Intraocular Lens Exchange Surgery Research Articles

Intraocular Lens (IOL) Exchange Procedure in Refractive Surprise After Ten Years of Cataract Surgery

Introduction: Postoperative refractive surprises may manifest following cataract surgery. A residual refraction difference of > 2.0 D after cataract surgery was considered a refractive surprise. Treating refractive error after cataract surgery includes non-surgical and surgical options. The objective is to report clinical outcomes of intraocular lens (IOL) exchange with ciliary sulcus placement technique to manage refractive surprise. Case Presentation: A female patient aged 70 years reported experiencing blurred vision in her right eye (RE) for the past two years. History of RE cataract surgery ten years ago, however, she only had control 1-2 times after surgery. After that, the patient underwent cataract surgery on the left eye (LE), and then she complained that her RE was getting blurry. Her RE's visual acuity (VA) was 1/60 with best corrected visual acuity (BCVA) S-8.00 C-1.00 X100° to 6/10, and her LE was 7/10 with BCVA C-0.75 X60° to 10/10. The anterior segment examination of the RE was a 3-piece sulcus intraocular lens with complete continuous curvilinear capsulorhexis (CCC) intact anterior capsule, posterior capsule rupture, and the LE was in the bag IOL. Ultrasound examination of the RE revealed posterior staphyloma. She was diagnosed with OD refractive surprise, pseudophakia, posterior staphyloma, and OS pseudophakia. She underwent IOL exchange surgery on her RE. Post-operatively, the visual acuity of the RE was 7/45 using the Snellen chart. Three months post-op, the BCVA of RE was 10/10. Conclusions: In well-prepared cataract surgery, unexpected refractive outcomes such as a refractive surprise can be prevented. IOL exchange with ciliary sulcus placement technique is a treatment option for refractive surprise associated with posterior capsule rupture, and it has a good outcome.

10-Year Outcomes of Pediatric Cataract Surgery with Foldable Intraocular Lens Implantation and Posterior Continuous Curvilinear Capsulorhexis.

We investigated the long-term outcomes of pediatric cataract surgeries performed with modern surgical techniques involving in-the-bag implantation of a foldable intraocular lens (IOL). Data were retrospectively collected from 42 eyes in 30 patients who underwent surgery at 6 years and younger (average 2.5 ± 2.3 years) and were followed up for an average of 12.2 ± 2.4 years (10-17 years). Surgical procedures included anterior continuous curvilinear capsulorhexis (CCC), lens removal, posterior CCC, anterior vitrectomy, and in-the-bag IOL implantation. There were 18 unilateral (2.7 ± 2.3 years) and 12 bilateral cases (2.3 ± 2.3 years), with no significant age difference between groups (p = 0.462). The mean best-corrected visual acuity (BCVA) at the final visit was 0.453 ± 0.488 (logMAR), correlating significantly with the age at surgery (r = -0.307, p = 0.048). The unilateral group had a worse BCVA (0.658 ± 0.615) than the bilateral group (0.298 ± 0.294) (p < 0.001). On average, eyes showed a myopic shift of -6.0 ± 6.3D, which significantly correlated with surgical age (r = 0.402, p = 0.008). While the myopic shift was -8.2 ± 6.1 D in the unilateral group and -4.9 ± 6.4 D in the bilateral group, the net shift for unilateral cases (comparing pseudophakic and fellow eyes) was -4.8 D. Three eyes (7.1%) exhibited suspected glaucoma (increased intraocular pressure), but no glaucoma or other severe complications were noted. IOL exchange surgery was necessary in two eyes (4.8%) due to pronounced myopic drift and significant IOL decentration. Three eyes (7.1%) required surgery for significant visual axis opacification. Contemporary surgical strategies appear to yield promising long-term outcomes in patients with infantile cataracts.

Differential Diagnosis of Changes in Intraocular Lenses.

