Posterior Chamber Intraocular Lens Research Articles

Clinical Outcomes of Transscleral-Sutured Intraocular Lens Combined With Descemet Membrane Endothelial Keratoplasty.

The aim of the study was to report clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) combined with transscleral-sutured intraocular lens (IOL) compared with DMEK combined with phacoemulsification and posterior chamber IOL (Phaco-DMEK). A retrospective chart review of all patients who underwent DMEK combined with transscleral-sutured intraocular lens fixation or combined with phacoemulsification for Fuchs endothelial corneal dystrophy from 2016 to 2021 at the Toronto Western Hospital or the Kensington Eye Institute (Toronto, ON, Canada) and had at least 18 months of follow-up was performed. Main outcomes were postoperative distance-corrected visual acuity, rebubbling rate, graft survival rate, and complications. Twenty-one cases of DMEK combined with transscleral-sutured IOL (DMEK-TSS-IOL) and 44 cases of Phaco-DMEK were evaluated. Twelve eyes (57.15%) had a foldable acrylic 3-piece IOL (AR40E) and 9 (42.85%) had a single-piece polymethylmethacrylate (PMMA) IOL (CZ70BD). LogMAR distance-corrected visual acuity improved significantly from 1.48 ± 0.62 (SD) to 0.86 ± 0.82 (P = 0.01) 12 months after DMEK-TSS-IOL and from 0.41 ± 0.29 logMAR to 0.11 ± 0.11 logMAR (P < 0.0001) after Phaco-DMEK. No statistically significant differences were observed in donor (P = 0.97) or 1-year postoperative endothelial cell density (P = 0.11) between the groups. Rebubbling was necessary in 33.33% of eyes in DMEK-TSS-IOL compared with 25% of Phaco-DMEK eyes (P = 0.55). Graft survival rate was 76.19% in the DMEK-TSS-IOL group compared with 90.90% in the Phaco-DMEK group (P = 0.13). Transscleral-sutured IOL combined with DMEK is an option for the management of endothelial diseases in aphakic eyes or those which require IOL exchange for the experienced surgeon. However, when compared with routine Phaco-DMEK, there are higher complication and lower survival rates at 18 months.

Efficacy of scleral-fixated 3-looped haptics intraocular lens implantation for surgical management of microspherophakia.

To evaluate the safety and efficacy of scleral-fixated 3-looped haptics intraocular lens (IOL) implantation for surgical management of microspherophakia. A retrospective case series include 10 microspherophakic patients (15 eyes) who underwent lens removal plus a modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation. The primary outcomes involved visual acuity, intraocular pressure (IOP). Secondary outcomes were spherical equivalent (SE), anterior chamber depth (ACD), corneal endothelial cell density and postoperative complications. After a postoperative follow-up of 17.60±15.44mo, improved visual outcomes can be observed. The uncorrected distance visual acuity (UCVA) logMAR improved from 1.54±0.59 preoperatively to 0.51±0.35 postoperatively (P=0.001), and best corrected visual acuity (BCVA) logMAR improved from 0.97±0.91 preoperatively to 0.24±0.23 postoperatively (P=0.003). Moreover, the SE decreased from -9.58±7.47D preoperatively to -0.65±2.21 D postoperatively (P<0.001). In terms of safety profile, the average IOP decreased from 21.10±12.94 mm Hg preoperatively to 14.03±3.57 mm Hg postoperatively (P=0.044), and the previously elevated IOP of three eyes decreased to the normal range. The ACD increased from 2.25±1.45 mm preoperatively to 3.35±0.39 mm postoperatively (P=0.017). The density of corneal endothelial cells did not change significantly after surgery (P=0.140). The posterior chamber IOLs were well centered and no severe complications were found. Lens removal plus the modified surgical treatment of scleral-fixated 3-looped haptics IOL implantation can help in improvement of visual acuity, which can be regarded as a relative safe method for the surgical management of microspherophakia.

