IOL Position Research Articles

Clinical outcomes after implantation of a toric intraocular lens with a transitional conic toric surface

PurposeTo evaluate the postoperative outcomes after implantation of a hydrophilic toric intraocular lens (tIOL) with a transitional conic toric surface in patients with astigmatism undergoing refractive lens exchange (RLE) or...

Vitreolensectomy combined with intraocular lens implantation by single haptic scleral suturing for the traumatic lens subluxation

Objective To evaluate the efficacy of vitreolensectomy combined with posterior chamber intraocular lens (PCIOL) implantation by single haptic scleral suturing for the treatment of traumatic lens subluxation. Methods The data of 18 eyes of 18 cases with traumatic lens subluxation were collected and analyzed retrospectively. All cases underwent vitreolensectomy retaining partial capsule and PCIOL were fixated by single haptic scleral suturing and retained capsular. The follow-up time was 6-18 months. Position of PCIOL, BCVA, intraocular pressure, and complications were observed and retrospectively analyzed. Results Post-operative BCVA was increased significantly (P=0.000). Post-operative intraocular pressure was stable and the position of IOL was steady. There was no complication associated with IOL. Conclusion Vitreolensectomy retaining partial capsule combined with IOL implantation by single haptic scleral suturing is a practicable and safe procedure for traumatic lens subluxation. Key words: Vitreolensectomy; Lens subluxation, traumatic; Lens, intraocular

Early versus late traumatic cataract surgery and intraocular lens implantation

PurposeTo determine the proper time for traumatic cataract surgery after open globe injuries.SettingFarabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.DesignRandomized clinical trial.Patients and methodsIn a randomized clinical trial, 30 eyes with traumatic cataract after open globe injury with IOL implantation underwent early (in the first week after the trauma) and 30 eyes underwent late cataract surgery (from the first to second month after the trauma). We excluded patients who were under 12-year-old. All patients were visited at 1 week, 4 weeks, 12 weeks, and 6 months after surgery. In each visit, patients were examined regarding visual acuity, intraocular pressure (IOP), anterior chamber inflammation, IOL position, and posterior synechiae. In addition, posterior segment evaluation and fundoscopy were performed. Intraoperative complication including posterior capsular rupture, anterior vitrectomy, and zonulysis as well as the site of IOL implantation were documented and post-operative complications including raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were listed.ResultsBest-corrected visual acuity 6 months after surgery was not different between the two groups. Also in early cataract surgery group, the rate of posterior capsular rupture was not significantly higher than the late surgery group (P=0.069). On the other hand, zonulysis was significantly higher in the late procedure group (P=0.039). Other complications including anterior vitrectomy, raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were not different in the two groups.ConclusionsEarly and late traumatic cataract surgery and IOL implantation after open globe injuries, have no significant difference regarding the post-surgical BCVA and prominent intraoperative and post-operative complications.

The First Results of New Russian Lens Exchange IOL in Patients with High Myopia

Purpose: To evaluate safety, precision and stability of refractive results after phacoemulsification with implantation of NanOptica (Russia) IOL like a method for high myopia correction. Patients and methods. 4 eyes of 2 patients aged 34 and 81 y.o. with high myopia: sph -6.5D — sph -12.0D (mean -9.12Д±2.39) were operated by phacoemulsification with hydrophylic IOL “Aquamarine” NanOptica (Russia) implantation. In first case operation was performed in young female, for correction of myopia with clear lens, the target was about -2.0 D. The second patient was treated for mature cataract by the same method. Study included evaluation UCVA, UCVA, Autorefractometry, IOP measurement, IOL master, ultrasound biometry, slit lamp examination, fundus examination, keratotopography, Cirrus OCT of posterior segment. Pre op mean UCVA (Decimal) 0.0475 (0.04–0.05 ), mean ВCVA 0.73 (0.4–1.0). Biometry (А method) from 26.82 mm to 28.49 mm, average 27.48 mm ±0.72. For IOL calculation we used SRK/T formula. The standard phacoemulsification was performed. Incision 2.4 mm. Injector Comfort C, RET, (Korea) was used for IOL delivery into the eye. There were no difficulty with IOL positioning in cartridge, injection in the eye and centration. Follow up period was 4 months. Study was performed at International Center for Ophthalmology in Moscow, Russia. Results: Early postoperative period was without any complications. Post op mean UCVA (Decimal) was 0.66±0.27 (0.4–0.9), mean ВCVA — 0.95±0.05 (0.9–1.0). Target refraction corresponded to predetermined values: sph -1.75D–0.0 D (average -0.81). 34 years old patient had signs of posterior capsule fibrosis I st. after 3 months after operation. It didn’t affect at the visual acuity. Conclusion: First successful results of IOL “Aquamarine” Naooptica (Russia) implantation were reached. Refractive target have been achieved. Aquamarine can be recommend for correction in patients of different age with high myopia patients. Future follow-up study is required.