Differentiating between various intraocular lens (IOL) changes can be a challenge. In particular, certain IOL models carry the risk of late postoperative calcification. A major cause of IOL exchange surgery could be avoided if appropriate modifications were made during the IOL manufacturing process. The use of a hydrophilic acrylate carries the risk of IOL calcification, especially when a secondary procedure, such as a pars plana vitrectomy or other procedures using gas or air, is performed. In secondary IOL calcification, there is a wide range of opacification patterns, which are usually located in the centre on the anterior surface of the IOL or sometimes elsewhere. Often, granular deposits accumulate just below or on the surface of the IOL, leading to significant deterioration in visual quality and eventually requiring IOL exchange surgery. Therefore, in the case of eyes requiring secondary surgical intraocular intervention in the future, the use of hydrophilic IOLs should be critically evaluated. With regard to hydrophobic IOL materials, there are clear differences in the susceptibility to the formation of glistenings. Over time, there has been a significant decrease in glistening formation over the past 30years due to optimisation of the material. With hydrophobic IOLs, special care should also be taken to avoid mechanical damage. In general, the only treatment option for functionally-impairing IOL opacification is surgical lens exchange, which carries potential risks of complications. In cases with a low degree of functional impairment, and especially in eyes with additional ocular diseases, it may be difficult to weigh the risk of additional surgery against the potential benefit. In some cases, it may be more appropriate not to perform an IOL exchange despite the IOL opacification. Recent visualisation methods that allow high-resolution analysis of the opacities in vivo and in vitro may be used in the future to estimate the functional effects of various IOL material changes on the optical quality.

Indications, Complications, and Early Postoperative Course of Recovery of Intraocular Lens Exchange Surgery: a Single-Center Retrospective Study

To analyze the indications, complications, and early course of recovery of intraocular lens (IOL) exchange surgery. Records of patients who underwent IOL exchange during a 6-year period at a tertiary referral center were reviewed and the indications and complications after surgical intervention were analyzed. Their effects on postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), use of IOP-lowering medications, and refractive cylindrical power were assessed. One hundred and seventy-one eyes (165 patients) were investigated. The most frequent indication for IOL exchange was lens dislocation in 163 eyes (95.32%). The main causes of IOL dislocation were pseudoexfoliation syndrome (PEX) in 98 eyes (57.31%) and complications during cataract surgery in 40 eyes (23.39%). During IOL exchange, an anterior iris-claw fixation was performed in 159 eyes (92.98%). After significant initial deterioration to 1.59 ± 1.08 logMAR on postoperative day 1 (p ≤ 0.001), the CDVA recovered to preoperative levels within 28 days. A significant decrease in IOP was observed on postoperative day 1 (p = 0.04). The most common postoperative complications were corneal edema in 114 eyes (66.67%) and vitreous hemorrhage in 67 eyes (39.18%). The high early postoperative prevalence of corneal edema and intraocular hemorrhage was found to affect visual recovery after IOL exchange, causing a significant initial deterioration of CDVA and a delay of full visual recovery. These findings suggest that surgical approaches minimizing the risk of this type of complications should be favored.

Cases of replacing diffractive bifocal intraocular lens with extended depth of focus intraocular lens due to waxy vision.

PurposeTo investigate the postoperative course of patients who explanted a diffractive bifocal intraocular lens (IOL) due to waxy vision and implanted with an extended depth of focus IOL.MethodsThis study evaluated 29 eyes of 25 patients who underwent diffractive bifocal IOL explantation followed by TECNIS Symfony® implantation because of dissatisfaction due to waxy vision at the Takabatake West Eye Clinic between January 2018 and November 2019. The indication criteria for this surgery were patients with uncorrected distance visual acuity of 0.05 logMAR or better, without eye diseases that may affect visual function, and no dissatisfactions about photic phenomena. We investigated patient demographics, uncorrected and corrected visual acuity, manifest refraction, contrast sensitivity, subjective symptoms, time to IOL explantation, explanted IOL type, and spectacle independence.ResultsThe time to the IOL exchange after the initial IOL implantation was 55.3 ± 50.4 days (range: 14–196 days). The logMAR corrected distance visual acuity before and after IOL exchange were −0.13 ± 0.06 and −0.14 ± 0.06, respectively (p = 0.273). After IOL exchange surgery, the area under log contrast sensitivity function increased significantly from 1.07 ± 0.12 to 1.21 ± 0.12 (p < 0.001), and the waxy vision symptoms improved. The spectacle independence rate at the last visit was 88.0%.ConclusionFor patients who complain of waxy vision despite good visual acuity after diffractive bifocal IOL implantation, exchange to extended depth of focus IOL was considered one of the useful surgical options.

