Secondary intraocular lens implantation in children

PURPOSE: We describe a technique for secondary intraocular lens implantation in the ciliary sulcus in patients with congenital cataract or with primary aphakia. MATERIAL AND METHODS: Secondary intraocular lens implantation was performed in 119 eyes of 74 children. The average age at this procedure was 6.8 (range 22 months to 10 years), whereas the average age at primary cataract surgery was 18 weeks (range 7 weeks to 19 months). The average follow-up was 5.7 years. All eyes received a PMMA IOL. The sites of IOL fixation was ciliary sulcus. All patients had cataract extraction (lensectomy) via the pars plana, leaving in situ peripheral collarette of capsular bag to enable secondary lens implantation. RESULTS: Complications included IOL dislocation in five eyes, visual axis opacification in four, pupillary capture in one eye. CONCLUSIONS: Secondary IOL implantation in the ciliary sulcus is a safe and effective method to correct aphakia in pediatric patients with adequate capsular support. This surgical procedure is associated with a low rate of complications.     

Posterior capsule opacification after silicone lens implantation and its management

The incidence and time of onset of posterior capsular opacification in a consecutive series of 147 silicone lens implants and in 585 polymethylmethacrylate (PMMA) lens implants were compared. Silicone lenses, sulcus and capsular bag fixated, had an opacification rate of 27.9%, while PMMA had a rate of 7.0%. In the silicone lens series, 65.9% of the opaque capsules required YAG laser posterior capsulotomies in the first four months. In the PMMA implants, only 28.6% required YAG laser capsulotomies in the first four months. The mean follow-up time was nine months. Management of capsular opacification in silicone lenses required early YAG laser capsulotomy, with focusing posterior to the capsule to avoid pitting the implant.     

人工晶状体囊袋内缝线睫状沟固定术的临床应用

目的:观察探讨人工晶状体囊袋内缝线睫状沟固定术的临床应用、手术方法及效果。方法:对19例19眼伴晶状体不全脱位和4例4眼超声乳化术或手法小切口囊外摘除术中误吸囊袋或其他操作致局限性悬韧带离断的白内障患者(悬韧带离断≥3个钟点位～≤6个钟点位14眼,>6个钟点位～≤9个钟点位者9眼),行计划性或术中一期人工晶状体囊袋内缝线睫状沟固定术。结果:所有患者经过6～36mo的随访,视力稳定;人工晶状体位置:正常者17眼,轻度倾斜者2眼,偏中心者4眼,瞳孔不圆者4眼,患者均无不良主诉;4眼后囊膜轻度混浊,未做处理;无固定缝线松解脱落及囊袋皱缩发生。结论:人工晶状体囊袋内缝线睫状沟固定术对伴有晶状体不全脱位、悬韧带形态异常、功能缺陷的白内障病例,临床效果好,费用低,可替代人工囊袋内张力环。     

外伤性白内障的后房型人工晶体植入手术时机及方法的临床观察

对74例外伤后不同时期施行人工晶体植人术后眼部的反应及预后进行对比分析.结果显示不同时期人工晶体植入对视力预后无明显差异.Ⅰ期和Ⅱ期人工晶体植人术包括睫状沟固定术同样可取得良好的视力,但植入手术一般选择在外伤3月炎症反应完全消失以后较好.对于无后囊、后囊破裂较大的病例施行Ⅱ期人工晶体睫状沟缝合固定术同样可取得良好的效果.     

人工晶状体前膜形成与晶状体襻固定位置的关系

目的 探讨人工晶状体前膜形成与晶状体支撑襻固定位置之间的关系。方法 对45例45只眼老年性白内障行白内障摘出及人工晶体植入术后人工晶状体前膜形成进行回顾性分析术中人工晶状体襻固定的位置。结果 人工晶状体襻固定于囊袋内1只眼;不对称囊袋和睫状体沟内固定26只眼;18只眼为完全睫状体沟内固定。结论 人工晶状体襻不完全睫状体沟内固定是前膜形成的因素之一,而囊袋内固定人工晶状体则可减少人工晶状体前膜的形成。     

Effect of anterior capsular polishing on the rate of posterior capsule opacification: A retrospective analytical study

