Posterior Chamber Intraocular Lens Research Articles

A Glistening Intraocular Lens: A Case Report

Introduction Cataract surgery with a posterior chamber intraocular lens (PCIOL) is one of the most performed surgeries in North America. A common complication of cataract surgery is the development of post-surgical opacities on the posterior lens capsule, known as posterior capsule opacification (PCO). When visually significant, PCO is treated with a YAG laser. Less commonly however, opacities can form within the lens implant itself known as lens glistening. Case Presentation An 86-year-old male patient with a history of macular retinoschisis and vitreoretinal traction in both eyes presented to the eye clinic with complaints of visual disturbance in the left eye over the course of 4 months. Clinical examination and diagnostic testing revealed stable retinal disease with new findings of PCIOLs with lens glistening, left eye greater than right eye. The patient was referred to the cataract surgeon and the decision was made to manage the lens glistening conservatively. Discussion Lens glistening can be managed with observation or intraocular lens (IOL) exchange depending on its impact on the patient’s quality of life or the degree to which the opacities preclude examination of the fundus.

Comparison of Hill-RBF 3.0 with Barrett Universal II, SRK/T, Hoffer Q, Haigis, and Holladay 1 to predict the accuracy of post-cataract surgery refractive outcomes in Indian eyes.

To compare Hill-RBF 3.0 with Barrett Universal II (BU II), SRK/T, Hoffer Q, Haigis, and Holladay 1 in predicting the accuracy of post-cataract surgery refractive outcomes in Indian eyes. In this prospective, comparative, observational study, consecutive patients with uncomplicated age-related cataracts undergoing uneventful phacoemulsification with posterior chamber intraocular lens (IOL) implantation were included. The mean absolute errors (MAEs) and median absolute errors were used to determine the accuracy of predicted postoperative target refractions. A total of 219 eyes of 173 patients were enrolled. Based on the axial lengths (AL), the patients were classified into: AL <22 mm (short), 22-24.5 mm (normal), and >24.5 mm (long). BU II exhibited the lowest MAE for normal ALs (0.2683 ± 0.2790 D) as well as for the entire population (0.2764 ± 0.2764 D). For the short ALs, Hill RBF 3.0 exhibited the lowest MAE (0.3268 ± 0.3268 D), while for the long ALs, SRK/T showed the lowest MAE (0.2823 ± 0.2642 D). BU II exhibited the highest percentage of eyes of 57.5%, 95.4%, and 98.6% within ±0.25, ±0.75, and ±1.0 D of postoperative target refractions respectively, whereas Hill RBF 3.0 had the highest percentages of eyes (88.1%) within ±0.5 D of postoperative target refraction. Hill-RBF 3.0 exhibited the least MAE for patients with short ALs, while BU II showed the least MAE for normal ALs as well as for the entire population and SRK/T for long ALs. This study is likely to aid surgeons in selecting the most appropriate IOL power formula, which thereby improves the refractive outcomes with utmost accuracy.

Visual outcome of cataract surgery in paediatric uveitis

1. To analyse the visual outcome in patients of paediatric uveitis who underwent cataract surgery; 2. To analyse the post-operative complications of cataract surgery in paediatric uveitis.Retrospective observational study was done on patients of uveitis who underwent cataract surgery. Patients who were under 18 years and co-operative for examination were included.They underwent Phacoaspiration with posterior chamber IOL implantation by a single surgeon after 3 months of activity free interval, BCVA(in Log MAR) in every follow up, anterior segment examination using slit lamp and posterior segment examination using IDO, post-operative complications and Intra ocular pressure was recorded using Noncontact tonometer.Uveitis was classified using the SUN classification of uveitis. Use of corticosteroids, biologics and immunosuppressive drug were collected at each visit. Total of 18 subjects diagnosed with cataract as a complication of uveitis &amp; undergone cataract surgery were studied (6 were females, 12 were males) 9 had anterior uveitis, 1had intermediate uveitis and 5 had pan uveitis. JRA (66.7%) was the most common cause identified. Improvement in vision from baseline was observed post-surgery at the end of first, third and 6th month which was statistically significant (P- Value &amp;#60;0.05). Average duration of disease before they underwent surgery was 18 months. Most common post op complication was posterior capsular opacification (50 %), others include secondary glaucoma (38.9), exudative retinal detachment (5.6%) and Vitritis (22.2%)Unlike adult uveitic patients, the surgical management of paediatric uveitic cataract is both challenging and controversial, and the surgery itself has been associated with poor visual outcomes. However, our study had shown that with implantation of IOL, good immunosuppressants and control of the disease can give these children a good visual outcome.

