Foldable Intraocular Lens Research Articles

Posterior optic capture of intraocular lens in difficult cases of pediatric cataract.

We describe the technique of posterior optic capture without anterior vitrectomy in two difficult cases of pediatric cataract. We demonstrate how a three-piece foldable intraocular lens can be maneuvered behind the posterior capsule after an improvised posterior capsulotomy. This technique provided excellent intraocular lens (IOL) stability with the absence of lens epithelial cell proliferation in infants with altered posterior capsule morphology.

P.0328 Adult bipolar disorder and attention deficit/hyperactivity disorder - a common comorbidity?

To explore the cost utility of cataract surgery in patients with stabilized vision-threatening diabetic retinopathy (DR).Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.Prospective case series.Patients diagnosed with cataracts combined with stabilized vision-threatening DR had successful phacoemulsification with foldable posterior chamber intraocular lens implantation. The corrected distance visual acuity (CDVA) and utility value obtained using the time tradeoff method at 3-month postoperative intervals were compared with those preoperative values. The cost per quality-adjusted life year gained was calculated using the bootstrap method. Sensitivity analyses were performed to test the robustness of the results.The study comprised 126 patients (153 eyes). All surgeries were successful. The weighted logMAR CDVA changed from 0.82 logMAR ± 0.34 (SD) to 0.58 ± 0.30 logMAR (P < .001). The utility values increased from 0.58 ± 0.14 to 0.72 ± 0.14 (P < .001). The gain in utility values was correlated with the postoperative weighted logMAR CDVA, the change between the postoperative and preoperative weighted logMAR CDVA, performance of bilateral cataract surgery, and duration of DR or diabetic macular edema. The patients gained 1.50 quality-adjusted life years by cataract surgery. The cost per quality-adjusted life year was US $768. This surgery was cost-effective at the threshold of US $22 526 per quality-adjusted life year in China. The cost per quality-adjusted life year varied from US $630 to US $8707 in sensitivity analyses.Cataract surgery was a cost-effective intervention for patients with coexisting, stabilized, vision-threatening DR.

Rhegmatogenous retinal detachment in Coats\u2019 disease: a case report

BackgroundCoats’ disease was originally defined as a unilateral idiopathic exudative retinopathy in young males, characterized by abnormal retinal vascular telangiectasia with intraretinal and subretinal lipid exudation. The retinal detachment is usually exudative. Herein, we describe a case of rhegmatogenous retinal detachment with detectable retinal break in a patient with Coats’ disease.Case presentationA 15-year-old Indo-Aryan male patient presented with sudden painless diminution of vision in his right eye of 4 days duration. Upon examination, the anterior segment in both eyes and left fundus was within normal limits. Dilated fundus evaluation of the right eye revealed telangiectasia of the retinal vessels, with subretinal exudation in superotemporal and superonasal quadrants and presence of subretinal fluid in the superotemporal area extending into fovea. There was also presence of single flap horseshoe tear in the superotemporal quadrant at around the 10 o’clock position in the equatorial region, with no secondary changes. The retina was reattached with encircling band buckle combined with vitrectomy and silicon oil tamponade. Seven months post vitrectomy, lenticular opacification developed, for which he underwent silicon oil removal, along with lens aspiration and implantation of foldable intraocular lens. Over the period of 1 year, his best corrected visual acuity improved from 6/60 to 6/18 in the affected eye at the last follow-up visit. The recovery was uneventful following the subsequent surgery.ConclusionCoats’ disease has a remarkable diversity in clinical presentation and morphology. The disease can also present with an underlying break, which may not be attributed to any iatrogenic modality. The treatment modalities in coats’ disease should be tailored individually due to the low incidence of the disease and the great variation in severity upon presentation. Prompt management restores the best possible anatomical outcome and maintains good vision.

Refractive Outcomes of Simultaneous Pterygium and Cataract Surgery With Fibrin Glue.

