Rupture Of Posterior Lens Capsule Research Articles

Application of optical coherence tomography in the assessment of the posterior lens capsule during anti-angiogenic therapy

This study uses optical coherence tomography method to analyze the risks of developing changes in the posterior lens capsule in patients after IVI of an anti-angiogenic drug. The study involved 100 people (14 men and 86 women) with a natural lens and neovascular age-related macular degeneration (nAMD). The average age was 70.57±7.98 years. During the study (12 months), all patients underwent IVI of an anti-angiogenic drug aflibercept in the treat-and-extend (T&E) mode. All subjects were divided into 2 groups: with a total number of IVI less than 10 - group 1 (50 patients), and more than 10 IVI - group 2 (50 patients, of which 49 were included in the study). All patients underwent OCT using the Optopol REVO NX device (Poland) with the Anterior B-scan Wide protocol before inclusion in the study, as well as after 3, 6 and 12 months. It was found that the risk of developing a posterior lens capsule rupture, visualized using OCT, depends on the total number of IVI (correlation coefficient 0.473 p=0.001): the more IVI, the higher the probability that damage to the posterior capsule will occur after the next IVI, and after the 15th injection the risk of developing damage to the posterior capsule increases sharply. The astudy analyzed the risk factors for the development of posterior lens capsule damage that can be detected using OCT, and presented three risk groups for the development of rupture (or damage) of the posterior lens capsule depending on the number of intravitreal injections performed.

Posterior lens capsule rupture in non‐diabetic canine cataracts: Pre‐operative, intra‐operative, and post‐operative findings

To describe clinical features of non-diabetic canine cataracts with presumed pre-existing posterior capsule rupture (PLCR) and their surgical outcomes. Clinical records of 497 non-diabetic canines that underwent elective cataract surgery were reviewed. Twelve canines met the inclusion criteria indicative of PLCR pre-dating surgery. The incidence of presumed pre-existing PLCR was 12/497 (2.4%). Cataracts included were unilateral in 10 out of 12 canines (83.3%) and bilateral in the remaining two (16.7%). Four eyes (28.6%) had clinically detectable pre-operative lens-induced uveitis. The mean age at cataract diagnosis for cases included was 6.6 years, and golden retrievers were the most common breed affected (28.6%). Phacoemulsification surgery was performed at a median time of 110 days (range 17-403 days) after presentation. Pre-existing PLCR was found intra-operatively as a large ellipse spanning the posterior capsule from equator to equator centrally in 12 eyes and peripherally in two eyes. The capsular defect in all eyes with PLCR incorporated a distinct "pseudo-capsule" preventing vitreal presentation and ruling out intraoperative surgeon rupture. Ten eyes (71.4%) received an intraocular lens implant (IOL), and 13 eyes (92.9%) maintained vision throughout a mean follow-up period of 12 months. Posterior lens capsule rupture of blunt trauma origin and associated cataract formation, as reported in humans, may also be an infrequent but distinct cause of some cases of non-diabetic canine cataracts. Medical management of phacolytic uveitis and delayed phacoemulsification surgery may be beneficial by allowing time for "pseudo-capsule" development, increasing the likelihood of IOL placement and improved visual outcomes.

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.

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.

Influence of an intentionally induced posterior lens capsule rupture on the real-time intraocular pressure during phacoemulsification in canine ex vivo eyes.

To evaluate the changes in the intraocular pressure (IOP) following an intentionally induced posterior lens capsule rupture (PLCR) during phacoemulsification in enucleated canine eyes. Furthermore, to compare the IOPs between different stages of phacoemulsification for two different bottle heights (BH). Coaxial phacoemulsification was performed using a venturi-based machine at a 60 or 90 cm BH. A pressure transducer, inserted into the anterior chamber through the peripheral cornea, monitored real-time IOP. For one half of the lens, the sculpt-segment removal (SS) was followed by irrigation/aspiration (IA). The PLCR was intentionally created, and the SS and IA were repeated on the residual lens fragments. For the 60 cm BH, the mean IOP following the PLCR was significantly higher than before the PLCR during SS (28.30 ± 12.56 and 38.71 ± 9.43 mmHg before and after PLCR, respectively) and IA (42.76 ± 12.46 and 47.88 ± 7.10 mmHg before and after PLCR, respectively) stages (P < 0.001). For the 90 cm BH, the mean IOP following the PLCR was also significantly higher than before the PLCR during SS (33.39 ± 11.09 and 58.17 ± 6.89 mmHg before and after PLCR, respectively) and IA (62.39 ± 12.46 and 72.04 ± 8.59 mmHg before and after PLCR, respectively) stages (P < 0.001). The occurrence of a PLCR led to an increase in IOP during both the SS and IA stages. The elevated IOP after the PLCR might be one of the most important factors for ocular tissue damage, as it reduces ocular perfusion. Additionally, the BH should be reduced following PLCR to prevent complications stemming from the raised IOP.

