Opacification of the visual axis after cataract surgery and single acrylic intraocular lens implantation in the first year of life.

PURPOSE: To report the incidence and risk factors for secondary surgical intervention to treat visual axis opacification (VAO) after cataract surgery and acrylic intraocular lens (IOL) implantation during the first year of life. METHODS: A retrospective review of 29 eyes of 20 patients receiving a hydrophobic acrylic (AcrySof; Alcon, Fort Worth, TX) IOL implantation was conducted. All eyes underwent primary posterior capsulectomy and anterior vitrectomy. Statistical analysis was performed using SPSS for Windows (SPSS, Chicago, IL). RESULTS: Average age at surgery was 4.8 +/- 3.7 months, and average follow-up was 33.4 +/- 16.1 months. Eleven of 29 (37.9%) eyes developed VAO requiring secondary surgical intervention at a median of 4.8 months (95% confidence interval 3.4 to 6.2). Average age at surgery for eyes that subsequently opacified was 3.8 +/- 3.0 months compared with 5.4 +/- 4.0 months for those whose visual axis remained clear (P = 0.26). The relative risk of subsequent VAO surgery was 2.7 for primary surgery performed at or before the first 6 months of life. Opacification was significantly related to eyes with associated ocular anomalies (eg, anterior segment dysgenesis, iris hypoplasia, or persistent fetal vasculature) with a relative risk of 8.6 (P < 0.001). Proliferation of cortex was the most common form of VAO, followed by mixed-type with predominantly fibrous, fibrous alone, or Elschnig pearls. When secondary surgery was required, it occurred primarily during the first 6 months (ie, 9 of 11 patients) after the initial cataract surgery. CONCLUSIONS: When cataract and IOL surgery was undertaken within the first year of life, a secondary surgical procedure was required in 37.9% of eyes to maintain a clear visual axis. Most secondary surgery for VAO occurred within the first 6 months after surgery. Postoperative opacification was most common in eyes with associated ocular anomalies.     

Nd:YAG laser capsulotomy rates following implantation of square-edged intraocular lenses: polymethyl methacrylate versus silicone versus acrylic

Objective: To study the influence of square-edged intraocular lenses (lOLs) on the development of posterior capsule opacification (PCO) and the requirement for laser capsulotomy.Design: Retrospective study.Participants: Three hundred seventy-seven eyes of 377 patients were included.Methods: All these patients underwent phacoemulsification and implantation of square polymethyl methacrylate (PMMA) (Aurolab), silicone (Tecnis Z9000), acrylic hydrophobic (AcrySof MA60AC and Sensar Optiedge), or acrylic hydrophilic (Akreos Adapt) lOLs with a minimum of 2 years’ follow-up. Only those cases in which Nd:YAG laser capsulotomy had been performed for visually significant PCO were evaluated.Results: Three hundred seventy-seven eyes of 377 patients were included in the study. Follow-up duration ranged from 24 to 54 (mean 40.27, SD 8.42) months. The incidence of PCO requiring Nd:YAG laser capsulotomy was found to be significantly less in the silicone lens group: 1.4% as compared with an incidence of 11.7% in the PMMA lens group (p = 0.018). In the square-edged acrylic group, visually significant PCO requiring Nd:YAG laser capsulotomy was observed in 3.6%, 4.8%, and 6.8% of eyes implanted with AcrySof MA60AC, Sensar Optiedge, and Akreos Adapt lOLs, respectively. In 5 of the 7 eyes (71.4%) exhibiting PCO in the PMMA group, the condition developed within the first 6 months. In the silicone and acrylic group, development of PCO was delayed.Conclusions: The rate of visually significant PCO as well as the need for Nd:YAG laser capsulotomy is influenced by IOL biomaterial in addition to square edge. It is significantly delayed with square-edged foldable acrylic and silicone lOLs compared with square-edged PMMA IOLs.     

比较聚甲基丙烯酸甲酯与疏水性丙烯酸酯人工晶状体在小儿白内障手术中的应用

目的：比较聚甲基丙烯酸甲酯(PMMA)与疏水性丙烯酸酯人工晶状体(IOLs)用于小儿白内障摘除联合人工晶状体植入术术后视力效果及并发症。

方法：回顾性研究。包括63例117眼接受双侧小儿白内障手术和原发性人工晶状体植入术患者。将所有患者分为两组,组I包括30例58眼植入聚甲基丙烯酸甲酯人工晶状体患者; 组II包括33例59眼植入疏水性丙烯酸酯人工晶状体患者。比较两组间的临床特点、屈光不正、最佳矫正视力(BCVA)和手术并发症。

