Posterior Chamber Intraocular Lens Research Articles

Application of the suture needle retrograde threading method in scleral fixation of intraocular lenses

BackgroundHere we described a new threading technique for the universal fixation of any posterior chamber intraocular lens (IOL).MethodsTwenty-seven eyes of 27 patients whose surgery done by Surgeon A with the needle-guided method or the suture needle retrograde threading (SNRT) method for intrascleral IOL fixation were enrolled in the first group. Thirty-four eyes of 34 patients whose surgery done by Surgeon A, Surgeon B or Surgeon C with the SNRT method for intrascleral IOL fixation were grouped into three sub-groups by surgeon. Information regarding age, sex, best-available visual acuity (BCVA), intraocular pressure (IOP), past ophthalmological history, threading time (from puncturing to externalizing suture) and complications during and after the surgery were gathered.ResultsThe analysis showed that the threading time was less in the SNRT group than needle-guided group by Surgeon A. There was one eye with suture needle slipping from the guide needle when guiding out of the eye. The threading procedure was completed one time without suture ruptures or loop slippage in the SNRT group operated by Surgeon A. And using the SNRT method, Surgeon A, Surgeon B, and Surgeon C did not show any significant difference in threading time. No complications (e.g., vitreous hemorrhage, hyphemia, retinal detachment, suprachoroidal hemorrhage, or hypotony) were observed during surgery or postoperatively in all cases. No leakage occurred at the site of the puncture after the operation.ConclusionsThe described technique appears to be a safe, simple, easy-to-learn, and universal surgical method, which is suitable for various types of IOLs.

Five-year follow-up of a posterior chamber phakic intraocular lens with a central hole for correction of myopia

PurposeTo evaluate intermediate and long-term visual outcomes and safety of a phakic intraocular posterior chamber lens with a central hole (ICL V4c) for myopic eyes.MethodsRetrospective, consecutive case study of patients that uneventfully received a ICL V4c for myopia correction, with a 5-year postoperative follow-up. Department of Ophthalmology, Goethe University Frankfurt, Germany.ResultsFrom 241 eyes that underwent ICL implantation, we included 45 eyes with a mean age at surgery of 33 years ± 6 (18–48 years), with a 5 years follow-up. CDVA improved from 0.05logMAR ± 0.15 CDVA preoperatively to − 0.00 ± 0,07 at 5 years and did not change significantly from 3 to 5 years’ time (p = 0.266). The mean spherical equivalent (SE) improved from -10.13D ± 3.39 to − 0.45D ± 0.69. The change in endothelial cell count showed a mean decrease of 1.9% per year throughout the follow-up. Safety and efficacy index were 1.16 and 0.78, respectively. Cataract formation was seen in 2 of 241 eyes (0.8%), but in none of the 45 eyes that finished the 5-year follow-up.ConclusionsOur data show a good intermediate and long-term stability, efficiency, and safety of ICL V4c phakic lenses in myopic eyes comparable to other known literature.

Modified Four-Point Scleral Fixated Sutured Posterior Chamber Intraocular Lens Implantation Using 2 Eyelets Polymethyl Methacrylate Lens and 8-0 Polypropylene Suture.

To present a modified technique of 4-point scleral fixation using polymethyl methacrylate (PMMA) 2 eyelets intraocular lens (IOL) with 8-0 polypropylene sutures. A 270-degree conjunctival peritomy is done, and 4 sclerotomies (2 nasal and 2 temporal) are created. Lamellar scleral or clear corneal incision is made at superior site (6 mm wide for sclera or 5.5-6 mm for corneal). A short segment of 8-0 polypropylene is inserted into each eyelet, each thread of the suture is externalized through the sclerotomy site, and the lens is inserted. The suture is tightened evenly, and the knot is rotated and internalized. Scleral incision and conjunctival peritomy are sutured with 8-0 vicryl. We have performed this technique in 6 patients with excellent visual outcomes and no reported complications over 1 year of follow-up. This technique has practical advantages including rigid and stable PMMA IOL, high tensile, and slim 8-0 polypropylene suture which is easily internalized and less irritated, and affordable and widely available overall consumables. We present a modified 4-point scleral fixation technique for posterior chamber IOL placement using PMMA IOL with 2 eyelets and 8-0 polypropylene as compared to previous studies that used foldable IOL with 4 eyelets and 10-0 polypropylene or Gore-Tex sutures. This procedure has moderate technical complexity, comparable to previously reported techniques with good overall clinical outcomes and several practical advantages, particularly related to the affordability and availability of the consumables.

