Phacoemulsification without intraocular lens implantation in patients with high myopia: long-term results

PURPOSE: To estimate the cumulative incidence of postoperative retinal detachment (RD), rhegmatogenous retinal lesions requiring argon laser treatments, anterior (ACO) and posterior (PCO) capsule opacification, and neodymium:YAG (Nd:YAG) laser capsulotomy in patients with high myopia who had phacoemulsification without intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: Seventy-three eyes of 57 patients with high myopia who had phacoemulsification without IOL implantation from 1993 to 1996 were retrospectively reviewed. The mean postoperative follow-up was 62.3 months and the mean axial length, 30.22 mm (range 29.10 to 33.70 mm). The incidence of RD and preoperative and postoperative prophylactic argon laser photocoagulation for rhegmatogenous retinal lesions were assessed. Between 1997 and 2000, ACO was evaluated subjectively and PCO was evaluated using the EPCO photographic image-analysis system. The incidence of Nd:YAG laser capsulotomy was noted. RESULTS: Argon laser photocoagulation was performed in 8 eyes (10.9%) preoperatively and 3 eyes (4.1%) postoperatively. One RD (1.3%) was observed 26 months after surgery; no preoperative or postoperative prophylactic argon laser photocoagulation or Nd:YAG laser capsulotomy was performed in this eye. At 1 year, 49 eyes (67.1%) had mild ACO and 24 (32.8%) had anterior capsule fibrosis. The data did not change during subsequent follow-up visits. At 6 years, the mean PCO grade was 1.109 (range 0.972 to 2.931); an Nd:YAG laser capsulotomy was performed in 12 eyes (16.4%). CONCLUSIONS: Compared with other studies that evaluated the outcomes of highly myopic patients who had cataract surgery with posterior chamber IOL implantation, our patients, who did not have IOL implantation, had a lower incidence of postoperative rhegmatogenous retinal lesions requiring argon laser treatments and a similar incidence of postoperative RD and visually significant PCO.     

晶状体囊袋张力环植入对高度近视白内障手术效果的对比观察

目的 评价晶状体囊袋张力环(CTR)在高度近视白内障人工晶状体手术中的应用价值.方法 将827例(1081只眼)高度近视白内障患者随机分为A、B两组,A组427例(549只眼),B组400例(532只眼),其中A组患者行超声乳化白内障吸出术及后房型人工晶状体和CTR植入,B组患者仅行超声乳化白内障吸出术及后房型人工晶状体植入.结果 A组术后一过性高眼压179只眼,其中1例取出CTR;随访18个月中有2例2只眼发生视网膜脱离,5例5只眼因发生后发障而行激光治疗.B组术后随访18个月中有9例9只眼发生视网膜脱离、35例35只眼因发生后发障而行激光治疗.两组的视网膜脱离发生率及后发障发生率比较差异均有统计学意义.结论 晶状体囊袋张力环在高度近视白内障手术中的应用能防止晶状体悬韧带离断,使人工晶体居中,并进而能有效防止后发障和视网膜脱离的发生.     

Clear lens extraction for the correction of high myopia

OBJECTIVE: To evaluate the postoperative outcomes and intraoperative and postoperative complications of clear lens extraction (CLE) with posterior chamber intraocular lens (IOL) implantation in highly myopic eyes. DESIGN: Retrospective case series. PARTICIPANTS: One hundred seven patients (190 eyes) who had undergone CLE with posterior chamber IOL implantation and who had been observed for at least 3 years after surgery. METHODS: Medical records of patients who had undergone CLE with posterior chamber IOL implantation to treat high myopia (axial length >26.00 mm) over 7 years (January 1990 to December 1996) were reviewed. Visual acuity and refractive error were assessed before and after surgery, and perioperative, intraoperative, and postoperative complications were recorded. MAIN OUTCOME MEASURES: Axial length, preoperative and final best spectacle-corrected visual acuity (BSCVA), preoperative and postoperative spherical equivalent (SE), argon laser treatments, surgical complications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy, retinal detachment (RD), time from surgery or Nd:YAG capsulotomy to RD, subfoveal choroidal neovascularization (CNV), and follow-up period. RESULTS: The mean postoperative follow-up period was 4.78 years (range, 3.10-8.03 years). Final BSCVA was better than preoperative BSCVA in 159 eyes (83.68%), equal in 24 eyes (12.63%), and worse in 7 eyes (3.68%). Postoperative BSCVA was 20/40 or better in 136 eyes (71.60%) vs. 52 eyes (27.36%) before surgery (P<0.001). The mean final postoperative SE was -1.22 diopters. The risk of Nd:YAG laser capsulotomy was 77.89%. The incidence of RD was 2.10%; retinal reattachment was achieved in all cases, and none of these eyes had worse final BSCVA than before surgery. Subfoveal CNV developed in 4 eyes (2.10%) of 3 patients; all of these eyes presented with a macular lacquer crack. CONCLUSIONS: Clear lens extraction with posterior chamber IOL implantation has good outcomes with acceptable predictability and improvement in best-corrected visual acuity. During follow-up, patients tended to remain stable, and the risk of retinal detachment was low. We attribute our favorable results to careful patient selection and follow-up.     