A novel custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses

PURPOSE: To describe a custom bent 27G needle-guided suture snare technique for scleral fixation of posterior chamber intraocular lenses (PCIOL). METHODS: An 8-0 polypropylene suture was threaded into the lumen of a custom bent 27G needle, and the needle tip was advanced into the eye from the IOL fixation point. The suture was threaded through the posterior limbal incision inside the IOL haptic loop and pulled out. The needle tip was advanced into the eye again, going around the IOL haptic loop through the same limbal incision. The suture was threaded in again, and the needle was withdrawn from the eye, completing fixation of the IOL haptic loop. The suture knot was buried in the stroma of the sclera. RESULTS: The technique was performed in 10 eyes of 10 patients, with a preoperative logarithm of the minimum resolution angle corrected visual acuity of 0.73 ± 0.55 (Snellen 20/107), improvement of 0.24 ± 0.27 (Snellen 20/35) at the final follow-up visit, and a mean postoperative PCIOL tilt of 2.78 ± 1.32°. There were no cases of pupillary capture or suture-related complications during follow-up. CONCLUSION: The curved needle-guided suture snare technique provides a simple minimally-invasive method of scleral suture fixation of PCIOL.

Prevalence and Associated Factors of Cataract, Cataract Surgery and Postoperative Outcome in an Old Population in Russia: The Ural Very Old Study

PurposeTo assess prevalence of cataract and cataract surgery in a very old population in Russia. DesignPopulation-based study. ParticipantsThe Ural Very Old Study included 1526 (81.1%) participants out of 1882 eligible individuals aged 85+ years. MethodsBased on anterior and posterior segment imaging, we assessed the prevalence of cataract, cataract surgery and other ocular disorders affecting best corrected visual acuity (BCVA). Main outcome measuresPrevalence of cataract and cataract surgery. ResultsThe study included 1163 (76.3%) individuals with lens information. Cataract surgery had been performed in 469 right eyes (41.0%;95%CI:38.1,43.9) (92.1% with posterior chamber IOL; 4.7% with multifocal IOL) and 479 left eyes (41.6%;95%CI:38.7,44.4) (92.7% with posterior chamber IOL; 4.2% with multifocal IOL). Among the 1163 study participants, 610 (52.5%) individuals had undergone cataract surgery in at least one eye. Higher prevalence of previous cataract surgery correlated (multivariable analysis) with lower IOP (OR:0.92;95%CI:0.88,0.95;P<0.001), glaucomatous optic nerve damage stage (OR:1.20;95%CI:1.05,1.36;P=0.006), and better visual acuity (OR:0.67;95%CI:0.51,0.89;P=0.005). Postoperative BCVA (mean:0.83±1.43logMAR) was reduced to moderate-to-severe vision impairment (MSVI) in 202 eyes (44.6%;95%CI:40.0,49.2) and to blindness in 53 eyes (11.7%;95%CI:8.7,14.7). Causes of postoperative MSVI were age-related macular degeneration (AMD) (34.2%), glaucoma (13.9%), and secondary cataract (5.4%). Causes for blindness were AMD (24.5%), glaucoma (18.9%), corneal opacifications (15.8%) and myopic macular degeneration (11.3%). YAG-laser capsulotomy had been performed in 6 (1.3%) out 469 right eyes after cataract surgery and in 12 (2.5%) out of 479 left eyes after cataract surgery. Prevalence of nuclear cataract and cortical cataract was 604/671 (90.0% in phakic eyes 51.9% in the whole study population) and 97.9% eyes (48.4% in total study population). Cataract caused bilateral MSVI and blindness in 28.2% (95%CI:25.6,30) and 2.9% (95%CI:1.9,3.9), respectively, of all study participants. ConclusionsDespite a relatively high prevalence of cataract surgery, this multiethnic cohort aged 85+ years from Russia showed a high prevalence of cataract-related MSVI and blindness, due to the old age of the participants. After cataract surgery, main causes for MSVI (prevalence:44.6%) and blindness (prevalence:11.7%) were AMD, glaucoma, corneal opacifications, and myopic macular degeneration. Almost all individuals aged 85+ years need cataract surgery, despite limited chance of postoperative good vision.

