Outcomes Of Intraocular Lens Implantation Research Articles

Ten-year refractive and visual outcomes of intraocular lens implantation in infants with congenital cataract.

There is no consensus regarding optimal target refraction after intraocular lens implantation in infants. This study aimed to clarify relationships of initial postoperative refraction with long-term refractive and visual outcomes. This retrospective review included 14 infants (22 eyes) who underwent unilateral or bilateral cataract extraction and primary intraocular lens implantation before the age of 1 year. All infants had ≥10 years of follow-up. All eyes exhibited myopic shift over a mean follow-up period of 15.9 ± 2.8 years. The greatest myopic shift occurred in the first postoperative year (mean=-5.39 ± +3.50 dioptres [D]), but smaller amounts continued beyond the tenth year (mean=-2.64 ± +2.02 D between 10 years postoperatively and last follow-up). Total myopic shift at 10 years ranged from -21.88 to -3.75 D (mean=-11.62 ± +5.14 D). Younger age at operation was correlated with larger myopic shifts at 1 year (P=0.025) and 10 years (P=0.006) postoperatively. Immediate postoperative refraction was a predictor of spherical equivalent refraction at 1 year (P=0.015) but not at 10 years (P=0.116). Immediate postoperative refraction was negatively correlated with final best-corrected visual acuity (BCVA) (P=0.018). Immediate postoperative refraction of ≥+7.00 D was correlated with worse final BCVA (P=0.029). Considerable variation in myopic shift hinders the prediction of long-term refractive outcomes in individual patients. When selecting target refraction in infants, low to moderate hyperopia (<+7.00 D) should be considered to balance the avoidance of high myopia in adulthood with the risk of worse long-term visual acuity related to high postoperative hyperopia.

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract. Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated. Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery. Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome.

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract. Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated. Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery. Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome.

Surgical Outcome of Intraocular Lens Implantation in Children with Bilateral Developmental Cataract

Purpose: To evaluate the visual outcome and long-term complications of intraocular lens implantation along with primary posterior capsulectomy &amp; anterior vitrectomy in children with bilateral developmental cataract.&lt;/p&gt; &lt;p&gt;Methods: This retrospective study was carried out on the 48 eyes of 24 children who had undergone cataract surgery under general anesthesia. Age range was 2 to 8 years. All patients underwent primary posterior capsulectomy, primary in-bag intraocular lens (IOL) implantation, irrigation-aspiration of lens debris, and anterior vitrectomy. At intervals of one week, one month, three months, and six months, every case was evaluated. After 6 months best corrected visual acuity was recorded and intraocular pressure, anterior chamber angle, optic disc, and peripheral retina were evaluated.&lt;/p&gt; &lt;p&gt;Results: Postoperative best corrected visual acuity were 6/6 in 10.4% eyes, 6/9-6/18 in 56.3% and &lt;6/18 in 33% eyes. Intra ocular pressures were found within normal limit (12 ± 2.09 mm of Hg) in all cases. Anterior chamber angle was normal in 44 eyes (91.7%). Peripheral retina and vitreous were normal in all cases. No significant Optic disc changes were noticed. The most common cause of decreased vision was amblyopia (79.2%) in the fellow eye due to delayed surgery.&lt;/p&gt; &lt;p&gt;Conclusion: Amblyopia is the main cause of decreased visual recovery in children after cataract surgery. Surgical intervention in proper time results in good visual outcome

Longer-term outcomes of intraocular lens implantation in children with marfan syndrome: trans-scleral sutured versus ophtec iris-enclaved

Treatment of ametropia in children with Marfan syndrome due to ectopia lentis entails removal of the dislocated crystalline lens. The ensuing aphakia has been treated by intraocular lens (IOL) implantation using either a trans-scleral sutured, posterior chamber IOL (TSS-IOL) or an iris-enclaved anterior chamber IOL (Ophtec IOL). Here we compare efficacy and safety outcomes after TSS-IOL or Ophtec IOL implantation in a series of Marfan syndrome children.

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

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

Optimizing optical outcomes of intraocular lens implantation by achieving centration on visual axis.

In existing designs of intraocular lenses (IOLs), optical outcomes are compromised even after perfectly executed surgery. The reason for this is misalignment of optical axis of the eye and its visual axis. There is a need to design an IOL which compensates for this misalignment and hence enhances the optical outcomes of cataract surgery. The present innovation attempts to fulfill this unmet need and optimizes optical outcomes of all IOLs of different optical profiles – spherical, aspheric, toric, and multifocal. In addition, the improvised design of IOL offers other benefits such as delaying the formation of after-cataract and ameliorating negative dysphotopsia.

