PC IOL Research Articles

10-year follow-up study of secondary transscleral ciliary sulcus fixated posterior chamber intraocular lenses

Purpose To study the outcome of transscleral ciliary sulcus fixated posterior chamber intraocular lenses (transscleral fixation of PC IOLs) at 10 years after surgery. Design Longitudinal observational study. Method A total of 16 patients (16 eyes) who had undergone transscleral fixation of PC IOL were studied. We evaluate the clinical outcome in each patient at 10 years after the operation. Setting The Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan. Results Visual loss and other complications occurred within 2 years of the operation but not later. Postoperative complications were cystoid macular edema in three eyes (18.8%) and age-related macular degeneration in one eye (6.3%). Conclusion It is important to carefully observe and adequately treat patients for 2 years postoperatively.

Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery

Purpose To determine and quantify corneal endothelial damage after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs). Setting Eye Clinic, University of Trieste, Trieste, Italy. Methods This retrospective study comprised 125 patients who had implantation of an AC IOL from January 1987 to December 1998. The mean follow-up was 5.2 years. The IOLs were the Domilens Chiron Vision Z (n = 52), the Iolab U85J (n = 38), and the AMO AC51B (n = 35). The Konan specular microscope was used to perform full morphometric analysis of the corneal endothelium. The values obtained were compared with those in fellow eyes, which were phakic or pseudophakic with a posterior chamber IOL (PC IOL). Two years later, 63 patients (mean follow-up 2.1 years) had another morphometric analysis and the values obtained were compared with those in the same eye at the previous examination. The Student t test for unpaired groups was used to compare the results at a 5% significance level. Results The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes ( P<.01). Patients who had primary AC IOL implantation in 1 eye and PC IOL implantation in the fellow eye had a difference in ECD that was not statistically significant. The endothelial cell difference was significantly greater in aphakic patients who had a secondary AC IOL implantation ( P<.05). The ECD ranged from 1015 to 2980 cells/mm 2. The endothelium in the various groups showed no significant changes in the coefficient of variation (CV) in cell size. The ECD and endothelial CV in the same eyes at the second examination were not significantly different from the values 2 years previously. Conclusions Anterior chamber IOL implantation did not appear to alter corneal endothelial function. Results indicate that the endothelial cell loss was related to surgical trauma rather than the presence of an IOL in the anterior chamber.

Modified capsular tension ring for patients with congenital loss of zonular support

Purpose To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. Setting Cincinnati Eye Institute, Cincinnati, Ohio, USA. Methods Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). Results At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months ± 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). Conclusions Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.

Effect of an acrylic posterior chamber intraocular lens on posterior capsule opacification in cataract patients with associated risk factors

Purpose To evaluate the effect of an acrylic foldable posterior chamber intraocular lens (PC IOL) on the rate of posterior capsule opacification (PCO) in patients with associated risk factors. Setting Department of Ophthalmology, Seoul National University, Seoul, Korea. Methods The medical records of 570 patients who had phacoemulsification and foldable PC IOL implantation by the same surgeon from January 1, 1998, to December 31, 1999, were reviewed. Patients with risk factors for PCO (ie, young age, diabetes mellitus) received an acrylic PC IOL to decrease the opacification rate. Their rate was compared to that in patients without associated risk factors who received a foldable silicone PC IOL. Results In the patients without diabetes mellitus, the PCO rate in patients younger than 60 years with an acrylic PC IOL and in patients older than 60 years with a silicone PC IOL were similar. In patients older than 60 years, the rate of PCO was significantly lower in patients with diabetes mellitus and an acrylic PC IOL than in patients without diabetes mellitus with a silicone foldable PC IOL. Conclusions The rate of PCO in patients with risk factors for PCO with an acrylic PC IOL was similar to or lower than that in patients without risk factors with a foldable silicone PC IOL. Therefore, acrylic PC IOLs are preferable, particularly in patients with risk factors for PCO.

