Posterior Chamber Intraocular Lens Insertion Research Articles

Outcomes of Cataract Surgery Following Treatment for Retinoblastoma.

PurposeTo evaluate the long-term visual outcomes and complications of cataract surgery in eyes previously treated for retinoblastoma.MethodsWe reviewed the medical records of patients who underwent cataract extraction and intraocular lens implantation at Seoul National University Children's Hospital for a secondary cataract that developed after retinoblastoma treatment.ResultsDuring the period between 1990 and 2014, 208 eyes of 147 patients received eye-salvaging treatment (radiotherapy, chemotherapy, and local therapy) for retinoblastoma at Seoul National University Children's Hospital. Among these eyes, a secondary cataract was detected in 17 eyes of 14 patients, and five eyes of five patients underwent cataract surgery. The median age of cataract formation was 97 months (range, 38 to 153 months). The medial interval between the diagnosis of retinoblastoma and cataract formation was 79 months (range, 29 to 140 months). All patients received posterior chamber intraocular lens insertion after irrigation and aspiration of the lens through a scleral tunnel incision. Anterior vitrectomy and posterior capsulotomy were performed in two eyes and a laser capsulotomy was subsequently performed in one eye. No intraoperative and postoperative complications occurred. The median follow-up after surgery was 36 months (range, 14 to 47 months). The final best corrected visual acuities were improved in all five eyes. No intraocular tumor recurrences or metastases occurred.ConclusionsAfter retinoblastoma regression, cataract extraction in our series was not associated with tumor recurrence or metastasis. Visual improvement was noted in every patient.

Risk Potentiality of Frontline Radiotherapy Associated Cataract in Primary Ocular Adnexal Mucosa-associated Lymphoid Tissue Lymphoma

PurposeTo elucidate risk potentiality of frontline radiotherapy associated cataracts in primary ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML).MethodsData from eight consecutive patients of 41 total OAML patients who had undergone cataract surgery after frontline radiotherapy were analyzed.ResultsThe median patient age was 46 years (range, 36 to 69 years). The median total radiation dose was 3,780 cGy (range, 3,060 to 4,500 cGy), and the mean duration from radiation irradiation to cataract surgery was 36.60 ± 8.93 months. Preoperative lens opacification was primarily at the posterior lens subcapsule, and best-corrected visual acuity (BCVA) was 0.43 ± 0.21. Patients underwent the phacoemulsification surgical procedure with posterior chamber intraocular lens insertion. The average BCVA improved to 0.90 ± 0.14 after cataract surgery. Two patients underwent posterior continuous curvilinear capsulorhexis, and one had posterior capsule rupture. For posterior capsule opacification (PCO), three patients received Nd:YAG laser posterior capsulotomy after the initial surgery, and one patient is currently under consideration for laser posterior capsulotomy.ConclusionsRadiotherapy increased posterior subcapsule opacification at a relatively young age in primary OAML. Phacoemulsification was a manageable procedure without severe complications, and final visual outcomes were good. However, because after-cataracts progressed earlier than did senile cataracts, close follow-up should be considered for PCO management.

The effect of descemet-stripping automated endothelial keratoplasty combined with phacoemulsification cataract surgery or lens exchange

To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification cataract surgery or lens exchange in corneal endothelial dysfunction eyes with lens disorders. Retrospective case series. Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulsification and intraocular lens (IOL) insertion. Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up. The irritation was disappeared in all of patients. All of the corneas became transparent. The preoperative and postoperative mean CCT of the recipient beds was 859 µm and 553 µm respectively. T value was 5.303 (t = 5.303, P < 0.01). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm(2). The ECD was 1803 cells/mm(2) in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection. These complications occurred in anterior chamber IOL eyes. DSAEK combined with phacoemulsification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.

Delayed Suprachoroidal Hemorrhage after Reinstitution of Warfarin in Combined Procedure.

A 79-year-old non-compliant male with pseudoexfoliative glaucoma and cataract in the left eye underwent uneventful combined phacoemulsification, posterior chamber intraocular lens insertion and trabeculectomy with mitomycin C through one port a week after replacement of warfarin with subcutaneous injections of enoxaparin (Clexane; Sanofi-Aventis, Netaniya, Israel). The intraocular pressure (IOP) following surgery was zero. Four days later, warfarin was restarted because of short ventricular tachycardia when the patient developed suprachoroidal hemorrhage and later hyphema and vitreous hemorrhages. The patient underwent drainage of the suprachoroidal hemorrhage. His IOP increased to 10 to 12 mm Hg while the bleb was functioning, but visual acuity remained poor because of chorioretinal retinal scarring from age-related macular degeneration. Premature reinstitution of warfarin may cause delayed hemorrhages if the postoperative IOP is low. Preoperative approval from the internist for a prolonged replacement of warfarin with lesser potent agents, or tightening of the scleral flap and releasing the sutures later in trabeculectomy in combined procedures may be warranted.