Phacoemulsification and lens implantation after scleral buckling surgery

PURPOSE:To determine the intraoperative and postoperative complications and best-corrected visual acuity outcomes of eyes undergoing phacoemulsification and intraocular lens implantation after retinal detachment repair by the scleral buckling technique. METHODS:The charts of all patients who underwent phacoemulsification and intraocular lens implantation between July 1991 and May 1998 in two surgical practices were reviewed to identify eyes with a history of retinal detachment repaired by the scleral buckling technique. Eyes with a history of pars plana vitrectomy were excluded. Demographic and surgical data, preoperative and postoperative best-corrected visual acuity, and intraoperative and postoperative complications were recorded.RESULTS:We identified 34 eyes of 32 patients. The mean interval from retinal detachment repair to phacoemulsification was 12.4 years. The mean interval from phacoemulsification to final examination was 20 months. Risk factors for retinal detachment included isolated myopia (82%), myopia with lattice retinal degeneration (5.9%), and myopia with trauma (8.8%). One eye (2.9%) had no identifiable risk factors. Final best-corrected visual acuity of 20/40 or better was attained in 29 (85%) of 34 eyes and 20/20 or better in 18 (53%) of the eyes. Of the five eyes with the lowest best-corrected visual acuity, three had a macula-off retinal detachment; one had a posterior capsule opacity, epiretinal membrane, and corneal edema secondary to ocular ischemia; and one had advanced glaucoma. All five eyes still experienced an improvement in best-corrected visual acuity. With regard to complications, one eye had a posterior capsular tear with vitreous loss and another developed a postoperative retinal tear. Posterior capsule opacification requiring laser capsulotomy developed in 13 eyes (38%). No eye developed a retinal redetachment. CONCLUSION:Phacoemulsification and intraocular lens implantation can be performed safely after scleral buckling surgery and excellent best-corrected visual acuity results can be attained in most eyes. No modification of surgical technique is necessary. No retinal redetachment occurred in this series.     

Phakic intraocular lens implantation versus clear lens extraction in highly myopic eyes of 30- to 50-year-old patients

PURPOSE: To compare the outcome of treatment for myopia by phakic intraocular lens (IOL) implantation or by clear lens extraction (CLE). SETTING: Service d'Ophtalmologie, Hopital Purpan, Toulouse, France. METHODS: Thirty-nine patients from 32 to 49 years of age were studied. Forty-one eyes of 21 patients received a phakic IOL, and 36 eyes of 18 patients had phacoemulsification of the crystalline lens. The mean preoperative spherical equivalent (SE) was -13.6 diopters (D) +/- 3.0 (SD) in the phakic IOL group and -16.7 +/- 3.8 D in the CLE group. RESULTS: Postoperatively, the mean SE was -1.06 +/- 0.78 D in the IOL group and -1.88 +/- 0.83 D in the CLE group. At 12 months, the best corrected visual acuity (BCVA) had improved in 78.0% of eyes in the IOL group and 83.3% in the CLE group; no eye lost 1 line of BCVA. In 3 eyes (7.31%) in the IOL group, opacification of the crystalline lens developed 34, 36, and 44 months after implantation. Visual recovery after phacoemulsification was excellent. No eye in this group lost 1 or more lines of BCVA between 1 and 4 years of the initial surgery. In the CLE group, a retinal detachment occurred in 2 eyes at 39 and 43 months. The final BCVA in these eyes was counting fingers and 20/200. CONCLUSION: Implantation of a phakic IOL in a highly myopic eye of a patient between 30 and 50 years of age can be considered an adequate technique with a lower risk for loss of BCVA than CLE.     

