Lens Aspiration Research Articles

Olanzapine-induced Cataract in a Teenage Girl

Cataract, defined as cloudiness of the lens, is a common adverse effect of first-generation antipsychotic medications. Newer generation antipsychotics, also known as atypical antipsychotics, are less commonly associated with cataract. A 19-year-old girl with underlying schizophrenia on olanzapine for the past two years complained of gradual blurring of vision in both eyes for four months prior to presentation. On examination, the best corrected visual acuity was counting finger in both eyes. The anterior segment examination showed bilateral diffuse cortical cataract precluding fundus examination. Systemic examination was unremarkable. Blood investigations revealed a high random blood sugar, which normalised after she was initiated on oral hypoglycemic medication. After bilateral lens aspiration, her visual acuity was 6/6 bilaterally. Olanzapine may be cataractogenic via its action as a serotonin antagonist, which results in reduced glucose responsiveness of the pancreatic beta-cells. Patients on anti-psychotic medication are at risk of developing diabetes mellitus and cataract compared to the general population. Screening for diabetes mellitus should be part of the follow-up of these patients. Ophthalmological evaluation is warranted in the presence of visual complaints.

Stożek tylny soczewki – wyniki leczenia chirurgicznego u dzieci

Aim: To present the results of surgical treatment of the posterior lenticonus with implantion of multifocal IOLs in children. Material and method: Lens aspiration with a multifocal IOL implantion was performed in 22 children aged 1–10 years. Before and during the 2–5-year follow- up, the anterior and posterior eye segment, visual acuity, binocular vision and intraocular pressure were evaluated. Results: The visual acuity before surgery was ranged from 0.05 to 0.1. After the operation, it improved from 0.1 to 1.0 and depended mainly on the effectiveness of amblyopia treatment. Visual acuity better than 0.3 was found in 81.8% of operated patients. There was a significant improvement in binocular vision in comparison to the preoperative period. In 1 case, the child had to be reoperated due to the IOL dislocation. There were no glaucoma cases in the operated group of children. Conclusions: Lens aspiration with a multifocal IOL implantation is a method that provide good functional outcomes in operated children. However, the technique of surgery treatment is more difficult than in the patients with congenital cataract due to the very thin and weak posterior lens capsule and occurrence pre-operative capsule tearings.

Visual outcome of congenital and developmental cataract surgery in Lumbini Eye Institute

Background: Paediatric blindness presents as an enormous problem to developing countries in terms of human morbidity, economic loss and social burden.Aims and Objective: The objective of this study was to observe the visual outcome of congenital and developmental cataract surgery.Materials and Methods: This study was prospective, longitudinal and interventional. The patients aged ≤15 years, diagnosed either congenital or developmental cataract and planned for cataract surgery were enrolled during March 2014 to February 2015 at Lumbini Eye Institute, Nepal. The patients underwent either: a) Lens aspiration + PPC+ Anterior Vitrectomy; b) Lens aspiration + PPC+ Anterior Vitrectomy + PCIOL; c) Lens Aspiration + PCIOL depending upon age of patient. The patients were examined after surgery day 1, day 2, after 2 weeks and after 6 weeks. Glasses were prescribed at 6 weeks from the date of surgery. Occlusion therapy was initiated in cases wherever necessary.Results: A total of 54 eyes of 43 children were included in the study. The sex ratio was 1.26 female per male with mean age of 3 years (SD ± 2.16). In the verbal group, 61.1% (33 eyes) had final visual acuity (6/6-6/18). In the non verbal group, 16.7% (9 eyes) had final visual acuity of good fixation and follow. There was a statistically highly significant improvement in post surgical Best corrected visual acuity (p< 0.001).Conclusion: Good visual outcome after pediatric cataract surgery can be obtained if surgery is performed by skilled surgeon. The awareness of pediatric cataract, early diagnosis and timely intervention to surgical treatment, and postoperative management of residual uncorrected refractive error and amblyopia are important factors for the prevention of childhood blindness from cataract.Asian Journal of Medical Sciences Vol.9(2) 2018 36-39