IntroductionPterygium is commonly reported in India because of its tropical location. It is often accompanied by senile cataract. The current study aimed to evaluate the refractive outcomes of patients undergoing simultaneous pterygium and cataract surgery.Materials and methodsA total of 12 patients with cataract and pterygium underwent simultaneous phacoemulsification with a foldable intraocular lens (IOL) followed by pterygium excision with conjunctival limbal autograft secured with fibrin glue under peribulbar anesthesia. Nasal pterygium was present in all the cases, and its size ranged from 2.5 to 3.5 mm from the limbus. All the patients exhibited nuclear sclerotic cataract of grades 2 and 3.ResultsThe results of the patients were analyzed retrospectively. We determined the best-corrected visual acuity ([BCVA] in logMAR), manifest astigmatism, and mean corneal astigmatism before operation and after 12 months of surgery. We also analyzed the correlation between the prediction error (calculated by subtracting the predicted postoperative refraction from the actual postoperative spherical equivalent) and changes in the mean keratometry and prediction errors and pterygium size. The mean age of the patients was 61.9 ± 7.14 years (range: 50-70 years). The mean BCVA at presentation was 0.67 ± 0.24 logMAR units, which significantly increased after surgery to 0.01 ± 0.03 logMAR units (p < 0.001, Wilcoxon signed-rank test). The mean manifest corneal astigmatism significantly reduced from −1.98 ± 0.84 diopters (D) preoperatively to −0.54 ± 0.18 D postoperatively (p < 0.001). Mean corneal keratometry increased from 43.81 ± 1.77 D preoperatively to 44.19 ± 1.76 D postoperatively (p < 0.05). At 12 months, 58.33% and 41.66% of the eyes were within ±0.5 D and ±1.0 D, respectively. A significant correlation was observed between the prediction errors and changes in the mean keratometry (Spearman signed-rank test, r = −0.65, p < 0.05) and pterygium size (Spearman correlation coefficient, r = −0.75, p < 0.05).ConclusionThe simultaneous pterygium and cataract surgery with conjunctival autograft and fibrin glue was safe and effective in providing excellent and predictable refractive outcomes. Steepening of the cornea after combined surgery results in myopia; therefore, the IOL power should be selected appropriately. The use of fibrin glue in surgeries reduces the operative time and postoperative pain and results in early postoperative rehabilitation of patients.

Scleral fixation of subluxated or dislocated multifocal and multifocal toric intraocular lenses.

To evaluate the feasibility of scleral fixation of subluxated or dislocated multifocal/multifocal toric intraocular lenses (IOLs) to rescue the IOL and restore both near and far vision. A total of 18 eyes of 17 patients who underwent transscleral or intrascleral fixation of subluxated or dislocated multifocal or multifocal toric IOLs at 2.5mm posterior to the limbus were enrolled. Preoperative uncorrected distance visual acuity (UDVA) and postoperative UDVA values were compared in this retrospective cross-sectional study. The postoperative corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at 40cm, residual sphere, cylinder, spherical equivalent, and IOL centration were evaluated. The mean follow-up period was 4.0 ± 5.0months. The mean preoperative UDVA was 0.73 ± 0.71 logMAR and the postoperative UDVA was 0.05 ± 0.10 logMAR, which was significantly improved relative to the preoperative UDVA. The mean postoperative CDVA was 0.00 ± 0.00 logMAR and the mean postoperative UNVA at 40cm was 0.05 ± 0.07 logMAR. The mean postoperative residual sphere, cylinder, and spherical equivalent values were - 0.21 ± 0.41 D, - 0.29 ± 0.26 CD, and - 0.33 ± 0.39 D, respectively. Postoperative anterior segment photographs showed good centration of optics in all cases of single-piece foldable multifocal IOLs but a slight inferior decentration in one case of a three-piece multifocal IOL. Scleral fixation of subluxated or dislocated multifocal and multifocal toric IOLs could be one of the treatment options to rescue subluxated or dislocated multifocal IOLs and restore both near and far vision.

