IOL Placement Research Articles

Nucleus drop following phacoemulsification surgery: Incidence, risk factors and clinical outcomes.

To determine the incidence, risk factors and clinical outcomes in patients with nucleus drop (ND) following phacoemulsification surgery at a tertiary care ophthalmic institute. Medical records of patients with ND during phacoemulsification between January'2019 and December'2022 were reviewed retrospectively. Incidence of ND was calculated overall, and according to surgical expertise levels and surgical steps. Associated pre- and intra-operative risk factors were assessed. Clinical outcome parameters [best-corrected visual acuity (BCVA) and intraocular pressure (IOP)] were compared with respect to timing of PPV (immediate vs early vs delayed), location (sulcus vs scleral fixated-IOL) and timing of IOL placement (primary vs secondary). Among 93,760 phacoemulsifications, ND was noted in 130 patients (0.1%). Significant direct and associated pre-operative risk factors were advanced cataract, glaucoma, posterior polar cataract, and diabetes mellitus. Junior medical consultants had 40 ND (mostly in non-complex cases), whereas senior medical consultants had 90 ND (mostly in complex cases). ND most frequently occurred during emulsification of nuclear fragments. Sulcus placement of IOL during primary surgery yielded significantly better visual outcome compared to secondary procedures, although timing of PPV had insignificant effect. 77.1% had BCVA of 6/12 or better at final follow-up. Timing of IOL implantation, PPV, and type of IOL did not have any significant effect on IOP. Though the incidence of ND is low, it is a dreaded complication. Accurate pre-operative evaluation, risk stratification, distribution of cases among surgeons based on their surgical expertise, and immediate or early management of ND yields better anatomical and functional outcomes.

Clinical Outcomes in Scleral Fixation Secondary Intraocular Lens with Yamane versus Suture Techniques: A Systematic Review and Meta-Analysis.

Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; p < 0.05 was considered statistically significant. Results: Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = -0.01, 95% CI: [-0.06, 0.04], p = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = -0.10, 95% CI: [-0.16, -0.04], p = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = -0.06, 95% CI: [-0.16, 0.04], p = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = -24.68, 95% CI: [-35.90, -13.46], p < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. Conclusions: The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods.

Double capsulorhexis technique for safe phacoemulsification in intumescent cataract

Intumescent white cataracts are a challenge for novice and experienced surgeons alike. Creating a continuous curvilinear capsulorhexis may pose a problem in these cataracts due to many factors like increased intra capsular pressure, absence of red reflex, poor visibility, fragile or calcified anterior capsule.[1] These cataracts tend to have a shallow anterior chamber and presence of fluid vacuoles or sectoral markings in subcapsular area which can be seen on slit lamp biomicroscopy.[2] Argentinian flag sign, which is a radial tear in anterior capsule, can occur while creating capsulorhexis, due to raised intracapsular pressure.[3] Radial tears extending to the equator, makes phacoemulsification unsafe, since it may lead to further complications such as extension of the tear to posterior capsule, nucleus drop in vitreous cavity and difficulty with IOL placement. This video demonstrates the steps of 2 staged capsulorhexis, to prevent radial extension while operating a type 1 (liquified cortex) intumescent cataract and type 2 (no liquified cortex, only tense fibres) intumescent cataract.[4]

A retrospective analysis of surgical outcome in sutureless glueless scleral fixation of foldable intraocular lens.

Cataract surgery constitutes one of the highest volume surgeries performed worldwide approximating 10 million annually, varying from 100 to 6000 per million population. Implantation of scleral fixated intra-ocular lens (SFIOL) is getting popular in managing difficult situations like aphakia, subluxated lens, and dislocated cataracts. This retrospective series evaluated our experience with foldable 3-piece acrylic SFIOL implantation for various challenging surgical scenarios in a tertiary care ophthalmic institute in the southern part of India. The data from the first 150 patients, those operated in our hospital in the aforementioned technique, have been reviewed and analyzed. The mean age of the population was 46.43 years. The most common indication was found to be surgical aphakia (34.66%) followed by traumatic subluxated lens (8.33%). Postoperative BCVA at 3 months improved to 0.255 on the LogMAR scale from preoperative BCVA of 0.795 (P < 0.01). Intraocular pressure was found to stabilize over 3 months follow-up (P = 0.002). The various intraoperative and postoperative complications have been recorded. Ten patients required resurgery out of which eight had postoperative haptic dislocation. A detailed comparison of the role of a surgeon's experience in influencing outcomes has been evaluated. The technique offers physiological IOL placement using minimal surgical maneuvers. We strongly recommend this as a technique of choice for the surgical management of complicated scenarios with inadequate capsular bag support.

