Intraocular Lens Implantation Implantation Research Articles

Effect of intraocular lens material and haptic design on anterior capsule contraction after cataract surgery: A systematic review and meta-analysis.

To compare anterior capsule contraction (ACC) after cataract surgery with implantation of intraocular lens (IOLs) of different materials and designs. We searched three electronic databases for relevant studies published up to January 1, 2023. Five randomized controlled trails (RCTs) and three cohort studies involving 1,221 eyes were included in quantitative synthesis. We extracted data, assessed their quality independently, and calculated standard mean difference (SMD) using a random-effects model. Six RCTs and one retrospective cohort were included in information summary. The contraction of the anterior capsule opening area in the hydrophilic group was larger than that of the hydrophobic group from one month to one year postoperatively (P < 0.001 and P < 0.001, respectively). Specifically, the hydrophilic group showed greater contraction of the anterior capsule opening area at one month postoperatively (Standardized mean difference [SMD] = -0.73, 95% confidence interval [CI] = -0.93 to -0.52), three months (SMD = -1.04, 95% CI = -1.32 to -0.75), six months (SMD = -0.99, 95% CI = -1.24 to -0.74) and one year (SMD = -1.33, 95% CI = -2.50 to -0.16). As of one year postoperatively, the anterior capsular opening area showed a trend of decreasing over time in both groups (P = 0.046 and P = 0.050, respectively). In information summary, three studies indicated no relationship between haptic design and ACC, while the other four studies reported that the number and shape of haptic would affect ACC. This meta-analysis suggested that the postoperative ACC after the implantation of hydrophobic IOLs was less than that induced by hydrophilic IOLs. Haptic design may also affect the degree of ACC.

Some Consideration On Cataract Surgery With IOL Implant

Useful vision after cataract surgery and implantation of intraocular lens (IOL) depends on surgical techniques, measurement of refractive parameters as well as adaptation of the patient. (neural adaptation). Multifocal or progressive lenses, if used prior to cataract surgery, are relatively more adaptable. Results of visual acuity after IOL implantation surgery depends on surgical techniques, on setting the correct refraction first and then the quality of the IOL after, lastly on adaptation of the patient (neural adaptation). The IOL manufacturing process of different brands is not the same and it is recommended to use the same brand IOL for both eyes Identification of multifocal IOLs through bio microscopy is essential for both doctors and patients in using it. The objective of this paper is to note some characteristics of lens aberrations, types of IOL and surgical selection procedures with IOL for better vision.

Comparative analysis of intraocular pressure dynamics after phacoemulsification with intraocular lens implantation in eyes with primary glaucoma

PURPOSE. To conduct a comparative analysis of changes in intraocular pressure (IOP) after cataract phacoemulsification with implantation of intraocular lens (IOL) in comorbidity with primary open-angle (POAG) and primary closed-angle glaucoma (PACG).METHODS. The study analyzed the dynamics of IOP changes after cataract phacoemulsification in 65 patients (89 eyes) with comorbid PACG and 46 patients (58 eyes) with comorbid POAG, aged 50 to 92 years. Thirty-five (53.85%) patients with POAG had history of glaucoma surgery, and 12 (20.69%) patients with PACG had been treated with laser iridectomy. The disease was in the initial stage in 14.6% of POAG patients and 5.15% of PACG patients; moderate stage — in 55.05% and 47.19%, respectively; advanced stage — in 30.34% and 24.14%. Intraocular pressure in POAG was compensated in 84.5% and subcompensated in 15.5% of patients; in PACG it was compensated in 77.6%, subcompensated in 12.6%, and uncompensated in 10.4% of patients. Compensation of IOP was achieved either by previous surgeries, or application of local antihypertensive medications. Patients with subcompensated and elevated IOP received the maximum possible amount of hypotensive medications. The follow-up period ranged from 1 month to 2 years.RESULTS. Patients were divided into three groups according to postoperative IOP levels: the first group with IOP equal to preoperative level, the second group — with IOP below the initial level, and the third group with IOP above the initial level. The IOP levels were consistent with preoperative values at all follow-up periods in most of study patients, and after 2 years their portion exceeded 70%, while in POAG it was somewhat higher than in PACG (77.42% against 71.43%). The IOP below the preoperative level was observed in eyes with initial and moderate open-angle and closed-angle glaucoma, with the amount decreasing with longer follow-up (from 63.16% at 3 months to 16.13% after 2 years in POAG, and from 62.74% to 19.04% in PACG). In the early postoperative period, number of POAG and PACG patients in this group was comparable, but after 8 months it included more PACG patients. Elevation of IOP in both forms of glaucoma was most often observed in faradvanced stage in the early post-op period after phacoemulsification, subsequently their number decreased and by two years it decreased by almost twice (6.45% vs. 11.84% in POAG and 9.53% vs. 15.69% in PACG). During the entire follow-up period, the number of patients with ophthalmic hypertension in PACG was 30% higher than in POAG.CONCLUSION. The study showed that in most cases phacoemulsification has a stabilizing effect in patients with cataracts in combination with glaucoma. The hypotensive effect of the operation was observed in initial and advanced stages of glaucoma, when the drainage system of the eye was still preserved, and in the long term it was observed in a larger percentage of cases in angle-closure glaucoma compared to open-angle glaucoma. An increase in intraocular pressure relative to the preoperative level was observed in advanced glaucoma throughout the entire follow-up period, and the number of patients with angleclosure glaucoma was one-third higher than the number of patients with open-angle glaucoma. The obtained ambiguous results of intraocular pressure measurements after phacoemulsification of cataract with implantation of IOL in combination with various forms of glaucoma dictate the need for further study of this problem.

