Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes.

PURPOSE: Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. METHODS: A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior-posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). RESULTS: There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). CONCLUSION: In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.

Comparison of the effectiveness of different corneal curvature measurement methods for IOL implantation in traumatic aphakic eyes with corneal injury.

BACKGROUND/AIM: To assess the refractive outcomes of secondary intraocular lenses (IOL) in patients with traumatic aphakic eyes with corneal penetrating injury and compare different corneal curvature measurement methods. METHODS: Patients with unilateral penetrating eye injuries underwent corneal wound repair and cataract extraction, followed by secondary IOL implantation. Corneal curvature measurements were taken on the contralateral healthy eye (Group A), from the affected eye before removing corneal sutures (Group B), or after suture removal (Group C). The refractive outcomes were compared among the three groups. RESULTS: The study included 261 eyes. The Mean Absolute Error (MAE) in Group C (0.99 ± 0.85 D) was significantly smaller than that in Group A (1.87 ± 1.71 D) and Group B (1.37 ± 1.20 D) (both P < 0.001). Moreover, the percentage of eyes with IOL prediction errors within ± 0.50 D in Group C (40%) was higher than that in group A (21.7%) (OR = 2.364, 95%CI: 1.272-4.392, P = 0.006) and group B (28.0%) (OR = 1.714, 95%CI: 0.948-3.099, P = 0.073), and the percentage of eyes with IOL prediction errors within ± 1.0 D in Group C (90.9%) was higher than that in group A (67.9%) (OR = 4.758, 95%CI: 2.131-10.626, P < 0.001) and group B (75.0%) (OR = 3.370, 95%CI: 1.483-7.660, P = 0.003) as well. CONCLUSIONS: In traumatic aphakic eyes with corneal sutures, IOL power calculation based on the corneal curvature of the injured eye after removing the corneal sutures yields the best refractive outcomes.

Simultaneous Management of Retinal Detachment and Aphakia with Pars Plana Vitrectomy, Silicone Oil Tamponade and Retropupillary Iris-Claw Intraocular Lens Implantation in These Cases.

BACKGROUND: Marfan Syndrome is an autosomal dominant disease with multiple ocular abnormalities including ectopia lentis and a high incidence of rhegmatogenous retinal detachment (RRD). The management of RRD may be challenging in cases of aphakic patients with Marfan. PURPOSE: To report on the management of four cases of simultaneous RRD and aphakia with vitrectomy, silicone oil tamponade, and retropupillary iris-claw intraocular lens (IOL) implantation in patients with Marfan that have been operated at the Jules-Gonin Eye Hospital between 2019 and 2020. HISTORY AND SIGNS: Ages at presentation were 20, 30, 32, and 31 years, respectively. All patients had a history of extraction of a dislocated lens. None of the patients had a previous posterior vitrectomy. Two patients had records of previous measurements for IOL calculation by optical biometry (IOL Master, Carl Zeiss Meditec AG, Jena, Germany) about 1 year prior to the RRD development. In two cases, measurements for IOL calculation by optical biometry were based on the contralateral eye. THERAPY AND OUTCOME: All patients underwent 23 G vitrectomy, peripheral iridotomy, and retropupillary iris-claw IOL. No intraoperative complications were encountered. All patients had silicone oil tamponade, one of which required heavy silicone oil. Silicone oil was removed 3 months following primary surgery. Minimum follow-up was 1 year. The single surgery anatomic success rate was 100%. All patients had visual acuity of at least 0.8 at the last follow-up (1.25, 1.0, 0.8, and 0.8 respectively). The targeted refractive results were accurately achieved in all four cases postoperatively. One patient presented ocular hypertension 2 weeks after surgery due to presumed steroid response and was managed conservatively. None of the patients had silicone oil migration into the anterior chamber. CONCLUSION: Retropupillary iris-claw IOL implantation in cases of RRD and aphakia creates a barrier to tamponades from the posterior segment, effectively preventing them from entering the anterior segment of the eye. Therefore, the management of aphakia and retinal detachment with simultaneous vitrectomy and a retropupillary iris-claw IOL may be a successful strategy in reducing postoperative complications in patients with Marfan syndrome.

Long-term outcome of scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients.

BACKGROUND: To investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal. METHODS: Records of ocular trauma patients who underwent implantation of SFIOL without conjunctival peritomies and sclerotomy during primary pars plana vitrectomy or silicone oil removal. RESULTS: Sixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6-99 months). The average patient age at the time of surgery was 44 years old (range, 4-80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively (P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (5.8%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%). CONCLUSIONS: Use of a scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support.

