Lens Changes Research Articles

Dysfunctional lens syndrome: a literature review

Introduction. The term “Dysfunctional Lens Syndrome” (DLS) refers to age-related changes in the lens, including early cataracts and presbyopia, that do not significantly reduce visual acuity. This syndrome is characterized by a decrease in accommodative amplitude, an increase in light scattering, and a reduction in contrast sensitivity. With rising life expectancy, the prevalence of DLS is increasing, necessitating a more in-depth study of the pathogenic mechanisms underlying the syndrome and the refinement of its diagnostic criteria to establish standards for treatment correction. Aim: to summarize information on the pathogenesis of DLS, the potential for staging the syndrome using objective examination methods, and to provide treatment recommendations. Materials and methods. A bibliographic study of scientific publications was conducted using the Pubmed, ScienceDirect, and Cyberleninka databases. Literature sources were searched using the following keywords: dysfunctional lens syndrome (DLS), presbyopia correction, cataract, age-related lens changes. A total of 32 publications, primarily from the last 10 years, were included in the study from more than 100 viewed sources. Results. The DLS encompasses a wide range of conditions, from early stages characterized by a loss of accommodative amplitude and minor refractive anomalies to later stages involving a decrease in visual acuity and quality due to increased light scattering and aberrations. Currently, the evaluation of age-related lens changes involves assessing visual acuity and determining the degree of lens opacification using slit-lamp examination. Additionally, objective instrumental methods, such as optical coherence tomography and Scheimpflug imaging, can be used to assess the degree of lens opacification. Various methods are employed for the correction and treatment of DLS, ranging from glasses and contact lenses to surgical interventions, such as lens extraction and intraocular lens implantation. Research is also ongoing into drugs aimed at slowing the progression of lens changes. Conclusion. The term “Dysfunctional Lens Syndrome” is currently used to describe early cataracts and presbyopia, where the reduction in visual acuity is still minor, but patients experience visual complaints due to age-related lens changes. Further research is necessary to develop and standardize diagnostic criteria and to evaluate the effectiveness of new treatment methods and interventions in order to create the most effective and adequate approach to correcting DLS and alleviating the associated visual complaints.

Simulation and experimental analysis of a double-liquid negative lens based on flat electrode

In order to carry out detailed research on focusing of liquid lens in negative optical power with simple structure, a double-liquid negative lens based on flat electrode is proposed. By adjusting voltage applied to indium tin oxide (ITO) conductive glass plates, the interface between glycerol and silicone oil can be changed to tune the focal length. With COMSOL, MATLAB and Zemax softwares, an optical model of the double-liquid negative lens based on flat electrode is established, its focal length at different voltages is simulated and analyzed, and it is found that when the flat exists with a small tilt (1°∼4°), the parallelism of the flat electrode has little influence on the focal length. In addition, through device fabrication and experimental analysis of this double-liquid negative lens, the focal length of the lens changes from -40.21622 mm to -24.2088 mm when operating voltage is 0V-320 V, which is basically consistent with the simulation results. And the maximum resolution of the proposed liquid lens can reach 71.838lp/mm. A lens with negative focal length holds great promise in diverse applications such as endoscopes, holographic imaging and adaptive optics.

Metabolic changes in the eye lens in the progression of cataract

Background. Cataract is one of the main causes of decreased visual acuity in the world, and therefore scientists are continuing researches on the mechanisms of development of this ophthalmic pathology.The aim. To study metabolic changes in a cloudy lens using an experimental model.Materials and methods. The study was carried out on adult male Wistar rats (n = 60), which were divided into control (n = 30) and experimental (n = 30) groups. Experimental cataract were simulated by daily ultraviolet irradiation (λ = 300–350 nm) during 6 months for 20 minutes. At the months 2, 4 and 6 of the study, we carried out a biomicroscopic examination of the anterior eye of animals using a slit lamp to monitor the development of cataract. Lenses were collected to determine the content of stearoyl-coenzyme-A desaturases and melatonin using enzyme immunoassay.Results. At the stage of initial cataract, the content of the stearoyl-coenzyme A desaturase was statistically significantly lower than the control values by 38 %; at the stage of immature cataract – by 30 %; at the stage of mature cataract – by 15.4 %. It was revealed that at the month 6 of the study, the concentration of melatonin in lens homogenates was 17 % lower when compared with the control. A statistically significant correlation was established between stearoyl-coenzyme A desaturase and melatonin (r = 0.32).Conclusion. Melatonin and stearoyl-coenzyme A desaturase play an important role in a number of biochemical processes that ensure the proper functioning of the visual analyzer. Changes in the concentration of these biological molecules can play a key role in the pathogenesis of cataract and a number of other ophthalmic diseases

Longstanding iris foreign body to treat or not to treat!