Comparative Study of Postoperative Astigmatism Following Phacoemulsification with Scleral Incision and Posterior Chamber Foldable and Rigid (Nonfoldable) Intraocular Lens Implantation

Purpose: To study and compare the postoperative astigmatism following phacoemulsification with scleral incision and posterior chamber foldable and rigid (nonfoldable) intraocular lens (IOL) implantation. Materials and Methods: It was a hospital-based prospective observational study which included 200 eyes with presenile and senile cataract and were divided into two groups. Group I; included hundred cases with superior scleral incision (3.2 mm) phacoemulsification and foldable posterior chamber IOL (PCIOL) implantation. Group II; included 100 cases with superior scleral incision (5.5 mm) phacoemulsification and rigid (nonfoldable) PCIOL implantation. The data were analyzed by Chi-square test and P &lt; 0.05 was considered statistically significant. The surgically induced astigmatism (SIA) at 6 weeks was compared between the two groups. SIA was calculated by the vector analysis. Results: The mean SIA in Group I was 0.67 ± 0.46 D, whereas in Group II was 1.17 ± 0.44 D. There was statistically significant difference between the two groups P &lt; 0.05. Group II showed higher mean SIA than Group I at 6 weeks. Postoperatively, majority of patients developed against the rule astigmatism, 62% in Group I and 76% in Group II. Conclusion: SIA is less in 3.2 mm incision as compared to 5.5 mm incision with increase in against the rule astigmatism postoperatively.

A comparison of axial length measurement by using applanation A- Scan and IOL master for accuracy of predicting postoperative refraction

The higher cost of IOL master is an issue in developing countries and hence it cannot be widely used for calculation of IOL power in such countries. Thus, the aim of the current study is to evaluate a cheaper alternative for the calculation of IOL power by comparing the axial length measurement obtained using applanation A-scan with that of IOL Master for accuracy of predicting postoperative refraction.A prospective, randomized, comparative study was done with 100 patients who were posted for cataract surgery. The patients were randomly divided into two groups of 50 patients each using computerized random number method. In Group A (n=50) axial length was measured with applanation A-scan and in Group B (n=50) axial length was measured with IOL Master. Before cataract surgery keratometry reading was taken with auto keratometer and intraocular lens (IOL) power calculation was done using SRK 2 formula in all patients. All patients were operated for cataract surgery by phacoemulsification and foldable intraocular lens were implanted in the bag. Postoperatively, best accepted refraction at 8th week was taken and mean spherical equivalent was calculated. 100 patients of cataract were subjected for cataract surgery by phacoemulsification.Corrected spherical equivalent on 8th postoperative week showed: 88% patients in Group A and 96% patients of Group B were within ± 1.00 D.56% patients of Group A and 76% patients of Group B were within ± 0.50 D.There was no statistically significant difference (p &amp;#62; 0.05) in axial length and corrected spherical equivalent between the two groups. There is no extra advantage of IOL Master over applanation A-scan for measuring Axial Length between 21 and 24.50 and predicting post-operative refractive outcome.

Long-Term Effect of Early Phacoemulsification in Primary Angle Closure Glaucoma Patients with Cataract: A 10-Year Follow-Up Study.

PurposeTo assess the 10-year effects of early phacoemulsification with intraocular lens (IOL) implantation in primary angle closure glaucoma (PACG) patients with cataract.Patients and MethodsThis prospective cohort study included 102 eyes of 102 patients with PACG. All patients had coexisting cataracts compromising vision. Patients underwent phacoemulsification and foldable IOL implantation. The main outcome measures were anterior chamber depth (ACD), angle width, value of intraocular pressure (IOP), and number of medications needed postoperatively and during follow-up.ResultsHalf (53%) of the patients were female, with ages ranging from 55 to 73 with a mean of 59.82±5.19 years. Mean IOP decreased significantly from 22.15±2.08 mmHg at baseline to 14.08±2.13 mmHg postoperatively (p˂ 0.05). The ACD increased from 2.2±0.21 preoperatively to 3.73±0.25 postoperatively (p˂0.001). Nasal angle width increased postoperatively to 40.05±2.09 compared to the preoperative value of 16.02±2.08 (p˂0.001). Temporal angle width increased from 13.05±2.07 to 41.9600±1.94 (p˂0.001). Anti-glaucoma treatment significantly decreased postoperatively (p˂0.001). A significant positive correlation was detected between ACD and angle width, while a negative correlation was detected between IOP and both ACD and angle width (p˂0.001). There was also a significant negative correlation between postoperative angle width and IOP (p˂0.001). Preoperative lens thickness was positively correlated with preoperative IOP and number of medications, while it was negatively correlated with preoperative AC depth and angle width. Preoperative lens thickness positively correlated with postoperative IOP and medications. Complete and qualified success was achieved in 69.65% and 30.4% of cases, respectively, while 2.9% failed to be controlled. Visual acuity significantly improved from 0.17±0.1 to 0.9±0.08 (p˂0.001). All parameters showed high stability throughout the follow-up period.ConclusionPhacoemulsification with IOL implantation is a safe and effective early modality for long-term control of IOP in PACG patients with coexisting cataract. The effects can persist for at least 10 years.

