Vitreous Prolapse Research Articles

Study of the Efficacy of Postoperative Topical NSAID for Prevention of Pseudophakic Macular Edema after Phacoemulsification Complicated with Rupture Posterior Capsule and Vitreous Prolapse

Study of the Efficacy of Postoperative Topical NSAID for Prevention of Pseudophakic Macular Edema after Phacoemulsification Complicated with Rupture Posterior Capsule and Vitreous Prolapse

Dexamethasone Intracanalicular Insert versus Standard Topical Steroids for the Prophylaxis of Inflammation after Cataract Surgery

To compare the efficacy of an intracanalicular dexamethasone intracanalicular insert (DII) to a topical prednisolone acetate 1% taper for preventing breakthrough inflammation (iritis or cystoid macular edema) during the first post-operative month (POM1) after cataract surgery DESIGN: Retrospective, non-randomized comparative interventional study METHODS: Patients received either DII or topical prednisolone acetate 1% eyedrops (control) during POM1. Exclusion criteria included history of iritis, glaucoma, intraoperative posterior capsular rupture or vitreous prolapse, immediate postoperative anterior chamber inflammation requiring treatment, or less than 1 month follow up post-operatively. Outcomes included development of breakthrough inflammation after >3 days postoperatively necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1. 266 eyes of 174 patients were included in the DII group, and 258 eyes of 167 patients in the control group. Demographics, comorbidities, and baseline IOP were comparable between groups. The breakthrough inflammation rate was significantly higher in the DII group compared to control (9.0% vs 3.1%; p < .01); cystoid macular edema rates were similar between groups (4.9% vs 4.3%; p = .75). There were no cases of increased IOP >10mmHg at POM1 compared to baseline in either group. After cataract surgery, DII demonstrated a higher rate of breakthrough inflammation than a standard topical steroid regimen with no significant differences in CME rate or IOP increase; however, overall, the rate of postoperative complications was low. DII can be a safe and effective alternative to topical corticosteroid therapy after cataract surgery.

Corneal perforation with vitreous prolapse having an intact anterior hyaloid face

Corneal perforation with vitreous prolapse having an intact anterior hyaloid face

Unilateral lifebuoy cataract: A case report.

Lifebuoy cataract is a rare congenital condition characterized by lens thinning. Due to its rarity, detailed treatment reports and standardized surgical approaches are limited. This study aims to enhance the current body of knowledge by presenting comprehensive case reports and describing surgical techniques for the treatment of lifebuoy cataracts. A 14-year-old boy was diagnosed with a congenital cataract in his right eye at the age of 9, which was left untreated. The patient visited our hospital due to progressive visual impairment. The visual acuity of the right eye was counting fingers at 30 cm. The uncorrected visual acuity of the left eye was 20/100, whereas the best corrected visual acuity was 20/20. The intraocular pressures were 18 mm Hg (left eye) and 20 mm Hg (right eye). Slit-lamp microscopy revealed central calcification of the lens capsule in the right eye and slightly opaque cortical tissue in the periphery, with no observable lens nucleus. Anterior segment optical coherence tomography (CASIA2, TOMEY, Nagoya, Japan) of the right eye showed fused anterior and posterior capsules and an absence of the lens nucleus, leading to a diagnosis of lifebuoy cataract. Cataract surgery was performed on the right eye. Following a 2.4-mm sclerocorneal incision and trypan blue staining, continuous curvilinear capsulorrhexis was performed around the central opacity. The surrounding cortex was removed using irrigation and aspiration, while a viscoelastic agent was injected between the central calcified membrane and the posterior capsule. The membranous tissue was carefully peeled away and removed using forceps. Despite residual posterior capsular opacification, posterior capsulotomy was not performed due to concerns about vitreous prolapse. The intraocular lens was fixed within the capsule. Ten days post-surgery, the remaining posterior capsular opacification was treated with neodymium-doped yttrium aluminum garnet laser capsulotomy. The uncorrected visual acuity and best corrected visual acuity of the right eye improved to 20/100 and 20/50, respectively. This case report demonstrates a successful surgical approach for a lifebuoy cataract, highlighting its unique morphology and the need for careful, specialized techniques. These findings aim to guide ophthalmologists in managing this rare condition, potentially improving patient care.

Intraocular lens selection in diabetic patients: How to increase the odds for success.