A 61 year female presented with whitish discolouration of left eye noticed few days ago with a forgotten history of trauma 28 years ago for which a consultation was made and was asked for review with orbital x-ray, which was not done as she was asymptomatic. On examination, her best corrected visual acuity was 6/6 both eyes. Examination of right eye was unremarkable except for early lens changes, while left eye showed a nebular corneal opacity, suggesting entry wound. A brown coloured foreign body was seen stuck to iris surface temporally, measuring 4*3mm with degenerative changes over it and exposing underlying pigment epithelium with focal cataract. Rest of anterior segment, gonioscopy and fundus examination were normal. A thorough search for other intraocular foreign bodies (IOFBs) was made, revealing no other IOFBs. Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) demonstrated foreign body limited to iris surface, while orbital x-ray showed no evidence of metallic foreign body and electroretinogram (ERG) showed mildly decreased amplitude of b-wave. Plan for foreign body removal with cataract surgery was made as per patient’s request for cosmesis, and was retrieved through viscoexpression after a failed attempt to remove it through magnetic forceps thereby confirming its non-metallic nature. Special care was taken during capsulorhexis to not damage the intact capsule. Rest of cataract surgery was performed as usual and anterior chamber wash was done to flush all the debris. Post operative picture shows an area of partial and full thickness iris defect while maintaining a good visual acuity. The debate for removal of longstanding, well encapsulated, inert foreign body over iris without functional impairment depends on multiple factors.[1,2] Which in our case was due to the patient’s demand for cosmesis. Video link: https://youtu.be/pC3ZRoqxB8o

Structural changes in the crystalline lens as a function of the postmortem interval assessed with two-photon imaging microscopy.

The properties and structure of the crystalline lens change as time after death passes. Some experiments have suggested that these might be used to estimate the postmortem interval (PMI). In this study, the organization and texture of the rabbit lens were objectively evaluated as a function of the PMI using two-photon excitation fluorescence (TPEF) imaging microscopy. Between 24 h and 72 h, the lens presented a highly organized structure, although the fiber delineation was progressively vanishing. At 96 h, this turned into a homogeneous pattern where fibers were hardly observed. This behaviour was similar for parameters providing information on tissue texture. On the other hand, the fiber density of the lens is linearly reduced with the PMI. On average, density at 24 h was approximately two-fold when compared to 96 h after death. The present results show that TPEF microscopy combined with different quantitative tools can be used to objectively monitor temporal changes in the lens fiber organization after death. This might help to estimate the PMI, which is one of the most complex problems in forensic science.

Storage-induced mechanical changes of porcine lenses assessed with optical coherence elastography and inverse finite element modeling

Storage-induced mechanical changes of porcine lenses assessed with optical coherence elastography and inverse finite element modeling

Climate change impact on barrier island freshwater lenses and their transition zones: a multi-parameter study

Freshwater lenses and their freshwater–saltwater transition zones are affected by climate change. Both sea-level rise and groundwater recharge influence freshwater volume and transition zone thickness. This study used a semi-generic approach to investigate climate change effects on freshwater lenses: a hypothetical island cross-section was combined with real-world boundary conditions. Sea-level projections including tides and storm surges, annual mean sea-level rise data, and monthly recharge projections of several climate models of the German barrier island Norderney in the North Sea were used to evaluate changes in freshwater lens and transition zone size between 1971–2000 and 2071–2100. Firstly, impacts of sea-level and recharge boundary conditions were investigated on islands of different widths. Secondly, a multi-parameter study was conducted focussing on variations of several relevant hydrogeological parameters. Results showed that it is very likely but not certain that freshwater lens volume and depth will decrease and transition zone thickness increase as a consequence of climate change. Model predictions revealed a strong dependency on the employed climate models and to a lesser extent on the hydrogeological parameters, at least for the parameter ranges used in this study. Of all hydrogeological parameters tested, the largest effects were caused by the hydraulic conductivity and its anisotropy. Furthermore, the study showed that boundary conditions have larger impacts on smaller islands. These results illustrate the importance of using projections from climate models in a sufficiently high resolution. Furthermore, their uncertainties and changes in variability of boundary conditions should be considered in studies about climate change impacts on freshwater lenses.