Implantation of foldable intraocular lens with anterior optic capture in isolated posterior capsule rupture

We would like to raise several pertinent points regarding isolated posterior capsule rupture occurrence and its management described in the article by Pushker et al.1 Isolated posterior capsule rupture is a well-recognized clinical entity. In our literature review, we came across 22 cases reported prior to the authors' case.2–9 Previous authors suggest that the absence of a formed nucleus in young patients allows contrecoup forces to be transmitted through the lens substance.3 We theorize that its occurrence in young patients following blunt trauma is due to localized pressure buckling the cornea and deforming the soft nucleus (with posterior bulging against the posterior capsule). In addition, zonular tension pulls the posterior capsule centrifugally. This combination results in a blow-out rupture of the posterior capsule. We recently managed a similar case. Two months following blunt ocular trauma, a 19-year-old man had lens aspiration with implantation of an Alcon MA60BM intraocular lens (IOL) in the capsular bag. We aspirated the lens through a superior 2.75 mm clear corneal incision using automated irrigation/aspiration with an anterior chamber maintainer (ACM). With low-flow settings and the ACM, no vitreous prolapsed and anterior vitrectomy was not required. The posterior chamber IOL was placed in the capsular bag, with no optic capture, and has remained stable with over 1 year of follow-up. Even without grossly fibrotic edges, these posterior capsular defects are relatively stable and resistant to enlargement like posterior capsulorhexis. In essence, we feel that vitreous loss should be avoided with the attendant reduction in the risk for retinal detachments and cystoid macular edema. Plain capsular bag fixation is also possible in most cases and is ideal because prolapsing the optic anteriorly brings it closer to the iris and increases the risk for iris chafing and pigment dispersion. If the defect is extremely large or the edges of the posterior capsule defect are not visualized, the posterior chamber IOL haptics should be placed in the ciliary sulcus (with posterior optic capture through an intact anterior capsulorhexis). In fact, anterior optic capture was recommended by Gimbel and DeBroff10 in cases in which the posterior capsule tear occurred during or after posterior chamber IOL insertion rather than in cases with preexisting breaks. In cases of posterior capsule tear during or after posterior chamber IOL insertion, leaving the haptics in the capsular bag, rather than trying to dial them out into the sulcus, minimizes vitreous disturbance. Finally, we would like to point out that the Alcon MA30BA has polymethyl(methacrylate) haptics not polypropylene haptics as mentioned by the authors.

Pars Plana Lensectomy and Intraocular Lens Implantation in Pediatric Radiation-Induced Cataracts in Retinoblastoma

To investigate visual outcomes, surgical complications, and tumor recurrence among children with retinoblastoma (RB) undergoing pars plana lensectomy, vitrectomy, and simultaneous intraocular lens insertion for radiation-related cataract secondary to external beam radiotherapy (EBRT). Retrospective, noncomparative, consecutive case series. The medical records for all patients treated with pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens implantation for radiation-induced cataract after EBRT for RB at a single institution between January 1, 1990, and December 31, 2000, were reviewed. The study included 16 eyes of 12 children with Reese-Ellsworth stage V RB. Visual acuity, surgical and postoperative complications, postoperative refraction, and tumor recurrence. The median age at diagnosis of RB was 6 months (range, 1-49 months). All patients received EBRT as primary treatment and experienced radiation-induced cataracts. The median interval from RB diagnosis to cataract surgery was 42 months (range, 28-95 months). Preoperative mean visual acuity was 20/400, with 12 of 16 eyes (75%) having macular tumor involvement. All patients underwent pars plana lensectomy, vitrectomy, and posterior chamber intraocular lens insertion. Vitreous samples were evaluated by cytopathologic examination, and no viable tumor cells were identified in any of the vitreous specimens. Postoperative complications included transient cystoid macular edema in 5 eyes (31%) and iridocyclitis in 3 eyes (19%). The mean follow-up after cataract surgery was 66 months (range, 30-94 months). Final visual acuity was 20/40 or better in 11 of 16 eyes (69%). No late intraocular recurrence, orbital tumors, or metastatic disease was noted in this study. Pars plana lensectomy, vitrectomy, and simultaneous intraocular lens implantation is an effective means of managing EBRT-induced cataracts in eyes with previously treated RB. There was no evidence of active tumor in eyes undergoing surgery at least 28 months after the diagnosis and commencement of therapy for RB, and no late intraocular, orbital, or metastatic tumors were detected. Visual acuity was limited by the presence of primary macular tumor pathologic features in a subset of patients, but final vision better than 20/400 may be achieved in these eyes.

