Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia

AIM: To evaluate the efficacy and safety of one-stitch anastomosis through the skin with bicanalicular silicone tube intubation in repairing of bicanalicular laceration.METHODS:The clinical data of 15 consecutive patients with both superior and inferior canalicular laceration in one eye who underwent surgical repair using one-stitch anastomosis through the skin and bicanalicular stent were retrospective studied. All the operations were performed under surgical microscope, 5-0 silk sutures were used and were with bicanalicular silicone tube (diameter was 8mm) intubation, for one lacerated canaliculi one-stitch anastomosis through the skin. The stents were left in place for 3 months postoperatively and then removed. The follow-up period was 3 - 36 months (average 14 months).RESULTS:In 15 patients, 13 patients were cured entirely, 1 patient was meliorated, 1 patient with no effects. All patients had got good recovery of eyelid laceration with no traumatic deformity in eyelid and canthus. Complication was seen in one case, for not followed the doctor’s guidance to come back to hospital to had the suture removed on the 7^th day after operation, when he came at the 15^th day, the inferior canalicular wall and eyelid skin were corroded by the suture caused 2mm wound, and the inside silicone tube was exposed, a promptly repair with 10-0 nylon suture was done, the wound healed in a week. There were no early tube protrusions and punctal slits in the patients.CONCLUSION:One-stitch anastomosis through the skin with bicanalicular silicone tube intubation is a good method in repair of bicanalicular laceration in one eye, the cut ends can be anastomosed directly, and with excellent cosmetic results, it is acceptable for the patients. For there is no suture remained in the wound permanently, so there is no suture-related granuloma which may cause obstruction or stenosis of canaliculi. It is simple, economical, effective and safe.     

Correcting high astigmatism with piggyback toric intraocular lens implantation

An 86-year-old man presented for cataract surgery with corneal astigmatism of 5.12 diopters (D). After cataract extraction with small-incision techniques, 2 toric plate-haptic silicone intraocular lenses (IOLs) were implanted in the capsular bag, each with a 3.50 D cylinder add (2.30 D at the spectacle plane). Six weeks postoperatively, corneal astigmatism was 3.38 D at 70 degrees and refractive astigmatism was 1.00 D at 20 degrees. Uncorrected visual acuity was 20/40. No IOL rotation was observed. Implantation of piggybacked toric lenses may be a viable option for correcting moderate to high astigmatism.     

Angle-closure glaucoma after piggyback intraocular lens implantation

PURPOSE: To report a case of angle closure glaucoma after piggyback intraocular lens implantation and its treatment. METHODS: The authors present the case of a 75-year-old woman who was seen in the emergency department with angle closure glaucoma. Two years before she had undergone piggyback intraocular lens (IOL) implantation in order to correct a refractive error after cataract surgery. Ultrasound biomicroscopy revealed a closed angle with synechiae in 360 degrees as well as the presence of two IOLs: one in the capsular bag and the other in the ciliary sulcus. Extraction of the anterior IOL was precluded due to the poor endothelial count. Peripheral iridotomy and trabeculectomy were ineffective to lower the intraocular pressure (IOP); the authors decided to implant with an Ahmed valve and to place the valve's tube between the two IOLs to protect the endothelium. RESULTS: After Ahmed valve implantation, IOP maintains stable around 10-12 mmHg without medical treatment. CONCLUSIONS: Ahmed valve implantation is a good option in angle closure glaucoma due to piggyback. The placement of the valve's tube between the two IOLs is a good option to protect corneal endothelium.     

