Lens Removal Research Articles

Refractive Lens Exchange after Implanted Collamer Lens: A Case Report

Introduction: Myopia stands as a prevalent ametropic condition. Posing ongoing challenges for ophthalmologists. Surgery to correct refractive errors is a primary intervention for severe myopia, encompassing procedures like the removal of the crystalline lens coupled with the placement of an intraocular lens (IOL), and the insertion of phakic IOL. The Implantable Collamer Lens (ICL) is commonly utilized in the posterior chamber but carries potential risks including the disruption of the eye’s normal function, potentially leading to conditions like cataracts and glaucoma. Methods and Purpose: This case report explains a single case patient with ICL that includes previous clinical condition, current condition, steps of surgical procedure, and follow-up after procedure. Case Illustration: We present the case of a 66-year-old male patient who came to the hospital for refractive surgery due to a cataract with a history of implantable collamer lens (ICL) for high myopia. Cataract surgery was performed after an explanation of the ICL followed by an implanted capsular tension ring (CTR) and IOL. Discussion: Several cases of patients using ICL will have complications such as glaucoma and cataracts. Determining ICL design will influence the progression of these complications. An explanation procedure by tuck and pull method is needed for age-related cataract patients. Conclusion: ICL is a safe procedure for high myopia patients. Explanation of ICL can be performed by several medical conditions.

Surgical Efficiency Comparison Between Two Phacoemulsification Systems.

To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.

Appropriate addition power for aphakic infants determined by a smart wearable device Clouclip

ABSTRACT Clinical relevance It is particularly important to perform reasonable and effective optical correction to enable visual development after primary lens removal surgery for congenital cataracts. Aphakic infants need a suitable addition power of prescription (ADD) to help them focus on close visual objects. Background It is challenging to obtain appropriate ADD power for infants due to poor cooperation and lack of subjective feedback. We aimed to determine the appropriate ADD for aphakic infants using a recently developed smart wearable device called Clouclip. Methods The study was a cross-sectional, observational pilot study. Twenty-three aphakic infants (aged from 6 months to 3.5 years) were invited to wear a smart wearable device for 7 days consecutively to monitor the near viewing distance in real life. Viewing habits and its associations with the possible influencing factors were investigated based on the data obtained from the device. Results The average proportion of near viewing time was 77.9% (95% confidence interval (CI) 72.1–83.7%). The average of the median near viewing distance was 23.8 cm (95% CI 20.6 cm-27.0 cm), which corresponded to an ADD of +4.25 D (95% CI + 3.75 D – +4.75 D) spectacle prescription. The height of the child was found to be positively correlated with the median of near viewing distance (r = 0.646, p = 0.001). Age, current ADD, age of cataract extraction surgery and bilaterality or monocularity of the aphakic eyes showed no significant correlation with the aforementioned viewing habits (all p > 0.05). Conclusion By using the novel wearable device, we found the suitable ADD of spectacle prescription for aphakic infants is about +4.25 D. The height of the child was an influencing factor for ADD.

Persistence of Contact Lens-Induced Corneal Parainflammation Following Lens Removal.

Contact lens wear induces corneal parainflammation involving increased immune cell numbers after 24hours' (CD11c+, Lyz2+, γδ-T cells) and six days' (Ly6G+ cells) wear. We investigated the time course of onset and resolution of these responses. LysMcre or C57BL/6J mice were fitted with a contact lens (four to 48hours). Contralateral eyes did not wear lenses. After lens removal, Lyz2+, MHC-II+ or Ly6G+ cells were examined by quantitative imaging. RT-qPCR determined cytokine gene expression. Lens wear for 24hours increased corneal Lyz2+ cells versus contralateral eyes approximately two-fold. Corneas remained free of visible pathology. The Lyz2+ response was not observed after four or 12 hours' wear, nor after 12 hours' wear plus 12 hours' no wear. Lens removal after 24hours' wear further increased Lyz2+ cells (∼48% after one day), which persisted for four days, returning to baseline by seven days. Lyz2+ cells in contralateral eyes remained at baseline. MHC-II+ cells showed a similar response but without increasing after lens removal. Lens wear for 48 hours showed reduced Lyz2+ cells versus 24hours' wear with one day discontinuation, correlating with reduced IL-1β and IL-18 gene expression. Lens wear for 24hours did not induce Ly6G+ responses six days after removal. Lens-induced corneal parainflammation involving Lyz2+ cells requires 24hours' wear but persists after lens discontinuation, requiring seven days for reversal. Lens wear for 48 hours may suppress initial Lyz2+ cell and cytokine responses. The significance of parainflammation during and after lens wear remains to be determined.