History of diagnosis and treatment of cystoid macular edema

AbstractFollowing the introduction of the ophthalmoscope by Helmholtz in 1851, very early descriptions of macular edema were reported by Jaeger in 1856 and Nettleship in 1872. Macular disease following cataract surgery was described by Hruby in 1950, Irvine in 1953, Chandler in 1954, Nicholls in 1954, and Maumenee in 1957, among others. The introduction of fluorescein angiography by Novotny and Alvis in 1961, with subsequent modifications by David, Sever and Justice, greatly facilitated the diagnosis of this condition. Using fluorescein angiography, Gass and Norton reported 44 patients with “cystoid macular edema” (CME) in 1966, which appears to be the first use of this term. The eponym “Irvine‐Gass syndrome” appears to have been published first in 1971. In 1991, Puliafito and colleagues reported the first use of optical coherence tomography, and published one case of postoperative CME in 1995.Treatments for CME developed as the pathophysiology became better understood. Early reported treatments included oral vasodilators (Laws, 1964), oral prednisone (Gehring, 1968), and pulsed ruby photocoagulation (Zweng and colleagues, 1968). Alternatively, other investigators recommended observation for at least 12 months, including Gass and Norton in 1969 and Jacobson and Dellaporta in 1974. Miyake reported good results with topical indomethacin prophylaxis in 1977; other investigators subsequently reported benefit with topical or oral indomethacin, including Yannuzzi and colleagues in 1979 and Kraff and colleagues in 1982. Various surgical factors, including posterior (rather than anterior) chamber intraocular lenses, were found to be beneficial during the 1980s. Multiple topical medications, including prednisolone acetate, flurbiprofen, ketorolac, diclofenac, and others, were investigated in the 1990s and 2000s. Gaudric and colleagues published treatment of CME with intravitreal triamcinolone acetonide in 2003.At the present time, the use of topical corticosteroids and nonsteroidal anti‐inflammatory agents is widely used in the prophylaxis and treatment of CME, but there is relatively little evidence from randomized clinical trials to support this practice. In both the US and Europe, no agent has achieved regulatory approval for the treatment of postoperative CME; all agents are used “off‐label”.

Three-piece intraocular lens in the sulcus with optic capture in patients with mild to moderate zonular weakness in exfoliation.

To study the use of sulcus placement of a 3-piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3-piece IOL implanted in the sulcus with optic capture over a 5-year period between January 2017 and January 2022 were included in this retrospective case series. The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil-expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of "in the bag" posterior chamber IOL or major complications. There was a significant improvement in visual acuity. The sulcus placement of 3-piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of "in the bag" IOL.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia.

This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA-assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal Ⅱ and Hill-RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Sixty-five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal Ⅱ (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill-RBF > Haigis > SRK/T > Barrett Universal Ⅱ). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill-RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal Ⅱ (53.84%). IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal Ⅱ although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift.

Accuracy of newer generation intraocular lens power calculation formulas in pediatric cataract patients.

To evaluate the accuracy of newer generation intraocular lens (IOL) power calculation formulas (EVO 2.0 and Kane) with established formulas (Barrett Universal II, Haigis and SRK/T) in pediatric cataract patients. Retrospective study. We enrolled 110 eyes (110 patients) in Eye Hospital of Wenzhou Medical University. All patients underwent uneventful cataract surgery and implanted with posterior chamber IOL in the bag. We calculate the mean prediction errors (PE) and percentage within 1 diopter (D) at 1month to assess the accuracy, and percentage > 2D was defined as prediction accident. Then, we performed subgroup analysis according to age and axial length (AL). The mean age and AL were 37.45 ± 23.28months and 21.16 ± 1.29mm. The mean PE for all patients was as follows: Barrett (- 0.30), EVO (0.18), Haigis (- 0.74), Kane (- 0.36), and SRK/T (0.58), p < 0.001. In addition, EVO and SRK/T formulas were relatively accurate in patients younger than 24months and with AL ≤ 21mm, while EVO got lower prediction accident rate than SRK/T (3/41 vs 8/41, 4/52 vs 5/52). Moreover, Barrett, EVO, and Kane formulas achieved better accuracy and lower prediction accident rate in patients older than 24months and with AL > 21mm (both > 51/69 and 43/58, and < 3/69 and 3/58). In patients older than 24months and with AL > 21mm, Barrett, EVO, and Kane formulas were relatively accurate, while in patients younger than 24months and with AL ≤ 21mm, EVO was more accurate, followed by SRK/T formula.