Iris Clip Lens Implantation with Novel Approach for Aphakia After Previous Filtration Surgery.

Purpose To present a novel and simplified surgical technique of Artisan lens implantation for intraocular lens luxation and aphakia in glaucoma patients with previous superior filtration surgery. Methods Analysis of 12 patients with a history of previous superior filtration surgery for glaucoma, who underwent artisan lens implantation. To allow lens manipulation and implantation without alteration of the filtration bleb, the main sclerocorneal incision was performed laterally and the Artisan lens was held in place for enclavation of the iris stroma via a superior corneal incision without disturbing the filtration bleb. Results Mean pre-operative visual acuity was 0.54 ± 0.85 LogMAR, and intraocular pressure (IOP) was 15.8 ± 7.7 mmHg. At the end of follow-up (11.6 ± 8.1 months), visual acuity had improved to 0.32 ± 0.57 LogMAR and intraocular pressure was 14.7 ± 5.4 mmHg. No disturbance of the filtration bleb was observed. Conclusions Artisan lens implantation can be performed successfully via a combined lateral and superior approach despite the presence of a filtration bleb at the 12 o'clock position.

[Clinical results of aphakia correction with multifocal intraocular lenses]. / Klinicheskie rezul'taty korrektsii afakii mul'tifokal'nymi intraokulyarnymi linzami.

AIM: to assess visual functions and ergonomics after bilateral versus unilateral implantation of Lentis Comfort LS-313 MF15 multifocal intraocular lenses (MIOL) in aphakic eyes. MATERIAL AND METHODS: A total of 20 patients with М LENTIS LS-313 MF15 MIOLs were followed up. Group 1 consisted of 12 patients after bilateral symmetric implantation, group 2 - of 8 patients after unilateral procedure. The following parameters were examined: uncorrected binocular visual acuity at far, near, and intermediate distances under photopic and mesopic conditions, the range of pseudoaccommodation, spatial contrast sensitivity to achromatic sinusoidal gratings, lens stability with account to its optical design, and patient satisfaction with the resultant vision. RESULTS: In both groups, distance visual acuity was high under any lighting conditions. At near and intermediate distances as well as at 5-6 m, binocular visual acuity in group 1 was higher than in group 2, regardless of the lighting conditions. The range of pseudoaccommodation was 3.5 D and 3.25 D in groups 1 and 2, respectively. Spatial contrast sensitivity function appeared typical, with maximum values at intermediate frequencies and lower values at higher frequencies. None of the patients required distance correction. Of 32 eyes, 7 exhibited MIOL rotation of 10-25 degrees at 1 month after surgery, however, none of the patients presented complaints characteristic of IOL decentration. CONCLUSION: Bilateral symmetric implantation of М LENTIS LS-313 MF15 MIOLs has the advantage over a unilateral procedure, since it enables a wider range of pseudoaccommodation and less dependence on lighting conditions with no compromise of high visual acuity at far and intermediate distances.

[Clinical results of aphakia correction with bifocal intraocular lenses].

AIM: To evaluate the effect of symmetrical vs. asymmetrical and bilateral vs. unilateral implantation of M LENTIS LS-312 MF 30 multifocal intraocular lenses (IOLs) on visual functions and ergonomic parameters. MATERIAL AND METHODS: A total of 44 patients (68 eyes) with lens opacities of different intensity were enrolled. Group 1 included 24 patients who underwent symmetrical bilateral multifocal IOLs implantation, group 2--20 patients who received unilateral procedure. Binocular uncorrected near and intermediate visual acuity (VA) under photopic and mesopic conditions, amplitude of pseudoaccomodation, and spatial contrast sensitivity to achromatic sinusoidal gratings were evaluated. Patient's satisfaction with visual results was also analyzed. Taking into account the peculiar design of multifocal IOLs optics, lens rotational stability in the postoperative period was also assessed. RESULTS: Regardless of lighting conditions binocular distance VA was similarly high in both groups, while binocular near and intermediate VA was higher in group 1 as compared with group 2. The amplitude of pseudoaccomodation in groups 1 and 2 was 3.75 and 3.5 diopters correspondingly. Contrast sensitivity function was of typical shape peaking at intermediate frequencies and gradually decreasing toward higher frequencies. None of the patients from either group required optical correction for distance vision. Two patients from group 2 (and none from group 1) at times were in need of reading vision correction. Another patient from group 2 used spectacles for intermediate work. To evaluate lens rotational stability in the postoperative period, the alignment of axis marks on the IOL with the horizontal meridian of the eye was checked under maximum mydriasis. At the 1-month follow-up, rotation of 10-15 degrees was found in 31 eye, however, none of the patients presented complaints characteristic of IOL decentration. CONCLUSION: Symmetrical bilateral implantation of M LENTIS LS-312 MF 30 multifocal IOLs provides advantages over unilateral procedure because not only does it allow to retain high distance VA, but also ensures larger amplitude of pseudoaccomodation at near and intermediate distances.

