Lens Removal Research Articles

Fluid reservoir thickness and corneal oedema during closed eye scleral lens wear

PurposeTo examine the relationship between central post-lens fluid reservoir thickness and central corneal oedema during short-term closed eye scleral lens wear, and to compare these empirical oedema measurements with open eye lens wear data and current theoretical modelling for overnight scleral lens wear. MethodsTen participants (mean ± standard error 30 ± 1 years) with normal corneas wore scleral lenses (Dk 141 × 10−11 cm3 O2(cm)/[(sec.)(cm2)(mmHg)) under closed eye conditions on separate days with an initial central post-lens fluid reservoir thickness considered to be low (160 ± 7 μm), medium (494 ± 17 μm), or high (716 ± 16 μm). Epithelial, stromal, and total corneal oedema were measured using high-resolution optical coherence tomography immediately after lens application and following 90 min of wear, prior to lens removal. Data were compared to open eye scleral lens induced corneal oedema and a theoretical model of overnight closed eye scleral lens wear (Kim et al., 2018). ResultsCentral corneal oedema was primarily stromal in nature and increased with increasing fluid reservoir thickness; the mean total corneal oedema was 3.86 ± 0.50%, 4.71 ± 0.28% and 5.04 ± 0.42% for the low, medium, and high thickness conditions, respectively. A significant difference in stromal and total corneal oedema was observed between the low and high fluid reservoir thickness conditions only (both p ≤ 0.01). Theoretical modelling overestimated the magnitude of central corneal oedema and the influence of fluid reservoir thickness upon corneal oedema during closed eye conditions. ConclusionScleral lens induced central corneal oedema during closed eye lens wear increases with increasing fluid reservoir thickness, but at a decreased rate compared to theoretical modelling.

Duration of contact lens removal before myopic refractive surgery.

To compare refractive surgery outcomes in patients with different periods without contact lenses prior laser surgery. Patients included in this study underwent myopic keratorefractive laser surgery between January 2005 and December 2014. Patients were divided into three groups based on the duration of time passed free of soft contact lens wearing prior to final preoperative evaluation and surgery (<24 h, 1-3 days or >3 days). Spectacle wearers served as a control group. Postoperative safety index, efficacy index and % of eyes within 0.5 D of the four groups were compared. A general linear model was used to compare main outcomes while adjusting for age, gender, preoperative measurements, and procedure type (LASIK vs PRK). Overall, 19,747 eyes were included. Soft contact lenses were worn by 42.3% (<24 h: 4.8%, 1-3 days: 18.5% and >3 days: 19.0%) and spectacles by 57.7% prior to surgery. In the PRK group, after adjusting for differences in baseline variables, the <24-h group had a significantly lower efficacy index than all the other groups. There were no significant differences between groups in terms of % eyes within ±0.5 D of intended correction (p = 0.55) or safety index (0.20). In the LASIK group, after adjusting for differences in baseline variables, there were no significant differences between groups in all primary outcomes. Soft contact lenses should be removed at least 24 h prior to final preoperative evaluation and refractive surgery, especially for patients undergoing PRK.

