Intraocular Lens Pupillary Capture Research Articles

Characteristics and Risk Factors for Pupillary Capture of Intraocular Lens in Congenital Ectopia Lentis

ABSTRACTImportance: To analyze the characteristics and risk factors for pupillary capture (PC) of the intraocular lens (IOL) in congenital ectopia lentis (CEL) patients.Methods: Data of CEL patients who underwent lens extraction and intraocular implantation from 2013 to 2016 at Zhongshan Ophthalmic Center in China were collected. Best-corrected visual acuity (BCVA), axial length (AL), refractive status, corneal curvature, intraocular pressure (IOP), degree of lens dislocation, presence of strabismus, and methods of IOL fixation were recorded. Postoperative data were collected from the routine one-month postoperative follow-up. Patients with PC of IOL were characterized and risk factors for PC of IOL were analyzed using age-sex adjusted multiple logistic regression analysis.Results: Of the 89 included CEL subjects, 43.8% (39/89) of them suffered from PC after IOL implantation. There was no statistically significant difference in BCVA, AL, refractive status and IOP between the eyes which developed PC versus those which did not. Age-sex multiple logistic regression analysis shows that PC of IOL was associated with a more severe degree of lens dislocation and eyes with strabismus before surgery.Conclusions: Eyes with strabismus and more severe degrees of lens dislocation before surgery are risk factors for PC of IOL. When treating patients that present these risk factors, preoperative communication, and postoperative follow-up should be strengthened. Considering that PC of IOL has little effect on visual acuity, patients with slight PC of IOL can be exempt from surgical intervention.

Intermittent pupillary capture of intraocular lens after transscleral fixation in congenital ectopia lentis patient triggered by dark environment

Rationale:Although transscleral-fixated intraocular lens (IOL) implantation has been the most frequently chosen treatment for patients with inadequate capsule support, the ghost pupillary capture phenomenon did not cause enough attention.Patient Concerns:We present an unusual case withintermittent pupillary capture of intraocular lens.Diagnosis:After 5 minutes staying in the dark environment, the pentacam examination revealed a mild nasal pupillary capture of the IOL.Interventions:A clear observation using the slit-lamp was attempted, and the light shining on the pupil sped up the sliding of the captured IOL.Outcomes:The captured portion of the IOL recovered rapidly accompanied with pupil retraction when the patient was exposed in the light.Conclusions:Pupillary capture of an IOL is an uncommon but potentially serious postoperative complication of transscleral fixation. Many pupillary capture cases may have been overlooked in the past. Physicians should be aware of its potential side effect, recognize its clinical manifestation, and knowledgeable of effective management.

Safety Barricade Suture for Preventing Pupillary Capture of Intraocular Lens With Scleral Fixation: H-Technique.

Safety Barricade Suture for Preventing Pupillary Capture of Intraocular Lens With Scleral Fixation: H-Technique.

ANATOMICAL AND VISUAL OUTCOMES OF MACULAR HOLE SURGERY WITH SHORT-DURATION 3-DAY FACE-DOWN POSITIONING

The role of face-down posturing after macular hole (MH) surgery remains unclear and controversial. We evaluated the anatomical and visual outcomes of MH repair using a short duration (3 days) of prone positioning. Prospective series of 50 consecutive eyes in 50 patients with Stage 2 or Stage 3 idiopathic MHs. All eyes underwent vitrectomy MH surgery with internal limiting membrane peeling and 20% sulfur hexafluoride (SF6) gas tamponade. The procedure was combined with phacoemulsification cataract surgery in phakic eyes. Surgical outcomes, MH closure rates, complications, and postoperative visual acuity were investigated. Anatomical closure of MHs was achieved in 49 (98%) of 50 eyes by 1 surgery. Postoperative logarithm of the minimum angle of resolution visual acuity decreased (i.e., improved) by 0.271 (95% confidence interval, 0.101-0.441 [P = 0.0024]). One complication of intraocular lens pupillary capture and one case of chronic cystoid macular edema were observed. There were no complications attributed to intraocular pressure fluctuations. Vitrectomy with internal limiting membrane peeling and gas tamponade with SF6 followed by short-duration 3-day face-down positioning is a successful surgical intervention for Stage 2 and Stage 3 idiopathic MHs. This method possessed minimal complications and offered significant improvement in visual acuity.

Prospective Randomized Comparative Study of the Effect of Pupil Dilation or Miosis in Intraocular Lens Pupillary Capture After Combined Phacoemulsification and Vitrectomy With Intraocular Tamponade.