Management of a Bilateral Ectopia Lentis in a Patient with Marfan Syndrome: A Case Report

AIMS: to highlight the management procedure of a bilateral subluxated lens in a patient with marfan syndrome. Case Report: We report a case of a 51-year-old woman, with a family history of Marfan syndrome; who presented for a bilateral subluxated lens, iridodonesis and bilateral macular degeneration. Given the family history, the general physical features and the ocular findings, diagnostic of Marfan syndrome was established. The management of the ectopic lentis was very challenging. An intracapsular lens extraction with posterior chamber intraocular lens fixed to the sclera was performed and the patient regained 2/10 visual acuity on the right eye and remained at counting fingers in the left. Conclusion: Marfan syndrome is a rare condition, with various ocular manifestations. The only guarantee for a better visual outcome is a well-designed therapeutic approach.

Bilateral dead bag syndrome

Introduction: Posterior capsular rupture (PCR) is defined as breach in the continuity of the posterior part of the capsular bag in the human crystalline lens. Dead bag syndrome (DBS), a term coined by Samuel Masket, is a rare late complication of cataract surgery, which may present with spontaneous posterior capsular tear, causing intraocular lens (IOL) decentration or dislocation. It is usually seen in patients who have undergone an uneventful phacoemulsification with in-the-bag posterior chamber IOL implantation many years ago. Patient and Clinical Findings: A 73-year-old man presented with reduced vision in the right eye 17 years after an uneventful phacoemulsification and in-the-bag posterior chamber IOL implantation. There was no history of trauma to the eye. On examination, a decentered IOL with an inferior PCR was noted. Diagnosis, Intervention, and Outcomes: Decentered IOL was explanted, and a retro-iris–fixated IOL was implanted. Similar findings were noted in the left eye 4 years after the involvement of the right eye. There was no IOL dislocation or decentration. A diagnosis of DBS as the cause of PCR was made. The left eye was managed conservatively, and the patient remains under observation. Conclusions: The case described here seems to correspond to bilateral DBS. Physicians should be alert to look for the possibility of development of a similar complication in the other eye.

Склерокорнеальная фиксация заднекамерных интраокулярных линз в осложненных случаях хирургии катаракты с использованием политетрафторэтиленовых нитей

Original article Sclerocorneal fixation of posterior chamber intraocular lenses in complicated cases of cataract surgery using polytetrafluoroethylene sutures T.G. Sazhin, M.O. Sokolova Clinical Hospital «RZD-Medicine», Saint Petersburg, Russian Federation S.M. Kirov Militar y Medical Academy Ministr y of Defense of the Russian Federation, St. Petersburg, Russian Federation Relevance. Dislocation of the intraocular lens (IOL) is a serious complication in cataract surgery. Therefore, the search for an effective method of IOL fixation for non-standard surgical situations is still important. Purpose. To analyze clinical results of flanged corneoscleral IOL fixation the technique using polytetrafluoroethylene sutures. Material and methods. The results of surgical treatment of 34 patients (34 eyes) who underwent IOL suturing with suture material made of polytetrafluoroethylene 6-0 (Ecoflon) through the sclera and fixation of flanges in the lumen of corneal paracentesis (Sclerocorneal IOL Fixation Technique) without incisions of the conjunctiva and sclera were analyzed. Results. The average index of maximally corrected visual acuity before surgery was 0.27±0.11. A day after surgery, this parameter increased to 0.41±0.1. One week after surgery, the average index of maximally corrected visual acuity was 0.65±0.1, while the improvement in visual acuity was statistically significantly different from the parameter before surgery and a day after surgery (p&lt;0.05). Conclusion. Application of polytetrafluoroethylene suture material in the ab externo technique, passing through the sclera and fixing the flanges in the lumen of the corneal paracentesis is safe and effective method. As a result, patients had positive visual acuity dynamics with a low frequency of complications. Key words: dislocation of IOL, aphakia, sclerocorneal fixation, polytetrafluoroethylene suture, flanged technique

Visual outcome and complications of phacoemulsification and manual small incision cataract extraction for age related cataract