[Retroiridal iris claw lens as routine procedure]. / Retroiridale Irisklauenlinse als perfektioniertes Routineverfahren.

BACKGROUND: Absence of capsular support or extended zonulolysis is today the main indication for retroiridal enclavation of the unfoldable PMMA iris claw lens (Verisyse®/Artisan®) if there is sufficient iris support. Contraindications are uveitis or ischaemic retinopathies. PATIENTS AND METHODS: 'In-the-bag' IOL dislocation due to PEX zonulopathy usually occurring 8 years after phacoemulsification is the main indication. For complicated phacoemulsification with extended zonular defect the retroiridal iris claw lens (Verisyse®/Artisan®) has become the stand-by IOL of first choice. A rare indication for Verisyse is optical rehabilitation after lens luxation into the vitreous in combination with vitrectomy. RESULTS: 81 eyes were analysed. With laseroptic biometry target refraction was within 1 D for 100 % of the 'in-the-bag' luxation cases and in 62 % for the other more complicated cases. Wavefront analysis showed no significant difference for optical quality between retroiridal iris claw lens and a endocapsular fixated spherical for scotopic 5 mm pupil. Iris pigment atrophies of the enclavation site had no clinical significance. Risk for cystoid macular oedema is lower compared to sclera suture-fixated posterior chamber lenses. Intra- and postoperative complications were rare. Spontaneous or traumatic de-enclavation due to haptic defects may occur. After vitrectomy instable refraction may be caused by hypermobile iris diaphragma. CONCLUSIONS: Retroiridal iris claw lenses can be implanted atraumatically under topical anaesthesia. IOL related complications are minimal.

Congenital ocular and adnexal disorders in reptiles.

Ocular and adnexal congenital disorders are those that manifest at birth and could involve single or multiple tissues. Several abnormalities have been reported in literature affecting reptilian ocular and/or adnexal tissues. The objectives of this review are: (i) review those disorders previously reported in reptile literature; (ii) present new cases; (iii) provide a basic classification of them according to the moment of occurrence and (iv) indirectly, encourage the clinician dealing with these cases to go further in their diagnosis. The authors consider that categorizing ocular and adnexal congenital disorders could help the clinician to deal with them. The categorization of these disorders required an intense review of cases previously reported in literature and allows the authors suspect that some of them could not have been accurately diagnosed according to the definitions of the anomalies and/or not accurately described. The authors consider that ocular and adnexal congenital disorders could have been underestimated in reptiles and further studies could be helpful to promote the description of new disorders and to expand the knowledge about those previously reported. The review will first describe abnormalities reported during organogenesis (describing possible etiopathogenesis, cases reported, an approach to their diagnosis and recommended therapeutic options).Then a mention of the ocular disorders occurring after organogenesis is made. These disorders are divided when possible in those affecting all or most part of the globe and those affecting only specific tissues (surface ectoderm, neurocrest and mesenchyma and neuroectoderm).

Globe rupture with aphakia, aniridia, secondary glaucoma and late corneal decompensation: A multi-staged approach to management.

Severe blunt ocular trauma may result in immediate and delayed complications requiring appropriate management algorithms. We hereby report a case of globe rupture, aphakia, traumatic aniridia, and secondary glaucoma in a 33-year-old male following road traffic accident. He was treated initially by primary repair followed by novel combined approach of aniridia IOL with Ahmed glaucoma valve implantation. Delayed corneal decompensation required deferred penetrating keratoplasty. After a follow-up of 3.5 years after last surgery, patient maintains good functional vision with stable IOL, clear corneal graft and controlled intraocular pressure. A meticulously planned and staged management approach appears better suited in complex ocular trauma in such scenarios giving a good structural and functional outcome.

Primary aphakia: clinical recognition is the key to diagnosis.