Chick Eyes Can Recover from Lens Compensation without Visual Cues

This study shows that nonvisual mechanism(s) can guide chick eyes to recover from myopia or hyperopia bidirectionally to regain their age-matched length. Because eye growth control is phylogenetically conserved across many species, it is possible that, in general, emmetropization mechanisms are not exclusively based on a local visual feedback system. Across species, growing eyes compensate for imposed defocus by modifying their growth, showing the visual controls on eye growth and emmetropization. When the spectacle lens is removed, the eyes rapidly recover back to a normal size similar to that in the untreated eyes. We asked whether this recovery process was dependent on visual feedback or whether it might be guided by intrinsic nonvisual mechanisms. Chicks wore either a +7 (n = 16) or -7 D (n = 16) lens over one eye for 4 to 7 days; the fellow eye was left untreated. After lens removal, half were recovered in darkness and half in white light. Refractive error and ocular dimensions were measured before and after lens treatment and after recovery with a Hartinger refractometer and A-scan biometer, respectively. Whereas chick eyes completely recovered from prior lens treatment under normal light after 2 days, they also partially recovered from prior hyperopia (by 60%) and myopia (by 69%) after being kept in darkness for 3 days: a +7 and -7 D lens induced a difference between the eyes of +7.08 and -4.69 D, respectively. After recovery in darkness, the eyes recovered by 3.18 and 2.88 D, respectively. In the absence of visual cues, anisometropic eyes can modify and reverse their growth to regain a similar length to their fellow untreated eye. Because eye growth control is phylogenetically conserved across many species, it is possible that nonvisual mechanisms may contribute more generally to emmetropization and that recovery from anisometropic refractive errors may not be wholly visually controlled.

Longitudinal changes of the macular structure after lens removal combined with anterior vitrectomy after pediatric cataract surgery.

To explore the macular thickness changes after lens removal combined with anterior vitrectomy for pediatric cataract surgery. The Eye Hospital of Wenzhou Medical University, Zhejiang, China. Prospective study. Thirty children (40 eyes) aged between 3 years and 9 years with pediatric cataracts, including 20 children (20 eyes) with unilateral cataracts and 10 children (20 eyes) with bilateral cataracts, were enrolled. Spectral-domain optical coherence tomography was used to obtain macular images. Central subfield thickness (CST) and retinal thickness in the Early Treatment Diabetic Retinopathy Study subfields (inner 1.0 to 3.0 mm annulus and outer 3.0 to 6.0 mm annulus) were recorded preoperatively as well as at 1, 3, 6, and 12 months postoperatively. Forty eyes of 30 children were included. Retinal thickness in every subfield significantly thickened at 3 months postoperatively (all P < .05). CST significantly thickened compared with preoperative levels (228.03 ± 18.58 vs 240.35 ± 17.41, P = .005) at 3 months postoperatively; macular thickness gradually decreased in the following months. At 6 months postoperatively, retinal thickness in inner nasal, inferior, temporal, and outer nasal subfields remained significantly thicker compared with preoperative levels (P = .048, P = .036, P = .029, and P = .017, respectively). At 12 months, the retinal thickness in all subfields reached the preoperative level. The influence on macular thickness lasted until 12 months after pediatric cataract surgery. The inner macular thickness increased for a longer time than the outer macular thickness postoperatively.

Twist and out intraocular lens removal.

Foldable acrylic posterior chamber intraocular lenses (PC IOLs) can be removed via a variety of methods. In this technique, the PC IOL is freed from its position in the capsular bag or sulcus space and raised into the anterior chamber. The IOL is manipulated such that a haptic is externalized through a 2.2 mm corneal incision. A spatula is inserted through a paracentesis incision and placed above the PC IOL. Straight forceps are inserted through the main incision and the haptic/optic junction closest to the paracentesis is grasped with the hand completely supinated. The hand is then pronated while rolling the PC IOL around the forceps using the spatula to guide the PC IOL and guard the cornea. The forceps are then retracted through the main wound, enveloped by the PC IOL, thereby removing an acrylic PC IOL in its entirety using standard intraocular instruments through a 2.2 mm incision.