Incision width after phacoemulsification with foldable intraocular lens implantation

PURPOSE: To determine the incision size after insertion of foldable intraocular lenses (IOLs) using both a forceps and injectors. SETTING: Intermountain Ocular Research Center, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: One hundred patients had phacoemulsification through a clear corneal wound. The incision width was measured before and after IOL implantation. A 3-piece silicone IOL and a 3-piece acrylic IOL (both with an optic diameter of 5.5 mm) were inserted using a forceps. A plate-haptic silicone lens and a 3-piece silicone lens with a 6.0 mm diameter optic were inserted using an injector. RESULTS: The wound size in the group with the 3-piece silicone lens inserted with a forceps enlarged 4.4% (3.23 to 3.38 mm) in the low-power IOL group (15.0 to 20.0 diopters [D]) and 6.2% (3.24 to 3.44 mm) in the high-power IOL group (20.5 to 25.0 D). Similarly, the acrylic IOL wound enlarged 5% (3.21 to 3.37 mm) in the low-power IOL group and 6% (3.25 to 3.44 mm) in the high-power IOL group when a forceps was used. The 3-piece silicone and plate silicone lenses inserted using an injector enlarged the wound 3.2% and 3.3% (3.02 to 3.11 mm and 3.05 to 3.15 mm), respectively. There was no difference in the wound size with higher IOL powers in eyes with injected lenses. CONCLUSIONS: Clear corneal incisions enlarge after insertion of foldable IOLs in a predictable manner, with a forceps-inserted IOL enlarging the wound diameter more than lenses inserted with an injector. The forceps-inserted lens group also showed a difference in wound size related to IOL power.     

青光眼滤过术后白内障超声乳化吸除联合折叠式人工晶状体植入

目的评价青光眼滤过术后白内障超声乳化吸除联合折叠式人工晶状体植入的疗效.方法对18只青光眼滤过术后白内障眼采用3.5mm的隧道切口行白内障超声乳化吸除联合折叠式人工晶状体植入,术后切口不缝合.随访3～30个月,观察术后视力,角膜散光及眼压等情况.结果18只眼术后视力均较术前提高,其中0.02者1只眼(0.06%),0.05～0.2者2只眼(11.1%),0.3～0.4者5只眼(27.8%),0.5～0.9者7只眼(38.9%),1.0～1.2者3只眼(16.7%).术前角膜散光(0.78±0.88)D,术后1周,1个月,3个月角膜散光分别为(0.89±0.80)D,(0.75±0.82)D,(0.72±0.78)D,与术前相比P＞0.05(t检验),差异无显著性,术前眼压为(2.13±0.34)kPa,术后1个月眼压为(2.20±0.23)kPa,与术前相比P＞0.05(t检验),差异无显著性.结论对于青光眼滤过术后白内障采用超声乳化吸除联合折叠式人工晶状体植入可较易避开滤过泡,术后反应轻.角膜散光无明显改变,患者术后视功能改善且不影响眼压的控制,手术安全可靠.     

Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼

目的：：探讨Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼的手术方法及疗效评价。方法：选取2012-01/2014-01期间我院通过行Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼的患者47例47眼,距前次晶状体玻璃体切除术3~6mo。所有患者随访6~12(平均8.21±2.63)mo。结果：本次研究中47例患者人工晶状体均植入顺利,未见位置偏斜情况。最后一次术后随访的裸眼视力(0.44±0.19),与术前最佳矫正视力(0.41±0.23)相比,差异不具有统计学意义(t=0.879,P=0.342)。无明显术中及术后并发症。结论：Ⅱ期折叠型人工晶状体植入术治疗玻璃体切除术后囊膜残余无晶状体眼患者的效果良好,有效减少了并发症,对于改善患者视力安全有效。     

折叠式人工晶体二期植入术

目的探讨采用折叠式人工晶体矫正无晶体眼的疗效和技术。方法对２５只后囊膜和悬韧带完整或仅中央区后囊膜缺损的无晶体眼，通过无缝线３．５ｍｍ巩膜隧道切口，二期植入硅凝胶折叠式人工晶体。结果术后第１天，２１只眼（８４％）的裸眼视力达到０．５，９只眼（３６％）达到１．０，随诊全部术眼的矫正视力均等于或高于术前最佳矫正视力。结论折叠式人工晶体二期植入术是矫正后囊膜完整或大部分完整的无晶体眼简单而有效的方法。     

