IOL Implantation Research Articles

Profile of Unilateral Cataract in Children With Congenital Rubella Syndrome

A congenital cataract is preventable blindness in children and is associated with intrauterine rubella infection known as congenital rubella syndrome (CRS), mostly found in developing countries. This study aims to describe the profile of unilateral cataracts in children with CRS, which are more difficult to manage than bilateral ones. As a retrospective study, we reviewed complete medical records of children with CRS and unilateral cataracts at Cipto Mangunkusumo hospital from 2017 to 2020. Fifteen patients were included, mostly male and from outside Jakarta.The mean age of onset was 2.9 months, while the average age at first presentation and surgery was 27.7 months and 29.1 months, respectively.No correlation was found between patients’ residential distance from the hospital towards duration between onset of symptoms and first presentation to the hospital. 100% and 66.7% of patients had leukocoria and microcornea as ocular manifestations. The majority of systemic manifestations are congenital heart disease.66.7% of children underwent cataract surgery without IOL implantation. Improvement of visual acuity postoperatively was observed in 13.3% of patients, and 66.7% of patients used contact lenses for visual rehabilitation. 60% of patients had posterior capsule opacity within six months of follow-up. The challenge of wearing contact lenses in children makes the risk of amblyopia even greater

Outcomes of combined phacoemulsification/intraocular lens implantation and silicon oil removal.

To evaluate the outcomes and complications of simultaneous silicon oil removal (SOR) and phacoemulsification and intra ocular lens implantation. In this retrospective non-comparative case series, the visual, refractive and anatomical outcomes of patients who underwent combined phacoemulsification/silicone oil removal (5700 centistokes) surgery between 2017 and 2019 in a single center were evaluated. Forty-four eyes of 44 patients (eighteen males) were included. The mean age of the patients was 51.45 ± 11.59 years. The primary pathology was tractional retinal detachment (TRD) secondary to diabetic retinopathy in 36 eyes and rhegmatogenous retinal detachment (RRD) in 8 eyes. The median time period between silicone oil tamponade and removal was 9 months. There was no statistically significant difference between best corrected visual acuity (-0.14 ± 0.69 LogMAR, p= 0.19) and intraocular pressure (p= 0.26) before and after the surgery. Mean post-operative spherical equivalent (SE) at last visit was 0.36 ± 1.64 which was different from the target refraction (- 0.5D). After cataract/SOR surgery, one eye (2.3%) developed retinal re-detachment in RRD patient. Vitreous hemorrhage occurred in nine eyes (20.5%) which all had TRD as the primary pathology. Combined phacoemulsification, silicone oil and IOL implantation removal surgery seems to be a safe and useful procedure with high success rate and acceptable visual, refractive and anatomical outcomes.

Клинические случаи факоэмульсификации катаракты у пациентов с крайними степенями аметропий

Purpose. To evaluate the features of the phacoemulsification technique with IOL implantation and clinical and functional results in patients with extreme eyeball length. Material and methods. There were 2 patients under observation: a 70-year-old patient with a diagnosis of OU: Complicated cataract. High myopia. Amblyopia moderate. Primary open-angle glaucoma 2A. Visual acuity at admission vis OD = 0.001 n.c.; vis OS = 0.04 sph +2.00 D cyl –2.50 D ax 105° = 0.1. The second patient, aged 65, was diagnosed with OU: Complicated cataract. Hyperopia of a high degree. Amblyopia moderate. Primary open-angle glaucoma 1A, operated. Visual acuity at admission OD = 0.01 sph +11.00 D cyl +1.50 D ax 110° = 0.2; OS = 0.01 sph +11.00 D cyl +1.00 D ax 105 = 0.1. Both patients underwent phacoemulsification with Asphina IOL implantation (Carl Zeiss Meditec AG, Germany): the right eye of patient N 1 and the left eye of patient N 2. Results. A month after the operation, the uncorrected visual acuity in the first patient was Vis OD = 0.15. In the second patient, a month after the operation, visual acuity was Vis OS = 0.04 sph (+) 11.0 D = 0.2. Both patients are subjectively satisfied with the obtained visual functions. Conclusion. Thus, this clinical case demonstrates a very successful implementation of cataract phacoemulsification with IOL implantation in patients with extreme eyeball length. Keywords: microphthalmos, high myopia, high degree ametropia, complicated cataract, cataract phacoemulsification.