CASE PRESENTATION: BILATERAL ANTERIOR POSTERIOR LENTICONUS

Aim: To report a case of bilateral anterior and posterior Lenticonus without sensorineural hearing loss, without renal associations. Case report We describe a case of bilateral anterior and posterior Lenticonus and absence of family history. No renal association could be identied on urine routine microscopy and ultrasonography of the abdomen. Clear lens extraction with phacoemulsication with posterior chamber Intraocular lens (PCIOL) was performed for the patient. Conclusion The presence of bilateral anterior and posterior Lenticonus is rare but may be a presentation of Alport syndrome. Clear lens extraction with Intraocular lens is a viable treatment option with good visual prognosis.

Application of the three-step method of mydriasis with prone position followed by anterior chamber paracentesis in post-vitrectomy vitreous hemorrhage.

Application of the three-step method of mydriasis with prone position followed by anterior chamber paracentesis in post-vitrectomy vitreous hemorrhage.

Management and Complications of Dexamethasone Intravitreal Implant Migration Into the Anterior Chamber.

To report patient demographics, the clinical course, and visual outcomes across a case series of patients who experienced dexamethasone (DEX) intravitreal implant (Ozurdex, Allergan, Inc) migration into the anterior chamber (AC), with a focus on the corneal transplantation rate. In this retrospective cross-sectional study, a chart review of all cases was performed. For numerical responses, means and SDs were calculated. Percentages and absolute numbers were used to report the proportion of patients who experienced various outcomes of interest. The study comprised 32 cases. All cases occurred in pseudophakic eyes; of those, 8 (25.0%) had posterior chamber intraocular lenses in the capsular bag with no known capsular or zonular issues. The mean duration from DEX implant injection to detection of migration was 19.4 ± 14.5 days. The DEX implant was explanted in 21 patients (65.6%) and repositioned in the vitreous cavity or subconjunctival space in 6 patients (18.8%). Twelve patients (37.5%) ultimately required corneal transplantation. To our knowledge, this is the largest case series of DEX intravitreal implant migration into the AC compiled to date. Cases of migration occurred in individuals with no known history of significant prior zonule disruption. This potential complication should be discussed with all patients undergoing DEX implant injection, which may aid in earlier presentation and improved visual outcomes.

Comparative study to assess the effect of ropivacaine and a mixture of lidocaine and bupivacaine on intraocular pressure after peribulbar anesthesia for cataract surgery.

To compare the efficacy of ropivacaine with a mixture of lidocaine and bupivacaine in peribulbar anesthesia for cataract surgery, in terms of post-block intraocular pressure (IOP). A one-year comparative study was done to compare two anesthetic solutions in peribulbar anesthesia for cataract surgery, from January 2020 to December 2020 at a tertiary health care hospital. Two hundred patients (40-70 years of age) planned for small-incision cataract surgery with posterior chamber intraocular lens (IOL) implantation under peribulbar anesthesia were included in the study. A single-site inferotemporal injection was given till a total eyelid drop was observed. The IOP was measured at four time-points: before block (control), 1-, 5-, and 15-minute post-block with a tonometer. The 1-minute post-block mean IOP in both the groups was higher than the baseline levels. This reflected raised intraorbital pressure secondary to peribulbar injection of local anesthetic. However, the rise in 1-minute post-block IOP was significantly less in the ropivacaine group. The 5- and 15-min post-block mean IOP values in the ropivacaine group were significantly lower than the corresponding values of the lidocaine-bupivacaine group and baseline (control) ropivacaine values. The results of this study support that ropivacaine as a local anesthetic drug for peribulbar block for small-incision cataract surgery can be a suitable alternative to the lidocaine-bupivacaine combination. Studies involving a larger sample size are required to consider ropivacaine as a superior drug to the lidocaine-bupivacaine combination.

Corneal endothelial protection during manual small-incision cataract surgery: A narrative review.

