Posterior Lens Capsule Research Articles

Influence of the quality of viscoelastic removal on phacoemulsification results. Part 2. Dependence of “IOL – posterior lens capsule” interface status on viscoelastic visualization

BACKGROUND: Main methods of intraoperative secondary cataract prevention are measures aimed at the formation of full contact of the intraocular lens (IOL) with the posterior capsule. The diastasis between the IOL and the posterior capsule is explained by the presence of viscoelastic in the interface. Maximum visualization of the stained viscoelastic will obviously make it possible to completely remove it from the eye, which will increase the number of eyes with the optimal IOL posterior capsule interface with standard phacoemulsification.
 AIM: The aim was to study IOL posterior capsule interface status after phacoemulsification of senile cataract in relation to viscoelastic visualization.
 MATERIALS AND METHODS: 122 eyes of 122 patients were included, which underwent phacoemulsification of senile cataract with femto-laser assistance and were divided into 2 groups depending on viscoelastic characteristic (colored or transparent) used for anterior chamber filling prior to IOL implantation. IOL posterior capsule interface status was examined on the 1st and 7th day post-op in order to evaluate the contact between two structures.
 RESULTS: On the 1st day post-op, the absence of contact between IOL and posterior capsule was noticed more often in the second group, the number of eyes with this type of interface was 1.5 times lower in the 1st group. On the 7th day after surgery, optimal interface had place in 9 out of 10 eyes in the 1st group, in comparison with 2/3 of patients from the second group.
 CONCLUSION: Conducted investigation showed that the use of colored viscoelastic allowed creating the optimal IOL posterior capsule interface on the 7th day post-op in 87% of eyes of the main group in comparison with 67% eyes from the control group (the difference is statistically significant). The absence of contact between IOL and capsule can be considered as relative capsule block, which may form the high risk of secondary cataract.

Removing residual cortical material during cataract surgery: Visco polishing and the grindstone effect as a new surgical technique.

To describe a new technique for removing residual cortical material adjacent to posterior lens capsule during cataract surgery with the help of cohesive ophthalmic viscosurgical devices. In this technique, if there are still cortical remnants and lens epithelial cells left after the routine irrigation-aspiration and polishing at the final steps of cataract surgery, the capsule is filled to about one-third with a highly viscous cohesive ophthalmic viscosurgical device. Rinsing is performed from the anterior chamber with the water jet directed tangentially to the ophthalmic viscosurgical device bolus and towards the posterior capsule, which creates a turbulence creating a "grindstone effect". The ophthalmic viscosurgical device bolus transforms into a ball and starts to rotate very quickly within the capsule, grinding away the cortical remnants. In the first series of 62 cases, there were no intra-operative or post-operative complications. At day 1 there was no corneal oedema and no hypertension of intraocular pressure. Visual outcomes were good with a mean best corrected distance visual acuity of -0.01 ± 0.11 logMAR. This technique appears to be effective and fast in removing persistent cortical remnants from the surface of the posterior capsule, while minimising risks such as capsule aspiration during irrigation/aspiration. There is limited pressure and mechanical force applied on the capsule; the anterior chamber and the corneal endothelium remain safe since the ophthalmic viscosurgical device stays inside the capsular bag to its high cohesiveness and molecular weight. More data on a larger cohort of patients is planned to confirm these results and evaluate long-term effects on posterior capsule opacification.

Comperative analysis of accuracy between low-frequency ultrasound biomicroscopy and 14-MHz ultrasonography with tissue harmonic imaging for the evaluation of the posterior lens capsule in traumatic cataracts