Bilateral Anterior and Posterior Lens Dislocation in Marfan Syndrome in Teenager : A Case Report

Introduction : The zonular defect leads to ectopia lentis, which is a hallmark of Marfan ocular abnormalities. Bilateral dislocation of lens in marfan’s syndrome occurs frequently in same location. In this case the lens of RE dislocated in the anterior chamber and the lens of LE was found in vitreous cavity. Iris fixation IOL and Yamane’s scleral fixation technique are prompt treatment for crystalline lens displacement.&#x0D; Case Illustration : A 14 year-old male patient came with chief complaint a painless blurred vision on LE since 2 weeks before visit Ophthalmologist. The BCVA in both eyes was 6/30 RE and 1/60 LE. There was no history of ocular injury nor development disorder. Lens dislocation in anterior chamber was found in RE and aphakic lens was found in LE during slit lamp examination. The IOP ODS were 9.7 mmHg and 3.0 mmHg. Further examination from funduscopy showed the lens of LE was seen in vitreous cavity.&#x0D; Discussion : Bilateral dislocation of lens in opposite position are quite rare. To avoid many of the potential complications, Iris Fixation IOL placement is preferred choice to improve visual impairment on the right eye. Yamane’s Scleral Fixation technique has been performed on left eye however challenging and time consuming it is, to achieve excellent improvement with minimal or no intra- and postoperative complications.&#x0D; Conclusion : This case shows that manifest of crystalline lens in marfan syndrome could happen differently to each eye. Different surgical approach especially IOL placement technique is crucial and must be considered carefully depends on the condition during surgery.

A novel technique of IOL placement in the sulcus in a pediatric eye with dense iridocapsular adhesions

A secondary intraocular lens (IOL) insertion technique in an aphakic eye with dense iridocapsular adhesions is described. Ultrasound biomicroscopy (UBM) helps to assess the clear picture behind the iris and decide the appropriate management technique.

Peripheral Intravascular Catheter-Assisted Sutureless Scleral Fixation of Three-Piece Intraocular Lenses: A Novel Technique.

To describe and report the anatomical and functional outcomes of a novel sutureless peripheral intravascular catheter (PIVC)-assisted scleral fixation of three-piece IOL. A retrospective chart review of all patients who underwent scleral fixation surgery performed by a single surgeon was conducted. In all cases, a novel scleral fixation technique of three-piece IOL was performed with the aid of a 24-gauge PIVC cannula. Patients were followed up at postoperative months 1, 3, and 6. Thirteen eyes of 12 patients were included in the analysis. Preoperatively, mean best-corrected visual acuity was 1.26 ± 0.82 LogMar (20/364 Snellen Equivalent), and it improved significantly at all follow-up endpoints being of 0.52 ± 0.25 LogMar at 1 month (20/66 Snellen Equivalent, P = 0.02), 0.4 ± 0.22 LogMar at 3 months (20/50 Snellen Equivalent, P = 0.007) and 0.37 ± 0.2 LogMar (20/47 Snellen Equivalent, P = 0.008) at 6 months postoperatively. No serious intraoperative or postoperative complications were registered. Postoperatively, there were no cases of conjunctival erosions. Over the follow-up period, in all the included cases, the IOL remained centered and stable. The PIVC-assisted scleral fixation technique may be a safe and reliable surgical option for secondary IOL placement in cases of insufficient capsular support.