Causes and outcomes of implantable collamer lens explantation in patients with corneal endothelial cell loss.

To investigate the correlated factors of corneal endothelial cell density (ECD) loss and ECD change in implantable collamer lens (ICL) explantation patients. Seoul St. Mary's Hospital, Seoul, South Korea. Retrospective analysis. The study cohort consisted of 93 eyes from 50 patients who underwent ICL explantation. Correlation analysis was performed to assess the ocular parameters associated with ECD loss, while percentage of ECD change (ΔECD%) was monitored up to 6 months postoperatively. Receiver operating characteristic (ROC) curve was used to set cutoff values of ocular parameters to prevent ECD loss after explantation. In multiple regression analysis, high vaulting, high vaulting/anterior chamber depth (ACD), low anterior chamber angle (ACA), and high iris pigmentations are the significant factors of ECD loss. At postoperative 6 months, 14 eyes (15.1%) had decrease (10.5% loss), 47 eyes (51.0%) were stationary, and 32 eyes (34.4%) had increase (12.7% gain) of ECD. The ROC curve analysis showed that vaulting had the highest area under the curve (AUC = 0.822), followed by vaulting/ACD (AUC = 0.821), ECD (AUC = 0.753), and ACA (AUC = 0.723) (all P < .01). Preoperative ECD showed a sensitivity of 77.6% and specificity of 86.7% in preventing ECD loss after explantation, with a cutoff value of 1722 cells/mm 2 , as determined by ROC curve analysis. Our study demonstrated that high vaulting is a significant factor in ECD loss among ICL-inserted patients. To prevent continuous ECD loss in ICL patients, close monitoring of ECD and making appropriate decisions regarding explantation may be necessary.

Age-related increase in lens thickness and changes in the profile of anterior chamber angle in patients with moderate and high axial hyperopia

PURPOSE. To determine the age-related increase in lens thickness (LT), decrease in anterior chamber depth (ACD) and anterior chamber angle (ACA) in patients with short axial length (APA) of the eyes.METHODS. The study included 100 patients (200 eyes) with short AL (23 mm or less), with a transparent lens or with initial stage of age-related cataract: 46 men and 54 women, aged 19 to 85 years. The LT and ACD, ACA parameters were assessed using optical coherence tomography.RESULTS. In the total population of patients, LT increased by an average of 32 μm per year. At the same time, ACD and ACA decreased by an average of 14 µm and 0.3° per year, respectively (p&lt;0.001). In men, LT increased by 35 μm per year, while in women it increased by 29 μm per year, the difference was not statistically significant (p=0.071). But the decrease in ACA in men averaged 0.38° per year, while in women it was 0.23° per year, this difference was statistically significant (p=0.003). In addition, the rate of decrease in the ACD in men and women also differed statistically significantly: 18 µm versus 11 µm per year (p=0.018).CONCLUSION. 1. According to our data, the annual increase in LT in eyes with short AL averages 32 μm, the decrease in ACD and ACA is on average 14 μm and 0.3° per year, respectively.2. We did not find a statistically significant gender difference in the rate of annual increase in LT, although the rate of decrease in ACA and ACD in men turned out to be statistically significantly higher.3. The obtained data on the annual changes in such morphometric parameters as LT, ACA and ACD in eyes with short AL are key in the formation of primary angle-closure glaucoma (PACG). It may allow a more precise prediction of the timeline of an increased risk of PACG in each particular case.

Dynamic Changes of Capsular-Intraocular Lens Adhesion in Plate-Haptic Hydrophilic and Loop-Haptic Hydrophobic Eyes.

