Underwent Lens Extraction Research Articles

Changes in Iridotrabecular Contact and Intraocular Pressure after Phacoemulsification in Primary Angle-Closure Disease Spectrum.

To compare changes in the swept-source (SS) anterior-segment optical coherence tomography (AS-OCT) parameters and intraocular pressure (IOP) control after lens extraction in various spectra of primary angle-closure disease (PACD). A total 92 eyes from 92 patients with PACD who underwent lens extraction were included in the study. All patients underwent IOP measurement preoperatively and at 1 day, 1 week, and 1, 3, and 6 months postoperatively. SS AS-OCT was performed in all subjects preoperatively and 1 month postoperatively. All participants were divided into two groups depending on the presence of glaucomatous optic disc or visual field damage (group A, PAC suspect or PAC; group B, PAC glaucoma). The changes in IOP and anterior chamber angle parameters of SS AS-OCT of each group were compared. Regression analysis was performed to find factors associated with the degree of IOP reduction after lens extraction. Preoperatively, there was no significant difference in IOP between the two groups (16.3 ± 2.5 mmHg vs. 16.9 ± 3.2 mmHg, p = 0.297), but the number of glaucoma medications used was greater in group B (0.6 ± 1.0 vs. 2.0 ± 0.9, p < 0.001). Postoperatively, IOP was not significantly different, but the number of medications used was greater in group B (0.2 ± 0.7 vs. 0.9 ± 0.8, p < 0.001). Anterior chamber angle parameters including angle opening distance and trabecular-iris angle had a greater increase in group B after lens extraction. However, the residual iridotrabecular contact (ITC) index was significantly greater in group B (5.6 ± 7.0 vs 10.7 ± 12.1, p = 0.014). A greater change in the ITC index was related to a greater degree of IOP reduction (β coefficient, 0.429; p < 0.001). Eyes with PAC glaucoma had a greater residual ITC index after lens extraction compared with eyes of other PACD spectrum and required a greater number of glaucoma medications to maintain a similar level of IOP.

Effect of monofocal, wavefront-shaped and diffractive trifocal intraocular lenses on scanning-slit automated refraction

PurposeTo compare scanning-slit retinoscopy automated refraction spherical equivalent (ARSE) to subjective manifest refraction spherical equivalent (MRSE) in normal eyes with four different types of intraocular lenses (IOLs). DesignRetrospective cross-sectional study Methods279 pseudophakic eyes that underwent lens extraction at a private center with implantation of either a wavefront shaped IOL (Acrysof® Vivity, DFT015), a nonapodized diffractive trifocal IOL (Acrysof® Panoptix), or a monofocal IOL with negative spherical aberration (Tecnis ZCBOO) or aberration-free (Envista Mx60E). Patients who had an automated refraction measurement with retinoscopy refractometer and aberrometer (NIDEK OPD Scan III, Nidek Technologies) and subjective refraction data 1-2 months postoperatively were included in the study. Main outcome measured was the difference between automated refraction and subjective refraction. ResultsSixty-one eyes implanted with a DFT015 IOL, 78 eyes with a TFNT00 IOL, 40 with a ZCBOO IOL and 100 with a Mx60E IOL were enrolled in this study. Statistically significant myopic results were observed when using ARSE compared to MRSE in the DFT015 (-0.95±0.64, -0.33±0.65, p < .001), TFNT00 (-0.43±0.36, -0.2±0.35, p <.001), ZCBOO (-0.81±0.63, -0.4±0.69, p = .008) and Mx60E (-0.75±0.65, -0.45±0.52; p <0.05) IOL groups. The absolute difference between the 2 methods was statistically significant in the DFT015 IOL group (0.65±0.49; p< 0.05). ConclusionAutomated refraction yields myopic results in pseudophakic eyes with monofocal and presbyopia correcting IOLs and may be used with caution. Manifest refraction “push-plus” technique should be used in all pseudophakic eyes to avoid over-minus prescriptions, especially in patient with residual refractive error following cataract surgery.

IOL calculation using six formulas in children undergoing lens extraction and primary IOL implantation with and without posterior optic capture.

