Scleral suspension pars-plana lensectomy for ectopia lentis followed by suture fixation of intraocular lens

PURPOSE: To describe a simple technique of scleral suspension-pars plana lensectomy (SS-PPL) in acquired and congenital ectopia lentis and scleral fixation of intraocular lens (IOL). MATERIALS AND METHODS: Twenty eyes of 16 patients (12 unilateral and 4 bilateral cases of "essential familial lens subluxation") aged 10-40 years (mean 25 years) underwent SS-PPL with implantation of scleral fixated IOL. Indications for surgery were best-corrected visual acuity < 6/18, bisection of pupil by the lens, and lens-induced glaucoma. Prerequisites for SS-PPL were, visibility of part of the lens in the pupillary area and soft lens. RESULTS: Postoperative visual acuity ranged from 6/6 - 6/36. Lens tilt in 3 cases(15%) and small decentration in 2 cases(10%) were seen; however these did not seriously compromise the visual result. Scant vitreous bleeding on the first postoperative day was seen in 3 cases (15%). CONCLUSION: The advantages of the scleral suspension of subluxated lens prior to lensectomy include stabilization; it allows proper viewing of the lens, avoids injury to the iris and ciliary body during lensectomy and reduces the possibility of dislocation of the lens.     

Functional and structural outcomes following lensectomy for ectopia lentis.

PURPOSE: High refractive errors and optical aberrations reduce vision when the lens edge bisects the pupil. We studied outcomes of eyes with ectopia lentis following lensectomy. METHODS: Charts of 11 consecutive patients with bilateral ectopia lentis who underwent lensectomy-anterior vitrectomy in at least one eye from 1985 to 2004 were reviewed. Eighteen eyes were operated. One eye was excluded due to short-term follow-up (<2 years). RESULTS: Mean age at surgery was 7.7 years (2 to 17 years). Median follow-up after lensectomy was 10 years (range 2 to 16 years). Six eyes were followed for 6 to 10 years, and another six eyes were followed for 11 to 16 years. Patient diagnoses included Marfan syndrome (nine eyes), ectopia lentis et pupillae (three eyes), simple ectopia lentis (two eyes), homocystinuria (two eyes), and sporadic spherophakia (one eye). Preoperative best-corrected visual acuity (BCVA) ranged from 20/60 to light perception, and postoperative BCVA ranged from 20/20 to 20/100 (14 eyes were at least 20/30). Complications included posterior vitreous detachment (two eyes, 12%), glaucoma (one eye, 6%), transient ocular hypertension (one eye, 6%), wound dehiscence with iris incarceration (one eye, 6%), transient vitreous hemorrhage (one eye, 6%), and peripheral anterior synechiae (one eye, 6%). No retina detached. CONCLUSIONS: Our cohort of patients with long-term follow-up shows that pars plana lensectomy can be successful in restoring vision when conservative measures fail.     

Outcomes of surgical intervention in cases of ectopia lentis

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

Treatment of dislocated lenses in patients with Marfan's syndrome using vitrectomy and intraocular lenses

PURPOSE: To evaluate results of surgical complex treatment of lens dislocation in Marfan syndrome cases. MATERIAL AND METHODS: Nineteen eyes of 13 patients were operatively treated for lens dislocation. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in 5 eyes and with an intracapsular method in 14 eyes. The scleral fixation technique was used for primary posterior chamber intraocular lens implantation in 18 eyes, and one eye remained aphakic. Time of observation ranged between 6 and 71 months (mean 3.5 years). RESULTS: All eyes achieved improvement in visual acuity or good preoperative visual acuity was maintained. The vision between 6/6 and 6/8 was achieved in 14 patients. There were no serious intraoperative or early postoperative complications. Retinal detachment appeared in two eyes in a long observation time and it was successfully operatively treated. The not good visual results were due to amblyopia (n = 2), complications of retinal detachment surgery (n = 2) and glaucomatous optic disc atrophy coexisting with macular degeneration (n = 1). CONCLUSIONS: Pars plana vitrectomy and primary scleral-fixated IOL implantation gives quick and good visual rehabilitation in adult patients with Marfan's syndrome. The described surgical method is complex and need a prolonged operative time, but gives very good functional results and very few complications.     