The incidence of cataracts is significantly higher in diabetic individuals, particularly in younger age groups, with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics. Cataract surgery in diabetic patients poses many challenges: Poor epithelial healing, decreased corneal sensitivity, increased central corneal thickness, decreased endothelial cell count, variable topography, poor pupillary dilatation, anterior capsular phimosis, posterior capsular opacification (PCO), chances of progression of diabetic retinopathy (DR), zonular weakness, and vitreous prolapse and diabetic macular edema. Selection of an appropriate intraocular lens (IOL) is crucial for visual rehabilitation and monitoring DR. The choice of IOL in diabetic cataract patients is a challenging scenario. Square-edge IOLs are favored for their capacity to mitigate PCO, whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR. The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation, particularly in the presence of advanced retinopathy. Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications. Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes. This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

Delayed vitreous prolapse causing corneal decompensation with normal Intraocular pressure: A case report

Vitreous prolapse is a postcataract surgery complication that can further cause corneal decompensation, glaucoma, macular edema, and retinal detachment. We present a rare case report of delayed vitreous prolapse in a 55-year-old man 20 years after cataract surgery with posterior capsular rupture causing diminution of vision and central corneal decompensation. To our surprise, the intraocular pressure was 18.6 mmHg (within the normal limits). The patient underwent pars plana vitrectomy for the same and had excellent postoperative visual recovery.

Epithelial ingrowth in descemet membrane endothelial keratoplasty associated with vitreous loss

BackgroundEpithelial ingrowth is a rare but potentially sight-threatening complication caused by the invasion of corneal or conjunctival epithelial cells into the eye during ocular surgeries. DMEK is emerging as a widely used surgery for endothelial keratoplasty with its improved safety profile. We describe a case of epithelial ingrowth in the graft-host interface after uneventful DMEK associated with vitreous prolapse in the anterior chamber.Case presentationAn 81-year-old female with Fuchs endothelial dystrophy underwent DMEK for corneal decompensation following cataract surgery. During the DMEK procedure, vitreous prolapse was observed around the intraocular lens (IOL). Her early postoperative course was unremarkable, but a dense paracentral interface opacity was observed during the 3-month follow-up. The area of epithelial ingrowth was imaged with optical coherence tomography (OCT) as a uniform nodule with a discrete increase in interface hyperreflectivity. A low-energy YAG laser was applied to remove the opacity. She maintained good vision and clear cornea without reoccurrence after treatment.ConclusionsWe propose that, in addition to the introduction of epithelial cells during surgery, vitreous retention in the anterior chamber may be a risk factor by providing a scaffold that potentially aggravates epithelial ingrowth in DMEK. Our case demonstrated that early YAG intervention may disrupt interface epithelial cell growth, and the transmitted laser energy may fragment the scaffold vitreous noninvasively.

Zone 1 trauma: wound dehiscence compared to primary trauma.

The study aims to assess if Zone 1 globe injuries hold a favorable prognosis for all situations, including wound dehiscence, or just primary traumatic injuries. Retrospective cross-sectional chart review of patients who underwent open globe repair from 1/1/2019 to 12/1/2020 at an urban hospital setting was evaluated for final visual outcomes, associated ocular pathology, long-term complications, and need for further surgeries. Fifty-eight eyes were identified-38 primary trauma and 20 dehisced wounds (11 penetrating keratoplasties, five clear corneal incisions, one laceration, one extracapsular cataract extraction, one radial keratotomy, and one tectonic graft). Dehisced wounds had more posterior segment pathology vs primary trauma, i.e., hemorrhagic choroidal, vitreous hemorrhage, retinal detachment, choroidal effusion (all 20% vs 2.63%, 5.26%, 5.26%, and 0%, respectively), vitreous prolapse (20% vs 2.63%), and uveal prolapse (80% vs 36.84%). Dehisced wounds had more traumatic aphakia (40% vs 0%) and dislocated lenses (15% vs 0%). Primary trauma was more likely to have traumatic cataracts (55.26% vs 10%) or no lens changes (44.74% vs 25%). About 10% dehisced wounds required enucleation (0% primary trauma). Cataract/secondary intraocular lens surgery was performed in 34% of the primary traumas (10% in dehisced wounds). Primary traumas achieved 20/40 vision or better in 44.74% (10% dehisced wounds). About 7.89% of patients with wound dehiscence ended with no light perception (none in primary trauma). Zone 1 open globe injuries due to wound dehiscence may exhibit worse prognosis compared to primary trauma open globe injury. More important than the zone of injury may be the source.

Imaging Mismatch of Nail in the Eyeball: What’s next?