To evaluate formulas for intraocular lens (IOL) calculation in children undergoing lens extraction and IOL implantation. Retrospective, consecutive case series at the Department of Ophthalmology, Goethe University Frankfurt, Germany. We included eyes that received lens extraction and IOL implantation (SN60AT, Alcon, Fort Worth, TX) due to congenital or juvenile cataract. Preoperative assessments included biometry (IOLMaster 500/700, Carl Zeiss Meditec, Germany). To evaluate the measurements, we compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of six different formulas, and number of eyes within ± 0.5, ± 1.0, ± 2.0D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4-12 weeks after surgery. 66 eyes matched our inclusion criteria with a mean age of 6.3 years ± 3.2. MedAE was lowest in SRK/T (0.55D ± 1.08) followed by Holladay I (0.75D ± 1.00), EVO 2.0 (0.80D ± 0.89), Barrett Universal II (BUII, 0.86D ± 1.00), Hoffer Q (0.97 D ± 0.94), and Haigis (1.10D ± 0.95). Regarding eyes within ± 0.5D SRK/T (45.5.%, 30 eyes) performed best, followed by Holladay I (36.4%, 24 eyes), EVO 2.0 and BUII (each 34.8%, 23 eyes). There was a myopic shift seen in all formulas (MPE: -0.21 to -0.90D). Using modern formulas, or even AI formulas, for IOL calculation in children's eyes does barely improve predictability of the postoperative refraction. A myopic shift can be found for all formulas. However, specific formulas like SRK/T seem to better anticipate this.

Clinical Outcome of Manual Small-incision Cataract Surgery in Patients with Phacolytic Glaucoma

Abstract Aim and Objective: To study the clinical outcome of cataract surgery in patients with phacolytic glaucoma. Materials and Methods: This is a hospital based prospective interventional study done on 50 eyes of 50 cases of phacolytic glaucoma conducted over one year. Following initial medical management, patients underwent lens extraction through manual small incision cataract surgery (SICS). Clinical examination, best corrected visual acuity and intraocular pressure were noted preoperatively as well as postoperatively. Result: A total of 50 patients were enrolled in this study with female to male ratio of 1.5:1. The mean age of presentation was 62.48 years. Preoperative vision in the affected eye was only perception of light in all of them and IOP measured at presentation was &lt;30 mm Hg in 11 (22%), 30-40 mm in 17 (34%), 40-50 mm in 14 (28%) and &gt;50 mm in 8 (16%). Thirty patients (60%) had good vision in fellow eye due to pseudophakia. The average duration between the first and second eye surgery was 1-3 years. 94% of our patients were from rural areas. All patients presented within one week of the onset of symptoms. All patients underwent manual small incision cataract surgery with rigid IOL implantation in 35 patients (70%), whereas 15 cases (30%) were left aphakic and planned for secondary IOL at a later date. Intraoperative complications noted were zonular dehiscence in 38%, anterior capsular calcification which led to difficulty in anterior capsulorhexis in 32%, peripheral rhexis runoff in 20%, subluxated lens in 12% and posterior capsular rupture in 14%. BCVA at the end of 1 month was &gt;6/12 in 21 patients (42%), 6/12-6/18 in 14 patients (28%), and &lt;6/18 in 15 patients (30%). Among the 15 patients with vision &lt;6/18, 14 had low vision due to aphakia, and 1 had cystoid macular edema which was treated with systemic and oral steroids and topical non-steroidal anti-inflammatory agents. Conclusion: We concluded that lens-induced glaucoma is a cause of preventable blindness, particularly in elderly patients. Factors such as ignorance, socioeconomic challenges, lack of awareness, absence of an escort, and good vision in the other eye contribute to delayed presentation. Early diagnosis and treatment, along with sequential cataract surgery, are crucial for achieving better visual outcomes and preventing complications like lens-induced glaucoma.

Invivo generated autologous plasmin enzyme assisted vitrectomy, partial circumferential-oral retinotomy, silicone oil injection in patients with chronic retinal detachment without posterior vitreous detachment

