Posterior Chamber Lens Implantation Research Articles

Efficacy and safety of the new generation of excimer laser trabeculotomy in aheterogeneous patient population-1-year follow-up

Microinvasive procedures have become established in glaucoma surgery and are preferred for patients with target pressure values that are not too low. Excimer laser trabeculotomy (ELT) represents such aminimally invasive approach and can easily be combined with cataract surgery. Over 12months the reduction in intraocular pressure (IOP), the number of antiglaucoma drugs and the incidence of adverse events were evaluated using the new EliosTM method (Elios Vision GmbH, Germering, Germany) for real-life data from aheterogeneous patient population undergoing ELT in combination with cataract surgery (phaco-ELT). In this study 20eyes of 13patients who underwent phaco-ELT were retrospectively analyzed. After standard phacoemulsification with posterior chamber lens implantation, 10microchannels were created using the excimer laser. The patients were followed for 12months and the intraocular pressure (IOP), number of antiglaucoma drugs and the occurrence of adverse events were analyzed. The average age was 65years. The preoperative IOP was 17.5(± 5.3) mm Hg. The mean IOP reduction was 4.8 mm Hg (27.4%, p < 0.001) on the first postoperative day, 3.2 mm Hg (18.3%, p = 0.22) after 6months and 2.5 mm Hg (14.3%, p = 0.14) at 12months. The number of antiglaucoma drugs decreased from an average of3.2 (± 1.3) preoperatively to0.5 (± 0.9) on day1 (p < 0.001), 1.9(± 1.2) after 6months (p = 0.008) and 2.2(± 1.3) after 12months (p = 0.013). In our cohort ELT in combination with cataract surgery is asafe minimally invasive procedure leading to an IOP reduction of 14.3% and areduction of pressure-lowering medication by1 active ingredient in patients with low initial pressure at 1‑year follow-up. As no implant is used in ELT and the conjunctiva remains untouched, subsequent procedures, including bleb-related surgery, are not negatively affected.

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens.

Background. The management of patients with aphakia and/or lack of capsular support remains debated. The sutureless posterior chamber IOL (PCIOL) fixation is a very useful surgical option. The purpose of the study was to compare the early outcomes as well as post-operative best corrected visual acuity, refractive errors and complications of two different techniques of sutureless PCIOL secondary implantation. Methods. Patients who underwent secondary implantation from December 2019 to January 2021 in the Department of Ophthalmology of Creteil Hospital, and in the Granville Ophthalmology Center, were retrospectively included. Eyes implanted with the iris claw lens (Artisan Aphakia IOL model 205, Ophtec BV, Groningen, The Netherlands) were included in group 1, and eyes implanted with a newly developed sutureless trans-scleral plugs fixated lens (STSPFL, Carlevale lens, Soleko, Pontecorvo, Italy) were included in group 2. Results. Twenty-two eyes of 22 patients were enrolled in group 1, and twenty eyes of 20 patients in group 2. No difference was found in visual acuity between two groups (0.35 +/− 0.29 logmar for group 1 and 0.23 +/− 0.51 logmar for group 2) (p = 0.15) at mean post-operative follow up (6.19 +/− 3.44 months for group 1 and 6.42 +/− 3.96 months for group 2) (p = 0.13). Both the mean refractive error (MRE) and induced astigmatism (IA) were greater in group 1 compared to group 2, respectively: the MRE was 0.99 +/− 0.57 vs. 0.46 +/− 0.36 (p < 0.01), and IA was 1.72 +/− 0.96 vs. 0.72 +/− 0.52 (p < 0.01). Conclusions. No significant differences in terms of the recovery of visual acuity were found between the two groups. Group 2 (STPFL) gives better results in our sample due to less post-operative induced astigmatism and less refractive error.