Recurrent microhyphema despite intracapsular fixation of a posterior chamber intraocular lens

A 61-year-old woman experienced multiple episodes of transient visual blurring in her pseudophakic eye, each of which lasted about 1 hour. Repeat examination during a symptomatic episode revealed anterior chamber red blood cells consistent with a microhyphema in the pseudophakic eye despite intracapsular fixation of a posterior chamber intraocular lens (PC IOL). Ultrasound biomicroscopy confirmed intracapsular fixation of the IOL haptics and revealed proximity of the edge of the IOL optic to the inferior pupillary margin in the region of an iridociliary body cyst. Uveitis–glaucoma–hyphema syndrome may occur despite intracapsular fixation of a PC IOL.

Suture fixation of a posterior chamber intraocular lens in anticoagulated patients

Purpose To describe a technique of suture fixating posterior chamber silicone intraocular lenses (PC IOLs) to the iris through a limbal incision and to evaluate its effectiveness in preventing intraocular hemorrhages. Setting Price Vision Group, Indianapolis, Indiana, USA. Methods This retrospective single-center study comprised 7 eyes (5 patients) that had suture fixation of a silicone PC IOL from a limbal approach to the midperipheral iris using 9-0 polypropylene (Prolene®) suture. All patients were taking warfarin sodium (Coumadin®) preoperatively and postoperatively. At each follow-up examination, visual acuity and intraocular pressure were measured, the stability of the PC IOL was assessed, and the anterior chamber and posterior segment were evaluated for blood. Results There was no incidence of intraocular hemorrhage during surgery in any eye. In 6 eyes, there was no blood in the anterior chamber or posterior segment at any postoperative examination. A nonlayering hyphema that resolved within 1 week without sequelae was noted in 1 patient 6 weeks postoperatively. The mean follow-up was 10.7 months (range 6 to 25 months). Conclusion Suture fixating a PC IOL to the iris through a limbal approach was an effective means of placing an IOL in anticoagulated patients without capsule support.

Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification

Purpose To determine the incidence of retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) and define the characteristics of this type of RD. Setting A private practice, with statistical evaluation at a university department. Methods Five hundred twenty-six consecutive eyes that had Nd:YAG capsulotomy because of visually disturbing PCO were followed prospectively for up to 52 months (median 21 months) to determine the incidence of RD. The median age of the 142 men and 320 women was 76 years and the median axial length, 23.3 mm (range 20.5 to 31.3 mm). Before the capsulotomy, all eyes had uneventful phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). Eyes with additional surgical procedures or with panretinal laser photocoagulation were excluded. Eyes in which a retinal hole had been treated before Nd:YAG (n = 4) were included. The fundus was examined by binocular indirect ophthalmoscopy with a 2.2 diopter Volk lens in full mydriasis. If necessary, an examination with a 3-mirror lens was done. Results The incidence of RD was 0% (0/483; 95% confidence interval [CI], 0.0%-0.8%) at 6 months, 0% (0/407; 95% CI, 0.0%-0.9%) at 12 months, and 0.5% (1/213; 95% CI, 0.0%-2.6%) at 24 months. Twenty-one months after Nd:YAG capsulotomy, 1 eye developed an RD that occurred as the result of a horseshoe tear that reopened. The tear, which formed 7 months after phacoemulsification and PC IOL implantation and 6 years before Nd:YAG capsulotomy, had been immediately treated with argon laser photocoagulation. Excluding the 4 eyes with preexisting tears, presumably sealed retinal holes, the incidence at 24 months was 0% (0/212; 95% CI, 0.0%-1.7%). No other eye developed RD over the follow-up. Conclusions Retinal detachment after Nd:YAG capsulotomy for PCO was rare in eyes that had previous uneventful phacoemulsification and PC IOL implantation. The exact relationship between the 2 events remains to be established.