PurposeTo report the results of invivo generated autologous plasmin enzyme(IVAP) assisted vitrectomy, partial circumferential-oral retinotomy and silicone oil injection for surgical treatment of patients with chronic retinal detachment without posterior vitreous detachment(PVD).MethodsStudy was performed in retrospective, comparative manner. A total of 16 consecutive eyes with chronic retinal detachment who had intravitreal injection of 50 µgr of t-PA and 0.1 ml of autologous whole blood, 3 days before surgery, underwent lens extraction with phacoemulsification, IVAP assisted vitrectomy, partial circumferential-oral retinotomy, and silicone oil injection(Study Group) were compared to a similar group of 15 eyes who had undergone vitrectomy, with or without lens extraction and silicone oil injection(Control Group) for the treatment of chronic retinal detachment. Primary outcome measures were initial retinal reattachment and number of operations at postoperative 6 months.ResultsMean age of 16 patients of whom 7 were female, was 39.31 ± 17.76 years in study group and 15 patients of whom 4 were female, was 35.40 ± 11.92 years (p = 0.607). Mean follow-up time was 10.68 ± 7.15 months in study group and 29.13 ± 18.83 months in control group (p = 0.001). Initial retinal reattachment was achieved in 87.50% (14 out of 16 patients) in the study group, whereas it was 46.66% (7 out of 15 patients) in the control group (p = 0.017). The mean number of operations for reattachment in the study group was 1.12 ± 0.34, whereas it was 1.46 ± 0.51 in the control group (p = 0.039) at postoperative 6 months While the preoperative LogMAR visual acuity was 1.25 ± 0.64, it was 0.53 ± 0.37 at postoperative 6 months in study group (p = 0.001). Conversely, in the control group, the preoperative LogMAR visual acuity was 1.22 ± 0.33, it was 1.20 ± 0.89 at postoperative 6 months (p = 0.780). At postoperative 6 months,, epiretinal membrane developed in 2 eyes of the study group, 1 eye in the control group, and phthisis bulbi occurred in 1 eye of control group.ConclusionIVAP assisted vitrectomy, partial circumferential-oral retinotomy and silicone oil injection is effective and safe for the surgical treatment of chronic retinal detachment without PVD.

Intraocular lens calculation using the ESCRS online calculator in pediatric eyes undergoing lens extraction.

To evaluate the ESCRS online calculator for intraocular lens (IOL) calculation in children undergoing lens extraction and primary IOL implantation. Department of Ophthalmology, Goethe-University Frankfurt, Frankfurt am Main, Germany. Retrospective, consecutive case series. Eyes that received phacoemulsification and IOL implantation (Acrysof SN60AT) due to congenital or juvenile cataract were included. We compared the mean prediction error (MPE), mean and median absolute prediction error (MAE, MedAE) of formulas provided by the recently introduced online calculator provided by the ESCRS with the SRK/T formula, as well as the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. Postoperative spherical equivalent was measured by retinoscopy 4 to 12 weeks postoperatively. 60 eyes from 47 patients with a mean age of 6.5 ± 3.2 years met the inclusion criteria. Mean axial length was 22.27 ± 1.19 mm. Mean preoperative spherical equivalent (SE) was -0.25 ± 3.78 D, and mean postoperative SE was 0.69 ± 1.53 D. The MedAE was lowest in the SRK/T formula (0.56 D, ± 1.03) performed significantly better ( P = .037) than Hoffer QST and Kane, followed by BUII (0.64 D, ± 0.92), Pearl DGS (0.65 D, ± 0.94), EVO (0.69 D, ± 0.94), Hoffer QST (0.75 D, ± 0.99), and Kane (0.78 D, ± 0.99). All of those were significantly above zero ( P < .001). 41 eyes received an intraoperative optic capture (68%). When excluding eyes that did not receive intraoperative optic capture (n = 19; 32%), the MedAE was shown to be lower. Using modern IOL calculation formulas provided by the ESCRS calculator provides good refractive predictability and compares for most of the formulas with the results with SRK/T. In addition, the formulas seem to anticipate the postoperative refraction better for eyes that receive a posterior optic capture.

A novel ADAMTSL4 compound heterozygous mutation in isolated ectopia lentis: a case report and review of the literature