AimTo determine whether anterior capsule polishing during cataract surgery done by phacoemulsification has any effect on the rate of posterior capsule opacification.Materials and methodsWe conducted a 3 year retrospective analytical study at our hospital. The medical records of patients who underwent cataract extraction by phacoemulsification with foldable square edge hydrophilic PCIOL between April 2007 and March 2010 were reviewed.The study included 1009 eyes of 950 patients who underwent phacoemulsification with foldable square edge hydrophilic IOL in the bag implantation with anterior capsular polishing. The control group included 981 eyes of 957 patients in whom anterior capsular polishing was not done.Patients in the age group of 45–65 years with well dilating pupils were included in the study. They were evaluated at 1 week, 1 month and 1 year post-operatively. Exclusion criteria included glaucoma, shallow anterior chamber, uveitis, high myopia, pseudoexfoliation, diabetes mellitus, traumatic cataracts, posterior polar cataract, subluxated cataracts, previous ocular surgeries, patients allergic to dilating drops, and steroid intake. Intraoperatively, the exclusion criteria were not achieving the total anterior capsule cover on the IOL optic, sulcus fixated IOL, and any intraoperative complications like posterior capsule rupture. After bimanual irrigation/aspiration, all enrolled patients were randomly assigned to receive either 360 degree anterior capsular polishing or No anterior capsular polishing and results were studied.ResultsThe rate of posterior capsule opacification in the study group and in the control group was not statistically significant.ConclusionThough it was thought that anterior capsular polishing will lead to reduced rate of PCO formation, our study showed that there was no significant difference in PCO formation between the two groups. However, it was seen that the rate of anterior capsule opacification and capsular phimosis showed a significant reduction in cases in which anterior capsular polishing was done.     

Morphology of capsular sack retraction in relation to capsulotomy technique, lens design and sulcus-/saccus fixation

Over a period of several months the dynamics and morphology of capsular retraction were analyzed with various capsulotomy techniques and IOL types implanted into the capsular bag or the sulcus. The techniques compared were peripheral and intermediate canopener capsulotomy, intermediate and small letter-box capsulotomy, intermediate and small capsulorrhexis with and without superior incisions. The posterior chamber IOLs implanted were one-piece and three-piece C-loop lenses and, in a limited pilot study, one-piece disk lenses. The authors' results indicate that capsular retraction and the stable position of the implant depend on the type, form, and size of the capsulotomy, the type of IOL and its fixation in the bag or sulcus. Any irregularity of the anterior capsule induces irregular capsular retraction with the risk of IOL decentration. Free-floating anterior capsular flaps may induce formation of iridocapsular synechiae. Contact between the anterior capsular rim and the posterior capsule results in capsulocapsular adhesions, capsular wrinkling, and capsular opacification of the contact zone. In order to avoid these capsulocapsular adhesions the diameter of the IOL optics should exceed that of the capsular opening in endocapsular implantation. However, peripheral capsulocapsular adhesions are necessary to stabilize IOL haptics, which for this reason must be of open design. Capsulocapsular adhesions may inhibit migration of lens epithelial cells in secondary capsular opacification. The ideal anterior capsulotomy technique seems to be the symmetrical, small, circular, continuous capsulorrhexis, if endocapsular implantation is desired. However, the technique is mainly designed for phacoemulsification, as a small capsulorrhexis inhibits nuclear expression in extracapsular cataract extraction.(ABSTRACT TRUNCATED AT 250 WORDS)     

人工晶体植入术后后囊混浊的观察

本文报告了360眼IOL术后随访观察6个月～2.5年的结果,有87眼发现后囊混浊(24.17%);但其中仅14眼(3.89%)影响视力.先天性白内障IOL术后后囊混浊影响视力者占47.37%,老年性白内障IOL术后后囊混浊未发现明显影响视力.IOL术后后囊混浊的发生的高峰时间是术后3～6月,并无随时间延长混浊率增加的趋势,术后后囊混浊的防治关键应放在术后3个月内.     

