Cataract surgery in eyes with iridoschisis using the Perfect Pupil iris extension system

PURPOSE: To evaluate the use of the Perfect Pupil system (Milvella Pty. Ltd.) in 3 eyes in cataract surgery with iridoschisis. SETTING: Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. METHODS: Patient 1 was an 83-year-old man with a nuclear cataract, pseudoexfoliation syndrome, and iridoschisis. He was also having systemic anticoagulation therapy. Preoperative best corrected visual acuity (BCVA) was 0.05 in the right eye and 0.08 in the left eye. Patient 2 was a 73-year-old mentally retarded man with a brunescent cataract in the right eye. Preoperative BCVA was 0.1. RESULTS: In the first patient, cataract surgery was performed under topical anesthesia in both eyes through a clear corneal incision. Intraoperative pupil size was 3.0 mm. The Perfect Pupil device was inserted manually and fixated at the iris rim, leading to pupil dilation of 6.0 mm. Uneventful cataract surgery was performed without damage to the iris. Hydrophobic acrylic foldable intraocular lenses (IOLs) were implanted with forceps. Postoperative BCVA was 0.5 in the right eye and 0.4 in the left eye. The second patient was operated on under general anesthesia. Pupil dilation was successfully achieved. The brunescent cataract was removed and a hydrophobic acrylic IOL was implanted with an injector, resulting in postoperative uncorrected visual acuity of 0.3. CONCLUSION: In iridoschisis patients, there is risk of aspiration of iris fibers during cataract surgery. In these 2 patients, this was prevented using the Perfect Pupil system.     

分段小切口虹膜根部断离复位成形术的临床研究

目的 探讨分段小切口在虹膜根部断离后的复位成形手术方法及疗效.方法 采用分段小切口法修复外伤性虹膜根部断离63例（63眼）.结果 所有的虹膜根部断离均得到修复,未出现并发症.术后瞳孔基本恢复圆形或椭圆形,复视症状消失.结论 分段小切口修复虹膜根部断离是一种微创、安全、简便而有效的手术方式.     

自制虹膜钩在虹膜根部离断修复术中的应用

目的:观察自制虹膜钩在虹膜根部离断修复术中的应用效果。方法:在黏弹剂维持前房的情况下,在虹膜根部离断的相应位置角膜缘后1mm行45°斜行切口,并根据虹膜根部离断的范围决定切口的大小和数量。在虹膜根部离断范围内进行逐段切开、逐段缝合,缝合点间距为30°。使用自制的虹膜钩勾取离断的虹膜组织,拉至角膜缘切口处,用10-0尼龙线经角膜切口前唇、缝合虹膜根部约0.5mm,然后再穿过角膜切口后唇出针,结扎缝线。虹膜钩应用1mL或2mL一次性注射器针头根据术中具体情况制作。结果:根部离断的虹膜组织得到良好修复,恢复了瞳孔形态,提高了视力。结论:应用自制的虹膜钩可以准确的勾取离断的虹膜组织,使修复手术更加简单、准确、易行,有效恢复瞳孔,提高视功能。     

切口缝合预防儿童白内障术后虹膜前粘连效果的观察

目的:评估伤口缝合对预防儿童白内障术后虹膜切口处前粘连的效果。方法:设计随机前瞻对照研究。42眼儿童白内障被分为伤口缝合组和对照组。随访观察比较两组术后伤口虹膜前粘连的发生率的差异。结果:42眼患儿共发生伤口虹膜前粘连5眼(12%)。缝合组27眼共发生虹膜前粘连1眼(4%)。对照组15眼出现4眼(27%)。经非配对t检验统计分析,P<0.05,两组差异显著。结论:缝合可以有效减少和避免术后虹膜切口处前粘连。     

A modified iris repair technique and capsular tension ring insertion in a patient with coloboma with cataracts