Hypotony maculopathy and photoreceptor folds with disruptions after vitrectomy for epiretinal membrane removal: two case reports

BackgroundHypotony maculopathy has been classically reported as a complication of glaucoma surgery or ocular trauma. There have been only a few reports of hypotony maculopathy following pars plana vitrectomy (PPV). Here, we report two cases of hypotony maculopathy occurring after PPV for epiretinal membrane (ERM) removal and characteristic photoreceptor folds observed on optical coherence tomography (OCT).Case presentationA 53-year-old Korean woman (case 1) underwent phacoemulsification and posterior chamber lens implantation combined with 25-gauge PPV for ERM removal in the right eye. On the following day, she had severe ocular hypotony, with an intraocular pressure (IOP) that was unmeasurable using a pneumatic tonometer. Despite normalization of IOP, macular retinal and photoreceptor folds with photoreceptor disruptions developed, and Henle’s fiber layer hyperreflectivity was identified. Thereafter, retinal and photoreceptor folds gradually disappeared but photoreceptor disruption and Henle’s fiber layer hyperreflectivity did not improve until 1 year postoperatively, with persistent central visual field distortion and visual acuity worse than that at the preoperative state. A 20-year-old Korean man (case 2) underwent an additional 25-gauge PPV for ERM removal in the left eye. Examination on the following day showed ocular hypotony and retinal folds with peripheral choroidal detachment. Although IOP was normalized, further OCT revealed photoreceptor folds and photoreceptor disruptions. Since then, the photoreceptor folds resolved; however, the photoreceptor disruption remained in the macula at the 1-year follow up, with persistent distorted vision and visual acuity worse than that at the preoperative state.ConclusionsEarly hypotony after vitrectomy for ERM could result in maculopathy leading to irreversible visual decline and metamorphopsia. Photoreceptor folds on OCT are characteristic features and the predominant mechanism of central visual loss in cases of hypotony maculopathy.

Pattern of Presentation, Management and Outcome of Lens Induced Glaucoma at a Tertiary Eye Care Centre

Objective: To outline the clinical presentation, management and outcome of lens induced glaucoma in Chittagong Eye Infirmary and Training Complex. Methods: A case series review was done among the patients who visited Chittagong Eye Infirmary and Training Complex from January 2015 to December 2018. Demographic data, clinical presentations, management and outcome were recorded and analysed. Results: 30 phacomorphic cases and 20 phacolytic glaucoma patients were included in our study. The mean age at presentation was 60 years. Female to male ratio was 2:1. The reason for late presentation was distance which was 60% in phacomorphic glaucoma and 50% in phacolytic glaucoma. The main symptoms were reduced vision followed by ocular pain and redness of eye. Visual acuity was either HM or just PL in all eyes before surgery. All patients underwent SICS with posterior chamber lens implantation. IOP reduced tremendously upon discharge and vision kept improving up to a month after surgery. Conclusion: Reduced vision, ocular pain and redness are the main clinical presentations of lens induced glaucoma. Cataract surgery proves to be effective in lowering IOP and visual recovery in patients with lens induced glaucoma.

Retrospektywna ocena powikłanych operacji zaćmy z implantacją na torebkę przednią jednoczęściowych zwijalnych soczewek wewnątrzgałkowych

Cel pracy: Ocena odległych wyników leczenia w grupie pacjentów poddanych operacji fakoemulsyfikacji zaćmy z fiksacją na torebkę przednią jednoczęściowych zwijalnych soczewek wewnątrzgałkowych.&#x0D; Materiał i metody: Grupę badaną stanowiło 24 oczu u 24 pacjentów, którzy w latach 2008–2015 zostali poddani operacji fakoemulsyfikacji zaćmy na Oddziale Okulistyki Centralnego Szpitala Klinicznego MSWiA w Warszawie. W grupie tej po śródoperacyjnym przerwaniu torebki tylnej soczewki zastosowano implantację jednoczęściowej zwijalnej soczewki wewnątrzgałkowej do komory tylnej z fiksacją na torebce przedniej soczewki. Oceniano ostrość wzroku, ciśnienie wewnątrzgałkowe, odcinek przedni i tylny oczu przed zabiegiem chirurgicznym, w 1. i 7. dobie po operacji oraz w okresie 6–84 miesięcy od zabiegu.&#x0D; Wyniki: W obserwacji trwającej od 6 miesięcy do 7 lat wykazano poprawę najlepszej skorygowanej ostrości wzroku (BCVA, best corrected visual acuity) średnio o 2 linie na tablicy Snellena oraz stwierdzono: u 25% badanych podwyższone ciśnienie wewnątrzgałkowe lub konieczność modyfikacji leczenia przeciwjaskrowego, u 42% pacjentów dyspersję barwnika z listka barwnikowego tęczówki, u 17% transiluminację tęczówki.&#x0D; Wnioski: Zastosowanie jednoczęściowej zwijalnej soczewki tylnokomorowej do fiksacji na torebce przedniej soczewki w sytuacji uniemożliwiającej jej implantację śródtorebkową u 67% pacjentów pozwoliło na poprawę pooperacyjnej ostrości wzroku. Jeśli decydujemy się na takie rozwiązanie, powinniśmy zapewnić pacjentom możliwość częstych kontroli, gdyż u 25% spośród nich możerozwinąć się jaskra wtórna. W przypadku gdy nie dysponujemy trzyczęściową soczewką tylnokomorową, wyżej opisany sposób fiksacji jednoczęściowej zwijalnej soczewki jest względnie bezpieczną techniką chirurgiczną.