视网膜脱离巩膜外垫压术后白内障超声乳化人工晶状体植入术的疗效

目的 评价视网膜脱离巩膜外垫压术后施行白内障超声乳化和人工晶状体植入术的术中、术后并发症和最佳矫正视力结果。方法 回顾性观察1997年11月～2002年11月施行视网膜巩膜垫压术后施行白内障超声乳化和人工晶状体植入术的患者。记录术前、术后的最佳矫正视力，术中、术后并发症。并对其临床特点进行分析和讨论。结果 48例49眼。从视网膜脱离手术到超声乳化手术之间的时间为6月～43年，平均13．5年；超声乳化手术平均随访24．6个月。术后最佳矫正视力≥0．1者43眼(87．76％)，≥1．0者25眼(51．02％)。6眼矫正视力低于0．1的患者中，5眼黄斑区有增殖条索改变，1眼存在视网膜前膜。3眼发生后发性白内障行激光晶状体后囊膜切开术。随访期内未发现视网膜再脱离者。结论 视网膜脱离巩膜外垫压术后行白内障超声乳化联合人工晶状体植入术，可使大部分患者恢复较好的视功能，手术并发症少，无视网膜脱离再复发，具有较高安全性。     

巩膜环扎术后超声乳化白内障吸除人工晶状体植入术的疗效观察

目的　探讨视网膜脱离巩膜环扎术后超声乳化白内障吸除人工晶状体植入术的疗效和并发症。方法　对 33例 ( 33只眼 )视网膜脱离巩膜环扎术后患者行超声乳化白内障吸除人工晶状体植入术 ,观察手术前、后视力的变化情况和手术并发症的发生情况。结果　 2 8只眼 ( 84 8% )术后最佳矫正视力≥ 0 1,其中 12只眼 ( 36 4% )≥ 0 4,与术前比较差异有非常显著性意义 (P <0 0 1)。 2只眼发生后发性白内障行激光晶状体后囊膜切开术。平均随访时间 ( 1 9± 1 0 )年 ,未发现视网膜再脱离者。结论　视网膜脱离巩膜环扎术后行超声乳化白内障吸除人工晶状体植入术 ,可使患者恢复较好的视功能 ,手术并发症少 ,视网膜脱离的复发率低 ,具有较高的安全性。     

Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification

PURPOSE: To determine the incidence of retinal detachment (RD) after neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) and define the characteristics of this type of RD. SETTING: A private practice, with statistical evaluation at a university department. METHODS: Five hundred twenty-six consecutive eyes that had Nd:YAG capsulotomy because of visually disturbing PCO were followed prospectively for up to 52 months (median 21 months) to determine the incidence of RD. The median age of the 142 men and 320 women was 76 years and the median axial length, 23.3 mm (range 20.5 to 31.3 mm). Before the capsulotomy, all eyes had uneventful phacoemulsification with implantation of a posterior chamber intraocular lens (PC IOL). Eyes with additional surgical procedures or with panretinal laser photocoagulation were excluded. Eyes in which a retinal hole had been treated before Nd:YAG (n = 4) were included. The fundus was examined by binocular indirect ophthalmoscopy with a 2.2 diopter Volk lens in full mydriasis. If necessary, an examination with a 3-mirror lens was done. RESULTS: The incidence of RD was 0% (0/483; 95% confidence interval [CI], 0.0%-0.8%) at 6 months, 0% (0/407; 95% CI, 0.0%-0.9%) at 12 months, and 0.5% (1/213; 95% CI, 0.0%-2.6%) at 24 months. Twenty-one months after Nd:YAG capsulotomy, 1 eye developed an RD that occurred as the result of a horseshoe tear that reopened. The tear, which formed 7 months after phacoemulsification and PC IOL implantation and 6 years before Nd:YAG capsulotomy, had been immediately treated with argon laser photocoagulation. Excluding the 4 eyes with preexisting tears, presumably sealed retinal holes, the incidence at 24 months was 0% (0/212; 95% CI, 0.0%-1.7%). No other eye developed RD over the follow-up. CONCLUSIONS: Retinal detachment after Nd:YAG capsulotomy for PCO was rare in eyes that had previous uneventful phacoemulsification and PC IOL implantation. The exact relationship between the 2 events remains to be established.     