When to postpone cataract surgery: Taking in consideration patients’ quality of life

Purpose: Assessment of complication in surgery of complicated cataracts and option of post- ponement of surgery. Setting: Clinic for eye diseases, Clinical Centre of Serbia Methods: This was a retrospective observational case series. Results: In 16 patients subjected to cataract sur- gery by method of phacoemulsification, three experi- enced complications during surgery. Two experienced rupture of posterior lens capsule and prolapse of the vi- treous body, and one, expulsive hemorrhage. The vi- sual acuity in all three patients was lesser than the preo- perative visual acuity. In the second group of 16 pati- ents, after having been acquainted with the survey, the cataract surgery was postponed and the patients were controlled after one year. The cataract progressed just partially in certain patients and all the patients were sa- tisfied with the status of their vision and did not de- mand surgery. CONCLUSIONS: Cataract surgery in complica- ted cases may be accompanied by complications with uncertain postoperative visual results. Therefore, in patients with complicated cataracts and relatively pre- served visual acuity, it is necessary to be careful with proposing surgery and often obey their wish to postpo- ne surgery. This should be done particularly with pati- ents of advanced age, patients with poor general status of life and in monoculuses.

Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract

To compare the accuracy of 3 imaging modalities for preoperative evaluation of the posterior lens capsule in traumatic cataract. Farabi Eye Hospital, Tehran, Iran. Case series. The study comprised eyes with traumatic cataract opaque enough to prevent visualization of the posterior lens capsule on slitlamp examination. To detect posterior lens capsule rupture before surgery, imaging was performed with 20 MHz echography (Eye Cubed), anterior segment optical coherence tomography (AS-OCT) (Visante model 1000), and Scheimpflug imaging (Pentacam). All patients subsequently had cataract extraction, and the intraoperative findings of the posterior lens capsule were compared with the preoperative findings of the imaging modalities. The study enrolled 21 eyes of 21 patients (20 men, 1 woman) with a mean age of 31.5 years ± 1.45 (SD). The nature of trauma was blunt (5 eyes) or sharp (16 eyes). To detect posterior lens capsule rupture, the sensitivity and specificity were, respectively, 80% and 86% for 20 MHz echography, 71% and 77% for AS-OCT, and 62% and 57% for Scheimpflug imaging (95% confidence intervals: sensitivity, 30.00-90.32; specificity, 54.81-92.95). Insufficient resolution for posterior lens capsule evaluation occurred in 33.3% cases for AS-OCT and 57.1% cases for Scheimpflug imaging. The accuracy of 20 MHz echography, AS-OCT, and Scheimpflug imaging was 76.1%, 61.9%, and 42.9%, respectively. In the evaluation of the posterior lens capsule in eyes with traumatic cataract, 20 MHz echography had higher accuracy than AS-OCT and Scheimpflug imaging. No author has a financial or proprietary interest in any material or method mentioned.

Retrospective analysis of 100 phacoemulsification

Objective To investigate the curative effect and complication of phacoemulsification at the first stage of the beginner.Methods A retrospective review of collected 109 eyes of 100 patients,who were followed-up for 0.5 - 2 years.Resnlts Ninty-eight eyes had completely successful phacoemulsification.Eleven eyes changed to undergo extracapsular cataract extraction and intraocular lens implantation (ECCE +IOL).The corrected visual acuities of eyes less than 0.1 were 5(4.59％ ),between 0.1 -0.5 were 43 (39.45 ％ ) and better than 0.5 were 61 (55.96％) after the surgery.A month after phacoemulsification,the corrected visual acuities of less than 0.1 were 4 eyes ( 3.67％ ),bettween 0.1 -0.5 were 31 (28.44％) and better than 0.5 were 74(67.89％ ).Corneal edema occurred in 25 eyes (22.94％).There were posterior lens capsule rupture in 16 eyes ( 14.68％ ),the incision without closure in 7 eyes (6.42％),iris damage in 5 (4.59％),partial rupture of capsulorhexis in 4 eyes ( 3.67％ ),lens cortex left over in 3 eyes (2.75％),partial rupture of suspensory ligament in 2 eyes ( 1.83％ ),detachment of Descemet' smembrane in 1 eye (0.92％),retinal detachment in 1 eye (0.92％),IOL inversion in 3 eyes (2.75％),IOL fall in vitreous cavity in 1 eye (0.92％).Condusion Beginners have more complications during phacoemulsification operation.There is a leafing curre. Key words: Early stage; Phacoemulsification; Complication; Learing curve