Introduction : A retained foreign body (FB) can lead to severe complications, the most devastating of which is eye loss. We present a discrepancy of imaging that resulted in a dilemma in the approach management of a mixed global-adnexal FB case.&#x0D; Case Illustration : A 31-year-old man came to the emergency room with blurry vision for 1.5 hours after a nail hit his right eye (RE). The visual acuity of RE is light perception. Ophthalmological examination revealed a central Y-shaped full-thickness corneal laceration with iris and vitreous prolapse. The lens appeared cloudy, and the posterior segment was difficult to assess. Imaging showed a foreign metal object asa nail in the oculi to intraconal without penetration to the orbital wall. He was planned to undergo FB extraction with corneal laceration repair and aspiration of lens mass irrigation. However, the nail was hard to find intraoperatively because the vitreous and choroid kept coming out. Hence evisceration with DFG was performed. The nail was found more posteriorly and attached to the bone.&#x0D; Discussion : While primary repair is the standard practice for open globe injury, managing retained intraocular metallic foreign bodies is controversial. Imaging such as CT scans can help determine the location of FB and approach management. In this case, imaging showed the FB was in the iris plane and not penetrating the orbital wall, so primary repair and FB extraction were planned.&#x0D; Conclusion : The imaging may not always be accurate in determining the exact location of FB, and the surgical approach may need to be adjusted accordingly.

Corneal laceration with expulsive iridodialysis and vitreous prolapse following blunt trauma

Aims/Purpose: A full‐thickness corneal laceration can occur following blunt trauma and is an ocular emergency that requires decisive immediate, short and long‐term management. We describe an unusual case of blunt trauma leading to dehiscence of an old cataract wound with traumatic expulsive Iridodialysis associated with vitreous prolapse to create awareness among ophthalmologists on key diagnostic features and patient specific management for this condition.Methods: An 84 year old female presented to the eye emergency department following accidental trauma to her right eye. Ocular examination revealed a 3 mm corneal laceration that was just away from the limbus which was compatible with the incision used for prior cataract surgery over 10 years prior. There was signs of expulsive Iridodialysis as well as vitreous prolapse from this wound with associated ruptured posterior capsule, inferior IOL subluxation and pupil block angle closure.Results: Immediate management included excision of prolapsed vitreous and iris from the corneal laceration, placement of bandage contact lens and an eyeshield, as well as topical and systemic antibiotic therapy, topical steroids and IOP control. Within 3 days, the corneal laceration remained sealed following removal of the bandage contact lens and surgery was performed which included pars plana vitrectomy, IOL repositioning and corneal suturing.Conclusions: We report this case to emphasize the importance of careful anterior segment examination in cases of suspected globe rupture to identify the site of the opening and to always consider old surgical wounds. Once confirmed, no pressure should be placed on the eye to reduce the risk of further extravasation of intraocular contents.

ND YAG Capsulotomy-induced Acute non-pupillary Block Glaucoma in a Pseudophakic Patient

Secondary angle-closure glaucoma (ACG) due to pupillary block in pseudophakic patients has numerous reports in the literature. We report a 60-year-old pseudophakic patient with occurrence of unilateral non-pupillary block secondary ACG caused by vitreous prolapse after laser capsulotomy. He received topical and oral aqueous suppressants as treatment, and he underwent anterior vitrectomy with pars plana vitrectomy. This report aims to supplement the scant literature on this condition and to educate clinicians of the value of imaging in secondary ACG with non-pupillary block in pseudophakic patients to determine the cause and tailor treatment.

Pediatric corneal transplantation: techniques, challenges, and outcomes.

Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.

Femtosecond laser LenSx–assisted phacoemulsification of mature intumescent cataract

Background: Phacoemulsification (phaco) of mature intumescent cataract is one of the most difficult to perform anterior eye surgeries. In mature intumescent cataract phaco, the most difficult phase is performing a continuous capsulorhexis which should be as round as possible. The incidence of an anterior capsular tear during capsulorhexis has been reported to range from 0.8 to 5.0% and increases with an increase in cataract density. This is because in dense intumescent cataracts, capsulorhexis tends to extend to the periphery due to high intracapsular pressure. Femtosecond laser–assisted phaco of mature intumescent cataract enables a safe laser-assisted capsulotomy with a substantially reduced risk of intraoperative complications. Because this approach is as yet not widely used in ophthalmology, we aimed to share our experience in the use of femtosecond laser in phacoemulsification of mature and intumescent cataracts. Purpose: To assess the efficacy of femtosecond laser–assisted treatment of mature intumescent cataract. Methods: Sixty-five patients (68 eyes) with mature intumescent senile cataract underwent femtosecond laser-assisted cataract surgery (FLACS) with intraocular lens (IOL) implantation and were involved in this study. Results: In 55 eyes (80.8%), laser capsulotomy of the desired diameter (5.0 mm) was performed completely. In 8 eyes (11.7%), capsular bridges (capsular tissue remnants at the site of laser-assisted cut of the anterior capsule) were seen. In addition, after the laser phase of surgery, 3 eyes (4.4%) showed an irregularly shaped anterior capsular disc due to the failure of the laser to cut through the capsule in several regions. In all study eyes, the IOL was well centered in the bag. Conclusion: In eyes with mature intumescent cataract, it is reasonable to use the femtosecond laser for a safe and accurate anterior capsulorhexis to avoid the severe intraoperative complications (those associated with posterior capsular rapture and vitreous prolapse) that can be seen during manual capsulorhexis.

