Epicapsular Stars in an Asymptomatic Patient.

This case report discusses a diagnosis of epicapsular stars during a routine ophthalmologic examination in an asymptomatic female patient aged 14 years.

UV Effect on Human Anterior Lens Capsule Macro-Molecular Composition Studied by Synchrotron-Based FTIR Micro-Spectroscopy.

Ultraviolet (UV) irradiation is an important risk factor in cataractogenesis. Lens epithelial cells (LECs), which are a highly metabolically active part of the lens, play an important role in UV-induced cataractogenesis. The purpose of this study was to characterize cell compounds such as nucleic acids, proteins, and lipids in human UV C-irradiated anterior lens capsules (LCs) with LECs, as well as to compare them with the control, non-irradiated LCs of patients without cataract, by using synchrotron radiation-based Fourier transform infrared (SR-FTIR) micro-spectroscopy. In order to understand the effect of the UV C on the LC bio-macromolecules in a context of cataractogenesis, we used the SR-FTIR micro-spectroscopy setup installed on the beamline MIRAS at the Spanish synchrotron light source ALBA, where measurements were set to achieve a single-cell resolution with high spectral stability and high photon flux. UV C irradiation of LCs resulted in a significant effect on protein conformation with protein formation of intramolecular parallel ß-sheet structure, lower phosphate and carboxyl bands in fatty acids and amino acids, and oxidative stress markers with significant increase of lipid peroxidation and diminishment of the asymmetric CH3 band.

[Fixation of an intraocular lens using reverse optic capture with haptic tuck for intraoperative posterior capsule rupture]. / Fixation einer Intraokularlinse bei intraoperativem Hinterkapseldefekt durch Einklemmen der Linsenoptik in der vorderen Kapsulorhexis.

Exact positioning and optimal axial alignment are mandatory to achieve satisfactory postoperative refractive results after implantation of a toric or presbyopia correcting intraocular lens (IOL). Posterior capsule rupture can preclude stable capsular fixation. In such cases, reverse optic capture with haptic tuck results in stable fixation of the lens with respect to centering, rotation and axial position. Only the haptics are positioned in the capsule, behind the anterior capsulorrhexis. The optic remains in the sulcus; thus, the lens is fixed in the rhexis, providing long-term stability despite the presence of posterior capsule rupture.

Achieving successful capsulorhexis in intumescent white mature cataracts to prevent Argentinian flag sign - A new multifaceted approach to meet the challenge.

Purpose: To present a case series of intumescent white cataract cases managed by a new surgical technique to attain a single stage Continuous Curvilinear Capsulorhexis (CCC). Methods: The series included 60 eyes of 60 patients with white cataract which underwent preoperative anterior chamber depth, lens thickness and ultrasonographic A-scan for intralenticular spikes. A partial size main port (~1.8mm) is created as the first entry into the anterior chamber (AC). A 30-gauge needle of insulin syringe entered through a limbal stab incision is used to decompress the anterior and posterior intralenticular compartments. Following which a standard size, one stage capsulorhexis was performed in a trypan blue stained capsule using microcapsulorhexis forceps entered through the partial sized trapezoidal main port. The main port was secondarily enlarged for phacoemulsification. Results: Based on the intraoperative findings, 43 eyes were categorized as Intumescent type-1 cataracts i.e., with presence of actual liquefied cortex aspirated using 30-gauge needle and 17 eyes as Intumescent type-2 cataracts, i.e., presence of swollen lens without any obvious liquefied cortex. Standard size, circular and centred CCC was achieved in 100% of the cases and no Argentinean flag sign was noted. Surgeon perceived raised intralenticular pressure in 41% of the cases in type-1 subset and 61% cases in type-2 subset (P-0.06). Posterior capsular plaque was observed in 22% of the cases, adherent cortex in 25% and anterior capsular plaque in 5% of the cases. At 6weeks follow up 92% patients had best corrected visual acuity of 20/40 or better. Conclusion: A multi-layered approach can help in attaining successful CCC in cases of white mature cataract with high intralenticular pressure.

Krukenberg's Spindles Strongly Suggest Long Anterior Zonule Associated Pigment Dispersion Mechanism in Older Patients.