Comparison of Barrett Toric Calculations Using Measured and Predicted Posterior Corneal Astigmatism in Cataract Surgery Patients.

AimTo compare residual astigmatism prediction errors across Barrett toric calculations using predicted posterior corneal astigmatism (PCA) and PCA measured using the IOL Master 700 with total keratometry (IOLM).MethodsA retrospective cohort study was undertaken on patients with corneal astigmatism and no other ocular comorbidities that underwent uneventful refractive femtosecond laser-assisted cataract surgery with toric IOL implantation between May 2019 and November 2019. Toric calculations were performed using the Barrett toric calculator and the following values: predicted PCA with anterior corneal measurements from Pentacam, IOLM standard keratometry (SK), OPD scan, and median measurements from these devices; predicted PCA with IOLM total keratometry (TK); and measured PCA with IOLM SK or IOLM TK. Residual astigmatism prediction error was calculated for each device and method of calculation at postoperative month 1 and 3 using the astigmatism double angle plot tool.ResultsA total of 24 eyes, 10 with-the-rule (WTR), 10 against-the-rule (ATR) and 4 oblique astigmatism, from 24 patients were included in this study. PCA ranged from 0.00 to 0.67 D with a mean of 0.24 ± 0.15 D in all eyes. PCA was significantly greater in WTR eyes (0.32 D) compared to ATR eyes (0.16 D; p < 0.05). In ATR eyes, calculations made using IOLM SK and measured PCA had significantly lower total corneal astigmatism and toric IOL cylinder power compared to calculations made using Pentacam and IOLM TK (p < 0.05). No significant difference in mean absolute or centroid residual astigmatism prediction error was observed across devices or calculation methods. The percentage of eyes with absolute astigmatism prediction errors ≤0.5 D was not significantly different across groups.ConclusionBarrett toric calculations using predicted PCA and PCA measured using IOLM produced comparable residual astigmatism prediction errors. The incorporation of median measurements did not significantly impact calculation accuracy.

Cluster outbreak of Pseudomonas stutzeri acute endophthalmitis following phacoemulsification: A report of 14 cases from North India.

Purpose:To report clinical features, antibiotic susceptibility profile, management, and outcomes of a cluster outbreak of post-cataract surgery Pseudomonas stutzeri endophthalmitis.Methods:This was a hospital-based case series in which 14 patients with acute postoperative endophthalmitis who underwent cataract surgery on the same day were included. Based on severity of presentation, they either underwent pars plana vitrectomy (PPV) with intraocular antibiotics (IOAB) or vitreous tap with IOAB. Vitreous aspirates and environmental surveillance samples were inoculated on culture media and further processed by MALDI-TOF MS for identification and Vitek3 for susceptibility profile.Results:There were 8 females and 6 males with a mean age of 62.14 ± 8.08 years. Presenting signs included corneal folds (100%), hypopyon (57.1%) and fibrin (50%). Ten patients with mild presentation underwent vitreous tap with IOAB. Four patients with severe presentation underwent PPV with IOAB. Pseudomonas stutzeri was isolated from the vitreous samples and was pan-sensitive. Six eyes required multiple interventions. Favorable outcome was obtained in 12 eyes, one eye developed phthisis, and one patient was lost to follow-up.Conclusion:We report the first ever cluster outbreak of Pseudomonas stutzeri endophthalmitis following phacoemulsification with IOL implantation in a single surgeon setting. Majority of the patients had a mild presentation and responded well to targeted anti-microbial treatment.