BackgroundTo compare the accuracy of low-frequency ultrasound biomicroscopy (LFUBM) and 14-MHz ultrasonography with tissue harmonic imaging (14-MHz + THI) in the assessment of posterior capsule (PC) integrity in patients with traumatic cataracts (TCs).MethodsFrom January 2019 to October 2020, 51 patients (51 eyes) with TCs who were scheduled for cataract extraction and for whom the PC of the lens could not be observed by the slit lamp visited Tianjin Eye Hospital, including 47 patients (47 eyes) with a penetrating injury of the eyeball and 4 patients (4 eyes) with a blunt injury of the eyeball. All eyes underwent LFUBM and 14-MHz + THI examinations before cataract extraction to determine the integrity of the PC. The integrity of the PC observed in surgery was the actual findings, and the consistency between the 2 methods was assessed in terms of the preoperative examination and intraoperative findings. Fisher’s exact test was used for consistency analysis, and P < 0.05 was considered statistically significant.ResultsThirty-two eyes with ruptured PCs and 19 eyes with intact PCs were actual findings in surgery. Thirty eyes with ruptured PCs and 21 eyes with intact PCs were examined by LFUBM. Thirty-two eyes with ruptured PCs and 19 eyes with intact PCs were examined by 14-MHz + THI. There were no significant differences between the 2 methods and the intraoperative findings (P = 0.293 LFUBM, P = 0.623 14-MHz + THI). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of LFUBM and 14-MHz + THI were 91 and 94%, 95 and 89%, 97 and 94%, 86 and 89% and 92 and 92%, respectively.ConclusionsBoth LFUBM and 14-MHz + THI were proved to have high levels sensitivity and specificity in diagnosing the status of the PC in TC and they can be used as accurate diagnostic tool in these cases.

Хирургическое лечение при повреждении задней капсулы хрусталика после лазерного витреолизиса

Damage to the posterior capsule of the lens after laser vitreolysis causes the formation of traumatic cataracts and a decrease in visual acuity. The search for surgical methods of treating such complications is relevant. Purpose. To develop and improve the technique of posterior capsulorexis during phacoemulsification and implantation of IOL combined with vitrectomy in the presence of an initial injury of the posterior lens capsule. Material and methods. Clinical case - a patient came to the clinic with complaints about a decrease in visual acuity and quality after laser vitreolysis performed in another clinic. Observed the damage of the posterior capsule of the lens. The operation was performed according to the developed technique. Results. A method of primary posterior capsulorexis during phacoemulsification and implantation of IOL after vitreolysis, combined with vitrectomy, is proposed. Achieved high visual acuity after the operation, OD=1.0. Conclusions. 1) The developed technique of primary posterior capsulorexis is safe and allows partially preserving the posterior capsule of the lens, while forming a «window» in the area of damage, and implanting the IOL into a capsule bag. 2) The installation of scleral ports during primary posterior capsulorexis makes it possible to successfully combine this operation with vitrectomy and prevent the displacement of lens fragments to the fundus. Key words: сataract, posterior capsulorexis, laser vitreolysis, phacoemulsification, pseudophakia, IOL, vitrectomy, vitreous body.

Glaucoma secondary to congenital fibrovascular pupillary membrane: a single tertiary center experience

We report the clinical features, treatments, and outcomes of 9 infants with glaucoma secondary to congenital fibrovascular pupillary membrane. The clinical features included unilateral low vision, high intraocular pressure (IOP), enlarged and cloudy cornea, loss of anterior chamber, and pupillary membrane. All patients underwent membranectomy, peripheral iridectomy, pupilloplasty, and goniosynechialysis as primary treatment. The membranes were posterior to the iris in all 9 eyes. In 5 eyes, the membrane covered the ciliary processes, and in 1 eye the membrane reached the posterior lens capsule. Following primary surgery, 3 patients developed membrane recurrence, 4 had refractory elevated IOP, and 2 developed lens opacities. All 4 eyes with poor postoperative IOP control had iris root insertion anterior to the scleral spur. Five patients received additional surgeries including membranectomy, pupilloplasty, goniosynechialysis, cyclocryotherapy, ciliary photocoagulation, Amhed valve implantation, and lensectomy. One patient had refractory elevated IOP at last follow-up. IOP in the other 8 eyes was well controlled. None of the affected eyes was able to fix and follow at last follow-up.

Real-time intraoperative OCT imaging of the vitreolenticular interface during pediatric cataract surgery.