The purpose of this study is to compare visual outcome and complications of manual small incision cataract surgery (MSICS) with posterior chamber IOL implantation (PC-IOL) and phacoemulsification with posterior chamber IOL implantation for age related cataract. The study compares the visual outcome and complications of MSICS and phacoemulsification with PC-IOL performed in 80 eyes at M &amp; J Western Regional Institute of Ophthalmology (M&amp;J WRIO) Ahmedabad, by assessing post operative Best corrected Visual acuity (BCVA), Surgically Induced astigmatism (SIA) and complications. This was an Institutional based cohort interventional randomized, prospective study. MSICS and Phacoemulsification was performed on 80 eyes at M &amp; J WRIO. The intraoperative complications were documented. The parameters that were examined on 1 postoperative day, 1 week, and 6 weeks postoperatively included uncorrected visual acuity, best corrected visual acuity (BCVA) at 6 weeks, intra ocular pressure by non -contact tonometry and keratometry at 6 weeks to rule out SIA.Statistical analysis was performed using chi square test. p value &amp;#60;0.05 was taken as significant.: MSICS &amp; phacoemulsification had similar visual outcomes post-operatively. Phacoemulsification group produced less mean SIA (1.27 D) compared to MSICS group (1.29 D) and lesser (5%) complications than the MSICS group (10%). The comparison of all three parameters was not statistically significant between the two groups.: Visual outcomes, SIA and complications were comparably the same in MSICS &amp; phacoemulsification. Therefore, MSICS can be excellent alternative to phacoemulsification.

A Modified Girth-Hitch Suture Technique to Rescue Single-Haptic Dislocation of Scleral Fixated IOL's.

To describe the technique of modified girth-hitch suture for one side transscleral fixation to rescue a single haptic dislocation. In this surgical technique report, dislocated scleral fixated posterior chamber IOL were secured to the sclera using 10-0 polypropylene suture looped around the IOL haptic. Three types of IOL were secured in this study (4 case of 1-piece PMMA IOL, 1 case of 3-piece acrylic IOL with PMMA loop and 1 case of acrylic foldable IOL with a two-plate loop design). Six patients, who had subluxation of the scleral-fixated posterior-chamber IOL due to single-knot dehiscence, underwent refixation of scleral-fixated IOL surgery using this technique. In all cases successful repositioning with stable and central fixation of the IOLs was achieved. No intraoperative or postoperative complications were noted. Internal re-fixation with a girth-hitch suture is relatively quick and convenient method for management of a dislocated IOL haptic on one side.

Flapless and Sutureless Intrascleral Fixation of Posterior Chamber Intraocular Lens for Correction of Aphakia in Absence Of Capsular Support

Flapless and Sutureless Intrascleral Fixation of Posterior Chamber Intraocular Lens for Correction of Aphakia in Absence Of Capsular Support

Influence of anterior chamber depth and vault on anterior chamber angle morphology after phakic posterior chamber intraocular lens implantation.

This study aims to investigate the influence of anterior chamber depth (ACD) and vault on the anterior chamber angle (ACA) morphology in myopic individuals implanted with posterior chamber phakic intraocular lenses. This retrospective case series involved 231 eyes receiving a 13.2-mm implantable collamer lens (ICL). Preoperative anterior chamber anatomy was assessed using anterior segment optical coherence tomography (AS-OCT) and optical tomography, while postoperative evaluation employed AS-OCT. ACA morphology was characterized pre- and postoperatively through trabecular iris angle (TIA750), ACA distance opening (AOD750) and trabecular iris space area (TISA750). The influence of ACD and vault was examined by categorizing the sample into ACD (shallow, average and deep) and vault (low, optimal and high) groups. Preoperative ACA morphology varied based on ACD, with shallower ACDs exhibiting narrower TIA750, smaller AOD750 and TISA750. ICL implantation induced greater ACA narrowing more in the deep ACD group (TIA750 = 20.1 degrees; AOD750 = 0.82mm and TISA750 = 0.44mm2) compared to the shallow ACD group (TIA750 = 15.2 degrees; AOD750 = 0.44mm and TISA750 = 0.21mm2). Postoperatively, deeper ACDs showed larger ACAs. Increasing vault magnitude led to increased ACA narrowing, with the low vault group exhibiting smaller closure (TIA750 = 14.3degrees; AOD750 = 0.56mm and TISA750 = 0.29mm2) compared to the high vault group (TIA750 = 20.8degrees; AOD750 = 0.73mm and TISA750 = 0.36mm2). The magnitude of ACA narrowing associated with the vault had a consistent effect across different ACD groups. Posterior chamber intraocular lens implantation results in ACA narrowing, the extent of which is contingent upon preoperative anterior chamber and ACA morphology, with additional influence from vault magnitude.