BackgroundCongenital ectopia lentis is characterized by dislocation of the lens caused by partial or complete abnormalities in the zonular fibers. It can be caused by either systemic diseases or isolated ocular diseases. Gene detection techniques can provide valuable information when an etiological diagnosis is challenging. Herein, we report the case of a six-year-old girl with a confirmed diagnosis of isolated ectopia lentis caused by a compound heterozygous ADAMTSL4 gene mutation.Case presentationThe patient was a 6-year-old Chinese Han girl with strabismus in the right eye. Slit lamp examination revealed that the lens in the right eye was opacified and dislocated, without an ectopic pupil. Gene detection demonstrated the presence of a compound heterozygous mutation in the ADAMTSL4 gene [c. 2270dupG (p.Gly758Trpfs *59) and c. 2110A > G (p.Ser704Gly)], and the diagnosis of isolated ectopia lentis was confirmed. She underwent lens extraction, and a sutured scleral-fixated posterior chamber intraocular lens (IOL) was placed in the right eye. The best-corrected visual acuity was 0.1 one month postoperatively.ConclusionGene detection plays a crucial role in diagnosing disorders with similar symptoms, such as isolated ectopia lentis and Marfan syndrome. In this study, we used whole exons sequencing to diagnose isolated ectopia lentis and identified the variant c.2110A > G (p.Ser704Gly), which may be associated with the development of ectopia lentis and early-onset cataract in the patient. These pathogenic gene mutations have significant implications for the genetic diagnosis of congenital ectopia lentis, treatment, surveillance, and hereditary and prenatal counseling for the patient and their family members.

Paediatric cataract surgery with 27G vitrectomy instrumentation: the Ghent University Hospital Experience.

To describe a cohort of paediatric patients who underwent unilateral or bilateral lens extractions at Ghent University hospital using the Dutch Ophthalmic Research Center (D.O.R.C.) ultra-short 27G vitrectomy system. Retrospective analysis of the medical and surgical records of all children that underwent lens extraction between September 2016 and September 2020 using the D.O.R.C. ultra-short 27G vitrectomy system. Seventy-two eyes of 52 patients were included. The most important aetiologies in this study were of secondary (25.5%), developmental (13.7%), or genetic (13.7%) nature. No definitive cause could be established in more than a quarter of cases (27.5%) despite extensive work-up, them being deemed idiopathic. The remainder of cases (19.6%) was not assigned a final aetiologic designation at the time of the study due to contradicting or missing diagnostic data. This study could not identify any cataract cases related to infection or trauma. Surgical complications rate was 61.1% of which posterior capsule opacification was the most frequent with a rate of 25%. A significant short-term postoperative best-corrected visual acuity gain (≤ -0.2 LogMAR) was observed in 60.5% of eyes for which usable acuity data were available (n = 38). Many different instruments and techniques have been described and used in the context of paediatric lens extractions, each with its advantages and disadvantages. This study illustrates that an ultra-short 27G vitrectomy system can be used to perform paediatric lens extractions with good surgical outcomes. Further studies and comparative trials are needed to ascertain this further.

Scleral fixation of a novel modified, injected canine intraocular lens by haptic capture, in 17 dogs.

The aims of lens removal surgery are to re-establish or preserve both a clear visual axis and emmetropic vision. Trans-scleral intraocular lens (IOL) fixation has been described in cases where lens capsule instability precludes the insertion of a prosthetic intraocular lens into the lens capsule. Previous techniques have necessitated enlargement of the corneal incision to accommodate either a rigid polymethylmethacrylate IOL or an acrylic foldable IOL inserted using forceps. This paper reports the modification of an endocapsular IOL to be used as an injectable suture-fixated IOL introduced through a 2.8 mm corneal incision. All cases underwent lens extraction by phacoemulsification followed by removal of the unstable lens capsule. A PFI X4 IOL (Medicontur) was modified to create four open-loop haptics. The IOL was injected into the anterior chamber, each haptic was captured in a loop of suture introduced ab externo, and the lens was sutured with four-point fixation. The results from 20 eyes in 17 dogs are reported. Over an average follow-up time of 14.5 months, vision was retained in 16/20 eyes. Vision was lost in four eyes due to corneal ulceration and ocular hypertension (1/20), retinal detachment (2/20), and Progressive Retinal Atrophy (1/20). The modified PFI X4 proved suitable for injection and scleral fixation through a 2.8 mm corneal incision, with a success rate comparable to previously published techniques.

The Role of Genetic Testing in Children Requiring Surgery for Ectopia Lentis.