Effect of time and temperature-dependent changes of IOL material properties on IOL: Lens capsule interactions

Posterior Capsule Opacification (PCO) is the most common complication associated with Intraocular Lens (IOL) implantation. Based on the assumption that the interactions between an IOL and the lens capsule (LC) may influence the extent of PCO formation, a new in vitro model was developed to quantify the adhesion force of an IOL to simulated LC using a custom-designed micro-force tester. Using this system, we examined the influence of temperature (room temperature vs. body temperature) and incubation time (0 vs. 24 h) on the adhesion force between IOLs and LCs. The results show that, in line with clinical observations of PCO incidence, the adhesion force increased at body temperature and with increase in incubation time in the following order, Acrylic foldable IOLs > Silicone IOLs > PMMA IOLs. By examining the changes of surface properties as a function of temperature and incubation time, we found that acrylic foldable IOLs showed the largest increase in their hydrophilicity and reported the lowest surface roughness in comparison to other IOL groups. Coincidentally, using a newly established macromolecular dye imaging system to simulate cell migration between IOLs and LC, we observed that the amount of macromolecular dye infiltration between IOLs and LCs was in the following order: PMMA IOLs > Silicone IOLs > Acrylic foldable IOLs. These results support a new potential mechanism that body temperature, incubation time, surface hydrophilicity and smoothness of IOLs greatly contribute to their tight binding to LCs and such tight binding may lead to reduced IOL: LC space, cell infiltration, and thus PCO formation.

The Effect of Secondary Intraocular Lens Implantation Time on Visual Prognosis in Aphakia Cases after Open Globe Injury.

PurposeWe investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury.MethodsThe study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012 and 2019. Demographic characteristics, trauma zone, ocular trauma score, type of injury, time of secondary IOL implantation, final best-corrected visual acuity (BCVA), and complications were recorded for each patient.ResultsThe mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40 ± 0.86 logarithm of the minimum angle of resolution (logMAR), while the postoperative final BCVA was found to be 0.53 ± 0.70 logMAR (p < 0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r = 0.140, p = 0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA logMAR (r = 0.895, p < 0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p = 0.007).ConclusionsAlthough time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.

Outcomes and Complications of Sutured Scleral-Fixated Foldable Intraocular Lens Implantation: A Retrospective Study of 5-Year Follow-Up.

Purpose To evaluate long-term outcomes and complications of sutured scleral-fixated foldable intraocular lens (IOL) implantation. Design Retrospective study. Methods Patients who underwent sutured scleral-fixated foldable IOL implantation using 10-0 polypropylene suture were followed up for at least 5 years at one Chinese tertiary hospital and two primary hospitals. Results 52 eyes among 48 patients (35 male and 13 female) were evaluated. The mean age (years) was 50.27 ± 20.08 (range: 6 to 81). The mean postoperative follow-up time (months) was 79.70 ± 18.84 (range: 60 to 121). The mean best-corrected visual acuity (BCVA) improved from 0.83 ± 0.69 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.50 ± 0.45 logMAR at the last follow-up visit. There was improved or unchanged BCVA in 44 eyes (84.62%) and reduced BCVA in 8 eyes (15.38%). Mild intraoperative intravitreal hemorrhage was observed in 3 eyes (5.77%). Early postoperative complications included transient elevated intraocular pressure (IOP) in 5 eyes (9.62%) and hypotony in 1 eye (1.92%). Secondary epimacular membrane occurred in 5 eyes (9.62%) and retinal detachment (RD; 3 years postsurgery), subconjunctival suture knot exposure (5 years postsurgery), and persistent elevated IOP (in a GRAVES patient) occurred in 1 eye (1.92%) each. No suture erosion or breakage nor IOL dislocation was observed. No visually threatening IOL tilt or decentration was reported in any patient. Conclusion Sutured scleral-fixated foldable IOL implantation demonstrated satisfactory long-term outcomes and rare suture-related complications. This technology was safe and did not require complicated equipment and is of considerable interest in the setting of aphakia without adequate capsule support.

