma. There were signs of reduced visual acuity in four eyes due to complications of the surgery. Conclusions: The authors of this report recommend care in use of black diaphragm intraocular lens implantation, by studies done with an average follow-up period of 7 years and 8 months post operatively. Also reported were severe complications with this treatment such as bullous keratopathy and glaucoma.

Black diaphragm intraocular lens for congenital aniridia or traumatic iris deficiency

To evaluate the efficacy of a black diaphragm intraocular lens (IOL) implantation for congenital aniridia or traumatic iris deficiency and to explore the mechanism of postoperative complications. The therapeutic effects and postoperative complications of twenty-five cases (27 eyes) of black diaphragm intraocular lens implantation were analyzed. Ultrasound biomicroscope (UBM) and gonioscopy were used to observe the position of the IOL haptics and anterior chamber angle structure in patient who developed secondary glaucoma postoperatively. After 3-18 months of follow-up, photophobia was reduced or disappear. The best corrected visual acuity (BCVA) Postoperation was improved 2 lines in 20 eyes, no change or within 1 line in 5 eyes, decreased 2 lines or more in 2 eyes. The complications included secondary glaucoma (10 eyes, 37.0%), astigmatism (17 eyes, 63.0%), corneal decompensation (2 eyes, 7.4%), hyphema (2 eyes, 7.4%), vitreous hemorrhage (3 eyes, 11.1%), and retinal detachment (1 eye, 3.7%). Of the 20 haptics in 10 patients, 9 were adequately located in the sulcus region, the others were located in chamber angle, ciliary processes or posterior to the ciliary processes. The changes of chamber angle included angle recession, anterior adhesion of iris and angle closure. The black diaphragm intraocular lens implantation provides an effective method in the treatment of congenital aniridia or traumatic iris deficiency. Chamber angle impair is major cause of postoperative secondary glaucoma. Abnormality of lens haptics position, hemorrhage and persistent inflammation were also play a role in secondary glaucoma.

Black diaphragm intraocular lens implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy

Purpose: To evaluate the efficacy of secondary black diaphragm intraocular lens (IOL) implantation in aphakic eyes with traumatic aniridia and previous pars plana vitrectomy (PPV). Setting: Shandong Eye Institute and Hospital, Qingdao, China. Methods: This retrospective study comprised 15 aphakic eyes with aniridia and no vitreous that had implantation of a secondary black diaphragm IOL 6 to 72 months after PPV. The PPV was performed as a result of trauma to the posterior segment. Before implantation of the IOL, all patients had reduced visual acuity from aphakia and intolerable glare from aniridia. Eyes were aphakic as a result of previous extracapsular cataract extraction (1 eye), lens extrusion during trauma (3 eyes), or simultaneous cataract lensectomy during PPV (11 eyes). Significant iris defects were present, with 9 eyes being aniridic after the injury. The mean follow-up was 17 months (range 3 to 34 months). The postoperative visual acuity, intra- ocular pressure (IOP), endothelial cell density, IOL centration, and intraocular inflammation were monitored. Results: All 15 eyes had improved visual acuity and marked glare reduction after IOL implantation. No major IOL decentration was seen. Five patients had increased IOP 3 to 5 days after IOL implantation; 3 were known to have secondary glaucoma from trauma before surgery and their IOP was controlled preoperatively (< 21 mm Hg) with timolol 0.5% eyedrops. The other 2 patients had normal- appearing angles, and 1 was diagnosed with hemolytic glaucoma after IOL insertion. Postoperative elevated IOP was controlled by timolol eyedrops (4 eyes) or selective laser trabeculoplasty (1 eye). Hyphema was seen in 1 patient on the first day after IOL implantation, but no further bleeding was noted. Vitreous hemorrhage was seen the first day after IOL insertion in 2 patients. One resolved without sequelae; the other required vitreous washout. Retinal detachment and cystoid macular edema did not occur in any patient. Conclusions: Black diaphragm IOL implantation can be considered in eyes with coexisting aphakia and aniridia and without vitreous. Intraoperative IOP regulation is crucial in vitrectomized eyes to prevent complications such as expulsive hemorrhage. In general, visual function was better after IOL insertion as a result of better visual acuity and glare reduction. Although this IOL appears to be safe, long-term results must be assessed in studies with a longer follow-up and a larger study group.