History Of Phacoemulsification Research Articles

A case of Phialemoniopsis curvata keratitis and literature review

We reported the case of a keratomycosis caused by an extremely rare filamentous fungus. A patient with a history of phacoemulsification and intraocular lens implantation surgery followed by bullous keratopathy and was wearing a bandage contact lens presented with signs of keratitis. Microbiological examinations revealed a filamentous fungus identified as Phialemoniopsis curvata. Penetrating keratoplasty was performed due to spontaneous corneal perforation during the treatment. P. curvata is an extremely rare agent of fungal keratitis. Although the course of infection is serious, recovery without sequela may be possible with early diagnosis and appropriate treatment.

Virna Glaucoma Implant (VGI) as the Management of Secondary Glaucoma following TASS : A Case Report

Introduction : Secondary glaucoma may occur in severe TASS. The inflammatory cell and debris can clog trabecular meshwork causing IOP to rise. In this case, we describe the successful management of secondary glaucoma due to TASS using Virna Glaucoma Implant (VGI).
 Case Illustration : A 66-year-old woman presented with decreased vision in the left eye one week after anterior vitrectomy and anterior segment lavage due to TASS. She had a history of phacoemulsification and intraocular lens placement with complication of PCR. On ocular examination, the visual acuity was 1/60 in the left eye with intraocular pressure (IOP) 55 mmHg. After maximum glaucoma medication using timolol, latanoprost, brinzolamide eye-drops and oral acetazolamide IOP was 22mmHg. Glaucoma Drainage Device (GDD) surgery using VGI was performed. After 2.5 weeks, IOP in the left eye was reduced to 19 mmHg without anti-glaucoma medication and visual acuity has improved to 6/60, showing a favourable outcome.
 Discussion : TASS may cause significant damage to the trabecular meshwork, which leads to secondary glaucoma. Although medical therapy is often used to control elevated IOP, surgical therapy may be required to treat refractor IOP elevation. GDD surgery has been reported to have effective outcomein secondary glaucoma and pseudophakic eyes.
 Conclusion : Secondary glaucoma is considered as one of the characteristics in the late stages of TASS, and required prompt treatment. VGI implantation is a promising choice of treatment in managing secondary glaucoma following TASS when medication is not effective.

The relationship between corneal calcareous degeneration and various ophthalmic diseases in dogs: A retrospective study

AbstractObjectiveTo investigate ocular factors that influence the development of corneal calcareous degeneration (CCD) in dogs.Animals and ProceduresThe medical records of 96 eyes of dogs with CCD and 288 eyes without CCD were retrospectively reviewed. Dogs with evidence of causative systemic illness associated with CCD were excluded from the study. Logistic regression analysis was used to identify the ocular factors associated with the development of CCD. To identify the effect of phosphate‐containing eyedrops on CCD, the application periods of phosphate‐containing antiglaucoma eyedrops were compared between the glaucomatous eyes in the CCD and non‐CCD groups.ResultsIncreased age, brachycephalic breed, keratoconjunctivitis sicca, advanced cataract, history of phacoemulsification, and topical corticosteroid application were significantly associated with CCD development. Glaucoma was significantly overrepresented in the non‐CCD group, and the application period of phosphate‐containing antiglaucoma eyedrops was significantly longer in eyes with CCD than in those without CCD.ConclusionsOphthalmic diseases requiring long‐term management of ocular inflammation and long‐term application of phosphate‐containing eyedrops may contribute to the development of CCD. Glaucoma is overrepresented in dogs without CCD, which is thought to be due to the differences in predisposed age and breeds between dogs with glaucoma and CCD.

Анализ эффективности хирургического лечения при злокачественной глаукоме

Purpose. To analyze the types of treatment of malignant glaucoma and their effectiveness using clinical examples. Material and methods. 3 patients with malignant glaucoma were included, with a history of phacoemulsification with implantation of an intraocular lens at different times. All patients underwent a complete ophthalmological examination, including visometry, tonometry, biometry, ultrasound B-scan, biomicroscopy, and surgical treatment of malignant glaucoma, consisting of posterior closed vitrectomy 25 G, iridectomy and capsulotomy. Results. All cases resulted in a favorable outcome after the treatment. Conclusion. The study proved that an effective surgical treatment patients diagnosed with malignant glaucoma, after cataract phacoemulsification with intraocular lens implantation, is to perform a posterior closed vitrectomy 25 G with iridectomy and capsulotomy. Keywords: malignant glaucoma, a posterior closed vitrectomy

Diode laser transscleral cyclophotocoagulation causes intraocular collamer lens displacement in pseudophakic eye: a case report