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.&#x0D; Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&amp;3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&amp;6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.&#x0D; Discussion : Age older than 60 years old, female gender, short axial length (&lt;23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.&#x0D; Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

DIFFERENT APPROACHES IN MANAGING LENS-INDUCED ANGLE CLOSURE GLAUCOMA: A SERIAL CASE

Introduction : Lens-induced angle-closure glaucoma can be caused by phacomorphic lens and ectopia lentis. Several factors affect the disease progression. Early diagnosis and appropriate management are important.&#x0D; Case Illustration : Case 1. A 67-year-old woman presented with acute redness and blurred vision in her left eye with visual acuity (VA) of 1/300 and intraocular pressure (IOP) of 60 mmHg. Axial length showed 23.66 mm and anterior chamber depth (ACD) was 1.61mm (Figure1). She was diagnosed with phacomorphic glaucoma. Phacoemulsification combined with trabeculectomy was performed (Figure2&amp;3). Her VA was improved to 0.08 and her IOP was reduced to 19mmHg after surgery. Case2. A 67-year-old man came with painful blurred vision in his right eye. His VA was a perception of light with an IOP of 40 mmHg. He had axial length of 22.7 mm and ACD of 2.07 mm (Figure4). The lens was anteriorly subluxated and showed zonular laxity. Intracapsular cataract extraction combined with trabeculectomy was performed (Figure5&amp;6). His VA was unchanged while his IOP was reduced to 18 mmHg after surgery.&#x0D; Discussion : Age older than 60 years old, female gender, short axial length (&lt;23.7 mm), shallow ACD, and zonular laxity are factors for progressivity of lens-induced glaucoma. Cataract removal was a definitive treatment along with IOP-lowering medications. The choice of lens extraction technique varies among individuals.&#x0D; Conclusion : Removal of cataractous lens is a definitive treatment in conjunction with intraocular pressure and inflammatory regulations for managing lens-induced angle-closure glaucoma. Comprehensive clinical assessments in patients are necessary for managing the symptoms and preventing complications.

Cataract Surgery After Keratoplasty: How Should We Prepare?

Introduction : Cataract surgery following corneal transplantation demands special attention to corneal graft stability and optimization to allow for excellent IOL selection, as well as corneal graft preservation since lens removal damages the corneal endothelium. This study aimed to determine how we should prepare for cataract surgery after keratoplasty.&#x0D; Case Illustration : Case 1: A 34-year-old male has phacoemulsification in his right eye (last eye). He had a history of eye surgery, including, keratoplasty for RE in 2019, and vitrectomy for RE because of endophthalmitis. The pre-operative visual acuity is 0.5/60 with PAS and an irregular pupil. Post-operative VA 3/60 with BCVA 6/40. Last follow-up, the grafted cornea was still clear with normal IOP. Case 2: A 50- year-old female underwent phacoemulsification for both eyes (BE). She had histories of keratoplasty in 1986, 1989, and 1997 for BE. She also had extreme myopia for BE (RE S -17.00, LE S-14.00). Pre- operative VA was 1/60 of BE, and BCVA was 6/20 a month after surgery. During the last check-up, both transplant corneas were clear with normal IOP. Last visit, her both grafts remained clear.&#x0D; Discussion : &#x0D; Conclusion : IOL calculations are challenging due to inaccuracy in corneal measurements, astigmatism, or corneal pathology. The best time to perform surgery is at least 2 years after keratoplasty. We suggest using total keratometry in the K-6 formula or Haigis for the IOL formula. Good dispersive viscoelastic, operating away from the corneal endothelium, and employing low phaco-energy/fluids will help to deliver a clear cornea after surgery. Last, steroid treatment will enhance graft survival rate.