Morphological and clinical aspects of anterior capsulotomy in femtosecond laser-assisted cataract surgery

The review covers morphological and clinical aspects of femtosecond laser-assisted anterior capsulotomy in cataract surgery. Literature data suggests that femtosecond laser-assisted capsulotomy is more accurate in size, shape, and centration than manual. Femtosecond laser-assisted anterior capsulotomy improves the accuracy of IOL positioning within the capsular bag.

The efficacy of various surgical procedures for the treatment of traumatic subluxation of lens

Objective To observe the efficacy of various surgical procedures for the treatment of traumatic subluxation of lens. Methods Sixty eyes of 60 cases with traumatic cataract combined with subluxation of lens were retrospectively analysed. Based on the different degree of the dislocation of the lens, the patients were divided into four groups, each group contained 15 eyes of 15 cases. Group A, the range of broken suspensory ligament was <90°, underwent phacoemulsification and implantation of the C loop IOL .Group B, the range was 90°-<180°, underwent phacoemulsification combined with implantation of IOL and capsular tension ring.Group C, the range was 180°-<270°, underwent capsular tension ring suture in the ciliary sulcus. Group D, the range was ≥270°, received the three channels closed lens ectomy and anterior segment vilmectomy and IOL implantation with the ciliary suture fixation. At 1 week, 1, 3 and 6 months after operation the anterior chamber inflammation, location of IOL, the best corrected visual acuity (BCVA), intraocular pressure and other complications were observed. Results One week after operation, in Group A, aqueous flare was (-), position of IOL was centered. BCVA ≥0.5 were in 11 eyes(73.3%); in Group B and Group C, aqueous flare was (+ ), position of IOL was centered, BCVA ≥0.5 were in 9 eyes(60.0%). In Group D, aqueous flare was (+ ), IOL was slightly offset position in 3 eyes, BCVA ≥0.5 were in 4 eyes(26.7%). One month after operation, four groups of patients with anterior chamber inflammation reaction had subsided. In Group A, BCVA ≥0.5 were in 13 eyes (86.7%); in Group B and Group C, BCVA ≥0.5 were in 12 eyes (80.0%) in each group; in Group D, BCVA ≥0.5 were in 8 eyes(53.3%). After 3 and 6 months after surgery, four groups of BCVA were stable, position of IOL centered and macular edema, detachment of cyclodialysis and choroidal detachment serious complication. Conclusion According to the degree of lens subluxation, a reasonable choice of correct operation can significantly improve the postoperative visual acuity and reduce the intraoperative and postoperative complications. Key words: Ocular trauma; Subluxation of lens, traumatic; Capsular tension ring; Surgical procedures; Efficacy

Оптимизация расчета оптической силы интраокулярной линзы у пациентов с осложненной катарактой на фоне псевдоэксфолиативного синдрома