Clinical Study of Intraocular Lens Implantation by Scleral Suture Fixation after Lensectomy and Vitrectomy

Objective: To investigate the surgical techniques and clinical significance of intraocular lens implantation by scleral suture fixation after lensectomy and vitrectomy. Methods: According to the inclusion and exclusion criteria, 19 cases (20 eyes) were selected for IOL implantation by scleral suture fixation after lensectomy and vitrectomy. The uncorrected visual acuity (VA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), preoperative IOL position and surface clarity, and complications were recorded, analyzed and compared. Results: In 20 eyes of 19 patients who underwent IOL implantation by scleral suture fixation in this study, both VA and BCVA after surgeries were significantly improved compared with those before surgeries (P&lt;0.05). 11 eyes of 10 patients had IOP ≥ 21mmHg before surgeries. Three months after surgeries, IOP of all these affected eyes were within 21 mmHg, and no affected eyes required the application of ocular hypotensive drugs. Three months after surgeries, 17 eyes of 16 patients (85%) had centered IOL position and 3 eyes of 3 patients (15%) had slightly tilted IOL, all of these tilted IOLs were in patients with ocular trauma and all of them were found to be caused by scar adhesion in the peripheral part. In two eyes, the IOL optical edge was completely blocked by the pupil, which was only found after dilating the pupil. The pupil of one eye was traumatic and irregularly dilated, and the edge of the optical part of IOL was exposed. In two eyes of two patients who underwent silicone oil removal and IOL fixation during the same surgery, a small number of silicone oil droplets were found on the surface of IOL in the early stage after surgeries, and in the later stage, small flakes of pigment granules were observed. During the 3-month postoperative follow-up period, no patient had complications such as IOL dislocation, exposure of fixation suture, retinal detachment and corneal endothelial decompensation. Conclusion: For patients ....

SMILE for the Treatment of Residual Refractive Error After Cataract Surgery.

IntroductionIn the context of managing patients’ expectations and satisfaction regarding visual acuity after cataract surgery, we aimed to investigate the improvement in visual acuity and patient satisfaction after small-incision lenticule extraction (SMILE) in pseudophakic (trifocal intraocular lens, IOL) patients with residual myopic refraction after cataract surgery.MethodsSeventy-six patients (82 eyes) who underwent cataract surgery with ZEISS AT LISA tri 839MP IOL implantation were included in this retrospective study. The included patients were 56–79 years old, wanted spectacle independence, and had preoperative myopic refraction between − 1.0 and − 2.25 diopters (D) and astigmatism between − 0.75 and − 1.75 D. The treatment status of these patients was defined as trifocal IOL (n = 82). SMILE was performed in patients who were dissatisfied after cataract surgery, and these patients were followed up for 1 year on average. We evaluated visual acuity and satisfaction and further examined laser vision correction and satisfaction levels in patients who were dissatisfied after trifocal IOL implantation.ResultsThe possible reasons for patient dissatisfaction were reading books, using a computer, and driving at night. After SMILE, the residual myopic refractive error (spherical) decreased significantly from − 2.08 ± 0.28 [− 2.25 to − 1.0] preoperatively to − 0.25 ± 0.20 − 0.5 to 0] 1 year postoperatively (p < 0.001). Additionally, the uncorrected distance visual acuity increased from 0.65 ± 0.08 [0.52–0.7] logMAR preoperatively to 0.09 ± 0.02 [0.05–0.1] logMAR at 1 month postoperatively (p < 0.001), 0.09 ± 0.02 [0.05–0.1] logMAR at 6 months postoperatively, and 0.06 ± 0.02 [0.05–0.1] logMAR at 12 months postoperatively (p < 0.001). Patient satisfaction measures after SMILE (reading, night driving, and using a computer) were significantly improved.ConclusionSMILE is a reliable method for treating residual refraction after cataract surgery, as it provides results in the shortest time without complications and increases patient satisfaction.Trial RegistrationThe protocol was registered on clinicaltrials.gov (NCT04693663).