不同年龄Marfan综合征晶状体半脱位两种术式的疗效观察

目的 探讨两种晶状体摘除联合一期人工晶状体（IOL）悬吊术治疗不同年龄Marfan综合征晶状体半脱位的效果。设计 回顾性病例系列。研究对象 Marfan综合征先天性晶状体半脱位患者10例（18眼）。方法 ＞12岁患者3例（5眼）采用晶状体超声乳化术摘除晶状体同时行一期IOL悬吊术（乳化组）;≤12岁患者7例（13眼）采用晶状体切除联合一期IOL悬吊术,同时行前段玻璃体切除术（晶切组）。平均随访（1.40±1.02）年。主要指标 最佳矫正视力、眼压、并发症。 结果 18眼术前平均最佳矫正视力（0.29±0.20）,术后（0.51±0.24）（P=0.008）。 乳化组术前平均最佳矫正视力（0.17±0.04）,术后（0.41±0.16）（P=0.026）;晶切组术前平均最佳矫正视力（0.34±0.22）,术后（0.55±0.25）（P=0.000）。两组间比较,平均矫正视力改善无统计学差异（P=0.062）。所有患者术前等效球镜为（-2.76±14.1）D,术后为（-0.79±1.95）D。无一例出现严重并发症。结论 晶状体超声乳化与晶状体切除及前部玻璃体切除联合一期IOL悬吊术两种手术方式均能有效改善不同年龄Marfan综合征晶状体半脱位患者视力,手术方式选择与视力改善无明显关系。（眼科,2016, 25： 86-89）     

Surgical management of non-traumatic pediatric ectopia lentis: A case series and review of the literature

PurposeTo report a small series of pediatric patients with ectopia lentis that underwent limbal-approach lensectomy and vitrectomy and scleral-fixated intraocular lens implantation and to review the literature on the topic of surgical management of ectopia lentis.MethodA retrospective review of 13 eyes of seven patients that underwent lensectomy, vitrectomy, and scleral-fixated intraocular lens implantation and a review of the ophthalmic literature.ResultsIn our series, the average age at surgery was 70.3 ± 13.8 months and the average length of follow-up was 23.8 ± 5.9 months. The mean pre-operative visual acuity was 0.86 ± 0.17 which improved to 0.23 ± 0.09 post-operatively (p < 0.001). No complications were encountered in our series. A review of the literature found that amblyopia was the biggest vision-limiting factor. In general, the literature suggested that a higher percentage of eyes that were left aphakic achieved better vision than those implanted with a scleral-fixated intraocular lens. However, there may be selection bias in that more eyes receiving an intraocular lens may have pre-existing amblyopia. The complication rates for lensectomy or scleral-fixated intraocular lens implantation were low in the literature. In the latter group, suture breakage and resultant intraocular lens dislocation is a worrisome late complication.ConclusionSurgical intervention for ectopia lentis via vitrectomy techniques yields good result. In cases of unilateral aphakia or in settings where compliance with aphakic refractive correction is questionable and amblyopia is a constant threat, scleral-fixated intraocular lens implantation is highly encouraged. However, long-term follow-up is required due to the risk of suture breakage and resultant intraocular lens dislocation over time.     

先天性晶状体半脱位超乳手术中植入囊袋张力环的临床观察

目的:评价晶状体囊袋张力环(capsular tension ring,CTR)在先天性晶状体半脱位超声乳化吸除术中的应用价值.方法:对18例31眼先天性晶状体半脱位患者行晶状体超声乳化吸除联合CTR及 IOL 植入术.测量手术前后视力,使用Image-ProPlus v6.0软件测定IOL位置,观察术中术后并发症.结果:所有患者术后裸眼视力均较术前提高.术后人工晶状体均有不同程度的偏心,其中2眼人工晶状体偏位大于2mm并逐渐加重,于术后3mo行Ⅱ期手术将偏位最大方向CTR缝合固定于巩膜后恢复正位.结论:在白内障合并晶状体半脱位患者中行晶状体超声乳化吸除术中植入CTR是安全有效的方法,有利于保持囊袋的稳定,便于手术操作,保持人工晶状体的基本正位,减少手术并发症.如术后晶状体偏位加重可Ⅱ期行CTR巩膜缝合固定术.     

Surgical treatment of lens dislocation in children--analysis of complications

PURPOSE: To present the surgical complications in eyes with ectopia lentis in children. Material and methods: 116 eyes of 65 children were operatively treated for lens dislocation. Pars plana lensectomy, vitrectomy and IOL implantation with scleral fixation were done in all eyes. Time of observation ranged between 1-6 years (mean 3.4). RESULTS: There were no serious intraoperative complication (mainly hemorrhage to anterior and posterior chamber). Postoperative complications included retinal detachement in 3 (2.6%) eyes and endophthalmitis in 1 (0.8%) eye, were the major complications observed in all patients. Complications related to scleral fixation included exposure of the scleral fixation suture in 8 (6.9%) eyes, lens decentration in 9 (7.8%) eyes, pupil capture in 3 (2.6%). CONCLUSIONS: The surgical procedure is useful and safe in the management of subluxated lenses in children.     