Intraocular lens exchange surgery at a tertiary referral center: Indications, complications, and visual outcomes

To identify indications for and visual outcomes of intraocular lens (IOL) exchange to understand recent changes in this surgery. Academic tertiary referral center. Retrospective case series. Cases were identified by searching the institution's electronic medical records from January 2010 to September 2015 for patients treated by 1 staff physician with the American Medical Association's Current Procedural Terminology code for IOL exchange. These cases were reviewed to determine the surgical indication, type of IOL removed, type of IOL implanted, time between surgeries, surgical complications, and visual outcomes. The study comprised medical records of 109 eyes. The mean time between the primary cataract surgery and IOL exchange was 1657days. Dislocation of an in-the-bag posterior chamber IOL (27.5%), intolerance of a multifocal IOL (18.3%), and uveitis-glaucoma-hyphema syndrome (11.9%) were the most frequent indications for IOL exchange. The final IOL position after exchange was most frequently in the capsular bag (43.1%), anterior chamber (25.7%), or sulcus(22%). The final visual acuity at 1month was 20/40 or better in 78.9% of cases. Of those not achieving this level of acuity, pathology not related to exchange surgery was identified in 48% of cases. The most frequent complications after IOL exchange surgery were posterior capsule opacification (13.8%), cystoid macular edema (10.1%), and high astigmatism (>1.5 diopters) (8.3%). The most frequent indication for IOL exchange surgery was dislocated IOLs; the second most frequent indication was patient dissatisfaction after multifocal IOL implantation. The increased ability to place an intracapsular IOL with few intraoperative complications and largely treatable postoperative complications enhances the effectiveness of IOL exchange surgery and patient satisfaction. Neither author has a financial or proprietary interest in any material or method mentioned.

Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital.

Objectives:To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL) in a tertiary referral eye hospital.Materials and Methods:Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease.Results:The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX) was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively.Conclusion:IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery.

Wrong intraocular lens events—what lessons have we learned? A review of incidents reported to the National Reporting and Learning System: 2010–2014 versus 2003–2010

PurposeTo identify the causal factors in wrong intraocular lens (IOL) events from a national data set and to compare with similar historical data (2003-2010) prior to mandatory checklist use, for the purpose of developing strategies to prevent never events.MethodsData from wrong IOL patient safety incidents (PSIs) submitted to the National Reporting and Learning System (2010-2014) were reviewed by thematic analysis and compared with the data previously collected by the group using the same methodology.ResultsOne hundred and seventy eight wrong IOL PSIs were identified. The contributory factors included: transcription errors (n=26); wrong patient biometry (n=21); wrong IOL selection (n=16); changes in planned procedure (n=16); incorrect IOL brought into theatre (n=11); left/right eye selection errors (n=9); communication errors (n=9); and positive/negative IOL power errors (n=9). In 44 PSIs, no causal factor was reported, limiting the learning value of such reports. Compared with the data from previous years, biometry errors were much reduced but IOL transcription and documentation errors were greater, particularly if further checks did not refer to the original source documentation. IOL exchange surgery was reported in 45 cases.ConclusionsThe selection and implantation of the correct IOL is a complex process which is not adequately addressed by existing checking procedures. Despite the introduction of surgical checklists, wrong IOL incidents continue to occur and are probably under-reported. Human or behavioural factors are heavily implicated in these errors and need to be addressed by novel approaches, including simulation training. There is also scope to further improve the quality and detail of incident reporting and analysis to enhance patient safety.