A potential role for inflammatory cytokines in a rare late-onset capsular block syndrome: a case report

BackgroundLate-onset capsule block syndrome (CBS) is a rare complication of cataract phacoemulsification and the implantation of a posterior chamber intraocular lens (PCIOL), which manifests six months to years after surgery. The hallmark of CBS is the formation of an opaque liquid substance between the implanted intraocular lens (IOL) and the posterior capsule. However, its pathogenesis remains unclear.Case presentationA 64-year-old female patient with chronic angle-closure glaucoma (axis length < 21 mm) underwent trabeculectomy surgery combined with phacoemulsification and PCIOL. After a 4-year follow-up, a decline in visual acuity occurred in her right eye due to the location of opaque fluid in the visual axis and distension of the capsular bag. The initial course of action was to release the trapped fluid. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy could not be employed due to her non-dilating pupil and high extension of the posterior capsule. Subsequently, anterior capsule peeling and anterior segment vitrectomy surgery were performed. The depth of the anterior chamber (ACD), the distance between the face of the retro-IOL and the posterior capsule, the best-corrected visual acuity (BCVA), and the visual quality (VQ) were measured both before and after surgery. Inflammatory cytokine levels in the opaque substances (OS) trapped between the PCIOL and the posterior capsule were assessed using a flow cytometer and compared to normal statistical data in aqueous humor. After surgery, the patient experienced a significant improvement in BCVA and VQ. The distance between the face of the retro-IOL and the posterior capsule was on the verge of disappearing. However, ACD did not differ between pre- and post-operatively. Interleukin-8 (IL-8) and basic fibroblast growth factor (BFGF) concentrations were higher in the OS than in aqueous humor, especially in the former. However, the concentration of vascular cell adhesion molecule (VCAM) in the OS was lower than in aqueous humor.ConclusionsAnterior segment vitrectomy surgery proved to be a successful treatment for late-onset CBS, presenting a challenging case. In the human lens, inflammatory cytokines originating from the opaque substances may contribute to abnormal metabolism in the sealed area, a consequence of late-onset CBS.

Pars Plana Vitrectomy in the Treatment of Rhegmatogenous Retinal Detachment.

The aim of the study is to retrospectively evaluate the anatomical success rate and functional results of 25G+ PPV in the treatment of newly diagnosed rhegmatogenous retinal detachment (RRD). The set consists of 152 eyes of 152 patients, of which 71 (47%) were men, average age 54 years, operated on by one surgeon for RRD at the Eye Clinic of the University Hospital and Medical Faculty of Masaryk University Brno from 1.7.2019 to 4.5.2021 using the 25G+ PPV technique. 25G+ PPV with pre-equatorial cerclage was performed on 7 patients. The patients' anamnesis included blunt ocular trauma and uncomplicated cataract surgery with implantation of a posterior chamber intraocular lens. The cause of RRD was retinal tear/s, regardless of their number and location. The transparency of the anterior segment of the eye enabled reliable visualization of the posterior segment. Preoperative proliferative vitreoretinopathy (PVR) grade A-D2 was admissible. Patients with a history of penetrating ocular trauma were excluded. The postoperative findings and functional outcomes of the patients were evaluated 1-3 months after PPV. The operation was anatomically successful if the retina was fully attached. Final visual acuity (VA) was evaluated for each patient. The final visual acuity examination was carried out typically on a Snellen optotype, either without correction, with the patient's own spectacle correction or with correction according to the current values on the autorefractometer. The arithmetic average was used for the numerical expression of the attained results, and the numerical values were also expressed in percentages. Since the different groups were not compared with each other, no statistical test was necessary to analyze the results. In 150 (98.7%) of the 152 patients in the group, we achieved complete retinal reattachment, in 2 (1.3%) patients the retina remained detached, and we recorded anatomical failure of the treatment. Fifty (33%) patients achieved VA ≥ 4/8. In 133 (87.5%) patients, we are able to state anatomical success even without the presence of intraocular tamponade in the operated eye. These patients can be considered completely cured. 25G+ PPV has demonstrated its contribution to resolving RRD.

Six-point scleral fixation of a three-looped haptics one-piece posterior chamber intraocular lens by a single suture.