Visual and optical quality of enhanced intermediate monofocal versus standard monofocal intraocular lens

PurposeIntraocular lens designs are constantly evolving, trying to obtain more spectacle independence after cataract surgery. This advantage can be linked to some disadvantages, such as optical quality decrease. For that reason, it is important to assess, not only the amount of vision provided but also the quality of vision once they are implanted. The purpose of the present work was to compare the visual performance between two monofocal intraocular models: a standard model and a monofocal with enhanced intermediate vision lens.MethodsProspective, randomized, comparative study. Sixty adult subjects scheduled to undergo bilateral cataract surgery and IOL implantation were randomized to receive one of the two IOLs in both eyes at Miranza IOA, Madrid, Spain (group A: monofocal with enhanced intermediate vision lens and group B: standard monofocal lens). Monocular outcomes (right eyes) determined 1 and 3 months postoperatively were photopic corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), perceived halo, corrected intermediate-distance contrast sensitivity, and higher-order aberrations. The impact of the new IOL in the postoperative management with autorefraction devices was also evaluated.ResultsNo differences were found in CDVA between the two groups. Significant differences were detected between the two lenses evaluated in both total HOA (p = 0.028) and internal HOA (p = 0.037). Contrast sensitivity and halometry results obtained at 1 month were similar across the two IOL groups.ConclusionIn patients undergoing cataract surgery, monofocal with enhanced intermediate vision IOL offered similar distance performance and contrast sensitivity along with perceived HOA and halos compared with the standard monofocal IOLs tested.

Случай успешного хирургического лечения трофической язвы роговицы

Purpose. To present the results of clinical outcomes of modern high-tech surgical treatment of a patient with unilateral neurotrophic keratitis using layered keratoplasty, which helps to prevent the development of further irreversible complications. Material and methods. A 45-year-old patient, after a course of radiation therapy for a brain tumor with the development of numbness on the upper left-side of her face, conjunctiva and cornea underwent six months later cataract phacoemulsification with IOL implantation in the left eye. After 2 months the patient’s vision decreased significantly, the examination showed that she developed neurotrophic keratitis on the operated eye, followed by progression and transformation into a trophic corneal ulcer with descemetocele. Results. In order to prevent further complications in the form of corneal perforation, anterior deep layered keratoplasty with a small diameter graft was performed. Extremely slow epithelialization was noted, and therefore a successful and effective biopsy of the cornea with an amniotic membrane was carried out. Conclusion. Cataract extraction in patients after radiation therapy with further loss of corneal sensation is extremely risky and can lead to serious consequences, in particular, the development of neurotrophic keratitis and corneal trophic ulcers. The use of the surgical technique of anterior deep layered corneal transplantation is an effective method of treating trophic ulcers, and the technique of performing the operation has certain features compared to the classical technology and requires extensive experience of the surgeon. However, the use of this method of surgical treatment for corneal trophic ulcers with descemetocele due to neurotrophic keratitis developed on the basis of radiation therapy does not always lead to success. In this case, the additional use of the amniotic membr ane for therapeutic purposes contributed to the r elief of the pathological process, paving the way for subsequent surgical interventions to restore high visual acuity i n the future. Key words: radiation therapy, neurotrophic keratitis, trophic ulcer, anterior deep layered keratoplasty, amniotic membrane

Implantation of a Toric IOL with Enhanced Depth of Focus for Unilateral Traumatic Cataract

Implantation of a Toric IOL with Enhanced Depth of Focus for Unilateral Traumatic Cataract

Visual Acuity and Complications After Secondary Retropupillary Iris-Claw Intraocular Lens Implantation at Undaan Eye Hospital Surabaya in 2019 - 2020

Introduction : Intraocular lens implantation is a treatment of choice in cases of aphakia. Aphakia conditions with minimal or no capsular support can use the anterior chamber LIO technique, iris, sulcus, and scleral fixation. The retropupillary iris fixation technique is an alternative technique that is often chosen by operators in aphakia caused by minimal complications and good visual outcomes. Purpose: to describe visual acuity and complication after secondary iris claw retropupillary intraocular lens implantation in patients with aphakia. Method: this research was a descriptive study by taken data from medical records at Undaan Eye Hospital Surabaya on January 2019 to Desember 2020. We observed the outcome visual acuity and complication from first day until 3 months after surgery. The population in this study was all aphakia patients who had secondary retropupillary iris-claw IOLs implantation surgery that fulfilled the inclusion criterias. Results: This study found that from 19 subjects, dominated by male (57,90%). The age group consisted of 49-76 years old, mean 59,05 years old. The most common cause of aphakia was lens subluxation (78.94%) as a result of previous cataract surgery. The complication found was a surgical induced astigmatism (52.63%).

