Intraocular Lens Repositioning Research Articles

CASE REPORTS: Rotational stability of two different piggyback toric intraocular lenses for correction of high post-keratoplasty pseudophakic ametropia

We present the case of a 65-year-old man with bilateral keratoconus and history of bilateral penetrating keratoplasty (PK) who developed gradual visual decline in the left eye due to cataract formation. Following successful left eye cataract surgery and monofocal, non-toric intraocular lens (IOL) in-the-bag implantation, the patient experienced persistently low uncorrected distance visual acuity (UDVA) due to high residual refractive error and intolerance to contact lenses. A supplementary toric IOL was placed in the ciliary sulcus, but subsequent rotational instability of the lens required repeated realignment. Despite two attempts at IOL repositioning, the rotational instability persisted, necessitating the replacement of the original Sulcoflex IOL with a toric, implantable Collamer lens. Following the implantation of the toric ICL, the patient achieved excellent UDVA with no adverse events over a 4-year follow-up period. This case highlights the potential rotational instability associated with toric piggyback IOLs in keratoconic, post-PK, pseudophakic eyes and the special considerations on choosing the type of piggyback lens in these eyes.

MANAGEMENT OF RECURRENT INTRAOCULAR LENS SUBLUXATION AFTER IOL REPOSITION IN APHAKIC PEDIATRIC PATIENT WITH SECONDARY GLAUCOMA AND DEPRIVATIVE AMBLYOPIA

Introduction : Malposition of the intraocular lens (IOL) can be in the form of decentration, subluxation, dislocation, or luxation. Conservative management and surgery are used to treat IOL subluxation.
 Case Illustration : A 14-year-old boy came to clinic with chief complaint of diplopia since 1 month ago. There were histories of cataract surgery of both eyes in 2014 and 2015 at a secondary hospital, secondary IOL implantation and membranectomy of right eye in December 2017, and IOL reposition of right eye in February 2022. Ophthalmologist examination revealed BCVA of right eye is 0.5 with S+10.00 C-2.25 x180 and left eye is 1/300. The right eye's intraocular pressure was 23 mmHg and the left eye's was 16 mmHg. Anterior segment examination of the right eye showed aphakia with subluxation of the IOL to the inferotemporal (Figure 1) and PC IOL of the left eye. Patient diagnosed with aphakia ODS with IOL subluxation OD, secondary glaucoma OD, astigmatisma Hypermetropia composite OD, astigmatism Myopia Compositus OS, Hypermetropia OD, Myopia Gravior OS, Deprivative Amblyopia ODS, and Last Eye OD. Patient given monofocal spectacles, prednisolone asetat eye drop tapering dose, and timolol maleate eye drop, with observation of IOL position
 Discussion : Recurrent IOL subluxation without clear signs of zonular or capsular instability in this patient was managed with conservative management using spectacles and medication due to secondary glaucoma. Long-term observation needed to evaluate possibility of repositioning or explanting the IOL in the future.
 Conclusion : Management of IOL subluxation could temporarily undergo conservative treatment. A surgical approach is considered in cases of recurrent dislocation

Reposition of dislocated piggyback intraocular lens in a patient with induced keratectasia after radial keratotomy

Aim – to substantiate low-traumatic sutureless surgery for piggyback intraocular lens (IOL) reposition as a method of choice in a patient after previous keratorefractive surgery and cataract phacoemulsification.
 The article provides the examination and surgical treatment data of one patient with piggyback intraocular lens dislocation after previous radial keratotomy and keratectasia.
 The presented clinical case shows that proper consideration of eye anatomical features allows for effective low-traumatic sutureless piggyback IOL reposition in patients who have previously undergone radial keratotomy, and may lead to sustainable high visual and functional results.

Repositioning Rates of Toric IOLs Implanted in Cataract Surgery Patients: A Retrospective Chart Review.