Keratitis caused by Pseudomonas aeruginosa: treatment in the experiment

The aim of the study was to investigate the effectiveness of treatment of keratitis caused by Pseudomonas aeruginosa using official ophthalmic forms of antibiotics, which are effective against the pathogen. Materials and methods. Adult 36 rabbits weighing 3–3.5 kg were undergone the causing of purulent keratitis by applying a clinical strain of P. aeruginosa as a suspension of one-day culture of the microorganism at a concentration of 5×10 8 CFU/ml on the partially de-epithelialized (approximately 1 cm 2 ) cornea followed by coating for 24 hours with soft contact lens made of belafilcon A (water content: 36 %, oxygen permeability DK/t:110.0). In half of the cases, microbial biofilms were pre-grown on the contact lens surfaces via incubation into the broth culture of P. aeruginosa strain. The treatment of keratitis was performed with ocular official forms of antibiotics: levofloxacin 0.5 % (5 mg/ml), ciprofloxacin 0.3 % (3 mg/ml), tobramycin 0.3 % (3 mg/ml). Their effectiveness against the strain of P. aeruginosa was previously proven in vitro. The animals were divided into three corresponding as for severity of keratitis groups, in each of which treatment was performed with one of the three above antibiotics. In half of the cases within each group, the antibiotic was combined with the ocular official form of decamethoxine 0.02 % (0.2 mg/ml). The antibiotics were used in the mode of the most frequent instillation for the first 2 days after the onset of purulent keratitis, then 5 and 4 times a day. The assessment included evaluation of clinical signs, culturing, ophthalmological examination of the cornea with fluorescein test and photofixation. Animals were removed from the study on days 7 th , 10 th , 14 th (depending on the term of epithelialization of the affected cornea). Results. Totally, 36 cases of purulent keratitis caused by P. aeruginosa in rabbits were modelled: 8 moderate (22.2 %), 13 semi-severe (36.6 %), 15 – severe (41.7 %). Regardless of the chosen antibiotic, 10-12 hours after removal of the infected contact lens and the start of treatment, there was mostly a burst enhancement of the inflammatory process. Subsequently, the inflammatory signs showed a gradual attenuation with complete corneal epithelialization for 7 th –8 th days (for moderate keratitis), 10 th –12 th days (for severe and semi-severe in Group I and Group III) and (12 th –14 th days for severe and semi-severe in Group II). In comparison with the Group I (levofloxacin 0.5 %), the reducing of the corneal inflammation and lesion epithelialization within the Group II (ciprofloxacin 0.3 %), was 1–2 days delayed. The use of 0.3 % tobramycin (Group III) provided the highest control of purulent inflammation during the first three to four days, but further there was a slowdown in the positive dynamics and delayed epithelialization compared with Group I. For all study groups, the use of combination antibiotic therapy with decamethoxine was accompanied by acceleration in regression of purulent-inflammatory lesions, especially due to a decrease in conjunctival response and pyorrhea. Among the outcomes, in most of cases (69.5 %) there were areas of corneal opaque turbidity of various sizes. Total leucoma was noted in more than a third of cases; always due to severe keratitis. It was managed to avoid the complications that could lead to eye loss (corneal abscess, perforation, malacia) in all animals. The culturing from the surface of the eye has shown a decrease from 100 % to 63.9 % in presence P. aeruginosa after 48 hours and the whole pathogen disappearance after 3 days of treatment. However, in 11 of 15 severe keratitis (30.6 % of total observations) microbiological tests of the cornea, obtained after removal of animals, were positive as for P. aeruginosa even after complete lesion epithelialization. Conclusions . Treatment of experimental keratitis caused by P. aeruginosa, with antibiotics, to which the sensitivity of pathogen is proven, in the mode of the earliest and most frequent instillations on the first 48 hours in combination with removal of purulent masses provides reducing of inflammation, restoring of cornea surface and prevents the most serious complications, e.g. corneal perforations and keratomalacia. Early and active antimicrobial treatment with effective drugs led to the elimination of P. aerugenosa from the ocular surface in the first 2–3 days. However, in 30.6 % of cases there was no complete eradication of the pathogen from the cornea. The choice of antibiotic from those, to which the sensitivity of P. aerugenosa is proven, did not have a significant influence on treatment outcome. Concomitant use of decamethoxine makes better effect and somewhat improves the results

Characterisation of Glutathione Export from Human Donor Lenses.