Nanophthalmos with angle closure glaucoma, a challenging case

Link of Video Abstract: https://youtu.be/eGhTbOkaaQI Introduction: Nanophthalmos basically is a simple microphthalmos with clinical characteristics of short axial length (AL), shallow anterior chamber (AC), high lens to eye volume ratio, small cornea and thick sclera, associated with angle closure glaucoma. We report a case of nanophthalmos with angle closure glaucoma and cataract who underwent trabeculectomy and end up with malignant glaucoma. Pars plana vitrectomy (PPV) and phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation was done to manage the case. Case Description: A 41-year-old man came with blurred vision in the right eye with redness and headache for 8 weeks. Intraocular pressure (IOP) was 46 mmHg, visual acuity was counting fingers at 2 m with nystagmus. Slit lamp examination revealed short axial length (AL), shallow anterior chamber (AC), small corneal diameter and high lens to eye volume. Trabeculectomy with 5FU was done with complication of malignant glaucoma. After PPV combined with phacoemulsification and PC IOL implantation, IOP was 14 mmHg, visual acuity 0.125 with deep AC. Conclusion: Surgical intervention in nanophthalmos with angle closure glaucoma must be managed with good preparation. Malignant glaucoma in this case can be managed with pars plana vitrectomy and phacoemulsification without scleral procedure.

Transient band keratopathy associated with epithelial ingrowth treated with antimetabolites

Introduction: To report a case of visually significant band keratopathy associated with ocular inflammation in the setting of epithelial ingrowth, both of which resolved after repeated antimetabolite treatments. Patient and Clinical Findings: A 74-year-old woman with a history of uveitis–glaucoma–hyphema syndrome after complicated cataract surgery presented with epithelial ingrowth in the right eye and diffuse central band keratopathy after posterior chamber intraocular lens (IOL) removal and pars plana vitrectomy and anterior chamber IOL placement. Diagnosis, Intervention, and Outcomes: After multiple intraocular injections of antimetabolites, the epithelial ingrowth and visually significant band keratopathy resolved. Conclusions: Treating the underlying source of inflammation, such as epithelial ingrowth with antimetabolites, was associated with clearance of the band keratopathy without further intervention.

Evolution of Scleral Fixation, Haptic Externalization and Tucking Techniques

Phakic rehabilitation poses challenges for patients without capsular support, making traditional intraocular lens (IOL) implantation difficult. In such cases, an Anterior Chamber (AC) IOL or a scleral-fixated posterior chamber IOL (SF-PC IOL) can be considered as options. To ensure a well-centered IOL, haptics should be away from the ciliary processes, iris, and oraserrata, with sufficient distance from the iris to prevent capture. Delayed IOL dislocation can occur due to suture breakage, but it can be prevented by proper IOL size and snugly opposing the stitched haptics into the ciliary sulcus.

A Comprehensive Investigation Into the Outcomes of Descemet's Stripping Endothelial Keratoplasty (DSEK) as a Treatment for Corneal Endothelial Disorders.