Measurement of accommodation after implantation of an accommodating posterior chamber intraocular lens

Purpose To analyze techniques of measuring accommodation after implantation of an accommodating posterior chamber intraocular lens (PC IOL). Setting Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany. Methods This prospective study analyzed 23 eyes of 23 patients (aged 41 to 87 years) after cataract surgery and PC IOL implantation (1 CU®, HumanOptics) 4 weeks and 3 and 6 months after surgery. The results were compared to those in an age-matched control group (n = 20) 6 months after surgery. The following methods were used to measure accommodation: dynamic with objective techniques (PlusOptix PowerRefractor® videorefractometry, streak retinoscopy) and subjective techniques (subjective near point [push-up test, accommodometer], defocusing); static with pharmacologic stimulation after pilocarpine 2% eyedrops directly (conventional refractometry); indirectly (change in the anterior chamber depth [ACD] with Zeiss IOLMaster®). Results Results at 6 months, given as mean ± SD (range), in the study and control groups, respectively, were as follows: near visual acuity (Birkhäuser reading charts at 35 cm) with distance correction, 0.32 ± 0.11 (0.20 to 0.60) and 0.14 ± 0.10 (0.05 to 0.30); accommodation amplitude (diopters) by PowerRefractor, 1.00 ± 0.44 (0.75 to 2.13) and 0.35 ± 0.26 (0.10 to 0.65), by retinoscopy, 0.99 ± 0.48 (0.13 to 2.00) and 0.24 ± 0.21 (–0.13 to +0.75), by subjective near point, 1.60 ± 0.55 (0.50 to 2.56) and 0.42 ± 0.25 (0.00 to 0.75), and by defocusing, 1.46 ± 0.53 (1.00 to −2.50) and 0.55 ± 0.33 (0.25 to 0.87). The mean ACD decrease (mm) was 0.78 ± 0.12 (0.49 to 1.91) and 0.16 ± 0.09 (0.00 to 0.34) after pilocarpine 2% eyedrops, indicating a mean accommodation of 1.40 D and 0.29 D, respectively, based on Gullstrand’s model eye ( P = .001). The lowest fluctuation between follow-ups was with the subjective near point and the defocusing techniques followed by ACD decrease with the IOLMaster. Conclusions Accommodation after implantation of an accommodating PC IOL should be assessed with several techniques, including subjective and objective, to differentiate true pseudophakic accommodation from pseudoaccommodation. Researchers should be aware of the different variability and consistency of measurements with each technique over time.

Visual acuity after penetrating keratoplasty for pseudophakic and aphakic bullous keratopathy

Purpose To identify prognostic factors that determine the visual acuity after penetrating keratoplasty (PKP) for bullous keratopathy secondary to cataract surgery. Setting Department of Ophthalmology, University Hospital Antwerp, Antwerp, Belgium. Methods Twenty-six patients who had PKP for bullous keratopathy were examined before and after surgery. The patients were divided into 3 groups: pseudophakic bullous keratopathy (PBK) after cataract extraction with implantation of a posterior chamber intraocular lens (PC IOL) (Group 1) or an anterior chamber IOL (AC IOL) (Group 2); aphakic bullous keratopathy (ABK) (Group 3). The following parameters were recorded: preoperative and postoperative visual acuity, age at the time of surgery, interval between cataract surgery and development of bullous keratopathy, presence of an AC IOL or a PC IOL, aphakia, and presence of concomitant ocular pathology. Results Visual acuity improved in Group 1 (0.02 to 0.26); no visual improvement was observed in the other groups. Posterior segment damage occurred in one third of the patients in Group 1 and in all patients in the other groups. Patients with an intact posterior segment had a significantly better visual outcome. In eyes without posterior segment pathology, visual acuity improved from a mean of 0.03 (range 0 to 0.20) to a mean of 0.37 (range 0.03 to 0.90). In eyes with posterior segment pathology, no visual acuity improvement could be obtained. Conclusion The most important negative prognostic factors affecting visual acuity were the presence of concomitant ocular pathology, an AC IOL, and a long interval between surgery and the development of bullous keratopathy.

Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis

Purpose To determine the safety and efficacy of capsular tension ring (CTR) insertion in eyes with zonular dialysis of less than 150 degrees having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. Setting Dr. Agarwal’s Eye Hospital, Chennai, India. Methods This prospective study comprised 21 eyes of 19 patients with zonular dialysis of less than approximately 150 degrees determined preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with PC IOL implantation was performed. The mean follow-up was 242.33 days. Results Capsule collapse did not occur in any eye with a CTR. Intraoperative extension of the dialysis occurred in 2 eyes (9.52%). The IOL was placed in the bag in all the eyes except 1 that had traumatic cataract and received a scleral-fixated IOL during a subsequent surgery. Postoperatively, there was minimal corneal edema in 2 eyes (9.52%) and mild iritis in 5 eyes (23.80%). Three eyes (14.28%) developed raised intraocular pressure that responded well to medical therapy. The symptoms resolved in the 3 patients with preoperative diplopia. Fifteen eyes (71.42%) had a final visual acuity of 6/12 or better. Six eyes had a final best corrected visual acuity of worse than 6/12 because of coexisting fundus pathology. A dilated pupil examination at 6 months showed a well-centered IOL in all eyes. Conclusions Phacoemulsification with in-the-bag PC IOL and CTR implantation in eyes with zonular dialysis of up to approximately 150 degrees had a success rate of 90.47%. Visual recovery was not as good as in normal eyes because of the problems associated with zonular dialysis.

Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses

Purpose To analyze and compare the outcomes and complication rates of secondary implantation of flexible, open-loop, anterior chamber intraocular lenses (AC IOLs) and single-piece, scleral-fixated, posterior chamber IOLs (PC IOLs). Setting Departments of Ophthalmology, Gaziantep University Medical Faculty, Research Hospital, Gaziantep, and Inönü University Medical Faculty, Research Hospital, Malatya, Turkey. Methods This study comprised 124 eyes of 113 aphakic patients (61 men, 52 women) with insufficient capsule support who had secondary IOL implantation from January 1997 to June 2001. In Group 1 (n = 73 eyes), a flexible, open-loop AC IOL was implanted and in Group 2 (n = 51 eyes), a single-piece, scleral-fixated PC IOL. The mean follow-up was 34 months (range 6 to 53 months) and took place at several different clinical settings. The mean interval between the initial cataract operation and secondary IOL implantation was 63 months (range 6 months to 12 years). The postoperative outcomes, safety, efficacy, and complication rates were analyzed, and the preoperative and postoperative best spectacle-corrected visual acuities (BSCVAs) were compared. Results The postoperative mean BSCVA was 20/34.8 ± 45.2 (SD) in Group 1 and 20/32.1 ± 33.7 in Group 2; the difference was not significant ( P = .718). A BSCVA of 20/40 or better was achieved in 62 eyes (84.9%) in Group 1 and 45 eyes (88.2%) in Group 2. A BSCVA of 20/25 or better was achieved in 40 eyes (54.8%) and 33 eyes (64.7%), respectively. The difference between the 2 groups was not significant ( P = .472). Complications occurred in 25 eyes (34.2%) in Group 1 and 13 eyes (25.5%) in Group 2 ( P > .05). The most frequent complications in Group 1 were early transient corneal edema, intraocular pressure elevation, cystoid macular edema, hyphema, secondary glaucoma, and iris capture or pupil decentration and in Group 2, suture erosion, a tilted or decentered IOL, fibrin reaction, and vitreous prolapse into the anterior chamber. Conclusions The AC IOLs and PC IOLs were safe and effective for secondary implantation to correct aphakia. Secondary implantation of the scleral-fixated PC IOL seemed to provide a more favorable outcome and a lower complication rate than the open-loop AC IOL in complicated cataract cases with inadequate capsule and zonular support. As scleral-fixated PC IOL implantation is technically more difficult than AC IOL implantation, the decisive factor in choosing a secondary IOL is surgical experience. Long-term comparison of both techniques is required.