Cataract causes bilateral blindness in 20 million people globally, the vast majority of whom live in developing countries. Manual small-incision cataract surgery (MSICS) has emerged as an efficient and economical alternative to phacoemulsification, giving comparable results in terms of final visual gain. One of the important determinants of postoperative visual gain is the status of the corneal endothelium. Multiple factors such as corneal distortion, irrigation solution turbulence, mechanical trauma by instruments, nuclear fragments, intraocular lens contact, and free oxygen radicals, all have been implicated in causing corneal damage during cataract surgery. MSICS with posterior chamber intraocular lens implantation has been reported to cause an endothelial cell loss of 15.83%, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification. Thorough preoperative assessment of endothelial status and taking necessary steps for endothelial protection during surgery can decrease the endothelial cell loss and overall burden of pseudophakic bullous keratopathy. In addition to surgical techniques, the type of irrigating solutions, ocular viscoelastic devices, intracameral dyes, and drugs all affect the endothelial cell status. This review presents a summary of available literature on the protection of endothelial cells during different steps of MSICS. This is especially relevant for developing countries where large-scale MSICS cataract surgeries are performed to decrease the cataract blindness burden.

Outcomes of very delayed onset chronic postoperative endophthalmitis caused by Cutibacterium acnes including treatment with endolaser photocoagulation

Introduction: To the authors' knowledge, these are 2 of the longest reported time periods between cataract surgery and diagnosis of chronic postoperative endophthalmitis. The clinical course and outcomes are discussed. Patient and Clinical Findings: 2 patients underwent uneventful cataract surgery and presented with recurrent anterior segment inflammation years after the surgery. In the first case, an 88-year-old man presented with granulomatous uveitis in the left eye 4 years after intracapsular cataract extraction and posterior chamber intraocular lens (CE/PC IOL) placement. In the second case, a 79-year-old woman presented with iritis 7 years after CE/PC IOL. Diagnosis, Intervention, and Outcomes: Both patients were treated for presumed idiopathic uveitis for years before the diagnosis of chronic endophthalmitis caused by Cutibacterium acnes. 1 case required endolaser photocoagulation to an infectious nidus. Conclusions: Chronic postoperative endophthalmitis can present many years after uneventful cataract surgery.

Comparative evaluation of the results of phacoemulsification using domestic and foreign viscoelastics

BACKGROUND: Phacoemulsification, being the safest technique, is the golden standard of cataract surgery worldwide. However, as any surgery, it is accompanied by inevitable damage to intraocular structures. The most prevalent among them is the loss of corneal endothelial cells. In order to prevent these complications, various viscoelastics with particular features and characteristics are widely used.&#x0D; AIM: To compare the anatomical and functional state of ocular structures after standard phacoemulsification with monofocal posterior chamber intraocular lens (IOL) implantation using domestic (Kogevisc and Adgevisc) and foreign (Viscoat and Amvisc Plus) viscoelastics.&#x0D; MATERIALS AND METHODS: 60 cataract patients (60 eyes) were included in the clinical study, which were divided into two equal groups. In the first group (30 patients, 30 eyes), Adgevisc and Kogevisc (Solofarm, Russia) were used during the procedure. The mean age of the patients was 66 11 years. In the second group (30 patients, 30 eyes), Viscoat (Alcon) and Amvisc Plus (BauschLomb) were used. The mean age of the patients was 69.03 10.44 years. All patients underwent phacoemulsification with the implantation of the AcrySof IOL (model SA60AT, Alcon) according to the standard technique. Visual acuity, IOP level, CCT, corneal endothelial cell density were assessed. All studies were performed before surgery, the next day, 7 days and 1 month after surgery.&#x0D; RESULTS: In patients of the second group, on the 1st (p 0.05) and 7th day (p 0.01) after surgery, a statistically significant increase in IOP was revealed compared to the first group. The central cornea thickness in the early postoperative period was higher in patients of the second group, however, it was not statistically significant. The loss of corneal endothelial cells 1 month after surgery was 8.5 7.0% (p 0.01) in the first group and 6.6 6.4% in the second group (p 0.01). The mean value of endothelial cell loss in patients of the first group was higher, however, it was not statistically significant. The best corrected visual acuity in both groups at all stages of follow-up after surgery (days 1, 7 and 30) was comparable, there was no significant difference between the groups.&#x0D; CONCLUSIONS: The clinical efficacy of domestic adhesive and cohesive viscoelastics Adgevisc and Kogevisc (Solofarm, Russia) in phacoemulsification using the soft-shell technique is comparable to the foreign analogues Viscoat (Alcon) and Amvisc Plus (Bausch Lomb), which is confirmed by the absence of statistically significant differences in the studied parameters of the postoperative state of ocular structures and explained by their similar composition, molecular weight and viscosity.