Descemet's stripping endothelial keratoplasty (DSEK) has emerged as the preferred method for posterior lamellar keratoplasty, as it enables the replacement of the compromised host endothelium with a viable donor lamella. The objective of this study was to assess the impact of DSEK on surgical outcomes and visual acuity. The research was carried out from November 2019 to October 2021, encompassing a sample of 18 patients (18 eyes) who satisfied the inclusion criteria for DSEK. The pre-operative evaluation was performed once before the surgery, while post-operative evaluations were conducted at one, three, and six months after the surgical intervention. The main variables assessed in this study encompassed demographic characteristics, visual acuity, surgical techniques, and surgical complications employed during the surgical procedure. The collected data were statistically analyzed using IBM SPSS software version 21 (IBM Corp., Armonk, NY, USA). Patients in the study ranged in age from 25 to 70, with a mean age of 53.16 ± 14.19 years. The participants were 61% male and 39% female. The main reasons for DSEK use were pseudophakic bullous keratopathy (61%) and post-penetrating keratoplasty (PK) graft failure (17%). The other indications were aphakic bullous keratopathy (11%), bullous keratopathy with cataracts (5%), and Fuchs's endothelial dystrophy (5%). The study included 18 eyes: 14 eyes underwent DSEK, two underwent DSEK with small-incision cataract surgery (SICS) and posterior chamber intraocular lens (PCIOL) implantation, and two underwent DSEK with scleral-fixated FIL. A significant improvement in best-corrected visual acuity (BCVA) was observed at six-month follow-up (0.73 ± 0.37 vs. 1.73 ± 0.59 logMAR pre-operatively). During donor cornea dissection, buttonholing was the main concern, occurring 11% of the time. Descemet's perforation and donor preparation thickness variations were also observed. Reverse donor unfolding, incomplete DM stripping, and donor button displacement were quickly addressed and managed. Post-operative graft failure occurred in 22% of cases, while acute graft rejection occurred in 11%. Graft dislocation, pupillary block, and secondary glaucoma each had a 5% prevalence. Descemet's stripping endothelial keratoplasty is a safe and effective treatment for corneal endothelial disorders, particularly in cases where scarring is not present. Surgical skills are essential to achieving the desired results. Descemet's stripping endothelial keratoplasty is favored over conventional keratoplasty for endothelial dysfunction due to its technical advantages and manageable risks. Our research demonstrates a significant improvement in visual acuity through DSEK. Despite manageable post-operative complications, it is vital to educate patients and medical professionals on surgical complexities. Descemet's stripping endothelial keratoplasty appears promising for the treatment of endothelial disorders, but its long-term implications must be studied.

Morphological Changes in the Endothelium of Cornea after Cataract Surgery: A Comparison between Phacoemulsification and Manual Small Incision Cataract Surgery

Background: Endothelial cell loss and corneal decompensation after cataract surgery is well-documented. After endothelial cell loss, the adjacent cells enlarge and slide over to maintain endothelial cell continuity, which is observed as a change in the endothelial cell density and morphology of the cornea. Objective: The study aims to assess and compare morphological changes (i.e., endothelial cell loss) in cornea after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation. Methods: This observational study was conducted in the Department of Ophthalmology of Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh, between January and July of 2016. A total of 80 patients of age-related cataract were randomly selected based on inclusion and exclusion criteria. All patients underwent complete ophthalmic evaluation pre- and post-operatively (at day 1, after 1 week and 3 months) specifically for observation of the endothelial changes in cornea. Specular microscopy was done to assess corneal endothelial change. Results: The mean endothelial cell count was found decreased at day 1 (2585.07±355.65/mm2 vs. 2598.07±385.76/mm2), after 1 week (2564.72±347.23/mm2 vs. 2388.77±326.46/mm2) and after 3 months (2476.72±346.69/mm2 vs. 2248.77±354.47/mm2) following phacoemulsification and MSICS from their preoperative values (2745.35±395.27/mm2 vs. 2673.04±388.28/mm2) respectively. However, no significant difference was observed in mean endothelial cell count of both groups (P>0.05). The mean percentage of endothelial cell loss were observed 5.84±10.02% and 2.80±0.65% at day 1, 6.58±12.15% and 10.63±15.92% at 1 week, 9.78±12.29% and 15.87±8.71% at 3 months after phacoemulsification and MSICS. However, the difference observed in amount of endothelial cell loss between the groups was not statistically significant (P>0.05). Conclusion: To summarize, a decreased endothelial cell count was observed after cataract surgery in both phacoemulsification and MSICS procedures from their preoperative values respectively. However, the difference was not significant between two procedures. Mugda Med Coll J. 2023; 6(1): 11-15

Small incision cataract surgery in rural communities in Uttar Pradesh: A clinical study of postoperative complications and visual outcomes at a tertiary eye hospital