Multifocal Intraocular Lens Explantation: A Case Series of 50 Eyes

To assess the visual complaints, reasons, and patient satisfaction for multifocal intraocular lens (IOL) explantation. Retrospective observational case series. This study evaluated 50 eyes of 37 patients who underwent multifocal IOL explantation followed by IOL implantation. Before and 3 months after IOL exchange surgery, we investigated the symptoms, reasons, patient demographics, clinical results, and patient satisfaction in eyes undergoing multifocal IOL explantation. Data collected included preoperative subjective and objective findings, reasons, IOL type, postoperative course, and patient satisfaction. The most common complaints for IOL explantation were waxy vision, followed by glare and halos, blurred vision at far, dysphotopsia, blurred vision at near, and blurred vision at intermediate. The most common reasons for IOL explantation were decreased contrast sensitivity, followed by photic phenomenon, unknown origin including neuroadaptation failure, incorrect IOL power, preoperative excessive expectation, IOL dislocation/decentration, and anisometropia. The axial length was 25.13±1.83 mm. Of the explanted multifocal IOLs, 84% were diffractive and 16% were refractive. Monofocal IOLs accounted for 90% of the exchanged IOLs. Patient satisfaction was significantly improved from 1.22±0.55 preoperatively to 3.78±0.97 postoperatively, which was graded on a scale of 1 (very dissatisfied) to 5 (very satisfied) (Wilcoxon signed-rank test, P<.001). Multifocal IOL explantation was required in some patients undergoing multifocal IOL implantation. IOL exchange surgery appears to be a feasible surgical option for dissatisfied patients with persistent visual symptoms after multifocal IOL implantation.

Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses

To evaluate the perioperative complications and the outcomes of intraocular lens (IOL) exchange in patients with opacified lenses. Retrospective multicentrical consecutive series of cases that comprised 22 eyes from 21 patients who had previous phacoemulsification with implantation of an IOL in the capsular bag and developed severe late opacification of the IOL. All patients had loss of vision and reported light disturbances. The IOLs were explanted and replaced with new IOLs. The perioperative complications were evaluated. The best spectacle-corrected visual acuity (BSCVA) before and after the surgery was compared. The mean time lapsed between the original cataract surgery and the IOL exchange surgery was 89.1 ± 33.6 [48-216] months. The IOL exchange was uneventful in 14 eyes (63.6 %). Anterior vitrectomy was needed in seven cases (31.8 %). Other complications included zonular dehiscence in one case (4.5 %). In most of the cases, 14 eyes (63.6 %), the IOL was implanted in the sulcus. The most explanted IOL was the Hydroview H60M (Bausch & Lomb). The mean BSCVA (LogMAR) before and after the surgery were 0.57 ± 0.69 (0.10-3) and 0.18 ± 0.22 (0.0-1.10) respectively (t paired test, p < 0.001). After the operation, 20 eyes (90.9 %) achieved a BSCVA ≤ 0.3. No eye lost 1 or more lines of corrected vision after the surgery. IOL exchange surgery, although associated with a high incidence of complications, restores and significantly improves the visual acuity of patients with opacified IOLs.

Wrong intraocular lens implant; learning from reported patient safety incidents

To consider wrong intraocular lens (IOL) implant events in cataract surgical care reported through a national incident reporting database. To propose potential solutions for such events where possible. Thematic retrospective review of wrong IOL implantation incidents, as reported through clinical incident reporting methods in NHS care in England and Wales from 2003 to 2010, ascertained from database mining at the National Patient Safety Agency. In total, 164 patient safety incident (PSI) reports of wrong IOL implantation were located from the study period and considered. There were 47 reports where further surgical intervention was required. All, but one of these required IOL exchange surgery. A total of 62 reports did not provide any causal reason for the wrong IOL implantation and thus provide little if any potential learning. Inaccurate biometry (n=29), wrong IOL selection (n=21), transcription errors (n=10) and handwriting misinterpretations (n=7) were causal reasons reported and are thus potential areas for ophthalmic teams to review and improve practice. Although infrequent, biometry/IOL implant errors or wrong implants do occasionally occur during cataract care and are thus a threat to quality. There is room for improvement in incident reporting in NHS cataract care as root causation of error was usually lacking in the PSI reports. Nevertheless, lessons for improvement of care from a national incident reporting database for a frequently undertaken surgical procedure were found. Suggestions are proposed for improving quality by reducing wrong IOL problems in cataract care based on analysis of such reports.