Intrascleral anchoring knot on the double suture without peritomy for fixation of intraocular lens.

A new minimally invasive technique for universal fixation of any posterior chamber intraocular lens (IOL), iris prosthesis or capsular tension device (CTD), both for rescuing in case of dislocation and for secondary implantation, is described. It uses intrascleral anchoring knot on the reinforced double 9-0 polypropylene suture without conjunctival opening or scleral dissection. The technique was applied for scleral fixation of the S-shaped monoblock acrylic IOL dislocated into the vitreous cavity in 1 eye, and decentered IOL-CTD-capsular bag complexes in 3 eyes. In none of the cases, complications including knot slippage, suture exposure or hypotony were observed. All patients were followed up for 6 months. The uncorrected distance visual acuity was significantly improved and the IOLs positions remained stable. The described technique might be a simple, effective and safe alternative to flanged scleral fixation approaches.

Outcome of Therapeutic Penetrating Keratoplasty in R.M. Kedia Eye hospital - A Retrospective Study

Infectious keratitis is the major cause of vision threatening condition and the leading cause of corneal blindness in developing countries. Therapeutic keratoplasty is the procedure for terminating or improving an actively infectious corneal disease. This study was carried out to determine the outcome of therapeutic keratoplasty for infective keratitis at R.M. Kedia eye hospital. This was retrospective study where all cases that underwent TPK for active infective keratitis from May 2019 to April 2020 were included in the study. Data were collected about demographic parameters, indication for surgery, details of donor tissue in terms of donor size, graft size and endothelial density. The outcome of TPK was measured in terms of anatomic stability, eradication of disease, graft clarity and development of cataract and glaucoma. 30 eyes of 30 patients underwent TPK for infective keratitis. 73.3% were male. Average age of the patients was 42. In 60% of patients organisms were isolated as follows: 11 cases of fungus, 3 cases of bacteria and 4 cases of mixed bacteria and fungus. Two surgeries (6.6%) were combined with extracapsular cataract extraction without posterior chamber intraocular lens. The eradication of infection after primary TPK was 23 (76.8%). Twelve eyes (40%) had documentation of variable grades of cataract. One case had secondary glaucoma. Six cases (20%) had graft failure. Therapeutic keratoplasty is the procedure for terminating or improving an actively infectious corneal disease. It helps to save the eye and preserve vision in severe infective keratitis. There is a high incidence of postoperative glaucoma, cataract, and graft failure in such a surgery.

Intraocular lens dislocation: manifestation, ocular and systemic risk factors

PurposeThe aim of this study was to evaluate ocular and systemic risk factors for posterior chamber intraocular lens dislocation, as well as forms of manifestation.MethodsA retrospective case–control study were all patients presented in the period 2012–2016 having intraocular lens dislocation and being treated with implantation of an iris-fixated intraocular lens was conducted at the University Hospital Mainz. As controls, pseudophakic patients presenting for other reasons were included.Results150 eyes of 150 patients (mean age 72.7 ± 12.4 years, range 24–93 years) with IOL dislocation and 150 eyes of 103 controls were included in this study. The average time between primary implantation and IOL luxation was 86 months (iQR: 39.25–127 months) for all dislocations. Previous pars plana vitrectomy (PPV) (crudeOR = 2.14 (95% CI 1.23, 3.72), p = 0.011) and PEX (crudeOR = 11.6 (4.79, 28.12), p < 0.001) was linked with a higher risk of IOL luxation. Luxation occurs also earlier in patients with previous PPV and PEX than in eyes with neither PEX nor previous PPV (82.2 vs. 127 months). Rhegmatogenous retinal detachment was the major pathology that required a previous PPV for eyes with an IOL dislocation (57%). The average time between PPV and IOL dislocation was 74.67 months (range 0–186 months).ConclusionPatients with a coexistence of both: PEX and a previous PPV had an elevated risk of IOL dislocation, and also had a shorter time interval between primary IOL implantation and IOL dislocation followed by eyes with PEX only and eyes with only a previous PPV.