To study the incidence of postoperative complications and visual outcome following manual small incision cataract surgery.This is a hospital-based retrospective study comprised of 1020 eyes of 1020 cataract patients above 31 years without any systemic illness. This study was overseen in a rural tertiary hospital in North India from November 2020 to February 2021. All patients were analyzed according to their history, age, sex and a thorough clinical examination was done. Manual small incision cataract surgery was done for all patients, and they were examined on the first postoperative day and after 1 month.In our study 57% of patients are male and 43% are female. The maximum number of patients were in the age group of 61–70 years. Intraoperative complications PC rent noticed in 1 case zonular dehiscence in 2 patients, and 3 patients were left aphakic. On the first post-op day, Striate keratopathy was 2%, Residual cortex 3%, FM Threads 9%, Anterior uveitis cells 3%, Blood clots & Dispersive hyphema 3%, Epithelial defects 1%, Corneal edema 4% were seen. Post-operative uncorrected vision at day one 83% of cases achieved good visual acuity (≥ 6/18) and the rest 16% were borderline acuity (<6/18-6/60), which at 1-month post-operative day good visual acuity improved to 87% of cases. Small incision cataract surgery (SICS) with Posterior chamber intraocular lens (PCIOL) is an approved method of community-premised cataract surgery to overcome the large cataract reserve in our country it gives consistently good visual acuity post-operatively and negligible complications.

The Effects of Uneventful Phacoemulsification on Subfoveal Choroidal Thickness.

To evaluate the impacts of phacoemulsification preoperative and intraoperative factors on postoperative subfoveal choroidal thickness (SFCT). This prospective interventional study was conducted on patients undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation at the private clinic Ophthalmica Eye Institute, in Thessaloniki, Greece. Forty-six eyes of 46 patients were included in the study. Operative time (OT), phacoemulsification time (PT), effective phacoemulsification time (EPT) and phacoemulsification power (PP) were recorded for each patient. All patients received dexamethasone and nepafenac drops for 4weeks postoperatively. Choroidal thickness (CT) at five anatomical locations was measured preoperatively and at 1week, 1month and 3months postoperatively. Subfoveal choroidal thickness significantly increased over baseline thickness at 1week postoperatively, returned to preoperative levels at 1month and increased again at 3months. Changes at 1week and 3months postoperatively correlated to baseline choroidal thickness (p = 0.023 and p = 0.011, respectively). Spherical equivalent (SE) inversely correlated to SFCT throughout the entire follow-up period (baseline p = 0.044, 1-week p = 0.011, 1-month p = 0.013, 3-month p = 0.018). EPT was the most significant determinant of increased SFCT at all time points (1-week p = 0.011, 1-month p = 0.01, 3-month p = 0.015). PT and PP significantly correlated to the SFCT increase at 3months postoperatively (p = 0.033 and p = 0.043, respectively). OT was not associated with a change in SFCT at any time point (p > 0.05). Phacoemulsification can alter choroidal thickness until at least 3months after surgery. Preoperative and intraoperative factors, notably SE, baseline SFCT, PT, PP and especially EPT, can influence postoperative CT increase.

Outcomes of three-piece rigid scleral fixated intraocular lens implantation in subjects with deficient posterior capsule following complications in manual small incision cataract surgery

ObjectiveTo evaluate the surgical visual outcomes of three-piece rigid scleral fixated intraocular lens (SFIOL) implantation in subjects with deficient posterior capsule following complications of cataract extraction. DesignRetrospective 4-year cohort study. ParticipantsData from 174 eyes that underwent SFIOL combined with pars plana vitrectomy (PPV) between January 2018 and March 2022 and follow-up exams were included. MethodsDemographic characteristics including primary indications for surgery, history of trauma, laterality, baseline and best-corrected visual acuity (BCVA), refraction as spherical equivalent (SE), intraocular pressure (IOP), duration of follow-up, and complications were analyzed. ResultsThe mean preoperative BCVA was 1.38 ± 0.46 logarithm of the minimum angle of resolution (logMAR), which improved significantly to 0.37 ± 0.22 logMAR. The baseline refractive status measured in spherical equivalent (SE) was 4.1 ± 6.2 Diopters (D), and the postoperative status was −0.4 ± 0.97 D. Early postoperative complications included hypotony (n = 1; 0.57%, vitreous hemorrhage (n = 3; 1.72%), elevated IOP (n = 8; 4.59%), mild dilated pupil (n = 1; 0.57%) and corneal edema (n = 16; 9.19%). Late complications included in this study were retinal detachment (n = 1; 0.57%), cystoid macular edema (CME) (n = 1; 0.57%), primary glaucoma (n = 1; 0.57%), secondary glaucoma (n = 13; 7.47%), zonular dehiscence (n = 3; 1.72%), retinal pigment epithelium (RPE) changes (n = 3; 1.72%), choroidal coloboma (n = 2; 1.14%), posterior dislocation of posterior chamber IOL (PCIOL) (n = 1; 0.57%), corneal decompensation (n = 1; 0.57%), retinal hemorrhage (n = 1; 0.57%), macular hole (n = 1; 0.57%), chronic uveitis (n = 1; 0.57%), mild non-proliferative diabetic retinopathy (NPDR) (n = 3; 1.72%), and mild NPDR with diabetic macular edema (DME) (n = 1; 0.57%). ConclusionIntegrating IOL implantation with vitrectomy various posterior segment complications were resolved in the same setting without attempting a second surgery.