Combined cataract surgery and vitrectomy for recurrent retinal detachment

PURPOSE: To report our experience with combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in the management of recurrent retinal detachment (RD) and visually significant cataract. METHODS: Retrospective chart review of patients with cataract and recurrent RD who underwent combined cataract extraction, posterior chamber intraocular lens implantation, and pars plana vitrectomy between January 1991 and September 1998 at the Bascom Palmer Eye Institute. Sixteen eyes were included. All eyes had visually significant cataract and had undergone primary repair of the RD with encircling scleral buckle; eight eyes also had undergone pars plana vitrectomy during the primary repair. The technique of cataract extraction included phacoemulsification (10 eyes), extracapsular cataract extraction (5 eyes), and pars plana lensectomy (1 eye). All eyes underwent pars plana vitrectomy, membrane peeling, fluid-air exchange, endolaser treatment, and placement of a retinal tamponade. Perfluoropropane (C3F8) gas was used in 14 eyes, and silicone oil was placed in two eyes. RESULTS: The postoperative follow-up interval ranged from 4 to 64 months (mean, 16 months). Preoperative visual acuity ranged from 20/60 to hand motions and was better than 20/200 in 3 (19%) eyes. Postoperatively, 9 (56%) eyes improved to better than 20/200. Anatomic success was achieved after the initial reoperation in 13 (81 %) eyes. With further surgery, the overall success rate was 94%. CONCLUSIONS: Combined cataract surgery, posterior chamber intraocular lens implantation, and pars plana vitrectomy in selected patients with cataract and recurrent RD was successful in improving visual acuity and achieving retinal reattachment in most of these reoperated patients.     

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous

AIM: To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous (PHPV). METHODS: This retrospective study included patients with cataract and PHPV treated with various strategies. Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization, posterior capsulotomy, anterior vitrectomy, and intraocular lens (IOL) implantation. Posterior PHPV was treated with lensectomy, posterior vitrectomy, retinal photocoagulation, and IOL implantation or silicone oil tamponade. Visual acuity (VA), pattern visual evoked potential (P-VEP), anatomic recovery, postoperative complications, and amblyopia outcome were examined. Subjects were followed-up for 3-48mo after surgery. RESULTS: Of the 30 patients (33 eyes) with congenital cataract and PHPV included (average age, 39.30±35.47mo), 9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage (6 eyes) and two-stage (3 eyes) implantation. Postoperative complications included retinal detachment (1 eye) and recurrent anterior chamber hemorrhage (1 eye). In eyes with posterior PHPV, 6 and 11 eyes received IOLs in one- and two-stage procedures, respectively. Silicone oil was retained in 2 eyes, and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48mo of amblyopia treatment. P-VEP P100 was improved following surgery in both PHPV types. CONCLUSION: Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.     

婴幼儿先天白内障的疗效观察

本文总结了145例205眼先天白内障显微手术临床资料.采用显微镜下囊外摘除术.后囊切开术、人工晶体植入术、晶体联合前部玻璃体切除术.术后圆孔圆眼底清晰可见166眼,占81%.近期并发症瞳孔上移14眼,玻璃体疝10眼,后期并发膜性白内障72眼,占35.1%.斜视眼,占15·6%、术后矫正视力0.1以上者91眼,占44.4%.强调显微手术安全、损伤小、增视机会多.对手术适应证、时机、并发症及视力预后等进行了讨论.     