To determine the incidence of postoperative repositioning of toric intraocular lenses (IOLs) due to clinically significant rotation. This study included consecutive cataract patients with pre-existing astigmatism who had undergone cataract surgery with toric IOL implantation by a single experienced surgeon. Case records of patients who were recommended to undergo toric IOL repositioning surgery due to clinically significant postoperative IOL rotation from the implanted axis were identified. The need for a secondary intervention to manage residual astigmatism was based upon postoperative residual astigmatic error ≥0.75 D, the patient's qualitative dissatisfaction with the level of postoperative distance vision, dilated post-op examination, and confirmation of the significant potential for astigmatism reduction. Case records of 993 eyes implanted with AcrySof toric (N = 362), Tecnis Toric I (N = 53), Tecnis Toric II (N = 308), or enVista Toric IOLs (N = 270) were included. Postoperative toric IOL repositioning was recommended in 16 eyes (1.6%). The repositioning rate was highest in the eyes implanted with Tecnis Toric I (5.7%), followed by AcrySof Toric (2.2%), enVista Toric IOLs (1.1%), and Tecnis Toric II (0.6%). This real-world analysis of eyes implanted with toric IOLs revealed that the rate of surgical IOL repositioning due to clinically significant IOL rotation was lower than 2% for enVista and Tecnis Toric II IOLs. When needed and with appropriate planning, toric IOL repositioning can be very successful.

Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment of dislocated intraocular lenses

BackgroundTo compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL).MethodsThirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed.ResultsThe major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was − 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01).ConclusionAll three IOL repositioning techniques resulted in favorable ocular prognosis.

Rotational stability of a novel toric intraocular lens with an advanced optical profile.

To examine the rotational stability of a novel toric intraocular lens (TIOL), the Tecnis Eyhance Toric II, over a course of three months. Vienna Institute for Research in Ocular Surgery, Hanusch Hospital Vienna. Prospective, unmasked, single-center study. Fifty eyes of 50 patients with cataract and regular corneal astigmatism ≥ 0.75 D were included. The Tecnis Eyhance Toric II IOL (Johnson & Johnson Vision) was implanted in one eye of each study patient. Images of the alignment axis of the IOL were taken intraoperatively, one hour, one week, and 3 months after surgery. For measurement of TIOL rotation, images were superimposed on basis of ocular landmarks. Uncorrected and corrected distance (4 meters) and intermediate (66 cm) visual acuity were assessed at the 3-months visit. There was no significant difference in rotational position between the intraoperative and 3 months timepoints, with a mean rotation of 1.35° ± 1.46° (p=0.313; n =27). No patients had to undergo repositioning of the TIOL. A significant reduction of refractive cylinder occurred from preoperatively 1.8 ± 1.1 D to 0.40 ± 0.42 D at the 3 months visit (p= 0.001; n=43) Corrected distance visual acuity improved significantly, from 0.28 ±0.16 LogMar preoperatively to -0.01 ± 0.13 LogMar 3 months postoperatively. (p=0.001; n=43). The Tecnis Eyhance Toric II showed a good visual performance with no significant rotation over a course of three months and, therefore, an excellent rotational stability. The intraocular lens showed a good safety profile with no adverse events.

Rotational stability and clinical outcomes after implantation of a new monofocal toric intraocular lens with double C-loop design

To investigate rotational stability and visual outcomes of patients unilaterally or bilaterally implanted with a new monofocal toric intraocular lens (IOL). Ophthalmology service, clinique Beausoleil, avenue de Lodève, Montpellier. Single-center retrospective study. This study included patients who underwent routine cataract surgery with the PODEYE toric (BVI/PhysIOL SA, Liège, Belgium) IOL using the ZEISS CALLISTO eye®. Biometry and keratometry data, refractive outcomes, rotational stability, and astigmatism correction were recorded. IOL rotation was evaluated using an image analysis technique. Postoperative assessments were performed at 1 week, 1 month, and 4 to 6 months after surgery. Clinical outcomes of 102 patients (136 eyes) were analyzed. Patients had a mean age of 74 years. Of the included eyes, 25% had an axial length greater than 24.5mm. Median postoperative IOL rotation from baseline (surgery) was 2̊. With the exception of one outlier (15̊ rotation), IOL rotation was≤6̊ (1 month) and≤10̊ (4-6 months) in 100% of the eyes. No surgical IOL re-positioning was required. Median postoperative corrected distance visual acuity was -0.08 logMAR, and median postoperative subjective cylinder was between 0.25 and 0.50 D. The PODEYE toric IOL showed high rotational stability, allowing for correction of corneal astigmatism during cataract surgery.

Short-term clinical results with a trifocal diffractive toric intraocular lens using an optimized preoperative and intraoperative protocol.

