Posterior Intraocular Lens Implantation Research Articles

Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract.

To evaluate the effectiveness and safety of 2 enhanced monofocal intraocular lenses (IOLs). The TECNIS Eyhance IOL (Model ICB00) was compared with a standard monofocal IOL (TECNIS Monofocal, Model ZCB00). European multicenter study. Prospective, bilateral, randomized, comparative/evaluator-masked, controlled study. Adult subjects scheduled to undergo bilateral, primary phacoemulsification cataract extraction and posterior IOL implantation were randomized to receive the enhanced monofocal ICB00 IOL or the monofocal ZCB00 IOL in both eyes. Monocular endpoints at 6 months included distance-corrected intermediate visual acuity (DCIVA), photopic corrected distance visual acuity, and uncorrected intermediate visual acuity (UIVA). Binocular visual acuities, monocular corrected distance contrast sensitivity (first eyes), patient-reported outcomes, and safety were assessed at 6 months. Overall, 139 patients were bilaterally implanted with the enhanced monofocal IOL (n = 67) or standard monofocal IOL (n = 72) and available for the 6-month visit. The enhanced monofocal IOL significantly improved mean monocular and binocular DCIVA and UIVA by at least 1-line logarithm of the minimum angle of resolution vs the standard monofocal IOL (all P ≤ .0001). Distance vision for the enhanced monofocal IOL was 20/20 or better and comparable with that of the standard monofocal lens at 6 months. Contrast sensitivity, photic phenomena outcomes, and rates of adverse events were similar between the 2 groups. In patients undergoing cataract surgery, TECNIS Eyhance IOL Model ICB00 provided enhanced intermediate vision and similar distance performance and photic phenomena compared with a standard monofocal IOL, along with improved functional performance in daily life.

Density and morphology of corneal endothelial cell after phacoemulsification using ringer lactate versus balanced salt solution as irrigating solutions

AIM: To compare the difference in corneal endothelial cell density and morphology after phacoemulsification using ringer lactate (RL) and balanced salt solution (BSS) irrigating solutions. METHODS: The prospective randomized controlled trial study was conducted between February 2017 and April 2017 in Dr. YAP Eye Hospital, Yogyakarta, Indonesia. There were a total of 52 subjects (52 eyes) who were senile cataract patients further grouped into two, 26 patients undergoing the phacoemulsification procedure using RL irrigating solution and the other 26 patients with BSS irrigating solution, both conducted by one operator. On the 1, 7, and 28d post operative, an evaluation was done to measure the density and corneal endothelial cell morphology, as well as the variable of inflammation in the two groups. RESULTS: Fifty-two eyes had undergone phacoemulsification with posterior intraocular lens implantation. Both groups were evaluated for the endothelial cell reduction and corneal endothelial cell morphology change, along with postoperative inflammation. On the 28d postoperative, endothelial cell reduction in the BSS group (173.96 cell/mm2, 8.12%) was lower than the RL group (253.20 cell/mm2, 10.25%), percentage of corneal endothelial cell variation coefficient increase in the BSS group (2.92%, 8.36%) was lower compared to the RL group (3.42%, 9.96%), decrease of hexagonal cells of corneal endothelium cells presentation percentage in the BSS group (4.30%, 8.17%) was lower compared to the RL group (4.84%, 8.97%), and the percentage increase of central corneal thickness in the BSS group (4.69 μm, 0.89%) was almost equal to the RL group (4.53 μm, 0.90%). All of the results regarding difference in density and corneal cell endothelium morphology between the two groups did not reveal any statistically significant difference (P>0.05). Inflammatory variable in the two groups were even. CONCLUSION: BSS and RL were equal in their capability of maintaining endothelial cell loss and endothelial cell morphologic change in senile cataract patients after phacoemulsification.

Quantitative measurement of the central corneal thickness and anterior chamber angle before and after phacoemulsification by Oculyser