Agreement between the biometric measurements used to calculate the size of the implantable collamer lenses measured with four different technologies.

Purpose:To evaluate the agreement between the biometric measurements used to calculate the size of the implantable collamer lenses (ICL) with different technologies: swept-source optical coherence tomography, spectral domain optical coherence tomography, and Scheimpflug tomography.Methods:This retrospective observational study included subjects undergoing refractive surgery with posterior chamber phakic IOL implantation to correct their myopia. The anterior chamber depth (ACD) and the horizontal white to white (WTW) or the angle to angle (ATA) distance were measured with the following four devices: the IOLMaster 700 biometer (Carl Zeiss Meditec, Jena, Germany), based on swept-source optical coherence tomography; the Cirrus and Visante optical coherence tomographs (Carl Zeiss Meditec) based on low-coherence interferometry; and the Pentacam rotating Scheimpflug camera (Oculus, Wetzlar, Germany).Results:In the horizontal corneal diameter measurements, there were statistically significant differences between Pentacam–IOLMaster 700 pair (P < 0.001) and Pentacam–Visante pair (P < 0.001). WTW from CIRRUS showed the lowest correlation when paired with Pentacam and IOLMaster 700 (R2 = 0.452 and 0.385 for Visante and R2 = 0.494 and 0.426 for Cirrus). Regarding the linear correlation of the ACD measurements, all pairs of devices were statistically significant and all of them showed a very good correlation index.Conclusion:There is a good agreement between the different devices under evaluation for ACD measurements. As for WTW, the values measured with the different devices showed large discrepancies with low correlation levels, especially when comparing the tomographs with the other devices under evaluation.

Cataract surgery in patients with extremely elongated eyeball

Aim to evaluate the specific features of the phacoemulsification and IOL implantation, as well as clinical and functional outcomes in patients with extremely elongated eyeball.&#x0D; Clinical cases. Two female patients were observed. Patient 1: 67 years, diagnosed OU complicated cataract, high myopia, moderate amblyopia, primary open-angle glaucoma 3A. Visual acuity at admission vis OD = 0.001 n.c.; vis OS = 0.04 sph +2.00 D cyl -2.50 D ax 105 = 0.1. Patient 2: 68 years, diagnosed OU complicated cataract, high hyperopia, moderate amblyopia, primary open-angle glaucoma 1A, operated. Visual acuity at admission OD = 0.01 sph +11.00 D cyl +1.50 D ax 110 = 0.2; OS = 0.01 sph +11.00 D cyl +1.00 D ax 105 = 0.1. The phacoemulsification and implantation of Asphina IOL (Carl Zeiss Meditec AG, Germany) was performed in both patients: on the right eye of patient 1 and on the left eye of patient 2.&#x0D; Results. A month after the operation, patient 1 had the uncorrected visual acuity Vis OD = 0.15, patient 2 had visual acuity Vis OS = 0.04 sph (+) 11.0 D = 0.2. Both patients were subjectively satisfied with the obtained visual functions.

Оптимизация объема предоперационной диагностики у пациентов с персистирующей сосудистой фетальной сетью