Background . In recent years the phacoemulsification with IOL implantation (PHACO+IOL) is a «gold» standard for cataract surgery. This requires high refractive outcomes that depend upon a number of reasons. One of those is a change in the IOL position in the eye, which can be caused by dystrophic lesions of the zonular system of lens associated with the pseudoexfoliative syndrome (PEХ). Purpose. To increase the accuracy of IOL power calculations in patients with complicated cataract and pseudoexfoliative syndrome. Material and methods . A comparative analysis of refractive results in phacoemulsification with IOL implantation PHACO+IOL was performed in 57 cases of cataract with PEХ. All clinical materials were divided into two groups based on bio-microscopic characteristics: with initial and advanced PEX symptoms. All patients underwent standard examinations. A comparative analysis of refractive outcomes in the study groups was carried out using the «reverse calculation» method that consists in a recalculation of IOL power based on post-operative examination data in both groups. Results. There was no necessity in any amendments to the IOL power calculation in patients with cataract and initial PEX stage. An error of the calculated IOL power was detected in patients with advanced PEХ stage on an average 0.37±0.12D. Сonclusion. The detected error of the calculated IOL power in patients with advanced PEX stage requires an amendment amendment for A constant Am=A+0.3.

Precise IOL Position Measurement to Improve Refractive Outcomes in Cataract Surgery

Precise IOL Position Measurement to Improve Refractive Outcomes in Cataract Surgery

New Parameter for Predicting the Postoperative IOL Position: Preoperative Lens Equator Depth measured By Three‐Dimentional Anterior Segment Optical Coherence Tomography

PurposeTo test the hypothesis that the preoperative crystalline lens equator depth (pre‐LED) measured by three‐dimensional anterior segment optical coherence tomography (OCT) is an effective predictor of the postoperative anterior chamber depth (post‐ACD).MethodsThirty‐nine eyes that underwent phacoemulsification and implantation of a one‐piece, plate‐haptic intraocular lens between December 2013 and June 2014 were examined to develop the new algorithm for predicting the post‐ACD. The pre‐LED was defined as the depth from the back surface of central cornea to the line connecting the intersecting points between the anterior and posterior capsule intraoperatively using 3‐D OCT in Catalys (Abbott Medical Optics). The post‐ACD was measured by Pentacam (Oculus) in each case at 2 months postoperatively and was analyzed by multiple linear regression for covariance with preoperatively defined variables including the pre‐LED, lens thickness, lens vaulting measured by the OCT and the preoperative ACD (pre‐ACD) measured by the OCT and Pentacam.ResultsThe mean pre‐ACD, pre‐LED, AL, lens thickness and lens vaulting was 2.74 ± 0.50 mm (range, 1.75–3.36); 4.14 ± 0.35 mm (range, 3.36–5.91); 23.97 ± 1.37 mm (range, 21.89–27.63), 4.23 ± 0.46 mm (range, 3.01–5.12) and 1.42 ± 0.27 mm (range, 0.82–1.89). Single regression analysis showed significant correlations between the post‐ACD and pre‐LED, R2 = 0.468, P &lt; 0.001; pre‐ACD, R2 = 0.379, P &lt; 0.001) Using a new regression formula with the two most significant variables (pre‐LED and pre‐ACD), the post‐ACD can be predicted with an accuracy of 47.3%. In the prospective study, the postoperative ACD was predicted with a correlation coefficient of 0.696.ConclusionsThe crystalline lens equator depth may be a promising preoperative parameter to predict the postoperative IOL position.

Intraoperative optical coherence tomography (iOCT) in toric IOL implantation

SummaryThe effectiveness of the correction of astigmatism depends on the accuracy of the IOL position in the lens capsule. Removal of viscoelastic from the bag and the right IOL centration have a direct impact on the effectiveness of this IOL. Intraoperative use of OCT in real time (RESCAN 700 Zeiss) allows the evaluation of IOL in the bag position. iOCT plays role in the estimation of the distance from the posterior capsule of the lens. The use of iOCT allows to achieve an improved surgical results in patients with cataract and coexisting astigmatism.