PurposeTo investigate whether human donor lenses are capable of exporting reduced glutathione.MethodsHuman lenses of varying ages were cultured in artificial aqueous humor for 1 hour under hypoxic conditions to mimic the physiologic environment and reduced glutathione (GSH) and oxidized glutathione (GSSG) levels measured in the media and in the lens.ResultsHuman donor lenses released both GSH and GSSG into the media. Donor lenses cultured in the presence of acivicin, a γ-glutamyltranspeptidase inhibitor, exhibited a significant increase in GSSG levels (P < 0.05), indicating that GSSG undergoes degradation into its constituent amino acids. Screening of GSH/GSSG efflux transporters revealed Mrp1, Mrp4, and Mrp5 to be present at the transcript level, but only Mrp5 was expressed at the protein level. Blocking Mrp5 function with the Mrp inhibitor MK571 led to a significant decrease in GSSG efflux (P < 0.05), indicating that Mrp5 is likely to be involved in mediating GSSG efflux. Measurements of efflux from the anterior and posterior surface of the lens revealed that GSH and GSSG efflux occurs at both surfaces but predominantly at the anterior surface.ConclusionsHuman lenses export GSH and GSSG into the surrounding ocular humors, which can be recycled by the lens to maintain intracellular GSH homeostasis or used by neighboring tissues to maintain GSH levels.Translational RelevanceEarly removal of a clear lens, as occurs to treat myopia and presbyopia, would eliminate this GSH reservoir and reduce the supply of GSH to other tissues, which, over time, may have clinical implications for the progression of other ocular diseases associated with oxidative stress.

Managing Corneal Epithelial Defects Using High Molecular Weight Fluorescein to Prevent Contact Lens Staining and Removal of Bandage Contact Lenses

Managing Corneal Epithelial Defects Using High Molecular Weight Fluorescein to Prevent Contact Lens Staining and Removal of Bandage Contact Lenses

Intraocular pressure changes in neophyte scleral lens wearers: A prospective study

PurposeTo examine the variation in intraocular pressure (IOP) during the first six months of scleral lens wear. MethodsThirty-two neophyte scleral lens wearers were recruited and IOP was measured using Goldman applanation tonometry before, and after 1 and 6 months of scleral lens wear (following lens removal). All scleral lenses were designed based on scleral topography or an impression of the ocular surface. Central corneal thickness and the central post-lens fluid reservoir thickness were quantified using optical coherence tomography. ResultsPost-lens removal IOP displayed an increasing trend after 1 and 6 months of lens wear, but the magnitude of change was not clinically or statistically significant using several repeated measures analyses to account for sporadic missing longitudinal data (mean increase of 1 mmHg or less, p > 0.05). Central corneal thickness and the central post-lens fluid reservoir remained stable throughout the first six months of lens wear. ConclusionIOP measured following lens removal did not vary significantly during the first 6 months of lens wear in scleral lens neophytes. Further research is required to determine if IOP varies during lens wear, following lens removal, or after longer-term lens wear due to suction forces or tissue compression beneath the landing zone.

Knowledge, attitudes and practices of contact lens use in a South African adolescent population.

Contact lens usage is becoming increasingly popular amongst young people. Assessing their knowledge, attitudes and practices in relation to contact lens wear is therefore important, so that gaps in understanding or incorrect practices can be rectified to promote continued safety and success of contact lens wear. This study aimed to assess and describe the knowledge, attitudes and practices of contact lens wearers aged 18 to 30 years, in the greater Durban area of South Africa. A semi-structured questionnaire was used to assess the knowledge, attitudes and practice of the participants. Results: Two hundred and forty six participants completed the survey. Young contact lens wearers in this sample generally had poor knowledge with regards to appropriate hygiene and contact lens wear complications. Despite wearers exhibiting a positive attitude with satisfactory hand hygiene and lens cleaning practices, important aspects such as lens case hygiene, storage and lens removal practices were found to be unsatisfactory. Compliance with after-care visits was also unsatisfactory. There is a need for contact lens practitioners to educate young contact lens wearers regarding appropriate contact lens-related care, to promote long term ocular health and contact lens-related safety.