PURPOSE: We describe our successful experience using a capsular tension ring (CTR) and iris repair during cataract surgery in a patient with bilateral coloboma. METHODS: A 67-year-old woman had no history of trauma, but had zonular deficiency and inferonasal iris defects in both eyes. An extracapsular cataract extraction and intraocular lens (IOL) scleral fixation was performed in the left eye. A CTR was implanted in the right eye through a sclerocorneal incision. After the IOL was placed centrally in the capsular bag, two paracenteses were made at the limbus (5 o'clock and 7 o'clock). A long, straight needle was passed through the 7 o'clock paracentesis site into a angled, blunt tipped 27 gauge needle inserted from the 5 o'clock paracentesis. The two needles were pulled out at 5 o'clock. After inserting the long needle into the blunt tipped needle at 7 o'clock, both were passed back through the 7 o'clock paracentesis site. The needles were pulled out again at the 5 o'clock paracentesis site tied. Equal tension was used to tie both sides. RESULTS: Visual acuity improved to 20/20 in the right eye. CONCLUSIONS: Both capsular tension ring implantation and iris repair was successfully performed at the time of cataract surgery in a coloboma patient, which resulted in improvements in visual function and cosmesis.     

Successful argon laser photocoagulation of diffuse epithelial ingrowth following concomitant persistent pupillary membrane removal and phacoemulsification

A 57-year-old woman had concomitant surgery of persistent pupillary membrane removal and uneventful phacoemulsification through the same temporal clear corneal incision in her left eye. Short axial lengths (right eye, 21.08 mm; left eye, 20.39 mm) with shallow angles were noted bilaterally, and other findings were not remarkable. The patient experienced angle-closure attacks 3 and 7 months postoperatively. At the second angle-closure attack, diffuse epithelial ingrowth was observed. The epithelial ingrowth covered the intraocular lens surface in the interpupillary area, the iris surface surrounding the pupil, and the temporal anterior chamber angle, but did not reach the corneal endothelial incision. After observation of iris blanching with laser photocoagulation, argon laser photocoagulation was applied to the epithelium covering the iris and angle 7 times during the following month. The epithelial ingrowth was completely removed and did not recur during the 36-month follow-up. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.     

New iris retractor for pupil dilatation during anterior vitrectomy: double-hook iris retractor

To report a new iris retractor as a tool for pupillary dilatation in eyes with a small pupil. This instrument was designed to prevent the retractor from dropping out of corneal incision, especially during anterior peripheral vitrectomy requiring a scleral indentation. A new iris retractor was designed with the top in the form of a double-hook, based on the conventional flexible iris retractor. The new instrument was used in 16 eyes, and the conventional flexible iris retractor was used in 14 eyes, with proliferative retinopathy or proliferative diabetic retinopathy in cases in which anterior vitrectomy was performed. The number of times that the instrument has been replaced were recorded. The conventional flexible iris retractor was replaced at mean number of 4.2 times, while the new iris retractor was replaced a mean number of 0.3 times during vitreous surgery. The difference was statistically significant (P = 0.009, Mann-Whitney test). The new iris retractor can easily hook onto the iris and is useful in anterior vitrectomy.     

Phacoemulsification of intumescent cataract, IOL implantation and reconstruction of congenital iris coloboma through one anterior chamber superior opening. Case report

PURPOSE: To report a phacoemulsification of intumescens cataract and repair of congenital iris coloboma through one superior incision. MATERIAL AND METHODS: Retrospective case report. RESULTS: Postoperative repair resulted in adequate pupil restoration, exact IOL position that allowed good visual rehabilitation. CONCLUSIONS: Cataract surgery in most cases is performed through superior incision. Congenital iris coloboma repair using the same incision is difficult but provides good cosmetic and functional results.     