To evaluate the short-term clinical outcomes of a specific toric diffractive trifocal intraocular lens (IOL) implanted following an optimized clinical protocol in a large population. Retrospective analysis of 337 eyes of 231 patients (mean age, 62.2 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL AT.LISA tri toric 939M/MP (Carl Zeiss Meditec). A strict and careful clinical protocol was followed, including an accurate measurement of corneal astigmatism, use of a latest generation IOL power calculator, photography-based method intraoperative control of IOL alignment and IOL reposition at 1 week postoperatively if needed. Clinical outcomes in terms of visual acuity, refraction, efficacy of astigmatic correction analysed by vector analysis and patient satisfaction were evaluated during a 3-month follow-up. A total of 82% and 98% of eyes achieved a postoperative uncorrected distance visual acuity of 0.00 and 0.10 logMAR or better, respectively. Furthermore, 99.7%, and 100.0% of eyes showed a postoperative spherical equivalent within ± 0.50 D and ± 1.00 D, with 97.9% of eyes having a postoperative cylinder ≤ 0.50 D. Uncorrected near and intermediate visual acuities were 0.2 logMAR or better in 89.0% and 99.1% of eyes, respectively. Mean difference vector, magnitude of error and angle of error were 0.02 ± 0.14 D, 0.02 ± 0.13 D and 0.11 ± 1.18°. Patient satisfaction was referred as high or very high by 97.6% of patients. The implantation of the trifocal toric IOL evaluated following a careful clinical protocol provides an efficacious visual rehabilitation and astigmatic correction, leading to high levels of patient satisfaction.

Correction of high astigmatism with toric intraocular lens in eyes with corneal transplant.

To evaluate the results of toric intraocular lens (IOL) implantation during cataract surgery in eyes with high regular astigmatism associated with prior penetrating keratoplasty (PK). A retrospective data analysis of patients with prior PK, who underwent uncomplicated cataract surgery with hydrophobic toric single piece IOL (EyeCryl Toric®, Biotech Vision Care, Luzern, Switzerland). A total of 18 eyes of 18 patients were included in the study. The mean age was 53.4 ± 12.4 (25-70) years. The mean follow-up period was 15.5 (4-24) months. The mean best corrected visual acuity (BCVA) significantly increased from 1.36 ± 1.0 logMAR to 0.31 ± 0.17 logMAR (p < .001) pre- and post-operative 4 weeks, respectively. There was no significant change in mean BCVA during follow-up; mean BCVA was 0.32 ± 0.17 logMAR at the last visit. The mean pre-operative topographic astigmatism was 6.52 ± 1.80 diopters (D). The mean manifest refraction astigmatism was decreased from 6.55 ± 1.62 D to 2.80 ± 1.43 D (p˂0.001). The mean Surgically induced astigmatism (SIA) was 3.74 ± 0.77 D according to vector analysis. There was no patient with graft rejection or failure, the mean endothelial cell loss rate was 12.75 ± 3.76% (7-17%). There was no patient requiring IOL reposition. Toric IOL implantation during cataract surgery provides an option to correct astigmatism in post-PK eyes with high regular astigmatism. When appropriate patients are selected it is a safe method to achieve significant improvements in visual acuity and astigmatism.

Surgical Treatment of Patients with Dislocation of IOL — Fibrosed Capsule Bag Complexes

Violation of the correct location of the complex IOL capsule bag (CICB) in the delayed postoperative period occurs with a frequency of 0.2 to 2.8 %. The basis of the pathogenesis of this complication is the destruction of the zonal ligament due to progressive pseudoexfoliative syndrome, as well as the process of fibrosing the capsule bag. The stage of the flow and the different degree of severity of each mechanisms determines the variety of clinical manifestations. CICB dislocation in combination of these two mechanisms requires a special approach to treatment.Objective: to develop a system of surgical treatment of IOL dislocations in contract capsule syndrome, with varying degrees of severity, combined with the weakness of the ligament apparatus of the lens, and to present the results of its use.Patients and methods. Retrospective analysis of 55 cases of CICB dislocations with the observation period of more than 4 years operated in 2014-2016. Number of dislocations with certain IOL type: Hydrophilic monolithic — 27, Hydrophilic monolithic — 11, Hydrophilic three-part — 10, Hard — 7. The selection criterion was the presence of CICB dislocation in the combination of weakness of the ligament apparatus (II–III st. of severity) and contraction capsule syndrome, with varying degrees of severity. A system is proposed to allow a low-invasive repositioning of intraocular lenses dislocated with a fibrous capsule bag with subsequent suture fixation to the iris. Signs used for choice of surgical technique: localization of capsule bag fibrosis, contract effect of capsule bag fibrosis on IOL position and correct location of haptic elements, size, and severity of equatorial lens masses (Semmering ring). In cases when insufficiency of the ligament apparatus prevails, with insignificant fibrosis of the capsule bag, without contractional influence, fixation of KIKM to iris is carried out without cutting of the capsule bag (method 1). As the fibrous changes of the front or back leaf of the capsule progress without changing the position of IOL inside the capsule bag due to contraction, along with fixation of KIKM, the fibrous front/back capsule is excised (method 2). The variant of complete removal of the fibrous capsule bag is used in faraway stages of CCS with further fixation of IOL to the iris (method 3).Results. The data of BCVA and IOP of patients treated by a certain method (before the operation, early postoperative period (2–5 days), delayed period (more than 4 years)) are presented.Conclusion. Surgical treatment of patients with CICB dislocation combining manifestations of Capsule contraction syndrome and weakness of the lens ligament apparatus can now be standardized using a proper approach and certain methods of treatment, but requires a comprehensive assessment of such parameters as the safety of the ligament apparatus, the localization and degree of fibrous changes of the anterior / posterior capsule, the contractional effect of the capsule bag fibrosis on the front position of the IOL optics and the correct location of the haptic elements, the severity of the ring.