Combined Phacoemulsification, Intraocular Lens Implantation, and Scleral Buckling Surgery for Cataract and Retinal Detachment

To evaluate the effects of simultaneous surgery for cataract and retinal detachment. Six patients with a diagnosis of retinal detachment accompanied by dense cataracts precluding fundus visualization were enrolled in this study. A triple procedure involving phacoemulsification, posterior chamber intraocular lens insertion, and scleral buckling was performed in all six cases. A clear intraoperative view of the fundus was obtained in all cases and retinal breaks were identified in five cases. The retina was successfully reattached in all six cases, five of which showed improvement in visual acuity. Combined cataract and scleral buckling surgery can be performed safely. This procedure spares the patient repeat surgery and may improve the visual outcome by clearly identifying the breaks and avoiding delays in detachment repair.

Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: A series of 223 cases

Purpose To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. Design Retrospective, consecutive, noncomparative, interventional case series. Participants Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. Methods A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. Main outcome measures Vision, number of secondary procedures, and complications. Results Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). Conclusions Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.

The effect of cataract on Accumap multifocal objective perimetry

PurposeTo determine the effect of visually significant cataract on Accumap multifocal objective perimetry. DesignInterventional case series. MethodsFifteen eyes of 15 adult patients who underwent standard outpatient phacoemulsification cataract surgery with posterior chamber intraocular lens insertion with subsequent improvement of best-corrected visual acuity underwent Accumap testing before and after cataract extraction. Patients had no other ophthalmic disease or other conditions that may have affected visual evoked potentials. Results were analyzed statistically. ResultsVisually significant cataract was associated with a statistically significant reduction of mean Accumap amplitudes within the central 107 degrees (zone 1, P = .002; zone 2, P = .003; zone 3, P = .001) but did not affect the outer two zones (zone 4, P = .074; zone 5, P = .931). ConclusionsAccumap visual fields may be affected by visually significant cataract. Multifocal objective perimetry defects in the central 10 degrees should be interpreted with caution in patients with cataract.

Outcome of extra-capsular cataract extraction with posterior chamber intraocular lens implantation performed at a cataract surgical campaign

Outcome of extra-capsular cataract extraction with posterior chamber intraocular lens implantation performed at a cataract surgical campaign

Combined Cataract Surgery and Vitrectomy for Breakthrough Vitreous Hemorrhage from Age-Related Macular Degeneration

To report combined cataract extraction (CE), posterior chamber intraocular lens (PCIOL) implantation, and pars plana vitrectomy (PPV) for concurrent cataract and breakthrough vitreous hemorrhage from age-related macular degeneration (AMD). Retrospective case series. Six eyes were included in the study. The postoperative follow-up interval ranged from 3 to 22 months (mean 8 months). Preoperative visual acuity (VA) ranged from 20/400 to hand motion. Postoperatively, 5/6 eyes had 2 or more lines of visual improvement. Three eyes were better than 20/200. Combined CE, PCIOL insertion, and PPV in selected patients with cataract and breakthrough vitreous hemorrhage from AMD was successful in improving VA in the majority of patients.

Outcome of extracapsular cataract surgery plus posterior chamber intraocular lens insertion for age-related cataract in eastern Nepal.

As age-related cataract is the leading cause of blindness in Nepal, much more attention should be given to improving surgical outcomes. The aim of our study was to determine the effectiveness and risks of extracapsular cataract surgery (ECCE) for age-related cataract in a tertiary hospital of eastern Nepal. ECCE with posterior chamber intraocular lens (PC IOL) insertion on 797 eyes (754 patients) revealed improved visual acuity in 97.9%. In 595 (74.6%) the best corrected visual acuity was 6/18 or better, and 167 (20.9%) had 6/24 to 6/60 with negligible operative/postoperative complications. Thus it is concluded that ECCE with PC IOL could be performed safely and effectively even in developing countries where people are unaware that surgery is available and of the good surgical outcome.