Objective To evaluate the changes of central corneal thickness (CCT) and anterior chamber angle depth (ACAD) before and after the phacoemulsification with posterior intraocular lens implantation through the eye anterior segment analysis system (Oculyser).Methods Sixty eyes of 60 patients with cataract treated by phacoemulsification with posterior chamber intraocular lens implantation were enrolled in this study,including 34 patients (34 eyes) without diabetes (senile cataract group) and 26 patients (26 eyes) with diabetes (diabetes group).Then all patients with cataract were divided into 3 groups by age:60 ～ 65 years old group,66 ～ 75 years old group,and over 76 years old group with 20 patients (20 eyes) in each group.The CCT and ACAD were examined by oculyser preoperatively and 3 d,7 d,and 1 month postoperatively.Results (1) CCT:In the diabetes group,senile cataract group,and each age group,the CCT was significantly increased at 3 d,7 d postopratively compared with that of preoperative CCT (t =4.799 ～ 10.519,t =5.593 ～ 11.059,P ＜0.05).The CCT at 1 month postoperatively was not significantly different from the baseline (t =1.441 ～ 3.126,P ＞0.05).Moreover,patients in diabetes group showed higher CCT compared with those in senile cataract group at 3 d,7 d (t =2.282,t =2.077,P ＜ 0.05) but not different at 1 month after surgery (t =0.792,t =1.367,P ＞ 0.05).CCT in each age group did not show significant differences among preoperative and postoperative 3 d,7 d,1 month (t =0.295 ～ 1.719,P ＞0.05).(2) ACAD:the ACAD was significantly increased after operation 3 d,7 d,1 month (t =6.281 ～11.869,t =7.926 ～ 10.939,t =8.504 ～ 12.912,P ＜ 0.05),but there were no significant differences be-tween patients with and without diabetes at different timepoints (t =0.056 ～ 0.980,t =0.003 ～ 1.098,P ＞ 0.05).(3) The negative correlation was shown between the CCT and ACAD (r =-0.330,P =0.010).Conclusion The Oculyser can observe the changes of CCT and ACAD before and after cataract phacoemulsification with posterior chamber intraocular lens implantation objectively and accurately. Key words: Oculyser; Cataract ; Thickness, central, corneal; Depth, angle, chamber, anterior

The operation timing of traumatic cataract caused by corneal penetrating injury

Objective To investigate the timing of traumatic cataract surgery.Methods 37 cases (37 eyes) of traumatic cataract caused by corneal penetrating injury were retrospectively analyzed.They underwent cataract surgery by phacoemulsification or extracapsular cataract extraction combined with posterior intraocular lens implantation at different time during 1 d to l m after injury.Primary or secondary IOL implantation was done.Results After 1 to 3 months follow-up postoperatively,the visual acuity was between no light perception to 1.0.It was no light perception in one eye (2.7％),hand movement in one eye (2.7％),0.05～0.1 in3 eyes (8.1％),0.12～0.3 in 11 eyes(29.7％),0.4～1.0 in21 eyes (56.8％).Infective endophthalmitis happened in two eyes in which one eye resulted in atrophy.Conclusion For traumatic cataract caused by corneal penetrating injury,suitable surgical timing and proper surgical method is important for visual outcome. Key words: Corneal penetrating injury ; Traumatic cataract; Lens, intraocular, posterior chamber; Implantation; Timing

Conductive keratoplasty: an approach for the correction of residual hyperopia in post-lasik pseudophakia.

Although there are many formulae for the calculation of intraocular lens power in the eyes with previous kerato-refractive surgeries, unexpected refractive bias still exists. Hyperopic bias is particularly disliked because it affects both uncorrected distance and near visual acuity. Surgical treatment of the residual hyperopia for the eyes with both laser in situ keratomileusis and cataract surgery remains to be a big problem. Conductive keratoplasty has been shown to be an effective, safe and predictable method for low and moderate hyperopia in the pseudophakic eyes or in the eyes with kerato-refractive surgeries. However, the efficacy and safety of conductive keratoplasty in the correction of residual hyperopia after both corneal and lens refractive surgeries has not been reported. Herein, we reported the surgical correction with conductive keratoplasty for cases of residual hyperopia with/without astigmatism after previous laser in situ keratomileusis for high myopia and following phacoemulsification combined with posterior intraocular lens implantation for complicated cataract.

The Efficacy of Retrobulbar Block Anesthesia Only in Pars Plana Vitrectomy and Transconjunctival Sutureless Vitrectomy

To evaluate the adequacy of retrobulbar block anesthesia only in vitreoretinal surgery. The study involved 90 patients, 25 who underwent 25-gauge transconjunctival sutureless vitrectomy and 65 who underwent 20-gauge standard pars plana vitrectomy. Twenty-five of the 90 patients also underwent combined phacoemulsification and posterior intraocular lens implantation. The efficacy of retrobulbar block anesthesia only was assessed by monitoring vital signs during surgery, reviewing patient responses to a questionnaire regarding their experience during surgery, and analyzing surgical outcomes. Four patients complained of moderate pain during surgery, but no patient complained of severe pain. Infiltrative anesthesia was additionally required in 14 patients. No patient experienced intraoperative complications due to head movement. Increased systolic blood pressure greater than 15 mm Hg occurred in 11 patients and increased respiratory rate by 3 breaths per minute or greater occurred in 7 patients. Anatomical and functional success rates were 95% and 80%, respectively. Complications included manageable retrobulbar bleeding (1 patient) and postoperative neovascular glaucoma (2 patients). Vitreoretinal surgery, particularly 25-gauge transconjunctival sutureless vitrectomy, can be safely and efficiently performed under retrobulbar block anesthesia only. Retrobulbar block anesthesia only could become a more acceptable anesthesia for vitreoretinal surgery for selected patients.

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.