Surgical management of iris defects with prosthetic iris devices

PURPOSE: To evaluate the safety and efficacy of surgical implantation of prosthetic iris devices in patients with iris deficiency. METHODS: Nine patients with traumatic iris defects, congenital aniridia or iris coloboma, and surgical or optical iridectomies were included in a noncomparative case series. Cataract surgery with intraocular lens and prosthetic iris implantation was performed in 10 eyes. The visual acuity, subjective degree of glare disability, postoperative anatomic results, and intraoperative and postoperative complications were evaluated. RESULTS: The mean follow-up was 17.75 months (range 4-48 months). Best-corrected visual acuity improved in nine of 10 eyes (90%) and remained unchanged in one eye. Glare subjectively improved in four of five eyes (80%) of patients complaining of glare preoperatively. All eyes achieved the desired anatomic result. Intraoperative complications included one anterior capsular tear. Postoperative complications included a short period of mild postoperative anterior uveitis in four eyes. Secondary glaucoma was absent. CONCLUSION: In patients with iris deficiency, implantation of prosthetic iris device, and intraocular lens implant following cataract surgery appears to be safe and effective in reducing glare disability and improving visual outcomes.     

Secondary prosthetic iris implantation following traumatic total aniridia and pseudophakia

We present 2 pseudophakic patients who had traumatic episodes that resulted in total expulsion of the iris without disturbing the intraocular lens (IOL). Because of intolerable glare, each patient was managed by reopening the fibrosed capsular bag and implanting 2 multi-finned prosthetic iris devices through a small incision, leaving the IOL in place. Following surgery, glare was no longer present and excellent visual acuity was maintained. We believe these are the first pseudophakic patients with traumatic total aniridia to be managed by this approach.     

曲伏前列腺素滴眼液对虹膜颜色改变的影响

目的观察应用曲伏前列腺素滴眼液后虹膜颜色的改变。方法采用前瞻性、观察者单盲和对照性研究的设计方法进行临床试验研究。选取北京大学眼科中心确诊为原发性开角型青光眼（POAG）的患者37例73眼为用药组,患眼每晚睡前点质量分数0.004%曲伏前列腺素滴眼液1次,共30 d。健康志愿者21例42眼为对照组,不点任何滴眼液。2组虹膜均为纯棕色。用药组和对照组受试者于试验前后分别进行裂隙灯虹膜照相,对虹膜颜色是否加深进行评估,结果判断为加深、不确定、无变化,并应用计算机颜色分析软件对2组虹膜颜色数值变化进行量化比较分析。结果肉眼观察发现,用药组患者26眼（35.6%）用药后虹膜颜色加深,对照组颜色无改变,用药组虹膜颜色加深和不确定的眼数与对照组比较,差异有统计学意义（χ2=21.467,P=0.000）。用药组用药后肉眼和计算机软件判断均为虹膜颜色加深者共17眼（23.3%）,计算机软件分析结果显示用药组共22眼虹膜颜色加深（30.1%）,仅肉眼判断为虹膜颜色加深者26眼（35.6%）。结论在应用曲伏前列腺素滴眼液3个月后,约1/3的纯棕色虹膜患眼虹膜颜色加深。     

小切口非超声乳化白内障术切口缝合与否的疗效比较

目的：探讨小切口非超声乳化白内障手术中巩膜切口缝合两针与不缝合的疗效差异。

方法：对420例477眼白内障患者行小切口非超声乳化联合后房型人工晶状体植入术,一字形巩膜隧道切口大小为6～7mm,植入直径5.5mm硬性人工晶状体,切口对称缝合两针者205例230眼(A组),不缝合者215例247眼(B组),术后2d; 3mo观察术眼视力和角膜散光。

结果：术后2d,A、B二组裸眼视力或球镜矫正视力≥0.5者分别为193眼(83.9%)和190眼(76.9%),术后3mo,A、B二组裸眼视力或球镜矫正视力≥0.5者分别为205眼(89.1%)和198眼(80.2%),两组病例不同时期视力差异均有统计学意义(P<0.05); 术后2d; 3mo,A组的平均角膜散光分别为1.53±0.59,1.05±0.43D,B组平均角膜散光分别为1.85±0.97,1.31±0.65D,两组病例术后不同时间平均角膜散光度差异均有统计学意义(P<0.01); A组病例术后无出现切口渗漏、浅前房、虹膜膨出的并发症,B组病例术后有3眼(1.21%)出现切口轻度渗漏、前房稍浅,4眼(1.62%)术后第1d出现上方虹膜膨出并嵌顿于巩膜切口。