Clinical effect of peripheral capsule preservation in eyes with silicone oil tamponade.

BACKGROUNDAt present, silicone oil has been widely used in vitrectomy to deal with complex fundus diseases. Usually, cataract extraction is combined with vitrectomy. However, reducing the complications of silicone oil tamponade and facilitating the secondary implantation of intraocular lens (IOL) are still an urgent problem.AIMTo evaluate the clinical effect of vitrectomy combined with peripheral capsule preservation (PCP) in eyes with silicone oil tamponade.METHODSThis single-center retrospective analysis included 70 patients (73 eyes) who underwent vitrectomy and silicone oil tamponade combined with cataract surgery (stage I) between January 2015 and July 2019. All patients underwent selective reoperation for silicone oil extraction and IOL implantation (stage II) more than 3 mo after stage I. These patients were divided into three groups according to the different lens capsule preservation methods: 28 patients (31 eyes) in a whole capsule preserved (WCP) group, 17 (17 eyes) in a capsule absent (CA) group, and 25 (25 eyes) in a peripheral capsule preserved (PCP) group. Intraocular pressure (IOP), best-corrected visual acuity, surgery time, and other complications were recorded at each time point (1 d, 1 wk, and 1 mo after stages I and II).RESULTSThe IOP values were 14.9 ± 8.2 mmHg in the WCP group, 20.3 ± 13.0 mmHg in the CA group, and 14.2 ± 9.7 mmHg in the PCP group (P < 0.05) at 1 mo after stage I operation. Five eyes had IOP higher than 30 mmHg, and one eye in the WCP group appeared to have silicone oil entering the anterior chamber. There was no significant difference in IOP among the three groups at any other time point (P > 0.05). With IOL implantation, visual acuity improved significantly compared to stage I. The incidence rate of posterior capsule opacity was higher in the WCP group than in the other groups (P < 0.001). In the CA group, IOL deviation due to suture relaxation occurred in one case. There was no significant difference in the surgery time among the three groups in stage I (P = 0.618). In stage II, the surgery time of the PCP group and WCP group was significantly shorter than that of the AC group (P = 0.031).CONCLUSIONPreservation of the peripheral capsule in vitrectomy combined with lens removal is a better option. This method has significant advantages in reducing intraoperative and postoperative complications.

High power custom toric intraocular lens for correcting high corneal astigmatism in post-keratoplasty and keratoconus patients with cataract.