A new formula based on new parameters for predicting postoperative vault after posterior chamber intraocular lens implantation: a retrospective study.

To investigate the parameters influencing vault after posterior chamber intraocular lens implantation, thereby establishing a formula to predict the vault after operation. In this retrospective study, 61 patients (122 eyes) who underwent implantable collamer lens (ICL) implantation were enrolled consecutively from the Qingdao Eye Hospital of Shandong First Medical University, China, between August 2020 and October 2021. Comprehensive optometry, axial length, curvature, anterior chamber depth (ACD), lens thickness (LT), white-to-white distance (WTW), corneal thickness, sulcus-to-sulcus distance (STS), the distance between the sulcus-to-sulcus plane and the anterior crystalline lens surface (STSL), ciliary-to-ciliary distance (CTC) and the distance between the ciliary-to-ciliary plane and the anterior crystalline lens surface (CTCL) were recorded preoperatively. The vault was measured by ultrasound biomicroscopy at 1 month after operation. The correlation among vault, preoperative parameters and ICL size was analyzed. The accuracy and reliability of the prediction formula were verified by analyzing the postoperative correlation coefficient of actual and predicted vaults of the contralateral eye and through the Bland-Altman consistency test. Parameters significantly influencing the vault at 1 month after operation are ACD (r=0.260, P=0.004), LT (r=-0.338, P<0.001), WTW (r=0.240, P=0.03), STSL (r=-0.394, P<0.001), CTC (r=-0.199, P=0.03), CTCL (r=-0.328, P<0.001), ICL size (r=0.224, P=0.01) and ICL power (r=-0.231, P=0.01). The regression formula was as follows: vault (mm) = -2.179 - 0.227 * CTC (vertical) - 0.783 * CTCL (mean) + 0.472 * ICL size (fitting R=0.853, R2=0.727, adjusted R2=0.705). The predicted vault was 0.50±0.18 mm, and the actual vault was 0.56±0.24 mm. The Bland-Altman scatter plot showed a satisfactory agreement between actual and predicted vaults (-0.06 mm, 95% limits of agreement: -0.45 to 0.32 mm). ACD, LT, WTW, STSL, CTC, CTCL, ICL size and ICL power were the factors affecting vault after ICL implantation. The prediction formula with the new parameter CTCL was accurate and reliable.

Accuracy of an artificial intelligence-based mobile application for detecting cataracts: Results from a field study.

To assess the accuracy of e-Paarvai, an artificial intelligence-based smartphone application (app) that detects and grades cataracts using images taken with a smartphone by comparing with slit lamp-based diagnoses by trained ophthalmologists. In this prospective diagnostic study conducted between January and April 2022 at a large tertiary-care eye hospital in South India, two screeners were trained to use the app. Patients aged >40 years and with a best-corrected visual acuity <20/40 were recruited for the study. The app is intended to determine whether the eye has immature cataract, mature cataract, posterior chamber intra-ocular lens, or no cataract. The diagnosis of the app was compared with that of trained ophthalmologists based on slit-lamp examinations, the gold standard, and a receiver operating characteristic (ROC) curve was estimated. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed. The two screeners used the app to screen 2,619 eyes of 1,407 patients. In detecting cataracts, the app showed high sensitivity (96%) but low specificity (25%), an overall accuracy of 88%, a PPV of 92.3%, and an NPV of 57.8%. In terms of cataract grading, the accuracy of the app was high in detecting immature cataracts (1,875 eyes, 94.2%), but its accuracy was poor in detecting mature cataracts (73 eyes, 22%), posterior chamber intra-ocular lenses (55 eyes, 29.3%), and clear lenses (2 eyes, 2%). We found that the area under the curve in predicting ophthalmologists' cataract diagnosis could potentially be improved beyond the app's diagnosis based on using images only by incorporating information about patient sex and age (P < 0.0001) and best-corrected visual acuity (P < 0.0001). Although there is room for improvement, e-Paarvai app is a promising approach for diagnosing cataracts in difficult-to-reach populations. Integrating this with existing outreach programs can enhance the case detection rate.