Accuracy of IOL Power Calculation Using the New Carlevale Sutureless Scleral Fixation Posterior Chamber IOL.

To evaluate the refractive outcomes of the new Carlevale foldable sutureless scleral fixation intraocular lens (SSF-IOL) (Soleko in eyes without capsular support. This retrospective, single-center, noncomparative interventional case series included 25 consecutive eyes of 25 consecutive patients with either aphakia or lens/IOL dislocation due to capsular or zonular defects. The Hoffer Q, Holladay 1, and SRK/T formulas, which do not need measurements of the anterior chamber depth to predict the IOL position, were used to calculate the IOL power. Constant optimization was performed to zero out the mean prediction error (PE). The main outcome measures were mean PE ± standard deviation, median absolute error (MedAE), mean absolute error (MAE), and percentage of eyes with a PE within ±0.50 and ±1.00 diopters (D). Mean axial length was 24.09 ± 2.09 mm (range: 21.85 to 32.17 mm). No statistically significant differences were found among the three formulas for any parameter. The PE was zero due to constant optimization and its standard deviation ranged between 0.89 and 0.95 D. The MedAE ranged between 0.30 and 0.34 D, whereas the MAE ranged between 0.62 and 0.67 D. The percentage of eyes with a PE within ±0.50 D was between 56% and 64% and the percentage of eyes with a PE within ±1.00 D was between 69% and 72%. Reasonably good refractive outcomes can be obtained when implanting SSF-IOLs in eyes with no capsular support, although the accuracy is lower than what is reported for normal in-the-bag IOL implantation. [J Refract Surg. 2021;37(7):472-476.].

Misplaced and invisible intraocular lens

Traumatic dislocation of foldable posterior chamber intraocular lens (PCIOL) is very rare and an emergency condition. Again, intra-operative dislocation of foldable PCIOL is very rare. We are reporting a case of inadvertent intraoperative suprachoroidal dislocation of foldable PCIOL without any retinal detachment, irido-dialysis, zonular dialysis, or vitreous loss.

Comparative analysis of in vitro accelerated glistening formation in foldable hydrophobic intraocular lenses

PurposeTo analyse and compare the propensity to form glistenings in 4 different types of hydrophobic acrylic intraocular lenses (IOLs): Alcon AcrySof ® MA60AC, HOYA iSert® PC-60AD, Bausch&Lomb enVista, and Kowa Avansee™ PU6A.MethodsWe used an accelerated laboratory method to create glistenings. IOLs were first immersed in saline at 45 °C for 24 h and then at 37 °C for 2.5 h. Microvacuole (MV) density and size were documented and calculated using an image analysis program.ResultsMedian density of glistenings [MV/mm2] for Alcon AcrySof ® MA60AC was 623 (range 507–804), for HOYA iSert® PC-60AD 1358 (range 684–2699), for Bausch&Lomb enVista 2 (range 1–2), and for Kowa Avansee™ PU6A 1 (range 1–4). The prevailing MV size was: 0–5 µm for Hoya IOLs, 5–10 µm for Alcon IOLs, 20–50 µm for Bausch&Lomb IOLs, and 5–50 µm for Kowa IOLs.ConclusionsGlistenings could be induced in all studied IOLs using the accelerated laboratory method. The Alcon AcrySof ® MA60AC and HOYA iSert® PC-60AD IOLs showed MV of high density, while the glistenings in the Hoya IOLs were smaller in size compared to the Alcon IOLs. The MV density was minimal in the Bausch&Lomb enVista and Kowa Avansee™ PU6A IOLs. The propensity of the Alcon AcrySof ® MA60AC IOLs to form glistenings in vitro correlated with the findings of clinical results that are already published.

Outcomes of Bilateral Congenital and Developmental Cataracts Following IOL Implantation in Preschool Children.