Long-term outcomes following primary intraocular lens implantation in infants younger than 6 months

Purpose:To study the long-term safety profile and visual outcomes of primary intraocular lens (IOL) implantation in infants <6 months of age.Methods:This was a retrospective observational study conducted at a tertiary eye care center in South India. Infants under 6 months meeting the selection criteria who underwent cataract surgery (lens aspiration, primary posterior capsulorhexis, and anterior vitrectomy) with primary IOL implantation between January 2008 and December 2011 and minimum 3-year follow-up were included. Patient demographics, serial refractions, visual acuity, complications, and associated amblyopia/strabismus were reviewed. Visual acuity, myopic shift, and complications were the outcome measures.Results:Sixty-nine eyes of 38 infants (31 bilateral; mean age: 4.6 months) were reviewed. Mean follow-up was 51 months (range: 36–84). Median logMAR best-corrected visual acuity at the final visit was 0.74 (interquartile range [IQR]: 0.50–0.98) in eyes with bilateral cataracts and 0.87 (IQR: 0.60–1.14) in eyes with unilateral cataracts with an average myopic shift of 6.7 diopters over 4.2 years. Most common postoperative complication was visual axis opacification (VAO) (13 eyes, 18%), necessitating membranectomy followed by pigmentary IOL deposits (11 eyes, 15%), and IOL decentration and glaucoma in four eyes each (5.6%). Mixed linear effect model found no significant association of age, gender, laterality, and postoperative complications with final visual acuity (P ≥ 0.05). Eyes with unilateral cataracts had a greater myopic shift than bilateral cases (P = 0.03).Conclusion:Primary IOL implantation in infants <6 months is reasonably safe in appropriately selected infants. VAO was the most common postoperative complication, and a large myopic shift was observed.

Comparing the outcome of intraocular lens implantation with or without posterior optic capture in pediatric cataract surgery

Purpose To evaluate the outcome of intraocular lens (IOL) implantation with posterior optic capture versus in-the-bag implantation in pediatric cataract surgery. Setting Ain Shams University Hospital and Research Institute of Ophthalmology. Design It is a prospective, comparative clinical study. Patients and methods Thirty eyes with developmental cataract underwent primary cataract extraction and IOL implantation of hydrophobic acrylic multipiece Sensar IOL AR40e. In all cases, anterior and posterior continuous curvilinear capsulorrhexis, lens aspiration, and anterior vitrectomy were performed. IOL was implanted in the ciliary sulcus, and the optic was captured in both anterior and posterior capsulorrhexis in group A (15 eyes) and implanted in the bag without capture in group B (15 eyes). Visual acuity, visual axis opacification, red reflex, intraocular pressure, centration, and complications were all assessed. Results The mean age of children was 5.3±2.93 years. At 6 months of follow-up, the mean postoperative corrected distant visual acuity was 0.69±0.19 and 0.65±0.23 in groups A and B, respectively. The mean clear central zone was 4.29±0.24 and 3.6±0.55 mm in groups A and B, respectively (P=0.001). The mean IOL decentration measured in mm was 1.61±1.17 and 0.86±0.28 SD in groups A and B, respectively (P=0.003). There were no postoperative complications in all cases. Conclusion Placement of IOL haptics in the ciliary sulcus while capturing the optic through the posterior continuous curvilinear capsulorrhexis provides more central clarity of the visual axis, however IOL decentration was more common.

Anesthetic challenges in a child with Lowe's and Fanconi syndrome.

Oculocerebrorenal syndrome of Lowe is a rare X-linked metabolic disorder complicated by Fanconi's syndrome. Anaesthetic management of Lowe syndrome with Fanconi's syndrome is challenging to the anaesthesiologists in view of difficult airway due to microcephaly, metabolic abnormalities, and risk of peri-operative seizures. We report a successful anaesthetic management of a case of 2-year-old child scheduled for evaluation under anaesthesia following bilateral lens aspiration surgery.

Timing and approaches in congenital cataract surgery: a four-year, two-layer randomized controlled trial.