Scleral flaps, pars plana vitrectomy and gore-tex sutured posterior chamber intraocular lens placement: a case series and review of literature.

Cataract surgery is one of the most common surgical procedures performed worldwide. Intraocular lens (IOL) implants are placed routinely in the capsular bag after successful cataract extraction. However, in the absence of adequate capsular support, IOL may be placed in the anterior chamber, fixated to the iris or fixated to the sclera. The purpose of this study is to report the clinical outcomes and safety profile of a trans-scleral sutured intraocular lens (IOL) technique using scleral flaps, vitrectomy, and Gore-Tex suture to place posterior chamber IOL. Retrospective, interventional case series of eyes undergoing scleral fixation of an IOL using Gore-Tex suture with concurrent vitrectomy. Ocular examination with the logarithm of the minimum angle of resolution visual acuity (logMAR BCVA), tonometry, and slit-lamp biomicroscopy was performed on all patients at 1, 3, 6, and 12 months after the operation. All post-operative complications were recorded. Twenty-five eyes of 25 patients were included. Mean logMAR BCVA improved from 0.43 ± 0.36 (20\40 Snellen equivalent) preoperatively to 0.13 ± 0.18 (20\25 Snellen equivalent) postoperatively at 12 months (p<0.01). Indications included surgical aphakia (16) and dislocated lens implant (9). No cases of IOL opacification, suprachoroidal haemorrhage, post-operative endophthalmitis, IOL dislocation, Gore-Tex exposure, or retinal detachment were observed during the follow-up period. Ab externo scleral fixation of IOLs with Gore-Tex suture plus scleral flap is well tolerated and associated with a very low rate of suture exposition. Moreover, our study confirms excellent refractive outcomes after surgery.

Quaternary Knot Technique: Suture Knot Burial without Scleral Flap or Incision for Trans-scleral Fixation.

Despite the introduction of novel sutureless posterior chamber intraocular lens (IOL) fixation techniques, some conditions still require suture-assisted scleral fixation. If the scleral fixation suture knot is left directly under the conjunctiva, it may become exposed, resulting in an increased risk of endophthalmitis. To avoid this problem, we offer a new alternative, simple, and safe way for burying the end of the suture using knots in this report.

HYPERACUTE CUTIBACTERIUM ACNES ENDOPHTHALMITIS AFTER CATARACT SURGERY.

Postoperative endophthalmitis is a relatively uncommon, but potentially visually devastating, complication associated with cataract surgery. Specific microbial causes of endophthalmitis are characteristically associated with particular disease time courses. Although Cutibacterium acnes is typically associated with an indolent course of inflammation, we report a case of C. acnes endophthalmitis with onset on postoperative day (POD) 1 and a positive culture from POD 2. This is a case report. A 56-year-old man underwent cataract extraction and posterior chamber intraocular lens placement in his left eye. On POD 1, he presented with severe discomfort, reduced visual acuity, and significant inflammation. On POD 2, his anterior chamber was tapped and injected with broad-spectrum antibiotics and steroids. The inflammation ultimately resolved, and his visual acuity improved to 20/20. C. acnes is a rare cause of hyperacute-onset postoperative endophthalmitis. Maintaining a high clinical suspicion and initiating prompt treatment can help to optimize long-term visual outcomes.

Intraocular pressure changes following small-incision cataract surgeries in a tertiary care center: a prospective study