Purpose:To analyze the outcomes of phacoemulsification with high power customized toric intraocular lens implantation (IOL) in patients with high corneal astigmatism (6-10 D Cyl) post keratoplasty and keratoconus eyes with cataract.Methods:Five eyes post keratoplasty with clear graft, four eyes with stable keratoconus, one eye with pterygium excision scar with visually significant cataract were included in this retrospective study. Phacoemulsification was done followed by implantation of custom made high power toric IOL in all patients. Outcomes included uncorrected and best-corrected distance visual acuity (UDVA, BCVA), pre-operative astigmatism at the corneal plane and IOL plane, post-operative residual astigmatism, mean torus of all IOLs used were calculated.Results:The minimum follow-up time was 12 months. At the last follow-up visit, there was a significant improvement (pre-operative vs post-operative) of UDVA (1.5 ± 0.47 vs 0.28 ± 0.14 logMAR; P < 0.05), cylindrical refraction (-9.0 ± 1.80 D vs - 1.1 ± 0.45 vs ; P < 0.05). Range of IOL powers used was 1.0-26.50 DSph and 9.0-15.5 DCyl. Post-operative mean residual spherical equivalent was 0.75 ± 0.5.Conclusion:This novel study describes the effectiveness of custom toric IOLs in high astigmatism in the range of 9.0-15.5 DCyl. Phacoemulsification with implantation of a customized high power toric IOL was effective in correcting high astigmatism in complex cases in our study.

Congenital Cytomegalovirus Infection Initially Managed as Congenital Rubella Syndrome

Congenital cytomegalovirus (CMV) infection (cCMV) is challenging to differentiate from congenital rubella syndrome (CRS) clinically. Virus detection and serological tests are needed. However, they are often not readily available or are expensive. This is a case of a five-month-old male with bilateral cataracts. He was jaundiced at birth and started having seizure episodes at one month of age. He was also diagnosed with right inguinal hernia and had abnormal bilateral hearing tests. Both eyes were noted to have leukocoria at two months of age. There was dazzle on both eyes and sclerae were anicteric. Examination revealed dense cataracts on both eyes, but their ocular ultrasound results were essentially normal. Due to the bilateral hearing loss and bilateral cataracts, CRS was initially considered despite the absence of heart abnormality since there were reported CRS cases without the complete triad. However, possible coinfection or another disease was considered due to the presence of jaundice, seizures, and hernia, which were never seen in our previous CRS patients nor were reported in the literature. The patient underwent cataract extraction on both eyes without intraocular lens implantation (IOL) as recommended for CRS cataracts to prevent severe inflammation. TORCH (TOxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex) test was negative for rubella but positive for CMV. As such, the patient would have benefitted from early IOL implantation. The patient was then referred to a national medical center for possible treatment. However, since the patient already tested negative for CMV polymerase chain reaction (PCR) there, systemic antiviral therapy was no longer initiated. This case presented the challenge of clinically differentiating cCMV and CRS.

Clear lens extraction for patients who are unfit for laser-assisted in situ keratomileusis and implantable contact lenses in central Indian population.

Purpose:The purpose of this study is to establish the safety of clear lens extraction (CLE) for the correction of high myopia in patients unfit for implantable contact lenses (ICLs) and laser in situ keratomileusis in the central Indian population.Methods:In this retrospective observational study performed at a tertiary care centre, medical records of the patients who had undergone CLE with implantation of intraocular lens (IOL) to treat high myopia were retrieved. Details of the demographic profile, surgical procedure, complications, power, and type of IOLs implanted were recorded.Results:The average postoperative follow-up period was 64.1 ± 4.2 months. The average postoperative spherical power was −1.4 ± 0.6 D, which was much lower than the preoperative spectacle power - 15 ± 4.4 D. There was improvement in the postoperative visual acuity (0.4 ± 0.2 logMAR) from the preoperative distant uncorrected visual acuity (0.8 ± 0.2 logMAR). No significant change in intraocular pressure (IOP) was observed. The postoperative average anterior chamber depth (ACD) (2.66 ± 0.1 mm) was significantly deeper than the preoperative ACD (2.61 ± 0.1 mm) P = 0.00. Barrage laser was required for lattice degeneration in one patient before CLE and in two patients during follow-up. Two patients (8.7%) required Nd:YAG capsulotomy for posterior capsular opacification. None of the patients had corneal decompensation, retinal detachment, or endophthalmitis.Conclusion:CLE with implantation of IOL is the safe procedure for correcting high myopia in patients who are unfit for ICL. None of the patient had eye loss in the follow-up period of 5 years. The low incidence of complications can be attributable to the closed chamber lens removal and implantation of IOL and prophylactic retinal treatment.