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses

PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOL-optic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpflug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01 +/- 0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32 +/- 0.18 mm at the 12 o'clock position and 1.34 +/- 0.21 mm at the 6 o'clock position. The distance between the crystalline lens and the posterior surface of the IOL averaged 0.73 +/- 0.09 mm. CONCLUSIONS: The high quality of the three-dimensional Scheimpflug images allowed measurements of intraocular distances in PIOL implanted eyes. Distances between the foldable iris-fixated IOL and crucial surrounding tissues could be determined 3 months postoperatively.     

超声乳化吸除联合折叠IOL植入术治疗急性闭角型青光眼

目的:探讨超声乳化(Phacoemulsification,Phaco)联合折叠型人工晶状体植入术对急性闭角型青光眼的临床疗效。方法:选择>50岁患有急性闭角型青光眼伴有晶状体混浊的连续性患者20例23眼,行超声乳化联合折叠型人工晶状体植入术,比较手术前后视力和眼压的变化,超声生物显微镜(ultrasound biomicroscopy,UBM)检测手术前后前房深度(anterior chamber depth,ACD)和房角开放距离(an-gle opening distance,AOD500)的变化。结果:手术前视力和眼压是4.16±0.38和48.65±7.34mmHg,手术后视力和眼压为4.75±0.10和16.65±1.97mmHg;术前术后的前房深度为1.35±0.04mm和3.51±0.07mm,房角开放距离分别为225.09±12.43μm和511.18±12.20μm,手术前后比较差异有统计学意义(P<0.01)。结论:超声乳化联合人工晶状体植入术治疗急性闭角型青光眼安全、有效。     

两种AcrySof折叠式人工晶体植入后囊膜混浊的临床研究

目的：观察两种设计不同的AcrySof丙烯酸酯折叠式人工晶体(intraocular lens,IOL)对晶状体后囊膜混浊(posterior capsule opacification,PCO)的影响。方法：114例(114只眼)随机分为两组(1)试验组：59例(59眼)，植入一体式AcrySof折叠式IOL。(2)对照组：55例(55眼)，植入三体式AcrySof折叠式IOL。术后半年散大瞳孔观察Soemmering环和PCD情况。结果：瞳孔区PCD，试验组4只眼(6．8％)，混浊多为轻微皱褶。对照组11只限(20％)，试验组PCD明显少于对照组，差异有显著意义(P＜0．05)。两组术后Soemmering环边界均清晰而试验组更加明显，且撵周也形成明显的细胞增殖区。结论：一体式AcrySof折叠IOL具有独特设计的襻使晶状体后囊膜皱褶大为减少，远期PCO明显下降。     

Clear lens extraction with intraocular lens implantation for hyperopia

PURPOSE: To analyze the results of clear lens extraction (CLE) with posterior chamber intraocular lens (IOL) implantation to correct hyperopia. SETTING: Eye Research Center and Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 20 hyperopic eyes of 12 patients between 19 and 50 years who had CLE with posterior chamber IOL implantation. Five patients had peripheral iridectomy during CLE as the angles were occludable. RESULTS: The mean hyperopic spherical equivalent refraction was +6.66 diopters (D) +/- 2.17 (SD) (range +4.75 to +13.00 D). The IOL power was calculated using the Holladay 2 formula. The mean follow-up was 16.96 months (range 6 to 35 months).The mean postoperative uncorrected visual acuity was 0.45 +/- 0.25 (range 0.10 to 1.00), a mean improvement of 3 Snellen lines from preoperatively. The mean postoperative best corrected visual acuity (BCVA) was 0.63 +/- 0.30, a mean improvement of 1 Snellen line. Three patients gained 2 lines of BCVA and 2 patients, 1 line. One patient lost 1 line of BCVA. Seventy percent of patients were within +/-0.50 D of the intended refraction. CONCLUSION: The results indicate that CLE with posterior chamber IOL implantation is safe, predictable, and effective.     