Clinical Profile of Cystoid Macular Edema Following Small Incision Cataract Surgery

BACKGROUND&#x0D; This study was conducted to determine the incidence of cystoid macular edema after small incision cataract surgery by means of OCT, study the clinical profile and compare the incidence in non-diabetic and diabetic patients with and without retinopathy.&#x0D; METHODS&#x0D; This was a hospital based prospective study, conducted among 325 patients in the age group of 40 to 85 years who underwent Small Incision Cataract Surgery [SICS] conducted in Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumary District, Tamil Nadu, over a period of one year from January 2022 to December 2023, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants.&#x0D; RESULTS&#x0D; The incidence of CME was higher among diabetic patients when compared with non-diabetic patients and was statistically significant. Patients with a history of uveitis had a statistically significant increase (p&lt;0.05) in the incidence of CME in the 6th postoperative week. Patients with complicated surgery with iris prolapse, vitreous prolapse, difficult nucleus delivery and posterior capsular rent had an increased incidence of CME. This was statistically significant (p&lt;0.05) during all three postoperative evaluations.&#x0D; CONCLUSIONS&#x0D; Following cataract surgery, 18.8% of patients developed cystoid macular edema six weeks after the procedure. Three months following surgery, 13.2% had CME, which further declined to 5.2% at six months after surgery. The incidence of clinically significant cystoid macular edema was 4% at six weeks after surgery. It further declined to 1.2% at 3 months after surgery and was present in only 0.6% at 6 months after surgery. The incidence of CME was higher among the diabetic patients throughout the study when compared with non-diabetic patients and was statistically significant (p&lt;0.01). The association between the severity of diabetic retinopathy and the incidence of cystoid macular edema was not statistically significant. Patients with a history of uveitis had a statistically significant increase (p&lt;0.05) in the incidence of CME in the 6th postoperative week. Patients with complicated surgery with iris prolapse, vitreous prolapse, difficult nucleus delivery and posterior capsular rent had an increased incidence of CME. Patients not using topical NSAIDS were found to have an increased incidence of CME.

Novel trocar assisted intraocular lens and capsular bag complex fixation.

To describe the innovative technique of trocar-assisted intraocular lens (IOL) and capsular bag complex fixation. In this technique, initial pupil dilatation is achieved either with intracameral adrenaline or with the help of iris hooks. Automated anterior vitrectomy is performed in cases with vitreous prolapse. A 25 G trocar cannula is placed at the limbus through a paracentesis opposite the zonular dialysis area. The cannula lumen act as a guide to pass the double-arm polypropylene suture attached to the needle. This prevents any inadvertent corneal injury and acts as a perpendicular tract to pass the needle through IOL capsular bag complex. We performed this technique in 9 cases with an excellent outcome with a minimum of 3 months of follow-up. All patients had well-centred IOL. There was no incidence of corneal injury, Descemet membrane detachment, iris trauma, IOL tilt, decentration, dislocation, vitreous prolapse or retinal detachment. All patients achieved excellent visual acuity ranging from 6/12-6/6 postoperatively. The novel trocar-assisted IOL bag complex fixation technique is very effective and allows smooth IOL fixation in technically challenging cases with IOL subluxation. The trocar acts as a guide to prevent injury to the surrounding tissue, and IOL fixation is achieved with minimal manipulations in the anterior chamber. It also prevents the need for IOL explantation in these cases.

Pupillary Block Glaucoma after Nd: YAG Capsulotomy

A 65-year-old-woman presented following neodymium: YAG capsulotomy for posterior capsular opacification with acute glaucoma. Cataract surgery had been done with good outcomes. Cornea edema obscured detail of the anterior chamber, but the edge of the lens could be seen clearly within the pupillary space and the acute angle-closure glaucoma was due to vitreous prolapse in the anterior chamber. We believe this case demonstrates the possible complications of the Nd: YAG capsulotomy even if it is an effective tool to treat an opacified posterior capsule after cataract surgery.