A CASE REPORT OF CHRONIC ENDOPHTHALMITIS SECONDARY TO AQUAMICROBIUM terrae

Chronic postoperative endophthalmitis is a known complication of cataract surgery. Here, we report a case of chronic endophthalmitis following uncomplicated cataract surgery secondary to the atypical bacterium Aquamicrobium terrae . Retrospective case report of a single patient with endophthalmitis secondary to A. terrae. A 61-year-old healthy patient presented with recurrent iridocyclitis following uncomplicated cataract surgery. Repeated attempts to taper off topical steroid eyedrops were unsuccessful. Anterior chamber paracentesis cultures and vitrectomy cultures grew the same gram-negative bacillus, A. terrae , on six different occasions. The patient was treated initially with a series of intravitreal ceftazidime injections and adjuvant oral minocycline with recurrence of inflammation necessitating pars plana vitrectomy with intraocular lens removal and total capsulectomy. Inflammatory episodes recurred until residual capsule fragments were ablated using endoscopic vitrectomy. Since ablation over 18 months ago, no further recurrences have occurred and the patient has excellent visual outcome. A. terrae is a gram-negative bacillus recovered from polluted soil. This is the first case of postoperative endophthalmitis secondary to A. terrae and the first description of human infection caused by this newly identified microbe.

Assessment of contrast sensitivity in pre &amp; post trans-epithelial photorefractive keratectomy

Purpose: study was to compare the contrast sensitivity before and after Trans- PRK. Methods: The comparative study was conducted in department of ophthalmology medina teaching hospital Faisalabad. Total 30 myopic volunteers of both genders, with ages ranging from 20 years to 35 years, who had not undergone any ocular surgery or medical treatment for systemic or ocular diseases e.g. diabetes, Alzheimer's disease, glaucoma, macular degeneration, dry eye and cataract. Data was collected through non-probability convenient sampling technique from Sep 2018- May 2019. Data was entered in to SPSS version 20 and analyzed by using Paired sample t-test. Results: Significant improvement was seen in contrast sensitivity after Trans-PRK 0.00 (p&lt;0.005) by paired sample t-test. Contrast sensitivity test before and after Trans-PRK of right and left eye showed mean of right eye -.41533±0.18678 and left eye mean -.22167±0.24378 respectively. Conclusion: Our research concluded that, there is greater statistical difference between before and after Trans-PRK contrast sensitivity measurements. Contrast sensitivity improves after surgery significantly. Trans-PRK procedure is best method to correct refractive errors and removal of glasses and contact lens permanently with minimum chance of complications.

Rebound tonometry measurements over extended-wear bandage contact lenses

BackgroundThe aim of this study was to assess the validity of rebound tonometry measurements obtained over eyes wearing extended-wear bandage contact lenses with the highest oxygen transmissibility (Dk/t) value of 175 @ -3.00 D. MethodsA total of 151 normal eyes were included in this prospective pretest-posttest study. A rebound tonometer (iCare PRO) was used to collect intraocular pressure readings from “naked” eyes (eyes without contact lenses) and the same eyes wearing extended-wear lotrafilcon A bandage contact lenses (Alcon Air Optix Night & Day Aqua Contact Lenses). The mean pre- and post-application values were pooled and compared using the paired t-test. ResultsThe application of extended-wear lotrafilcon A contact lenses over normal eyes did not cause a statistically significant change in the intraocular pressure measurements obtained using an iCare PRO tonometer (13.74 ± 2.15 mm Hg vs. 13.77 ± 2.26 mm Hg, p-value = 0.6506). ConclusionBased on this study conducted on normal eyes, the removal of extended-wear bandage contact lenses is not necessary when taking intraocular pressure measurements using the iCare PRO rebound tonometer.