PURPOSE: To describe the presentation and treatment outcomes of a cohort of children with primary aphakia (PA). METHODS: Clinical photographs and ultrasound biomicroscopy (UBM) images of children presenting with sclerocornea and undetermined anterior segment dysgenesis between July 2017 and December 2020 were reviewed retrospectively. Children who had no crystalline lens visible on UBM were included. RESULTS: A total of 124 UBM images were captured for 124 children with cloudy corneas. Twelve children were identified with congenital primary aphakia: 5 had bilateral buphthalmos, 2 had buphthalmos in one eye and microphthalmos in the other, and 5 had bilateral sclerocornea-microphthalmia complex. All patients had a peculiar silvery-blue corneal appearance, with fine vascularization on the corneal surface. The overall corneal thickness was 409.1 ± 8.7 µm. The intraocular pressure (IOP) in eyes with glaucoma was 24.5 ± 7.3 mm Hg; in microphthalmic eyes, 11.4 ± 3.4 mm Hg (P <0.001). The raised IOP was treated with limited trans-scleral cyclophotocoagulation under transillumination and topical antiglaucoma medications. Children with glaucoma gained ambulatory vision with spectacles. CONCLUSIONS: Congenital primary aphakia has a characteristic clinical appearance and may present as buphthalmos or microphthalmos, depending on the extent of dysgenesis. Incisional surgery may result in phthisis because of ciliary body dysgenesis and unpredictable aqueous production.

Secondary developmental glaucoma in eyes with congenital aphakia.

PURPOSE: To describe the clinical spectrum and management of glaucoma in congenital aphakia. METHODS: The demographics and clinical spectrum of eyes with congenital aphakia with and without glaucoma were compared, and management outcomes of congenital aphakia cases with glaucoma were studied retrospectively between April 2000 and June 2020. RESULTS: There were a total of 168 eyes (84 subjects) with a diagnosis of congenital aphakia, of which 29 eyes of 18 subjects were diagnosed with glaucoma. Corneal opacity was the presenting complaint in 26/29 eyes with glaucoma and 139/139 eyes without glaucoma. The (interquartile range (IQR)) horizontal corneal diameterwas 10.5mm (IQR, 9.0-12.5) and 8mm (IQR, 5-10) in eyes with and without glaucoma (P = 0.01), respectively. The median (IQR) axial length was 17.5mm (IQR, 13.5-19.5) and 15mm (IQR, 14-16) mm in eyes with and without glaucoma (P = 0.03), respectively. Nineteen eyes with glaucoma had adequate intraocular pressure (IOP) control with one medication. Three eyes underwent transscleral diode cyclophotocoagulation and maintained IOP without medications. Three eyes underwent trabeculectomy and trabeculotomy, trabeculectomy followed by penetrating keratoplasty, and trabeculectomy, respectively, of which two eyes became phthisical. At the last follow-up, the median (IQR) IOP was 14 mm Hg (IQR, 14-17) Hg. The median(IQR) follow-up duration was 4.53 months (IQR, 2.03- 48.06). CONCLUSION: One-fifth of the eyes with congenital aphakia had secondary developmental glaucoma. The corneal diameter and axial lengths were higher in the eyes with glaucoma compared to eyes without glaucoma. Medical management is the preferred short-term mode of IOP control. Transscleral cyclophotocoagulation may be preferred over surgical intervention.

[Long-term results of binocular symmetric and asymmetric correction of aphakia using different multifocal intraocular lenses].

Long-term results (1-4 years after surgery) of bilateral symmetric and asymmetric implantation of multifocal intraocular lenses (MIOL) AcrySof Restore SN6AD3 (Alcon) and M-flex 630F (Rayner) A for aphakia correction were compared. Patients were divided into 3 groups. The 1st group included 20 patients with symmetric implantation of MIOL AcrySof Restore SN6AD3, 2nd group--19 patients with symmetric implantation of MIOL M-flex 630F and 3rd group--22 patients with asymmetric implantation of these MIOLs. Binocular non-corrected visual acuity (BNCVA) for long-, short- and intermediate distances in photo- and mesopic conditions, pseudoaccomodation range and results of questionnaire were estimated. Asymmetric bilateral implantation of MIOLs AcrySof Restore and M-flex 630F has advantages over symmetric implantation of identical MIOLs in terms of wider pseudoaccomodation range and lower dependence on light intensity.

[Contact lens in children: epidemiological aspects]. / Lente de contato em crianças: aspectos epidemiológicos.