Liberty® by Medicontur, a Complex in Structure, Hydrophilic Intraocular Lens in the Correction of Eyes with Preoperative Myopia

A retrospective analysis of visual function in patients with preoperatively diagnosed myopia, after implantation of Liberty® intraocular lens, including the influence of some factors like a kind of surgery, values of angle alpha and kappa, pupil size, values of higher order aberrations generated by the lens on visual acuity to far and near distances was done. Lens removal and Liberty® implantation was done 47 eyes, including in 13 patients in both eyes. In 7 eyes, it was a toric lens. A mean preoperative value of myopia was -6.72 Dsph. Cataract removal accounted for 55% of all procedures performed, the rest being Refractive Lens Exchange. Preoperative pupil size was between 3.6 and 6,4 mm. The average postoperative visual acuity to far distances was 0.13 (logMar), and to near distances was 0.51 (Snellen). Rare cases of insufficient quality of vision to intermediate distances, when the postoperative pupil size was greater than 4 mm, resolved after increasing light intensity in the room. A bigger values of higher order aberrations corresponded with lower values of preoperative visual acuity to far distances. A bigger values of angle alpha corresponded with lower values of postoperative visual acuity to far distances, which were significantly higher in cataract group. Visual acuity to far distances was also better in eye with bigger pupil size. A specific structure of the lens allows patients to see good to the near distances, even if the light intensity not perfect.

Intraocular schwannoma: case series of 28 patients and literature review.

Intraocular schwannoma is a rare tumour, which is often misdiagnosed. We presented the demographics and clinical characteristics of patients with intraocular schwannoma. Retrospective case series were collected between May 2005 and July 2021 in Beijing Tongren Hospital. A total of 28 patients were diagnosed with intraocular schwannoma on histopathological examination of surgical specimen. The median age was 39 years (range: 12-64). Fourteen patients were female and 14 were male. Among the all subjects, 21/28 patients (75.0%) presented as visual loss, and 3/28 patients (10.7%) had visual field loss. Intraocular schwannoma presented as nonpigmented mass in the ciliary body in 12/28 cases (42.9%), in the choroid in 9/28 cases (32.1%), and in ciliochoroid in 7/28 cases (25.0%). Intraocular schwannoma was often clinically misdiagnosed as uveal melanoma, which occurred in 16/28 patients (57.1%). Tumour excision with pars plana vitrectomy was performed for all included patients. Endoresection with lens removal was performed for tumours in the choroid, while transscleral resection was performed for tumours located in ciliary body or ciliochoroid. Increased light transmission was detected in 12/28 cases (42.9%). In the consecutive follow-up (median: 73 months, range: 7-193 months), no cases of recurrence or metastatic disease were detected. Intraocular schwannoma is a rare benign tumour. It usually presents as nonpigmented mass, which can easily be misdiagnosed as nonpigmented uveal melanoma.

Rotational technique for emulsification of soft lens nucleus

This study was conducted to develop a non-ultrasound technique for emulsification of a soft lens nucleus. Fifty-seven patients (57 eyes) underwent surgery. In 23 cases, early or immature cataracts were detected, and in 34 cases, lens removal was performed for refractive purposes in high myopia and complex myopic astigmatism. Phacoemulsifier Centurion Vision System (Alcon Laboratories, Inc., USA) was used for the surgery. Aspiration of soft lens nucleus was done using a rotational technique. The following aspects were evaluated in the course of the surgery: the volume of the required irrigation solution, and the frequency needing to involve ultrasound for complete emulsification of the lens nucleus. Intraoperative and postoperative complications were also assessed. The surgery was uneventful in all cases. There were no violations of the integrity of capsulorhexis edge. The need for short pulses of minimal power ultrasound during the removal of the soft lens using this technique arose only in 11 (19.3%) cases. The effective ultrasound time was less than 1 second. The required volume of irrigation solution was 33.0 (24.0; 43.0) ml, which does not differ significantly from that in ultrasonic phacoemulsification. The use of modern phacoemulsifiers providing a high vacuum level allows successful removal of a soft lens without using ultrasound, which prevents its negative impact on the ocular tissues. The use of adequate surgical techniques, including the optimal direction of rotation of the lens nucleus in the rotational technique, improves the efficiency of soft lens nucleus removal.