To compare visual prognoses and postoperative adverse events of congenital cataract surgery performed at different times and using different surgical approaches. In this prospective, randomized controlled trial, we recruited congenital cataract patients aged 3mo or younger before cataract surgery. Sixty-one eligible patients were randomly assigned to two groups according to surgical timing: a 3-month-old group and a 6-month-old group. Each eye underwent one of three randomly assigned surgical procedures, as follows: surgery A, lens aspiration (I/A); surgery B, lens aspiration with posterior continuous curvilinear capsulorhexis (I/A+PCCC); and surgery C, lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy (I/A+PCCC+A-Vit). The long-term best-corrected visual acuity (BCVA) and the incidence of complications in the different groups were compared and analyzed. A total of 57 participants (114 eyes) with a mean follow-up period of 48.7mo were included in the final analysis. The overall logMAR BCVA in the 6-month-old group was better than that in the 3-month-old group (0.81±0.28 vs 0.96±0.30; P=0.02). The overall logMAR BCVA scores in the surgery B group were lower than the scores in the A and C groups (A: 0.80±0.29, B: 1.02±0.28, and C: 0.84±0.28; P=0.007). A multivariate linear regression revealed no significant relationships between the incidence of complications and long-term BCVA. It might be safer and more beneficial for bilateral total congenital cataract patients to undergo surgery at 6mo of age than 3mo. Moreover, with rigorous follow-up and timely intervention, the postoperative complications in these patients are treatable and do not compromise visual outcomes.

Outcomes of small gauge pars plicata vitrectomy for patients with persistent fetal vasculature: a report of 105 cases.

To evaluate the surgical outcomes in eyes with persistent fetal vasculatures (PFV) managed by small gauge pars plicata vitrectomy. Consecutive patients with PFV treated by small gauge pars plicata vitrectomy at Beijing Tongren Eye Center between January 2010 and January 2013 were retrospectively reviewed. A total of 118 eyes of 105 patients with PFV were included and undergone small gauge pars plicata vitrectomy, of which 84 (71.2%) eyes had lensectomy and 16 (13.6%) eyes had lens aspiration and immediate intraocular lens implantation. The percentage of sutured scleral incision of 23 gauge vitrectomy (71.7%, 33/46) was higher than that of the 25 gauge vitrectomy (18.1%, 13/72). At last follow-up, visual acuity remained stable in 34 eyes (28.8%) and improved in 84 eyes (71.2%). Age at surgery (less than 2y), anterior type of PFV, and immediate IOL implantation were associated with postoperative improved visual acuity. Sixty five (55.1%) eyes had retinal detachment preoperatively, among which 33 (50.8%, 33/65) eyes had retinal reattachment or partial retinal reattachment. The results suggest that cases with PFV have a potential for developing good visual acuity after small gauge pars plicata vitrectomy with favorable anatomic outcomes and acceptable rate of serious surgical complications.

Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children.

PurposeTo assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts.MethodA retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation.ResultsA total of 178 eyes of 120 children underwent cataract surgery with primary IOL implantation. Mean age at the time of surgery was 6.9 years (range: 3 months to 15 years). Average follow-up time was 13.7 (±5.9) months. Associated ocular anomalies were present in 84 (47.1%) eyes. Postoperative complications were found in 33 eyes (18.13%) with inflammatory membrane being the most common (10.1%). Two eyes (1.1%) developed endophthalmitis. Second intervention was needed in 12 (6.5%) eyes. Preoperative vision of less than 6/60 was present in 105 eyes (57.69%). Final best corrected visual acuity of 6/12 or better was found in 81 (44.5%) eyes.ConclusionOur study shows that hydrophilic IOL is suitable for use in children. Results of this study are comparable with other studies on pediatric cataract surgeries using hydrophobic acrylic intraocular lenses. Low cost hydrophilic lens implantation is an effective approach in managing pediatric cataract surgery in developing countries like Nepal.

Modified technique of endocapsular lens aspiration for severely subluxated lenses.