To evaluate the different ocular outcomes and the potential factors affecting visual acuity in bilateral congenital cataracts and developmental cataracts after intraocular lens implantation in preschool children. In a retrospective study, 86 eyes (51 congenital and 35 developmental cataract cases) of 43 children aged 6 years and younger who were diagnosed as having bilateral cataracts and underwent cataract aspiration combined with primary or secondary foldable intraocular lens implantation between 2003 and 2018 were reviewed. A minimum of 1 year of follow-up was required. The best corrected visual acuity (BCVA) and the factors associated with visual results were explored. The postoperative BCVA in the developmental cataract group (0.20 ± 0.19 logarithm of the minimum angle of resolution [logMAR]) was significantly better than that in the congenital cataract group (0.57 ± 0.31 logMAR) (P < .001). The mean refractive error was 3.61 ± 3.03 diopters in the congenital cataract group and 2.15 ± 1.82 diopters in the developmental cataract group. All cases of strabismus and nystagmus were found in the congenital cataract group. In the congenital cataract group, the variables age at cataract extraction and refractive error were significantly associated with BCVA (P < .001, P = .001, respectively). These variables had little effect on the developmental cataract group (P = .971, P = .576, respectively). Postoperative complications were recorded in 18 eyes: 4 in the developmental cataract group and 14 in the congenital cataract group. The BCVA in the developmental cataract group was significantly better than that in the congenital cataract group. The therapeutic effects of patients with congenital cataracts and developmental cataracts should be evaluated separately. [J Pediatr Ophthalmol Strabismus. 2021;58(3):180-187.].

Vitreous Decompression Combined with Phacoemulsification for Medically Unresponsive Acute Angle Closure.

The management of acute angle closure combined with an extremely shallow anterior chamber and cataract remains complex. This study evaluated a technique of vitreous needle aspiration combined with phacoemulsification for the treatment of acute angle closure with continuous high intraocular pressure (IOP). We retrospectively reviewed the results of vitreous needle aspiration combined with phacoemulsification in 17 eyes (17 patients) with acute angle closure with continuous high IOP and coexisting visually significant cataracts between September 2018 and April 2020 at the glaucoma unit of the affiliated Changshu Hospital of Xuzhou Medical University. The main outcomes were the best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), angle open distance 500 (AOD500), number of antiglaucoma medications, and surgery-associated complications. There were no complications during phacoemulsification and a foldable acrylic intraocular lens was implanted in the capsular bag in all 17 patients. For all patients, vitreous needle aspiration was successful at the first attempt. The BCVA improved from 2.02 ± 0.54 logMAR preoperatively to 0.73 ± 0.57 logMAR postoperatively at the final examination (p < 0.001). The mean IOP was 54.47 ± 5.33 mmHg preoperatively and 15.59 ± 2.35 mmHg at the final examination (p < 0.001) without any medication. The ACD was 1.70 ± 0.16 mm preoperatively and 3.35 ± 1.51 mm at the final examination (p < 0.001). The AOD500 was 0.07 ± 0.02 mm preoperatively and 0.51 ± 0.04 mm at the final examination (p < 0.001). Our vitreous needle aspiration technique can be performed safely in phacoemulsification for the management of acute angle closure with continuous high IOP.

Report of a Cluster of Cases of Toxic Anterior-segment Syndrome After Implantation of a Specific Intraocular Lens Model

To report a cluster of cases of toxic anterior-segment syndrome (TASS) in eyes implanted with a specific foldable acrylic intraocular lens (IOL) model. Retrospective case series. The medical records were reviewed for 7 eyes of 4 patients diagnosed with TASS after cataract surgery at Shimane University and Matsue Red Cross Hospital between July and November 2020. Among the 162 eyes implanted with the Lentis Comfort/LS-313 MF15 IOL, acute anterior chamber (AC) inflammation with fibrin formation developed 1-15 days after uneventful surgeries in 7 (4.3%) eyes (cataract surgery alone, n=4 eyes; combined cataract and minimally invasive glaucoma surgery, n=3 eyes). Other than local steroid use, fibrin membrane removal, YAG laser membranotomy, pars plana vitrectomy, and AC washout were performed to treat inflammation and/or secondary angle closure due to pupillary obstruction. We experienced a cluster of TASS cases in eyes implanted with the Lentis Comfort/LS-313 MF15 IOL in a short period of time. To our knowledge, this is the first report of TASS associated with this IOL.