Comparison of visual improvement based on the Potential Visual Test "Retinometry" in patients with Posterior Capsular Opacity Fibrotic and Regenerative types before and after Nd YAG Laser Capsulotomy

Background: Posterior Capsular Opacity (PCO) can disrupt a patient's vision and is a prevalent challenge medical professionals face in restoring visual clarity after cataract surgery. Various evaluation methods can be employed to measure visual improvement and the efficacy of Nd: YAG Laser Capsulotomy. One such method is Retinometry, which harnesses interference patterns of light on the retina as light passes through the pupil to provide patients with relevant information regarding the potential outcomes of Nd: YAG Laser Capsulotomy. This study aims to review the efficacy of the potential vision test "Retinometry" in patients with posterior capsular opacity before and after Nd: YAG Laser Capsulotomy. Methods: Literature searching was conducted using six online databases (PubMed, Scopus, Science Direct, Clinical Key, and Google Scholar). Search terms included a combination of main keywords: "Retinometer", "Posterior Capsulotomy", "Nd: YAG laser", and "Visual Acuity". Results: A total of 5 articles were included in this review. It’s found that the retinometer visual potential test has a function in evaluating the effects that occur and visual function after Nd: YAG laser capsulotomy. Due to the increasing incidence of cataract surgery, the rise of IOL placement will increase the risk of PCO formation and the need for Nd: YAG capsulotomy. Conclusion: Posterior Capsular Opacity (PCO) management remains a significant concern in patients post-cataract surgery, given its potential to disrupt visual acuity. Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) laser capsulotomy is a practical approach for addressing PCO-related visual impairment. Still, its impact on visual improvement may be modest, especially regarding refractive measurements. The type of lens used does not significantly influence the procedure outcomes. As the incidence of cataract surgery continues to rise, the prevalence of PCO and the need for Nd: YAG capsulotomy are likely to increase.

Incidence and Predictive Risk Factors for Post-Cataract Surgery Endophthalmitis in Ministry of Health Hospitals from 2012 to 2020

ABSTRACT Purpose Postoperative endophthalmitis is a devastating complication, leading to poor visual prognosis. The purpose of this study is to determine the incidence, risk factors, and visual outcome of post-cataract surgery endophthalmitis in Malaysia over a 9-year period (2012–2020). Methods Data from National Eye Database (NED), involving all patients who have undergone cataract surgery from January 2012 until December 2020 were analyzed. Results Total number of patients who had undergone cataract surgery between the year 2012 till 2020 were 231,281 patients (267,781 eyes). Incidence of POE in this population was 0.08%. Patient aged 70 and above (p-value 0.047), Malay ethnicity (p-value: 0.009), presence of ischemic heart disease, renal failure, diabetic retinopathy, and poorer preoperative vision were shown to have a higher risk of POE. Cataract surgeries done in KK-KKM, duration more than 45 minutes, use of general anaesthesia, and no IOL or ACIOL implantation were significantly more in POE patients. Multivariate analysis revealed Malay ethnicity, presence of ocular comorbidity, poor preoperative vision, ACIOL, and presence of intra-operative complication were predictive factors for POE. Conclusions Incidence of POE is low in the Malaysian population. Surgeons have to be aware that Malay ethnicity, presence of ocular comorbidity, poor preoperative visual acuity, placement of IOL and complicated cataract operation have higher risk of POE.

Glaucoma Following Cataract Surgery: Pearls for Success Manuscript from the 2022 AOC/AACO/AAO Sunday Symposium

ABSTRACT Glaucoma Following Cataract Surgery (GFCS) remains a menace, so parents must be counseled prior to cataract removal in children. Age less than 7 months at the time of surgery increases this risk, and IOL placement has no effect. To lower IOP in GFCS, start with drops and before you escalate to surgery, consider phospholine iodide. Then, proceed cautiously with angle surgery and shunts, mixing in cycloablative procedures where appropriate in your hands. With patient-centered models for access, follow-up & adherence to treatment, GFCS can be controlled. Partnering with our certified orthoptist colleagues, we can achieve excellent results for the “whole patient” spanning cataracts, glaucoma, strabismus, and amblyopia.