The aim of this work is to investigate the dynamic changes of capsular-intraocular lens (IOL) adhesion in plate-haptic hydrophilic and loop-haptic hydrophobic eyes. Cataract eyes that met the inclusion criteria were randomly assigned to receive implantation of a plate-haptic hydrophilic or loop-haptic IOL. The anterior capsular adhesion, posterior capsular adhesion, and the configurations of the capsular bend were evaluated using swept-source optical coherence tomography at 1day, 1week, 1month, and 3months postoperatively. In total, 66 eyes of 66 patients were eligible for the analysis: 33 in the plate-haptic group and 33 in the loop-haptic group. The contact between the anterior capsule and IOL in the plate-haptic group was earlier than that in the loop-haptic group upon comparing the measurements taken at 1day and 1week (p = 0.001, p = 0.003, respectively). The complete attachment of the posterior capsule and IOL in the plate-haptic group was significantly greater at 1week, 1month, and 3months (p = 0.001, p = 0.000, p = 0.001, respectively). The capsular bend index of the plate-haptic group was significantly greater than that of the loop-haptic group at each time points except at 1day (p = 0.007, p = 0.049, p = 0.005, respectively). Furthermore, a new type of capsular bend, "cocked adhesion," was observed in the plate-haptic eyes. The plate-haptic IOL demonstrated excellent capsular adhesion compared to the loop-haptic IOL, which was probably attributed to haptic compressibility. A special cocked configuration of the capsular bend in plate-haptic IOL was observed for the first time. Further studies are warranted to confirm the effect of the new type of capsular bend.

Swimming exercise reverses transcriptomic changes in aging mouse lens

BackgroundThe benefits of physical activity for the overall well-being of elderly individuals are well-established, the precise mechanisms through which exercise improves pathological changes in the aging lens have yet to be fully understood.Methods3-month-old C57BL/6J mice comprised young sedentary (YS) group, while aging mice (18-month-old) were divided into aging sedentary (AS) group and aging exercising (AE) group. Mice in AE groups underwent sequential stages of swimming exercise. H&E staining was employed to observe alterations in lens morphology. RNA-seq analysis was utilized to examine transcriptomic changes. Furthermore, qPCR and immunohistochemistry were employed for validation of the results.ResultsAE group showed alleviation of histopathological aging changes in AS group. By GSEA analysis of the transcriptomic changes, swimming exercise significantly downregulated approximately half of the pathways that underwent alterations upon aging, where notable improvements were ‘calcium signaling pathway’, ‘neuroactive ligand receptor interaction’ and ‘cell adhesion molecules’. Furthermore, we revealed a total of 92 differentially expressed genes between the YS and AS groups, of which 10 genes were observed to be mitigated by swimming exercise. The result of qPCR was in consistent with the transcriptome data. We conducted immunohistochemical analysis on Ciart, which was of particular interest due to its dual association as a common aging gene and its significant responsiveness to exercise. The Protein-protein Interaction network of Ciart showed the involvement of the regulation of Rorb and Sptbn5 during the process.ConclusionThe known benefits of exercise could extend to the aging lens and support further investigation into the specific roles of Ciart-related pathways in aging lens.

Zone 1 trauma: wound dehiscence compared to primary trauma.

The study aims to assess if Zone 1 globe injuries hold a favorable prognosis for all situations, including wound dehiscence, or just primary traumatic injuries. Retrospective cross-sectional chart review of patients who underwent open globe repair from 1/1/2019 to 12/1/2020 at an urban hospital setting was evaluated for final visual outcomes, associated ocular pathology, long-term complications, and need for further surgeries. Fifty-eight eyes were identified-38 primary trauma and 20 dehisced wounds (11 penetrating keratoplasties, five clear corneal incisions, one laceration, one extracapsular cataract extraction, one radial keratotomy, and one tectonic graft). Dehisced wounds had more posterior segment pathology vs primary trauma, i.e., hemorrhagic choroidal, vitreous hemorrhage, retinal detachment, choroidal effusion (all 20% vs 2.63%, 5.26%, 5.26%, and 0%, respectively), vitreous prolapse (20% vs 2.63%), and uveal prolapse (80% vs 36.84%). Dehisced wounds had more traumatic aphakia (40% vs 0%) and dislocated lenses (15% vs 0%). Primary trauma was more likely to have traumatic cataracts (55.26% vs 10%) or no lens changes (44.74% vs 25%). About 10% dehisced wounds required enucleation (0% primary trauma). Cataract/secondary intraocular lens surgery was performed in 34% of the primary traumas (10% in dehisced wounds). Primary traumas achieved 20/40 vision or better in 44.74% (10% dehisced wounds). About 7.89% of patients with wound dehiscence ended with no light perception (none in primary trauma). Zone 1 open globe injuries due to wound dehiscence may exhibit worse prognosis compared to primary trauma open globe injury. More important than the zone of injury may be the source.

Incidence and predisposing factors of intraocular Lens tilt following secondary ciliary sulcus implantation in children: An ultrasound biomicroscopic study.

To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal. A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt. Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position. The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation.

Comment on: Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power.

Comment on: Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power.