Phakic refractive lens experience in Spain

PURPOSE: To evaluate the efficacy, predictability, and safety of a phakic refractive lens (PRL) for high myopia and hyperopia. SETTING: Instituto Oftalmológico Hoyos, Barcelona, Spain. METHODS: A PRL was implanted in 31 eyes (17 myopic, 14 hyperopic) with a mean preoperative spherical equivalent (SE) of -18.46 diopters (D) (range -11.85 to -26.00 D) for myopia and +7.77 D (range +5.25 to +11.00 D) for hyperopia. All eyes had a thorough ophthalmologic examination before and after surgery. The follow-up was at least 12 months. RESULTS: At 1 year, the mean postoperative SE in the myopic group was -0.22 D +/- 0.87 (SD) and 82% were within +/-1.00 D of the desired refraction. The mean postoperative SE in the hyperopic group was -0.38 +/- 0.82 D, and 79% were within +/-1.00 D. Snellen lines of visual acuity were gained in 65% of the myopic eyes (8 eyes gained 1 line, 3 eyes gained 2 lines), and no eye lost lines. In the hyperopic group, 1 eye gained 1 line of acuity and 1 eye lost 1 line. In the hyperopic group, complications included pupillary block in 2 eyes and pigment dispersion signs without intraocular hypertension in 1 eye. In the myopic group, 1 eye had a corticosteroid-induced intraocular pressure rise, 1 eye had a spot of anterior cortical lens opacity immediately after surgery that did not progress, and 3 eyes with the PRL model 100 had decentration that required replacement of the lens. Four patients (2 myopic, 2 hyperopic) reported night halos in both eyes. CONCLUSIONS: Results indicate that PRL implantation to correct high myopia and hyperopia is a relatively rapid, safe, predictable, and stable method that in many cases also improves the best corrected visual acuity. Complications such as visually significant progressive cataract and pigmentary glaucoma were not observed.     

Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy

PURPOSE: To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. SETTING: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. METHODS: This retrospective study comprised 42 eyes of 36 patients with glaucoma and cataract who had phacoemulsification with posterior chamber IOL implantation combined with trabeculectomy. The mean follow-up of 28.24 months +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocular pressure (IOP), visual acuity, visual field, endothelial cell loss, and notation of complications. RESULTS: There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity (BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes had a postoperative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm2 (range 1697 to 2906 cells/mm2) and postoperatively, 2005 +/- 397 cells/mm2 (range 1302 to 2801 cells/mm2). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectively, 2 patients (4.76%) had surgery to remove viscoelastic substance under the IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neodymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an acrylic IOL (3.70%) and 1 with a silicone lens (9.09%). CONCLUSION: Combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy was safe and effective in patients with coexisting glaucoma and cataract.     

Visual function and late complications after cataract surgery by phacoemulsification with primary posterior capsulotomy and intracapsular foldable intraocular lens implantation

PURPOSE: Evaluation of visual function and late complications after cataract phacoemulsification with primary posterior capsulotomy and intracapsular foldable intraocular lens implantation in 22-months follow-up. MATERIAL AND METHODS: Twenty five eyes of 25 patients (mean age: 53 years) were included in the study. All the eyes underwent primary posterior thermal capsulotomy and in-the-bag foldable IOL (Acrysof) implantation. Postoperative visual acuity and complications were analyzed. RESULTS: The best corrected visual acuity 1.0 (Snellen chart) was achieved in 92% (23/25) of the eyes. The most frequent complication was a slight vitreous dislocation to the anterior chamber (4/25 of eyes--16%), resulting in the pupil deformation in two eyes (2/25 of eyes--8%). In one eye (1/25 of eyes--4%) retinal detachment was observed. None of the patients presented CME. CONCLUSIONS: A very good visual function and low rate of serious late complications suggest, that cataract phacoemulsification with primary posterior capsulotomy and in-the-bag foldable IOL implantation should be taken into consideration, as an option for preventing PCO. The results of the present study suggest the risk of retinal detachment and CME does not appear, to increase after the primary posterior capsulotomy. However, this conclusion has to be confirmed by randomized studies with longer follow-up period and larger series of patients.     