Outcomes of intraocular lens implantation in the absence of capsular support: a review of current literature

to classify and comparatively analyze the latest published data on the outcomes of various kinds of complicated cataract surgery. Analysis of available literature on the subject of research published in 2003-2016. The method of sutured scleral fixation of the intraocular lens (IOL) is the most fully covered in the current literature. It has been used long enough and is, therefore, well tested. Its typical complications include sutures degradation, hemorrhage, and inflammation. Sutureless fixation of the IOL, which has become more common in recent years, is free of complications associated with degradation of the sutures. However, studies on the long-term results of this technique are few and most of them were conducted in a small clinical material. Basing on the present analysis, one may conclude that at the current level of surgery, sutureless scleral and iridal fixation of the IOL is more preferable in terms of possible postoperative complications.

Influence of corneal asphericity on the refractive outcome of intraocular lens implantation in cataract surgery

To evaluate the possible influence of anterior corneal surface asphericity on the refractive outcomes in eyes having intraocular lens (IOL) implantation after cataract surgery. Fondazione G.B. Bietti IRCCS, Rome, Italy. Retrospective comparative case series. Intraocular lens power was calculated using the Haigis, Hoffer Q, Holladay 1, and SRK/T formulas. Asphericity (Q-value) was measured at 8.0 mm with a Placido-disk corneal topographer (Keratron), a rotating Scheimpflug camera (Pentacam), and a rotating Scheimpflug camera combined with Placido-disk corneal topography (Sirius). The relationship between the error in refraction prediction (ie, difference between expected refraction and refraction measured 1 month after surgery) and the Q-value was assessed by linear regression. The same IOL model (Acrysof SA60AT) was implanted in 115 eyes of 115 consecutive patients. Regression analysis showed a statistically significant relationship between the error in refraction prediction and the Q-value with all formulas and all devices. In all cases, a more negative Q-value (prolate cornea) was associated with a myopic outcome, whereas a more positive Q-value (oblate cornea) was associated with a hyperopic outcome. The highest coefficient of determination was detected between the Hoffer Q formula and the Placido-disk corneal topographer (R(2) = 0.2630), for which the error in refraction prediction (y) was related to the Q-value (x) according to the formula y = -0.2641 + 1.4589 × x. Corneal asphericity influences the refractive outcomes of IOL implantation and should be taken into consideration when using third-generation IOL power formulas. Dr. Hoffer receives book royalties from Slack, Inc., Thorofare, New Jersey, and formula royalties from all manufacturers using the Hoffer Q formula. No other author has a financial or proprietary interest in any material or method mentioned.

Results of intraocular lens implantation with capsular tension ring in subluxated crystalline or cataractous lenses in children

Purpose:To evaluate the outcome of intraocular lens (IOL) implantation using capsular tension ring (CTR) in subluxated crystalline or cataractous lenses in children.Setting:Tertiary care settingMaterials and Methods:We prospectively studied 18 eyes of 15 children with subluxation of crystalline or cataractous lenses between 90° up to 210° after phacoemulsification, CTR and IOL implantation. Each child was examined for IOL centration, zonular dehiscence and posterior capsular opacification (PCO).Results:Age of the patient ranged between five to 15 years. Out of 18 eyes, seven had traumatic and 11 had spontaneous subluxation of crystalline or cataractous lens. Phacoemulsification was successfully performed with CTR implantation in the capsular bag. Intraoperative zonular dialysis occurred in two eyes. Anterior vitrectomy was performed in six eyes to manage vitreous prolapse. IOL implanted was polymethyl methacrylate (PMMA) in eight eyes, hydrophobic acrylic in seven and hydrophilic acrylic in three. Follow-up ranged from 24 months to 72 months. Sixteen eyes had a best corrected visual acuity of 20/40 or better. Nine eyes developed significant PCO and were managed with Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser posterior capsulotomy. One eye with acrylic IOL in the capsular bag had IOL dislocation after two years which was managed with vitrectomy and secondary trans-scleral fixation of IOL.Conclusions:Phacoaspiration with CTR implantation makes capsular bag IOL fixation possible in most of the eyes with subluxated crystalline or cataractous lenses. PCO still remains a challenge in children with successful phacoaspiration with CTR implantation

Preliminary results of intraocular lens implantation in infants with cataract under two years old

To explore the feasibility of anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation in infants with cataract under 2 years old. Anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation was performed in 22 cases (27 eyes) of infants with cataract under 2 years old. The results during and after the operation were observed. The mean follow-up time was 12 months. All surgeries were performed smoothly. The visual axis remained clear in 26 eyes (96%) after operation, there was white fibrosis and opacification posterior to the intraocular lens in 1 eye and needed re-operation, up drawn pupil in 3 eyes (11%), pupillary capture in 2 eyes (7%) and posterior synechia of the iris in 4 eyes (15%). Anterior and posterior capsulorhexis combined with anterior vitrectomy and intraocular lens implantation in infants with cataract under 2 years old can keep visual axis clear and restore the normal anatomy of anterior segment of the eye, the complications are reduced greatly. However, the ultimate visual acuity needs further observation.