PurposeSeverely subluxated crystalline lenses pose a difficult situation to anterior segment surgeons and can only be managed surgically by removal of the lens as well as the capsular bag. Several techniques have been described in literature for the management of such cases. We describe a modified technique of endocapsular lens aspiration by the limbal route for lens extraction through small incisions on the cornea.Patients and methodsThirty-two eyes of 16 consecutive patients with severely subluxated crystalline lenses were recruited in the study. All eyes underwent a modified technique of lens aspiration within the capsular bag using a single instrument, vitrectomy cutter, and irrigation cannula, followed by sacrificing of the capsular bag. The patients were either left aphakic or implanted with an open loop anterior chamber intraocular lens (ACIOL Kelman Multiflex) and prospectively followed up for a period of 3 months.ResultsThe mean age of the patients was 9 years 3 months±3 years (range 5-15 yrs). All eyes underwent complete lens aspiration within the capsular bag with no dislocation of the lens matter. ACIOL was inserted in 22 eyes (68.7%) and 10 eyes (31.2%) were left aphakic. All the surgeries were uneventful. The mean best corrected visual acuity (BCVA) at 3 months post surgery was 0.47±0.11 logMAR which was significantly better than pre-operative BCVA (P=0.001). The percentage endothelial cell loss at 3 months was 7.1%. There was no evidence of glaucoma, corneal decompensation, or retinal detachment. The astigmatism which increased from 1.45D±086 preoperatively to 3.76D±2.02 1 week post-operatively due to sutures reduced to 1.97D±0.81 post suture removal at 3 months.ConclusionThe modified technique of endocapsular lens aspiration proves to be a simple and effective method of removal of the lens-capsular bag complex in severely subluxated lenses.

Optimising the surgical outcome in a case of post-traumatic cataract using ultrasound biomicroscopy

A 12-year-old boy was brought with the chief complaint of diminution of vision in his left eye for the past 1 month. History revealed a blunt trauma to his left...

Infantile cataract: comparison of two surgical approaches

ObjectiveTo compare the results of 2 cataract extraction techniques with primary intraocular lens (IOL) implantation in children. DesignRetrospective comparative case series study. MethodsThis study included children with congenital or developmental cataract. In all cases, anterior capsulorhexis, lens aspiration, posterior continuous curvilinear capsulorhexis, and primary IOL implantation were performed. We compared 2 surgical approaches. In the first approach, after IOL implantation in the bag, posterior optic capture (OC) was performed without anterior vitrectomy (OC technique); in the second approach, anterior vitrectomy was performed without OC of the IOL (AV technique). Patient demographic data as well as ethnic origin, child’s age at cataract diagnosis, child’s age at surgery, axial length, IOL power in diopters, visual acuity, visual axis opacification, and complications were assessed. ResultsOne hundred twenty-three eyes were included for surgical approach outcomes comparison; 21 eyes underwent the OC surgical approach and 102 the AV surgical approach. The mean patient age at surgery was 57.3 ± 47.1 months. The mean follow-up was 63.13 months (range 12–202 months). Epithelial lens reproliferation was the major adverse event in our series, affecting 21.1% of patients’ eyes; the mean time to epithelial lens reproliferation development was 90 ± 9.70 months. There was no statistically significant difference between the two groups in best spectacle-corrected visual acuity or epithelial lens reproliferation incidence. ConclusionsIn our case series we did not find any difference between surgical techniques.

Effects of lens extirpation with anterior vitrectomy on vitreous three-dimensional mesh structure.

To investigate the changes in vitreous gel structure after lens extirpation combined with anterior vitrectomy in rabbit eyes. Twenty-eight chinchilla rabbits were divided into three groups. The control group (Group I) included 16 eyes from eight rabbits who did not receive any treatment. Group II included 20 eyes from 10 rabbits that underwent lens aspiration only. Group III included 20 eyes from 10 rabbits that underwent lens aspiration combined with posterior capsulotomy and anterior vitrectomy. Eyes were harvested on the 30th and 60th day postoperatively, respectively. Changes in vitreous gel stretch length due to gravity and the rate of vitreous liquefaction were observed. The collagen content in the vitreous body was examined using the L-hydroxyproline test. Electronic microscopic images were obtained from each eyeball. On both the 30th and 60th day postoperatively, the vitreous gel length of group III was significantly shorter than group I and group II (P<0.05), while the rate of liquefaction of the vitreous body in group III was significantly higher than group I and group II (P<0.05). The collagen content in group III was also higher than that in group I and group II (P<0.05). Loss of vitreous gel mass is more likely to occur in the eyes of rabbits receiving anterior vitrectomy. Lensectomy combined with anterior vitrectomy may damage the stable three-dimensional mesh structure of collagen, which could aggravate vitreous gel liquefaction.