UGH Syndrome Resolution after IOL Explantation and Concomitant Carlevale IOL Implantation

ABSTRACT Objective To examine the use of Carlevale IOL placement in patients with UGH, and to evaluate surgical outcomes. Design In this retrospective study, 28 patients with UGH syndrome that were subjected to IOL explantation and concomitant Carlevale IOL implantation were included in the study. Methods Information about VA, IOP, number of glaucoma medication, need for glaucoma surgery, presence of hemorrhage and inflammation were recorded up to 6 months after the procedure. Results We found a statistically significant increase in mean visual acuity and complete resolution of uveitis in all patients. Mean IOP and the mean number of glaucoma medications were significantly decreased postoperatively, while 14% of patients required additional glaucoma surgery. Conclusions IOL explantation and concomitant Carlevale IOL implantation may provide a viable solution for UGH syndrome resolution, increases visual acuity, and decreases the need for glaucoma medication.

Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications.

Purpose “In-the-bag” placement of an IOL is the Holy Grail for any cataract surgeon. However, in the absence of capsular integrity, alternative surgical options to place the IOL must be sought. We aim to report the clinical outcomes and safety profile of scleral-fixated Akreos AO60 intraocular lens implantation using Gore-Tex suture, combined with pars plana vitrectomy. Methods This is a single-center, retrospective case series descriptive study. Electronic clinical records of all patients subjected to scleral fixation of a Bausch and Lomb Akreos AO60 IOL combined with pars plana vitrectomy, between April 1, 2017, and August 1, 2021, were reviewed. Data concerning age, sex, laterality, past ophthalmological history, pre- and postoperative best-available visual acuity, surgical indication, and intra- and postoperative complications were collected. Measured outcomes were the differences in best-available visual acuity and frequency of postoperative complications. Results A total of 37 eyes (20 right eyes and 17 left eyes) from 36 patients (16 females and 20 males) were included in the statistical analysis. The mean age at time of surgery was 72.0 ± 12.4 years. The mean follow-up period was 548.9 days (range 39–1564 days). Globally, the mean best-available logMAR visual acuity improved from 1.61 preoperatively (0.025 decimal equivalent) to 0.57 postoperatively (0.3 decimal equivalent), this difference being statistically significant (P < 0.001). Indications for surgery included aphakia due to complicated cataract surgery (24.3%; n = 9); subluxated IOL due to closed trauma (21.6%; n = 8); PEX-related subluxated IOL (16.2%; n = 6); non-traumatic, non-PEX-related subluxated IOL (18.9%; n = 7); subluxated crystalline lens due to closed trauma (8.1%; n = 3); aphakia due to open-globe injury (5.4%; n = 2); silicone-induced IOL opacification (2.7%; n = 1); and aphakia post-endophthalmitis (2.7%; n = 1). Postoperative complications included transient ocular hypertension (27.0%; n = 10), transient corneal edema (18.9%; n = 7), cystoid macular edema (18.9%, n = 7), self-limited hypotension (5.4%, n = 2), self-limited vitreous hemorrhage (2.7%, n = 1), central retinal vein occlusion (2.7%, n = 1), late retinal detachment (2.7%, n = 1), and Akreos IOL opacification (2.7%, n = 1). No suture-related complications were observed. Conclusion There was a statistically significant improvement in visual acuity after scleral fixation of Akreos AO60 intraocular lens using Gore-Tex suture, with no suture-related problems recorded. This procedure seems to be a valuable alternative for posterior chamber IOL placement when secondary IOL implantation is required.

Cataract surgery in patients with history of uveitis - medium term functional outcomes

Aim: Evaluating the functional outcomes in patients with history of uveitis who previously underwent cataract surgery during 2009-2019, analysis of the best postoperative visual acuity and IOP after first day, one month, 3 months and last postoperative. Material and methods: Comparative/retrospective study which included cataract surgery patients with a history of uveitis evaluated between January 2009 and December 2019 in Iasi, Department of Ophthalmology, “Sf. Spiridon” County Clinical Emergency Hospital. The study included a number of 102 eyes divided into two groups: 59 eyes from 51 patients (25 women and 26 men) the cataract and uveitis group (study group) and 43 cataract eyes (control group). All patients had cataract surgery performed by phacoemulsification and IOL-PC implantation, while the pre- and postoperative evaluation was performed according to a standardized protocol. The database was built in the EXCEL program and was statistically processed with the SPSS 18.0 program. Postoperative follow-up was performed at 1 day, 1 month, 3 months and last postoperative follow up (six month). Results: The average age of patients of the 2 groups was 65 years. In all cases, preoperative topical steroid anti-inflammatory treatment was administered for 1 week and postoperatively, for 6 weeks. General anti-inflammatory steroids (CSR) were administered preoperatively and postoperatively in 9 patients with intermediate or posterior uveitis for 8 weeks. In two cases a capsular tension ring was used to stabilize the bag. One case required ECCE + placement of IOL in the sulcus. Only one case required IOL explantation due to severe inflammation. Among the postoperative complications, the inflammatory glaucoma and recurrent uveitis predominated. Conclusions: Cataract surgery with IOL implantation resulted in improved postoperative visual acuity in patients with cataract and uveitis, which was maintained at the last follow-up. In the immediate postoperative period, both groups had similar functional results.