Clinical application of posterior continuous curvilinear capsulorhexis in traumatic cataract surgery

Objective To observe the clinical effect of posterior continuous curvilinear capsulorhexis in traumatic cataract with posterior capsular rupture. Methods Twenty-five 25 eyes of 25 patients were selected as clinical trial group and other 18 eyes of patients as control group. In trial group, traumatic cataract extraction, primary IOL implantation and posterior continuous curvilinear capsulorhexis were performed, while in control group, routine traumatic cataract extracion and IOL implantation were fulfilled. The visual acuity and surgical complications were compared between two groups. The follow-up period was 3 months. Results The differences of surgical complications and IOL position between two groups were statistically significant (P<0.05). Three months after operation, the differences of visual acuity, posterior capsular opacity, cystoid macular edema betweenin two groups were statistically significant (P<0.05). The visual acuity of trial group was better than that of control group, and the incidence rate of surgical complications in control group was higher than that in trial group. Conclusion Posterior continuous curvilinear capsulorhexis can improve the therapeutic effect and prevent surgical complications for traumatic cataract with posterior capsular rupture. Key words: Cataract, traumatic; Capsulorhexis, curvilinear, continuous, posterior

Axis measurement strip for Haag-Streit BM900 series slitlamp.

We describe a technique to measure the toric IOL axis using an axis measurement strip applied to the Haag-Streit BM900 series slitlamp. The technique was used by 3 surgeons to determine the postoperative toric IOL position in 47 eyes, and these data were compared with objective measurements derived from images made with a Galilei G2 corneal analyzer. The results indicate that the axis measurement strip provides a precise, clinically efficient measurement of toric IOL position. Neither author has a financial or proprietary interest in any material or method mentioned.

A case series of late postoperative capsular block syndrome treated by Nd:YAG laser posterior capsulotomy

AbstractPurpose To evaluate the clinical characteristics of the unusual late postoperative capsular block syndrome (CBS) and the effect of neodymium:yttrium‐aluminium‐garnet (Nd:YAG) laser posterior capsulotomy on visual acuity, refractive error as well as its possible complicationsMethods Retrospective cohort study. Twelve eyes of 11 patients with late CBS who had undergone Nd:YAG laser posterior capsulotomy were reviewed. A complete examination including Scheimpflug camera and anterior segment optical coherence tomography (AS‐OCT) imaging had been performed before and after posterior capsulotomyResults BCVA increased in 11 cases (91.7%). Only one eye showed a 0.5 diopter hyperopic shift following posterior capsulotomy. There were no post‐laser complications such as increased IOP or cystoid macular edema. In all patients, the posterior capsule was vaulted posteriorly and could not be seen clearly. AS‐OCT confirmed CBS in the studied cases, demonstrating a distended capsular bag. Rotating Scheimpflug imaging examination showed the white substance located behind the IOLConclusion Late CBS is usually not accompanied by shallow anterior chamber, forward IOL displacement or raised IOP. Nd:YAG laser posterior capsulotomy is a useful treatment and the prognosis of patients with this complication appears favorable. Although the AS‐OCT measurements are easier to get than Scheimplug imaging, both are useful to visualize the distended capsular bag containing the white material and the IOL position

Determination of post-operative toric IOL alignment - Analyzed by two different methods: Slit-lamp versus Adobe Photoshop