Four-point fixation of posterior chamber intraocular lenses in children with unilateral aphakia

Purpose To evaluate the results of 4-point scleral fixation of posterior chamber intraocular lenses (PC IOLs) in children. Setting Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. Methods This retrospective study comprised 20 aphakic eyes of 20 children. Preoperative investigations proved the absence of adequate posterior capsule support. All patients had ab externo 4-point scleral fixation of a PC IOL. All preoperative and postoperative data were studied and analyzed. Results The mean preoperative age was 7.7 years (range 4 to 11 years). The mean follow-up was 19.35 months (range 13 to 30 months). The preoperative findings included a best corrected visual acuity of 6/18 or better in 8 eyes (40%), corneal scarring in 18 eyes, sector iridectomy in 7 eyes, and after-cataract in 4 eyes. The intraoperative complications included vitreous hemorrhage in 2 eyes and slippage of 1 suture in 1 eye. Postoperative complications included mild anterior uveitis in 12 eyes and severe fibrinoid reaction in the anterior chamber in 8 eyes. There were no cases of suture exposure, IOL malpositioning, or infection. Twelve patients (60%) had a visual acuity of 6/18 or better. The cause of the poor visual outcome in many patients was preexisting amblyopia. Conclusions The results suggest that 4-point scleral fixation is an option to correct aphakia in children. However, long-term follow-up is important to assess the procedure’s safety.

Bilateral spontaneous subluxation of scleral-fixated intraocular lenses

Two young men with primary ectopic lenses had intracapsular cataract extraction and scleral fixation of posterior chamber intraocular lenses (PC IOLs) using 10-0 polypropylene sutures tied to the IOL eyelets. Three to 9 years after implantation, spontaneous IOL vertical subluxation occurred in all 4 eyes (5 IOL loops), probably because of suture breakage. Late subluxation of a sutured IOL may occur several years after implantation. Double fixation and thicker sutures should be considered, especially in young patients.

Retinal detachment in eyes with vitreous loss and an anterior chamber or a posterior chamber intraocular lens: comparison of the incidence

Purpose To compare the incidence of retinal detachment within 6 months of cataract surgery complicated by vitreous loss in eyes with a posterior chamber intraocular lens (PC IOL) or an anterior chamber IOL (AC IOL). Setting Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel. Methods In this retrospective consecutive nonrandomized comparative case series, all cases of cataract surgery complicated by vitreous loss between January 1991 and March 1998 were reviewed. Included were patients who had thorough anterior vitrectomy and primary IOL implantation and at least 6 months follow-up. Exclusion criteria were congenital and traumatic cataract, previous intraocular surgery, and previous retinal detachment. Patients receiving an unsutured single-piece poly(methyl methacrylate) (PMMA) PC IOL formed the PC group, while those receiving flexible open-loop single-piece PMMA AC IOLs formed the AC group. The incidence of postoperative retinal detachment in the 2 groups was compared. Results Of the 151 eyes of 149 patients, 66 received a PC IOL and 85 received an AC IOL. Two eyes (3.0%) in the PC group and 2 (2.4%) in the AC group developed retinal detachment; the difference between groups was not statistically significant ( P = 1.00, Fisher exact test). Conclusions In eyes that have vitreous loss and thorough anterior vitrectomy, AC IOL implantation did not appear to increase the incidence of retinal detachment.

Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract

Purpose To assess the feasibility, risks, and postoperative outcomes of phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorhexis (CCC) in the absence of a red reflex. Setting Dr. Agarwal’s Eye Hospital, Chennai, India. Methods This prospective study comprised 52 eyes of 52 patients with white cataract that had phacoemulsification through a clear corneal temporal incision with PC IOL implantation. In all the cases, trypan blue was used under air to stain the anterior lens capsule and the karate-chop technique was used to emulsify the nucleus. The mean follow-up was 192.2 days. Results Trypan blue adequately stained the anterior lens capsule in all cases. The CCC was completed uneventfully in 96.15% eyes; 3.85% of cases had to be converted to a conventional extraction technique because of the loss of the CCC. The mean phacoemulsification time was 2.2 minutes. Intraocular complications included incomplete capsulorhexis (3.85%) and pupillary miosis (3.80%). Postoperatively, 3 eyes (5.77%) had corneal edema (striate keratopathy) and 1 eye (1.9%) had fibrin in the anterior chamber. Five eyes (9.61%) had more than 2+ cells and flare at 2 weeks. All responded well to intensive topical and subconjunctival steroids. There were no cases of endophthalmitis. The mean central endothelial cell loss, measured in 37 eyes, was 8.5%. Of the 4 eyes (7.69%) that had increased intraocular pressure (IOP) postoperatively, all responded well to medications and the IOP was normal by the second postoperative week. Fifty eyes (96.16%) had a final best corrected visual acuity of 20/30 or better. In 2 cases, the final visual acuity was worse than 20/200 because of preexisting posterior segment pathology. Conclusion Phacoemulsification using trypan blue was safe and effective in managing white cataract and had a high success rate.