结果：患者平均年龄为5.8(2～12)岁,平均随访时间为40.5(6～196)mo。术后,80眼(68.4%)中最佳矫正视力 ≥0.5,两组间存在可比性。两组间视觉轴混浊情况分别为组I 28眼(48.3%),组II 16眼(27.1%),两组间差异有统计学意义(P=0.018)。术后形成眼内晶状体脱位和粘连。综上所述,疏水性丙烯酸酯人工晶状体组的并发症明显少于聚甲基丙烯酸甲酯人工晶状体组(P=0.020)。

结论：采用原发性人工晶状体植入术行小儿白内障手术是一种安全的方法。相较于聚甲基丙烯酸甲酯人工晶状体,疏水性丙烯酸人工晶状体术后并发症更少。     

Comparison of polymethylmethacrylate versus hydrophobic acrylic lenses for primary intraocular lens implantation in pediatric cataract surgery

AIM: To compare the visual results and postoperative complications of polymethylmethacrylate (PMMA) and hydrophobic acrylic intraocular lenses (IOLs) in children who underwent cataract extraction with primary IOL implantation.METHODS: This retrospective study included 117 eyes of 63 children with bilateral pediatric cataract undergoing cataract surgery and primary IOL implantation. The patients were divided into two groups, Group I included 58 eyes of 30 patients with PMMA IOLs; Group II included 59 eyes of 33 patients with hydrophobic acrylic IOLs. The clinical features, refraction errors, best corrected visual acuity (BCVA) and surgical complications were compared between two groups.RESULTS: The mean age at the time of surgery was 5.8 (2-12)y and mean follow up period was 40.5 (6-196)mo. Postoperatively, BCVA was ≥0.5 in 80 eyes (68.4%) and this was comparable in two groups. Visual axis opacification was seen in 28 eyes (48.3%) in Group I and 16 eyes (27.1%) in Group II and this difference was statistically significant (P=0.018). Postoperative IOL dislocation and posterior synechia formation were also noted. When all postoperative complications were considered, there were significantly less complications in the acrylic IOL group than PMMA IOL group (P=0.020).CONCLUSION: Pediatric cataract surgery with primary IOL implantation is a safe procedure. Hydrophobic acrylic IOLs may lead to less postoperative complications compared to PMMA IOLs.     

Inflammatory reaction following cataract surgery and implantation of acrylic intraocular lens in rabbits with endotoxin-induced uveitis

PURPOSE: To investigate whether inflammatory responses are more severe in uveitic eyes than nonuveitic eyes when acrylic intraocular lens (IOL) is implanted after cataract surgery. METHODS: Clear lens removal (phacoemulsification and aspiration) was conducted and the hydrophobic acrylic IOL (AR40e, AMO) was implanted in adult albino rabbits. Just after the operation, rabbits were divided into two groups. One group (nine rabbits) received intravitreal injection of lipopolysaccharide (LPS, 200 ng/10 microl) into both eyes to induce endotoxin-induced uveitis (EIU) and the other group (nine rabbits) received intravitreal injection of phosphate-buffered saline (PBS, 10 microl) into both eyes as the control. Aqueous humour (AH) and IOLs were harvested 1, 3 , and 7 days after the intravitreal injection. The infiltrating cell number in AH was counted and the protein concentration of AH was measured. IOLs were evaluated morphologically. RESULTS: At 1 day after intravitreal injection, both the infiltrating cell number in AH and protein concentration of AH were significantly higher in the LPS-injected group than in the PBS-injected group. Similarly, more inflammatory cells attached to the surfaces of the IOLs in the LPS-injected group. However, 7 days later, inflammatory reactions subsided and no clear differences in any of the parameters examined were observed between the two groups. CONCLUSIONS: At 7 days after the operation, inflammatory reactions in eyes implanted with the hydrophobic acrylic IOLs were similar in uveitic eyes and nonuveitic eyes. The data suggest that the hydrophobic acrylic IOLs may be suitable for patients with uveitis.     