Traumatic intraocular lens ectopia from a nonadhesive capsule

Introduction: This study describes a case of traumatic intraocular lens (IOL) ectopia with retention in the pupil that occurred 2 years after cataract surgery. Patient and Clinical Findings: A 55-year-old man, who underwent cataract surgery 2 years ago, sustained an ocular injury while slapping a bug on the left eyelid, following which he had decreased vision. His IOL shifted out of the capsule and was retained in the pupil. Diagnosis, Intervention, and Outcomes: The patient was diagnosed with IOL ectopia with retention in the pupil. An IOL reposition operation was performed successfully. The IOL was completely returned into the capsule, and postoperatively, his uncorrected distance visual acuity immediately improved to 0.097 logMAR. Conclusions: An IOL could slide out of the nonadhesive capsule under external force even if the capsulorhexis is performed perfectly with a continuous curvilinear circle at the center and the anterior capsule covers the IOL optical surface.

A Modified Intrascleral Intraocular Lens Fixation Technique Using 27-Gauge Blunted Needles with Fewer Intraocular Manipulations.

A new method for intraocular lens (IOL) fixation in the scleral tunnel using two common 27G blunted needles and an ultrathin 30G needle with fewer intraocular manipulations was developed. Half-depth scleral flaps were prepared, and vertically angled sclerotomies were performed under each scleral flap, 2 mm from the limbs with a 20G microblade or a 26G needle. Two bent 27G blunted needles connected the sclerotomy and corneoscleral incisions. One haptic was inserted into this bent 27G blunted needle extraocularly and extruded through the sclerotomy site. Each haptic was inserted into the lumen of the preplaced ultrathin 30G needle and buried into the scleral tunnel. In this retrospective study, we reviewed the outcomes of this new technique in patients with at least 3 months' follow-up data. Iris capture of the IOL was not observed in any case, and IOL repositioning was not performed either. Astigmatism induced by intraocular aberration was almost as same as that with other methods. Our technique can be performed in any operation room without any extra instruments. This trial is registered with UMIN000044350.

Real-world incidence of monofocal toric intraocular lens repositioning: analysis of the American Academy of Ophthalmology IRIS Registry.

To determine the 12-month incidence of reoperation to realign 2 commercially available types of implanted monofocal toric acrylic intraocular lenses (IOLs). American Academy of Ophthalmology IRIS (Intelligent Research in Sight) Registry. Registry retrospective study. Eyes that underwent cataract extraction and were implanted with a TECNIS or AcrySof monofocal toric IOL in 2016 and 2017 were identified. The rate of reoperation for IOL realignment (Current Procedural Terminology code 66825) within 365 days of implantation was determined for each IOL group. Risk factors for repositioning were evaluated using logistic regression modeling. A total of 6482 eyes were implanted with a monofocal toric IOL, including 2013 (31.06%) with a TECNIS and 4469 (68.94%) with an AcrySof IOL. During the first postoperative year, 87 (1.3%) eyes underwent surgical IOL repositioning. The incidence of repositioning was significantly higher (P < .0001) for TECNIS-implanted (3.1%, 62/2013) than for AcrySof-implanted (0.6%, 25/4469) eyes (odds ratio [OR] 5.6; 95% CI, 3.5-8.9). Younger age (OR 0.76; 95% CI, 0.67-0.86 per 5-year increase) was associated with a higher risk for IOL repositioning. Real-world analysis of U.S. patients in the IRIS Registry revealed that the rate of surgical IOL repositioning was 5 times higher in eyes implanted with TECNIS than with AcrySof monofocal toric IOLs for astigmatic correction at the time of cataract surgery. These findings should be considered when selecting a toric IOL for correction of astigmatism in cataract patients, particularly in younger patients with a higher risk for misalignment requiring repositioning.

Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation.

To evaluate the long-term efficacy and safety after intraocular lens (IOL) repositioning by scleral suturing of 1-piece IOL compared with other IOL designs in the treatment of late in-the-bag IOL dislocation. Patients referred to Oslo University Hospital Oslo, Norway. Prospective cohort study. The study comprised 54 patients (54 eyes) with late in-the-bag IOL dislocation treated with IOL repositioning by scleral sutures (10-0 polypropylene). All operations were performed with an anterior approach and by 1 surgeon. The following IOL designs were repositioned: 1-piece foldable (n = 17), 3-piece foldable (n = 28), plate-haptic (n = 8), and 1-piece rigid (n = 1) IOLs. Patients were evaluated comprehensively preoperatively and at 6 months (80%), 1 year (67%), and 2 years (61%) postoperatively. The main outcome measures were efficacy regarding corrected distance visual acuity (CDVA) and spherical equivalent (SE) and safety regarding complications. Postoperative visual acuity was similar for different IOL designs. The mean SE change to final observation was -0.08 (95% CI, -0.93 to 0.77) in the 1-piece IOL group (n = 11) and -0.98 (-1.73 to -0.23) in the 3-piece IOL group (n = 18) (P = .11). Regarding safety, no patients had uveitis-glaucoma-hyphema syndrome, retinal detachment, or endophthalmitis. The 3-piece IOL group had 1 case of redislocation and 1 case of iritis. No patients had symptoms related to clinical IOL decentration. Long-term intraocular pressure remained within normal limits with overlapping 95% CIs for different IOLs. Repositioning surgery of 1-piece IOLs seems as efficient and safe as that for other IOL designs in the treatment of late in-the-bag IOL dislocation.

Toric Intraocular Lens Implantation in the Correction of Moderate-To-High Corneal Astigmatism in Cataract Patients: Clinical Efficacy and Safety.

Methods A total of 57 cataract patients (57 eyes) with regular corneal astigmatism (≥2.57 D) were enrolled in this retrospective cohort study. Phacoemulsification with toric IOL implantation was performed for all patients. The uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded before and one year after surgery, and statistical analysis of preoperative corneal astigmatism, postoperative residual astigmatism, aberrations, IOL rotation, and related factors was performed to evaluate the efficacy, safety, and stability of toric IOLs in correcting moderate-to-high corneal astigmatism. Results One year after surgery, visual acuity was significantly improved compared with that before surgery (preoperative log MAR 0.87 ± 0.34 vs. postoperative log MAR 0.31 ± 0.26, p < 0.001), and the self-reported spectacle independence rate was 68.42%. The total residual astigmatism was 1.18 ± 0.85 D, which was significantly less than the preoperative value (3.41 ± 0.99 D) (p < 0.001). The degree of toric IOL rotation was 4.93 ± 3.02°, and 54.39% of patients had a lens rotation of less than 5°. The IOLs of 5.26% (3 eyes) of patients rotated more than 10°, and these patients received glasses instead of undergoing IOL repositioning. Conclusions Toric IOL implantation provided optimal vision outcomes and low spectacle dependence during a one-year follow-up period. The results from our study show that toric IOL implantation is a safe and effective option for cataract patients with moderate-to-high corneal astigmatism.

Adjustable 6-0 polypropylene flanged technique for scleral fixation, part 2: repositioning of subluxated IOLs.

To describe the technique of modified adjustable flange scleral fixation using 6-0 polypropylene sutures for repositioning of subluxated intraocular lenses (IOLs). Center for Applied Eye Research, Meir Medical Center, and the Ein-Tal Eye Center, Israel. Case series. Subluxated capsular-fixated posterior chamber IOLs are secured to the sclera using 6-0 polypropylene sutures looped around the IOL haptics. This method can be performed for any type of IOL: hydrophobic, hydrophilic, silicone, or poly(methyl methacrylate); 1-piece or 3-piece; and with either closed-loop or open-loop haptics. It can also be used in conjunction with capsular stabilizing devices. In the 18 cases performed, successful repositioning with stable and central fixation of the IOLs was achieved. One eye required a repeated surgery due to suture slippage. The eyes recovered relatively quickly with noted quiescence as early as 1 week postoperatively. Patients did not complain of ocular irritation from the subconjunctival flange up to the 6-month follow-up period. In 1 case, a flange was exposed postoperatively but the patient refused additional intervention and developed intraocular infection 7 months postoperatively. The adjustable 6-0 polypropylene flanged technique for IOL repositioning and scleral fixation was a relatively quick and simple method for management of subluxated IOLs. Complete coverage of the flange by conjunctiva and Tenon layer must be confirmed at the end of surgery.

Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach.

To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.

Comparison of surgical repositioning rates and outcomes for hydrophilic vs hydrophobic single-piece acrylic toric IOLs.

To evaluate the comparative rotational stability and the repositioning rates and outcomes of a hydrophilic and hydrophobic acrylic monofocal toric intraocular lens (IOLs). Single center, Aravind Eye Hospital in Madurai, India. Retrospective cohort study. All patients had either an Auroflex hydrophilic acrylic toric IOL (n = 4603) or AcrySof hydrophobic acrylic toric IOL (n = 926) implanted between January 2015 and April 2019. Surgical repositioning was offered if the toric IOL was 15 degrees or greater misaligned or there was a 2-line or greater improvement in uncorrected distance visual acuity (UDVA) predicted with repositioning. A total of 5529 single-piece toric IOLs were implanted during the study period. There was no statistically significant difference between the hydrophilic and hydrophobic acrylic toric IOL groups in need for surgical repositioning (2.5% vs 1.9%; P = .34) or actual surgical repositioning rate (1.8% vs 1.5%; P = .59). A higher rate of surgical toric IOL repositioning was associated with younger age (62.7 vs 67.2 years; P < .0001), higher presurgical astigmatism (2.32 vs 1.99 diopters [D]; P < .0001), and with-the-rule astigmatism (4.7% vs 2.1% against-the-rule astigmatism; P = .002). In 95 eyes that underwent toric IOL repositioning, there was significant preoperative to postoperative improvement in UDVA (0.48 vs 0.12 logarithm of the minimum angle of resolution; P < .001), mean residual cylinder (1.79 vs 0.7 D; P < .001), and mean toric IOL misalignment (49.7 vs 5.4 degrees; P < .001). The repositioning outcomes were statistically similar with both toric IOL models. There were no major complications or recurrent toric IOL rotation after surgical repositioning. The hydrophilic acrylic toric IOL had comparable rates of postoperative misalignment and surgical repositioning with the hydrophobic acrylic toric IOL. Early postoperative surgical repositioning was both safe and effective with both toric IOLs.

Visual outcomes after toric intraocular lens implantation in pediatric eyes undergoing cataract surgery.

To evaluate long-term visual outcomes and complications after toric intraocular lens (IOL) implantation in children with preexisting corneal astigmatism undergoing cataract surgery. Iladevi Cataract & IOL Research Center, Ahmedabad, India. Prospective, interventional case series. Children with regular corneal astigmatism of at least 1.5 diopters (D) were included. A standardized surgical technique with in-the-bag implantation of a toric IOL was performed. All children were followed up on postoperative day 1 and periodically thereafter, until 36 months postoperatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were documented 36 months postoperatively. Rotational stability of toric IOL was also evaluated through the follow-up duration. Complications, particularly visual axis obscuration (VAO) and glaucoma, were documented. In total, 76 eyes (51 children) were included in the study. Mean age at surgery was 7.41 ± 2.82 years (SD) and mean preoperative keratometric astigmatism was 1.56 ± 2.13 D. The CDVA (logarithm of the minimum angle of resolution [logMAR]) improved significantly from 0.59 ± 0.43 preoperatively to 0.23 ± 0.27 36 months postoperatively (P = .03). Mean postoperative UDVA was 0.32 ± 0.26 logMAR. Mean refractive astigmatism at final follow-up was -0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40; 5% of eyes needed VAO treatment and none developed glaucoma. No eye required repositioning of toric IOL until final follow-up. Toric IOL implantation reduced postoperative refractive astigmatism and gave excellent UDVA at 36 months follow-up in pediatric eyes undergoing nontraumatic cataract surgery.

Evolution of IOL exchange. Part 2. Modern problems of IOL exchange

The review discusses modern problems of intraocular lens (IOL) exchange. Making an adequate choice between IOL reposition and IOL exchange in pseudophakic patients with problems of lens fixation remains a largely unsolved issue. The literature data shows a noticeable increase in the number of supporters of retropupillary fixation of an iris-claw lens during the exchange procedure.