Analysis of related risk factors of vitreous hemorrhage after anti-vascular endothelial growth factor combined with vitrectomy for proliferative diabetic retinopathy

Objective To observe and analyze the risk factors related to vitreous re-hemorrhage (PVH) after anti-VEGF drugs combined with vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR). Methods Retrospective analysis study. From April 2017 to July 2018, 100 eyes of 87 PDR patients who were diagnosed in Jiaxing Eye Hospital and received anti-VEGF drugs combined with 25G PPV were included in the study. Among them, there were 44 eyes in 38 males and 56 eyes in 49 females. The age ranged from 26 to 83 years, with an average age of 57.72±8.82 years. All patients were type 2 diabetes, with an average duration of diabetes 10.84±6.03 years. All affected eyes were assisted by the same doctor with a non-contact wide-angle lens under the standard three-channel 25G PPV of the flat part of the ciliary body. Five to 7 days before the operation, intravitreal injection of ranibizumab or conbercept 0.05 ml (10 mg/ml) was performed. The incidence of PVH was observed. The age of PVH patients, duration of diabetes, vision before operation, average fasting blood glucose and average postprandial blood glucose before operation, systolic blood pressure and diastolic blood pressure before surgery, laser treatment before surgery, lens removal during operation, intraocular filling during operation, retinal laser points during operation, and fundus lesions during operation (hyperplasia film, Retinal hemorrhage, vascular occlusion, proliferative retinal traction, retinal hiatus, retinal detachment, exudation, neovascularization) were analyzed to find out the cause of PVH. Spearman bivariate correlation analysis and binary logistic regression analysis were performed on the data. Results Of the 100 eyes of 87 patients, PVH occurred in 17 eyes (17%). There were statistically significant differences in the number of eyes with vascular occlusion and proliferative traction during surgery in patients with and without PVH (χ2=5.741, 8.103; P 0.05). Spearman's bivariate correlation analysis showed that patients with low vision, poor control of fasting blood glucose levels, vascular occlusion and proliferative retinal traction during the operation were related risk factors for PVH (rs=0.208, 0.229, 0.240, 0.285; P<0.05). Binary logistic regression analysis showed that fundus vascular occlusion and hyperplastic retinal traction may be independent risk factors for PVH during surgery (OR=5.175, 13.915; P<0.05). Conclusion Fundus vascular occlusion and retinal traction caused by fibrovascular membrane hyperplasia in PPV may be independent risk factors for PVH in patients with PDR after anti-VEGF drugs combined with PPV. Key words: Vitreous hemorrhage; Diabetic retinopathy; Vitrectomy; Angiogenesis inhibitors/therapeutic use; Root cause analysis

The impact of short-term fenestrated scleral lens wear on intraocular pressure

PurposeTo examine the influence of short-term fenestrated scleral lens wear on intraocular pressure (IOP) in healthy eyes. MethodsIOP was measured before, during, and after a brief period (1–2 min) of fenestrated, scleral lens wear, using a rebound tonometer, in fifty, young healthy adults (mean age 23 ± 4 years) with normal corneas. ResultsImmediately following lens insertion, 48 of the 50 (96 %) of participants displayed an increase in IOP (mean ± SD increase in these participants of 3.8 ± 2.0 mmHg). Immediately following lens removal, 50 % of participants displayed a reduction in IOP, equal to or lower than, the pre-insertion IOP (-1.0 ± 0.8 mmHg lower than baseline). The remaining 50 % of participants displayed an IOP slightly greater than the pre-insertion IOP (1.6 ± 1.0 mmHg greater) after lens removal. ConclusionsShort-term fenestrated scleral lens wear resulted in a small, but statistically significant, increase in IOP in 96 % of young healthy participants (< 4 mmHg on average), which decreased to a level similar to pre-lens insertion IOP levels immediately following lens removal. Further research is required to determine if this measured change in IOP during scleral lens wear is artefactual, or an elevation in the true IOP.

Reply.