Purpose: To compare two different methods of determining the post-operative position of the toric IOL and to calculate the alignment error with each method. Setting/Venue: Cataract and Intraocular Lens Implantation Service, Shroff Eye Center, New Delhi, India. Design: Case series Materials and Methods: Eighty-nine eyes of 61 patients with cataract and co-existing corneal astigmatism ranging from 1 to 4 diopters planned for toric IOL implantation were included. All eyes underwent pre-operative automated keratometry and biometry. Toric IOL cylindrical power, axis of implantation, and anticipated residual astigmatism were calculated using the web-based Acrysof Toric calculator. All eyes underwent pre-operative reference marking to denote the 0° and the 180° positions (using bubble marker) followed by digital slit-lamp photography. All eyes were operated by the same surgeon, at the same incision location. At 3 months, the achieved IOL alignment was analyzed by aligning the slit-beam of the slit-lamp with the pair of marks denoting the axis of the IOL after pupillary dilation. Additionally, the IOL position was determined after capturing a digital retro-illuminated slit-lamp photograph, which was superimposed on the pre-operative photograph using single prominent major episcleral vessel around the limbus as landmark. The axis of orientation of the toric IOL was determined using tools in Adobe Photoshop (version 7.0) by aligning a line through the marks denoting the IOL axis. The amount of alignment error (in degrees) by both methods induced with respect to the desired axis of alignment was calculated and statistically analyzed. Results: The mean pre-operative keratometry was 44.19 ± 1.51 D, and the mean corneal cylinder was 2.54 ± 0.90 D. The mean post-operative absolute cylinder was 0.57 ± 0.28 D. Toric IOL models used were T3(1.03 D): 28 eyes (31.5%), T4(1.55 D): 21 eyes (23.6%), T5(2.06 D): 18 eyes (20.2%), T6(2.57 D): 11 eyes (12.4%), T7(3.08 D): 4 eyes (4.5%), T8(3.60 D): 4 eyes (4.5%), and T9(4.11 D): 3 eyes (3.4%). Mean post-operative alignment error was 3.44 ± 2.60 D by the slit-lamp method and 3.89 ± 2.86 D by the Photoshop method with no significant difference seen between the two methods (P = 0.384). Fifty-six eyes (62.9%) by the slit-lamp method and 52 eyes (58.4%) by the Photoshop method had rotation error ≤ 5 degrees (P = 0.526), and 78 eyes (87.6%) by the slit-lamp method and 75 eyes (84.3%) by the Photoshop method had rotation error ≤ 10 degrees (P = 0.422). Conclusions: Both Adobe Photoshop method and slit-lamp observation were reliable and predictable methods of assessing IOL alignment. Although the sensitivity is more with the Photoshop method, the slit-lamp method is more accessible in an outpatient setup. The clinical outcome following toric IOL implantation can be refined by reducing the alignment error, which is dependent on an accurate keratometry and biometry, surgeon-specific SIA, reference and intra-operative marking, and finally, placement of IOL in the bag.

Multifocal IOL Implant with or without Capsular Tension Ring: Study of Wavefront Error and Visual Performance

To evaluate visual performance and wavefront error after multifocal intraocular lens (MIOL) implant with or without capsular tension ring (CTR). Sixty eyes of 60 candidates for phacoemulsification and MIOL implantation were included in the study and were randomly divided into 2 groups. Thirty eyes (group 1) were implanted with the AcrySof ReSTOR® SN60D3 MIOL and Corneal® ACPI 11 CTR and 30 eyes (group 2) received the same MIOL with no CTR. Twenty days and at 360 days after surgery, the uncorrected and corrected distance visual acuity at high and low contrast were not significantly different between the 2 groups. The root mean square (RMS) of ocular and internal wavefront error was significantly different in the 2 groups early after surgery and did not modify significantly over the 1-year follow-up period. The RMS of total and internal high-order aberrations and ocular and internal trefoil and coma aberrations were significantly lower in group 1 compared to group 2 (p<0.05). Ocular, corneal, internal modulation transfer function at high and low spatial frequencies and ocular, corneal, internal Strehl ratio were not significantly different between the groups. The IOL decentration and tilt were higher in group 1 compared to group 2. ReSTOR MIOL was effective in improving visual performance and provided a good quality of vision due to a significant reduction of high-order spherical aberration. The implant of CTR additionally reduced the ocular wavefront error related to a reduction of third-order aberration related to better IOL position.