Efficacy and safety of glue assisted suture less trans-scleral fixation of posterior chamber intraocular lens (SF- PCIOL)

Context: Scleral-fixated posterior chamber lens implantation (SF-PCIOL) in eyes without sufficient capsular support remains a widely applied surgical procedure. Suture - less scleral IOL fixation, Is a new technique in which PC IOL is placed in eyes with deficient posterior capsule and the haptics are incarcerated in the scleral pocket which is sealed with quick-acting fibrin glue. Aims and Objectives: To evaluate the efficacy and feasibility of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation method in post cataract surgery. Material and Methods: The study includes 10 Patients presented with inadequate capsular support who underwent Glue assisted SF-PCIOL over a time period of 12 months at a tertiary care eye hospital. Statistical analysis was done on Microsoft excel. Results:In present study of ten eyes the final postoperative BCVA at 3rd month was improved or remained same in nine (90 %) patients and only one patient had reduced BCVA. Conclusion: Lots of complications are encountered with the use of sutures in the operative procedures; bio-adhesives fibrin glue have emerged as a viable alternative for glue assisted suture less transscleral fixation of posterior chamber intraocular lens (SF- PCIOL), over the last three decades. Keywords:Scleral-Fixated Posterior Chamber IOL (SF-PCIOL), haptics, Fibrin glue, Best Corrected Visual Acuity (BCVA)

Clinical Outcomes and Lens Constant Optimization of the Zeiss CT Lucia 602 Lens Using a Modified Yamane Technique.

PurposeTo report the clinical and refractive outcomes of a modified Yamane technique for scleral fixation of the CT Lucia 602 lens.DesignRetrospective case series.PatientsOne hundred twenty-one eyes with dislocated posterior chamber lens implants, surgical aphakia, subluxed crystalline lenses, capsular tear, anterior chamber, or iris sutured posterior chamber lens intolerance were included.MethodsSecondary implantation of the Zeiss CT Lucia 602 lens was performed by a single surgeon using a modified Yamane technique employing a single needle, rather than the double-needle approach. One hundred twelve eyes underwent simultaneous 3 port pars plana vitrectomy and 9 eyes had previously undergone posterior vitrectomy surgery. Exclusion criteria were age <18, simultaneous glaucoma or corneal procedures, staged corneal transplantation, and follow-up <30 days.Main Outcome MeasuresA paired t-test was used to compare pre- and post-operative corrected distance visual acuity (CDVA), the mean predictive error, and the mean absolute predictive error between the manufacturer’s and optimized constants for Hoffer Q, Holladay I, and SRK/T. Complication rates were reported.ResultsOne hundred twenty-one consecutive eyes with a mean follow-up of 237 days were included. The pre-operative CDVA was 0.871 ± 0.785 logMAR (mean ± standard deviation, Snellen equivalent 20/149), which improved to 0.401 ± 0.608 (Snellen equivalent 20/50) post-operatively. In 109 eyes with reliable postoperative refractions, the mean predictive refractive error (D) ± std was +0.74 ± 1.37 for Hoffer Q, +0.66 ± 1.41 for Holladay 1, and +0.47 ± 1.49 for SRK/T (p<0.05). Refractive outcome analysis yielded a mean optimized personalized anterior chamber depth (pACD) of 5.69, Surgeon Factor of 1.79, and A constant of 118.56. Vision-limiting complications occurred in 11 eyes (9.1%).ConclusionScleral fixation of the CT Lucia 602 lens using a single-needle modification of the Yamane technique resulted in very good visual acuity, predictable postoperative refractive errors, but some vision-limiting complications in this heterogeneous group of eyes with significant comorbidities.