Purpose. To optimize the scope of preoperative diagnostics in patients with persistent fetal vascular network. Material and methods. The Kaluga branch underwent surgical treatment of 30 patients with various manifestations of persistent fetal vascular network from 2015 to 2020. The age of the patients was from 3 months to 8.5 years. At the stage of preoperative diagnostics, additional research methods was used: fluorescence angiography (FAG), ultrasound color duplex scanning (UCDS), ultrasound biomicroscopy (UBM). Results. A complex of diagnostic measures made it possible to develop the most individualized plan for surgical treatment. In 16 patients, the anterior type of the disease was determined – phacoaspiration with IOL implantation was performed according to the standard technique, if necessary, a “dry vitrectomy” was carried out with the removal of the posterior lens capsule and adjacent parts of the vitreous body. In 11 patients (11 eyes) with a mixed type, phacoaspiration of the lens with IOL implantation and simultaneous 3-port 27g vitrectomy was performed according to the standard technique; tamponade of the vitreous cavity was not carried out. In 10 patients (30%) in the period from 6 months to 1.5 years after the first intervention the reoperation was required. In 27 patients (90%), the transparency of the optical surroundings was restored. Complete retinal attachment was observed in 22 patients (73%). For 3 to 6 months after surgery in 5 patients (17%), traction retinal attachment occurred. In 3 patients (10%), retinal attachment was not achieved despite repeated interventions. Conclusion. A differential approach to each patient based on preoperative multimodal diagnosis made it possible to expand the indications for surgical treatment and achieve satisfactory anatomical and functional results. Keywords: persistent vascular fetal network, complex of preoperative diagnostics, fluorescent angiography, ultrasound color duplex scanning, ultrasound biomicroscopy.

К вопросу профилактики капсульного блока после факоэмульсификации катаракты с имплантацией заднекамерной интраокулярной линзы

Purpose. Method for the formation of anterior capsulorhexis for the prevention of capsular block in cataract phacoemulsification with implantation of a posterior chamber IOL was suggested. Material and methods. 67 patients (67 eyes) were operated on, for whom capsulorhexis was performed according to the method proposed by the authors in the form of an ellipse with a large axis of 7.0–7.5 mm along the tunnel incision and a small axis of 4.0–5.0 mm. Results. We did not observe any complications during the operation, as well as in the early and late postoperative period (damage to the anterior capsulorhexis, capsule block, bullous keratopathy, etc.). Only 2 patients (3%) were diagnosed intraoperatively with posterior capsule fibrosis, which required posterior capsulorhexis, which was performed after IOL implantation. At the same time, it should be noted that capsulorhexis was technically easier to carry out, since access to the posterior capsule was increased due to the previously performed oval anterior capsulorhexis. It was noted that the proposed method of forming the anterior capsulorhexis facilitates the insertion of the working part of the chopper over the edge of the lens when using the core fracture technique, reduces the risk of damage to the lens capsules, ensures reliable fixation of the IOL in the capsule bag and increases access for carrying out the posterior capsulorhexis, if necessary. After the operation UCVA and BCVA showed statistically significant increase, as much as possible after a month, but the difference with the data at the hospital discharge is statistically unreliable. After 1 year, visual functions remained stable, IOP was normalized. Conclusion. The proposed method for the formation of anterior capsulorhexis in cataract phacoemulsification with implantation of a posterior chamber IOL reliably eliminates the possibility of a capsule block due to the formation of an oval shape of the capsule hole. In addition, during the operation, it facilitates the insertion of the working part of the chopper over the edge of the lens when using the core fracture technique, reduces the risk of damage to the lens capsules, ensures reliable fixation of the IOL in the capsule bag by preserving sufficient peripheral flaps of the anterior capsule, and also increases access for posterior capsulorhexis under the IOL, if necessary. Keywords: cataract phacoemulsification, posterior chamber IOL, capsule block, oval capsulorhexis.

Сравнение клинического использования индекса заболевания глазной поверхности, времени разрыва слезной пленки и состояния слезопродукции в диагностике послеоперационного синдрома сухого глаза