Purpose: The purpose of this study was to further investigate factors associated with Krukenberg's spindle (KS) presence in a primary eye care setting. Methods: As part of a larger investigation, several practitioners in an academic eye care facility in Chicago, IL, USA evaluated patients for the long anterior zonule (LAZ) trait during 2011 to 2018, and data were collected on ocular/systemic health, lifestyle, and demographic variables, including the presence of a KS. Multivariate regression was used to assess relationships to KS presence. Results: Analysis included 3501 subjects with mean age of 51 ± 15 years (18-98 years; 65% women; and 84% African American). Among the right eyes, 57 (1.6%) had a KS, with this group having a mean age of 62 ± 13 years (25-86 years; 75% women; and 82% African American). There were 120 subjects (3.4%) with right eye LAZ, with mean age of 64 ± 11 years (36-91 years; 77% women; and 92% African American). There were 19 of 57 (33.3%) KS eyes that also had LAZ. Controlling for other factors, variables with the strongest relationship to KS presence were the LAZ trait (odds ratio [OR] = 12.2, 95% confidence interval [CI] = 6.5 to 22.8, P < 0.0001) and advancing age (OR = 1.3 per decade, 95% CI = 1.3 to 1.9, P < 0.0001). Conclusions: In the population studied, KS presence had its strongest relationship to the LAZ trait and advancing age. The KS-LAZ relationship may not be well-known, but these data strongly suggest that pigment dispersion signs, such as a KS, should prompt the clinician to consider the LAZ trait as a potential etiology, especially because LAZ is associated with higher IOP and possibly glaucoma.

Flap motility sign: not diagnostic of posterior extension of anterior capsular tears.

Flap motility sign has been recently described as an aid to guide the surgeons regarding the feasibility of continuing safe phacoemulsification in the presence of peripheral extension of anterior capsular tears. While this sign may seem to provide a safety assurance to the operating surgeon who at such times may be under considerable stress, we believe, this sign may not always hold true and this hypothesis needs further investigation. We present a case in which an everted and fluttering flap was noted in the presence of a complete posterior extension of the anterior capsular tear, thus refuting the accuracy of flap motility sign.

Multimodal imaging in an idiopathic spontaneously absorbed cataractous lens: A rare case report.

PURPOSE: To report an unusual and rare case of idiopathic spontaneous absorption of the cataractous lens and its multimodal imaging features. METHODS: A 56-year-old female presented with a complaint of diminution of vision in both eyes (OU). Slit lamp examination of the right eye (OD) revealed Morgagnian cataract with a normal anterior segment. Slit lamp examination of the left eye (OS) revealed absorbed cataractous lens with intact lens capsule with clear visual axis. Fundus examination OS was unremarkable. No history of trauma, past ocular surgery or any ocular or systemic disease. Ultrasonography B-scan OU was unremarkable. Her blood examination was normal. Anterior segment optical coherence tomography showed increased anterior chamber depth OS. It also showed Morgagnian cataractous lens with nucleus in the bag OD and absorbed cataractous lens with thin adhered capsular bag OS. Scheimpflug imaging also showed decreased densitometry OS. She underwent successful phacoemulsification in OD with in-the-bag placement of intraocular lens. For OS with absorbed lens, she underwent phacoemulsification with anterior circular curvilinear capsulorhexis using a capsulotomy forceps. The cortical matter in the bag area was aspirated with implantation of intraocular lens in the ciliary sulcus over the intact capsule rim. RESULTS: The patient underwent phacoemulsification with anterior continuous curvilinear capsulorhexis with intraocular lens placement in the ciliary sulcus OS. CONCLUSIONS: This case is first of its kind in the literature. The role of ultrasound B-scan, anterior segment optical coherence tomography, and Scheimpflug imaging in the preoperative evaluation of capsulolenticular status and subsequent successful management is discussed.

Age-dependency of molecular diffusion in the human anterior lens capsule assessed using fluorescence recovery after photobleaching.

Purpose: To quantify the partition coefficient and the diffusion coefficient of metal-carrier proteins in the human lens capsule as a function of age. Methods: Whole lenses from human donors were incubated overnight in a solution of fluorescently labeled transferrin, albumin, or ceruloplasmin. In the central plane of the capsule thickness, fluorescence recovery after photobleaching (FRAP) experiments were conducted to measure the diffusion of the protein within the lens capsule. The anterior portion of the lens was recorded before the FRAP experiments to locate the boundaries of the anterior lens capsule and to measure the partition coefficient of the labeled proteins. The partition coefficient (P), the time to half maximum recovery of the fluorescent intensity (τ1/2), and the diffusion coefficient (D) for each protein were analyzed as a function of donor age. Results: There was no statistically significant relationship between the half maximum recovery time or the diffusion coefficient and age for transferrin (molecular weight [MW]=79.5 kDa, τ1/2=17.26±4.840 s, D=0.17±0.05 µm2/s), serum albumin (MW=66.5 kDa, τ1/2=18.45±6.110 s, D=0.17±0.06 µm2/s), or ceruloplasmin (MW=120 kDa, τ1/2=36.57±5.660 s, D=0.08±0.01 µm2/s). As expected, the larger protein (ceruloplasmin) took longer to recover fluorescent intensity due to its slower movement within the lens capsule. The partition coefficient statistically significantly increased with age for each protein (Palbumin: 0.09-0.71, Pceruloplasmin: 0.42-0.95, Ptransferrin: 0.19-1.17). Conclusions: The diffusion of heavy-metal protein carriers within the anterior lens capsule is not dependent on age, but it is dependent on the size of the protein. The permeability of the lens capsule to these heavy-metal protein carriers increases with age, suggesting that there will be a higher concentration of heavy metals in the older lens. This behavior may favor the formation of cataract, because heavy metals enhance protein oxidation through the Fenton reaction.

Phacoemulsification in bilateral anterior lenticonus in Alport syndrome: A case report.

RATIONALE: To report the visual status and results of phacoemulsification cataract surgery in a young patient with Alport syndrome associated with bilateral anterior lenticonus. The milestone of this report is the use of anterior segment optical coherence tomography (AS-OCT) to confirm the central protrusion of the anterior surface of the crystalline lens. PATIENT CONCERNS: A 23-year-old young woman presented with severe progressive visual loss in both eyes, which started several years ago. DIAGNOSES: Refractive status was indicative of high myopia with astigmatism and vision was not improved with optimal correction to better than 0.1 in the right eye and 0.2 in the left eye (visual acuities given in decimal notation). Slit-lamp examination showed transparent cornea, anterior lenticonus and posterior sub-capsular cataract in both eyes. The classical appearance of oil droplet was evident using retro-illumination on the slit lamp. INTERVENTIONS: The natural lenses were replaced with intraocular lens (IOL). OUTCOMES: An excellent refractive status achieved associated with an uncorrected distance visual acuity 0.9 and 0.8 in the right and left eye, respectively. LESSONS: AS-OCT is a valuable device for confirming the budging of the anterior crystalline lens surface.

Bioinorganic Markers of a Loss of the Crystalline Lens Capsule Barrier Properties and Consequent Age-Related Cataract Development.

The age-related cataract development consequent upon a loss of the lens capsule barrier properties proved to be associated with accumulation of sodium, calcium, phosphorus and potassium. For the first time the use of spatial cluster and correlation analyses showed that the physical light scattering in the crystalline lens volume depends on changes in the lens matter elemental composition. The fields of elevated concentrations of sodium, calcium, phosphorus, potassium and chlorine conformed to the lens capsule geometry and their clustering was similar to that of opacity fields in the lens body. The accumulation geometry of the elements in the lens body that are commonly seen in the aqueous humor of the anterior chamber, can be considered evidence for excessive transitioning of their compounds through the lens capsule shell, while its spatial connection with transparency changes-proof of participation in cataractogenesis.

Combination of capsular tension ring and capsular tension segment for the management of lens coloboma >4 clock hours.

Lens colobomas extending more than 4 clock hours and causing visual impairment require lens extraction along with capsular support devices with scleral fixation for adequate centration of the capsular bag and for prevention of capsular fornix aspiration with inadvertent extension of zonular dialysis intraoperatively. In this case series, we describe a technique for the management of isolated lens colobomas involving 4-5 clock hours by clear lens extraction and intraocular lens implantation using a combination of a capsular tension ring with a capsular tension segment (CTS) for the centration and stability of the capsular bag. Hoffman's corneoscleral pocket and half-bow sliding knot technique were used for scleral fixation of the CTS.

Postoperative Capsular Bag Distension Syndrome - Risk Factors and Treatment.

Introduction:Postoperative capsular bag distension syndrome (CBDS) is a rare complication of cataract surgery which might occur in the early postoperative period, as well as several years after uncomplicated surgery. The aim of this study was to review the current evidence on postoperative capsular bag distension syndrome. Material and Methods: PubMed and Web of Science were used for literature search. Results: The typical presentation involves deterioration in visual acuity, unexpected myopic shift or less frequently hyperopia. In eyes with clear capsular fluid and no posterior capsule opacification, usually in the late postoperative period, CBDS can be asymptomatic. Risk factors for developing CBDS include retained ophthalmic viscoelastic device, inadequate subincisional cortex cleaning, apposition between the intraocular lens (IOL) and the capsular bag, postoperative inflammation and IOL sequestration with Propionibacterium acnes. Visualization of the CBDS can be aided with Scheimpflug imaging, ultrasound biomicroscopy, and particularly anterior-segment optical coherence tomography. Conclusion:Nd:YAG posterior capsulotomy, and in some cases anterior capsulotomy, is accepted as a standard and effective CBDS treatment. Surgical approach could be beneficial in cases suspected of Propionibacterium acnes presence or when it is impossible to perform Nd:YAG posterior capsulotomy.

Iris Crystals: A Rare Clinical Finding in Chronic Anterior Uveitis.

Iris crystals are a rare clinical entity seen in cases of chronic anterior uveitis (CAU). We report one such case with crystal deposition on iris as well as corneal endothelium and anterior lens capsule. No significant change in the crystals was seen over a period of 11 years despite multiple episodes of exacerbation and resolution. Anterior segment optical coherence tomography (AS-OCT) showed crystals as hyperreflective deposits over the corneal endothelium. On confocal microscopy, the crystals were seen as ill-defined hyperreflective lesions on endothelium between 525 and 604 µm. Reduction in the number of crystals was seen after cataract surgery. In conclusion, AS-OCT and confocal microscopy can be used as additional diagnostic tools to analyze iris crystals in CAU.

A case of late-onset capsular block syndrome and its surgical treatment / Um caso de síndrome de bloqueio capsular tardio e uma abordagem cirúrgica

ABSTRACT - Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

RESUMO - Síndrome do bloqueio capsular é uma complicação incomum da cirurgia de facoemulsificação com capsulorrexis curvilínea contínua e implante de lente intraocular. Nós relatamos um caso de síndrome de bloqueio capsular de início tardio que se desenvolveu após 13 anos da extração da catarata e apresenta a abordagem cirúrgica utilizada para o sucesso do tratamento.

A case of late-onset capsular block syndrome and its surgical treatment.

Capsular block syndrome is a rare complication of phacoemulsification surgery with continuous curvilinear capsulorhexis and intraocular lens implantation. Here, we report a case of very late-onset capsular block syndrome that developed 13 years after cataract extraction and present the surgical approach used for its successful treatment.

Comparison of trypan blue and Brilliant Blue G for staining of the anterior lens capsule during cataract surgery: short-term results.

PURPOSE: The present study aimed to evaluate the potential corneal endothelial cell toxicity of trypan blue (TB) and Brilliant Blue G (BBG), two dyes used to stain the anterior capsule in cataract surgery. METHODS: We conducted a single-center, prospective, randomized study in which 150 eyes of 117 patients were randomly divided into control (CT), TB, and BBG groups. Preoperative and postoperative (1, 3, and 6 months) values for corrected distance visual acuity (CDVA), corneal endothelial cell count, and central corneal thickness were compared among the three groups. RESULTS: A total of 111 eyes from 88 patients were completely analyzed. The CDVA (logarithm of the minimal angle of resolution) values in the CT, TB, and BBG groups 1 month after surgery were 0.001, 0.023, and 0.019, respectively. The corneal endothelial cell counts 6 months after surgery were 2711 ± 225, 2748 ± 251, and 2680 ± 284 cells/mm2, respectively. The central corneal thicknesses 6 months after surgery were 524.3 ± 35.5, 532.2 ± 36.1, and 531.4 ± 33.0 µm, respectively. There were no significant differences in CDVA, endothelial cell count, or central corneal thickness among the three groups during the follow-up period. CONCLUSIONS: Our findings indicate that neither TB nor BBG was associated with detectable toxicity to corneal endothelial cells during cataract surgery, even when injected directly into the anterior chamber. Additionally, BBG exhibited equivalent staining efficiency to TB.

Femtosecond laser-assisted cataract surgery for the white cataract.

AIM: To report the capsulotomy and lens fragmentation outcomes of white cataracts managed with the femtosecond laser (FL). METHODS: Outcomes of a prospective, observational consecutive case series of white cataracts (June 2012-November 2016) that underwent FL-assisted cataract surgery (FLACS) (Victus, Bausch+Lomb, Munich, Germany) at the Singapore National Eye Centre were audited. Data collected: patient demographics, type of white cataract, levelness of docking, anterior capsule position following laser, completeness of capsulotomy and fragmentation, best-corrected visual acuity (BCVA) at 1 month, intraoperative complications. Outcome measures: capsulotomy integrity, fragmentation capability and BCVA at 1 month. RESULTS: 58 eyes of 54 patients underwent FLACS. White cataract types included dry white (24 eyes), intumescent (28 eyes) and Morgagnian (6 eyes). Docking was level in 22 eyes (38.6%). Following FL, the anterior capsule level dropped in 20 eyes (34.5%). Incomplete capsulotomies occurred in 10 eyes (17.2%). Lens fragmentation attempted in 38 eyes was effective or partially effective in 31 eyes (81.6%). No anterior or posterior capsule tears occurred. LogMAR BCVA at 1 month was 0.073 (SD 0.09). Risk factors for incomplete capsulotomy were Morgagnian cataract and lens thickness (multiple logistic regression, p<0.01 and p=0.03, respectively). CONCLUSION: The main complication of FLACS in white cataracts was incomplete capsulotomy (17.2%), significantly associated with Morgagnian cataracts and increased lens thickness. Lens fragmentation was effected in four-fifths of white cataracts but should be avoided in Morgagnian cataracts due to possible overlap of the lens fragmentation plan and the anterior capsule.

Reopacification of posterior capsular opening after ND: YAG capsulotomy: 2 cases with the different presentation.

Purpose: To report the complete opacification of posterior capsulotomy opening after neodymium: yttrium-aluminium-garnet (ND: YAG) posterior capsulotomy for posterior capsular opacification. Methods: A 70-year-old female had uneventful cataract surgery by phacoemulsification technique with implantation of in the bag hydrophilic intraocular lens (IOL) in her left eye. Eight months after surgery, the patient developed posterior capsular opacification (PCO) for which ND: YAG capsulotomy was performed. However, she returned after 7 months first post ND: YAG capsulotomy with the blurring of vision and glare at night. Slit lamp examination revealed pearl like opacification of posterior capsule occupying the YAG capsulotomy opening. A repeated ND: YAG capsulotomy restored her vision to 20/ 20. Another patient operated for posterior polar cataract had dehiscence in the posterior capsule during cataract surgery. The patient was implanted with hydrophobic IOL in the capsular bag without performing an optic capture. The patient presented 3 years later with occlusion of the posterior capsular opening with mixed pearl-like and fibrotic PCO. Conclusion: Occlusion of the posterior capsular opening may occur after ND: YAG capsulotomy and may cause a reduction in visual acuity. Pearl-like opacification is common to occur in reopacification of posterior capsular opening.

Ectopic lens material in an otherwise healthy 5-week-old infant.

PURPOSE: To report the unusual finding of ectopic lens material in an otherwise healthy 5-week-old infant. METHODS: Case report and literature review. RESULTS: An asymptomatic 5-week-old female infant was found to have unilateral ectopic lens material in the retrolental space of the left eye associated with a posterior capsular defect. CONCLUSION: The abnormality is likely embryological in origin, and the established progression for similar conditions means long-term monitoring is required to ensure the best possible visual outcome.