抗青光眼滤过术后超声乳化白内障吸除术的临床观察

目的　探讨抗青光眼滤过手术后进行白内障手术的方法及手术对滤过泡的影响。方法对抗青光眼小梁切除术后白内障患者 2 35例 (2 6 2只眼 ) ,采用颞侧透明角膜隧道切口进行超声乳化白内障吸除及折叠式人工晶状体植入手术 ,同时对固定的小瞳孔进行扩张或采用括约肌切开与缝合术。结果　白内障术后患者视力不同程度提高 ,视力≥ 0 5者占 74 0 % ;术后平均眼压升高 3 0 8mmHg(1mmHg =0 133kPa) ,与术前比较差异无显著性 (P >0 0 5 ) ;功能性滤过泡未见明显瘢痕化。结论　对抗青光眼滤过术后白内障患者进行颞侧透明角膜隧道切口超声乳化白内障吸除术 ,可提高视力 ,同时可保持滤过泡功能。     

Elevated intraocular pressure in secondary piggyback intraocular lens implantation

We report 2 cases of postoperative intraocular pressure (IOP) elevation in secondary piggyback intraocular lens (IOL) implantation without history of glaucoma or ocular hypertension. A 74-year-old woman with myopic pseudophakia and a 68-year-old man with hyperopic pseudophakia received secondary piggyback AcrySof IOL implantation in their left eyes. In both patients, the left IOP gradually increased and sustained around 30 mm Hg for about 1 year. In the first, IOP continued elevating despite topical and systemic medications. There was an episode of pupillary block in the second. Gonioscopically, heavier trabecular meshwork pigmentation in their left eyes was observed. Because of this, the 2 IOLs implanted were removed and replaced by an adequate IOL and trabeculotomy was performed in the former. The AcrySof IOL has a truncated optic edge, which increases the risk for chafing the iris, resulting in pigment dispersion syndrome; thus, it would be a poor choice for a sulcus-placed piggyback implantation.     

Longterm results after phacovitrectomy and foldable intraocular lens implantation

Purpose: This study aimed to evaluate the longterm results of phacovitrectomy and foldable intraocular lens (IOL) implantation in eyes with significant cataract and co‐existing vitreoretinal diseases. Methods: We carried out a retrospective study of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with phacoemulsification and foldable IOL implantation. Main outcome measures were visual acuity (VA), preoperative data, and intraoperative and postoperative complications. Results: The most common indications for surgery were non‐diabetic vitreous haemorrhage and proliferative diabetic retinopathy. Preoperative vision ranged from 0.6 to light perception; postoperative vision ranged from 1.2 to no light perception. Postoperatively, in 162 eyes (87.1%) VA improved by ≥ 3 lines on the decimal chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased by the last follow‐up. Postoperative complications included elevated intraocular pressure and posterior capsule opacification, corneal edema, macular edema, fibrinous reaction, vitreous hemorrhage, corneal epithelial defects, anterior chamber hyphema, choroidal detachment, persistent macular hole, posterior synechiae, recurrent retinal detachment, rubeosis iridis, neovascular glaucoma. Conclusions: Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities co‐existing with cataract. Based on extensive experience with the combined procedure, we suggest that combined surgery is recommended in selected patients with simultaneous vitreoretinal pathological changes and cataract.     