Psödofakik Retina Dekolmanlı Hastaların Demografik ve Klinik Özellikleri ve Bunların Cerrahi Başarıya Etkisi

Aim: In this study, we aimed to determine the demographic and clinical characteristics of patients who underwent surgical treatment for pseudophakic retinal detachment (PRD) and evaluate the effects of these characteristics on the success of the surgery. Materials and Methods: The study included 60 eyes of 60 patients who were diagnosed with PRD at the Retina Section of the 1st Eye Clinic of the Beyoğlu Eye Training and Research Hospital between February 2006 and January 2009. Demographic and pre-, peri- and postoperative clinical data of the patients were recorded. Results: The mean patient age was 58.45±14.91 years. Of the patients, 46 (76.7%) were male and 14 (23.3%) were female. Fifty-two (86.6%) patients underwent phacoemulsification surgery, 1 (1.6%) planned extracapsular cataract extraction, 1 (1.6%) intracapsular cataract extraction, 3 (5%) refractive clear lens extraction, and 3 (5%) lens extraction with irrigation/aspiration for diagnosed pediatric cataract. Twenty-two (36.6%) patients underwent posterior chamber lens implantation in the capsule, 32 (53.3%) posterior chamber lens implantation in the sulcus, 4 (6.6%) anterior chamber lens implantation, and 2 (3.3%) scleral-fixated lens implantation. In 44 (73%) patients, the posterior capsule integrity was impaired. A tear was detected in 27 (45%) patients during the preoperative retinal examination and in 18 (30%) patients during the surgery. No tear was detected in 15 (25%) of the patients. To treat the patients, four different surgical procedures were performed depending on factors including the proliferative vitreoretinopathy (PVR) stage, condition of the lens and posterior capsule, and location of the retinal tear: 360-degree scleral encircling band + local explant (Group I), 360-degree scleral encircling band + pars plana vitrectomy + tamponade (Group 2), 360-degree scleral encircling band + pars plana vitrectomy + intraocular lens removal + tamponade (Group III), and 23G pars plana vitrectomy + tamponade (Group IV). The mean follow-up was 18.3±5.2 (6–32) months. At the last follow-up visits, anatomical success was achieved in 58 (96.6%) of the 60 patients while 17 (32%) showed functional success. The functional success rate was higher in patients in the early stages (up to C1) of PVR (p&amp;lt;0.001). Discussion and Conclusion: According to our findings, PVR stage is directly related to anatomical and functional success in PRD. Surgical treatment is more successful in PRD patients with early-stage PVR.

Development of Algorithm of Surgical Treatment Choice in Patients with Cataract and Asteroid Hyalosis

The method of phacovitrectomy can be used for surgical treatment of patients with cataract and asteroid hyalosis. However, there is still a topical question in the choice of surgical treatment taking into account the completeness of the posterior hyaloid membrane (PHM) detachment.Patients and methods: the study involved 24 patients (24 eyes) with cataract and asteroid hyalosis. The average age of patients was 72.9 years, out of the total number of men — 11, women — 13. Pre-and postoperative diagnosis of all patients included standard methods of investigation, as well as optical coherence tomography performed on the Cirrus HD-OCT 400, Carl Zeiss, Germany. Pre-and postoperative subjective satisfaction was assessed using a validated visual Function Qusetionnaire 14 ophthalmological questionnaire. Patients were divided into 3 groups. In the first group of patients, cataract phacoemulsification with posterior chamber lens implantation and total three-port vitrectomy through a flat part of the ciliary body were performed. In the second patients’ group, cataract phacoemulsification with posterior chamber lens implantation and subtotal vitrectomy through posterior capsulorexis were performed. In the third group of patients, cataract phacoemulsification with posterior chamber lens implantation was performed. All operations were performed with the help of ophthalmic systems Infinity Vision System (Alcon, USA) and Constellation Vision System (Alcon, USA).Results: in the first day after the operation, all patients noted improvement in visual acuity and quality of life, but more significant improvement was noted in patients of the first and second groups.Conclusion: analysis of the results of surgical treatment, questionnaire survey, preoperative diagnosis allowed to develop an algorithm for choosing the method of surgical treatment in patients with cataract and asteroid hyalosis, taking into account the state of PHM.