结论：小切口非超声乳化白内障手术巩膜切口缝合两针者较不缝合者术后视力好,角膜散光小,手术更安全。     

Cataract surgery combined with implantation of an artificial iris

We describe 6 patients who presented with cataract or aphakia and absent or nonfunctional irides. The etiologies included congenital aniridia, traumatic iris loss, and chronic mydriasis secondary to recurrent herpetic uveitis. In 5 eyes, a prosthetic iris was successfully implanted in combination with small incision cataract surgery. In 2 eyes, a single-piece iris diaphragm and optical lens was implanted. Artificial irides offer a safe alternative for patients who previously had no viable options for iris reconstruction.     

Management of post-goniopuncture iris herniation: a two-step procedure

A 38-year-old male presented to the emergency room suffering acute pain in his left eye. Two months before he had been submitted to uneventful non-penetrating deep sclerectomy and one month before to YAG-laser goniopuncture. Examination showed iris herniation into the trabeculo-descemet’s window. Surgical reduction was carried out through a peripheral corneal incision, and a large air bubble was injected into the anterior chamber. Four days later a wide laser peripheral iridotomy was performed. This technique can transform a non-penetrating technique into a full-trabeculectomy, without reopening the superficial flap.     

Total iris expulsion through a sutureless cataract incision due to vomiting

PURPOSE: To present a case of isolated total iris expulsion through a self-sealing cataract incision 2 weeks postoperatively due to vomiting. METHODS: Ophthalmological examination included visual acuity assessment, tonometry, slit-lamp examination, fundus ophthalmoscopy and ultrasound examination. RESULTS: A 65-year-old woman experienced sudden visual loss during an episode of vigorous vomiting 2 weeks after uncomplicated phacoemulsification cataract surgery with a sutureless corneal incision. Clinical examination showed a dense anterior chamber haemorrhage. When the blood had cleared, isolated total aniridia was seen. CONCLUSIONS: This is the first reported case of aniridia after cataract surgery due to vomiting.     

Cauterising iris scissors.

The cauterising iris scissors described here are a modification achieved by suitably insulating the standard De Wecker's iris scissors. This modification provides in addition to cutting an advantageous cauterising effect, which could prove useful in the surgery of eye conditions with high risk of bleeding or metastasis. It utilises the optimum electric current range of 20-40 mA.     

Primary iris stromal cyst with unusual symptoms in an adult

BACKGROUND: Most epithelial cysts of the anterior chamber ("iris stromal cysts") occur after penetrating ocular injuries and represent secondary epithelial ingrowth. Primary iris stromal cysts are less common and mostly congenital. Acquired primary iris stromal cysts in adults are extremely rare and cause less often symptoms than congenital cysts. PATIENT: A 41-year old patient presented with sudden loss of visual acuity, epiphora and photophobia of his right eye. A large iris cyst was found in the nasal lower quadrant of the anterior chamber. It had not been present 3 years before when the patient was last seen by an ophthalmologist. There was no history of trauma and no signs of preceding ocular injury at slit-lamp examination. The cyst was surgically removed by iridocyclectomy. Postoperatively the patient developed cataract and macular edema. A phacoemulsification with posterior chamber lens implantation as well as a systemic treatment with steroids and acetazolamide were necessary. Until now, two years after surgery, the cyst did not recur. CONCLUSIONS: Primary iris stromal cysts also occur in adults. In contrast to previous reports the cyst of our patient has caused acute symptoms.     