To report on the use of intraoperative optical coherence tomography (OCT) imaging of the vitreolenticular interface (VLI) during pediatric cataract surgery and to determine the incidence of VLI dysgenesis and surgical difficulties. Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. Retrospective cohort study. This study included 51 pediatric patients who underwent cataract surgery between April 2016 and December 2018. Video recordings and OCT images of the VLI were analyzed and compared. VLI dysgenesis was considered present when intraoperative OCT images demonstrated partial or total adhesions between the posterior lens capsule and the anterior hyaloid membrane. Video recordings were analyzed to describe surgical difficulties, more specifically: inability to create a calibrated primary posterior continuous curvilinear capsulorhexis (PPCCC), occurrence of vitreous prolapse, need for anterior vitrectomy, and complicated IOL implantation. Of the 51 patients included, VLI dysgenesis was demonstrated in 27 patients (52.9%). The incidence of VLI dysgenesis was greater in children with unilateral cataract (72.4%), and children with a posterior capsule plaque (90%). PPCCC was challenging in 20 patients. A defect of the anterior hyaloid membrane was found in 16 patients. Anterior vitrectomy or cutting vitreous strands with scissors was necessary in 10 patients. Intraoperative OCT images were an excellent tool to evaluate the VLI and to demonstrate the presence of VLI dysgenesis during pediatric cataract surgery. Performing a calibrated PPCCC was more challenging in the presence of VLI dysgenesis. This can subsequently expose a defect in the anterior hyaloid membrane, which may result in vitreous prolapse.

Changes in ocular parameters the crystalline lens after implantation of a collamer lens

ABSTRACT Clinical relevance Understanding changes in ocular anatomical parameters after intraocular lens implantation will allow a more accurate determination of dioptric power prior to surgery. Background The crystalline lens position might change due to the implantation and removal of an implantable collamer lens (ICL) or toric implantable collamer lens (TICL). This study aimed to assess the effect of ICL implantation on position of the crystalline lens. Methods This retrospective study was conducted on patients who underwent V4c ICL or V4c TICL implantation between March and September, 2018. Preoperative and post-operative (2 weeks, 3 months and 6 months) axial length, central corneal thickness, crystalline lens position, crystalline lens thickness and vault height were analysed. Multivariable linear regression was used to determine the variables associated with 6-month changes in lens position. Results This study included 117 eyes of 117 patients. There were decreases in all vertical distance measures from the central corneal endothelium to the anterior and posterior crystalline lens capsule (all p > 0.05). The amount of reduction was related to the crystalline lens position before the operation and crystalline lens thickness after the operation (all p < 0.01). An error in anterior chamber depth and lens thickness may appear when the ICL/TICL is close to the crystalline lens. Conclusion Phakic intraocular lens implantation resulted in lens thickening and forward movement on day 1 post-operatively, which becomes stable within 6 months. Preoperative lens position and post-operative lens thickness were related to the amount of movement.

Клинический случай замены помутневшей интраокулярной линзы на авитреальном глазу

Purpose. Using a clinical example, to analyze the possible causes of opacity of the Hydro-4 Aspheric IOL (Rumex, Great Britain). Materials and methods. Patient K., 32 years old, underwent the surgery for tractional retinal detachment in both eyes, which arose against the background of proliferative diabetic retinopathy of the retina. A history of type 1 diabetes mellitus from the age of 9. The visual acuity of both eyes before surgery was 0.03 n/k. Microinvasive (25G) vitrectomy with silicone oil tamponade of the vitreous cavity was performed. The second stage of surgical treatment is the removal of silicone oil from the vitreous cavity and phacoemulsification of cataract with partial excision of the posterior lens capsule with IOL implantation into the capsule bag of both eyes. A Hydro-4 Aspheric IOL (Rumex, UK) was implanted in the right eye, and Aspira-aAy (HumanOptic AG, Germany) – in the left one. After 3 months, on examination, attention was drawn to the diffuse opacity of the IOL of the right eye. The visual acuity was 0.01 n/k. The IOL replacement technique was as follows. Viscoelastic was injected into the anterior chamber and into the capsule bag through corneal paracentesis at 10 and 2 o'clock. The lens was dislocated into the anterior chamber and cut in half with vitreal scissors. The cut parts of the IOL were removed through a 2.2 mm tunnel at 12 o'clock. The Tecnis lens (AMO, USA) was chosen for implantation. Results and discussion. There was an increase in uncorrected visual acuity up to 0.4. There were no intra- and postoperative complications such as hemorrhagic, inflammatory, and also any from the cornea. The question remains open why, with the same tactics of the first two stages of surgical treatment of both eyes and implantation of lenses made of hydrophilic acrylic, only one IOL became cloudy. Accounting for the materials from which the IOL is made, which lens model is better to prefer to this day remains an urgent and unresolved problem for ophthalmic surgeons. Conclusion. The presence of a concomitant diabetes mellitus in the patient could influence the development of opacification of the hydrophilic acrylic IOL. Key words: IOL opacity, hydrophilic acrylic, IOL explantation, avitria.