Repeatability of Peripheral Aberrations in Young Emmetropes: Erratum

To report an unfortunate case of patient selection for multifocal intraocular lens (MIOL) implantation. Interventional case report. A 69-year-old woman with bilateral corticonuclear cataract underwent uneventful phacoemulsification with diffractive MIOL implantation within 1 week. She reported no previous medical history. A few days later she had persisting dizziness and experienced extreme photic phenomena, which progressively deteriorated. After intensive conversation, we discovered that our patient had a medical history of Meniere's disease. Bilateral intraocular lens exchange surgery was performed. One week after monofocal intraocular lens implantation, the patient was satisfied with the final visual outcome and did not report any visual complaints. Retinocortical processing of visual information is impaired in patients with peripheral vestibular disorders such as Meniere's disease. Therefore, these patients are probably not good candidates for MIOL implantation, which requires an intact sensory system with rigorous visuovestibular interaction.

Evaluation of anterior segment parameter changes using the Pentacam after uneventful phacoemulsification

This study set out to evaluate the influences of uneventful phacoemulsification on the anterior segment parameters obtained with the Pentacam rotating Scheimpflug camera and intraocular pressure (IOP). A total of 42 eyes of 34 patients (26 men, eight women) were evaluated preoperatively, and at 1, 3 and 6 months postoperatively with the Pentacam. Intraocular pressure was measured with the Goldmann applanation tonometer. The non-parametric paired t-test was used to compare preoperative and 1-, 3- and 6-month postoperative measurements of anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), the central 3-, 5- and 7-mm corneal volume (CV), pupil size, and IOP. Pearson's correlation test was used to evaluate the relationships between IOP and ACD, ACV and ACA width. The differences between ACD, ACV, ACA and IOP values taken preoperatively and those taken postoperatively at 1, 3 and 6 months were statistically significant (p<0.05). The differences between CCT, central 3-, 5- and 7-mm CV, and pupil size measurements taken preoperatively and those taken postoperatively at 1, 3 and 6 months were not statistically significant (p>0.05). The decrease in IOP was not correlated with the changes in ACD, ACV and ACA (p>0.05). Uneventful phacoemulsification significantly reduced IOP, increased ACD and ACV, and widened the ACA. However, alterations in CV, CCT and pupil size values were not statistically significant. Alterations in ACD, ACV, ACA and IOP remain stable after the first month of surgery.

Intraocular lens exchange surgery in dissatisfied patients with refractive intraocular lenses

To evaluate surgical outcomes after intraocular lens (IOL) exchange of refractive IOLs in dissatisfied patients. Bascom Palmer Eye Institute, Palm Beach Gardens, Florida, USA. This retrospective case series comprised dissatisfied patients who sought consultation and subsequently had IOL exchange surgery to remove a refractive IOL. Data collected included preoperative subjective and objective findings, surgical technique, and postoperative course. Ten patients (12 eyes) had IOL exchange. All patients had subjective visual symptoms before IOL exchange surgery. Despite this, the preoperative corrected distance visual acuity (CDVA) was 20/30 or better in all eyes. During IOL exchange surgery, a monofocal IOL was placed in the capsular bag or the ciliary sulcus. Adjunctive anterior vitrectomy was performed as indicated for vitreous prolapse. The median follow-up after IOL exchange surgery was 8.9 months. Eight patients (10 eyes) were satisfied with the results of the IOL exchange surgery, while 2 patients said their initial symptoms persisted after the exchange. The CDVA was 20/25 or better in 9 eyes at 1 month. The CDVA in the remaining 3 eyes improved to 20/25 or better at 3 months (2 patients) or 6 months (1 patient). One patient had a complicated postoperative course that necessitated repeat IOL exchange with scleral fixation due to inadequate capsule support. Another patient had corneal decompensation after the IOL exchange surgery. Results show that IOL exchange is a feasible option for dissatisfied patients with persistent visual symptoms after refractive IOL placement.