Posterior Continuous Curvilinear Capsulorhexis With and Without Optic Capture of the Posterior Chamber Intraocular Lens in the Absence of Vitrectomy

ABSTRACT Purpose: To evaluate the efficacy of posterior continuous curvilinear capsulorhexis (PCCC) with optic capture of the posterior chamber intraocular lens (PC IOL) in the absence of vitrectomy in preventing secondary opacification of the visual axis following pediatric cataract surgery. Patients and Methods: Thirty-four eyes of 28 children with congenital or developmental cataract, aged 1.5 to 12 years (mean, 6.39 years), were included in this prospective, randomized study. Anterior continuous curvilinear capsulorhexis (ACCC) with PCCC without optic capture of the PC IOL was performed in group A (18 eyes) and ACCC with PCCC with optic capture of the PC IOL was performed in group B (16 eyes). None of the eyes underwent anterior vitrectomy. Secondary opacification of the visual axis, visual acuity, and possible complications were observed and analyzed. Results: The follow-up period ranged from 8 to 28 months (mean, 17.5 months). All 16 eyes (100%) in group B had a clear visual axis at the end of followup. Eight eyes (44.4%) in group A had significant opacification of the visual axis. The difference between the two groups was statistically significant (P = .0011). No eye in group B required secondary intervention, whereas all 8 eyes in group A with significant secondary opacification required secondary intervention. There was no statistically significant difference in other complications such as anterior chamber reaction, fibrin formation, lenticular precipitates, and posterior synechiae. The final best-corrected visual acuity at the end of follow-up was comparable in the two groups (P &gt; .05). Conclusion: PCCC with optic capture of the PC IOL prevents secondary opacification of the visual axis even in the absence of vitrectomy. J Pediatr Ophthalmol Strabismus 2002;39:278-287.

Monovision pseudophakia

Purpose To evaluate distance and near binocular visual acuities and patient acceptability after sequential posterior chamber intraocular lens (PC IOL) implantation for pseudophakic monovision correction. Setting Private practice and the Manhattan Eye Ear and Throat Hospital, New York, New York, USA. Methods This study comprised 140 binocular patients with less than 2.00 diopters (D) of astigmatism. Preoperatively, all patients expressed a desire to be independent of optical correction; 120 presented for removal of visually significant cataract and 20, for correction of high ametropia (+8.00 to −14.00 D). Phacoemulsification and implantation of a PC IOL calculated to achieve emmetropia were performed in the dominant eye. Ocular dominance was confirmed on multiple preoperative visits using a sighting technique. Implantation of a PC IOL calculated to yield a spherical equivalent of −2.75 D was performed in the nondominant eye. Seven postoperative examinations were performed during the 1-year follow-up, with 96 patients completing all evaluations. At each examination, interviews were conducted on patient acceptance and ability to perform near and distance tasks without correction. Results In the entire study group, 129 patients (92%) achieved 20/30 or better uncorrected distance acuity, J1 or better uncorrected near acuity, or both. One hundred ten patients (91%) in the cataract group and 19 (95%) in the clear lens group achieved this level. Patient acceptance was 90% in the cataract group and 100% in the clear lens group. Conclusions In a diverse group of self-selected patients from 1 metropolitan-area ophthalmology practice who were motivated to be free of spectacles, pseudophakic monovision provided a high level of satisfaction. No morbidity was associated with monovision as those who were dissatisfied with their uncorrected state did well with spectacle or contact lens correction.