Сравнительные клинико-функциональные результаты имплантации «реверсной-М» и «реверсной-М1» ИОЛ у пациентов с миопией высокой степени в отдаленном послеоперационном периоде

The formation of secondary cataracts in patients with high-grade myopia remains the main cause of vision loss in the long-term postoperative period. Taking this into account, a soft model of posterior chamber «reverse» IOL was developed in the Fyodorov Eye Microsurgery Federal State Institution, Moscow, which allows reducing the development of secondary cataracts. Purpose. Comparative analysis the clinical and functional results of implantation of «reverse M and M1» IOL in patients with high myopia in the long-term follow-up. Materials and methods. Clinical studies were conducted on 140 eyes of 97 patients with high-grade myopia aged from 42 to 83 years (on average, 64.24±0.79 years) after phacoemulsification cataract (FEC) with IOL implantation in high-grade myopia. The main group consisted of 57 eyes of 40 patients who were implanted with «reverse-M1» IOL, the control group-83 eyes of 57 patients who were implanted with «reverse-M» IOL. Visual acuity before surgery without correction in any patient did not exceed 0.01, and with the maximum correction was no more than 0.2 (80%). The follow-up period was up to 5 years. Results. Visual functions in the majority of patients increased and remained stable throughout the postoperative period, amounting to 0.55+0.04 in the main group, and 0.54+0.03 in the control group. In the late postoperative period, dissection of the posterior lens capsule with «reverse-M» IOL was performed in 11 eyes of 13 patients (13.2%), in the main group, YAG laser dissection of the posterior capsule was required in 2 patients with 3 eyes (5.3%). Conclusions. Implantation of a «reverse-M1» IOL is safe, predictable and allows you getting less PCO formation compare with «reverse-M» IOL in the long-term follow-up in patients with high myopia. Keywords: phacoemulsification cataract, implantation of «reverse» IOL, high myopia.

Объективная интраоперационная оценка локализации плавающих помутнений стекловидного тела при проведении ИАГ-лазерного витреолизиса

Purpose. To develop an optical method for assessing the localization of vitreous floaters in the vitreous cavity and to evaluate its efficacy compared to ultrasound assessment. Material and methods. The study included 35 patients (35 eyes) with Weiss ring. All the patients underwent echobiometry, as well as measurement of the distance from the vitreous floaters (VF) to the lens posterior capsule or towards retina by ultrasound and developed optical methods. Results. The mathematical modeling and the diopter difference between the slit-lamp oculars were used to develop a formula for the safe position of the VF in the vitreous cavity calculation. A comparative analysis of ultrasound and optical methods measurement results have showed their comparability. The values of the "limits of agreement" with 95% confidence intervals were: -0.02 [-0.07; 0.01] - the lower "consistency limit" and 0.25 [0.20; 0.29] - the upper "consistency limit". The average difference between methods with a 95% confidence interval was 0.11 [0.08; 0.13]. Conclusions. The developed optical method for assessing the safe localization of VF in the vitreous cavity showed comparable results with the ultrasound measurements. Futhermore, optical method allows to intraoperatively control the safe distance from the VF to the intraocular structures, thereby reducing the risk of YAG-vitreolysis complications. Key word: YAG laser vitreolysis, vitreous floaters, safe distance of vitreous floaters.