Improving effective lens position : comparison of femtosecond laser vs manual capsulotomy

AbstractPurpose Every IOL formula has its limits in estimating Effective lens position (ELP). The main one is the variability in capsulotomy size and centration. Our purpose was to compare the variability and predictability in ELP based on capsulotomy created by a femtosecond laser with those using manual continual curvilinear capsulorhexis.Methods 32 eyes from 24 patients undergoing cataract surgery had either femtosecond created 5.2 mm capsulotomy (VICTUS™ Femtosecond Laser Platform ‐ Technolas Perfect vision) (n=16) or manual continuous curvilinear capsulorhexis performed with an attempted diameter of 5.2 mm (n=16). One surgeon performed all the surgeries during a period of one month in April 2012, at Percy military hospital, Clamart. Three type of monofocal IOL were implanted in the bag. At one month after surgery, ELP was measured by Pentacam HR and compared to preoperative estimated lens position. Accuracy to target refraction was also calculated, being the difference between target refraction with Iolmaster v5 (Haigis, SRK/T and Holladay formula) and postoperative objective refractionResults Precision of IOL position was improved, as shown by statistically significant reduced variability of ELP (0,27 vs 0,45, p=0,03) in the laser group at one month. Better accuracy to target refraction using SRK/T formula (0,16 vs 0,5, p=0.02) and Holladay formula (0,26 vs 0,50, p=0,02) was also observed in the laser‐treated eyes compared to the manual group.Conclusion Femtosecond laser system provides a perfectly round, well‐centered, and precise diameter capsulotomy. In this study, this translated to more accurate and predictable ELP and IOL power calculation in femtosecond laser group compared to manual group.

Contribution of 3D anterior segment reconstruction by rotative UBM to the sizing of phakic IOL

AbstractPurpose Posterior phakic implantation is the recommended procedure for high ametropia correction but it is harmed by a difficult sizing inducing errors. We designed a 3D rotative UBM prototype in order to take into account the volume of the posterior chamber to improve the sizing.Methods 7 myopic eyes (mean MRSE: ‐10.8) of 4 patients underwent a phakic implantation by one surgeon with a “white to white”‐based sizing method. During the 3rd postoperative month, we evaluated several mesures that we assessed by anterior segment OCT (2D) and by our UBM prototype (3D), designed by the LaTIM ‐Inserm U1101 in association with Quantel Medical®. It contains a linear scanning probe of 50 MHz with a rotative motor (acquisition of 30 coaxial slides).Results 3D reconstruction gives us a representation of one eye on 360°. For each eye, we have compared data pre and postoperative implantation and our results reflect the conventional impact of implant.Conclusion Our rotative probe has allowed the first 3D reconstruction of the ocular anterior segment. This initial approach reports high anatomical variations and non uniformity of intraocular clearances, explaining potentially some unexpected IOL positioning. Our goal is to have an accurate visualization of relationship between phakic IOLs and intraocular surrounding structures. Perspectives could be the evaluation of the impact of accommodation on intraocular volumes in addition to preoperative simulations in 3 dimensions. Commercial interest

Modified capsular tension ring implantation in eyes with traumatic cataract and loss of zonular support

To evaluate the outcomes of implantation of a Cionni modified capsular tension ring (CTR) and a posterior chamber intraocular lens (PC IOL) in patients with traumatic cataract and loss of zonular support. Eye Clinic II, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. Case series. Eyes with traumatic cataract and loss of zonular support had phacoemulsification with implantation of a foldable IOL and a 1- or 2-eyelet modified CTR. Preoperative features, preoperative and postoperative corrected distance visual acuity (CDVA), intraoperative performance, IOL position, and complications were evaluated. The study enrolled 16 eyes (16 patients). The mean CDVA was 0.89 logMAR ± 0.41 (SD) preoperatively and 0.33 ± 0.43 logMAR at the last postoperative examination (P=.001). Postoperatively, the mean spherical equivalent was -0.23 diopter (D) (range -1.50 to +1.00 D) and themean postoperative astigmatism, 1.59 D (range 0.50 to 4.00 D). Eight eyes (50.0%) had phacodonesis preoperatively; no eye had pseudophacodonesis postoperatively. Preoperatively, 10 eyes (62.5%) had symptomatic decentration. Two eyes (12.5%) had asymptomatic nonprogressive decentration in the early postoperative period; no eye had symptomatic decentration throughout the follow-up. Three eyes (18.8%) preoperatively and 1 eye (6.2%) postoperatively had vitreous in the anterior chamber. Four eyes (25.0%) required anterior vitrectomy. Other complications were symptomatic posterior capsule opacification in 8 eyes (50.0%) and transient increased intraocular pressure in 2 eyes (12.5%). The use of a modified CTR preserved the capsular bag and resulted in good PC IOL centration with few significant complications in patients with traumatic cataract and loss of zonular support. No author has a financial or proprietary interest in any material or method mentioned.