Intraocular lens power in Russian population: distribution analysis

To analyze the distribution of implanted IOL power and optimize the IOL procurement system. Retrospective analysis of cataract surgeries performed from 2014 to 2015 in the ophthalmic department of Volga District Medical Centre of the FMBA was conducted. Inclusion criteria: age from 20 to 99 years, no refractive surgery in patient's medical history, primary IOL implantation with an A-constant of 118.4, achievement of planned refraction. The studied parameters were IOL power, gender and age of patients. To assess the effectiveness of the procurement system, we analyzed the number of additional «unplanned» purchases and exchanges of IOLs over the course of 5 years (2014-2018). According to the inclusion criteria, 1009 medical records were selected, the age of the patients was 68.7±10.9 years. The distribution of IOL power was similar, but different from the normal, characterized by the mismatch of the median and the mean, left-sided asymmetry and peaked shape. Comparison of 2014 and 2015 samples showed no significant differences and low variability of IOL power. Regression analysis revealed a weak correlation between the IOL power and age and no correlation with gender, a trend was observed for IOL power to increase in patients after 50 years. The use of a procurement planning system based on a mathematical model of the IOL power distribution allows reduction of the additional purchases and exchanges of IOLs with the supplier from 5-7% to 1-2% of the total purchases. The specific features of the IOL power distribution are related to the distribution of biometry parameters in the population. The use of a scientifically based procurement system reduces staff time and laboring costs, releasing economical and time resources.

Effect of cataract extraction with intraocular lens implantation in patients with myopia on optical coherence tomography measurements

One important question for patients with both myopia and glaucoma is comparability of optical coherence tomography (OCT) data obtained before and after a significant change in eye refraction following cataract extraction surgery with implantation of intraocular lens (IOL). To assess the impact of correcting moderate and high myopia during cataract phacoemulsification with IOL implantation (Phaco/IOL) on the parameters measured by OCT. OCT was performed in 31 patients (31 eyes) with axial eye length of more than 25.5 mm before and the day after Phaco/IOL. Changes in 17 parameters of the retina, retinal ganglion cells-inner plexiform layer (GCIPL), peripapillary retinal nerve fiber layer (RNFL) and optic nerve head (ONH) were analyzed. Axial eye length was 26.94±1.09 mm in average (25.57-29.39 mm). The average refractive effect of the intervention was 8.44±4.16 D (3.75-19.0 Diopters). Signal strength in all OCT protocols was no lower than 5. Changes in the average values of OCT parameters after surgery were insignificant. They exceeded 1% of the pre-operation values only in 7 cases, including all 5 parameters of the ONH, and were significant only in 5 out of 17 parameters. For GCIPL and RNFL thickness, the changes on average did not exceed 0.9 μm, for retinal thickness in the macular area - 2.1 μm. In relative terms, the largest decrease (an average of -0.03 mm2; -2.5%) was in the optic disc area. In patients with high and moderate myopia, the parameters of the retina, RNFL, GCIPL, and ONH, as measured by OCT, changed insignificantly on the first day after Phaco/IOL (considering the signal strength of Cirrus HD-OCT device was not lower than 5).

Anterior Segment Optical Coherence Tomography Changes after Phacoemulsification

Background: phacoemulsification can cause changes in the anterior segment parameters that could be detected by anterior segment optical coherence tomography. Purpose: To determine the changes in the anterior segment parameters and intraocular pressure after phacoemulsification (IOP). Subjects and methods: A prospective, non-randomized study included twenty eyes with visually significant cataract that underwent phacoemulsification with foldable intraocular lens implantation (IOL). Complete ophthalmological examination and anterior segment optical coherence tomography (ASOCT) were performed before surgery and one month postoperatively. Results: There were statistically significant differences in the anterior segment parameters after cataract surgery. The anterior chamber angle (ACA) at the temporal side before and one month after surgery were 22.58o ± 6.4o , 33.14 o ± 6.48o respectively (p < 0.001). The ACA at the nasal side before and one month after surgery were 23.33o ± 6.93o, 34.16o ± 6.99o respectively (P< 0.001). Conclusion: Phacoemulsification with IOL implantation results in significant widening of the ACA proved by quantitative assessment of ASOCT imaging. At the same time it caused small but significant reduction in IOP.