In our article, the evidence of anterior vitreous detachment (AVD) during phacoemulsification was verified with intraoperative optical coherence tomography. We postulate that the condition being linked to cataract surgery complications. The major intraoperative issue resulting from AVD is bulging of the posterior capsule (PC) being pushed from behind toward the anterior chamber by the irrigating fluid currents. That results in PC rupture due to its contact with a vibrating ultrasound needle or capsule aspiration into the irrigation/aspiration tips. Both are usually happening at the final steps of lens removal. AVD is having various definitions in different publications. The plurality of terms describing more or less the same entities reflects the absence of clear understanding of the pathophysiological mechanisms of these conditions.1,2 We basically agree with the fact that there is an unmet need for the precise terminology that has to be clear and precise. Aqua is the Latin word meaning water, whereas aqueous is an adjective, generally used as a term that denotes a solution in which the main solvent is water. It is important not to confuse this with the term aqueous humor, which is secreted by intraocular tissues.3Aqueous misdirection does not clearly characterizes the deviated flow of a balanced salt solution but rather the deviated flow of the aqueous humor. Fluid is a phase of matter and is defined as a substance that flows. A fluid can be in different forms of liquid or gas.A This term is less specific in comparison with the term aqueous. But indeed, it is routinely used in ophthalmology to describe the accumulation of pathologic liquids in the eye, eg, subretinal fluid and corneal interface fluid after refractive surgery. The term fluid to our knowledge is more universal in comparison with aqueous, and its use in our situation might be more appropriate. However, it is still very broad and not specific enough; therefore, we do believe that infusion misdirection syndrome or irrigating fluid misdirection syndrome might be more clear and practical to use. The first term is shorter and well describes the major aspect of the pathophysiology based on the abnormal flow of the irrigating fluid or infusion. That is why it is our personal preference. We also propose the new classification of infusion misdirection syndrome that explains the acute intraoperative process. The initial grade is usually subclinical and may be hardly noticeable by the presence of the lens particles in the Berger's space (grade 1). The mild grade (2) can be characterized by shallowing of the anterior chamber with PC bulging forward up to the level of the anterior capsulorhexis, but without intraocular pressure elevation. Finally, the severe grade (3) is the condition originally classified as an acute intraoperative rock-hard eye syndrome, which is the term that underlines the advanced stage of infusion misdirection syndrome with the presence of acute intraoperative intraocular pressure rise. We do believe that malignant glaucoma is a different entity. It is usually associated with the fluid accumulation in between the retina and posterior vitreous in the postoperative period, resulting in the displacement of the whole vitreous forward blocking the anterior pathways of aqueous humor outflow. We therefore think that chronic fluid misdirection syndrome does not really emphasize the progressive nature of that disease leading to visual and structural deterioration.4 That is why we think that the definition of malignant glaucoma is to be used as it is.

Clinical analysis of posterior segment injury in left-behind children in China

BackgroundWe aimed to evaluate the severity and prognosis of posterior segment injury between left-behind children (LBC) and guarded children (NLBC).MethodsA retrospective, controlled analysis of a case series was performed. Patients diagnosed with posterior segment injury in Department of vitreous and retinal, the Affiliated Ophthalmology and Otolaryngology Hospital of Fudan University were included in this study. Patients were divided into two groups, including LBC group (n = 48) and NLBC group (n = 44). All the children underwent 25G transconjunctival sutureless pars plana vitrectomy.ResultsCompared with NLBC, LBC had delayed treatment, worse baseline vision and visual prognosis, lower OTS rating, more times of vitrectomies, more complicated surgical procedures, and higher rate of lens removal and silicone oil tamponade.ConclusionsDue to lack of care and delayed treatment, posterior segment ocular trauma in the LBC was more severe, more common complicated with infectious endophthalmitis, and had worse visual prognosis. It was urgent to enforce the guardianship in LBC.

Does Long-Term Rigid Contact Lens Wear Lead to Acquired Blepharoptosis in Chinese Eyes?