To evaluate a novel technique for six-point scleral fixation of a three-looped haptics posterior chamber intraocular lens (PCIOL) by a single suture. Nine eyes of nine patients were studied from September 2021 to March 2023. All patients had undergone vitrectomy. Only a single 9-0 polypropylene suture was used for scleral fixation. The three looped haptics were fixed at 12, 4, and 8 o'clock with six-point scleral fixation. The entire procedure took about 30 min. Among the nine patients, eight (88.8%) eyes had a significant improvement in best-corrected visual acuity, whereas one (11.2%) eye showed no change. No intraoperative or postoperative complications were observed. By ultrasonic biomicroscopy examination, intraocular lenses were well positioned and stable with no tilt in the horizontal and vertical axis. The method of six-point scleral fixation of a three-looped haptics PCIOL by a single suture is safe and effective.

Long-term outcomes of iris-sutured subluxated intraocular lenses.

This study evaluated the long-term outcomes of managing posterior chamber intra-ocular lens (IOL) (PCIOL) subluxation through pars plana vitrectomy (PPV) with IOL iris suturing. Retrospective chart review. Patients who underwent PPV with iris-sutured IOL (IS-IOL) for IOL subluxation between January 2008 and April 2021 at a tertiary center with a minimum of 6 months of follow-up were included. The patients were divided into two groups: those who had prior PPV and those who had not undergone the procedure. A total of 54 patients underwent iris suturing of a subluxated IOL. Among them, 36 (66%) had previously undergone PPV, while 18 patients (33%) had not. The etiology of PCIOL subluxation was uncertain in 20 (37.0%), prior PPV in 17 (32%), and following complicated cataract surgery in 11 (20%) cases. The mean time between original IOL insertion and IS-IOL was 6.1 ± 7.0 years. The mean follow-up duration was 46.8 ± 39.7 months. The mean post-operative best corrected visual acuity (BCVA) was logMAR 0.43 ± 0.52 at final follow-up, a significant improvement from pre-operative BCVA. Vision was significantly better in the group with no prior PPV (logMAR 0.54 ± 0.59 vs. 0.21 ± 0.23 at final follow-up, P = 0.026). At final follow-up, 34 (63%) eyes had BCVA of 20/40 or better. The most common complication was cystoid macular edema, attributed to the IS-IOL in 13 (21.4%) eyes, 11 (68.6%) of which resolved or improved. The management of posterior chamber IOL subluxations with PPV and iris suturing of the subluxated IOL is a safe technique that provides excellent long-term visual outcomes.

Bilateral dead bag syndrome in skeletal dysplasia: A case report and review of literature

Abstract: Posterior chamber intraocular lens (IOL) dislocation is a rare yet grave complication of cataract surgery. Late in-the-bag IOL dislocation is usually spontaneous and occurs due to progressive zonular weakness. Aging, high myopia, pseudoexfoliation, vitrectomized eye, and connective tissue disorder are the predisposing factors. A floppy capsular bag without any proliferative deposits has been termed a “dead bag.” Bilateral in-the-bag IOL dislocation or dead bag syndrome is very infrequent. We present such a case in a 67-year-old male with skeletal dysplasia. The patient had undergone uneventful cataract surgery in both eyes 11 years and 6 years ago respectively. Skeletal dysplasia may cause zonulopathy and associated defective collagen synthesis can affect the anchorage points of the zonules. In these patients, cataract surgery should be accomplished by experienced surgeons after detailed counseling of such complications.