Tear‐borne interleukin 1‐beta and transforming growth factor‐beta and its relationship with clinical parameters in neophytes contact lens wearers

Aims/Purpose: To determine the presence of Interleukin 1‐beta (IL1‐β) and Transforming growth factor‐beta (TGF‐β) in the tears of neophytes contact lens wearers; and investigate the relationship between their concentration, tear stability, and ocular physiology findings.Methods: In this clinical trial, 12 neophytes (5 males, 24.0 ± 5.0 years) were dispensed with delefilcon A contact lenses. Physiological responses (bulbar and limbal hyperemia), non‐invasive tear break‐up times, and tear sample collections were obtained in the morning (before lens insertion; 9–10 a.m.) and afternoon (before lens removal; 7–8 p.m.) of the same day. The tear samples were assayed for IL1‐β and TGF‐β concentrations using Enzyme‐Linked Immunoabsorbent Assay kits. A parallel control group of 11 individuals (6 males, 25.0 ± 5.0) was also assessed to determine the levels of the biomarkers in the tears of non‐contact lens wearers.Results: Patients wore lenses for an average of 7:20 [6,9] h. Bulbar and limbal hyperemia increased throughout the day (p &lt; 0.001). Tear break‐up times were lower in the afternoon compared to the morning assessment (4.7 ± 2.0 Vs. 12.2 ± 8.8 seconds; p &lt; 0.001). The IL1‐β levels were higher in neophytes compared to controls (3.2 ± 4.7 Vs. 0.1 ± 0.1 ρg/ml; p = 0.05) but only in the afternoon. A significant correlation was found between IL1‐β concentration, bulbar (r = 0.405, p = 0.008), and limbal hyperemia (r = 0.499, p = 0.027) in the morning period. No substantial changes were reported for TGF‐β.Conclusions: The use of contact lenses might alter the IL1‐β regulatory mechanisms and disturb ocular surface homeostasis. However, more clinical evidence is needed to understand this phenomenon.

The Value of Higher Order Aberrations Generated by the Lens in Three Groups of Patients Qualified for Lens Removal

Purpose: to determine if Higher Order Aberrations generated by the lens can influence on the visual acuity, in eyes qualified to lens removal. Methods: Three groups of patients (171 eyes) who were qualified to lens removal because of diagnosed cataract, untolerated refractive error, or not yet diagnosed Congenital Lens Dysfunction were examined preoperatively for the values of Higher Order Aberrations generated by the lenses. Each patient was examined using iTrace analyser, which allows for the separation of aberrations generated by the cornea from those generated by the inside of the eye. Results: The average values were statistically the lowest in the group of patients qualified for refractive lens exchange (85 eyes), reaching the level of 0.170 μm. In this group, the natural lens was completely transparent. In the group with cataract (59 eyes) the values were statistically higher, reaching an average value of 0.350μm. In the third group with the so-called Congenital Lens Dysfunction (27 eyes) the values were the highest, reaching an average level of 1.020μm. Conclusions: As the value of aberrations generated by the inside of the eye (mainly lens) increased, visual acuity to far distances, assessed preoperatively and with best correction, deteriorated statistically.

Refractive surgery to correct visual impairments in 267 children with autism spectrum and related neuro-developmental disorders: improvements in vision and behavior.