To determine whether long-term rigid contact lens wear leads to acquired blepharoptosis and whether its development is affected by lens removal methods. Ninety rigid contact lens wearers (45 rigid gas permeable [RGP] [15-19 years old] and 45 ortho-k [15-40 years old]) who had worn lenses for at least 2 years and 45 spectacle-wearing controls (15-19 years old) were recruited. Margin reflex distance (MRD) and palpebral fissure height (PFH) were measured both subjectively and objectively, but levator function (LF) could only be measured subjectively. For RGP subjects, measurements were made before and 5 min after lens removal. Measurements were compared among the groups and, for rigid lens wearers, between two different lens removal techniques: using a suction holder or by finger-lid manipulation. No significant differences in MRD, PFH, and LF were found between different lens removal techniques in the rigid lens groups (P>0.05). No significant correlations were found between the parameters of interest and duration of lens wear (P>0.05). For the RGP group, MRD, PFH, and LF were significantly greater after than before lens removal (P<0.05), and after lens removal, MRD was significantly smaller than that of the ortho-k and spectacle groups (P<0.001, P=0.01, respectively) and PFH was significantly smaller than that of the ortho-k group (P=0.001). However, after lens removal, according to the definition (amount) for ptosis, no subject was diagnosed as having ptosis. Long-term rigid contact lens wear did not lead to acquired blepharoptosis in Chinese eyes. Margin reflex distance, PFH, and LF were not affected by different lens removal techniques.

Curious Case of a Foldable Intraocular Lens that did not Unfold

Phacoemulsification is a modern technique of cataract surgery that allows the removal of cataractous lens and implantation of a foldable Intraocular Lens (IOL) through a small sub 3 mm incision. For a good visual outcome, it is imperative that the IOL is well centered and its haptics unfold properly inside the capsular bag and keep it distended. However, at times the IOL haptics may not unfold properly leading to adverse visual symptoms. Herein, Authors present an unusual case of a 61-year-old elderly male with no other associated ocular or systemic illness, who presented nine months after cataract surgery in his left eye, with both haptics of the IOL unusually folded and the edge of one haptic encroaching into the pupillary area leading to visual symptoms. As multiple attempts to dial the haptics into the capsular bag were unsuccessful, likely due to strong capsular adhesions, the unfolded haptics were placed in the sulcus with attempted optic capture. The postoperative period was uneventful with BCVA of 20/20 at one year. The current case highlights the need to be vigilant about the proper positioning of the haptics at the end of routine cataract surgery and the need for early intervention in the event of any complication.

Combined Intracapsular Lens Removal and Scleral Fixation of Intraocular Lenses Through the Same Scleral Tunnel in Cases with Severely Dislocated Lenses.

Objectives:The management of severely dislocated lenses floating in the anterior vitreous is challenging. This study describes the clinical outcome of a surgical approach with intracapsular lens extraction (ICCE) and implantation of a scleral-fixated posterior chamber intraocular lens (SF-IOL) at the same surgical session.Methods:Records of patients who had severely dislocated lenses were retrospectively reviewed. All included patients had undergone ICCE, followed by implantation of an SF-IOL during the same surgical session through the same scleral tunnel placed 1.5 mm posterior to the limbus. Clinical characteristics of the patients were collected, and surgical videos were watched again to review intraoperative complications.Results:Thirty eyes of 30 patients (mean age, 68±11.1 years, 23 male, 7 female) were included in the study. Twenty-five patients had a history of blunt trauma, and five patients had pseudoexfoliation syndrome. The best-corrected visual acuity of the patient improved significantly after the procedure (p=0.001). The intraocular pressure of the patients remained unchanged (p=0.38). Three patients developed mild IOL dislocation that did not require any intervention. A patient developed transient hypotony, and another developed mild vitreous hemorrhage. These complications improved spontaneously without the need for further intervention.Conclusion:Simultaneous removal of dislocated lens and SF-IOL implantation through the same scleral tunnel was a safe and effective procedure for patients with severely dislocated IOLs.