Influence on posterior capsule opacification and visual function of intraocular lens optic material

PURPOSE: To examine the influence of optic material on posterior capsule opacification (PCO) by comparing PCO and visual functions between eyes with an acrylic intraocular lens (IOLs) and those with a silicone IOL of the same optic design and with the same haptics. DESIGN: Randomized clinical trial. METHODS: One hundred patients scheduled for phacoemulsification surgery underwent implantation of an acrylic IOL (AMO Sensar; AR40e) in one eye and implantation of a silicone IOL (ClariFlex) of the same optic design and loops in the fellow eye. Eighty-nine patients (89%) remained for analysis. The PCO value was measured using the Scheimpflug videophotography system at one, three, six, 12, 18, 24, 30, and 36 months postoperatively. The incidence of eyes that required a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy was examined; visual acuity and contrast sensitivity with and without a glare source were also evaluated. RESULTS: The mean PCO value did not increase significantly during follow-up in either the acrylic or silicone IOL group. When comparing the groups, no statistically significant difference was found in the PCO or in the incidence of Nd:YAG capsulotomy, although both tended to be slightly better in the silicone group than in the acrylic group. There was also no significant difference between the groups in visual acuity or in photopic and mesopic contrast sensitivity with or without glare. CONCLUSIONS: When acrylic and silicone IOLs are of the same optic design and with the same haptics, the optic material does not influence the development of PCO enough to impair visual function.     

白内障超声乳化吸除联合人工晶状体植入Ⅰ期后囊膜连续环形撕除的临床观察

目的探讨白内障超声乳化吸除联合人工晶状体植入术中Ⅰ期后囊膜连续环形撕除的临床疗效。方法对53例(60只眼)先天性白内障和后囊混浊的老年性白内障,施行白内障超声乳化吸除联合人工晶状体植入,同时行Ⅰ期后囊膜连续环形撕除,术后观察眼压、人工晶状体位置、视轴区后发障等情况。结果术中人工晶状体均顺利植入囊袋;54只眼术后视力较术前提高,术后24小时后眼压正常;术后随访3个月~2年,无发生玻璃体疝入前房,未发现人工晶状体异位或夹持,无一例出现后发障、视网膜脱离。结论白内障超声乳化吸除联合人工晶状体植入Ⅰ期后囊膜连续环形撕除是可行、安全的,能有效地治疗后囊膜混浊,预防后发障。     

Combined phacoemulsification, vitrectomy, foreign-body extraction, and intraocular lens implantation

PURPOSE: To assess the outcome of simultaneous phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and intraocular lens (IOL) implantation. SETTING: SSK Ankara Eye Hospital, Department of Vitreoretinal Surgery, Ankara, Turkey. METHODS: Seventeen patients with corneal perforation, intraocular foreign body, vitreous hemorrhage, and lens opacity had simultaneous clear corneal phacoemulsification, pars plana vitrectomy, intraocular foreign-body extraction, and IOL implantation. RESULTS: Postoperative complications included massive retinal fibrosis in 2 patients, retinal detachment in 1, and cilioretinal artery occlusion in 1. At a mean follow-up of 15.2 months, best corrected visual acuity improved in the remaining 13 eyes (76%). The IOL was stable in all cases. CONCLUSION: Combined phacoemulsification with IOL implantation and vitreoretinal surgery was safe in selected cases of penetrating ocular trauma resulting from an intraocular foreign body.     

囊袋张力环在高度近视白内障超声乳化及人工晶状体植入术中的应用

目的:评价晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体手术中的应用价值。方法:对427例549眼高度近视白内障患者行超声乳化白内障吸出术及后房型人工晶状体和囊袋张力环植入,术后随访3～18mo,测视力、眼压、散大瞳孔进行眼前节裂隙灯观察照像。结果:所有植入的人工晶状体均位于正位,术后3mo矫正视力>0.8者43眼,0.6～0.8者118眼,0.5者89眼,0.4者101眼,0.3者66眼,0.2者80眼,<0.2者52眼;术后1d眼压为3～47mmHg,一过性高眼压179眼,其中有1例患眼因术后高眼压无法药物控制而不得不取出CTR;随访18mo中有2例患眼发生视网膜脱离、5例患眼因发生后发性白内障而行激光治疗。结论:晶状体囊袋张力环在高度近视白内障联合低度数人工晶状体手术中的应用能防止晶状体悬韧带离断,使人工晶状体居中性更佳,并进而能有效防止后发性白内障和视网膜脱离的发生。     

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery

PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING: Tertiary care institution in India. PATIENTS: Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS: Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS: Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.     