BackgroundWith the rapid development of intraocular collamer lens (ICL) operation, it is foreseeable that we will encounter a large number of glaucoma patients with ICL implantation history. However, our current understanding of the treatment of glaucoma patients with ICL is limited. Hence we report a rare case of refractory glaucoma after intraocular collamer lens and intraocular lens implantation in a patient who underwent unsuccessful transscleral cyclophotocoagulation, which led to intraocular collamer lens displacement, angle closure and uncontrolled intraocular pressure.Case presentationA 39-year-old woman presented with intractably elevated intraocular pressure in the right eye. Since her intraocular collamer lens implantation surgery in 2017, her intraocular pressure had remained over 40 mmHg while using 3 types of anti-glaucoma medications. The patient had a history of phacoemulsification and posterior chamber phakic intraocular lens implantation for complicated cataracts secondary to uveitis in 2006. On gonioscope examination, there were signs of pigment dispersion, and the anterior chamber angle was open. Ultrasound biomicroscopy examination showed contact and rubbing between the intraocular collamer lens and posterior surface of the iris. And typical advanced glaucomatous optic neuropathy and visual field defects were observed. Transscleral cyclophotocoagulation was performed to control the intraocular pressure and prevent further visual field loss. However, the intraocular collamer lens was displaced after transscleral cyclophotocoagulation, which resulted in formation of a shallow anterior chamber 1 week later, angle closure and loss of intraocular pressure control 1 month later, even though the maximum dose of anti-glaucoma medication was used. Finally, an Ahmed glaucoma valve was successfully implanted in her anterior chamber, and the glaucoma was controlled, as observed at the 10-month follow-up.ConclusionsPigment dispersion is a common phenomenon after intraocular collamer lens implantation and may accelerate the progression of glaucoma. Transscleral cyclophotocoagulation should be carefully considered in glaucoma patients with elevated intraocular pressure after intraocular collamer lens implantation, given that transscleral cyclophotocoagulation may cause intraocular collamer lens displacement.

Pigmentary Glaucoma After Cataract Surgery with Single-Piece Hydrophobic Intraocular Lens Implanted into the Ciliary Sulcus: Case Report

A 59 years old man presented with a history of phacoemulsification with an hydrophobic intraocular lens implant in his left eye 4 years ago. The biomicroscopy revealed pigments in the corneal endothelium (Krukenberg’s spindle), peripheral transillumination of the iris and intraocular pressure of 52 mmHg in the left eye. Gonioscopy revealed hyperpigmentation of the posterior trabeculate. Posterior segment examination and visual field revealed a cup/disc 0.9 with significant field damage in strategy 10-2. Biomicroscopic ultrasonography showed asymmetric implantation of the IOL loops in the left eye (one loop in the ciliary sulcus and the other in the capsular bag). He underwent antiglaucomatous treatment with adequate control of intraocular pressure, with no need for surgical intervention.

Risk Factors for Onset or Progression of Posterior Vitreous Detachment at the Vitreomacular Interface after Cataract Surgery

To study the incidence and risk factors for onset or progression of posterior vitreous detachment (PVD) at the vitreomacular interface (VMI) after cataract surgery. Retrospective case series. Patients with a history of phacoemulsification from April 2018 through April 2019 at the Keye Eye Center, Seoul, Korea, and postoperative monitoring for more than 2 months. Cox proportional hazard ratios for the onset or development of PVD after cataract surgery in the presence of selected risk factors and demographic data were calculated. To evaluate the ocular risk factors, various ocular metrics, including spherical equivalent (SE), axial length (AL), anterior chamber depth, lens thickness, central subfield thickness, PVD status at macula and optic nerve head (ONH), peripapillary retinal nerve fiber layer thickness, and ONH parameters from OCT scans, were used for the analysis. Onset or development of PVD at the VMI. Among 988 eyes without PVD at baseline, 174 eyes (17.6%) showed changes in the VMI. Univariate analysis showed that age, SE, AL, PVD status at macula and ONH, and average and vertical cup-to-disc ratios (CDRs) were associated significantly with PVD onset or development (P= 0.046, P= 0.004, P= 0.040, P < 0.001, P < 0.001, P= 0.008, and P= 0.042, respectively). In a multivariate analysis, PVD status at the macula and ONH and smaller CDR were associated with PVD onset or progression after cataract surgery after adjustment for age, SE, and AL (P < 0.001, P < 0.001, and P= 0.005, respectively). The risk of PVD onset or progression was dependent on PVD status and the CDR detected on OCT scans, not on age or AL, in a large patient cohort. Patients who show risk factors on OCT should be monitored carefully during the postoperative period.

Photorefractive keratectomy after cataract surgery in uncommon cases: long-term results.