Non-traumatic ectopia lentis can be isolated or herald an underlying multisystemic disorder. Technological advances have revolutionized genetic testing for many ophthalmic disorders, and this study aims to provide insights into the clinical utility of genetic analysis in paediatric ectopia lentis. Children that underwent lens extraction for ectopia lentis between 2013 and 2017 were identified, and gene panel testing findings and surgical outcomes were collected. Overall, 10/11 cases received a probable molecular diagnosis. Genetic variants were identified in four genes: FBN1 (associated with Marfan syndrome and cardiovascular complications; n = 6), ADAMTSL4 (associated with non-syndromic ectopia lentis; n = 2), LTBP2 (n = 1) and ASPH (n = 1). Parents appeared unaffected in 6/11 cases; the initial presentation of all six of these children was to an ophthalmologist, and only 2/6 had FBN1 variants. Notably, 4/11 cases required surgery before the age of 4 years, and only one of these children carried an FBN1 variant. In summary, in this retrospective cohort study, panel-based genetic testing pointed to a molecular diagnosis in >90% of paediatric ectopia lentis cases requiring surgery. In a subset of study participants, genetic analysis revealed changes in genes that have not been linked to extraocular manifestations and highlighted that extensive systemic investigations were not required in these individuals. We propose the introduction of genetic testing early in the diagnostic pathway in children with ectopia lentis.

Association of Missense Variants in VSX2 With a Peculiar Form of Congenital Stationary Night Blindness Affecting All Bipolar Cells

Congenital stationary night blindness (CSNB) is an inherited stationary retinal disorder that is clinically and genetically heterogeneous. To date, the genetic association between some cases with CSNB and an unusual complex clinical picture is unclear. To describe an unreported CSNB phenotype and the associated gene defect in 3 patients from 2 unrelated families. This retrospective case series was conducted in 2021 and 2022 at a national referral center for rare ocular diseases. Data for 3 patients from a cohort of 140 genetically unsolved CSNB cases were analyzed clinically and genetically. Complete ocular examination including full-field electroretinography and multimodal fundus imaging (spectral-domain optical coherence tomography, color, infrared reflectance, and short-wavelength autofluorescence photographs) were performed. The gene defect was identified by exome sequencing and confirmed by Sanger sequencing and co-segregation analysis in 1 family. Screening was performed for genetically unsolved CSNB cases for VSX2 variants by direct Sanger sequencing. Ocular and molecular biology findings. The series included 3 patients whose clinical investigations occurred at ages in the early 30s, younger than 12 years, and in the mid 40s. They had nystagmus, low stable visual acuity, and myopia from birth and experienced night blindness. Two older patients had bilateral lens luxation and underwent lens extraction. Full-field electroretinography revealed an electronegative Schubert-Bornschein appearance, combining characteristics of incomplete and complete CSNB, affecting the function of rod and cone ON- and OFF-bipolar cells. Exome sequencing and co-segregation analysis in a consanguineous family with 2 affected members identified a homozygous variant in VSX2. Subsequently, screening of the CSNB cohort identified another unrelated patient harboring a distinct VSX2 variant. This case series revealed a peculiar pan-bipolar cell retinopathy with lens luxation associated with variants in VSX2. Clinicians should be aware of this association and VSX2 added to CSNB diagnostic gene panels.

Outcomes of surgical intervention in cases of ectopia lentis.

Purpose:To evaluate the outcomes of surgical intervention in cases of ectopia lentis.Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra-operative and post-operative complication, and specular count were recorded.Results: Seventy-eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra-lenticular lens aspiration was the most common (n-62/78; 79.5%) surgical procedure followed by lens aspiration, intra-capsular cataract extraction, phaco-aspiration, and pars-plana lensectomy. Simultaneous intra-ocular lens (IOL) implantation was performed in 46.2% (n-32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow-up. The post-operative CDVA was significantly better in the pseudo-phakic group compared to the aphakic group (p-0.02). The patient’s age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra-operative complication included vitreous hemorrhage (n-1) and lens matter drop (n-1). Post-operative complications were noted in 26.9% of the eyes (n-21/78) with a higher complication rate in the pseudo-phakic group (p-0.00). A second intervention was required in 7.7% of the eyes (n-6/78).Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate.

Active-fluidics versus gravity-fluidics in lens extraction: A systematic review and meta-analysis of randomized controlled trials.