Purpose. To compare clinical use of the Ocular Surface Disease Index (OSDI), tear breakup time (TBUT) and state of tear production (TP) in diagnosis of postoperative dry eye syndrome (DES). Material and methods. 161 patients (161 eyes) aged 62 to 83 years with senile cataract. All patients were assessed state of total TP (Schirmer I test), determined the TBUT and were questioned using the OSDI questionnaire. The patients were divided into 4 groups depending on level of TP before the operation. Phacoemulsification (PE) was performed in all eyes according to the standard technique with IOL implantation. Results. On the 10th day after PE, in all groups TP was below the initial level by 22–35 %, TBUT – by 30–41 %. Patients of all groups had high OSDI values. By the 30th day after PE, the TP indices did not reach the initial values in 29 eyes of patients of the 3rd group and 18 eyes of patients of the 4th group. A similar trend was observed in patients with normal and mildly depressed TP. Schirmer test was lower in 8 eyes (19.5 %) of the 1st and 21 eyes (36.2 %) of the 2nd group. The OSDI of the 1st and 2nd groups decreased by 40–50 %, in the 3rd and 4th groups – by 22–35 %, respectively. Indices of the OSDI, TP, and TBUT in 1st and 2nd groups corresponded to mild and moderate DES, in 3rd and 4th groups – to severe DES. Conclusion. The study comparing the OSDI, the dynamics of TP and TBUT in patients with senile cataract at different times after PE showed a direct dependence of indices obtained from the OSDI questionnaire on indices of TP and TBUT. OSDI questionnaire in patients after PE is quite effective in early diagnosis of DES. Keywords: senile cataract, phacoemulsification, tear production, OSDI questionnaire, tear breakup time.

Primary intraocular lens implantation in infants with unilateral congenital cataract operated before 12 weeks of age

The aim of this study was to report visual outcome and safety after cataract surgery with primary intraocular lens implantation before 12 weeks of age. Infants with visually significant unilateral congenital cataract having primary IOL implantation in the capsular bag before 12 weeks of age in 2007-2016 were enrolled for a prospective study examination in 2017. The medical records were also reviewed. In total, 23 patients with a median age at cataract surgery of 32 days (range, 12-75 days) were included. Seventeen (74%) eyes had persistent foetal vasculature (PFV). After a median follow-up of 6.3 years (range, 1.4-10.9 years), the corrected distance visual acuity was 0.8 logMAR (range, 3.0-0.1 logMAR). All, except one eye, required surgery for visual axis opacification (VAO), with a median of two (range 0-5) additional surgical procedures. Four (17%) eyes developed secondary glaucoma. Cataract surgery with primary IOL implantation before 12 weeks of age resulted in a high number of VAO operations, and the visual outcome varied considerably, showing the range in outcome for this challenging patient group. Co-existent PFV in these young patients was common. The incidence of secondary glaucoma was similar to other studies, despite the young age at surgery, high percentage of PFV and number of surgical procedures for VAO.

Клинический случай лечения ребенка с врожденной патологией радужки и хрусталика

Relevance. Congenital aniridia is a rare ocular malformation. Its occurrence in the world ranges from 1: 40,000 to 1: 96,000. Purpose. To study clinical and functional characteristics of both eyes and the effectiveness of treatment in a child with congenital aniridia, congenital cataract and lens subluxation. Material and methods. The article presents the results of the clinical case of the child T., born in 2006, diagnosed with: OU – Subluxation of the lens congenital III degree. Cataract congenital intrauterine polymorphic. Aniridia is congenital hereditary. Glaucoma congenital intrauterine initial subcompensated (m). Myopia congenital high with astigmatism. Nystagmus horizontal fine-caliber constant. Surgery was performed on both eyes – FAC + IOL + ICR with implantation of the complex «Artificial iris» + Anterior vitrectomy. The article presents an analysis of a clinical case with familial congenital aniridia in a child in order to increase the awareness of treating ophthalmologists about the complexity and systemic manifestations of this congenital malformation and the need for a systematic approach to its treatment. Results. Surgery and postoperative period without complications. Visual acuity after surgery was – OD – 0.08 w/c cyl (+) 1.0 D = 0.2; OS – 0.1 N/c. The position of the Artificial Iris complex is correct. IOL in the back chamber, in the capsule bag. A month after the operation, the visual functions are preserved, the IOP is compensated, the horizontal nystagmus has decreased Conclusion: • The use of the «Artificial iris» complex with a one-stage IOL implantation to correct the elimination of congenital aniridia makes it possible to achieve high cosmetic and functional results. • The child and the child’s parents are satisfied with the cosmetic effect after the operation. • A child after undergoing correction of aniridia with the «Artificial Iris» unit requires constant dynamic observation by an ophthalmologist. • It is necessary to take into account the high risk of postoperative ophthalmic hypertension in the child and the possibility of repeated interventions. Key words: congenital aniridia, congenital cataract, lens subluxation, cataract phacoaspiration with IOL implantation, intracapsular ring, Artificial iris complex