The Effects of Implantable Collamer Lens ICL Implantation in High Myopia Patients' Mental Health.

To investigate the psychological changes in patients pre and post implantable collamer lens (ICL, EVO) implantation surgery in the posterior chamber. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to assess the mental states of 43 patients who underwent ICL implantation surgery performed by the same surgeon between January 2021 and December 2022. Comparing the results before and one week after the operation, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). Similarly, when comparing the pre-operation and one-month post-operation results, there is also a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). However, when comparing the one-week post-operation and one-month post-operation results, there is no significant difference in either the SAS scale (P>0.05) or the SDS scale (P>0.05). Moving on to the comparison between the pre-operation results and the national norm level, there is a significant difference in both the SAS scale (P<0.05) and the SDS scale (P<0.05). When comparing the one-week post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). Similarly, when comparing the one-month post-operation results and the national norm level, there is a significant difference in the SAS scale (P<0.05). After undergoing ICL implantation surgery, patients typically experience a notable decrease in anxiety (SAS) and depression (SDS) scales. These improvements gradually stabilize and enhance during the postoperative recovery period. However, it may require a significant amount of time for patients to fully restore their psychological well-being to levels comparable to the national norm, particularly in terms of anxiety levels.

Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power.

To investigate toric monofocal intraocular lens (TIOL) rotation and associated changes in cylinder power caused by Nd:YAG laser capsulotomy performed due to posterior capsule opacification (PCO). Ekol Eye Hospital, Izmir, Turkey. Prospective case series. 41 eyes of 20 women and 21 men were included in the study. Before and 1 month after Nd:YAG laser capsulotomy, TIOL tilt and decentration were determined with Scheimpflug camera, and TIOL axial rotation and the change in cylinder power induced by this rotation were measured by ray tracing aberrometry. The time interval between cataract surgery and Nd:YAG laser capsulotomy was noted. Rotational misalignment of the TIOL was measured as 4.65 ± 2.75 degrees (range 0 to 11 degrees) before vs 6.97 ± 2.92 degrees (range 0 to 13 degrees) after capsulotomy, and absolute rotation was 2.75 ± 1.94 degrees (range 0 to 7 degrees, P = .028). Before and after Nd:YAG laser capsulotomy, cylinder power was 0.24 ± 0.70 diopter (D) (range 0.00 to 0.63 D) vs 0.56 ± 0.77 D (range 0.02 to 0.91 D), respectively, with an absolute change in cylinder power of 0.34 ± 0.22 D (range 0.01 to 0.90 D, P = .001). After capsulotomy, there was a significant decrease in IOL tilt in the horizontal and vertical planes and an increase in decentration ( P < .05). Time interval (33.02 ± 12.9 months) and IOL horizontal decentration were independent factors affecting IOL rotation after capsulotomy ( P < .05). Nd:YAG laser capsulotomy may cause TIOL rotation as well as tilt and decentration, resulting in a change in the TIOL's corrective effect on corneal astigmatism. Although this change was clinically insignificant, it may be beneficial to consider that TIOL rotational misalignment may occur in patients undergoing early capsulotomy.

Variations in Lens Thickness Affecting the Anterior Chamber Length and Their Potential Measurement Using a Biometer

Biometry is a critical aspect of ophthalmology, since it facilitates the measurement of several ocular parameters and aids in the diagnosis of conditions like glaucoma. The advent of the IOLMaster in 1999 marked a pivotal moment in biometry by introducing non-contact and highly precise measurements that revolutionized the field. Low-coherence optical reflectometry devices such as Lenstar LS900 and Aladdin have further advanced biometry, due to the exceptional accuracy they offer. Axial length, a fundamental measurement in biometry, directly correlates with conditions like myopia and glaucoma. The accurate measurement of axial length is crucial for diagnosis and treatment planning. Biometry also guides intraocular lens power calculation during cataract surgery, relying on factors like axial length, anterior chamber depth, lens thickness, and effective lens position (ELP). Ensuring precision in these measurements is essential for optimal surgical outcomes. While several studies have explored biometric parameters, dynamic changes in crystalline lens thickness during rest or accommodation have received little attention. These changes may have a significant effect on the measurement of the anterior chamber length, and consequently impact the overall biometric assessment. This study delves into dynamic biometry, particularly in the context of age-related presbyopia, and aims to assess the feasibility of incorporating into the biometric process a specialized device capable of accurately considering crystalline lens changes during different states like rest and accommodation. This exploration seeks to enhance the understanding of ocular dynamics and contribute to improving the precision of diagnostic and surgical techniques. It underscores the importance of staying at the forefront of biometric research, especially in the context of emerging technologies and their potential to transform ophthalmology.