To investigate differences in outcomes between active-fluidics and gravity-fluidics phacoemulsification systems. We searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published no later than December 1, 2021. The Cochrane Collaboration risk of bias tool was used for quality assessment. We presented the outcomes as standardized mean differences (SMDs) with 95% confidence intervals (CI). Sensitivity analysis was performed by removing studies that included ≥2 types of phacoemulsification tips. We analyzed six RCTs that totally enrolled 884 patients. Patients undergoing lens extraction with active-fluidics systems exhibited lower cumulative dissipated energy (CDE), total aspiration time (TAT), and estimated fluid usage (EFU) compared with patients who did not (SMD [95% CI]: CDE, - 0.818 [ - 1.054 to - 0.582]; TAT, - 0.664 [ - 0.850 to - 0.479]; EFU, - 0.655 [ - 0.932 to - 0.378]). A sensitivity analysis revealed similar results for CDE, TAT, and EFU. For endothelial cell density (ECD) 1 week after surgery, ECD 1 month after surgery, and central corneal thickness (CCT) 1 week after surgery, outcomes of both systems were comparable (ECD at 1 week, 0.074 [ - 0.177 to 0.325]; ECD at 1 month, 0.069 [ - 0.167 to 0.305]; CCT 1 week after surgery, 0.077 [ - 0.173 to 0.328]). No severe adverse events in patients treated with either system were reported in the studies. Active-fluidics systems are superior to gravity-fluidics systems with respect to CDE, TAT, and EFU; no differences in postoperative ECD and CCT were observed. Future studies are required to determine the reasons for heterogeneity and to detect rare adverse events.

Factors Associated with Deterioration of Primary Angle Closure after Lens Extraction.

The purpose of the study was to explore factors associated with glaucomatous deterioration in eyes with primary angle closure (PAC) after lens extraction, including PAC suspect (PACS), PAC, and PAC glaucoma (PACG). We retrospectively analyzed data of 77 eyes with PACS, PAC, and PACG that underwent lens extraction with more than 2 years postoperative follow-up. Postoperative glaucoma progression was analyzed by either structural (optic disc/retinal nerve fiber layer (RNFL) photographs or optical coherent tomography (OCT)) or functional (visual field (VF)) criterion. Cox proportional hazard analysis (hazard ratio (HR)) was used to determine risk factors for progression using uni-and multivariate analysis. The analysis was conducted in groups with or without glaucomatous optic neuropathy (PACS/PAC vs. PACG). Forty-one eyes with PACS/PAC and 36 eyes with PACG were included. The mean postoperative follow-up period was 3.5 ± 1.4 years. Intraocular pressure (IOP) was reduced postoperatively from 23.1 ± 14.4 to 13.4 ± 2.1 mmHg. In the PACS/PAC group, seven eyes (17.0%) showed structural progression, but none showed progression in VF. Preoperative RNFL thickness was the only risk factor for structural progression (HR = 0.928, p = 0.002) in the PACS/PAC group. In the PACG group, 24 eyes (66.7%) showed structural progression and 12 eyes (33.3%) showed VF progression. Thinner preoperative RNFL thickness (HR = 0.964, p = 0.043) and high postoperative IOP fluctuation (HR = 1.296, p = 0.011) were significantly associated with VF progression; none of the factors were associated with structural progression. Angle closure eyes with thinner baseline RNFL thickness and higher postoperative IOP fluctuation may require careful follow-up for glaucoma progression after lens extraction.

Clinical characteristics and treatment of secondary glaucoma, glaucoma suspects and ocular hypertension after congenital cataract surgery.

To evaluate changes in intraocular pressure after congenital cataract surgery in a real-world setting. This retrospective case series included all children aged 0-2 years undergoing lens extraction due to congenital cataract. Development of an elevated intraocular pressure was divided into three groups: secG, suspG and OHT. Further, risk factors for IOP changes, the therapeutic approach and functional outcome were assessed during follow-up. One hundred and sixty-one eyes of 110 patients aged 0-2 years were included, whereof 29 eyes of 17 children developed secondary glaucoma (secG; 11 eyes/8 patients), glaucoma suspect (suspG; three eyes/three patients) or ocular hypertension (OHT; 15 eyes/10 patients). No difference in surgrical procedure (p = 0.62) was found, but age at cataract surgery differed significantly (p = 0.048), with the secG group (1.74 ± 1.01 months) being the youngest (suspG: 3.93 ± 1.80 months; OHT group: 5.91 ± 5.36 months).Secondary surgical intervention was significantly higher in the secG (4.64 ± 3.41) followed by the suspG (2.00 ± 2.65) and OHT groups (0.40 ± 0.74; p < 0.001). Postoperative complications including nystagmus (p = 0.81), strabismus (p = 0.98) and amblyopia (p = 0.73) showed no difference, in contrast to visual axis obscuration which was more common in the secG group (p = 0.036). Initial lensectomy and anterior vitrectomy procedure together with or without IOL implantation seems to have no influence for the development of IOP changes after pediatric cataract surgery. However, children who developed secondary glaucoma had cataract surgery significantly earlier, within the first 2-3 months of life. Glaucoma surgery was required to achieve final IOP control in most eyes. The development of secondary glaucoma was also associated with a significant increase in surgical re-treatments.