Evolution of cataract surgery: Smaller incision - less complications

Cataract surgery has become one of the safest procedures in medicine thanks to advances in technology and surgical techniques. Although minimal, we still witness different complications. The aim of this study was to compare visual outcome and complication rate in different techniques of cataract surgery, ie in cataract surgeries with various corneal incision width. The study included 3,457 consecutive patients, ie 4,670 eyes that had undergone cataract surgery. The used surgical techniques were: extracapsular cataract extraction, phacoemulsification/forceps IOL implantation, phacoemulsification/injector IOL implantation, microincision cataract surgery (MICS). Patient follow up was 6 months. Patients were evaluated for: visual aquity, corneal astigmatism, cellular reaction in the anterior chamber, IOL position. Uncorrected visual aquity 30 days postoperatively was > or = 0.5 in 30% of the eyes - ECCE; 54.7% of the eyes - phacoemulsification/forceps IOL implantation; 63.0% of the eyes - phacoemulsification/injector IOL implantation; 5/8 of the eyes - MICS. Endophthalmitis was detected in 0.15% of the eyes - ECCE and 0.1% of the eyes - phacoemulsification/forceps IOL implantation. In eyes with phacoemulsification/injector IOL implantation or microincision cataract surgery (MICS) there were no cases of endophthalmitis. After a 6-month period intraocular lens were dislocated in 7.2% of the eyes - ECCE, and 0.6% of the eyes - phacoemulsification/PMMA IOL. There was no IOL dislocation in other surgical techniques. Shorter corneal incision implies less complications, less operative trauma, faster visual rehabilitation and better visual outcome.

LARV: Limbal Approach Retropseudophakic Vitrectorrhexis and Vitrectomy– An Innovative Technique for the Management of Pediatric Cataract

Aim: To report safety and efficacy of LARV (Limbal Approach Retropseudophakic Vitrectorrhexis and Vitrectomy), an innovative technique for the management of Pediatric Cataract. Subjects and Methods: This descriptive caseseries included children undergoing IOL implantation with primary posterior capsulectomy and anterior vitrectomy for developmental or traumatic cataract with no other ocular co-morbidity. All the patients had hydrophobic IOL implanted in the bag followed by LARV performed by a pediatric ophthalmologist in the learning phase of this technique. On follow up, the patients were evaluated for 1) IOL position, 2) size and centration of the posterior capsulectomy, 3) adequacy of anterior vitrectomy and 4) complications. Results: 23 eyes of 18 consecutive patients, aged 4.5 ± 3.5 years with a mean follow up of 7.3 ± 4 months were included. 3 had traumatic cataract, 20 had developmental cataract and 13 were females. Ninety one % (21/23) had IOL in the bag, mean posterior capsulectomy size was 4.6 ± 0.9 mm, IOL was well centered and anterior vitrectomy was adequate in all. During the surgery, one patient had partial dislocation of the IOL behind the posterior capsule that needed IOL repositioning in the sulcus. One patient had one haptic in the anterior chamber that needed repositioning. Three patients had posterior synechia < 1 clock hour, 4 had pigmentation on the IOL optic. Conclusion: LARV is a useful technique for pediatric cataract albeit with a steep learning curve. Potential complications of LARV during the learning phase need awareness. A case–control study is needed to assess its advantages over conventional technique of pediatric cataract surgery.