先天性白内障合并永存胚胎血管的手术治疗和预后

目的：观察先天性白内障合并永存胚胎血管（PFV）患儿的临床特征及手术治疗效果。方法：回顾性系列病例研究。分析2011 年5 月至2017 年6 月在温州医科大学附属眼视光医院杭州院区接受手术治疗的先天性白内障合并PFV患儿24例（28眼）的临床资料,记录手术年龄、手术方式、手术前后眼部检查情况以及手术前后视力。结果：术前合并先天性瞳孔虹膜异常14 眼,晶状体脐状凹陷或悬韧带异常6 眼,后囊膜缺损9 眼,先天性小角膜及角膜缘干细胞异常2 眼,眼底病变2 眼,眼球震颤5 眼,斜视7 眼,全身合并腭裂1 例。大于3 岁患儿7 例（10 眼）,行“晶状体切除+前段玻璃体切割+人工晶状体（IOL）植入术”,随访8.0（2.5～41.0）个月,末次随访视力均在0.1 以上,2 例（2 眼）在0.3 以上;小于1岁患儿17例（18眼）,行“晶状体切除+前段玻璃体切割术”,选择性注视卡Snellen视力均达0.1以上,注视追视及眼球震颤均明显改善;6例（6眼）患儿一期先行“晶状体切除+前段玻璃体切割术”,年龄（5.5±2.6）个月,二期再行IOL植入术,年龄（23.5±8.1）个月,1例（1眼）达到0.6,接近正常同龄儿童,5 例（5 眼）达到标准对数视力表视力0.1 以上。手术后随访4 个月至6 年（中位数12.0 个月）, 无严重并发症。结论：先天性白内障合并PFV大部分为单眼发病。微创晶状体切除联合玻璃体切割术后并发症的发生率非常低,术后视力明显提高,少部分可以达到正常视力。     

外伤性晶状体脱位的联合手术治疗

目的：评价晶状体、玻璃体联合手术治疗外伤性晶状体脱位或半脱位的临床疗效。方法：对1993年10月－2000年5月连续收治的外伤性晶状体脱位或半脱位36例作回顾性研究。所有患眼根据病情均采用不同的术式去除脱位晶状体,包括角巩缘切口圈套娩出、睫状体扁平部切口行晶状体切除或超声晶状体粉碎,同时切割玻璃体,并应用小梁切除、阀门管植入术、玻璃体视网膜手术联合治疗因晶状体脱位引起的并发症,17例I期植入前房或后房型人工晶状体。结果：所有患眼成功的去除晶状体,91．7％患眼视力有不同程度提高,52．3％患眼视力≥0．3,继发青光眼患者术后眼压获得控制,6例视网膜脱离全部复位。结论：各种手术方法联合应用治疗外伤性晶状体脱位及其所致并发症,视力增进效果明显。阀门管植入术是治疗严重眼外伤顽固性青光眼的有效手术方法。     

Okuläre Manifestationen und chirurgische Ergebnisse beim Marfan-Syndrom

AIM: This retrospective study should examine and judge the surgical indications and the therapeutic possibilities as well as their complications in patients with ocular manifestations of Marfan syndrome (MFS) diagnosed according to the criteria of the Ghent nosology. PATIENTS AND METHODS: The study included 17 patients. Operative indications were increasing subluxation of the lens, retinal detachments and secondary glaucoma. The operative procedure depended on patient age and findings. Eleven MFS patients were operated in both eyes and six MFS patients in one eye. RESULTS: Stabilization or functional improvement of visual acuity could be achieved in all patients in whom no disorders limiting visual acuity or amblyopia were present preoperatively. In six eyes of five patients, lens insertion was accomplished via a pars plana approach. Lens removal without implantation of an intraocular lens was performed in 16 eyes of 10 patients. Pars plana vitrectomy was accomplished in 12 eyes. Complications were well controlled by pars plana vitrectomy. CONCLUSIONS: Difficult preoperative situations and postoperative complications are not rare in MFS patients. However, they can be controlled well by means of modern vitreous surgery.     

Combined lensectomy, vitrectomy and scleral fixation of intraocular lens implant after closed-globe injury.

PURPOSE: To describe our experience in the surgical management of cataracts in patients with complications of closed-globe injury using pars plana lensectomy (PPL), pars plana vitrectomy (PPV), and scleral fixation of posterior chamber intraocular lens (PCIOL). METHODS: We retrospectively reviewed charts of all patients with closed-globe injury who underwent PPL, PPV and scleral fixation of PCIOL at our institution between January 1991 and July 1997. We identified 28 eyes; because of less than 2 weeks follow-up, 4 eyes were excluded from the current study. All eyes had lens subluxation/dislocation and visually significant cataract. Additional indications for surgery included secondary glaucoma (10 eyes), vitreous hemorrhage (3 eyes) and retinal detachment (1 eye). RESULTS: The postoperative follow-up interval ranged from 6 to 61 months (mean 18.5 months). Preoperative visual acuity (VA) ranged from 20/60 to hand motion and was 20/100 or better in 6 eyes (25%). Postoperatively, 19 eyes (79%) improved to 20/100 or better. Five eyes had subsequent surgery for the following indications: retinal detachment (2 eyes), poorly controlled glaucoma (2 eyes), and epiretinal membrane formation (1 eye). CONCLUSIONS: In patients undergoing PPL, PPV and scleral fixation of PCIOL for cataract after a closed-globe injury, a substantial visual improvement occurred in a majority of the involved eyes.     