Implantation of a Phakic Posterior Chamber Lens in Eyes with Keratoconus

Implantation of a Phakic Posterior Chamber Lens in Eyes with Keratoconus

Retraction: Effective Lens Position According to Incision Width in Cataract Surgery Using Phacoemultification and Posterior Chamber Lens Implantation

Retraction: Effective Lens Position According to Incision Width in Cataract Surgery Using Phacoemultification and Posterior Chamber Lens Implantation

The influence of low signal-to-noise ratio of axial length measurement on prediction of target refraction, achieved using IOLMaster.

PurposeTo evaluate the influence of low signal-to-noise ratio (SNR) of axial length measurement, achieved using IOLMaster, on prediction of target refraction.MethodsA total of 131 eyes of 131 patients who underwent phacoemulsification with posterior chamber lens implantation were enrolled. Preoperative axial length measurements were performed with the IOLMaster 500 (Carl Zeiss Meditec, Germany); preoperative SNR values were used to divide the eyes into three groups (Group 1; SNR <10, Group 2; 10 ≤ SNR <50, Group 3; 50 ≤ SNR <100). One month and 6 months after cataract surgery, the manifest refraction spherical equivalents (MRSE) were measured. The mean numeric errors (MNE), the mean of the difference between postoperative MRSE, and preoperative target refraction, using the various intraocular lens (IOL) formulas, were calculated and compared among the three groups.ResultsOne month after cataract surgery, postoperative MRSE was more hyperopic than preoperative target refraction, calculated by the Haigis formula in group 1, and by the SRK/T formula in group 2. After 6 months, for all formulas in group 1, there were significantly hyperopic results (approximately 0.35 diopter). Upon comparison of MNE among the three groups, group 1 was statistically significantly different from the other groups by Haigis formula.ConclusionsWhen the SNR values in biometry, using IOLMaster, are <10, careful attention should be given to determining IOL power, as postoperative spherical equivalents are more hyperopic than preoperative target refraction by IOL formula.

Impact of ab-interno trabeculectomy on Bruch's membrane opening-based morphometry of the optic nerve head for glaucoma progression analysis.

To analyze the longitudinal change in Bruch's membrane opening minimal rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) after glaucoma surgery via ab-interno trabeculectomy in adult glaucoma patients. Retrospective audit of 65 eyes of 65 participants undergoing ab-interno trabeculectomy using electroablation of the trabecular meshwork. In 53 eyes, surgery was combined with phacoemulsification and posterior chamber lens implantation. Pre- and postoperative SD-OCT examinations of the optic nerve head (ONH), intraocular pressure (IOP), and visual field data were analyzed. Longitudinal change in morphometric SD-OCT parameters of the ONH was compared and correlated to change in IOP and visual field function. BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first 6months after surgery (BL = 167.85 ± 90μm; FU = 175.59 ± 89μm; p = 0.034). This increase correlated with postoperative lowering of IOP (rho= - 0.41; p = 0.016). Nine months after surgery (range, 7-12months), there was no significant change in BMO-MRW (BL = 196.79 ± 79; FU = 196.47 ± 85μm; p = 0.95), while in later follow-up, a decrease of BMO-MRW was found (BL = 175.18 ± 78; FU = 168.65 ± 72; p = 0.05). RNFL thickness was unchanged in early (p > 0.16) and significantly decreased in later follow-up (p = 0.009). Mean deviation (MD) of visual field function did not show a significant change before and after surgery. Electroablative ab-interno trabeculectomy leads to a significant transient mild increase in BMO-MRW. This increase was shown to correlate with IOP lowering. Significant loss of BMO-MRW in later follow-up may reflect insufficient IOP reduction by surgery. The parameters RNFL thickness and MD seem less impacted directly by surgery.