Visual outcomes after vitreous loss during cataract surgery performed by residents

Purpose: To evaluate the visual outcomes after vitreous loss during cataract surgery performed by residents.Setting: Parkland Memorial Hospital, Dallas, Texas, USA.Methods: A retrospective chart review of all patients who had cataract extraction complicated by vitreous loss from 1997 through 1999 was conducted. All surgery was performed by third-year ophthalmology residents.Results: In 1400 cataract surgeries, 63 cases of vitreous loss (rate 4.5%) were identified. One case had less than 1 month of follow-up and was excluded from further analysis. Of the 62 remaining cases, 53 had phacoemulsification, 7 extracapsular cataract extraction (ECCE), 1 phacoemulsification converted to ECCE, and 1 intracapsular cataract extraction. Thirty-two eyes had a sulcus-fixated posterior chamber intraocular lens (PC IOL) implanted, 20 an anterior chamber IOL, and 7 a PC IOL in the capsular bag; 3 eyes were left aphakic at the time of initial surgery. Overall, 77% of patients had a postoperative best corrected visual acuity (BCVA) of 20/40 or better. Of the 14 patients who did not have a BCVA of 20/40 or better, 9 had preexisting ocular pathology affecting vision. If these 9 patients are excluded, 91% of patients with vitreous loss had a BCVA of 20/40 or better. Six patients (10%) developed clinical cystoid macular edema. No patient with vitreous loss developed a retinal detachment or endophthalmitis.Conclusions: Good visual acuity can be achieved after resident cataract surgery complicated by vitreous loss. The rate of vitreous loss in this study is consistent with that in previous reports of resident cataract surgery in the literature.

Indications for penetrating keratoplasty and associated procedures, 1996-2000.

To identify current indications and trends in indications for penetrating keratoplasty and associated procedures. Retrospective chart review of all patients who underwent penetrating keratoplasty at Wills Eye Hospital from January 1, 1996 to December 31, 2000. A total of 1,529 corneal transplants were performed during this 5-year period. The leading indications for penetrating keratoplasty were pseudophakic bullous keratopathy (PBK) in 416 (27.2%) cases, followed by regraft in 276 (18.1%), keratoconus in 236 (15.4%), and Fuchs endothelial dystrophy in 233 (15.2%) cases. Of the 416 PBK cases, 271 (65.1%) were associated with posterior chamber intraocular lenses (PC IOLs), 141 (33.9%) with anterior chamber intraocular lenses (AC IOLs), and four (1%) with iris-fixated lenses. Of these 141 AC IOLs, 107 (75.9%) were closed-loop and 34 (24.1%) were open-loop. Of the 416 PBK cases, in 281 (67.5%) cases, the IOL was not exchanged; in 127 (30.5%) cases, the IOL was exchanged; in six (1.5%) cases, the IOL was repositioned; and in two (0.5%) cases, the IOL was removed at the time of surgery. Of the 271 PC IOLs, 248 (91.5%) were not exchanged and 19 (7.1%) were exchanged. Of the 141 AC IOLs, 33 (23.4%) were not exchanged and 104 (73.7%) were exchanged (p = 0.001). Pseudophakic bullous keratopathy remains the leading indication for corneal transplantation at our institution followed by regraft. The percentage of PBK cases associated with PC IOLs has increased significantly, whereas the percentage associated with AC IOLs has decreased. The frequency of regraft has also increased significantly.

Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life

Purpose: To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocular lens (PC IOL) implantation in the first year of life. Setting: The Children’s Hospital, Dublin, Ireland. Methods: Twenty-seven eyes of 20 infants were reviewed. Seven infants (14 eyes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract. The mean age at surgery was 4 months (range 3 weeks to 11 months). A standard surgical technique involved anterior capsulorhexis, phacoemulsification with or without posterior capsulorhexis with in-the-bag PC IOL implantation, and no anterior vitrectomy. Surgery was performed by 1 surgeon. The mean follow-up was 41 months (range 6 to 88 months). Results: The main complication was lens reproliferation into the visual axis. Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 had 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser capsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsulotomies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary posterior capsulorhexis; 8 had no further intervention. Four eyes had persistent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotomy, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 developed open-angle glaucoma. There was a mean refractive shift of 6.0 diopters after a mean follow-up of 41 months, with most of the myopic shift occurring in the first 24 months. Conclusions: Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.