两种囊袋张力环巩膜固定方法在中重度晶状体不全脱位治疗中的应用研究

目的 比较一期改良式囊袋张力环(modified capsular tension ring,MCTR)巩膜固定或二期囊袋张力环(capsular tension ring,CTR)-囊袋复合体巩膜固定治疗中重度晶状体不全脱位的临床效果.方法 回顾性研究.收集我院2012年1月至2015年12月中重度(120°～270°)晶状体不全脱位患者30例43眼,均在局部麻醉下行超声乳化白内障吸出及MCTR或CTR和IOL囊袋内植入术,A组23眼均采用MCTR联合IOL植入术,一期巩膜固定;B组20眼均采用一期CTR联合IOL植入术,3～6个月后行二期CTR-囊袋复合体巩膜固定术.观察两组术后6个月最佳矫正视力、术后囊袋复合体的位置及并发症等情况.结果 术后6个月,A组87％患眼最佳矫正视力≥0.6,B组95％患眼最佳矫正视力≥0.6,两组相比差异无统计学意义(P＞0.05).术后所有CTR、IOL均位于囊袋内,囊袋中度收缩偏中心A组2眼,B组1眼,两组发生率相比差异无统计学意义(P＞0.05),均行YAG激光前囊膜松解后缓解.术后早期(1个月)并发症:前房渗出膜A组3眼,B组1眼;一过性高眼压A组5眼,B组2眼,两组两种并发症发生率相比差异均无统计学意义(均为P＞0.05).术后远期(6个月)并发症:后发性白内障A组3眼,B组1眼,两组相比差异无统计学意义(P＞0.05),均行YAG后囊切开术.结论 一期MCTR巩膜固定或二期CTR-囊袋复合体巩膜固定术后囊袋复合体的位置和稳定性均良好,对中重度晶状体脱位治疗均有效.     

Polishing the posterior capsule after extracapsular extraction of senile cataract.

Posterior capsular polishing is performed to delay or prevent capsular opacification. To study its effectiveness, a prospective study of 412 patients with bilateral senile cataracts was conducted. Each patient had bilateral extracapsular cataract extraction with laser ridge, posterior chamber lens implantation. The right eye of each patient had posterior capsular polishing using the Tennessee-Freeman polisher. The posterior capsule in the left eye was not polished. All patients above the age of 80 years (22 patients) had bilateral opacification within 16 months postoperatively. For patients less than 80 years old (390 patients), the cumulative capsulotomy rate in the polished capsule group was 9.2% (36 eyes); in the unpolished capsule group the rate was 12.0% (47 eyes) for the same follow-up time (average 30 months). There was no statistical difference in the incidence of posterior capsular opacification between the polished and unpolished groups. Polishing the posterior capsule after lens cortex cleaning had no significant role in delaying or preventing capsular opacification.     

Long-term study of the prevalence of capsular opacification following extracapsular cataract extraction

The prevalence of capsular opacification was studied in a group of patients who had extracapsular cataract extraction from 1978 to 1980 by one surgeon. In 94 eyes the follow-up was longer than four years. Capsular opacification developed in 41% of these eyes. In 72% of the eyes with opacification the diagnosis was made more than two years after surgery. In the patients who were operated on during 1980, capsular opacification appeared later and less frequently than in those operated on during 1978. Although the difference was not statistically significant, it probably reflects improved technique and more meticulous cleaning of residual cortex. Patients younger than 40 years had a higher prevalence of capsular opacification (70%) than those older than 40 years (37%). Pseudophakic and aphakic patients had a similar prevalence--47.6% and 39.7%, respectively.     

Secondary cataract treatment with laser YAG-ND

The purpose of the study is to present the favorable results of YAG: Nd laser capsulotomy for the treatment of secondary opacification of the posterior capsule, in our department. A 3 years retrospective study was performed. For 1440 cataract operations, most of them extracapsular extractions with PMMA IOL placed in the posterior chamber (ciliary sulcus or capsular bag), 285 laser capsulotomies were done. The results are presented statistically, including sex and age distribution, type of cataract surgery and implant, treatment protocol (number of sessions, number of impulses per session, energy per impulse) and complications. The frequency of secondary capsular opacification in our study is 19.78%. It is most important in the age group 60-70 years, where the surgery for cataract is performed more often. Capsulotomy was done after extracapsular extraction with IOL placed in the posterior chamber, but especially after extracapsular extraction without implant placement or with complications that have permitted only the use of an anterior chamber implant. Capsulotomy is performed in only one session in 88% of the cases. The energy per impulse is usually 3-5 mJ and the mean number of impulses per session is 10-30. There are few complications: transient elevation of intraocular pressure in 14.73%, discrete laser marks on the implant in 8.77% and moderate iritis in 1% of the cases. YAG: Nd laser capsulotomy appears to be a safe and efficient method of treating secondary cataract; it improved visual acuity in all cases, if different ocular pathology had not influenced it.     