Comparison of retropupillary fixated iris claw lens versus sclera fixated lens for correction of pediatric aphakia secondary to ectopia lentis

AIM:To evaluate the postoperative visual acuity and complications in eyes with ectopia lentis in children who underwent lens removal and then implantation of retropupillary fixated iris claw lens versus scleral fixated intraocular lens (SFIOL) implantation.MATERIALS AND METHODS:A retrospective analysis of pediatric cases who presented with lens subluxation secondary to ectopia lentis and who underwent lens extraction (57 eyes of 38 patients) with either retropupillary iris fixated intraocular lens (IOL) implantation (Group A – 36 eyes of 20 patients) and SFIOL implantation (Group B – 21 eyes of 18 patients) was done over a period of 5 years from March 2010 to February 2015. The main outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA) and secondary postoperative complications.RESULTS:The study patients were divided into two groups: Group A patients were implanted with retropupillary iris claw lens whereas Group B patients were implanted with SFIOL. The mean age of presentation was 12 years, the mean follow-up period was of 24 months (range 14–36 months), and the median follow-up period was 26 months in both the groups. An improvement in the mean BCVA (LogMAR) was seen in both the groups. In Group A, the mean BCVA improved from 1.5 ± 0.2 preoperatively to 0.3 ± 0.2 postoperatively, whereas in Group B, the mean BCVA improved from 1.5 ± 0.3 preoperatively to 0.3 ± 0.2 postoperatively (P < 0.001). None of the eyes in either of the groups had any serious complications such as glaucoma, uveitis, cystoid macular edema, or endophthalmitis.CONCLUSION:Retropupillary iris fixation and scleral fixation of IOL are both safe and viable options for the correction of ectopia lentis in pediatric age group.

Sutured Scleral Fixation of Posterior Chamber Intraocular Lens in Children under the Age of 9 with Congenital Ectopia Lentis

Introduction: This study aimed to report the visual acuity outcomes and complications of sutured scleral fixation of posterior chamber intraocular lens (IOL) in children under 9 years old with congenital ectopia lentis. Methods: Twenty-six children (47 eyes) with congenital ectopia lentis were included in this study. The mean age at surgery was 61.6 ± 22.3 months (range, 32–94). Patients underwent lens extraction, anterior vitrectomy, and sutured scleral fixation of posterior chamber IOL. The implanted IOL included rigid polymethyl methacrylate (PMMA) IOL (CZ70BD, n = 36) and foldable IOL (SA60AT, n = 9, and LI61SE, n = 2). The outcome measures used to assess the benefits were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, intraocular pressure, and any associated complications. Median follow-up was 33.0 months (range, 4–129). Results: After surgery, the median UCVA (1.30 vs. 0.35 logMAR) and BCVA (0.82 vs. 0.15 logMAR) improved significantly (p < 0.001). The median absolute spherical values decreased considerably (9.00 vs. 0.75 D; p < 0.001). The median astigmatism was lower in foldable IOL compared to rigid PMMA IOL (1.0 vs. 2.5 D; p = 0.026), but neither the UCVA nor BCVA was significantly different. There was no intraoperative complication. Postoperative complications included pupillary capture in 4 eyes (9%), IOL decentration in 4 eyes (9%), choroid edema in 1 eye (2%), and subretinal hemorrhage in 1 eye (2%). The rate of secondary surgery was 9%, caused by IOL decentration of IOL haptics which was broken in 3 eyes and suture degradation in 1 eye. Conclusion: Sutured scleral fixation of posterior chamber IOL provided good visual outcomes in children under 9 years of age with congenital ectopia lentis. Although there were some risks of secondary surgery, the complications were acceptable.

Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study.