Children with autism spectrum disorder (ASD) may have impaired vision owing to high refractive errors and aversion to spectacles or contact lenses. Visual blurring is caused by near-sighted myopia, far-sighted hyperopia, or astigmatism in one or both eyes. Refractive surgery can restore sharp vision and eliminate the need for spectacles and contact lenses. Restoration of sharp vision may improve ASD behavior. We aimed to determine the refractive outcomes in this cohort using ophthalmic measures and behavioral and school performance alterations after refractive surgery by employing parent-proxy reports. This interventional, retrospective case series included data from 267 children with refractive errors and neurodevelopmental disorders (NDDs) diagnosed as ASD alone or NDD with ASD-like behaviors over a 15-year period. One of three refractive surgery methods was employed, with the choice of method uniquely tailored to the child's eye anatomy. Laser photorefractive keratectomy (PRK) was performed in 131 children, implantation of a phakic intraocular lens (pIOL) in 115 children, and removal of the crystalline lens and implantation of an intraocular lens (refractive lens exchange, RLE) in 21 children. All procedures were performed under brief general anesthesia, with the child returning home on the same day. The median age at surgery was 10.9 years and the median follow-up period was 3.1 years. Pre-operative refractive errors ranged from a mean (standard deviation) +7.5 (0.09) D to -14.3 (4.8) D. Surgery corrected 87% of the children to normal focal length (± 1 D). Visual acuity improved an average of 0.6 logarithm of the minimum angle of resolution, the equivalent of 6 lines on a standard eye chart. Change in visual acuity was significant (all P < 0.01) between baseline and the most recent follow-up examination in each of subgroups. Change in spherical equivalent refractive error at 3, 12, 24, 36, 60, and > 60 months post-operatively were significant (all P < 0.01) between baseline and each follow-up visit in each of subgroups. Social interactions and ASD behaviors improved in 72% (192) of the treated children (P < 0.01). The incidence of sight-threatening complications was low. Refractive surgery improves both visual function and behavior in most children with ASD and major myopia, hyperopia, or astigmatism. The PRK, pIOL, and RLE procedures appear to be effective and reasonably safe methods for improving refractive error, visual acuity, and behavior in many ametropic children with ASD and ASD-like NDDs.

Corneal laceration with expulsive iridodialysis and vitreous prolapse following blunt trauma

Aims/Purpose: A full‐thickness corneal laceration can occur following blunt trauma and is an ocular emergency that requires decisive immediate, short and long‐term management. We describe an unusual case of blunt trauma leading to dehiscence of an old cataract wound with traumatic expulsive Iridodialysis associated with vitreous prolapse to create awareness among ophthalmologists on key diagnostic features and patient specific management for this condition.Methods: An 84 year old female presented to the eye emergency department following accidental trauma to her right eye. Ocular examination revealed a 3 mm corneal laceration that was just away from the limbus which was compatible with the incision used for prior cataract surgery over 10 years prior. There was signs of expulsive Iridodialysis as well as vitreous prolapse from this wound with associated ruptured posterior capsule, inferior IOL subluxation and pupil block angle closure.Results: Immediate management included excision of prolapsed vitreous and iris from the corneal laceration, placement of bandage contact lens and an eyeshield, as well as topical and systemic antibiotic therapy, topical steroids and IOP control. Within 3 days, the corneal laceration remained sealed following removal of the bandage contact lens and surgery was performed which included pars plana vitrectomy, IOL repositioning and corneal suturing.Conclusions: We report this case to emphasize the importance of careful anterior segment examination in cases of suspected globe rupture to identify the site of the opening and to always consider old surgical wounds. Once confirmed, no pressure should be placed on the eye to reduce the risk of further extravasation of intraocular contents.

Comparison of the Residual Amount of an Ophthalmic Viscosurgical Device Among Different Types of Intraocular Lens Implants in vitro.