Surgical and visual outcomes following exchange of opacified Hydroview intraocular lenses

AIM: To report the clinical and surgical outcomes following exchange of opacified Hydroview intraocular lenses (IOLs), and to relate the final visual and anatomic results to clinical and surgical variables. METHODS: This is a prospective study of seventy-three eyes that underwent exchange of opacified Hydroview IOLs in Waterford Regional Hospital, Ireland. Preoperative, intraoperative and postoperative details were recorded. RESULTS: This study comprised 73 eyes of 71 consecutive patients undergoing IOL exchange, performed at mean (+/-SD) intervals of 36.64 (+/-9.9) months following the primary cataract surgery. The mean (+/-SE) follow-up following the exchange procedure was 13 (+/-1) months (range: 1-45 months). The secondary IOL was placed in the capsular bag, in the sulcus, and in the anterior chamber in 22 (30.1%), 24 (32.9%) and 27 (37%) cases, respectively. The IOL exchange procedure was uneventful in 36 eyes (49.3%), whereas intraoperative events such as posterior capsule rupture, vitreous loss and zonular dehiscence were seen in the remainder (50.7%). Following the IOL exchange procedure, a significant improvement in best corrected visual acuity (BCVA) was noted at one and at three months, and at the final visit (Wilcoxon signed ranks test: p<0.001, p = 0.006, and p<0.001, respectively). Following exclusion of eyes with visually consequential ocular comorbidity, a better final BCVA was noted among those eyes where the secondary IOL was placed in the capsular bag or in the sulcus when compared with placement of the secondary IOL in the anterior chamber (IOL in the bag or sulcus: 26 eyes (35.6%), median (IQR) final BCVA: 0.2 (0.10-0.40); IOL in the anterior chamber: 19 eyes (26.02%), median (IQR) final BCVA: 0.5 (0.20-0.60); Mann Whitney U Test: p = 0.004). CONCLUSION: IOL exchange is a technically challenging, but visually rewarding procedure. However, placement of the secondary IOL in the anterior chamber is associated with a poorer visual outcome when compared with placement of the secondary IOL in the sulcus or in the capsular bag.     

Anterior chamber depth with sulcus and capsular bag placed IOGEL lenses

The anterior chamber depth was measured in 15 eyes with sulcus placed (Group 1) and 12 eyes with bag placed (Group 2) IOGEL PC-12 lenses, and in 11 eyes with bag placed IOGEL 1103 lenses (Group 3). The mean anterior chamber depth was 3.29 mm in Group 1, 4.17 mm in Group 2, and 4.16 mm in Group 3. The difference between the mean anterior chamber depth with sulcus and bag placed IOGEL PC-12 lenses is statistically significant (P less than .0005). One effect of the different anterior chamber depths was that the anterior surface of a sulcus placed IOGEL lens frequently touched the pupillary border, whereas this rarely occurred when it was placed in the capsular bag. Another effect of differing anterior chamber depths was a different A-constant for the SRK-formula for sulcus or bag placement. In this study it was about 1 diopter greater with bag fixation than with sulcus fixation. It is recommended that each surgeon use specific A-constants to enhance the predictability of the postoperative refraction.     

Pathogenesis of posterior capsular opacification. Part I. Epidemiological and clinico-statistical data

We examined 895 eyes having extracapsular cataract surgery; 403 had an intraocular lens (IOL) implanted and 492 did not. The incidence of posterior capsular opacification was 7.69% in the eyes with an IOL and 14.23% in the eyes without an IOL. If we exclude complicated cataracts from the cases that did not have an IOL, the incidence of posterior capsular opacification decreases to 9.06%. Various models of implanted IOLs showed different incidences of posterior capsular opacification: For J-looped lenses the incidence was 11.02%; for Frezzotti-Caporossi lenses, 7.35%. The follow-up was too short for soft lenses. The Frezzotti-Caporossi lens can be inserted with the convex side either anterior or posterior. A statistical evaluation shows that the reverse optic or posterior convex orientation in the bag caused a lower incidence of posterior capsular opacification (3.01%).     

Comparison of long-term incidence of posterior capsular opacification between phacoemulsification and phacotrabeculectomy.

PURPOSE: To investigate the long-term incidence of posterior capsular opacification after phacoemulsification compared with phacotrabeculectomy with or without adjunctive subconjunctival mitomycin C. METHODS: This was a retrospectively conducted long-term, observational, case-control study. One hundred eyes of 100 cataract patients who underwent phacoemulsification and posterior chamber intraocular lens implantation and 100 eyes of 100 primary open-angle glaucoma patients with cataract that underwent phacotrabeculectomy and posterior chamber intraocular lens implantation, matched with respect to age, intraocular lens type, prevalence of diabetes mellitus, and length of follow-up. The main outcome measure was the rate of clinically significant posterior capsular opacification as determined by slit-lamp biomicroscopy and necessity to perform neodynium:yttrium aluminum garnet (Nd:YAG) capsulotomy and as calculated by Kaplan-Meier survival analysis. Postoperative visual acuity and maintenance of intraocular pressure control were also measured. RESULTS: There was no significant difference in the rate of posterior capsular opacification requiring Nd:YAG capsulotomy between the phacoemulsification and phacotrabeculectomy groups (P =.77). However, a significant difference in the rate of posterior capsular opacification was found between those patients without diabetes mellitus and those with a preoperative diagnosis of diabetes mellitus (P =.016). Also, survival analysis comparing use of mitomycin C with no use of mitomycin C in the phacotrabeculectomy group showed a higher survival in the mitomycin C subgroup (P =.03). CONCLUSION: There was no significant difference in long-term posterior capsular opacification between phacoemulsification and phacotrabeculectomy in the study population. Intraoperative, adjunctive use of mitomycin C in the phacotrabeculectomy group and the presence of diabetes mellitus in the overall patients were beneficial (protective) factors against posterior capsular opacification.     

Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification

PURPOSE: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. SETTING: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic.Results: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P <.001, chi-square test) after a mean follow-up of 2.4 years +/- 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P <.001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P <.05, chi-square test). CONCLUSIONS: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.     

Retinal detachment with posterior chamber lens]

Pseudophakic retinal detachment was seen in 55 cases out of 13,692 patients that underwent cataract surgery and posterior chamber lens implantation in a 5 year period. The six-month incidence was 0.4%. Main risk factors were: myopia, capsular tear resp. zonular dialysis, and male gender. Sulcus- and capsular bag fixation showed the same incidence. 42% of pseudophakic retinal detachments occurred within the first 12 months after cataract surgery and 84% within the first three years. The resulting cumulation rate is discussed. The outcome of detachment surgery was reduced with increased rate of PVR. No typical localisation of retinal holes was found.     

吲哚青绿在白色白内障超声乳化吸除术中的应用

目的　评价吲哚青绿在白色白内障超声乳化吸除术中应用的有效性和安全性。方法对 10 5例 (10 5只眼 )白色老年性白内障患者行超声乳化白内障吸除术 ,Ⅰ组 (5 5只眼 )术中使用 0 5 %吲哚青绿溶液染色晶状体前囊膜 ;Ⅱ组 (5 0只眼 )术中不使用染色剂。记录术中完成连续环形撕囊(CCC)的时间 ,晶状体前囊膜放射状撕裂、晶状体囊袋破裂、人工晶状体囊袋内固定情况 ,以及术前、术后 1d、术后 3个月术眼眼压 ,角膜内皮变化和眼前节炎性反应情况。结果　术中平均CCC时间Ⅰ组明显短于Ⅱ组 ,晶状体前囊膜放射状撕裂和晶状体囊袋破裂的发生率Ⅰ组明显低于Ⅱ组 ,人工晶状体囊袋内固定率Ⅰ组高于Ⅱ组 ,两组比较差异均有显著意义 (P <0 0 5 )。两组术后均无眼压升高者 ,角膜始终保持透明 ,炎性反应轻微 ;手术前、后角膜内皮细胞密度、六角形细胞百分比、面积变异系数及中央角膜厚度两组比较 ,差异均无显著意义 (P >0 0 5 )。结论　在白色白内障超声乳化吸除术中应用吲哚青绿晶状体前囊膜染色技术 ,可提高手术的成功率 ,且效果安全、可靠 ,建议临床推广使用。     

Factors influencing the formation of posterior capsular opacities after extracapsular cataract extraction with posterior chamber lens implant

This study was designed to determine whether different factors could influence the formation of posterior capsular opacities. The study group comprised 271 patients who had undergone an extracapsular cataract extraction with implantation of a posterior chamber lens either with or without laser ridge. Between 12 and 25 months after surgery, a statistically significant difference was found with a lower rate of secondary cataract in the laser ridge group, but with respect to advanced secondary cataract, i.e. eyes which needed YAG capsulotomy, no statistically significant difference was found (P-value 0.99). No association was found between age or sex of patients, different surgeons or complications during or after surgery and the risk of getting a secondary cataract.