Comparison of wavefront aberration after cataract surgery with acrylic intraocular lens implantation

PURPOSE: To compare aberration changes in pseudophakic eyes with 3 types of acrylic intraocular lenses (IOLs) and in normal phakic eyes. SETTING: Department of Ophthalmology, Asan Medical Center, Seoul, Korea. METHODS: This single-center prospective study comprised 51 cataract patients who had cataract surgery and 12 phakic eyes. Fourteen eyes received an AcrySof MA60BM (Alcon), 18 eyes received a Sensar AR40 (AMO), and 19 eyes, a Corneal ACR6D (Corneal Laboratoire). One month after cataract surgery, aberrations in the eyes were measured using a Hartmann-Shack-type aberrometer. The same measurements were done in the 12 age-matched normal phakic eyes. Individual Zernike polynomials and the root-mean-square (RMS) 3rd- and 4th-order aberrations in the 2 groups were compared. The total RMS value was also compared. RESULTS: The RMS value of the 3rd- and 4th-order aberrations did not differ significantly between groups, nor did the total RMS value. In all IOL groups, an individual Zernike coefficient (C3(3), triangular astigmatism with base on the y-axis) was significantly different than that in the normal phakic group. CONCLUSION: There was no statistically significant difference in overall higher-order aberrations between normal eyes and eyes implanted with 3 types of acrylic IOLs.     

Severe band keratopathy following cataract surgery with intraocular lens implantation

Two similar cases of severe band keratopathy are reported that occurred about 4 weeks after routine intracapsular cataract extraction with implantation of an anterior chamber intraocular lens. The calcareous deposits were removed and analysed. The cornea remained damaged because of severe, irregular thinning. The cause of the condition could not be determined.     

Long term results of primary posterior chamber intraocular lens implantation for congenital cataract in the first year of life

AIM: To document the long term outcome of congenital cataract surgery with primary posterior chamber (PC) lens implantation in the first year of life. METHOD: A retrospective review of congenital cataract surgery in the first year of life with PC lens implantation in 18 infants, eight with unilateral and 10 with bilateral cataract. The average age at surgery was 15 weeks (range 3-44 weeks). The mean follow up was 95 months (range 60-139 months). RESULTS: The best outcomes were in the bilateral group where 50% of eyes achieved 6/18 or better, with a best acuity of 6/9. Acuities were poor in the unilateral group where only 38% achieved 6/60 or better, with a best acuity of 6/24. There was a mean refractive shift between first refraction after surgery and refraction at 36 months after surgery of -3.44 dioptres with a very wide range (+2.00 to -15.50). There was a significantly greater myopic shift in the unilateral cases. Many eyes in both groups continued to show an increasing myopic shift between 36 months after surgery and their final recorded refraction. The main complications were amblyopia, especially in unilateral cataracts, and posterior capsular opacification. Amblyopia was most probably related to a combination of early onset of dense cataract in this young age group, late presentation for initial surgery, delay in capsulotomies, and imperfect compliance with a rigorous occlusion regime. CONCLUSION: Intraocular lens implantation in infants less than 1 year of age is generally a safe procedure. The spread of final refractive error was very wide. Final refraction in the unilateral group was significantly more myopic than the bilateral group. Final acuities were often disappointing especially in the unilateral group.     

散光人工晶状体在白内障摘除手术中的应用

散光人工晶状体（Toric IOL）是将散光矫正与人工晶状体的球镜度数相结合的一种新型屈光性人工晶状体。利用这种人工晶状体矫正角膜散光是一种合理的、可预测性强、术后效果更加稳定的屈光矫正方式。目前在临床上应用较多的Toric IOL主要有AA4203TF、AA4203TL，MicrOSi16116TU，Acrysof SN60TF，Acri．Smart 646TLC等四种。其主要问题有人工晶状体的术后旋转导致矫正能力下降甚至产生新的散光等。本文就Toric IOL在白内障摘除手术中的应用作一综述。     

Multifocal intraocular lens implantation in pediatric cataract surgery

OBJECTIVE: To evaluate implantation of a zonal-progressive multifocal intraocular lens (IOL) in children. STUDY DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-five eyes of 26 pediatric patients aged 2 to 14 years with multifocal IOL implantation at one institution with more than 1 year of follow-up. INTERVENTIONS: Standard surgical procedure comprised an anterior capsulorrhexis, lens material aspiration via two side-port incisions, temporal tunnel incision, and multifocal IOL (SA40-N; Allergan, Irvine, CA) implantation in all eyes. In 24 eyes (68%), a 5-mm posterior capsulorrhexis was created with forceps, followed by an anterior vitrectomy in 19 of those eyes (54%). RESULTS: Twenty-six patients (35 eyes) had an average follow-up of 27.4 +/- 12.7 months (range, 12-58 months). At last follow-up, best-corrected distance visual acuity improved significantly (P = 0.001), 71% of eyes with a visual acuity of 20/40 or better and 31% of eyes with a visual acuity of 20/25 or better. In the 9 bilateral cases, spectacle dependency was moderate, with only 2 children (22%) reporting the permanent use of an additional near correction. The remaining children were either using distance-correction only (4 patients; 44%) or no glasses at all (3 patients; 33%). Stereopsis also improved significantly after multifocal IOL implantation (P = 0.01). Sixteen eyes (46%) experienced obscuration of the entrance pupil that required intervention, with 10 requiring a second intraocular surgery. Four eyes required an anterior membranectomy for persistent fibrinous membrane. Intraocular lens decentration requiring surgical intervention developed in six eyes. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in this age group.     