Aim This study aims to identify the pattern of intraocular pressure (IOP) changes after uneventful small-incision cataract surgery (SICS) in previously normotensive eyes, to know the cause for these postoperative changes, and to correlate the preoperative anterior chamber depth (ACD) to the postoperative IOP change. Patients and methods A prospective study was conducted at Yenepoya Medical College, Mangalore, India on 87 non-glaucomatous eyes that underwent an uneventful SICS with posterior chamber intraocular lens implantation. The IOP was measured preoperatively and postoperatively on days 1, 3, and weeks 1, 3, and 6. We tried to identify the cause of the IOP change. The preoperative and postoperative ACD change was also noted and correlated with the IOP change. Results The mean preoperative IOP was 14±1.81 mm Hg. On the first postoperative day (POD-1), 54% of the eyes showed a statistically significant rise in IOP (mean IOP=17.03±7.17 mm Hg, P=0.0002), and 28% showed a mean fall in IOP of 9.28 mm Hg. On the third postoperative day (POD-3), the IOP showed a statistically significant rise (14.82±3.93 mm Hg, P=0.028) compared with the preoperative value. At the end of the first postoperative week (POW-1), the IOP showed a statistically nonsignificant rise (P=0.66). By the third postoperative week (POW-3), the IOP decreased to 13.82±2.83 mm Hg, with a statistically nonsignificant difference compared with the preoperative IOP (P=0.45). However, there was a statistically significant decrease in the IOP (P=0.0001) in the sixth postoperative week (POW-6). Postoperatively, there was a statistically significant increase in ACD from 3.01±0.31 to 3.23±0.36 mm (P=0.0001) by the POW-3. The preoperative ACD showed a statistically significant moderate negative correlation with late postoperative IOP (r=−0.7394, P&lt;0.0001). Conclusion After SICS, at the end of 6 weeks, there was a statistically significant decrease in the mean IOP with an increase in the ACD. A moderate negative correlation existed between the preoperative ACD and late postoperative IOP. It was found that 2.3% of the eyes were steroid responders and showed a rise in IOP at POW-3.

Use of RGP lens as Temporary Keratoprosthesis in Open-Sky Technique for Heterotopic Autokeratoplasty

PURPOSE To present a case of a combined procedure of heterotopic autokeratoplasty and ECCE with posterior chamber intraocular lens (IOL) implantation, and to demonstrate the novel use of an RGP lens as a safe, cost-effective alternative to temporary keratoprosthesis. REPORT OF CASE A 65/F presented with blindness, OS from glaucoma but with a clear cornea, and corneal decompensation with cataract in OD with good visual potential. Heterotopic autokeratoplasty was performed due to the scarcity of corneal allografts and the high-risk nature of the case, with ECCE and IOL implantation in OD due to lens opacity. Temporary keratoprosthesis (TKP) (such as Eckardt and Landers models) was substituted with RGP due to lower cost and accessibility. Pre-placement of two polyglactin perpendicular mattress sutures in the episclera at the horizontal and vertical positions was done and left untied. Next, left corneal trephination was performed using an 8-mm vacuum trephine, followed by the instillation of oculoviscosurgical device (OVD) and placement of a 10-mm diameter RGP lens over the left open globe, secured in place by tying the pre-placed overlying cross sutures. Then, right corneal trephination using a similar-sized trephine proceeded. Cataract was extracted in open-sky technique with IOL in the bag implantation. The clear left corneal button was then transplanted to OD and vice-versa. Postoperatively, VA improved from hand motions to 10/200 (Day 1). The graft remained clear 4 weeks post-op with further improvement in VA. IOP was maintained below 15 mmHg. CONCLUSION Heterotopic autokeratoplasty is a valid option for unilateral cornea blind patients who have clear corneas in the fellow eye with no visual potential. This is useful in countries where corneal transplantation is costly, especially during time of pandemic when corneal allografts are scarce. In our experience, it can be safely performed using an RGP lens as a safe and cost-effective alternative to temporary keratoprosthesis.

Commentary: Innovation is the key to manage complications in rare ocular conditions like spherophakia.