Audit of outcome of an extracapsular cataract extraction and posterior chamber intraocular lens training course

BACKGROUNDA training course for cataract surgery with intraocular lens implantation was organised in April 1997 at the National Eye Centre, Kaduna, Nigeria. Operations were performed by six Nigerian consultant ophthalmologists...

A Pars Plana Approach for Cataract Surgery in Posterior Lenticonus

To report the management and outcome of cataract surgery and intraocular lens placement in a child with unilateral posterior lenticonus. Case report. A 7-year-old boy with a best-corrected visual acuity of RE, 20/200, posterior lenticonus, and cataract underwent a pars plana lensectomy, vitrectomy, posterior chamber intraocular lens insertion into the ciliary sulcus, and central anterior capsulotomy. At 2 years of follow-up, best-corrected visual acuity was RE, 20/40. This technique allowed complete removal of the opaque posterior lenticonus plaque while preserving the peripheral anterior capsule for sulcus fixation of the posterior chamber intraocular lens.

Risk Factors for Unsatisfactory Intraocular Pressure Control in Combined Trabeculectomy and Cataract Surgery

Trabeculectomy combined with posterior chamber intraocular lens (PC IOL) insertion is often chosen for the treatment of glaucoma combined with cataract. In this study, the clinical prognostic indicators for late intraocular pressure (IOP) control in combined procedures were investigated. The clinical records of 60 eyes that underwent trabeculectomy combined with PC IOL implantation were retrospectively analyzed using the Cox proportional hazards model. All of the patients received postoperative 5-fluorouracil injections. Extracapsular cataract extraction (ECCE) was found to be a statistically significant risk factor for unsatisfactory late IOP control (hazard ratio 2.54; P < .01) and for unsatisfactory filtering bleb appearance (hazard ratio 5; P < .001). The frequency of fibrin formation and the incidence of a transient IOP spike (> or = 25 mm Hg) were significantly lower in the phacoemulsification and aspiration (PEA) group than in the ECCE group. In the PEA group, the probability of IOP control (< or = 15 mm Hg) without medication was 54%, and the probability of persistent filtering bleb appearance was 80% at 18 months. The PEA technique, not ECCE, should be employed in combined trabeculectomy and PC IOL implantation.

Excimer Laser Phototherapeutic Keratectomy Before Cataract Extraction and Intraocular Lens Implantation

To determine whether sequential excimer laser phototherapeutic keratectomy (PTK) followed by cataract extraction and intraocular lens (IOL) implantation with power calculation based on the new corneal curvature is effective in managing superficial corneal disease. Of a consecutive series of 18 eyes of 16 patients who received PTK, extracapsular cataract extraction, and posterior chamber IOL insertion, twelve eyes had spheroidal degeneration and six eyes, calcific band keratopathy. The PTK was done with either a Summit ExciMed laser or a Visx 20/20 laser using a 5.0 to 6.0 mm diameter ablation zone. Intraocular lens calculations were done a mean of 3.3 months after PTK. Cataract surgery was by extracapsular cataract extraction with posterior chamber IOL implantation. Patients were followed up for a mean of 14 months. Eighteen eyes completed follow-up examinations. Mean time between PTK and cataract surgery was 3.3 months. Phototherapeutic keratectomy was completed in one surgery session using one ablation treatment (ablation and slitlamp microscopy) in five eyes, two treatments in seven eyes, and three to seven treatments in six eyes. Eleven (61%) of 18 eyes had a final spherical equivalent refraction within +/- 1.00 diopter. Two eyes developed moderate to marked subepithelial reticular corneal haze from PTK. No vision-threatening complications occurred. Excimer laser PTK followed by cataract extraction and posterior chamber IOL implantation can safely and effectively treat eyes with superficial corneal disease and age-related cataract. Calculation of the IOL power after the cornea has healed from the PTK compensates for changes in corneal curvature.