Результаты изучения катаракты у облученного населения на Южном Урале

Epidemiological data have revealed a significant association between exposure to ionizing radiation, loss of optical lens function, and cataract formation. Residents of villages in the Southern Urals were chronically exposed to external and internal radiation in the range of «small» and «medium» doses as a result of two radiation accidents at the «Mayak» plant in the middle of the last century. Purpose. Тo investigate changes in the lens in individuals who have been chronically exposed to radiation over a long time. Material and methods. Аn analysis of the results of the examination by an ophthalmologist in the clinical Department of the URCRM of 583 people from among those who were subjected to chronic radiation exposure and their offspring was carried out. The examination was carried out according to a special in-depth program with photo fixation of changes in the lens (18 characteristics). Results. According to the results of the examination, grade 1 and 2 opacities were most often detected in all layers of the lens. More expressed changes in the lens significantly reduce vision and require earlier cataract surgery. Lens Opacities in the cortical layers are the most common type of lens pathology in the development of cataracts in all age categories. The frequency of nuclear cataracts in the study group of patients of the URCRM Clinic gradually increases with attained age from 0% under the age of 40 to 19-23% in the age groups with members aged over 70. The same tendency is observed in the increase in the intensity of yellow color in the staining of the lens nucleus. The largest changes in the posterior lens capsule were observed in the oldest age group (over the age of 80 - 22% of all the opacities at this age). Conclusion. The ophthalmological examination of patients affected by radiation accidents in the Ural region revealed an increase in cataract cases with an increase in age, which corresponds to the trends in the non-irradiated population. Key words: eye diseases; chronic radiation exposure; cortical cataract; nuclear cataract; posterior subcapsular cataract.

Macrophage recruitment in immune-privileged lens during capsule repair, necrotic fiber removal, and fibrosis

SummaryEmerging evidence challenges the lens as an immune-privileged organ. Here, we provide a direct mechanism supporting a role of macrophages in lens capsule rupture repair. Posterior lens capsule rupture in a connexin 50 and aquaporin 0 double-knockout mouse model resulted in lens tissue extrusion into the vitreous cavity with formation of a “tail-like” tissue containing delayed regressed hyaloid vessels, fibrotic tissue and macrophages at postnatal (P) 15 days. The macrophages declined after P 30 days with M2 macrophages detected inside the lens. By P 90 days, the “tail-like” tissue completely disappeared and the posterior capsule rupture was sealed with thick fibrotic tissue. Colony-stimulating factor 1 (CSF-1) accelerated capsule repair, whereas inhibition of the CSF-1 receptor delayed the repair. Together, these results suggest that lens posterior rupture leads to the recruitment of macrophages delivered by the regression delayed hyaloid vessels. CSF-1-activated M2 macrophages mediate capsule rupture repair and development of fibrosis.

Large air bubble in the Berger space during cataract surgery

For treating retinal or Descemet membrane detachment, an expansive gas is purposefully injected into the vitreous cavity or the anterior chamber. However, it is important to consider the potential complications associated with gas injection, such as intraocular pressure elevation, intraocular lens (IOL) opacification, and gas bubble migration. It is crucial to deal effectively with unexpected intraocular air bubbles. The Berger space is an interspace between the posterior lens capsule and the anterior vitreous hyaloid that provides potential for gas bubble migration. In this study, the features and management during cataract surgery for an individual with a large air bubble in the Berger space is described. A 26-gauge needle was used to puncture the posterior capsule and aspirate the gas bubble; however, this intraoperative strategy was considered inappropriate. Other strategies, such as pars plana aspiration and posterior capsule capsulorhexis before IOL implantation, may be considered in similar cases in the future.