RETRACTED ARTICLE: Effective Lens Position According to Incision Width in Cataract Surgery Using Phacoemultification and Posterior Chamber Lens Implantation

Statement of RetractionRetraction: Effective Lens Position According to Incision Width in Cataract Surgery Using Phacoemultification and Posterior Chamber Lens ImplantationWe, the Editors, Publishers, and Authors of Seminars in Ophthalmology, have retracted the following article:Jiwon Baek, Kee-Sun Tae, Anna Lee, Man Soo Kim, and Eun Chul Kim (2018). Effective Lens Position According to Incision Width in Cataract Surgery Using Phacoemultification and Posterior Chamger Lens Implantation, Seminars in Ophthalmology 33:7-8, 846-851, DOI: 10.1080/08820538.2018.1534977The article is being retracted at the request of the authors and their institution, the Catholic University of Korea, Bucheon St. Mary's Hospital, after authors identified errors in subject randomization and concluded the resulting data and results are unreliable.We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as “Retracted.”

Preexisting epiretinal membrane is associated with pseudophakic cystoid macular edema.

The purpose of the present study was to evaluate whether preexisting epiretinal membrane (ERM) is a significant risk factor for developing pseudophakic cystoid macular edema (PCME). Two hundred four consecutive eyes and 153 consecutive eyes without preexisting epiretinal membranes were retrospectively compared regarding PCME development following phacoemulsification with posterior chamber lens implantation. Patients with vascular retinal diseases, uveitis, trauma, neovascular macular degeneration, chronic inflammatory conditions, diabetic retinopathy, endophthalmitis, eventful cataract surgery, and combination of cataract surgery and vitrectomy during the observation period were excluded. Macular examination was performed using spectral-domain optical coherence tomography (SD-OCT) before as well as at 4, 8, 12, 16, 24, and 36weeks after cataract surgery. Univariate and multivariate logistic regression analyses were calculated. PCME occurred in 32 of 204 eyes with preexisting ERM (15.7%), whereas 9 of 153 eyes without preexisting ERM (5.9%) developed PCME. The risk of PCME was significantly increased in eyes with ERM (p = 0.007). By multivariate logistic regression analysis, factors predictive of PCME included the history of previous pars plana vitrectomy for retinal detachment (odds ratio (OR) 3.619 [95% confidence interval (CI) 1.242 to 10.258]; p = 0.016) as well as the preexistence of ERM (OR 3.885 [95% CI 1.162 to 17.762]; p= 0.04). Preexisting ERM seems to be associated with an increased risk of PCME following cataract surgery. Therefore, this risk should be considered in surgery planning, preoperative medication, and follow-up care after surgery.

Combined Ab Interno Glaucoma Surgery Does not Increase the Risk of Pseudophakic Cystoid Macular Edema in Uncomplicated Eyes.

To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction. In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME. In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687). Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.

Comparison of Clinical Outcomes between Phacoemulsification and Laser Peripheral Iridotomy in the Spectrum of Primary Angle Closure Diseases of the Eye

Background: To compare clinical outcome between phacoemulsification and laser peripheral iridotomyin the spectrum of primary angle closure eyes.Methods: A literature review of databases were retrieved online through Pub-med, Clinical Key, andScience Direct, using keywords of ‘primary angle closure’, ‘primary angle closure glaucoma’, and‘acute primary angle closure’. In addition, all literatures involving the use of laser peripheral iridotomy(LPI) or phacoemulsification as a treatment in PAC diseases were included. Publications and journalsbefore the year 2000 were excluded.Results: There were 18 articles that fulfilled our inclusion criteria. All of the studies showed a decreasein IOP following cataract extraction or LPI, compared to baseline. This study also showed that thephacoemulsification group gave a significantly larger angle width increment when compare to LPI.When directly compared between phaco to LPI, the number of topical glaucoma medication was moredecreased in the phaco group, meanwhile the need for additional glaucoma surgery was higher in theLPI group.Conclusion: Phacoemulsification with posterior chamber lens implantation is more effective procedurethan LPI in lowering IOP and preventing IOP rise in long term follow up in PAC diseases. That surgerywill reduce the number of additional glaucoma medication and further glaucoma filtering surgery.Despite of superiority in phacoemulsification treatment, LPI is still the mainstay of initial treatment,especially in PAC eye diseases without cataract.Keywords: spectrum of primary angle closure eye disease, phacoemulsification, laser peripheral iridotomy, angle width