Evaluation of Eye Alignment before and after Cataract Surgery

ABSTRACT Purpose: To assess changes in eye alignment before and after cataract surgery. Subjects and methods: The medical records of 786 cataract patients without eye movement limitation who underwent bilateral cataract surgery under topical anesthesia with monofocal IOL placement were retrospectively reviewed at the Eye Center of Sanno Hospital in Japan. Results: Before cataract surgery, 121 of the 786 patients (15.4%) had constant strabismus, 263 (33.5%) had intermittent strabismus, and 402 (51.1%) had phoria. Among the 121 patients with constant strabismus on the preoperative exam, 64 (52.9%) had exotropia without vertical strabismus, 7 (5.8%) had esotropia without vertical strabismus, and 6 (5.0%) had vertical strabismus without a horizontal component. After surgery, 98 of the 786 patients (12.5%) had constant strabismus, 126 (16.0%) had intermittent strabismus, 562 (71.5%) had phoria. The rate of eye alignment agreement before and after surgery was 72.3% overall. We found that 17 patients (2.2%) who did not have constant strabismus preoperatively developed constant strabismus postoperatively, and all of these patients experienced binocular diplopia. Characteristics of patients at risk for constant strabismus and diplopia postoperatively included patients with vertical deviation preoperatively (intermittent or phoria). Conclusions: Uncomplicated cataract surgery under topical anesthesia did not influence eye alignment classification in 72.3% of patients; however, patients with vertical deviation preoperatively were more likely to transition to constant strabismus after surgery.

Scleral fixation of Carlevale intraocular lens: A new tool in correcting aphakia with no capsular support.

To report the clinical outcomes of the use of a novel specially designed scleral fixated intraocular lens, the Carlevale intraocular lens (carlevale IOL, Soleko, Italy) for the correction of aphakia in the absence of capsular support of variable etiology. This retrospective, non-comparative study included 169 eyes of 169 consecutive patients who underwent 3-port pars plana vitrectomy and scleral fixation on Carlevale IOL. Inclusion criteria were at least 6 months' follow-up period, patients > 18 years old who underwent vitrectomy and Carlevale IOL placement for aphakia and inadequate capsular support. The median follow up period of 9 months (range 6-18 months). Mean post-operative BCVA at the last follow-up visit was 20/25 (0.09 ± 0.1 LogMAR), improving from a mean baseline BCVA of 20/80 (0.58 ± 0.49 LogMAR), a statistically significant change (p = 0.0001). Regarding the post-operative complications, a transient rise in the IOP was observed in 28 patients (16.5%) and mild vitreous hemorrhage was observed in the immediate post-operative period in eight eyes (4.7%) and it spontaneously resolved within 3 weeks. All patients demonstrated good IOL position at the end of the follow-up without IOL capture. None of the patients required re-operation. The present study represents the largest to date in evaluating the use of carlevale IOL in patients with aphakia and inadequate capsular support. The technique is safe and provides excellent post-operative IOL fixation without IOL capture in any of the patients studied.

