Posterior Chamber Lens Implantation Research Articles

The effect of pars plana vitrectomy in the management of Fuchs heterochromic cyclitis.

Fuchs heterochromic cyclitis (FHC) is characterized by a unilateral chronic iridocyclitis of insidious onset and uncertain cause. Our aim was to evaluate the effect of vitreous surgery in patients with FHC and clinically significant visual symptoms caused by inflammatory vitreous debris. This study was a review of 12 eyes of 12 consecutive patients with FHC who underwent pars plana vitrectomy for visually significant vitreous opacities. Cataract extraction with posterior chamber lens implantation had been performed on four eyes preoperatively. Four eyes had a concomitant lensectomy for cataracts, and one had a surgical posterior capsulotomy. Visual and anatomic data were recorded before surgery and for at least 6 months after surgery. Visual acuity improved in all patients from an average logMAR of 0.57 to 0.007 (P = 0.0004) and by more than 2 Snellen lines in 8 of 12 of the eyes (P < 0.05). Symptoms of floaters resolved in all 11 patients in whom they were a symptom. Vitreous haze was cleared completely from an average Nussenblatt grade of 1.7 to 0 after 1 week (P = 0.0001). Pars plana vitrectomy is a safe and effective treatment for the visual symptoms associated with FHC and can be combined safely with a lensectomy if required.

Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma.

To analyze the postoperative outcome and complication rate after cataract extraction or lensectomy with primary intraocular lens (IOL) implantation for penetrating traumatic cataract. Retrospective, nonconsecutive, noncomparative case series. We retrospectively reviewed the files of 21 patients who were admitted to our departments because of traumatic cataract with corneal or scleral laceration caused by penetrating trauma with or without intraocular foreign body (IOFB) from 1992 through 1997. Lens aspiration or manual extracapsular cataract extraction with primary IOL implantation was performed in all patients. Removal of an IOFB was performed in eight patients. Final visual acuity and deviation of actual refraction from emmetropia and from expected postoperative refraction. The mean follow-up was 20.4 months. Fourteen eyes (67%) achieved final visual acuity of 20/40 or better, 95% obtained 20/60 or better final visual acuity, and all eyes achieved 20/100 or better final visual acuity. Major causes of limited visual acuity were central corneal scar and central retinal injury. Eleven eyes (57%) experienced secondary cataract and underwent neodymium:yytrium-aluminum-garnet capsulotomy. Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with favorable visual outcome and a low rate of postoperative complications.

Modified technique of haptic externalization for scleral fixation of dislocated posterior chamber lens implants

PURPOSE: To describe a modified technique of haptic externalization during repositioning of dislocated posterior chamber lens implants, which facilitates placement of scleral fixation sutures around the haptic for implant stabilization. METHODS: We describe a technique of repositioning a dislocated posterior chamber implant with scleral fixation sutures, which uses a small, clear corneal incision for externalization of the haptic. After a loop of 10–0 Prolene suture (Ethicon, Inc., Somerville, New Jersey) is placed around the externalized haptic, the sutures are retrieved through a sclerotomy 1.0 mm posterior to the limbus. The haptic is reimplanted into the ciliary sulcus. A separate scleral fixation bite closes the sclerotomy, and it is tied to the 10–0 Prolene sutures looped around the haptic. RESULTS: The dislocated implant was stable and fixated in good position 5 months after surgery using this technique. CONCLUSION: This externalization technique minimizes the extensive intraocular manipulations necessary to create a suture loop around a haptic of a dislocated implant. The clear corneal incision allows for clear visualization during externalization of the haptic.

Comparison of corneal endothelial changes after use of different adjuncts during lens implantation

To evaluate postoperative changes in corneal endothelial cell density, we conducted a retrospective study in 34 patients (35 eyes). Patients underwent extracapsular cataract extraction and posterior chamber lens implantation using an air bubble (23 eyes), sodium hyaluronate (Healon) (6 eyes), or air bubble plus sodium hyaluronate (6 eyes). The endothelial cell density of all eyes decreased from 2496±341 cells/mm2 preoperatively to 1539±371 cells/mm2 1 month postoperatively. The endothelial cell loss rate was 21%, 31%, and 29% in the air bubble, sodium hyaluronate, and air bubble plus sodium hyaluronate groups, respectively (P>.05).