Study of endothelial cell loss in small incision cataract surgery (SICS)

Purpose: To evaluate the density of the central corneal endothelial cell before and after a small incision cataract surgery with posterior chamber intraocular lens implantation and also determine the association between endothelial cell loss and post-operative visual acuity. Methods: A total of 205 eyes of 205 patients undergoing SICS were included in surgery. Patients underwent complete ophthalmic evaluation and endothelial cell density was measured with TOPCON SP1P specular microscope preoperatively and postoperatively day 7 and at 1 month. Results: The majority of the patients were in the age group 61-70 years. The mean endothelial cell count pre operatively was 2689.65 cells/mm2, post operatively on 7th day 2433.27 cells/mm2 and at 1 month was 2367.01 cells/ mm2. At 1 month postoperative mean visual acuity between 20/30-20/70. Conclusion: There is 11.21% endothelial cell count after SICS, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification.

Pseudophakic pupillary block after phacoemulsification and posterior chamber intraocular lens implantation: Cause identification and treatment refinement

BackgroundPseudophakic pupillary block (PPB) was rare in patients who undergo phacoemulsification and posterior chamber intraocular lens (PCIOL) implantation. Laser peripheral iridotomy was the most reported but ineffective treatment in the literature. MethodsRetrospective, interventional case series of patients who developed PPB in Taipei Veterans General Hospital from 2017 to 2021. Clinical course, diagnostic methods, treatment and outcomes were recorded and discussed. ResultsFour eyes of three patients were documented. All of them had diabetes and diabetic retinopathy. Anterior segment Optical coherence tomography (OCT) of these patients showed an exudative membrane at the peripapillary area while slit lamp image could not provide a clear view due to the severely edematous corneal condition. Laser peripheral iridotomy and yttrium aluminum garnet (YAG) laser aiming to the peripapillary exudation were applied to break the PPB successfully. ConclusionDiabetes mellitus, intravitreal injection and inflammation are crucial risk factors for PPB. Anterior segment OCT can be a useful diagnostic tool for the detection of the peripapillary exudative membrane while corneal clarity is compromised due to high intraocular pressure. In addition to peripheral laser iridotomy, an effective approach to resolve PPB may be the use of the YAG laser to break the exudative membrane.

Clear Lens Protection with a Phakic Posterior Chamber IOL During Iridoplasty

A 20-year-old man with a light-blue iris presented himself with fixed unilateral mydriasis, clear lens, a small inferior zonular dialysis, normal intraocular pressure (IOP), an uncorrected vision of 0.0 LogMAR, and retained accommodation. An assault 6 months before was reported. He asked for mydriasis reversal to decrease photophobia and to improve cosmesis. He wanted to avoid lens removal. We planned an encircling iris suture, and for protection a temporary implantation of a myopic phakic posterior chamber intraocular lens (Visian ICL), that results thicker in the foreseen working zone.

Intraocular foreign body during cataract surgery

Introduction: A large foreign body entered the anterior chamber through the infusion tubing during phacoemulsification. Patient and Clinical Findings: A 70-year-old woman presented for routine cataract extraction with implantation of a posterior chamber intraocular lens. During the phacoemulsification, a white fleck was captured on video entering the eye through the infusion tubing. Diagnosis, Intervention, and Outcomes: The fleck was removed immediately with a forceps through the main incision, and the surgery was completed. The fragment was preserved and sent for analysis. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were used to determine its composition. Conclusions: The origin of the fragment was consistent with the spike used to pierce the bag containing the balanced salt solution.