Risk factors for complications after congenital cataract surgery without intraocular lens implantation in the first 18 months of life

PURPOSE: To determine individual risk factors for the development of postoperative complications after pediatric cataract surgery in the first 18 months of life. DESIGN: Interventional, consecutive case series. METHODS: We retrospectively reviewed the records of 71 eyes of 46 children who underwent surgery for congenital cataract within the first 18 months of life. A limbal approach bimanual lens aspiration, posterior capsulorrhexis, and anterior vitrectomy without intraocular lens implantation was performed in all children. We examined the interrelationships of operative and postoperative complications with other variables such as patient age, family history, or ocular abnormalities. The mean follow-up period was 39 months. RESULTS: The most frequent postoperative complications were late-onset open-angle glaucoma (10.8%) and vitreous hemorrhage (10.8%), whereas early-onset glaucoma (4.6%) was less common. Secondary cataract was observed in seven eyes (9.2%). We determined a family history of aphakic glaucoma in first-degree relatives (P = .007) as well as cataract surgery in the first three months of life (P = .039) and nuclear cataracts (P = .0009) to be strong predictors of late-onset glaucoma. Secondary cataract formation was associated strongly with lensectomy in the first five months of life. The diagnosis of postoperative hemorrhages was associated significantly with the presence of persistent fetal vasculature (P < .0001). CONCLUSIONS: Patients with preoperative predictors at presentation such as young age at the time of surgery, a family history of aphakic glaucoma, nuclear cataract, or persistent fetal vasculature syndrome offer a clear target for extensive postoperative care after congenital cataract surgery.     

儿童白内障手术后二期人工晶状体植入的探讨

目的 探讨儿童白内障术后二期人工晶状体植入术的效果。方法 回顾了34例(41眼)儿童白内障手术后二期人工晶状体植入5年记录。介绍了二期人工晶状体植入的适应证，人工晶状体植入的手术方法。术前、术后视力、屈光不正。双眼状态和手术方法。结果 34例(41眼)儿童白内障手术后二期人工晶状体植入。其中8眼成功囊袋内植入，28眼睫状沟植入，余5眼行后房人工晶状体悬吊术。41眼中35眼(85．37％)有可测量的视力提高，有3眼视力降低2行。24眼(58．54％)与对侧眼的矫正屈光度差在 1．50D以内。31眼(75．61％)屈光度差在 3．00D以内。结论 对于不能耐受接触镜或眼镜的儿童无晶状体眼，二期后房型人工晶状体植入是一种安全、有效的选择。     

Intraocular lens implantation in the first year of life

We evaluated 36 eyes in 23 infants between one and eleven months old who had primary posterior chamber intraocular lens implantation for congenital cataracts. All eyes had a capsulorhexis of anterior and posterior capsulae and anterior vitrectomy. In order to obtain an emmetropia at age 5 years, we chose a 35% undercorrection of lens power for infants less than six months old, and 25% for infants between seven and eleven months old. The average follow-up was 15.3 months. Nine eyes developed posterior synechiae and eight developed a posterior opacification. The average postoperative refraction was +5.81 dioptries at one month, +4.56 at four months, +1.5, at one year, and +0.19 at two years. There was a marked subjective visual improvement in 34 eyes.     

Fluorophotometric evaluation of the blood-ocular barrier function following cataract surgery and intraocular lens implantation

Ocular fluorophotometry is a sensitive method for quantitative, in vivo evaluation of the blood-ocular barrier function. This paper reviews studies that have used this technique to evaluate the effects of devices or techniques used in cataract and implant surgery.     