Anterior Segment Optical Coherence Tomography Changes after Phacoemulsification

Background: phacoemulsification can cause changes in the anterior segment parameters that could be detected by anterior segment optical coherence tomography. Purpose: To determine the changes in the anterior segment parameters and intraocular pressure after phacoemulsification (IOP). Subjects and methods: A prospective, non-randomized study included twenty eyes with visually significant cataract that underwent phacoemulsification with foldable intraocular lens implantation (IOL). Complete ophthalmological examination and anterior segment optical coherence tomography (ASOCT) were performed before surgery and one month postoperatively. Results: There were statistically significant differences in the anterior segment parameters after cataract surgery. The anterior chamber angle (ACA) at the temporal side before and one month after surgery were 22.58o ± 6.4o , 33.14 o ± 6.48o respectively (p < 0.001). The ACA at the nasal side before and one month after surgery were 23.33o ± 6.93o, 34.16o ± 6.99o respectively (P< 0.001). Conclusion: Phacoemulsification with IOL implantation results in significant widening of the ACA proved by quantitative assessment of ASOCT imaging. At the same time it caused small but significant reduction in IOP.

Ciliary sulcus implantation of intraocular lens in manual small incision cataract surgery complicated by large posterior capsule rupture.

The present study aimed to evaluate the safety and efficiency of ciliary sulcus implantation of intraocular lens (IOL) in patients that had undergone manual small incision cataract surgery (MSICS) complicated by large posterior capsule rupture (LPCR). A total of 11 eyes taken from 11 patients in Brazzaville, Republic of the Congo, that had experienced LPCR following MSICS were included in the current study. A rigid single-piece IOL (5.5 mm optic, 12.50 mm overall length) was implanted into the ciliary sulcus. Postoperative follow-up assessments evaluated visual acuity, anterior segment biomicroscopy, IOL centration and position, and fundus biomicroscopy. The median follow-up time was 3.7 months (range, 2-6 months). All patients experienced vision improvement: Uncorrected visual acuity 2 months following surgery was 0.3-0.5 in 9 patients and >0.5 in 2 patients. Postoperative complications included pronounced anterior segment inflammation (1 patient), mild corneal endothelium edema (3 patients), residual cortex (1 patient) and intraocular pressure elevation (1 patient). Significant IOL decentration and tilt were not observed in any patients. The results of the present study indicate that ciliary sulcus implantation of a rigid single-piece IOL may be a feasible and effective method of treating patients that have experienced LPCR complications following cataract surgery, as it provides satisfactory visual acuity outcomes. Appropriate intraoperative management may reduce the incidence of postoperative complications.

Myopic Shift After Intraocular Lens Implantation in Children Less Than Two Years of Age.

The purpose of this study was to evaluate the myopic shift over a period of 2 years following implantation of intraocular lens (IOL) in children less than 2 years of age with axial length less than 22 mm. A retrospective analysis of records of children below 2 years of age with axial length less than 22 mm who had undergone cataract surgery with primary IOL implantation over a period of 7 years was undertaken. Mean myopic shift was analyzed at 6 months, in first year, second year and end of 2 years following surgery. Total 40 eyes of 23 children were included (mean age 13.55±7.38 months); with mean myopic shift at end of 2 years -2.35±2.15. Myopic shift in eyes with undercorrection in range of 3-4 D (group-I) and 5-7 D (group-II) was compared using Mann-Whitney test. Mean myopic shift at end of 2 years was -2.93±2.55 in group-I and -1.88±1.77 in group-II (p value not significant). There was no significant difference in myopic shift between two groups at 6 months and 1 year; a borderline significant difference was found in second year (p= 0.04). In our study amount of myopic shift in first two years in children with axial length less than 22 mm is below the expected normal. There was not much significant difference in the myopic shift over a period of 2 years in eyes, which were undercorrected by 3-4 D against those with 5-7 D. Thus aiming for less residual hyperopia by less undercorrection did not increase myopic shift. Thus high-level hyperopic glasses in the early years could be avoided and help in prevention of amblyopia after paediatric cataract surgery.