PURPOSE: To describe the epidemiology of children submitted to contact lens fit. METHODS: Retrospective study of 73 children that had been submitted to contact lens fit at the "Universidade Federal de São Paulo". This study analyzed sex distribution, age, diagnosis, indications and contact lens fitted at first examination. RESULTS: 34 children (46.6%) were male and 39 (53.4%) female, aged between 2 and 12 years with mean of 10.2 and standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9%) cases. Keratoconus was present in 14 (19.1%), leucoma in 11 (15%), anisometropia in 10 (13.7%), refractive errors in 9 (12.3%), irregular astigmatism in 7 (9.5%), ectopia lentis in 4 (5.4%), high myopia in one case (1.3%) and one child (1.3%) had no ocular pathology, just wishing to change eye color. 52 (71.2%) had medical indication, 9 (12.3%) had optical indication and 12 (16.4%) had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7%), soft lens in 41 (39.8%) and cosmetic soft lens in 11 (10.6%). CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.

Sclerocornea-Microphthalmia-Aphakia Complex: Description of Two Additional Cases Associated With Novel FOXE3 Mutations and Review of the Literature.

PURPOSE: To describe 2 sporadic Mexican patients having congenital bilateral, total sclerocornea, aphakia, and microphthalmia associated with novel mutations in the FOXE3 gene. METHODS: Two affected individuals with congenital bilateral, total sclerocornea, aphakia, and microphthalmia underwent detailed examinations including slit-lamp examination, visual acuity, and intraocular pressure measurements. Ocular ultrasonography and ultrasound biomicroscopy were performed. Genomic DNA was isolated from blood leukocytes in each subject, and molecular analysis of the FOXE3 gene was performed. For cosegregation analysis, presumable pathogenic variants were tested by Sanger sequencing in parental DNA. RESULTS: Molecular screening of FOXE3 was performed in 2 cases with congenital bilateral, total sclerocornea, aphakia, and microphthalmia. In patient 1, genetic analysis demonstrated a novel homozygous c.291C>G (p.Ile97Met) FOXE3 pathogenic variant. In patient 2, compound heterozygosity for the novel c.387C>G (p.Phe129Leu) transversion and for the previously reported c.244A>G (p.Met82Val) transition, was recognized. CONCLUSIONS: The sclerocornea-microphthalmia-aphakia complex is a severe malformative ocular phenotype resulting from mutations in the FOXE3 transcription factor. To date, patients from at least 14 families with this uncommon ocular disorder have been described. The identification of 2 novel pathogenic variants in our patients expands the mutational spectrum in FOXE3-related congenital eye disorders. In addition, we performed a review of the clinical and genotypic characteristics of all published patients carrying biallelic FOXE3 mutations.

Congenital anterior staphyloma associated with Peters' anomaly and aphakia in a Holstein calf.

A Holstein calf was born with a large protruding right eye and a central corneal opacity. Enucleation was the first choice of treatment. The calf had a good prognosis and was raised for milking purposes. Macroscopically, the enucleated eye was characterized by the protruded cornea, adherence of the iris to the central posterior cornea and aphakia. Microscopically, central corneal thickening and a defect in the endothelium and Descemet's membrane were observed. These data suggest that this represents a case of unilateral anterior segment dysgenesis consistent with congenital corneal staphyloma with Peters' anomaly and aphakia. Neither a mutation of the WFDC1 gene in multiple ocular defects nor any other identifiable cause for ocular anomalies was detected.

[Aphakia in a German Holstein calf]. / Aphakie bei einem Kalb der Rasse Deutsche Holsteins.

Aphakia and further malformations of both eyes were diagnosed in a female German Holstein calf. Besides aphakia of the left eye, the calf exhibited microphthalmia, glaucoma and a hypoplastic uveoscleral tissue. Additional findings in the right eye were buphthalmus and glaucoma. Instead of aphakia, pathohistological and investigations revealed a very small (microphakia) and luxated lens. Neither the clinical nor the pathological examination revealed further malformations of other organs. A BVD infection could be excluded as cause for the ocular malformations observed. A deficiency or excess of vitamine A was unlikely because this would have also applied to all other calves born at the same time on the farm. An inbreeding coefficient of 3.168% for the malformed calf and the exclusion of environmental causes for these malformations of the eyes let us suppose a hereditary problem.