Outcomes and complications in eyes that underwent intraocular lens fixation in the absence of capsular support

PurposeTo identify factors influencing the visual and refractive outcomes and complications in eyes that underwent intraocular lens fixation in the absence of capsular support.MethodsRetrospective case series. Patients records from 2014 to December 2019 in King Khaled Eye Specialist Hospital (KKESH) were reviewed and divided into two groups: posterior chamber iris fixated IOL (sutured) (IFIOL) and scleral fixated IOL (SFIOL). Demographic data, ocular factors (location of IOL placement), systemic comorbidities, lens status at the time of surgery were collected.Axial length, IOL calculation formula, surgeon level, IOL fixation technique, intraoperative complications, and concurrent or previous vitrectomy were correlated to the outcome. Postoperative data of corrected distance visual acuity, refraction, early and late postoperative complications were also collected and correlated to the outcome.ResultsSeventy‐five eyes of 69 patients were included in this study. The median follow‐up period was 9 months (range 0–60 months). The average age of patients in this study was 50 years. 14 eyes (18.6%) underwent IFIOL while 61 eyes (81.3%) underwent SFIOL. At the end of follow‐up, the preoperative mean of best‐corrected visual acuity (BCVA) was 0.3 log of the minimum angle of resolution (logMAR), which improved to 0.22 logMAR postoperatively. BCVA improved or remained unchanged in 71 eyes (94.6%), VA decreased two lines in 4 eyes (5.3%). Regular follow‐up examinations at 3, 6, and 12 months after IOL fixation revealed no intraoperative complications, and the postoperative complication rate was (18.6%).ConclusionsDifferent techniques of IOL fixation in the absence of capsular support are safe with favorable outcomes. However, they are technically challenging and time‐consuming. The innovation of new surgical techniques continues to provide safer and effective treatment options for the eyes that lack sufficient capsular support.

Clinical Comparison of the Performance of Two Marketed Ophthalmic Viscoelastic Devices (OVDs): The Bacterially Derived Healon PRO OVD and Animal-Derived Healon OVD.

This clinical investigation compared the clinical performance of two marketed ophthalmic viscoelastic devices (OVDs): the bacterially derived Healon PRO OVD (test) and the animal-derived Healon OVD (control) under normal use conditions during cataract removal and lens implantation. This prospective, multicenter, randomized, parallel, participant/evaluator masked, postmarket investigation enrolled 139 subjects (170 eyes), 116 (143 eyes) of which were treated (73 test; 70 control group). Both test and control OVDs were used, at a minimum, to inflate the anterior chamber and protect the endothelium prior to cataract extraction according to the standard procedure. The surgeon completed a postsurgery OVD clinical performance questionnaire, and intraocular pressure (IOP) was measured before surgery and at the 1 day postoperative visit with Goldmann applanation tonometry. Any IOP measurement of 30 mmHg or higher was considered a “spike” and recorded as a study-specific, serious adverse event. The bacterially derived Healon PRO OVD was found to be statistically noninferior to the overall clinical performance of the animal-derived Healon OVD control; thus, the primary hypothesis was satisfied. There were no statistically significant differences between OVD groups for any of the additional endpoints relating to IOP changes or to safety, thus satisfying additional hypotheses. The Healon PRO OVD showed statistically significant improvements in surgeon ratings for ease of injectability, transparency/visibility, and ease of IOL placement. The safety profile was also similar between OVD groups with regards to serious and/or device-related adverse events, as well as medical and lens findings. The results of this clinical investigation support the safety and effectiveness of the bacterially derived, currently marketed Healon PRO OVD and indicate that the intraocular surgical performance was similar between the two OVDs.

Paediatric cataract in the uveitis setting.

Cataract formation is common in uveitis and is visually more threatening in the paediatric cohort due to the risk of amblyopia. In addition, paediatric uveitis can often be difficult to manage. We report our experience with IOL placement in cataract surgery in the setting of paediatric uveitis. This non-comparative, retrospective interventional case series examined our cases of paediatric cataract occurring in patients with uveitis from 2003 to 2016. Parameters examined included visual acuity (VA), underlying diagnosis, immunosuppression status, intra-operative complications and requirement for further surgery. In total, 10 eyes of seven patients were identified. The mean age at diagnosis of uveitis was 7.7 years (range 5.2-14 years) with onset of cataract at a mean of 29.3 months later (range 0-66 months). Three cases were bilateral and four cases were unilateral. Final visual outcomes were excellent with 80% showing improvement in VA achieving greater than 6/9.5 (p < 0.05). These patients had significant co-morbidities with concurrent glaucoma, band keratopathy and cystoid macular oedema. Uveitis was quiet for a minimum of 6 months in all cases prior to surgery with augmentation of immunosuppression pre-operatively as well as intra-operative local or intra-venous steroids. Tight post-operative care was necessary as 80% developed further flare-up of uveitis requiring increased immunosuppression and surgical interventions to manage their uveitis. Paediatric uveitis patients who develop cataract can have good visual outcomes with IOL insertion at the time of surgery when there is aggressive control of uveitis in the pre, peri and post-operative period.