Although ophthalmic viscosurgical devices are quite important for safe cataract surgery, currently, postoperative residual ophthalmic viscosurgical devices can cause various complications. Previously, we developed a method to visualize residual ophthalmic viscosurgical devices after irrigation/aspiration in vitro and found that the amount of residual ophthalmic viscosurgical device on a single-piece intraocular lens was greater than that on a three-piece intraocular lens. In the present study, we compared the amounts of residual ophthalmic viscosurgical device among various foldable intraocular lenses to investigate the factors that determine the quantity of residual ophthalmic viscosurgical device. Simulated cataract surgery was performed in pig eyes using an ophthalmic viscosurgical device labeled with fluorescent silica particles. After the simulated surgery procedure, the fluorescent silica attached to the intraocular lens was observed and quantified by inductively coupled plasma-atomic emission spectrometry after intraocular lens removal. The amount of residual ophthalmic viscosurgical device was compared among five representative single-piece intraocular lenses and one three-piece intraocular lens. The distribution and amount of the residual ophthalmic viscosurgical device differed for each intraocular lens. The amount of silicon in the lens capsule differed among the intraocular lens types. The postoperative residual tendency of ophthalmic viscosurgical devices differed among various single-piece intraocular lenses. The behavior of the intraocular lenses within the capsule affected the residual tendency. The removal of ophthalmic viscosurgical device in the lens capsule should be tailored for each intraocular lens to improve efficiency.

Impact of in vitro lens deposition and removal on bacterial adhesion to orthokeratology contact lenses

PurposeThe purpose of this study was to explore the impact of several contact lens (CL) care solutions on the removal of proteins and lipids, and how deposit removal impacts bacterial adhesion and solution disinfection. MethodsLysozyme and lipid deposition on three ortho-k (rigid) and two soft CL materials were evaluated using an ELISA kit and gas chromatography respectively. Bacterial adhesion to a fluorosilicone acrylate material using Pseudomonas aeruginosa with various compositions of artificial tear solutions (ATS), including with denatured proteins, was also investigated. The impact of deposition of the different formulations of ATS on biofilm formation was explored using cover slips. Finally, the lysozyme and lipid cleaning efficacy and disinfection efficacy against P. aeruginosa and Staphylococcus aureus of four different contact lens care solutions were studied using qualitative analysis. ResultsWhile maximum lysozyme deposition was observed with the fluorosilicone acrylate material (327.25 ± 54.25 µg/lens), the highest amount of lipid deposition was recorded with a fluoro-siloxanyl styrene material (134.71 ± 19.87 µg/lens). Adhesion of P. aeruginosa to fluorosilicone acrylate lenses and biofilm formation on cover slips were significantly greater with the addition of denatured proteins and lipids. Of the four contact lens care solutions investigated, the solution based on povidone-iodine removed both denatured lysozyme and lipid deposits and could effectively disinfect against P. aeruginosa and S. aureus when contaminated with denatured proteins and lipids. In contrast, the peroxide-based solution was able to inhibit P. aeruginosa growth only, while the two multipurpose solutions were unable to disinfect lenses contaminated with denatured proteins and lipids. ConclusionBacterial adhesion and biofilm formation is influenced by components within artificial tear solutions depositing on lenses, including denatured proteins and lipids, which also affects disinfection. The ability of different solutions to remove these deposits should be considered when selecting systems to clean and disinfect ortho-k lenses.

Cystoid macular edema after vitrectomy and after phacovitrectomy for epiretinal membrane

ObjectifComparer l'incidence d’œdème maculaire cystoïde (OMC) après une vitrectomie et après une phaco-vitrectomie toutes 2 réalisées dans le but de retirer la membrane épirétinienne (MER). NatureÉtude comparative et rétrospective d'intervention. MéthodesOn a procédé à l'analyse rétrospective des dossiers médicaux des patients qui ont subi une vitrectomie ou une phaco-vitrectomie dans le but de retirer la MER aux mains d'un seul chirurgien. La phaco-vitrectomie a été réalisée dans tous les yeux phaques, tandis que la vitrectomie a été réalisée dans tous les yeux pseudophaques. On considérait qu'il y avait augmentation de l’épaisseur de la macula lorsque cette dernière avait augmenté de plus de 10 % lors de la visite postopératoire à la semaine 4, comparativement aux mesures initiales. RésultatsLe groupe phaco-vitrectomie comptait 214 yeux, et le groupe vitrectomie, 53 yeux. On a observé une augmentation de l’épaisseur de la macula dans 15,4 % des yeux du groupe phaco-vitrectomie, soit un taux plus élevé que celui du groupe vitrectomie, qui se chiffrait à 3,8 % (p = 0,023). ConclusionsL'augmentation de l’épaisseur de la macula, qui serait une forme d'OMC, n’était pas rare (15,4 %) après la phaco-vitrectomie dans des yeux phaques, mais peu fréquente (3,8 %) après la vitrectomie seule dans des yeux pseudophaques. Le syndrome d'Irvine-Gass semble être causé par le retrait du cristallin et non par l'intervention intraoculaire ou le traumatisme chirurgical en tant que tels.