Epithelial Inclusion Cyst of the Iris

We describe the clinical presentation, high-frequency ultrasound biomicroscopic characteristics, and pathologic findings associated with a conjunctival inclusion cyst within the iris. The patient had undergone an uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens insertion 9 months prior to presenting with a progressively enlarging iris mass. A clinical examination revealed a solid-appearing white tumor within the midiris stroma, accompanied by limbal-conjunctival hyperemia and anterior chamber inflammation. Ultrasound biomicroscopy revealed an egg-shaped solid iris stromal tumor that displaced the pigment epithelium. The mass was composed of three concentric layers of different echogenicity: a moderately reflective mantle, a less reflective middle zone, and a hyperreflective core. Within 3 days of initiation of topical corticosteroid therapy (prednisolone acetate, 0.5 mg per drop four times daily), the tumor enlarged and induced a plasmoid aqueous and a hypopyon. Histopathologic study revealed a conjunctival inclusion cyst with evidence of acute and chronic inflammation. We have found that the diagnosis of epithelial inclusion cyst within the iris can be aided by an ultrasound evaluation. This case also suggests that it may be preferable to excise these tumors prior to topical corticosteroid treatment.

Does Heparin Surface Modification Affect the Incidence of Inflammatory Related Complications in Patients with Glaucoma Undergoing Endocapsular Cataract Extraction with Posterior Chamber Lens Implantation?

OBJECTIVE: To see if heparin surface modification (HSM) of intraocular lenses affects the incidence of post-operative inflammatory related complications in patients with glaucoma undergoing endocapsular cataract extraction with posterior chamber intraocular lens insertion. STUDY DESIGN: A prospective study of post-operative results at one year follow up. SETTING: Ophthalmic Out-patient Clinic, Royal Hallamshire Hospital, Sheffield. PATIENTS: 34 adult patients with pre-existing glaucoma undergoing cataract surgery were randomly allocated to receive either an HSM lens or a standard PMMA lens. MAIN OUTCOME MEASURES: Pigmented deposits and non-pigmented cellular deposits, iridocapsular adhesions, iridolenticular adhesions, peripheral anterior synechiae. RESULTS: Comparing eyes that received HSM lenses with those receiving standard PMMA lenses, at one year follow up there was no statistically significant difference in the number of clear lenses; the number of non-pigmented cellular deposits per IOL; the amount of pigmented deposits per IOL; or the presence and extent of iridolenticular or iridocapsular adhesions or peripheral anterior synechiae. CONCLUSIONS: Heparin Surface Modification of PMMA lenses in our group of glaucoma patients failed to reveal any significant benefits with respect to inflammatory related complications at one year post-surgery, when compared to standard PMMA lenses.

Extracapsular Cataract Extraction and Posterior Chamber Lens in the Management of Phacolytic Glaucoma

OBJECTIVE:To determine whether extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PC IOL) insertion poses any particular surgical problem in the management of phacolytic glaucoma. STUDY DESIGN: A prospective study of postoperative results of ECCE and PC IOL at 1 week, 1 month and long-term follow-up ranging from 10 to 38 months. SETTING: University Eye Clinic of Athens. PATIENTS: Six patients suffering from phacolytic glaucoma of some 24–72 hours duration. MAIN OUTCOME MEASURES: Operative complications, postoperative status including intraocular pressure and visual acuity. RESULTS: No operative complications occurred. No significant intraocular pressure problems were recorded. One case of postoperative macular oedema complicated an otherwise excellent visual result in all cases. In the postoperative period of observation no significant opacification of the posterior capsule was noted. CONCLUSIONS: There were no significant problems related to cataract and lens implant surgery with patients with phacolytic glaucoma. The preoperative situation of inflammation and raised intraocular pressure resolved rapidly after surgery. The visual outcome was very satisfactory.

Healon GV in extracapsular cataract extraction with intraocular lens implantation

A randomized masked study was performed to compare Healon GV®, a new higher molecular weight sodium hyaluronate viscoelastic, with Healon® in extracapsular cataract surgery with posterior chamber intraocular lens insertion. Seventy patients were randomly divided into two groups. Postoperative intraocular pressures, pachymetry, endothelial cell counts and morphology, amount of viscoelastic and irrigating solution used, difficulty of surgery, and postoperative flare and cells were measured. Postoperative pressures were not significantly different between the Healon and Healon GV treatment groups, except at the eight-hour observation period, when the pressure was higher in the Healon GV group (P = .02). There was a significant (P = .002) reduction in the amount of viscoelastic required in the Healon GV group. Cell counts and morphology were not significantly different between the groups. Other parameters showed no significant difference. Clinically, Healon GV handled like Healon during instillation into the anterior chamber and aspiration at the end of the case. It did, however, appear to be much more effective at maintaining the anterior chamber, as demonstrated in the smaller amount of viscoelastic required.