[Retroiridal implantation of a Verisyse™ iris claw lens: refractive outcome and individualized intraocular lens constants]. / Retroiridale Implantation einer Verisyse(TM) Irisklauenlinse : Refraktive Treffsicherheit und Anpassung der Kunstlinsenkonstanten.

BACKGROUND: Evaluation of refractive predictability with retroiridal implantation of a Verisyse(TM) iris-claw lens (AMO) and optimization of the IOL-constants recommended by the manufacturer. PATIENTS AND METHODS: A retrospective study after retroiridal iris-claw lens implantation in the years 2007-2012 including 52 eyes of 50 patients with a lack of capsular support was carried out. Follow-up data was recorded on average 5 weeks after surgery. Demographic data, indications, accompanying diseases, biometrical data and refractive outcome were analysed and an individualization of the intraocular lens constants for the SRK/T-, Holladay-1, Hoffer-Q and Haigis-formula was carried out. RESULT: Indications for retroiridal implantation of a Verisyse(TM) lens were IOL luxation (32.7 %), complicated primary cataract surgery (25.0 %), secondary IOL Implantation (19.2 %), lens exchange (19.2 %) and luxation of the crystalline lens (3.8 %). Accompanying diseases were pancreatic diabetes (21.2 %), rheumatic diseases (7.7 %), homocystinuria (1.9 %), pseudoexfoliation of lens capsule (23.1 %), traumata (23.1 %), secondary glaucoma (23.1 %), proliferative diabetic retinopathy (9.6 %) and age related macular degeneration (5.8 %). Optimized IOL constants were an A-constant of 116.8 for the SRK/T formula, a surgeon factor (Holladay1) of 0.8, a pACD (HofferQ) of 4,4 and an a0 constant of 0,49 for the Haigis formula. Postoperative deviation of target refraction was within ± 2 D in 84.6 % of the eyes. CONCLUSION: The retroiridal Verisyse(TM) intraocular lens shows a broad spectrum of indications and achieves a good visual outcome. The previously published IOL constants show optimization potential due to the small number of cases.

Contact lens management of irregular corneas after traumatic aphakia: A pediatric case series.

PURPOSE: Pediatric patients account for 35% of all cases that present after ocular trauma and 20.9% of those result in a ruptured globe. When repairing the globe, the removal of the natural lens results in a significant change in refractive error and loss of accommodation. In addition, the eye can have scarring, irregular astigmatism, and changes to the ocular surface. Treatment and vision rehabilitation should be aggressive and done quickly to prevent amblyopia. Advanced lens designs are often needed to treat both the irregular ocular surface and the aphakia. Treatment options are often confounded with the usual issues of contact lens compliance, intolerance, and complications. CASE REPORT: This case series follows three aphakic pediatric patients through the contact lens fitting process after sustaining a ruptured globe that left them aphakic with residual irregular astigmatism and corneal scarring. Patient 1 is a 3-year-old Hispanic male fit with a bitoric gas permeable contact lens with irregular astigmatism and an elevated central corneal scarring. Patient 2 is a 12-year-old Caucasian male with minimal residual astigmatism fit in a multifocal soft contact lens. Patient 3 is an 8-year-old African American male fit with a hybrid contact lens that was needed to vault the irregular astigmatism and central corneal scarring. CONCLUSIONS: Treating patients with irregular corneas or aphakia can be challenging in their own right, but in combination are some of the most advanced specialty contact lens fittings. This case series followed three pediatric patients through the fitting process and demonstrated the options and challenges when fitting this unique patient population.

Rapid epidemiologic assessment of cataract blindness. The Aravind Rapid Epidemiologic Assessment Staff.

A major constraint to obtaining reliable information about blindness and its causes in developing countries is the limited availability of ophthalmologists for diagnosis in population-based surveys. This study in rural south India assessed the feasibility of using non-ophthalmologists to make diagnoses in a population-based survey. Ten men in their early twenties with 12 years of schooling were recruited and trained as ophthalmic assistants through a six week course in basic ophthalmology. All people aged 40 and older in households in 24 villages were enumerated and invited to have an eye examination. At a central site, 1309 subjects were independently examined by an ophthalmologist and two different ophthalmic assistants. Ophthalmic assistant cataract diagnosis is both sensitive and specific relative to the ophthalmologist's diagnosis. Sensitivity and specificity estimates were used to adjust prevalence estimates obtained from ophthalmic assistant examinations conducted at the central site as well as at the doorstep of sample households. The findings indicate that epidemiologic assessment of cataract blindness can be completed using non-ophthalmologists to diagnose cataract.