Modified capsular tension ring for patients with congenital loss of zonular support

PURPOSE: To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Ninety eyes of 57 patients with congenital loss of zonular support (Weill-Marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). RESULTS: At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months +/- 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). CONCLUSIONS: Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.     

白内障超声乳化IOL植入术后早期高眼压的临床分析

目的:探讨白内障超声乳化人工晶状体植入术后早期高眼压(IOP)发生的相关因素及应对措施.方法:对我院2014-01/2016-01完成的白内障超声乳化人工晶状体植入术658例726眼临床资料进行回顾分析.结果:术后发生高眼压共38眼,发生率为5.2％.术后眼压升高的幅度为21～ 55 mmHg,大多数患者出现高眼压的时间为术后6～24h.其中主要的相关因素:前房黏弹剂残留24眼(63.2％),葡萄膜炎9眼(23.7％),前房积血2眼(5.3％),皮质残留2眼(5.3％),囊袋阻滞综合征1眼(2.6％).应用降眼压药物,抗炎治疗联合前房放液,术后3d均能有效控制眼压≤21 mmHg,其中囊袋阻滞综合征1眼联合YAG激光治疗.结论:黏弹剂残留和炎症反应是引起术后高眼压的主要原因.术前评估,提高手术技巧,术后及时发现和正确处理,能有效防止术后高眼压,促进视功能的恢复.     

Comparison of posterior capsule opacification between fellow eyes with two types of acrylic intraocular lens

PURPOSE: To compare the degree of posterior capsule opacification (PCO) and visual function between fellow eyes that received two different types of hydrophobic acrylic intraocular lenses (IOLs). METHODS: Forty-five patients underwent bilateral phacoemulsification and implantation of an Alcon AcrySof IOL (MA60AC) in one eye and an AMO Sensar IOL (AR40e) in the fellow eye. The PCO density value was measured using the Scheimpflug videophotography system at 1, 6, 12, and 24 months after surgery. The incidence of eyes that required a neodymium:YAG (Nd:YAG) laser capsulotomy, visual acuity, and contrast sensitivity with and without a glare source were also examined. RESULTS: The mean PCO value did not show a significant increase in either the AcrySof MA60AC or Sensar AR40e IOL groups, and was similar between the two groups throughout the 24-month follow-up period. The incidence of Nd:YAG laser capsulotomy was also the same between the groups. No significant difference was found in mean visual acuity between the two IOL groups during the follow-up, and there was no significant difference in photopic or mesopic contrast visual acuity with and without a glare source at 1 and 24 months after surgery. Conclusion: The degree of PCO in eyes with an AcrySof IOL are almost the same as that in eyes with a Sensar IOL, with the results that visual acuity and contrast sensitivity with and without glare are similar.     

Surgical results of combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation

PURPOSE: To evaluate the results and complications of combined pars plana vitrectomy (PPV), phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. METHODS: A total of 117 eyes from 114 patients who had undergone PPV combined with PEA and IOL implantation were retrospectively analyzed. Combined surgery was performed for a wide variety of vitreoretinal diseases. Intraoperative and postoperative complications were also reviewed. RESULTS: The postoperative BCVA improved by 2 lines or more in 85 eyes (72.6%). Intraoperative complications consisted of retinal tears in 14 eyes (12.0%) and posterior capsular rupture in 2 eyes (1.7%). Iatrogenic retinal tears occurred more frequently in eyes with a macular hole than in eyes with any other disease (p=0.005, chi-square test). Postoperative complications consisted of posterior capsule opacification (PCO) (21 eyes), transient IOP elevation (29 eyes), vitreous hemorrhage (6 eyes), anterior chamber fibrin exudation (11 eyes), posterior iris synechia (8 eyes), neovascular glaucoma (1 eye), and recurrent retinal detachment (RD) (2 eyes). Fibrin exudation occurred more frequently in eyes with proliferative diabetic retinopathy (PDR) and RD than in eyes with any other disease (p=0.03, chi-square test). PCO occurred more frequently in eyes with PDR than in eyes with any other disease (p=0.03, chi-square test). CONCLUSIONS: The present study suggests that a high success rate can be achieved when recently improved PPV techniques are combined wi th PEA and IOL implantation. The complications that were observed following this combined treatment varied with respect to the vitreoretinal disease present prior to surgery.