Possible Predisposing Factors for In-the-Bag and Out-of-the-Bag Intraocular Lens Dislocation and Outcomes of Intraocular Lens Exchange Surgery

To examine the possible predisposing factors for intraocular lens (IOL) dislocation within the capsular bag (in-the-bag dislocation) and IOL dislocation outside of the capsule (out-of-the-bag dislocation) and to study surgical outcomes of explantation of dislocated IOLs and scleral suturing of posterior chamber IOLs. Retrospective interventional case series. Thirty-eight eyes of 38 patients who developed in-the-bag IOL dislocation and 24 eyes of 24 patients who experienced out-of-the-bag dislocation. Medical records of 62 consecutive patients who underwent IOL exchange surgery for dislocation between 1999 and 2005 were reviewed. Possible predisposing factors and the other characteristics of in-the-bag and out-of-the-bag IOL dislocations; outcomes of IOL exchange surgery, including visual acuity (VA) and refractive status before and at 12 months after surgery; and serious postoperative complications. Possible major predisposing factors for in-the-bag IOL dislocation were pseudoexfoliation (17/38 [44.7%]), retinitis pigmentosa (4/38 [10.5%]), the status after vitrectomy (2/38 [5.3%]), trauma (2/38 [5.3%]), and a long axis (2/38 [5.3%]), whereas those for out-of-the-bag dislocation were secondary IOL implantation (11/24 [45.8%]), surgical complications (3/24 [12.5%]), mature cataract (3/24 [12.5%]), and pseudoexfoliation (2/24 [8.3%]). The interval between IOL implantation and exchange surgery was significantly shorter for the in-the-bag dislocation group than for the out-of-the-bag dislocation group (P = 0.0006). Mean uncorrected VA improved significantly after IOL exchange (P = 0.0080), and corrected VA also tended to improve, although the improvement was not significant (P = 0.0704). Mean absolute value of spherical power decreased significantly after surgery (P = 0.0008), whereas refractive astigmatism showed a significant increase (P = 0.0003). The primary serious complications after surgery were a marked rise in intraocular pressure (12/62, 19.4%), retinal detachment (4/62, 6.5%), and redislocation (2/62, 3.2%). Possible major predisposing factors for in-the-bag IOL dislocation are pseudoexfoliation, retinitis pigmentosa, the status after vitrectomy, and trauma, whereas those for out-of-the-bag dislocation are secondary implantation, surgical complications, and mature cataract. After IOL exchange surgery, corrected VA does not improve markedly. Because the incidence of postoperative complications after IOL exchange with scleral suturing is high, the use of other surgical techniques should be considered.

Clinical analysis of intraocular lens exchange surgery

目的 探讨临床行人工晶状体置换术的原因、手术方法和效果.方法回顾性分析7例(8眼)人工晶状体置换术的原因,总结于术方法,对手术效果进行观察.结果人工晶状体置换术的原因包括人工晶状体浑浊5例(6眼),人工晶状体屈光度数错误2例(2眼).手术方法为人工晶状体取出和另一枚人工晶状体囊袋内植入.术后最佳矫正视力≥0.5者7眼(87.50%),0.25者1眼(12.50%).术后并发症为散光2眼.结论人工晶状体浑浊和屈光度数错误是人工晶状体置换术的原因,人工晶状体置换术是解决人工晶状体异常的有效方法。

Secondary closure of neodymium:YAG laser posterior capsulotomy

A 67-year-old man reported reduced vision after cataract surgery and neodymium:YAG (Nd:YAG) laser posterior capsulotomy. The diagnosis was complicated due to severe glistenings within the optic of an acrylic foldable intraocular lens (IOL), proliferation of lens epithelial remnants over the capsulotomy opening, and presumed vitreous opacity. Although IOL exchange surgery was considered, a second Nd:YAG laser intervention successfully removed the proliferated lens materials and restored the visual acuity. The glistenings were not the cause of the reduced vision.

Inaccuracy of intraocular lens power calculation after traumatic corneal laceration and cataract

A 53-year-old man sustained a perforating, central corneal injury with a nail in his right eye. After primary repair of the laceration, a traumatic cataract was removed and a Multiflex-style intraocular lens (IOL) was inserted. A 4.00 diopter surprise resulted, probably due to calculation of the IOL power using measurements from the contralateral normal eye. Inability to wear a contact lens for visual correction resulted in IOL exchange surgery in which a sulcus-sutured IOL was implanted. The IOL power was calculated using simulated keratometry from videokeratoscopy and axial length measurements of the injured eye. This resulted in an IOL power closer to emmetropia, allowing for a best spectacle-corrected visual acuity of 20/20 and comfortable wearing of spectacles.