Long-term results of intraocular lens implantation in pediatric patients

Between 1980 and 1990, 42 eyes of 34 patients (age range: 18 months to 18 years) were implanted with an intraocular lens, with 29 being primary implantations and 13 secondary. The primary implantation group comprised patients with congenital, developmental, and traumatic cataracts. Patients in the developmental and traumatic cataract groups achieved the best visual acuity. Those with congenital cataracts had the poorest visual outcome. Follow-up ranged from a minimum of three months to more than ten years. Overall the patients demonstrated an improvement in visual acuity and the psychological advantage of enhanced visual function without spectacles or contact lenses. We conclude that with proper case selection and a controlled, skilled surgical approach, the use of an intraocular lens for visual rehabilitation in the pediatric age group is a feasible approach.

Results of intraocular lens implantation in paediatric aphakia.

Intraocular lenses were implanted in 16 eyes of 13 patients with congenital cataract, and visual progress was plotted using a preferential-looking technique. Initial surgery was by lens aspiration with preservation of the posterior capsule, and subsequent posterior capsulotomy without anterior vitrectomy. Poly-HEMA posterior chamber lenses were used, usually as a primary procedure but in four cases as a secondary procedure after contact lens failure. No serious complications were encountered. Most eyes achieved a very significant visual improvement, and none were worse than preoperatively. Residual refractive error was highly unpredictable, but did not exceed 6 dioptres. The importance of rigorous occlusion therapy is stressed. With close follow-up, this procedure offers an effective and safe method for the correction of unilateral paediatric aphakia, and, in selected cases only, for bilateral aphakia.

Intraocular lens implants for uniocular cataracts in childhood.

We report the outcome of intraocular lens implantation in 20 children with visually significant cataracts (seven traumatic, 13 non-traumatic). Six patients had anterior and 14 had posterior chamber implants. The mean age of the whole group at the time of surgery was 5.9 years (range 0.3 to 15.1 years), while the mean period of follow-up was 2.4 years (range 0.8 to 5.9 years). Postoperatively 10 patients developed a transient fibrinous uveitis, four required lens repositioning, one needed lens removal, and eight required posterior capsulotomy. Complications warranting secondary surgical procedures occurred predominantly in eyes with posterior chamber implants. Co-operation with conventional amblyopia treatment was satisfactory in eight out of 16 patients. Postoperatively nine out of 18 patients had peripheral fusion, four patients regained visual acuities of better than 6/9, and visual acuity did not improve beyond 3/60 in six cases. In 19 eyes the optical pathway to the retina is clear and the implants are stable with no evidence of persisting inflammation. Contact lenses remain the initial treatment of choice in infancy, but modern intraocular lenses are well tolerated and have a role in the visual rehabilitation of patients with contact lens and probable contact lens failures and older children with uniocular cataracts.

Managing dense retropseudosphakos membranes with a pars plana vitrectomy.

Formation of thick and occasionally dense retropseudophakos membranes and rapid fibrosis of the posterior capsule is a complication that adversely affects the outcome of intraocular lens implantation. We have observed this condition in 17 patients, most of whom presented with traumatic and congenital cataracts. It appears to occur more frequently in young individuals and children. Simple capsulotomy, by the limbal approach or with the YAG laser, does not reliably eliminate the membranes. We have used vitrectomy and scissors dissection through the pars plana to achieve good anatomical results. Postoperative visual acuity has been satisfactory, except in amblyopic eyes related to congenital cataracts.

Differences and similarities in a series of cases with bilateral intraocular lenses and evaluation of the results.

A review is given of the results of intraocular lens implantation in 38 patients, that is, 76 eyes. The observation time was up to 7 1/2 years. Only 5 cases were done as a secondary procedure. The Binkhorst 4-loop lens was preferred. Most of the lenses were fixated with an iris-lens suture. Out of 8 lens luxations 2 were fixed with an iris suture. The final visual acuity and the difference in refraction in spherical as well as cylindrical power are surveyed. The astigmatism and the astigmatic axis are compared in the 2 eyes of each patient. Most of the patients regained stereoscopic vision. It is concluded that neither the lens position, the lens type, the number of iris sutures, nor the number of iridectomies had any influence on the eventual results.