Posterior capsular vacuuming to avoid PCO formation

To retrospectively evaluate the effectiveness of the capsular vacuuming technique in reducing posterior capsule opacification (PCO). Group 1 of the study consisted of 2752 eyes of 2752 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing between January 2010 and December 2014. Group 2 consisted of 2761 eyes of 2761 patients with a cataract who had undergone phacoemulsification and IOL implantation surgery with anterior, equatorial, and posterior capsular polishing as well as posterior capsular vacuuming between January 2010 and December 2014. The mean patient age was 63.45 ± 12.23years (range, 43-89) in Group 1 and 64.02 ± 13.36years (range, 40-91) in Group 2. The two groups did not significantly differ with respect to age, sex, preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements (p > 0.05). At the 5-year follow-up, 253 eyes (9.19%) in Group 1 developed PCO requiring Nd:YAG laser capsulotomy, whereas 24 eyes (0.86%) in Group 2 developed PCO requiring Nd:YAG laser capsulotomy (p < 0.001). During capsular vacuuming, posterior capsule rupture was observed in the shape of a hole in only 2 eyes in Group 2. But the IOLs were implanted in the capsular bag in all eyes in both groups. PCO is the most common complication of cataract surgery; therefore, surgical technique is important in preventing PCO formation. We recommend posterior capsular vacuuming together with anterior, equatorial, and posterior capsular polishing, as this method significantly reduced the PCO rate.

Сравнительный анализ уровня провоспалительных цитокинов в слезной жидкости у пациентов с далекозашедшей стадией пролиферативной диабетической ретинопатии и осложненной начальной катарактой

Purpose. Undertake a comparative analysis of the level of pro-inflammatory cytokines (IL-8, MCP-1, ICAM-1) in tear of patients with advanced proliferative diabetic retinopathy and complicated primary cataract after phacoemulsification surgery and IOL implantation with vitreoretinal surgery accomplished at once in comparison with vitreoretinal surgery only. Material and methods. 34 cases of surgery treatment of patients with PDR and complicated primary cataract were enrolled. This patients were divided into two groups depending on the treatment tactics. In the 1st group patients were subjected to a two-step surgical procedure: vitreoretinal surgery(VRS) with silicone oil tamponade performed as the first step in their treatment; followed by the second step, phacoemulsification surgery and silicone oil removal, and the IOL implantation, respectively. In the 2 nd group phacoemulsification performed simultaneously with vitreoretinal surgery: phacoemulsification, IOL implantation, vitreoretinal surgery with silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. On the 2 nd day after the first step surgery and before surgical treatment the tear samples of the patients of both groups have been examined. Results. At the early postoperative period after VRS, an increase in the inflammatory reaction was observed in patients of both groups by the 2 nd day, while the severity of the inflammatory reaction was significantly higher in the 2 nd group patients (p &lt; 0,001) relative to the 1 st group patients. A concentration of the following cytokines: IL-8, MCP-1, ICAM-1 in the 2 nd group was 2,5–5 times higher than in the 1 st group. In the 2 nd group patients, there was a statistically significant correlation between the development of NVH in the long-term postoperative period and the level of IL-8, MCP-1, ICAM-1 in tear on the 2 nd day after the first step surgery (p = 0.015). Conclusion. The research revealed that the patients with advanced PDR are accurately determined by the increased concentration of IL-8, MCP-1, ICAM-1 in tear after phacoemulsification surgery and IOL implantation with vitreoretinal surgery accomplished at once in comparison with vitreoretinal surgery only. Keywords: cytokines, diabetic retinopathy, cataract, vitreoretinal surgery.