The objective of the study was to compare the safety and efficacy of postoperative pharmacological pupil dilation, miosis, and alternate-day pupil dilation and miosis after combined phacoemulsification (phaco), intraocular lens (IOL) implantation, and pars plana vitrectomy (PPV) with intraocular tamponade. This was a prospective, randomized controlled clinical trial. Patients who were indicated for phaco with IOL implantation, PPV, and intraocular tamponade were randomly assigned into 3 different groups: (1) pupil dilation using 4% homatropine (dilation group), (2) pupil miosis using 1% pilocarpine (miosis group), and (3) alternate-day pupil miosis and dilation starting with 1% pilocarpine on the first day postoperatively and switched to 4% homatropine thereafter on alternate days (alternate-day group). The main outcome measured was the rate of IOL capture postoperatively. The secondary measurable outcomes were the complication rates, visual acuity, and ease of fundal examination with binocular indirect ophthalmoscopy. Twenty-two, 21, and 20 eyes were allocated to the dilation, miosis, and alternate-day groups, respectively. Intraocular lens capture was found in 7 (11.1%) of 63 eyes. Intraocular lens was captured in 6 (27.3%) of 22 eyes in the dilation, 1 (4.5%) of 21 eyes in the miosis, and none in the alternate-day groups (P = 0.0133). The difference of the visual acuity among the 3 groups was not statistically significant (P = 0.650). Anterior chamber reaction of more than +1 cell in the first week was found in 6 (27.3%) of 22, 13 (61.9%) of 21, and 10 (50%) of 20 eyes in the dilation, miosis, and alternate-day groups, respectively (P = 0.074). Although more eyes were found with posterior synechia in the miosis group, the difference was not statistically significant (P = 0.478). The number of eyes that had suboptimal binocular indirect ophthalmoscopy view was 3 (13.6%) of 22, 12 (57.1%) of 21, and 6 (30%) of 20 in the dilation, miosis, and alternate-day groups, respectively (P = 0.01). Pupil dilation after combined phaco with IOL implantation, PPV, and intraocular tamponade could lead to a higher chance of IOL capture. Pupil miosis may lead to more anterior chamber inflammation. The regimen of alternate pupil dilation and miosis may cause less chance of IOL capture.

Clinical observation of delayed uveistis after cataract extraction with intraocular lens implantation

目的 探讨手法小切口白内障囊外摘出人工晶状体植入术术后迟发性葡萄膜炎的临床特点、治疗方法和预防措施.方法 回顾分析226例(239眼)手法小切口白内障囊外摘出人工晶状体植入术的11例(11眼)发生迟发性葡萄膜炎的临床资料.结果 手法小切口白内障囊外摘出人工晶状体植入术术后迟发性葡萄膜炎的发生率为4.60%,多数发生于术后2～3周.应用散瞳剂,糖皮质激素,非甾体消炎药等进行治疗,3～10 d前房炎症完全控制,视力恢复良好,1例人工晶状体瞳孔夹持.结论 迟发性葡萄膜炎是手法小切口白内障囊外摘出人工晶状体植入术术后出现较晚的并发症,对术后恢复良好的视力又造成严重损害,及早诊断和治疗效果良好。

Long-term Safety and Functional Outcome of Combined Pars Plana Vitrectomy and Scleral-Fixated Sutured Posterior Chamber Lens Implantation

To investigate the complication profile and the long-term functional outcome of combined pars plana vitrectomy and scleral-fixated sutured posterior chamber lens (PC IOL) implantation. Retrospective, consecutive, interventional case series. The records of 63 patients (mean age, 67.5 years) were reviewed retrospectively (follow-up, 12 to 132 months; mean, 43.5 months). The underlying ocular pathologic features; the intraoperative, early (within two weeks after surgery), and late complications (more than two weeks after surgery); final best-corrected visual acuity (BCVA); and the refractive outcome were recorded. Fifty-nine of 63 procedures (93.7%) were performed without complications. Intraoperative complications included vitreous hemorrhage (n = 2), a retinal tear (n = 1), and a rupture of the iris base (n = 1). Early complications included transient raise of intraocular pressure (IOP; n = 19), transient vitreous hemorrhage (n = 2), scleral tunnel insufficiency (n = 5), pupillary capture of intraocular lens [IOL] (n = 6), persistent vitreous (n = 3), and choroidal hemorrhage (n = 1). Late complications occurred in 12 patients: rhegmatogenous retinal detachment (n = 4), proliferative vitreoretinopathy retinal detachment secondary to the underlying ocular pathologic features (n = 2), choroidal hemorrhage (n = 1), macular pucker (n = 1), and IOL dislocation (n = 4), including two cases of suture break. Mean BCVA in logarithm of the minimum angle of resolution units improved significantly from 1.025 (standard deviation [SD], 0.654) to 0.766 (SD, 0.750; P = .03). Mean cylindric equivalent significantly changed from 0.92 diopters (D; SD, 1.075) to 1.76 D (SD, 1.344; P = .005). The surgical procedures were performed safely in approximately 94% of patients. Most postoperative complications were minor: significant ones occurred in approximately 20%, whereas suture breaks were observed rarely. The only moderate long-term functional improvement in this case series was mainly determined by the underlying ocular pathologic features.

The causes and reposition of fixed intraocular lens pupillary capture in children

To analyze the cause of fixed intraocular lens (IOLs) pupillary capture in children and investigate the rational methods to reposit intraocular lens. Thirty-one eyes (30 cases) with fixed intraocular lens pupillary capture under 14 years old were analyzed based on clinical data; the causes and the complications were also evaluated. The IOL reposition procedure was performed in 8 cases (8 eyes) with severe complications. Different extent of secondary cataract, posterior iris synechia caused by severe postoperative uveal tract reaction were existed in all 30 cases, corecleisis was occurred in some severe cases. During reposition operation, different extent of lens cortex regeneration in the equator portion of capsule bag was found in all eight cases. Fixed pupillary capture of IOL is the common complication in children after cataract surgery. Severe postoperative uveal tract reaction and secondary cataract and lens cortex regeneration are the major causes of intraocular lens pupillary capture. The intraocular lens could be reposited through iris synechia separation, regenerated lens cortex cleaning and secondary cataract extraction.