Corneal incision width after lens implantation: Comparing delivery systems

Abstract Purpose To compare corneal incision width after phacoemulsification and intraocular lens implantation (IOL) using different delivery systems. Methods One hundred and seventeen patients with cataract and no other anterior segment pathological features or previous eye surgery underwent cataract surgery with IOL implantation through a 2.2 mm incision. Three foldable IOL were implanted with their recommended delivery systems: Acrysof© SN60WF with Monarch© III/cartridge D (Group A, 38 patients); Tecnis© ZCB00 with Unfolder Platinum/cartridge easy load (Group B, 38 patients); Acrysof© SN60WF with Ultrasert™ preloaded system (Group C, 42 patients). Incision width was measured before and after phacoemulsification and IOL implantation. Results Before and after phacoemulsification incision width was, respectively, 2.21 ± 0.02 mm and 2.34 ± 0.08 mm in group A; 2.20 ± 0.02 mm and 2.31 ± 0.06 mm in group B; 2.20 ± 0.02 mm and 2.30 ± 0.07 mm in group C. Incision width was not significantly enlarged after phacoemulsification. Before and after IOL implantation incision width was, respectively, 2.34 ± 0.07 mm and 2.47 ± 0.07 mm in group A; 2.32 ± 0.06 mm and 2.45 ± 0.08 mm in group B; 2.30 ± 0.07 mm and 2.39 ± 0.07 mm in group C. Incision widths in group C were significantly different to groups A and B. No relationship was found between incision sizes and phacoemulsification time, ultrasound energy and IOL powers. Conclusion In cataract surgery Ultrasert™ enlarges the corneal incision less than other delivery systems.

Anterior Chamber Culture at the Conclusion of Cataract Surgery and Its Relation to Post-Cataract Surgery Endophthalmitis

Purpose: The purpose of this study is to reassess the pathogenesis of postoperative endophthalmitis (POE), aiming to determine the presence of bacteria in the anterior chamber at the conclusion of phacoemulsification cataract surgery, and the subsequent development of POE. Methods: A single surgeon performed all cataract procedures across the two nominated day surgical centres. Phacoemulsification surgery with intraocular lens implantation (IOL) was performed on 209 eyes. Patient demographics and POE risk factors were obtained, as well as an anterior chamber (AC) aspirate from each patient at the conclusion of the surgical procedure. The aspirate was cultured for 1 – 5 days. Fourteen eyes also underwent bacterial 16S polymerase chain reaction (PCR) analysis of the AC aspirate. Any subsequent development of POE was recorded. No intracameral antibiotics were used. Results: Of the 209 cultures, three cases (1.4%) were positive for growth (95% confidence interval). The three positive cases yielded different microorganisms. One case was positive for bacteria (Corynebacterium species) while the other two cases were positive for fungi (Candida species and a Zygomycete). Cases with positive culture growth had no statistically significant difference in the incidence of preoperative, operative and postoperative risk factors for POE, compared with patients with negative culture. No patient in this study developed POE. Conclusion: The bacterial contamination rate of the AC after phacoemulsification surgery with IOL implantation is extremely low. Strict aseptic technique and definitively closed incisions can potentially be attributed to the zero percentage incidence of POE. It is probable that POE is more likely due to postoperative factors.

Morphologic changes in the anterior segment using ultrasound biomicroscopy after cataract surgery and intraocular lens implantation.

To evaluate morphologic changes in the anterior segment using ultrasound biomicroscopic imaging (UBM) after phacoemulsification and foldable intraocular lens implantation (IOL). Thirty-six patients with a mean age of 68.68 ± 8.44 years (range 51-89) who had phacoemulsification and foldable IOL implantation were included in this prospective study. Several anterior segment parameters including aqueous depth (AQD), trabecular meshwork-iris angle (TIA), ciliary body thickness (CBT), sclera thickness (ST), trabecular meshwork-ciliary process distance (T-CPD), iris-ciliary processes distance (I-CPD), and iris thickness (IT) were measured using UBM preoperatively and at postoperative month 2. There was a significant increase in AQD (p&lt;0.001) and TIA (p&lt;0.001) at postoperative month 2. However, CBT, ST, T-CPD, I-CPD, and IT did not significantly change (p&gt;0.05) during the study period. Removal of the crystalline lens results in change in the anterior segment parameters. Our results confirmed that UBM is a helpful option for the analysis of anterior segment structures both qualitatively and quantitatively.

Effect of Corneal Incision Enlargement on Surgically Induced Astigmatism in Biaxial Microincision Cataract Surgery.