Effect of cataract extraction and posterior chamber lens implantation on outflow facility and its response to pilocarpine in Korean subjects

AIMTo investigate the effect of the lens on outflow facility in Korean patients with cataracts.METHODSIntraocular pressure was measured by Goldmann applanation tonometry in 42 patients with cataracts and outflow facility...

Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy

PURPOSE: To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract. METHODS: In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases. RESULTS: After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4 ± 3.3 mm Hg, reduced the number of medications by 1.28 ± 0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2 ± 4.6 mm Hg ( P = .0001), reduced the number of medications by 1.76 ± 0.82 ( P= .0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye ( P = .05). Both groups had similar improvement in visual acuity and perioperative complications. CONCLUSIONS: Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.

Phakic posterior chamber lenses for high myopia: functional and anatomical outcomes

PurposeTo evaluate the functional and the anatomical outcomes after implantation of phakic posterior chamber intraocular lenses (IOLs) in highly myopic eyes. SettingService d’Ophtalmologie, Hopital Purpan, Toulouse, France. MethodsFifty-eight eyes of 46 patients that had implantation of phakic posterior chamber lenses for high myopia were evaluated. Predictability, efficiency, safety, and subjective and objective quality of vision were evaluated preoperatively and at least 6 months postoperatively. The effect of the procedure on the cornea, aqueous humor, pupil, anterior chamber angle, crystalline lens, and retina were studied. ResultsMean preoperative myopia was −13.85 diopters (D) ± 3.1 (SD) (range −8.00 to −19.25 D). Mean postoperative spherical equivalent was −1.22 ± 0.83 D (range +0.75 to −3.50 D); 56.9% of eyes were within ±1.00 D of the predicted result, and 77.6% gained 1 or more lines of best corrected visual acuity. All contact-lens-intolerant patients had improved quality of vision for day and night driving, distance vision, and vision under dim illumination. The mean postoperative level of contrast sensitivity without correction was higher than the mean preoperative level with correction. Adverse events were 2 cases of crystalline lens opacification 16 and 18 months after surgery and 2 cases of pigment deposits in the angle with increased intraocular pressure, which was controlled by beta-blockers. ConclusionImplantation of posterior chamber phakic IOLs is effective and predictable; however, long-term follow-up is needed.

Interpseudophakos intraocular lens surface opacification as a late complication of piggyback acrylic posterior chamber lens implantation

We present a case involving opacification of the apposing surfaces of 2 acrylic intraocular lenses (IOLs) that had been implanted in a piggyback fashion 16 months previously. Clinical observations derived from our experience with piggyback acrylic lens implantation are presented, along with a discussion of late complications of piggyback IOL implantation and recommendations.

HIGH INCIDENCE OF CATARACT FORMATION AFTER IMPLANTATION OF A SILICONE POSTERIOR CHAMBER LENS IN PHAKIC, HIGHLY MYOPIC EYES

High incidence of cataract formation after implantation of a silicone posterior chamber lens in phakic, highly myopic eyes.

Phakic posterior chamber lens implantation in children with high myopia

Purpose To evaluate the anatomical and functional results after implantation of a phakic posterior chamber lens (implantable contact lens [ICL™]) to correct high myopia with amblyopia in pediatric patients in whom conventional treatments had failed. Setting Department of Ophthalmology, Purpan Hospital, University of Toulouse, France. Methods An ICL was implanted in 5 eyes with amblyopic high myopia in 4 children aged 3 to 16 years. Mean preoperative spherical equivalent refraction was –12.8 diopters (D) (range –8.0 to –18.0 D) and best spectacle-corrected visual acuity (BSCVA) was counting fingers to 20/200. Mean follow-up was 11.8 months (range 4 to 21 months). Results Postoperatively, the ICLs appeared to be well tolerated, with no inflammatory reactions, stable intraocular pressure, and good positioning in all eyes. Predictability was +0.5 D (range –0.5 to +2.0 D) and BSCVA improved, with a gain of 3 or more Snellen lines with recovery of binocular vision in 2 cases and orthotropia in 3 patients. All parents reported an improvement in their children’s quality of life. Conclusion This preliminary study indicates that ICL implantation is a safe surgical procedure to correct amblyopia resulting from high myopia in children when conventional amblyopia treatments have failed. Longer follow-up of more patients is needed.