Изучение влияния различных вариантов интерфейса «интраокулярная линза – задняя капсула хрусталика» на остроту зрения и рефракцию артифакичных глаз в раннем периоде факоэмульсификации с фемтосекундным лазерным сопровождением у пациентов с возрастной катарактой

Purpose. To study the influence of various types of «intraocular lens – posterior lens capsule» (IOL–PLC) interface on visual acuity (VA) and refraction pseudophakic eyes in early postoperative period after femtosecond laser-assisted cataract surgery in patients with senile cataract. Material and methods. The study included 133 pseudophakic eyes of 133 patients after femtosecond laser-assisted cataract surgery. The study did not include patients with uncorrected VA less than 0.8 on the first day after surgery; with eye axial length less than 22 and more than 26 mm; with initial posterior capsule opacification in the central area; with corneal pathology; with corneal astigmatism more than 1 diopters; with pseudoexfoliation, rigid pupil and zonal weakness and with severe somatic pathology and cognitive impairment. On the first day and one month after the surgery, corneal astigmatism, the spherical and cylindrical component of objective refraction, uncorrelated and best corrected VA were studied and the type of IOL–PLC interface was determined. Results. On the first day after the surgery, all studied eyes were divided into 3 groups depending on the type of IOL–PLC interface and dependence of postoperative refraction on relations between IOL and PLC was revealed. The greatest changes in astigmatism during month after surgery were detected in eyes with initial incomplete contact IOL with PLC and presence of folds of the latter. The most stable indexes of VA and refraction in pseudophakic eyes were in presence full contact IOL and PLC. Conclusion. Initial incomplete contact IOL and PLC was exerted greatest negative influence on VA and refraction, which led to deformation PLC in form of residual folds and local sections of fibrosis in the central area in 51 eyes (66.2%) during month after surgery. Key words: phacoemulsification, cataract, posterior lens capsule, astigmatism, femtosecond laser-assisted.

A study for lens capsule tearing during capsulotomy by finite element simulation

Background and objectiveDuring capsulotomy, the force applied to the anterior capsule is a crucial parameter controlling capsule tears, that affects the clinical performance. This study aims to investigate the tear force in capsulotomy and analyze the effects of different tearing conditions on the tear force. MethodsA three-dimensional model of the human lens was constructed based on published clinical data using the finite element (FE) method. The lens model consisted of four layers: the anterior and posterior lens capsule, the cortex, and the nucleus. Distortion energy failure criterion combined with the bilinear interface law was used to express the crack propagation process at the edge of the anterior lens capsule. At the clamping position, a local coordinate system was established to parameterize the capsule tearing. The simulation results were then validated by conducting a capsulorhexis experiment using isolated porcine eyes with force-sensing forceps. ResultsThe simulation results showed a good agreement with the experimental data of two porcine specimens (No. 6 and 9) during a stable tearing process (p-values = 0.76 and 0.10). The mean force differences between the experimental data and the simulation were 3.10 ± 2.24 mN and 2.14 ± 1.73 mN, respectively. The tear direction with a minimum mean tear force was at θ1 = 0° and θ2 = 30°. The tear velocity was not significantly different to the variation in the tear force. However, an appropriate capsulorhexis diameter was found to contribute to the reduction of tear force. ConclusionsThe outcome of this paper demonstrates that our FE model could be used in modeling lens capsule tearing and the theoretical study of tear mechanism.

Macrophage Recruitment in Immune-Privileged Lens During Capsule Repair, Necrotic Fiber Removal and Fibrosis

Emerging evidence of the presence of immune cells challenges the concept of the lens as an immune privileged organ, however, the underlying mechanism remains elusive. Here, we provide a direct mechanism supporting a role of macrophage recruitment in immuno-privileged lens during capsule rupture repair, fiber cell removal and fibrosis. Posterior lens capsule rupture was observed in a connexin (Cx) 50 and aquaporin 0 (AQP0) double knockout (dKO) mouse model. A ruptured posterior lens capsule resulted in lens fiber tissue extrusion into the vitreous cavity, forming a disorganized “tail-like” tissue at postnatal age of 15 days (P15). This “tail-like” tissue also contained hyaloid vessels, fibrotic tissue and macrophages. The regression of the hyaloid vessel system that contains macrophages was delayed. Moreover, fiber cell debris were detected inside the macrophages, suggesting phagocytic engulfment by macrophages. Additionally, necrotic fiber cells were surrounded by macrophages in the “tail-like” lens tissue. These macrophages were reduced after P30, and phenotypically distinct M2 macrophages were detected inside the lens, which coincided with an increase in necrotic fiber cells. By P90, the “tail-like” tissue completely disappeared, and the posterior capsule rupture was healed and replaced with thick fibrotic tissue. Furthermore, administration of colony stimulating factor 1 (CSF-1) activated polarization of macrophages to M2 and accelerated capsule repair, while inhibition of the CSF-1 receptor delayed the repair process. Taken together, these results suggest that necrotic fiber cells associated with lens posterior rupture lead to the recruitment of macrophages, which are delivered by the regression delayed hyaloid vessel system. M2 macrophages activated by CSF-1 mediate capsule rupture repair, fiber cell removal and development of fibrosis.