The Complications of Cataract Surgery in Patients with Pseudoexfoliation

Abstract The senile cataract represents the blurring of the crystalline lens after the age of 65. It occurs due to metabolic changes in the crystalline lens which occur over the years. The only effective way to treat cataract is the surgical one. Pseudoexfoliation is an age related systemic disorder. PEX represents the accumulation fibrillar material in the extracellular matrix of the tissue. The most known ocular manifestation of the PEX are the collection at iris pupillary margin and anterior lens capsule. This accumulation is associated with many intraoperative and postoperative complications in patients scheduled for cataract surgery. The aim of the study was to investigate the prevalence of the surgical complications during phacoemulsfication in patients with PEX. The study included 91 patients scheduled for cataract surgery divided into two groups (PEX group 46, control group 45 patients). Poor intraoperative midryasis, zonular dehiscence, postoperative corneal edema, anterior chamber inflammation, elevated intraocular pressure and tear film instability had particularly higher rate of occurring in PEX group comparing to the control group (p&lt;0.001). The highest mean value of intraocular pressure was observed in PEX group on the first postoperative day 25.6 ± 1.1 mmHg, while the best corrected visual acuity was measured in control group 0.71 ± 1.2 one month after phacoemulsification. Cataract surgery in patients with PEX carries great risk, but with adequate preoperative planning, the awareness of the potential complications, can provide safe and routine phacoemulification in these patients.

Transient vacuolar changes of the crystalline lens in patients using a dispersive ophthalmic viscosurgical device.

To report the clinical prognosis and pathological findings of accidental lens vacuolar changes in eyes with intraoperative exposure to a dispersive ophthalmic viscosurgical device (OVD). Two patients who developed transient lens vacuolar changes during uneventful persistent pupillary membrane (PPM) removal surgery were presented and followed up. This event was speculated to be associated with an intraoperative dispersive OVD DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4.0%) exposure. Then, to provide the pathological basis for our speculation, another four cataract patients were randomly exposed to different OVDs, and their anterior lens capsules were investigated with transmission electron microscopy (TEM). After months, the subcapsular vacuoles in both PPM cases were gradually disappeared without visual deterioration. For the cataract patients, similar lens changes were observed intraoperatively in those exposed to a dispersive DisCoVisc but not a cohesive OVD IVIZ (sodium hyaluronate gel 1.0%). In addition, marked ultrastructural changes, including chromatin condensation, extensive cytoplasmic vacuoles, and obvious intercellular space between lens epithelial cells in the anterior lens capsules of all eyes exposed to DisCoVisc, were observed by TEM. The lens vacuolar changes may be associated with a dispersive OVD exposure. Therefore, it is not preferable to use dispersive OVDs in patients with transparent lenses or without the intention of lens extraction. In addition, close follow-ups instead of immediate lens extraction are recommended for the occurrence of similar lens lesions.

Alport Syndrome: A Comprehensive Review.

Alport syndrome is an genetic disorder that distresses the basement membrane of the kidneys and can also impact other organs, such as the cochlea of theinner ear and eyes. It is characterized by mutation causing abnormalities in the collagen within the basement membrane, which has a crucial role in the filtration process of the kidneys. These abnormalities lead to progressive kidney damage and often result in chronic kidney disease. In some cases of Alport syndrome, the abnormal collagen can also affect the cochlea in the inner ear, leading to sensorineural hearing loss. Additionally, changes in the ocular lens, named anterior lenticonus, can occur, causing vision problems. Alport syndrome can manifest differently among individuals, and its severity can vary. Some people may experience mild symptoms, while others may develop more severe kidney problems, including end-stage renal disease, which may need dialysis or kidney transplant. Treatment for Alport syndrome primarily focuses on managing its symptoms and complications. Regular monitoring of kidney function and blood pressure, along with medications to control hypertension, are crucial aspects of the management plan. In cases of severe kidney damage, kidney transplantation may be necessary. As with any medical condition, early detection and intervention can improve results and quality of life for persons with Alport syndrome. Therefore, if there is a family history of the disorder or any concerning symptoms, it is essential to seek medical attention promptly. Genetic testing can help confirm the diagnosis and identify affected family members, allowing for appropriate monitoring and management.