Comparative study of 25- versus 20-gauge pars plana capsulotomy and vitrectomy in pediatric cataract surgery.

To compare 25- and 20-gauge pars plana vitrectomy (PPV) for the management of pediatric cataract. 20 eyes of 15 patients were randomly divided into two groups to undergo pars plana capsulotomy and vitrectomy by either 25-gauge (group A) or 20-gauge (group B) PPV after lens aspiration and IOL implantation. The two groups were compared for total surgical time, time taken in doing pars plana capsulotomy and vitrectomy, and the size of posterior capsulotomy. Post-operative astigmatism was compared at 3months. The mean total surgical time in group A was 49.2±6.7min, while mean total surgical time in group B was 62.5+5.48min (p=0.001). The mean time taken for pars plana capsulotomy and vitrectomy was 4.1±1.19min in group A and 5.0±0.73min (p=0.03) in group B. The mean size of the PCCC in group A was 3.3±0.34mm, while in group B it was 4.0±0.33mm (p=0.001). The mean astigmatism at 3months in group A was 0.65±0.31 diopters, while in group B it was 1.45±0.92 diopters (p=0.019). 25-gauge transconjunctival sutureless PPV can be an attractive alternative to 20-gauge system in the management of pediatric cataracts.

Timing and approaches in congenital cataract surgery: a randomised controlled trial

BackgroundThe optimum timing of surgery and the approach that should be used during congenital cataract surgery are controversial and present challenges for paediatric cataract surgeons in China. The aim of this study was to compare visual prognoses and postoperative adverse effects of paediatric cataract surgery done at different times and using different surgical approaches. MethodsIn this prospective, randomised controlled trial, we recruited Chinese patients aged 3 months or younger who were diagnosed with bilateral diffuse or total cataracts, but who did not have coexisting ocular, systemic or neurological diseases. Patients were randomly assigned into two surgical timing groups: a 3-month-old and a 6-month-old. Each eye had one of three randomly assigned surgical procedures: lens aspiration, lens aspiration with posterior continuous curvilinear capsulorhexis, and lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy. Long-term visual acuity and incidence of postoperative secondary glaucoma and severe posterior capsular opacification were the primary outcomes. χ2 tests, Fisher's exact tests and Kruskal-Wallis tests were used to compare the outcomes between groups. Generalised Estimating Equation with a working covariance matrix of unstructured correlations was integrated into the multivariate linear regression to explore the relationship between long-term visual acuity and the incidence of complications. The research protocol was approved by the Institutional Review Board and Ethics Committee of Sun Yat-sen University. Informed written consent was obtained from at least one family member of each participating patient, and the study was done according to the Declaration of Helsinki. This trial is registered with ClinicalTrials.gov, number NCT02581046. FindingsWe recruited 61 patients (30 girls, 31 boys) to our study. 4 children were excluded from the final analysis because their parents declined participation. A total of 57 participants (114 eyes) with a mean follow-up of 48·7 months were included in the final analysis. Long-term visual acuity in patients who underwent surgery aged 6 months (0·81 [SD 0·28]) was better than that of patients who had surgery aged 3 months (0·96 [0·30], p=0·02) and incidence of posterior capsular opacification during the 6 months following surgery was positively correlated with long-term visual acuity (β=-0·080, p=0·036). Two (2/95, 2%) eyes with a confirmed diagnosis of secondary glaucoma were in the 3-month-old group, and additional surgical interventions were done in these patients to lower the intraocular pressure. For patients who had surgery aged 6 months, the incidence of severe posterior capsular opacification was significantly higher in the lens aspiration group than other two groups (lens aspiration, 8/15 [53%]; lens aspiration with posterior continuous curvilinear capsulorhexis, 3/21 [14%]; and lens aspiration with posterior continuous curvilinear capsulorhexis and anterior vitrectomy, 3/16 [19%]; p=0·03). InterpretationIt was safer and more effective for Chinese bilateral diffuse congenital cataract patients to have surgery of lens aspiration with posterior continuous curvilinear capsulorhexis with or without anterior vitrectomy at 6 months of age than at 3 months of age. FundingNational Basic Research Program (973; 2015CB964600); Natural Science Foundation of Guangzhou (91546101, 81300750); Clinical Research and Translational Medical Center for Pediatric Cataract in Guangzhou, China.

Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children

Purpose To assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts. Method A retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation. Results A total of 178 eyes of 120 children underwent cataract surgery with primary IOL implantation. Mean age at the time of surgery was 6.9 years (range: 3 months to 15 years). Average follow-up time was 13.7 (±5.9) months. Associated ocular anomalies were present in 84 (47.1%) eyes. Postoperative complications were found in 33 eyes (18.13%) with inflammatory membrane being the most common (10.1%). Two eyes (1.1%) developed endophthalmitis. Second intervention was needed in 12 (6.5%) eyes. Preoperative vision of less than 6/60 was present in 105 eyes (57.69%). Final best corrected visual acuity of 6/12 or better was found in 81 (44.5%) eyes. Conclusion Our study shows that hydrophilic IOL is suitable for use in children. Results of this study are comparable with other studies on pediatric cataract surgeries using hydrophobic acrylic intraocular lenses. Low cost hydrophilic lens implantation is an effective approach in managing pediatric cataract surgery in developing countries like Nepal.

Outcomes of Pediatric Cataract Surgery in the Copperbelt Province of Zambia.

To study the outcomes of pediatric cataract surgeries in children operated on in the Copperbelt Province of Zambia and the barriers to accessing surgery. All children who had congenital, developmental, and traumatic cataracts operated on by lens aspiration, primary posterior capsulotomy, and anterior vitrectomy with posterior chamber intraocular lens implantation from 2012 to 2013 and followed up beyond 6 months were studied. Each child underwent a comprehensive preoperative evaluation. An active, assisted follow-up was done and parents were asked about reasons for delay between presentation and surgery. One hundred two eyes of 70 children met the inclusion criteria of the study. Preoperatively, 76 of 77 (98.7%) eyes in the congenital and developmental cataract group had presenting visual acuity of worse than 6/60. This improved postoperatively, with 19 (29.7%) eyes having best corrected visual acuity (BCVA) of better than 6/18, 23 (35.9%) having BCVA of 6/24 to 6/60, and 22 (34.4%) having BCVA of worse than 6/60. Older age (P = .005), better preoperative vision (P = .045) at presentation, unilaterality (P = .012), and delay between presentation and surgery (P = .004) were predictors of a better postoperative outcome. On multivariate analysis, only age was significant (P = .025). Distance and cost of travel and surgery were the causes of delay in presentation. In the patients with traumatic cataracts, 17 of 25 (68%) had BCVA of better than 6/18, 6 (24%) had BCVA between 6/24 and 6/60, and 2 (8%) had BCVA of worse than 6/60 at the 6-month follow-up. The most common causes of injury were being struck by sticks and stones (10 children, 25%). Visual outcomes after pediatric cataract surgery in Zambia were comparable and satisfactory. Cost of treatment was a barrier, but delay did not adversely affect outcome. [J Pediatr Ophthalmol Strabismus. 2016;53(5):311-317.].

Glaucoma After Open-globe Injury at a Tertiary Care University Hospital: Cumulative Causes and Management.