Effect of capsular tension ring implantation on capsular stability after phacoemulsification in patients with weak zonules: a randomized controlled trial. CTR implantation in cataract patients with weak zonules

BackgroundThe use of capsular tension ring (CTR) implantation to treat cataract patients with weak zonules is still controversial. The aim of this study was to examine the effects of CTR implantation on capsular stability after phacoemulsification in patients with weak zonules, especially patients who have undergone pars plana vitrectomy (PPV) or those who suffer from severe myopia.MethodsA total of 42 patients who underwent phacoemulsification and received an intraocular lens (IOL) were randomized to undergo CTR implantation or not. The control and CTR groups were compared in terms of uncorrected distant visual acuity (UDVA), best corrected distant visual acuity (BCDVA), refractive prediction error, the area of anterior capsulorhexis, and IOL inclination angle. Follow-up visits were conducted postoperatively at 1 day, 1 week, 1 month and 3 months. Subgroup analyses were performed based on PPV and severe myopia.ResultsSurgery significantly improved UDVA and BCDVA to similar extents in CTR and control patients, and refraction prediction error was similar between the two groups at all follow-up times. At 3 months after surgery, the area of anterior capsulorhexis was significantly larger in CTR patients than in controls (p = 0.0199). These differences were also significant between the subgroups of patients with severe myopia. Vertical IOL inclination was less within CTR groups at 3 months after surgery, especially in patients with severe myopia (p = 0.0286). At 1 week postoperatively, the proportion of individuals whose posterior lens capsule that had completely adhered to the posterior IOL surface was significantly higher among CTR patients (p = 0.023). No serious surgical complications were observed.ConclusionCTR implantation can benefit cataract patients with weak zonules by maintaining the shape of the capsular bag, reducing capsule shrinkage and stabilizing IOL inclination.Trial registrationChinese Clinical Trial Registry ChiCTR-INR-17011217, date of registration April 22, 2017, prospectively registered.

Retrospektywna ocena powikłanych operacji zaćmy z implantacją na torebkę przednią jednoczęściowych zwijalnych soczewek wewnątrzgałkowych

Cel pracy: Ocena odległych wyników leczenia w grupie pacjentów poddanych operacji fakoemulsyfikacji zaćmy z fiksacją na torebkę przednią jednoczęściowych zwijalnych soczewek wewnątrzgałkowych.&#x0D; Materiał i metody: Grupę badaną stanowiło 24 oczu u 24 pacjentów, którzy w latach 2008–2015 zostali poddani operacji fakoemulsyfikacji zaćmy na Oddziale Okulistyki Centralnego Szpitala Klinicznego MSWiA w Warszawie. W grupie tej po śródoperacyjnym przerwaniu torebki tylnej soczewki zastosowano implantację jednoczęściowej zwijalnej soczewki wewnątrzgałkowej do komory tylnej z fiksacją na torebce przedniej soczewki. Oceniano ostrość wzroku, ciśnienie wewnątrzgałkowe, odcinek przedni i tylny oczu przed zabiegiem chirurgicznym, w 1. i 7. dobie po operacji oraz w okresie 6–84 miesięcy od zabiegu.&#x0D; Wyniki: W obserwacji trwającej od 6 miesięcy do 7 lat wykazano poprawę najlepszej skorygowanej ostrości wzroku (BCVA, best corrected visual acuity) średnio o 2 linie na tablicy Snellena oraz stwierdzono: u 25% badanych podwyższone ciśnienie wewnątrzgałkowe lub konieczność modyfikacji leczenia przeciwjaskrowego, u 42% pacjentów dyspersję barwnika z listka barwnikowego tęczówki, u 17% transiluminację tęczówki.&#x0D; Wnioski: Zastosowanie jednoczęściowej zwijalnej soczewki tylnokomorowej do fiksacji na torebce przedniej soczewki w sytuacji uniemożliwiającej jej implantację śródtorebkową u 67% pacjentów pozwoliło na poprawę pooperacyjnej ostrości wzroku. Jeśli decydujemy się na takie rozwiązanie, powinniśmy zapewnić pacjentom możliwość częstych kontroli, gdyż u 25% spośród nich możerozwinąć się jaskra wtórna. W przypadku gdy nie dysponujemy trzyczęściową soczewką tylnokomorową, wyżej opisany sposób fiksacji jednoczęściowej zwijalnej soczewki jest względnie bezpieczną techniką chirurgiczną.