Evaluation of Posterior Lens Capsule by 20-MHz Ultrasound Probe in Traumatic Cataract

To investigate the accuracy of echography with a 20-MHz probe for evaluation of posterior lens capsule in traumatic cataract before surgery. Prospective interventional case series. This study consisted of 43 eyes with traumatic cataract that were scheduled to undergo surgery. In all cases, cataract was dense enough to prevent visualization of the posterior lens capsule. Echography was performed using a 20-MHz probe to detect rupture of the posterior lens capsule. All patients subsequently underwent cataract extraction and intraoperative findings of the posterior lens capsule were compared with the preoperative echographic findings. This study included 43 eyes of 43 patients (38 men and 5 women) with a mean age of 35.6 ± 15.3 years (range, 4-68 years). The trauma was either blunt (4 eyes) or sharp (39 eyes); there was closed globe injury in 2 eyes and open globe injury in 41 eyes. By 20-MHz echography, posterior border of the crsytalline lens was clearly visualized in all 43 eyes. By 20-MHz echographic imaging, rupture of the posterior lens capsule was identified in 17 eyes (39.5%). During cataract surgery, it was noted that 14 eyes (32.6%) had rupture of the posterior lens capsule. Sensitivity, specificity, positive predictive value, and negative predictive value were 93%, 86%, 76%, and 96%, respectively, for 20-MHz echography to detect rupture of the posterior lens capsule. Also, the positive likelihood ratio, negative likelihood ratio, and odds ratio were 6.7, 0.08, and 81, respectively. Echography with 20-MHz probe is an accurate imaging modality for detection of posterior lens capsule rupture in traumatic cataract preoperatively. This technique helps ophthalmologists have an appropriate surgical plan before operating.

Endophthalmitis after phacoemucification surgery

To study the infective endophthalmitis after phacoemulsification and to discuss the methods for prevention and treatment of this complication. A retrospective analysis was performed on phacoemulsification with implantation of artificial lens underwent in 10 MaiGe Ophthalmological Centers during past 10 years (from 1993 to 2003). Among 63,372 cases (84,497 eyes) underwent the phacoemulsification, 14 cases suffered infective endophthalmitis with the incidence of 0.02%. In these 14 cases, 11 cases occurred before 1999 (78.6%). There were 5 cases of ruptured posterior lens capsule in these 14 cases (35.7%). Microbiological examination was performed in 11 cases (aqueous or vitreous sample), 7 cases showed positive results (63.6%), including 3 cases of staphylococcus epidermidis (42.8%), 1 case of pseudomonas aeruginosa (16.7%), 1 case of bacilli (16.7%) and 2 cases (33.4%) of fungus (yeast and candida albicans). After the treatment, the vision of 5 patients was recovered to 2.0 or more, 4 cases recovered to hand movement and light perception, enucleation was performed in 3 cases and atrophy of eyeballs occurred in 2 cases. The attack rate of endophthalmitis after phacoemucification surgery is 0.02%. The main pathogen is staphylococcus epidermidis. Rupture of posterior lens capsule is one of the main risk factors of endophthalmitis. Observing the operative routine strictly pre-, during and post-operatively can reduce the occurrence of infective endophthalmitis.