Scleral fixated (sutured) posterior chamber intraocular lens implantation in children

Background: Optical rehabilitation of unilateral aphakia in eyes with no capsular support is problematic in pediatric patients who cannot tolerate contact lenses. Possible options include a unilateral aphakic spectacle, an anterior chamber intraocular lens (IOL), or a scleral fixated posterior chamber IOL. Of these choices the posterior chamber IOL is the most physiologic. Experience in adults shows increased complications with this technique. Objective: The objective of this study was to report the short-term results and complications of unilateral scleral fixated posterior chamber IOLs in the pediatric population. Methods: All patients with scleral fixated lenses younger than 16 years were retrospectively reviewed. Nine patients aged 12 months to 15 years underwent unilateral scleral fixated posterior chamber lens implantation using buried polypropylene fixation sutures. Follow-up averaged 24 months. Results: Postoperative visual acuity improved in all patients. Refractive goals were achieved in all but 1 patient. Complications included elevated intraocular pressure controlled with medications (1 patient), anterior uveitis (1 patient), and mild IOL decentration (1 patient). Conclusions: Although short-term visual results appear encouraging, this procedure is technically more difficult and has an increased incidence of postoperative complications when compared with secondary sulcus-fixated IOLs supported by capsular remnants. Caution should be exercised when recommending this procedure for pediatric patients because long-term risks are unknown. (J AAPOS 1999;3:289-94)

High incidence of cataract formation after implantation of a silicone posterior chamber lens in phakic, highly myopic eyes

Objective To assess the effectiveness and safety of implantation of a negative, silicone, posterior chamber intraocular lens (IOL) in the ciliary sulcus of phakic, highly myopic eyes. Design Noncomparative consecutive interventional series. Participants Eighteen eyes of 10 patients suffering from high-degree myopia (spherical equivalent < −10 diopters) undergoing implantation of a Fyodorov 094M-1 IOL by the same surgeon (P.H.B.) were evaluated. Intervention A standard surgical technique was used in all patients under peribulbar anesthesia. The IOL was implanted in the ciliary sulcus immediately in front of the natural lens under protection of a viscoelastic substance (Healon) through a 3.5-mm temporal or nasal clear-corneal tunnel. No sutures were necessary in any case. A peripheral iridectomy was performed intraoperatively in 14 eyes, whereas 4 additional eyes received a yttrium-aluminum-garnet peripheral iridectomy after surgery. At the end of surgery, gentamicin and dexamethasone were given both topically and subconjunctivally. Main outcome measures Visual acuity and refraction were measured before surgery, as well as 1 day, 3 months, 6 months, and 2 years after surgery. Postoperative complications were recorded. Results Best-corrected visual acuity remained unchanged (1 eye) or improved (6 eyes by 1, 5 eyes by 2, and 2 eyes by 3 Snellen lines, respectively) in 14 of 17 eyes, whereas 3 eyes experienced a decrease in best-corrected visual acuity by 1 Snellen line. Postoperative refraction approached the desired slight undercorrection at all times of examination. Cataract formation of the anterior subcapsular (8 eyes) or nuclear (only 1 eye) type was observed in overall 9 (52.9%) of 17 eyes. When considering only the patients with a follow-up of 2 years, the incidence of cataract formation was 81.9% (9 of 11 eyes). Conclusions The high incidence of cataract formation should discourage the implantation of the type of IOL used in this study in phakic eyes to correct high-degree myopia.