Corneal and total wavefront aberrations in phakic and pseudophakic eyes after implantation of monofocal foldable intraocular lenses

PURPOSE: To compare the correlation between corneal and total wavefront aberrations in normal phakic and pseudophakic eyes after implantation of foldable monofocal intraocular lenses (IOLs). SETTING: University Hospital, Eye Clinic, Zurich, Switzerland. METHODS: Wavefront aberrations and corneal topography of 29 eyes that had cataract surgery with implantation of hydrophobic monofocal foldable IOL (AcrySof, Alcon Labs) were measured at least 2 months postoperatively and compared with wavefront measurements performed in 33 normal young phakic eyes. The total wavefront aberrations were measured by means of a Tscherning wavefront sensor at a wavelength of 660 nm (Allegro Wave Analyzer, WaveLight Laser Technology). The corneal aberrations were derived from corneal topography measurements ascertained with a Placido-based topography system (Keratograph 70600, Oculus). The correlations between corneal and total wavefront aberrations were calculated for all Zernike coefficients from 2nd up to 6th order. RESULTS: There was a significant correlation between corneal and total wavefront aberrations in astigmatism C3 and C5 as well as for all 3rd-order Zernike coefficient in both groups (except C8 in the pseudophakic group). The correlation between corneal and total astigmatism (C3 and C5) was higher in the pseudophakic than in the phakic eyes. In contrast, the correlation for the coma-like aberrations was weaker in the pseudophakic eyes (R>0.18) than in the group of phakic eyes (R>0.58). In both groups, there was no significant correlation between spherical aberration C12 of the cornea and the C12 of the total eye. CONCLUSION: After cataract surgery with an IOL implantation, both vertical and horizontal coma, as well as spherical aberration, were of higher value than in normal eyes. The compensation effect for corneal aberrations of the natural lens is absent in the IOL and explains these findings. The corneal aberrations in pseudophakic eyes reflect better the optical quality of the total eye than the phakic eyes. Nevertheless, the missing correlation in some specific aberrations, such as C8 and C10, shows the inability of corneal topography to provide suitable information on the optical quality of the total eye after cataract surgery. Thus, both corneal and total wavefront measurements are relevant for the assessment of outcomes after cataract surgery.     

Clear lens extraction with intraocular lens implantation for hyperopia.

PURPOSE: Current surgical options for the correction of moderate to severe hyperopia include hyperopic laser in situ keratomileusis (LASIK), phakic intraocular lens implantation and clear lens extraction with intraocular lens (IOL) implantation. We investigate the safety and efficacy of clear lens extraction with IOL implantation to correct hyperopia. METHODS: Phacoemulsification and IOL implantation was performed on 18 eyes of 10 patients. In 16 eyes, the Hoffer-Q formula was used for IOL power calculation and a single IOL was inserted; in the remaining 2 nanophthalmic eyes, the Holladay-II formula was used and two piggy-back IOLs were inserted. RESULTS: Mean preoperative spherical equivalent for distance was +6.17 D (range, +4.25 to +9.62 D). Patients were followed postoperatively for a mean of 10.5 months (range, 4 to 27 mo). Uncorrected visual acuity in all eyes was 20/50 or better with a median uncorrected visual acuity of 20/40 (range, 20/30 to 20/50). Two patients lost 2 lines of spectacle-corrected visual acuity; both of these patients achieved spectacle-corrected visual acuity of 20/30. CONCLUSIONS: Clear lens extraction with IOL implantation is a safe and effective procedure for the correction of moderate to severe hyperopia in the presbyopic age range.     

Primary piggyback implantation of 3 intraocular lenses in nanophthalmos

We present a patient with bilateral nanophthalmos who had uneventful cataract extraction in the right eye with primary implantation of 3 intraocular lenses (IOLs) of 2 different materials: a 30 diopter (D) acrylic IOL and a 9 D silicone IOL in the capsular bag and a 30 D silicone IOL in the ciliary sulcus. Subsequently, cataract extraction was done in the left eye with bag-sulcus implantation of two 30 D silicone IOLs. The use of 3 IOLs in 1 eye was necessary because the highest available power of acrylic and silicone IOLs at our institution was 30 D. The only short-term complications were temporary corneal edema and partial displacement of the sulcus IOL anterior to the iris in the right eye and bilateral posterior capsule opacification. The late complication of interlenticular opacification was not present 1 year after piggyback IOL implantation.