Purpose To compare ocular anatomy differences of lens subluxation between eyes with or without acute angle closure (AAC). Methods This is a retrospective and case-control study. Sixty cases with mild lens subluxation were recruited. Among them, 30 eyes with acute angle closure were assigned to the AAC group and 30 eyes without AAC were assigned to the non-AAC group. The anterior segment was quantitatively evaluated by ultrasound biomicroscopy (UBM). The axial length (AL) was measured with IOL Master. All patients underwent lens extraction surgery and were followed up for six months. Results The history of blunt trauma accounted for 22 (73.3%) cases in the AAC group and 21 (70%) cases in the non-AAC group. Fifteen (50%) patients in the AAC group had iridotomy history, and high intraocular pressure recurred. The UBM analysis showed that the average central chamber depth of the affected eyes in the AAC group was 1.82 mm, which was significantly shallower than that in the fellow eyes (2.58 mm, P < 0.05) or both eyes in the non-AAC group.Both eyes in the AAC group presented a shorter AL and shallower anterior chamber than the eyes in the non-AAC group. Conclusions An asymmetrical anterior chamber between bilateral eyes is an important feature in lens subluxation-induced AAC. The crowded anterior chamber and shorter AL might be the anatomic basis for the eye with lens subluxation-induced AAC.

Glaucomatous Progression After Lens Extraction in Primary Angle Closure Disease Spectrum.

Substantial proportion of primary angle closure glaucoma (PACG) eyes showed glaucomatous worsening after successful lens extraction and intraocular pressure (IOP) control, which may suggest that an earlier intervention may be required to prevent PACG. The purpose of this study was to investigate the longitudinal clinical course of the primary angle closure (PAC) disease spectrum, including PAC, primary angle closure suspect (PACS), and PACG patients, who underwent lens extraction. This retrospective observational study included 77 eyes from patients with PACS, PAC, and PACG who underwent lens extraction and were followed up for >2 years after surgery. The mean, peak, and fluctuation of IOP were analyzed before and after lens extraction among groups. Visual field (VF) mean deviation was compared immediately after lens extraction and the final follow-up. Postoperative glaucoma progression determined by 3 criteria (optic disc/retinal nerve fiber layer photographs, optical coherent tomography, and VF) was compared among the 3 groups. Seventeen PACS, 24 PAC, and 36 PACG eyes were included. The mean and peak IOP, and IOP fluctuation IOP were significantly reduced postoperatively in all groups. Postoperative VF mean deviation was significantly aggravated only in the PACG group (from -7.26 to -8.82 dB, P<0.001). The prevalence of postoperative glaucoma progression by at least 1 criterion was significantly higher in PACG, and none of the eyes with PACS and PAC showed VF conversion (PACS, PAC, PACG; 11.8%, 12.5% vs. 61.1% in disc/retinal nerve fiber layer, 11.8%, 8.3% vs. 63.9% in optical coherent tomography, 0%, 0% vs. 33.3% in VF, all P<0.001). In the PAC spectrum, lens extraction achieved significant IOP reduction. However, despite IOP control, a substantial proportion of PACG eyes showed glaucomatous progression. This result may suggest that lens extraction should be performed early to prevent PACG.

Characteristics and Risk Factors for Pupillary Capture of Intraocular Lens in Congenital Ectopia Lentis

ABSTRACTImportance: To analyze the characteristics and risk factors for pupillary capture (PC) of the intraocular lens (IOL) in congenital ectopia lentis (CEL) patients.Methods: Data of CEL patients who underwent lens extraction and intraocular implantation from 2013 to 2016 at Zhongshan Ophthalmic Center in China were collected. Best-corrected visual acuity (BCVA), axial length (AL), refractive status, corneal curvature, intraocular pressure (IOP), degree of lens dislocation, presence of strabismus, and methods of IOL fixation were recorded. Postoperative data were collected from the routine one-month postoperative follow-up. Patients with PC of IOL were characterized and risk factors for PC of IOL were analyzed using age-sex adjusted multiple logistic regression analysis.Results: Of the 89 included CEL subjects, 43.8% (39/89) of them suffered from PC after IOL implantation. There was no statistically significant difference in BCVA, AL, refractive status and IOP between the eyes which developed PC versus those which did not. Age-sex multiple logistic regression analysis shows that PC of IOL was associated with a more severe degree of lens dislocation and eyes with strabismus before surgery.Conclusions: Eyes with strabismus and more severe degrees of lens dislocation before surgery are risk factors for PC of IOL. When treating patients that present these risk factors, preoperative communication, and postoperative follow-up should be strengthened. Considering that PC of IOL has little effect on visual acuity, patients with slight PC of IOL can be exempt from surgical intervention.