Spherophakia is a rare diagnosis that is characterized by weak zonules encircling a more spherical, smaller, and thicker anteroposterior crystalline lens.[1] The eye is usually severely myopic. The lens zonules are abnormally weak and hypoplastic during development. It frequently coexists with lenticular myopia, lens subluxation, angle-closure glaucoma, and a shallow anterior chamber.[1] The crystalline lens in this situation has an increased anterior–posterior diameter and a smaller equatorial diameter.[2] Lens subluxation can cause pupillary block glaucoma[3] and can happen anteriorly, inferiorly, or posteriorly.[4] The indication of undergoing a lensectomy has already been mentioned for treating a displaced lens.[5] The surgeon and the patient’s characteristics play a significant role in the intraocular lens (IOL) selection. Both iris-fixated lenses[6] and angle-supported anterior chamber lenses (ACIOLs) are frequently used. Numerous case studies have also discussed posterior chamber IOLs (PCIOLs) and scleral-fixated IOLs (SFIOLs) – glued or sutured with/without capsule tension rings (CTR).[7,8] In 2008, Agarwal et al.[9] introduced the glued IOL technique, which was glued intrascleral haptic fixation of a PCIOL. Zonular weakness is frequently linked to ectopia lentis, congenital cataract with luxation, or traumatic cataract. A PCIOL (foldable or nonfoldable) is implanted in the eyes with a defective posterior capsule using a quick-acting surgical fibrin sealant. Glued IOL in various indications has shown very promising results. In nearly half of the cases of spherophakia, it is accompanied with subsequent glaucoma.[10] When the intraocular pressure (IOP) is uncontrolled, there is disagreement over the treatment to manage these eyes. Based on our previous experience and various studies, lens removal alone appears to help with IOP management in around 50% of the eyes, with the remainder perhaps handled with additional drugs. Glaucoma surgery is seldom required for IOP management.[11] Lensectomy, vitrectomy, and glued IOL have been done in eyes with spherophakia and secondary glaucoma in the current investigation. The findings of these procedures seem to be favorable in terms of the procedure’s safety and effectiveness. In one-third of the eyes, the IOP was managed without the use of Anti-Glaucoma Medications (AGM); the remaining eyes required AGM for IOP management. Lensectomy with glued IOL resulted in significant improvement in visual acuity and correction of refractive error to almost emmetropia in a majority of the eyes. Other factors associated with poor glaucoma control were also evaluated. Preoperative AGM, male gender, and low preoperative visual acuity were shown to be related to poor glaucoma management and the requirement for AGM or surgery to reduce IOP. Rao et al.[11] previously showed that younger age at presentation, higher IOP, and more disk injury at presentation were all substantially linked with increased failure after lensectomy. Muralidhar et al.[5] did report that lensectomy did not have any impact on IOP. Lensectomy was performed in 16 eyes in their study, but only four eyes had raised IOP before lensectomy. Hence, from four eyes, one cannot interpret that lensectomy is not effective in controlling IOP. In a study by Rao et al.,[11] following lensectomy, close to half of the patients had IOP control without AGM, while only one-third of the patients in this glued IOL cohort could achieve the same. The percentage of eyes needing surgical intervention for IOP control was similar (16%) either with lensectomy or with lensectomy with glued IOL surgery in eyes with spherophakia and secondary glaucoma. To the best of our knowledge, this was the first study to report on the results of lensectomy with glued IOL in spherophakia and glaucoma eyes.[12] Overall, IOP was managed well in 30% of the eyes after lensectomy and glued IOL without the need for AGM, 65% of the eyes required AGM for IOP management, and only 5% of the eyes required glaucoma surgery. The study’s shortcomings include a small sample size and a short postoperative follow-up period. The benefits of conducting lensectomy with glued IOL in eyes with spherophakia include not only improved IOP management, but also improved uncorrected and corrected visual acuity. There were no intraoperative or postoperative complications in this sample, indicating that the technique is safe. The authors would like to advocate lensectomy with glued IOL in spherophakic eyes with subluxated crystalline lens and increased IOP in the absence of syndromic disease due to these benefits and the shorter learning curve.[12] However, these individuals require regular monitoring of IOP; one-third of the eyes had well-controlled IOP, and almost two thirds required further antiglaucoma drugs or surgery for IOP management. Because this is a recent surgery, long-term results and complications must be investigated to determine the technique’s long-term effectiveness and safety.

Scleral Suture Fixation of Dislocated Posterior Chamber Intraocular Lens: Modification for Tapered Haptics.

To present a surgical modification to a previously published technique that allows repositioning and scleral fixation of one-piece acrylic intraocular lenses with tapered haptics. A retrospective review of three consecutive cases. Our technique modification enables repositioning using scleral suture fixation of one-piece intraocular lenses with tapered haptics by looping the haptic at its proximal, notched junction to the optic with the polypropylene suture. The suture knot is internalized which effectively suspends the intraocular lens and allows for better adjustment of the intraocular lens centration. Two cases were endocapsular dislocations; the third case was dislocated extracapsularly due through a posterior capsule rupture. All showed adequate lens centration at 3 months of follow-up. One case had suffered a vitreous hemorrhage a month postoperatively that is clearing. Repositioning using scleral fixation of one-piece intraocular lenses with tapered haptics is possible with a minor technique modification. This offers an alternative to intraocular lens exchange.