To investigate causes and treatment modalities of traumatic glaucoma after open-globe injury (OGI). The medical records of all patients with postrepair follow-up of OGI at a tertiary care university hospital from January 1996 to December 2010 were reviewed. These patients had persistent elevated intraocular pressure (IOP) of >21 mm Hg at 2 consecutive visits, with or without optic disc damages. Over the 14-year study period, 41 eyes of 41 patients with repaired OGI that developed glaucoma were identified. In the early stage (within 1 mo), high IOP levels occurred owing to the presence of unremoved lens particles in 11 patients (26.8%), inflammation in 6 patients (14.6%), and hyphema in 3 patients (7.3%). In the intermediate stage (2 to 6 mo), the IOP increased owing to the presence of synechial angle closure in 9 patients (21.9%) and ghost cells in 3 patients (7.3%). In the late stage (>6 mo), the IOP rose owing to the presence of unremoved lens particles in 2 patients (4.8%), angle recession in 4 patients (9.7%), and synechial angle closure in 3 patients (7.3%). Surgical interventions included trabeculectomy in 9 eyes (22%), lens aspiration in 9 eyes (22%), cyclophotocoagulation (CPC) in 5 eyes (12.2%), anterior chamber washout in 3 eyes (7.3%), and tube surgery in 2 eyes (4.9%). Traumatic glaucoma is not uncommon long-term complication after OGI. It is important to inspect the association between the initial cause and achieving a successful treatment. Surgical intervention may be crucial in the majority of cases.

Intravitreal phacoemulsification using torsional handpiece for retained lens fragments

Purpose:To evaluate the results of intravitreal phacoemulsification with torsional hand piece in eyes with posteriorly dislocated lens fragments.Methods:In this prospective, interventional case series, 15 eyes with retained lens fragments following phacoemulsification were included. All patients underwent standard three-port pars plana vitrectomy and intravitreal phacoemulsification using sleeveless, torsional hand piece (OZiL™, Alcon's Infiniti Vision System). Patients were followed up for a minimum of six months to evaluate the visual outcomes and complications.Results:The preoperative best-corrected visual acuity (BCVA) ranged from light perception to 0.3. No complications such as thermal burns of the scleral wound, retinal damage due to flying lens fragments, or difficult lens aspiration occurred during intravitreal phacoemulsification. Mean post-operative BCVA at the final follow-up was 0.5. Two eyes developed cystoid macular edema, which was managed medically. No retinal detachment was noted.Conclusion:Intravitreal phacoemulsification using torsional hand piece is a safe and effective alternative to conventional longitudinal phacofragmentation.

Modified Capsular Tension Ring Scleral Fixation and Toric Intraocular Lens Implantation in a Patient with Homocystinuria

Purpose: To report a case of modified capsular tension ring scleral fixation and in-the-bag toric intraocular lens (IOL) implantation in a pediatric patient with severe crystalline lens subluxation due to homocystinuria. Case summary: A 9-year-old male diagnosed with homocystinuria and crystalline lens subluxation presented with progressive decrease of visual acuity. Uncorrected distant visual acuity (UDVA) and corrected distant visual acuity were 0.03 and 0.6 in the right eye and 0.01 and 0.5 in the left eye, respectively. Slit-lamp examination showed severe crystalline lens subluxation toward the inferiomedial side in both eyes. Corneal astigmatism in the right eye and left eye was 2.75 diopters (D) and 3.00 D, respectively based on keratometry. A combination of subluxated crystalline lens aspiration, scleral-fixated modified capsular tension ring insertion and in-the-bag toric IOL implantation were performed in both eyes. After continuous curvilinear capsulorhexis, nucleus and cortex of the crystalline lens were removed by irrigation and aspiration. A modified capsular tension ring with 2 fixation hooks (Model 2-L) was inserted into the capsular bag and fixed at the scleral wall. Next, toric IOL was inserted into the capsular bag. UDVA was 0.8 in the right eye and 0.9 in the left eye and 3 months postoperatively, the IOL rotation was less than 3 degrees from intended axis in both eyes. Conclusions: In a patient with severe congenital crystalline lens subluxation and moderate to severe corneal astigmatism, scleral fixation of modified capsular tension ring and in-the-bag toric IOL implantation is a possible surgical option. J Korean Ophthalmol Soc 2015;56(4):614-619