Objectives:To evaluate surgically induced astigmatism (SIA) in biaxial microincision cataract surgery with enlargement of one corneal incision during intraocular lens implantation (IOL).Materials and Methods:Data from 683 eyes with cataract that underwent biaxial microincision cataract surgery and IOL were retrospectively analyzed. The operated eyes were divided into 4 groups defined by final corneal incision length after IOL implantation. There were 83 eyes with 1.6 mm corneal incisions (group 1) and 200 eyes in each of the 2, 2.4, and 2.8 mm corneal incision groups (groups 2, 3 and 4, respectively). SIA was assessed using preoperative and postoperative keratometric values at one month.Results:The mean magnitude of SIA was 0.83±0.4 D in group 1, 0.93±0.5 D in group 2, 1.03±0.6 D in group 3 and 1.04±0.7 D in group 4. The SIA showed statistically significant differences between the four groups (p=0.05). Pairwise group comparisons revealed significant differences between groups 1 and 3 and groups 1 and 4 (p=0.005).Conclusion:Biaxial microincision cataract surgery with an incision size of 1.6 mm resulted in the least SIA. Enlargement of the corneal incision beyond 2.0 mm during IOL implantation led to significant increases in SIA. We believe that with the development and dissemination of IOLs which can be inserted through small corneal incisions, biaxial microincision cataract surgery will be the best choice to prevent SIA and increase visual acuity.

Small-incision cataract surgery in patients with Fuch's heterochromic iridocyclitis.

Fuch's heterochromic iridocyclitis (FHI) is often complicated by cataract formation. To assess the results of small-incision cataract surgery (SICS) in FHI and to study the effect of preoperative factors on postoperative vision. Sixty-three eyes of 59 patients with Fuchs heterochromic iridocyclitis who had SICS with in-the-bag implantation of intraocular lens (IOL) were evaluated retrospectively; and the primary and secondary outcome measures evaluated were the postoperative vision and complication rate. The mean age was 39.22±4.95 years. The mean pre-operative vision was 0.75±0.24 Log MAR units. The mean final vision was 0.27±0.10 Log MAR units (P=less than 0.001). At the final follow-up, 84.1% of the patients had a final Snellen's vision of 6/12 or better. The mean follow-up period was 12.06±2.06 months. The causes of corrected distance visual acuity (CDVA) worse than 6/60 were vitreous opacities, posterior keratic precipitates (KPs), glaucoma, persistent uveitis and cystoid macular edema (CME). Preoperative factors like iris atrophy (P=0.973), heterochromia (P=0.10) and vessels in angle (P=0.074) did not have a significant effect on the final vision. On the contrary, vitreous opacities (P=0.002) and posterior KPs (P=0.009) had a significant effect on the final visual outcome. SICS with in-the-bag implantation of IOL in patients with Fuch's heterochromic iridocyclitis resulted in good visual outcomes. SICS in complicated cataracts can be performed in rural settings and eye camps with minimal instrumentation, obviating the need for referral to tertiary care centers. Pre-operative factors like vitreous opacities and posterior KPs have a significant effect on the final vision.

Intraocular Lens Implantation Procedures in Aphakic Eyes With Insufficient Capsular Support Associated With Previous Cataract Surgery

The aim was to evaluate the results of three different secondary intraocular lens implantation (IOL) procedures in aphakic eyes without capsular support In this retrospective comparative case series, 90 eyes of 90 patients who underwent secondary IOL implantation for correction of aphakia were enrolled. Patients were divided into three groups based on the secondary IOL implantation procedure: anterior chamber iris-fixated IOL (AC-IFIOL), retropupillary iris-fixated IOL (RP-IFIOL), and scleral-fixated posterior chamber IOL (SF-PCIOL). The efficacy and safety of each procedure were assessed at follow-up. All eyes had aphakia caused by a previous cataract surgery. A final corrected distance visual acuity of 20/40 or better was achieved in 22 eyes (62.9%) implanted with an AC-IFIOL, in 12 eyes (50%) with an RP-IFIOL, and 18 eyes (58.1%) with an SF-PCIOL. At final visit, mean postoperative endothelial cell loss was 175 cells/mm(2) (7.2%) in the AC-IFIOL group, 255 cells/mm(2) (11.4%) in the RP-IFIOL group, and 135 cells/mm(2) (5.9%) in the AC-IFIOL group (P > 0.05). The study showed that AC-IFIOL, RP-IFIOL, and SF-PCIOL implantation had similar visual outcomes and mean corneal endothelial cell loss.

AB0258 Cataract extraction (CE) and intraocular lens implantation (IOL) in patients with rheumatoid arthritis (RA)

BackgroundInflammation caused by arthritis and long-term use of steroids such as prednisone contributes to the development of cataracts and a significant visual disability. Cataracts are commonly and very successfully treated...