Vitreous prolapse with intraocular lens decentration – An uncommon complication following neodymium-yttrium aluminum garnet laser capsulotomy

Vitreous prolapse and intraocular lens decentration following neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy is rare. We report a case of a patient who developed blurring of vision, due to vitreous prolapse and decentration of the intraocular lens, following Nd:YAG laser capsulotomy for posterior capsular opacification (PCO), which was restored to complete visual recovery with surgical management. The report aims to highlight the importance of precise focusing, usage of minimum optimal power required, and appropriate sizing of Nd:YAG laser posterior capsulotomy. Although Nd:YAG laser posterior capsulotomy is a safe procedure for treating PCO, it is not free from complications.

Глаукома псевдофакичного глаза

Relevance. Currently, there is a steady increase in the age-associated eye diseases worldwide. First of all, this applies to such ocular diseases as age-related maculodegeneration (AMD), glaucoma and cataracts. Despite the development and standardization of surgical techniques, the widespread introduction of cataract phacoemulsification, appearance of many modifications of anti-glaucomatous surgery, and the active use of angiogenesis inhibitors used to treat AMD, these diseases continue to occupy a leading position in the causes of low vision and blindness. Purpose. To reveal the problem of the development of pseudophakic glaucoma in patients who underwent surgical treatment for cataracts. Material and methods.To complete this review, we searched for literature sources on the PubMed and Scopus abstract databases for the period up to 2021 inclusive. In total, 53 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 1963. Results. At risk are patients with pseudoexfoliative syndrome, high-grade myopia, traumatic, diabetic and uveal cataracts. Pseudophakic glaucoma can also be caused by intraoperative (iris damage, vitreous prolapse, implantation of an intraocular lens outside the capsular bag, incomplete viscoelastic washout) and postoperative complications (inflammatory process, hyphema, dislocation of the artificial lens, pupillary block or Ellingson syndrome). Conclusion. Pseudophakic glaucoma, although rare, is quite formidable, which can reduce result of cataract surgery. Key words: pseudophakic glaucoma, glaucoma, cataract, ophthalmohypertension, complications of phacoemulsification

Bag-in-the-lens intraocular lens implantation before 12 weeks of age in congenital cataract.

The aim of this study was to evaluate the intra- and postoperative complications, especially the risk of visual axis opacification (VAO), following the implantation of the bag-in-the-lens (BIL) intraocular lens (IOL) in infants with congenital cataract operated on before 12 weeks of age. Infants operated on before 12 weeks of age between June 2020 and June 2021 with a follow-up longer than 1year were included in the present retrospective study. This was a first-experience cohort of an experienced paediatric cataract surgeon with this type of lens. Nine infants (13 eyes) with a median age at surgery of 28 days (range, 21-49 days) were included. The median follow-up time was 21.6months (range, 12.2-23.4months). The lens was correctly implanted with the anterior and posterior capsulorhexis edges placed into the interhaptic groove of the BIL IOL in seven of 13 eyes; none of these eyes developed VAO. In the remaining six eyes, the IOL was only fixated to the anterior capsulorhexis edge, and in these cases, an anatomical anomaly of the posterior capsule and/or anterior vitreolenticular interface dysgenesis were observed. These six eyes developed VAO. One eye had a partial iris capture in the early postoperative phase. Otherwise, the IOL remained well centred and stable in all eyes. Anterior vitrectomy was necessary in seven eyes due to vitreous prolapse. One patient with unilateral cataract was diagnosed with bilateral primary congenital glaucoma at 4months of age. Implantation of the BIL IOL is safe even in the youngest age group less than 12 weeks of age. Although being a first-experience cohort, the BIL technique is shown to reduce the risk of VAO and the number of surgical procedures.

Blinding Ocular Trauma Caused by High-Pressure Waterjet

Ocular trauma remains a significant cause of visual impairment. Waterjet ocular injury is otherwise uncommon. We report a case of waterjet ocular trauma with penetrating injury to the lateral rectus and underlying sclera, with retinal detachment and lid laceration. This case posed diagnostic and management challenges due to its unusual presentation with an occult globe rupture initially. High index of suspicious globe rupture was made based on lower intraocular pressure with hyphema, and globe irregularities from the CT orbit. Surgical exploration revealed transacted lateral rectus and sclera laceration, with vitreous and uveal prolapse. Postoperative B scan demonstrated retinal detachment. Visual acuity was poor, with the traumatic eye demonstrated constant esotropia and became phthisical. The impact of waterjet in causing severe ocular injury should not be underestimated. Extra precaution should be taken, as severe ocular complications can be avoided with appropriate safety measures in handling the waterjet.