Combined pars plana vitrectomy and lens management in complex vitreoretinal disease

Concurrent cataract and vitreoretinal disorders are relatively common. Additionally, a considerable number of phakic eyes develop visually significant cataract following pars plana vitrectomy. The ophthalmic literature is replete with reports of a combined procedure consisting of simultaneous cataract extraction, intraocular lens implantation, and pars plana vitrectomy to treat a wide range of vitreoretinal disorders and co-existing cataracts. Historical concerns of increased risk of complications with the combined procedure have been shown not to be clinically significant. The combined procedure offers the advantages of a single procedure, including faster recovery time and cost effectiveness. Earlier reports of the combined procedure describe pars plana lensectomy and extracapsular cataract extraction as techniques for cataract extraction. Currently, phacoemulsification with implantation of a foldable posterior intraocular lens implantation has become the preferred technique of cataract removal. With advances in instrumentation and surgical techniques, the combined procedure offers a safe and effective way to manage concurrent cataract and complex vitreoretinal disease.

The Outcome of the Functioning Filter After Subsequent Cataract Extraction

To evaluate and compare the outcome of functioning filtration surgery followed by cataract surgery with posterior intraocular lens implantation by both phacoemulsification and extracapsular cataract extraction (ECCE) techniques in glaucomatous eyes. We retrospectively evaluated the clinical course of 77 eyes (68 patients) that after successful trabeculectomy, underwent cataract surgery by either phacoemulsification or ECCE techniques. We determined the frequency of partial and absolute failure following cataract surgery by either phacoemulsification or ECCE in eyes with functioning trabeculectomies. Partial failure of intraocular pressure (IOP), control after cataract extraction was defined as the need for an increased number of antiglaucoma medications or argon laser trabeculoplasty to maintain IOP < or =21mm Hg. Complete failure of IOP control after cataract surgery was defined as an IOP >21 mm Hg on at least two consecutive measurements one or more weeks apart or the performance of additional filtration surgery. Failure rates were calculated using the Kaplan-Meier actuarial method. Failure rates between phacoemulsification and ECCE subgroups were compared using the log rank test. The probability of partial failure by the third postoperative year after cataract surgery was 39.5% in the phacoemulsification subgroup and 37.3% in the ECCE subgroup. This small difference is not statistically significant (P = 0.48). The probability of complete failure by the fourth postoperative year after cataract surgery was 12.0% in the phacoemulsification subgroup and 12.5% in the ECCE subgroup. This difference is also not statistically significant (P = 0.77). At the 6-month follow-up visit, visual acuity of both groups improved one or more lines in 87.0% of patients, and worsened one or more lines in 3.9% of patients. Sixty-one percent achieved visual acuity of 20/40 or better. The most frequent complication was posterior capsular opacification requiring laser capsulotomy that occurred in 31.2% of patients. Cataract extraction by either phacoemulsification or ECCE following trabeculectomy surgery may be associated with a partial loss of the previously functioning filter and the need for more antiglaucoma medications to control IOP.

Clear Lensectomy and Implantation of Low-power Posterior Chamber Intraocular Lens for the Correction of High Myopia

Although a variety of surgical procedures to treat high myopia have been studied, no consensus exists on the optimum procedure. Clear lensectomy with implantation of a posterior chamber intraocular lens has been regarded as risky, due to the higher incidence of retinal detachment in highly myopic eyes. The authors performed surgery and evaluation over 1 year in 52 eyes in which prophylactic retinal treatment, clear lensectomy, and posterior chamber intraocular lens implantation were used to treat high myopia of 12 diopters (D) or greater. Before lens extraction, 31 eyes underwent argon laser photocoagulation. Over the 1-year period, three additional eyes were treated, and six eyes that had been treated preoperatively received additional treatment. No cystoid macular edema, retinal detachment, or persistent corneal edema was observed in this series. At 1 year, 88.5% of the group achieved corrected visual acuity of 20/40 or better, compared with 75% preoperatively. Uncorrected visual acuity of 20/100 or better was achieved by 84.6% of the group. The mean postoperative spherical equivalent was -0.86 +/- 0.84 D. The refractive objectives were achieved. Complications reported previously with clear lensectomy were not experienced in this group. The low incidence of complications can be attributed to the short follow-up and probably in part to the prophylactic retinal treatment, combined with the phacoemulsification procedure for lens extraction. Longer follow-up is needed to fully assess the complications. Properly randomized prospective clinical trials will be able to fully assess the benefits and risks of prophylactic retinal treatment and clear lens extraction with posterior intraocular lens implantation. This series can help in evaluating this surgical procedure.

Subretinal Neovascularization in a Pseudophakic Eye Treated With Krypton Laser Photocoagulation

A 76-year-old myopic woman who had undergone bilateral extracapsular cataract extractions and received posterior intraocular lens implants underwent two sessions of krypton laser photocoagulation for subretinal neovascularization secondary to age-related macular degeneration in her right eye. The patient expired and histopathologic examination of her treated eye showed a posterior chamber intraocular lens with both haptics in the ciliary sulcus, areas of macular degeneration, evidence of krypton laser photocoagulation including a full-thickness retinal scar, and an area of clinically unsuspected subretinal neovascularization.