Audit of extracapsular cataract extraction and posterior chamber lens implantation as a routine treatment for age related cataract in east Africa

AIMSTo evaluate the outcome of extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens implantation (PC-IOL) in an African eye clinic during the transition from intracapsular cataract extraction to ECCE...

Systemic levels of lidocaine after intracameral injection during cataract surgery

Purpose To evaluate the systemic concentrations of lidocaine after intracameral injection of a 1% solution during cataract surgery and the safety of this application mode. Setting Department of Ophthalmology, Medical University of Lübeck, Lübeck, Germany. Methods This prospective study included 10 patients who had phacoemulsification and posterior chamber lens implantation with a self-sealing scleral tunnel incision. Topical anesthesia was achieved using cocaine 10% eyedrops combined with 0.5mL of unpreserved lidocaine 1% injected into the anterior chamber. Blood samples were taken from all patients at predetermined intervals before and during the procedure. Consecutive analysis for lidocaine was performed with gas chromatography. Results In all samples, serum lidocaine concentrations were below a minimum detectable level of 100 ng/mL. No local or systemic intraoperative or postoperative complications were noted. Conclusions Intracameral injection of 0.5 mL lidocaine 1% revealed no systemic therapeutic concentrations. In patients in whom other forms of needle-delivered local anesthesia are contraindicated, intracameral injection of lidocaine should be considered to enhance topical anesthesia.

Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma

Objective To evaluate combined phacoemulsification, posterior chamber intraocular lens (PCIOL) implantation, and goniosynechialysis (phaco-GSL) prospectively in eyes with more than 180° of peripheral anterior synechiae (PAS) and uncontrolled intraocular pressure (IOP) when performed within 6 months of an attack of acute angle-closure glaucoma (ACG). Design Prospective, noncontrolled clinical trial. Participants Patients who had presented with acute ACG and had persistently uncontrolled IOP despite successful laser iridotomy for pupillary block and argon laser peripheral iridoplasty for continued appositional closure after iridotomy. Intervention After the completion of phacoemulsification and posterior chamber lens implantation, goniosynechialysis was performed in 52 eyes of 48 patients. Main outcome measures Postoperative visual acuity, IOP, extent of PAS, and number of medications, if any, required for IOP control. Results Intraocular pressure was less than 20 mmHg in 47 eyes (90.4%) without medications; 4 were controlled with medications and 1 required filtration. Mean extent of PAS was reduced from 310° to 60°. Peripheral anterior synechiae formation or IOP elevation did not recur after 3 months after surgery up to 6 years. Eight patients achieved 20/20 visual acuity, while 44 patients had less than 20/20 visual acuity. No patient had worse visual acuity after surgery compared to before surgery. Conclusion Phaco-GSL and PCIOL implantation is effective in reducing PAS and IOP and improving visual acuity in eyes with persistent chronic ACG when performed within 6 months after treatment for acute ACG.

Intraocular Pressure Reduction Following Phacoemulsification Cataract Extraction With Posterior Chamber Lens Implantation in Glaucoma Patients

To evaluate changes in intraocular pressure (IOP) following uneventful phacoemulsification cataract extraction with posterior chamber intraocular lens implantation (Phaco/PC IOL) in primary open-angle glaucoma (POAG) patients. The authors retrospectively reviewed preoperative and postoperative IOP in 31 consecutive medically-controlled POAG patients who underwent uneventful Phaco/PC IOL. None of the patients had prior intraocular surgery. The mean preoperative IOP in the POAG group was 18.1+/-3.1 mm Hg with patients receiving a mean of 1.7 antiglaucoma medications. With a mean follow-up of 16.4 months, the average postoperative IOP in the POAG group was 15.2+/-2.9 mm Hg (P < .001, Student's t test) with patients receiving a mean of 0.7 antiglaucoma medication (P < .001). Phaco/PC IOL may be associated with a significant decrease in IOP in POAG patients, allowing for decreased postoperative antiglaucoma medication.