Cataract Surgery Combined with Intravitreal Injection of Triamcinolone Acetonide

To evaluate whether the addition of cataract surgery to an intravitreal injection of triamcinolone acetonide markedly increases frequency and spectrum of complications. The comparative nonrandomized clinical interventional investigation included a study group of 60 eyes (56 patients) undergoing cataract surgery and additionally receiving an intravitreal injection of about 20 mg of triamcinolone acetonide and a triamcinolone control group of 290 eyes (262 patients) that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide without cataract surgery. Reasons for intravitreal injection of triamcinolone acetonide were exudative age-related macular degeneration (n=228; 65%), diffuse diabetic macular edema (n=94; 27%), central retinal vein occlusion (n=17; 5%), and branch retinal vein occlusion (n=11; 3%). Mean follow-up was 8.6+/-6.8 months. A second control group included 1068 patients (1068 eyes) who consecutively underwent routine cataract surgery without intravitreal injection. Study group and triamcinolone control group did not vary significantly in best visual acuity during follow-up (p=0.08), final visual acuity at the end of follow-up (p=0.30), maximal intraocular pressure during follow-up (p=0.99), frequency of an intraocular pressure higher than 21 mmHg (p=0.66), and intraocular pressure at the end of follow-up (p=0.06). Postoperative infectious endophthalmitis, wound leakage or other corneal wound healing problems, persisting corneal endothelial decompensation, rhegmatogenous retinal detachment, marked postoperative pain, or a clinically significant decentration of the intraocular lens were not observed. Study group and the non-triamcinolone control group did not vary significantly in the rate of posterior lens capsule rupture (p=0.11), postoperative infectious endophthalmitis, and persisting postoperative corneal endothelial decompensation. The addition of cataract surgery to an intravitreal injection of triamcinolone acetonide may not markedly increase amount and frequency of side effects and complications of intravitreal triamcinolone acetonide. No safe conclusions can be reached regarding differences in frequency of postoperative infectious endophthalmitis.

Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule

PURPOSE: To present a case of rapidly progressing traumatic cataract caused by posterior capsule rupture after nonpenetrating ocular injury, as well as a surgical procedure to safely implant the intraocular lens in such a traumatized eye. METHODS: In a 23-year-old man with traumatic cataract and posterior lens capsule rupture, a one-piece polymethylmethacrylate IOL was implanted before cataract extraction into the ciliary sulcus in front of the cataractous lens. Subsequently, the cataract was removed by pars plana lensectomy. RESULTS: The surgery and postoperative course were uneventful. Postoperative visual acuity was 20/20. CONCLUSION: We present a method of intraocular lens implantation in cases of rapidly progressing traumatic cataract caused by posterior capsule rupture after a blunt ocular trauma.

Long-term results of out-of-the-bag intraocular lens implantation

PurposeTo evaluate long-term results of out-of-the-bag intraocular lens (IOL) implantation. SettingDepartment of Ophthalmology, Tenri Yorozu Hospital, Nara, Japan. MethodsThis study comprised 22 patients, 13 women and 9 men, who had cataract surgery by phacoemulsification and out-of-the-bag IOL implantation because of a posterior lens capsule rupture. Sixteen patients had in-the-bag IOL implantation in the fellow eye, and these eyes were used as a control group. The IOL’s position was determined by ultrasound biomicroscopy (UBM). Anterior chamber flare counts were measured by a laser flare meter. The corneal endothelium was observed by specular microscopy. ResultsMean follow-up after cataract surgery was 35 months ± 22 (SD). The UBM revealed that in the 19 eyes with sulcus-to-sulcus IOL fixation, the optics touched the iris. In 3 eyes, 1 haptic was fixated at the sulcus and the other at the ciliary body. In 2 of these eyes, the optics did not touch the iris. Anterior chamber flare counts in eyes with sulcus-to-sulcus IOL fixation were significantly higher than in eyes with in-the-bag or sulcus-to-ciliary-body fixation (P < .05). There were no statistical differences in corneal endothelial cell counts based on haptic placement. ConclusionRubbing between the IOL optic and iris seems to contribute to the high flare counts in eyes with a sulcus-to-sulcus IOL fixation. A larger haptic angle may be needed to prevent contact between the iris and IOL optic in such cases.

Posterior lenticonus, cataracts and microphthalmia; congenital ocular defects in the Cavalier King Charles Spaniel

ABSTRACTEleven cases of congenital ocular defects were found in the screening of 144 Cavalier King Charles Spaniels in Sweden. Mainly posterior lenticonus, cataracts and microphthalmia were observed in the affected dogs, most of which were interrelated. Pathology was obtained from one of the cases demonstrating bilateral posterior lens capsule rupture with an unusual cellular reaction of the exposed lens material.

Ultrasonic Diagnosis of Posterior Lens Rupture

A case of ultrasonically-diagnosed posterior lens capsule rupture, confirmed at surgery, is presented. The A-scan and contact B-scan findings enabling the diagnosis to be made are presented. The ability to make such a preoperative determination allows for the planning of more rational therapy, and should help improve the final visual results in such cases.