Исследование офтальмопатологии у лиц, пострадавших в результате радиационных инцидентов

Aim. To investigate changes in the lens layers in individuals who have been chronically exposed to radiation over a long time. Methods. An analysis of the results of examination by an ophthalmologist in the clinical Department of the URCRM in 2018–2019 1 298 people. The examination was carried out according to a special in-depth program with photo fixation of changes in the lens. Results. An in-depth ophthalmological examination of patients affected by radiation accidents in the Ural region revealed an increase in cataract cases with increasing age, which corresponds to the trends in non-irradiated population. Initial changes in the lens were first detected in the age group from 40 to 50 years. At the age of less than 40 years, 41 people examined had no lens pathology. Changes in the cortical layers of the lens are the most common initial pathology in the development of cataract – in the age categories from 40 to 49 years and from 50 to 59, they accounted for 75 % of all types of lens opacities. Changes in the anterior lens capsule accounted for 21 % of all types of opacities, in the cortex –52 %, in the nucleus – 15 %, in the posterior capsule – 12 %. According to the intensity of lens opacities, the most frequent opacities of stages 1 and 2 were found in all layers. Changes in the lens nucleus gradually increase with age to 28–37 % in the age groups older than 70 years. The same trend is established in the increase in the intensity of yellow color in the staining of the lens. Opacity in the posterior lens nucleces capsule was found in 1 person aged 40–49 years, the greatest changes in the posterior lens capsule were observed in the oldest age group (over 80 years) – 20 % of all opacities at this age. Key words: ionizing radiation; small doses; cataract; involution processes.

Наш опыт хирургического лечения врожденной катаракты

Aim. To present our experience and evaluate the results of surgical treatment of congenital cataracts. Methods. A clinical analysis of the results of congenital cataract aspiration in 16 children (22 eyes) aged 2 months to 5 years is performed. Bilateral cataract was determined in 6 children, unilateral – in 10. Preoperative examination of children aged 3–5 years was carried out in a standard way. Children younger than 3 years of age at the initial appointment underwent non-contact examination methods, the remaining studies were performed under general anesthesia in the operating room immediately before surgery. Congenital cataract phacoaspiration was performed under general anesthesia using the Stellaris microsurgical system (Bausch and Lomb, USA) through a 1.2-mm paracentesis in the lens irrigation-aspiration regime. Hydrophobic IOL models were implanted. The posterior lens capsule was preserved in all cases. Mandatory was the appointment of cycloplegics in drops in the early postoperative period. Results. An increase in visual acuity (from 0.03 to 0.7) occurred in all cases. However, presence of obscuration amblyopia of varying degrees required regular courses of pleoptic treatment. Conclusions. The effectiveness of congenital cataracts phacoaspiration is ensured by the fulfillment of federal clinical recommendations, however, sutureless surgery allows achieving high functional results in the treatment of this pathology. Key words: congenital cataract; phacoaspiration; intraocular lens.