To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL) implantation in uncommon cases. Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK) enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA), best corrected visual acuity (BCVA) and corneal transparency and follow up ranged from 1 to 8y. The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both suture induced and preexisting. After cataract surgery and before the laser enhancement the mean spherical equivalent (SE) was -0.56±3 D ranging from -4.62 to +2.25 D in high myopic patients, instead it was -1±1.73 D ranging from -3.25 to +3.75 D in the astigmatic eyes, with a mean cylinder of -3.75±0 ranging from -3 to +5.50 D. After laser refractive surgery the mean SE was 0.1±0.73, ranging from -0.50 to +1.50 in the myopic group, and it was -0.50±0.57 ranging from -1.25 to +0.50 in astigmatic patients, with a mean cylinder of -0.25±0.75. In myopic patients the mean UCVA and BCVA were 0.038±0.072 logMAR and 0.018±0.04 respectively, both ranging from 0.10 to 0.0. In astigmatic patients, the mean UCVA and BCVA were 0.213±0.132 and 0.00±0.0 respectively, UCVA ranging from 0.50 to 0.22 and BCVA was 0.00. All patients presented normal corneal transparency. No ocular hypertension was detected and no corneal haze was observed. All registered values remained stable also at the end line evaluation. The excimer laser treatment of residual refractive errors after cataract surgery with IOL implantation in abnormal eyes resulted in satisfactory and stable visual outcome with good safety and efficacy.

Earliella scabrosa-associated postoperative Endophthalmitis after Phacoemulsification with intraocular lens implantation: a case report

BackgroundPostoperative endophthalmitis after cataract surgery is a severe eye infection that can lead to irreversible blindness in the affected eye. The characteristics, treatment and prognosis of this disease vary because of its association with different pathogens. Here, we report what is possibly the first case of endophthalmitis after cataract surgery to be associated with the rare pathogen Earliella scabrosa.Case presentationA 56-year-old man from Hainan Island (China) with a history of phacoemulsification and type II diabetes mellitus underwent intraocular lens (IOL) implantation. He later presented with progressive endophthalmitis in his right eye. IOL explantation with capsular bag removal and a 23G pars plana vitrectomy combined with a silicone oil tamponade was performed. The infection was cleared without recurrence, and the patient’s visual acuity improved from light perception to 20/200 in the right eye. An in vitro culture determined that the causative pathogen was Earliella scabrosa, and this result was confirmed by an internal transcribed spacer (ITS) sequence analysis.ConclusionEarliella scabrosa has never been reported as an infectious agent in human eyes, and its clinical significance remains unknown. Here, we report a rare case of Earliella scabrosa-associated endophthalmitis after cataract surgery. The fungal infection presented as an acute attack and was successfully treated with vitrectomy.

Sudden macular edema 2 years after cataract surgery due to retained nuclear fragment

Case reportA 78-year-old man presented with a 2-week history of decreased vision in the right eye (RE). Ocular history included uncomplicated cataract surgery in the RE 2 years earlier. Gonioscopy revealed a retained small nuclear fragment (sNF) in the anterior chamber (AC) and OCT showed macular edema (ME). The NF was fragmented with a YAG laser. DiscussionAC retained NF resulted in ME and reduced visual acuity. We recommend gonioscopy in cases of reduced visual acuity and history of phacoemulsification. ME and reduced vision may be reversed by removing the NF with YAG laser.

Edema macular agudo 2 años después de la cirugía de catarata por un fragmento nuclear retenido

Case reportA 78-year-old man presented with a 2-week history of decreased vision in the right eye (RE). Ocular history included uncomplicated cataract surgery in the RE 2 years earlier. Gonioscopy revealed a retained small nuclear fragment (sNF) in the anterior chamber (AC) and OCT showed macular edema (ME). The NF was fragmented with a YAG laser. DiscussionAC retained NF resulted in ME and reduced visual acuity. We recommend gonioscopy in cases of reduced visual acuity and history of phacoemulsification. ME and reduced vision may be reversed by removing the NF with YAG laser.

Sudden corneal edema due to retained lens nuclear fragment presenting 8.5 years after cataract surgery

A 79-year-old woman presented with a 1-week history of sudden onset of decreased vision, pain, and redness in the right eye. Ocular history included uneventful cataract surgery in both eyes more than 8 years prior to presentation. Slitlamp examination revealed significant corneal edema and mild iritis. Gonioscopy revealed a retained lens nuclear fragment in the inferior angle. Surgical removal of the fragment improved the patient's condition. The retained nuclear fragment presumably lodged behind the iris at the time of the initial surgery and spontaneously moved forward more than 8 years later. To our knowledge, this is the longest reported delay between phacoemulsification and presentation of a retained nuclear fragment. Before this case, retained nuclear fragments had been associated with complications within a year of surgery only. We recommend gonioscopy in cases of sudden-onset corneal edema extending to the inferior limbus in patients with a history of phacoemulsification.