改良晶状体切除术在眼外伤晶状体玻璃体联合术中的应用

目的:探求一种安全有效、并发症少且更适合眼外伤时晶状体玻璃体联合手术的晶状体切除术方式.方法:对27例(27眼)眼外伤行晶状体玻璃体联合手术者进行回顾性研究.所有患者均由睫状体平坦部巩膜切口行改良晶状体切除术,保留晶状体囊,并联合玻璃体视网膜手术.结果:所有患者均成功地切除了晶状体并最大限度保留有用的晶状体囊,患者术后视力均有不同程度的提高.继发性青光眼术后眼压得到控制.结论:该改良晶状体切除术是一种安全有效、并发症少且更适合眼外伤时晶状体玻璃体联合手术的手术方式.     

改良晶状体切除术在眼外伤晶状体玻璃体联合术中的应用

目的探求一种安全有效、并发症少且更适合眼外伤时晶状体-玻璃体联合手术的晶状体切除术方式。方法对27例(27眼)眼外伤行晶状体-玻璃体联合手术者进行回顾性研究。所有患者均由睫状体平坦部巩膜切口行改良晶状体切除术,保留晶状体囊,并联合玻璃体视网膜手术。结果所有患者均成功地切除了晶状体并最大限度保留有用的晶状体囊,患者术后视力均有不同程度的提高。继发性青光眼术后眼压得到控制。结论该改良晶状体切除术是一种安全有效、并发症少且更适合眼外伤时晶状体-玻璃体联合手术的手术方式。     

Management of the subluxed crystalline lens.

There has been a traditional reluctance to remove a subluxed (ectopic) lens because of the high surgical risk. The use of closed intraocular microsurgical techniques, however, now allows greater intraoperative control with few complications. The authors present the results of subluxed lens extraction, by limbal or pars plana lensectomy, in 44 eyes of 24 patients, in which the indication for surgery was lens subluxation causing a reduction in visual acuity or uncorrectable refractive error. Visual acuity was improved in all cases after surgery, with no significant complications. Patients with reduced visual acuity secondary to ectopic lenses have a good visual prognosis after lensectomy using a closed intraocular microsurgical technique.     

Application of a modified pars plana lensectomy within traumatic eyes

AIM: To investigate a surgical method of modified lensectomy within combined lensectomy and vitrectomy surgery in traumatic eyes. · METHODS: Clinical records were studied retrospectively for a series of consecutive 27 traumatic patients who were performed vitrectomy combined with lensectomy surgery. A modified lensectomy through pars plana incision of sclera was performed to these cases and lens capsule was reserved. It was then combined with vitreous and retinal operations. · RESULTS: All lens were removed completely with lens capsule remained. All cases achieved improved visual acuity. Intraocular pressure (IOP) in all eyes was in normal range after surgery. · CONCLUSION: The modified lensectomy is a safe and effective surgery manner which has few complications and is more suitable for traumatic eyes in the combined lensectomy and vitrectomy surgery.     

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

METHODS:Non-comparative retrospective observational case series. Participants:30 cases (30 eyes) of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4 Hospital from 2007 to 2011. According to the different situations of lens subluxation/dislocation, various surgical procedures were performed such as crystalline lens phacoemulsification, crystalline lens phacoemulsification combined anterior vitrectomy, intracapsular cataract extraction combined anterior vitrectomy, lensectomy combined anterior vitrectomy though peripheral transparent cornea incision, pars plana lensectomy combined pars plana vitrectomy, and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy. And whether to implement trabeculectomy depended on the different situations of secondary glaucoma. The posterior chamber intraocular lenses (PC-IOLs) were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present. Main outcome measures:visual acuity, intraocular pressure, the situation of intraocular lens and complications after the operations.RESULTS: The follow-up time was 11-36mo (21.4±7.13). Postoperative visual acuity of all eyes were improved; 28 cases maintained IOP below 21 mm Hg; 2 cases had slightly IOL subluxation, 4 cases had slightly tilted lens optical area; 1 case had postoperative choroidal detachment; 4 cases had postoperative corneal edema more than 1wk, but eventually recovered transparent; 2 cases had mild postoperative vitreous hemorrhage, and absorbed 4wk later. There was no postoperative retinal detachment, IOL dislocation, and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective, which can effectively control the intraocular pressure and restore some vision.