Travmatik Kataraktlı Çocuklarda Sklera Fiksasyonlu Arka Kamara Göz İçi Merceği

Objective: To report on the outcomes of posterior chamber lens implantation with scleral fixation (SFIOL) in children with traumatic cataract after 1 year. Material and Methods: Eleven eyes of eleven cases were included in the study. All patients had corneal or corneoscleral lacerations that were primarily repaired except one patient. Traumatic cataract subsequently developed and SFIOL was performed due to insufficient posterior capsule support. Pre-operative and post-operative best corrected visual acuity (BCVA), intraocular pressure (IOP), intraocular lens (IOL) position, anterior chamber reaction, and retinal evaluation were analyzed via retrospective medical record review. Results: From 2013-2015, 11 SFIOLs were implanted in 11 children with traumatic cataracts. The average age of the patients was 8.2 years (range: 5 to 14 years). All cases had SFIOL implanted via internal route using triangular double scleral flaps made of 10-0 polypropylene after a complete anterior vitrectomy. Average follow-up was 16.57±3.41 months (range: 12 to 26 months). Visual acuity was increased at the last visit in all patients (p<0.05). Common postoperative complications were fibrinous reaction in 5 (46%) patients, vitreous hemorrhage in 4 (36%) patients, and transient intraocular pressure increase in 2 (18%) patients. Results showed no evidence of complications after the postoperative first year. Conclusion: SFIOL is an effective and reliable method in patients with pediatric traumatic cataract who had insufficient posterior capsule support who are lacking other means for visual rehabilitation.

Pars Plana Vitrectomy Combined With Either Secondary Scleral-Fixated or Anterior Chamber Intraocular Lens Implantation

To compare visual outcomes among eyes that underwent pars plana vitrectomy (PPV) in combination with either anterior chamber intraocular lens implantation (ACIOL) or scleral suturing of posterior chamber lens (PCIOL). Retrospective comparative case series. All eyes presented with aphakia or luxated or subluxated posterior chamber intraocular lens (IOL) following complicated cataract surgery, trauma, or spontaneous dislocation. Eyes involving visually significant macular pathology, past retinal detachment, follow-up of less than 6months, and surgeries requiring the removal of an ACIOL were excluded. The main outcomes measured were final best-corrected visual acuity (BCVA) and surgical complication rates. Fifty-seven eyes met inclusion criteria; median follow-up was 13.2months. Initial median BCVA for ACIOL patients was logMAR 1.301 (Snellen equivalent 20/400, range 20/20 to light perception); final median BCVA was logMAR 0.477 (Snellen equivalent 20/60, range 20/20 to light perception, P < .001). Initial median BCVA for PCIOL patients was logMAR 1.239 (Snellen equivalent 20/347, range 20/60 to light perception); final median BCVA was logMAR 0.301 (Snellen equivalent 20/40, range 20/20 to hand motions, P < .001). The change in BCVA between the 2 groups over the course of the study was similar (P > .05). More epiretinal membrane (ERM) formations occurred postoperatively in the ACIOL group (P= .011). Other complication rates were similar between both groups. PPV with secondary IOL placement is safe and effective, resulting in improved visual outcomes regardless of the technique used. Patients undergoing ACIOL placement have a higher incidence of ERM formation.

Modified Small Incision Cataract Surgery and Intraocular Lens Implantation in HIV Patients.

AIMTo describe a surgical technique suitable for cataract surgery in regions with a high prevalence of HIV infection.METHODSWe reviewed the medical records of 20 consecutive AIDS patients with cataract who underwent modified small-incision cataract surgery (mSICS) with posterior chamber lens implantation. Classic extracapsular cataract extraction (ECCE) was compared to mSICS. The number of potentially risky steps for contamination during surgery and duration of surgery were analyzed. A risky step was defined as any time when the surgeon had to use a sharp instrument. Student’s paired t-test was carried out to compare continuous variables, and P-values <0.05 were considered statistically significant.RESULTSTwenty patients were included in the study, 13 males (65%) and seven females (35%). The mean age was 46.3 ± 13.6 years (range 22–70 years). The number of potentially risky steps for contamination was significantly higher in the classical ECCE than in mSICS (P < 0.001). The mean duration of cataract surgery with mSICS was significantly shorter as well (P < 0.001).CONCLUSIONConversion to mSICS is essential in order to reduce accidental injuries during cataract surgery in sub-Saharan countries. Sharp instruments should be passed through a neutral zone to ensure that the surgeon and nurse do not touch the same instrument at the same time.