Influence of tamsulosin on the iris and its implications for cataract surgery

PURPOSE: To study iris-related complications during cataract surgery in patients on tamsulosin medication. METHODS: Twenty-one consecutive cataract patients administered tamsulosin and 21 control patients were studied. Characteristics of the iris during surgery were recorded. Pupillary diameters of 16 patients were measured before and after iris dilatation. Tamsulosin concentrations in the aqueous humor and serum were analyzed. In five patients, surgery on the second eye was carried out after a 7- to 28-day pause in tamsulosin medication. RESULTS: Each patient administered tamsulosin had a sluggish hypotonic iris, along with a tendency toward miosis and a tendency for prolapse of the iris into the phaco tunnel or into the side port during cataract surgery. Sluggish irises also often adhered to the phaco tip or to the irrigation-aspiration tip. Despite a pause of 7 to 28 days in the use of tamsulosin, the adverse effects persisted. Tamsulosin concentrations varied between 0.1 and 1.0 ng/mL in the anterior chamber fluid. In three of five cases, tamsulosin remained in detectable amounts the aqueous humor after the 7- to 28-day pause. Preoperative pupillary diameter was smaller in the patients using tamsulosin than in the controls. CONCLUSIONS: Tamsulosin has selective alpha1A-adrenoreceptor antagonistic properties and obviously binds for a long period to the postsynaptic nerve endings of the iris dilator muscle, thus affecting iris dilatation and leading to complications in cataract surgery. The iris remained floppy after 7- to 28-day interruption of the tamsulosin regimen.     

带虹膜隔张力环植入治疗虹膜缺损

目的探讨带虹膜隔张力环植入手术治疗虹膜缺损的手术技巧、术中术后并发症。方法虹膜缺损24例（24眼）均行带虹膜张力环植入手术，分析手术操作方法、术中术后并发症及手术效果。结果根据虹膜缺损的范围和程度选择合适型号的带虹膜隔张力环。术中选择适当位置行透明角膜切口及辅助切口，前囊撕囊口应稍偏大并保证较好的连续性，防止植入过程中囊口的撕裂。部分型虹膜缺损者植入Morcher Type 96G，完全型虹膜缺损者植入2枚Morcher Type 50C。结论囊袋内植入带人工虹膜隔张力环治疗部分或完全虹膜缺损，取得了较好的治疗效果，开辟了该类疾病治疗的新思路。     

Prosthetic iris implantation for congenital, traumatic, or functional iris deficiencies.

PURPOSE: To determine the efficacy and safety of surgical implantation of prosthetic iris devices in patients with anatomic or functional iris deficiencies. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Twenty-five patients were enrolled in an interventional prospective noncomparative case series. Twenty-eight eyes had prosthetic iris diaphragm implantation for traumatic iris defects, congenital aniridia or iris coloboma, herpetic iris atrophy, surgical iris loss, or ocular albinism. Prosthetic iris implantation was performed with phacoemulsification and intraocular lens (IOL) implantation in 20 eyes, secondary IOL implantation in 6 eyes, and IOL exchange in 1 eye. A single pseudophakic eye with disabling glare secondary to traumatic aniridia had secondary prosthetic iris implantation alone. The surgical ease of insertion, intraoperative and postoperative complications, postoperative anatomic results, visual acuity, and subjective glare reduction were evaluated. RESULTS: Patients were followed postoperatively for a mean of 10.2 months (range 1.4 to 25.7 months). All eyes achieved the desired anatomic result. Visual acuity was improved in 22 of 28 eyes (79%), unchanged in 5 eyes, and worsened by a single line in 1 eye. Patients were surveyed postoperatively to determine the change in glare disability. The severity of glare disability was subjectively improved in 23 of 24 patients (96%) who responded to the survey. Intraoperative complications included 3 fractured implants as well as an incomplete or torn capsulorhexis in 3 eyes. Postoperative complications included transient hypotony in 2 eyes, mild persistent inflammation in 1 eye, and macular edema followed by a retinal detachment in 1 eye with recent severe trauma. CONCLUSIONS: Implantation of prosthetic iris devices improved postoperative outcomes by reducing glare disability and, in selected cases, by correcting aphakia. Although operating on traumatized, congenitally aniridic, or uveitic eyes presents special challenges, implantation of prosthetic iris devices appears to be a safe and effective method for reducing the ubiquitous glare in patients with iris deficiency.