Postoperative Complications after Phacoemulsification and Implantation of Foldable Acrylic Intraocular Lenses in Dogs

Background: Despite significant advances in canine cataract surgery over the years, many post-operative complications persist and reduces the success rate of phacoemulsification procedure. The aim of current study was to evaluate post-operative complications encountered till 90 days after bimanual phacoemulsification with implantation of different acrylic Intraocular Lenses.Methods: The study was conducted on 24 canine eyes. All the clinical cases were subjected to detailed ocular, ultrasonography and neuro-ophthalmic tests for ascertaining cataract and associated neuro-ophthalmic pathology. Dogs were divided in four groups with 6 eyes in each group and subjected to phacoemulsification procedure for removal of cataractous lens and implanted with square edge or round edge hydrophilic or hydrophobicintra ocular lenses.Result: Statistically non-significant (p£0.05) variations were found for all the post- operative complications among the groups. Within the groups initially higher values were recorded and on subsequent days a declining trend of varying degrees were observed. The corneal opacity was a major postoperative complication leading to failure to achieve vision with other coinciding neuro-ophthalmic conditions.

Transfixion of Foldable Intraocular Lens With Polytetrafluoroethylene Suture for Scleral Fixation.

To describe a new scleral fixation technique potentially usable for every acrylic foldable intraocular lens (IOL) available in the market, regardless of whether it is a three-piece, single-piece, or haptic shape. Before surgery, the authors performed the transfixion of the IOL optic in four points with the polytetrafluoroethylene suture under a surgical microscope. Four sclerotomy sites were marked 2 mm from the limbus, and two scleral grooves were created in between. The IOL was introduced into the posterior chamber. The four ends of the needleless polytetrafluoroethylene sutures were externalized through the sclerotomies, tightened for optimum IOL centration, and tied. The exposed sutures were placed within the scleral grooves, and the knots were buried within the sclerotomies. This technique was performed uneventfully in 7 cases. The foldable IOL was stable in all eyes 6 months after surgery, with no signs of IOL subluxation, dislocation, tilt, or suture-related complications, such as erosion or infection. The transfixion of the foldable posterior chamber IOL for stable four-point scleral fixation using a polytetrafluoroethylene suture provides excellent stability and prevents IOL tilt and decentration. This technique can immensely benefit patients requiring secondary foldable posterior chamber IOL implantation in the absence of capsular support. [J Refract Surg. 2021;37(3):180-185.).

Quantification of the In Vitro Predisposition to Glistening Formation in One Manufacturer's Acrylic Intraocular Lenses Made in Different Decades.

IntroductionFoldable hydrophobic acrylic intraocular lenses (IOLs) are prone to develop a long-term postoperative material change called glistenings. The aim of this study was to investigate the changes in the predisposition for glistening formation in one type of hydrophobic acrylic IOL material from its introduction to the present day.MethodsIn a laboratory setup, an in vitro model was used to induce glistenings in hydrophobic acrylic IOLs manufactured by one company (Alcon, Fort Worth, TX, USA) in different years: 23 1990s-manufacture hydrophobic acrylic three-piece IOLs (MA30BA/MA60AC) that were explanted in 1996 and 1997, and five of each of the newer AcrySof IOL models (MA60AC, SA60AT, TFNT00 and SN60WF) from 2014 to 2017. Furthermore, five Clareon (SY60WF) IOLs were put through the same accelerated aging procedure. The number of microvacuoles per square millimeter (MV/mm2) was determined in the central part of each IOL optic and compared between the groups.ResultsThe mean number of MV was highest in the 1990s-manufacture Alcon acrylic IOLs, with 1289 (± 738) MV/mm2. The number decreased to 650 (± 101), 192 (± 105), 175 (± 112) and 47 (± 26) for MA60AC, SA60AT, TFNT00 and SN60WF, respectively. The lowest count was obtained in the Clareon group, with 1 (± 1) MV/mm2. ConclusionsA high number of glistenings was induced in the explanted IOLs from the 1990s. The propensity for glistening formation decreased considerably after that decade and now in current use. Even though in vitro glistening formation in today’s AcrySof material was low, the Clareon material was essentially glistenings-free.