Visual and Anatomical Outcomes of Pars Plana Vitrectomy for Dropped Nucleus

Objective: To evaluate the visual and anatomical outcomes of pars plana vitrectomy (PPV) in patients with dropped nucleus following complicated phacoemulsification (PE).&#x0D; Materials and Methods: A retrospective study was conducted at the Ophthalmology Department of Lahore General Hospital, Lahore between 2017 and 2022. The study included 51 patients (33 males and 18 females) between the age 35 to 85 years who were referred after a complicated phacoemulsification with dropped nucleus.&#x0D; Results: This study included 51 patients in which 33 were males (64.71%) and 18 were females (35.29%). All patients underwent 23-gauge pars plana vitrectomy. Posterior chamber phacofragmentation was carried out in 32 (62.75%) eyes while in remaining 19 (37.25%) patients vitrectomy cutter was used for the dropped nucleus. Out of 51, 06 (11.76%) patients received an anterior chamber IOL at the time of cataract surgery, 21 (41.18%) eyes had IOL in the ciliary sulcus, 07 (13.73%) had a posterior chamber IOL, and the remaining 17 (33.33%) patients were aphakic. Of these 17 aphakic patients, an anterior chamber IOL was placed at the time of vitrectomy in 07 (41.18%) patients who were judged to have inadequate capsular support for a posterior chamber lens. In the remaining 10 (58.82%) eyes, where capsular support was deemed adequate, a posterior chamber IOL was inserted. Final visual acuity was 20/40 or better in 34 (66.67%) eyes and 20/50 in 06 (11.76%) patients.&#x0D; Conclusion: Poor visual outcome after dropped nucleus at phacoemulsification cataract extraction can be avoided if managed by prompt pars plana vitrectomy as it offers the advantages of a closed system for vitrectomy and manipulation of the nucleus, an improved view of the posterior segment and facilitated recognition and management of intraoperative complications with better visual and anatomical outcomes with low rate of postoperative complications.

Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis.

To evaluate the effect of lens surgery on health-related quality of life (HRQoL) of preschool children with congenital ectopia lentis (CEL). A prospective self-controlled study was conducted in Zhongshan Ophthalmic Center. Children aged from 5 to 7y whom were diagnosed with CEL and underwent phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation and their parents were enrolled in this study. All of them completed the child and proxy (parental) PedsQL™ 4.0 before and after the surgery. Their preoperative scores were compared to their postoperative ones. Subgroup analyses were performed based on gender and preoperative bilateral presenting visual acuity of the children. Thirty-two children with CEL successfully underwent surgery without any complications, among whom 8 had monocular surgery and 24 had binocular surgery. Preoperative and postoperative questionnaires were completed by 32 child-parent pairs. Surgical intervention could significantly improve the vision of affected children (P<0.001). The medians of physical, psychosocial and total health scores self-reported by the children were 68.75 (62.50, 81.25), 65.00 (60.00, 80.00) and 67.39 (60.87, 78.26) preoperatively and were 93.75 (87.50, 100.00), 90.00 (83.33, 96.67) and 89.13 (85.32, 95.65) postoperatively. The preoperative scores of the affected children were significantly lower in all scales than age-matched healthy children (P<0.001). All the postoperative scores were significantly higher than the preoperative scores in affected children and their parents (P<0.001). In the physical functioning evaluation, the preoperative score reported by parents of girls was higher than parents of boys (P=0.041), and the postoperative score of girls was higher than that of boys (P=0.036). CEL is associated with significantly worse quality of life in preschool children. Surgical intervention can significantly improve the HRQoL in affected children from both personal and family perspective.

The Influence of Lens Position, Vault Prediction, and Posterior Cornea on Phakic Posterior Chamber Intraocular Lens Power

BackgroundAchieving precise refractive outcomes in phakic posterior chamber intraocular lens (pIOL) implantation is crucial for patient satisfaction. This study investigates factors affecting pIOL power calculations, focusing on myopic eyes, and evaluates the potential benefits of advanced predictive models. DesignRetrospective, single-center, algorithm improvement study MethodsVarious variations with different effective lens position (ELP) algorithms were analyzed. The algorithms included a fixed constant model, and a multiple linear regression model and were tested with and without incorporation of the posterior corneal curvature (Rcp). Furthermore, the impact of inserting the postoperative vault, the space between the pIOL and the crystalline lens, into the ELP algorithm was examined, and a simple vault prediction model was assessed. ResultsIntegrating Rcp and the measured vault into pIOL calculations did not significantly improve accuracy. Transitioning from constant model approaches to ELP concepts based on linear regression models significantly improved pIOL power calculations. Linear regression models outperformed constant models, enhancing refractive outcomes for both ICL and IPCL pIOL platforms. ConclusionsThis study underscores the utility of implementing ELP concepts based on linear regression models into pIOL power calculation. Linear regression based ELP models offered substantial advantages for achieving desired refractive outcomes, especially in lower to medium power pIOL models. For pIOL power calculations in both pIOL platforms we tested with preoperative measurements from a Scheimpflug device, we found improved results with the LION 1ICL formula and LION 1IPCL formula. Further research is needed to explore the applicability of these findings to a broader range of pIOL designs and measurement devices.