Complications of pediatric cataract surgery and intraocular lens implantation

PURPOSE: To study the pattern of postoperative complications following extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in pediatric eyes. SETTING: Tertiary eye care center, New Delhi, India. METHODS: A retrospective analysis of 39 eyes of 28 children referred for complications after ECCE with IOL implantation was performed. The results evaluated were visual acuity, iridocapsular problems, and IOL-related complications. Additional interventions such as neodymium:YAG (Nd:YAG) capsulotomy, surgical membranectomy, and penetrating keratoplasty (PKP) were done when necessary. Visual acuity was measured 1 week following intervention and at the last follow-up. RESULTS: Congenital (17 eyes, 43.6%), developmental (11 eyes, 28.2%), and traumatic (11 eyes, 28.2%) cataract were the indications for surgery. Posterior capsule opacification (34 eyes, 87.2%), updrawn pupil (15 eyes, 38.5%), decentered IOL (13 eyes, 33.3%), and pupillary capture (12 eyes, 30.8%) were the major complications. An Nd:YAG capsulotomy was attempted in 19 eyes (48.7%). Surgical membranectomy was performed in 10 eyes (25.6%); PKP was performed in 2 eyes (5.1%) to treat pseudophakic bullous keratopathy. One eye had to be eviscerated because of uncontrolled endophthalmitis. In 31 eyes in which visual acuity could be measured, 27 had an acuity of 6/60 or worse at the time of presentation. Following intervention and amblyopia therapy, 19 eyes achieved a visual acuity of 6/18 or better. CONCLUSION: Routine ECCE with IOL implantation in pediatric eyes is associated with various problems and may lead to permanent visual disability.     

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system. METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of AcrySof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes, T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual refractive cylinder and intraocular lens (IOL) axis rotation. Objective optical quality were measured using optical quality analysis system (OQAS Ⅱ?, Visiometrics, Spain), included the cutoff frequency of modulation transfer function (MTFcutoff), objective scattering index (OSI), Strehl ratio, optical quality analysis system value (OV) 100%, OV 20% and OV 9% [the optical quality analysis system (OQAS) values at contrasts of 100%, 20%, and 9%]. RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18±0.11 and 0.07±0.08 logMAR; the mean residual refractive cylinder was 0.50±0.29 D; the mean toric IOL axis rotation was 3.62±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV 9% were 22.862±5.584, 1.80±0.84, 0.155±0.038, 0.76±0.18, 0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%, OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different (P>0.05), except the residual refractive cylinder (P<0.05). CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of AcrySof toric IOL implantation. Implantation of an AcrySof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.     

Microincisional cataract surgery and Thinoptx rollable intraocular lens implantation

Background Microincisional cataract surgery is a safe procedure with a very short learning period for an experienced cataract surgeon and rollable ultrathin intraocular lenses eliminate the need for enlargement of corneal incision. The purpose of the study was to evaluate the safety and efficacy of cataract surgery through a corneal microincision and implantation of rollable ultrathin intraocular lenses. The setting was Dokuz Eylul University Medical Faculty, Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital, Ophthalmology Clinic, Istanbul, Turkey.Patients and methods Ninety eyes in 85 patients were operated on through clear corneal microincisions with sleeveless phacoemulsification and rollable intraocular lenses were implanted. Forty-six of the patients were men and 39 were women between the ages of 27 and 83, with a mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4 patients had diabetes mellitus without retinopathy. Three eyes had posterior capsular opacifications of unknown etiology. Two eyes had primary open angle glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense nuclear sclerosis of grade 4 with very low visibility of retinal structures. Other patients had no ocular or systemic pathology other than nuclear/corticonuclear cataract of grade 2–3. Uncorrected and best spectacle-corrected distance and near visual acuities, keratometric values, and refractive status were noted preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical analysis of keratometric changes between preoperative and postoperative findings was performed using the paired samples t test.Results At 6 months postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA) of 0.2, the patient with atrophic senile macular degeneration. The rest of the eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55 (61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8 and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month, and 6 months were 0.69±0.43 D, 0.66±0.46 D and 0.65±0.48 D respectively. Statistical analysis revealed a significant change in corneal astigmatisms at the 1st week visit (p<0.05), but not at the 1st and 6th month visits (p>0.05) compared with preoperative findings.Conclusion Based on the limited data in the literature and in this study, it is not possible to make concrete decisions about the benefits and disadvantages of the ThinOptx IOL for longer durations. Intraoperatively, this IOL apparently eliminates the need for enlargement of the corneal incision during implantation. However, the statistical insignificance of induced astigmatisms after microincisions and classical phacoincisions should also be taken into consideration. We conclude that ThinOptx IOL is a pioneering intraocular lens implant that will contribute to the exciting future of cataract refractive surgical procedures. However, both clinical and laboratory investigations are needed to clearly describe the long-term effectiveness of this new rollable IOL.Authors do not have any proprietary interest in any of the materials mentioned in the textThis study did not receive any public or private fundingThis study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki