Ex-Vivo Method to Quantifiably Evaluate the Staining Effectiveness of Anterior Lens Capsule Dyes.

Purpose: High frequency of cataracts and the requirements of new European Union regulations for medical devices require the availability of preclinical models to adequately evaluate anterior lens capsule dyes before their use in patients. Herein, we describe an ex vivo method to quantifiably evaluate the macroscopic and microscopic staining effectiveness of anterior lens capsule dyes using porcine eyes. Methods: Commercially available trypan blue-based products or physiological saline solution (negative control) was injected into porcine eyes. Anterior pole and lens (after extraction) were macroscopically photographed, and the images were quantitatively analyzed. Lenses were histologically processed, and the staining intensity microscopically was semiquantified. Results: Macroscopic evaluation of the anterior pole revealed bluish staining of the anterior capsule; however, this coloring cannot be macroscopically discerned after lens extraction. Quantitative image analyses showed significant (P < 0.01) staining of the lens capsule compared to the negative control, but not significant (P > 0.05) between the products tested. Quantitative analysis of dying on lens images could not be performed. Microscopic semiquantification of the capsule staining intensity allows us to appreciate differences between products. Conclusions: The described method is a quick and useful tool for macroscopic evaluation by surgeons to choose an anterior capsule staining for use during everyday surgeries, and a more specific microscopic evaluation also allows us to determine the effectiveness and usefulness of these products. Translational Relevance: This method satisfies preclinical effectiveness evaluations required by European Union regulations and complements the safety and toxicity evaluations that new products must guarantee before they enter the market and are used in clinical practice.

Phacolytic glaucoma: A nearly forgotten entity.

PURPOSE: To report a case of phacolytic glaucoma with rupture of anterior lens capsule in a case of hypermature cataract. METHODS: Case report and literature review. RESULTS: An 80-year-old woman presented with cloudiness and pain in the left eye for 1 day. The patient had visual acuity limited to perception of light with raised intraocular pressure of 70 mm Hg. Careful slit-lamp evaluation revealed corneal epithelial edema in superior quadrant and a deep and turbid anterior chamber. Ultrasound biomicroscopy confirmed the presence of a deep anterior chamber, a hypermature cataractous nucleus with lax capsular bag, and ruptured anterior lens capsule. The patient underwent extracapsular cataract extraction. Cytological examination of the lenticular fluid revealed the presence of lens protein-laden macrophages. Post-operatively, the patient had best-corrected visual acuity of 6/60 with advanced glaucomatous optic neuropathy. CONCLUSION: Phacolytic glaucoma can present with a cloudy cornea and a turbid anterior chamber mimicking endophthalmitis. Careful examination and ancillary investigations including ultrasound biomicroscopy was helpful in making an accurate diagnosis.

Long-term follow-up of persistent low vault after implantable collamer lens exchange.

The implantable collamer lens (ICL) is a widely used posterior chamber phakic intraocular lens that achieves excellent refractive results. Nonetheless, serious postoperative complications related to inadequate vault have been previously reported. Therefore, lens exchange is advised when the vault is out of the recommended ranges. This article presents a case with persistent low vault after lens exchange in which no clinical evidence of crystalline lens opacity or decrease in uncorrected distance visual acuity has been identified during the 6-year clinical follow-up performed to date. Therefore, this suggests that clinical follow-up could be an appropriate approach for patients presenting with low vault, especially those who are older than 40 years and have a history of lens exchange.

Three-Dimensional Morphology Study of Capsule in Pseudophakic Eyes with High-Speed Swept-Source Optical Coherence Tomography.

PURPOSE: To study the capsule morphology in pseudophakic eyes on the three-dimensional level using high-speed swept-source optical coherence tomography (SSOCT). METHODS: This study collected patients with age-related cataract and divided them into two groups according to the anterior capsule and intraocular lens (IOL) optic relationship: total anterior capsule overlap (360°, Group-T) and partial anterior capsule overlap (<360°, Group-P). One standard SSOCT radial scanning was performed in all eyes at 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS: Thirty-two eyes from 25 patients were enrolled in the Group-T and 17 eyes from 13 patients in the Group-P. No eyes achieved complete adhesion between IOL optic and posterior capsule at 1 day after the surgery. However, the rate of complete adhesion was low (15/49, 30.6%) even at 3 months postoperatively and there was no statistically difference between Group-T and Group-P (21.9% vs. 47.1%, P > 0.05). At 1 day, 1 week, 1 month, and 3 months after the surgery, the capsule bend index (CBI) in the Group-T was 0.02 ± 0.09, 1.35 ± 1.48, 3.60 ± 0.54, and 3.88 ± 0.19, respectively. CBI rises linearly during the first month and the rise goes stable relatively with the great reduction of standard deviation in the following 2 months (All P < 0.05). The anterior capsule opening area and diameter were both reduced in the first month, and then they both became stable. CONCLUSIONS: With square-edge IOL, posterior capsule opacification risk is still high in most eyes at 3 months postoperatively for the complete adhesion of posterior capsule and IOL was only achieved in 30.6% eyes. IOL-in-bag may be driven by the significant capsule bag changes especially in the first month postoperatively.

Iris Thickness and Severity of Neovascular Glaucoma Determined Using Swept-Source Anterior-segment Optical Coherence Tomography.

PURPOSE: To investigate the iris thickness (IT) in neovascular glaucoma (NVG) using swept-source anterior-segment optical coherence tomography (ASOCT). PATIENTS AND METHODS: In this retrospective, clinic-based, comparative study, we enrolled 20 NVG patients [11 with 360-degree angle-closure (AC)-NVG and 9 with NVG without AC] and 14 healthy age-matched controls. Horizontal scanning images of swept-source ASOCT were analyzed using software calipers in temporal and nasal angle areas. ITs at 1 and 2 mm from the pupil edge were measured using ASOCT. The relation between IT and the severity of NVG, the effects of intraocular pressure (IOP), intravitreal antivascular endothelial growth factor (anti-VEGF) injection, and panretinal photocoagulation (PRP) were assessed using linear regression analysis based on the corrected Akaike information criteria index. RESULTS: The IT was thinner in 360-degree AC-NVG patients, followed by NVG patients without AC and controls (0.33 vs. 0.48 vs. 0.57 mm at 1 mm and 0.31 vs. 0.43 vs. 0.49 mm at 2 mm; P<0.001 by ANOVA). Multiple linear regression analysis revealed that 360-degree AC-NVG patients-NVG patients without AC and controls (coefficient: -0.16), NVG patients without AC-control (-0.13) and underwent PRP (0.23) at 1 mm, 360-degree AC-NVG patients-NVG patients without AC and controls (-0.12), NVG patients without AC-controls (-0.08), underwent PRP (0.16), received anti-VEGF injection (0.05) and IOP (-0.001) at 2 mm were selected predictors to explain IT. CONCLUSIONS: IT decreases with the progression of the NVG stage and is thinnest in 360-degree AC-NVG patients. Our study suggests a new morphologic feature of NVG.

Femtosecond Laser-Assisted Intraocular Lens Fragmentation: Low Energy Transection.

PURPOSE: To describe a case of femtosecond laser-assisted hydrophobic intraocular lens transection. METHODS: Case report. RESULTS: Femtosecond laser-assisted transection of a one-piece acrylic hydrophobic intraocular lens for explantation via a small surgical incision was successfully performed with low energy parameters. CONCLUSIONS: This case illustrates a novel and effective clinical application of the femtosecond laser. [J Refract Surg. 2017;33(9):646-648.].

Laser-Assisted Capsulotomy Centration: A Prospective Trial Comparing Pupil Versus OCT-Based Scanned Capsule Centration.

PURPOSE: To investigate different capsulotomy centration methods for femtosecond laser-assisted cataract surgery. The overlap between intraocular lens (IOL) optic and lens capsule was measured with different centration methods and IOL types. METHODS: This was a prospective randomized clinical trial. Patients with cataract scheduled for femtosecond laser-assisted cataract surgery were assigned to one of four treatment groups: optical coherence tomography (OCT)-based scanned capsule centration (SCC) and three-piece IOL (SCC with three-piece IOL); scanned capsule centration and plate-haptic IOL (SCC with plate-haptic IOL); pupil centration (PC) and three-piece IOL (PC with three-piece IOL); or PC and plate-haptic IOL (PC with plate-haptic IOL). At the end of surgery, the overlap between the IOL optic and capsular bag was measured. RESULTS: The results of 160 patients were evaluated (n = 40 in each group). There was no difference in age (P = .27), sex (P = .18), the number of treated left and right eyes (P = .64), or cataract grade (P = .06). With the new SCC method (capsulotomy diameter: 5 mm), a complete overlap was achieved in all cases in both SCC groups. The overlap was also complete in all cases with PC and plate-haptic IOLs. In the PC with three-piece IOL group, the overlap was incomplete in 3 eyes. CONCLUSIONS: The SCC method helps to achieve a 360° overlap in all eyes independent of the IOL type. A complete 360° overlap was achieved in all cases up to a calculated capsulotomy diameter of 5.1 mm with this new method. [J Refract Surg. 2017;33(2):74-78.].

[Combined YAG-laser capsulotomy in pseudophakic patients with anterior capsular contraction syndrome]. / Tekhnologiia kombinirovannoi lazernoi kapsulotomii pri perednekapsuliarnom kontraktsionnom sindrome v artifakichnykh glazakh.

Progressive metaplastic fibrosis of the anterior capsulorhexis opening is a frequent complication of the postoperative period. There is a widely practiced method of anterior capsular contraction syndrome (ACCS) correction through radial anterior laser capsulotomy. Despite many advantages, it can be complicated by unpredictable anterior capsule tearing and intraocular lens (IOL) dislocation into the vitreous Body, which justifies the search for new technical solutions. AIM: to develop a safe technique of combined laser anterior capsulotomy (LAC) in patients with ACCS. MATERIAL AND METHODS: The study included 19 patients (20 eyes) with ACCS. The suggested LAC technique involved two differently directed YAG-laser cuts that could be regarded as a combination of radial anterior capsulotomy and anterior peripheral linear capsulotomy. With the cuts located perpendicularly to each other, the distal end of each radial cut was connected to the middle of each longitudinal cut. RESULTS: The suggested technique allows an increase in the anterior capsulorhexis diameter up to more than twice the pre-laser size. The difference between the average pre- and post-laser capsulorhexis diameters was statistically significant (р<0.0001). Neither case developed an unpredictable anterior capsule tear. CONCLUSION: The safety of the new technique is ensured by preliminary longitudinal cuts that create a barrier against unpredictable radial tears in the capsular bag during radial capsulotomy.

In-the-bag decentration of an intraocular lens in a patient with a tendency to hypertrophic scarring.

We report a case of rapid anterior lens capsular contraction leading to decentration of a hydrophilic acrylic lens with stiff haptics (Rayner design). To our knowledge, this is the first report to investigate early capsular contraction with folding of the haptic over the optic in a patient with a tendency toward hypertrophic scar formation.

Anterior lentiplane associated with posterior lenticonus and microcornea.

We report a 12-year-old boy with a rare condition consisting of familial bilateral anterior lentiplane (a flat anterior lens capsule) posterior lenticonus, and microcornea.

Prevention of capsular bag opacification with a new hydrophilic acrylic disk-shaped intraocular lens.

PURPOSE: To evaluate capsular bag opacification with a new disk-shaped single-piece hydrophilic acrylic intraocular lens (IOL) suspended between 2 haptic rings connected by a pillar of the haptic material and with a commercially available single-piece hydrophobic acrylic IOL in rabbits. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: The study IOL was implanted in the right eyes of 5 New Zealand rabbits and the control IOL in the left eyes. Slitlamp examination was performed at weeks 1 through 5. After the rabbits were humanely killed, the globes were enucleated and examined by ultrasound. Capsular bag opacification scoring from the posterior aspect (Miyake-Apple view) was then performed, followed by histopathology. RESULTS: Trace honeycomb posterior capsule opacification (PCO) was noted in some study eyes. All control eyes developed moderate to marked PCO, which was more pronounced at the level of the optic-haptic junction. The mean PCO score was 0.4 ± 0.22 (SD) in the study group and 3.4 ± 0.54 in the control group (P=.000179, paired t test). Minimal proliferative cortical material was confined to the space between the anterior and posterior rings of the study IOL haptics. Anterior capsule opacification was absent in study eyes and mild in control eyes. There was no contact between the anterior capsule and the anterior surface of study IOLs. CONCLUSION: The peripheral rings of the study IOL, by expanding the capsular bag and preventing IOL surface contact with the anterior capsule, appear to prevent opacification of the capsular bag. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.