Comprehensive approach for capsular bag fixation in subluxated crystalline lens: preserving the anterior/posterior anatomical segment barrier.

To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. Retrospective, consecutive case series. This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA ( P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.

Clinical Factors, Treatment Selection, and Outcomes in Postcataract Fungal Endophthalmitis from Contaminated Viscoelastics

To investigate the factors associated with treatment outcomes of postcataract surgery fungal endophthalmitis outbreaks related to contaminated viscoelastics. Retrospective analysis of clinical data from multiple institutions. This study included 228 eyes of 210 patients who were diagnosed with postcataract surgery fungal endophthalmitis related to the use of viscoelastic material (Unial, Unimed Pharmaceutical Inc); they were followed up for 6 months after the diagnosis. Clinical features and causative species were identified and treatment outcomes were analyzed in patients who underwent 6 months of follow-up. Propensity score matching was conducted to elucidate the impact of vitrectomy timing and intraocular lens (IOL) removal on treatment outcomes. Clinical factors and selection of treatment modalities associated with treatment outcomes at 6 months. Baseline visual acuity (P < 0.01), age (P= 0.05), and the presence of corneal edema (P < 0.01) were closely associated with poor best-corrected visual acuity (BCVA) at 6 months. Patients who underwent immediate vitrectomy after diagnosis showed significantly better BCVA at 6 months (mean logarithm of minimum angle of resolution 0.26 ± 0.43 vs. 0.52 ± 0.52, P= 0.03) and greater degree of visual improvement (mean-0.17 ± 0.37 improvement vs. 0.10 ± 0.57 deterioration, P= 0.03) than those who underwent deferred vitrectomy. Patients who underwent IOL removal during vitrectomy required a lower number of intravitreal antifungal agent injections (mean 8.9 ± 9.1 vs. 16.7 ± 12.2, P < 0.01) and showed a lower incidence of repeated vitrectomy (20% vs. 82%, P<0.01) than in those without IOL removal. In postcataract fungal endophthalmitis, prompt vitrectomy at the time of diagnosis resulted in better treatment outcomes, and IOL removal reduced the treatment burden. Prompt and aggressive surgicalintervention should be considered for postcataract fungal endophthalmitis. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The influence of large-diameter multifocal contact lens on ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes

This study investigated the influence of large-diameter multifocal contact lenses on the ocular surface, visual quality, and visual function for presbyopic adults with dry eye syndromes. The study enrolled 40–55-year-old adults with presbyopia and dry eye syndromes (DES). The subjects were randomly assigned to three groups wearing different designs of contact lenses (Proclear, SMR, and Optimum) for 6–8 h a day for two weeks. Ocular surface health, tear quality, visual quality, and visual function were measured before and after lens wear. No significant difference was observed across all three groups for the amount of conjunctival redness, blink frequency (lens on), and stereopsis vision before and after wearing. Although there seemed to be a significant declining trend for corneal staining and limbal redness, non-invasive tear break-up time (TBUT), and lipid layer thickness while lens wear, the measured values were all within the normal range. Vice-versa after lens removal, results also showed significant improvement on lipid layer thickness, blink frequency (lens off), and contact TBUT. A significant improvement was observed in the modulation transfer function (MTF) of the total area ratio after wearing contact lenses. In contrast, the MTF of the high-order aberration area ratio resulting from lens wear was lower than that of the baseline measurement. There are also significant improvements observed for SMR and Optimum regarding near visual acuity, near point of accommodation, and the subjective questionnaire (OSDI and VBP) scores. Although it is difficult to avoid a specific negative impact on the ocular surface and tear film, visual function and visual quality can still be positively improved, especially shown on larger diameter and distance-center designed multifocal contact lenses.