Phacoemulsification and silicone oil removal through a single corneal incision

Objective Cataracts are a frequent complication after silicone oil infusion for the repair of complicated retinal detachments, occurring in up to 100% of eyes retaining silicone oil for 6 months or more. The authors devised a combined procedure for cataract and silicone oil removal with intraocular lens (IOL) implantation through a single corneal incision and evaluated their results. Design A prospective, noncomparative case series. Participants Thirty-four eyes of 34 consecutive patients with a history of retinal detachment repair requiring silicone oil placement in whom a clinically significant cataract subsequently developed were identified when removal of silicone oil was scheduled. Intervention All 34 eyes were prospectively entered into a study to evaluate the efficacy and potential complications of a combined procedure for cataract and silicone oil removal with posterior chamber lens implantation. All patients underwent uncomplicated phacoemulsification removal of cataract followed by removal of silicone oil and placement of an IOL through a single corneal incision. Main outcome measure Recurrent retinal detachment and IOL-related complications were measured. Results Ten eyes had recurrent retinal detachments develop. Final visual acuity ranged from 6/12 to hand movements with 25 eyes (74%) showing stabilized or improved vision. Pre-existing macular pathology and recurrent retinal detachment generally were responsible for poor visual outcome. Conclusions Combined phacoemulsification, IOL implant with silicone oil removal is a useful procedure in these complicated eyes. Visual outcome generally is good with improvement in visual acuity, even with recurrent retinal detachment or pre-existing macular pathology or both.

Superior oblique damage from the traction suture at cataract surgery

A 41-year-old woman underwent uneventful phacoemulsification and posterior chamber lens implantation in the right eye. Approximately a month later similar surgery was performed in the left eye. The surgery was performed with the patient under retro-bulbar anesthesia with a combination of bupivacaine (Marcaine) 0.75% and lidocaine (Xylocaine) 4% administered through a lower lid injection. Immediately after the patch was removed, the patient was aware of constant vertical diplopia. Over the ensuing 6 months the symptom worsened. Orbital computed tomography showed no abnormalities.

Intraocular pressure regulation after combined glaucoma and cataract operation

The success rate of combined glaucoma and small incision cataract surgery is not yet established. Therefore, 56 eyes of 52 patients (mean age 79.0 years) having trabeculectomy combined with phacoemul-sification and implantation of a silicone posterior chamber lens were retrospectively investigated. The mean follow-up was 21.6 weeks. Due to the combined surgery the mean intraocular pressure decreased significantly (p < 0.001) from 21.8 to 14.8 mmHg. Seventy-five percent of the patients did not need any antiglaucomatous medication, while 25% still had to use a local medication, but less frequently. The overall visual acuity increased significantly (p < 0.001) from a preoperative value of 0.24 to 0.52 postoperatively. The results of combined glaucoma and cataract surgery seem as good as those reported for two separate glaucoma and cataract procedures.

Retinal detachment after cataract extraction in myopic eyes

Purpose: To determine the incidence of retinal detachment (RD) after cataract extraction in people 40 years of age or older with axial myopia (i.e., axial length ≥25.5 mm).Setting: Fifteen Danish eye clinics.Methods: Two hundred forty-five eyes had cataract extraction performed at 15 eye clinics; 237 eyes had extracapsular cataract extraction (ECCE) and 8 eyes, intracapsular cataract extraction (ICCE). Postoperative data were reported by the practicing ophthalmologists. Mean follow-up was 27 months (range 14 to 32 months).Results: Five RDs occurred in the 245 eyes (2.0%). Excluding the ICCE cases and the two cases of combined cornea transplantation and ECCE, RD occurred in 4 of the 235 eyes that had ECCE (1.7%). The incidence after ECCE with posterior chamber lens implantation was 1.4%. Complete postoperative status was reported on 158 eyes. Forty-eight eyes (30.4%). had a neodymium:YAG capsulotomy and 3 (6.0%) developed an RD 1, 3.5, and 21 months after the capsulotomy.Conclusion: The RD incidence after ECCE with posterior chamber lens implantation was low but higher than that in unselected populations. The incidence increased after laser capsulotomy.