Iris-fixated phakic intraocular lens explantation.

To evaluate the visual outcomes and indication for surgery in a series of patients who underwent explantation of a phakic intraocular lens (PIOL). A retrospective case series of patients who underwent PIOL explantation in our institution was performed. The indication for explantation and visual and refractive outcomes were examined. The method of explantation is described. Twenty-two eyes of 16 patients underwent PIOL explantation with a mean time to explantation of 7 ± 3 years (range 3-11.4). The mean age at explantation was 50.3 ± 9.3 years. Sixteen Artisan PIOLs and six Artiflex PIOLs were explanted. The indications for explanation were cataract development (17/22), endothelial cell loss (4/22) and synechiae formation (1/22). All patients with cataract underwent a combined procedure with explantation and phacoemulsification and the placement of a posterior chamber IOL. Mean corrected vision after explantation was 0.22 ± 0.10 logMAR (range 0.1-0.3 logMAR). One patient with endothelial cell loss required a Descemet's Stripping Endothelial Keratoplasty (DSEK). Removal of PIOLs was necessitated most frequently by cataract followed by endothelial cell loss. Both explantation alone and explantation with concurrent phacoemulsification are safe procedures with good visual outcomes and will become more frequent in the future as more patients with PIOLs reach cataractous age.

A study on evaluation of acrysof toric intraocular lens implantation to correct pre-existing corneal astigmatism in patients undergoing cataract surgery- At a tertiary care hospital

The current study evaluates the results of acrysof toric intraocular lens implantation to correct pre-existing corneal astigmatism in patients undergoing cataract surgery. This study was done on Prospective interventional at Osmania Medical College, Sarojini Devi Eye Hospital, Hyderabad. The sample of the study is included 40 eyes of 38 consecutive patients with 1.5 D or more of pre-existing astigmatism consists of cataract surgery with toric open-loop IOL implantation (Alcon, Fort Worth, TX, USA). The pre-operative markings for the position of incisions and IOL placement were being done under the slit lamp. The visual acuity, residual keratometric and refractive cylinders, and toric IOL axis were being measured. 54.71 years was the mean age of the patients. All the 40 eyes at the final check-up had post-operative unaided visual acuity of 6/12 or better. 10 patients (25 %) had an unaided visual acuity of 6/6.37 eyes (92.5%) had best corrected post-operative visual acuity of 6/9 or better. The mean pre-operative refractive astigmatism in 40 eyes was 2.34D. 22 eyes had the Refractive astigmatism of &amp;#62;2D. No eyes had refractive astigmatism of &amp;#60;1.5D. The mean axial length was 24.22mmOut of 40 eyes in which Toric IOL was implanted, the post-operative residual refractive sphere was seen in 4 eyes. Out of 40 eyes in whom Toric IOL was implanted, a post-operative residual refractive cylinder was seen in 30 eyes. 10 patients had No post-operative refractive cylinder. The mean post-operative residual refractive cylinder was 0.58D. The mean Post-operative Keratometric cylinder was 2.24D. The mean post-operative Keratometric cylinder was 2.34D. In comparison, both pre-operative and post-operative keratometric astigmatism, it was found that there was no statistically significant difference between them.The misalignment of Toric IOL was 10 degrees or less in 36 patients (94.73%) and less than 5 degrees in 22 patients (57.89%). Misalignment of &amp;#62;10 degrees (11 degrees and 13 degrees) was seen in 2 patients. The mean IOL rotation among 38 patients was 4.55 degrees (Range 0-13 degrees, SD 3.43). None of the eyes required repositioning. The results of this study show that implantation of AcrysofTor ic IOL is a good surgical method to evaluate pre-existing corneal astigmatism in cataract surgery. Acrysoftoric IOL has shown good rotational stability.