[Age-related Cataract]. / Die senile Katarakt.

The purpose of this article is a condensed overview of contemporaneous "state of art and knowledge" of age-related cataract. As an introduction, some aspects of terminology, epidemiology, lens anatomy and pathophysiology of age-related cataract, selected for clinical interest and relevance, are outlined. Clinical aspects include signs and symptoms: Objective criteria for cortical, nuclear and posterior subcapsular cataract are described, followed by typical symptoms such as decreased visual acuity, contrast sensitivity and foggy vision, altered colour perception, decreased mesopic and scotopic vision, glare, myopization and monocular diplopia. Diagnostic evaluation consists of a general ophthalmic examination, including history, refraction and vision testing, tonometry and morphologic examination of anterior and posterior segment, and is supplemented by special tests and examinations, such as interference vision (retinometer), keratometry including corneal topo-/tomography, biometry (ultrasound and optical), specular microscopy of the corneal endothelium and OCT of the central retina. Treatment is exclusively surgical: Evaluating the indication for surgery individually, weighing chances and risks, determining individual decisions such as anesthesia, surgical technical options, target refraction and intraocular lens options is discussed in detail. Finally, some perioperative considerations for medical treatment and infection prophylaxis are outlined. The last section deals with short- and long-term complications and their management - including early pressure rises, corneal edema, inflammatory response and endophthalmitis, and, in the longer term, secondary cataract, refractive problems, cystoid macular edema and retinal detachment.

[Trabeculotomy (ab externo) as primary intervention for open-angle glaucoma : 5-year results]. / Trabekulotomie (ab externo) als Ersteingriff bei Offenwinkelglaukomen : 5-Jahres-Ergebnisse.

BACKGROUND: The published results of trabeculotomy ab externo (TOT), as an outflow channel surgery in adults with open-angle glaucoma, are underrepresented in comparison with other pressure-lowering glaucoma procedures. OBJECTIVE: To determine the long-term pressure lowering effect and complications of TOT as a stand-alone procedure or in combination with phacoemulsification with intraocular lens implantation (PIT) as a primary pressure-lowering procedure in adult patients with forms of chronic open-angle glaucoma. METHOD: This was a retrospective analysis of 121 eyes of 106 patients wherby 90 eyes underwent TOT and 31 eyes underwent PIT. The follow-up period was 5 years. Follow-up was performed in the same center under standardized conditions. Preoperative as well as postoperative best-corrected distance visual acuity, intraocular pressure, pressure-lowering medication, and complications were recorded. For success criterion 1, the intraocular pressure was not allowed to exceed 17 mm Hg at any control. For success criterion 2, the intraocular pressure was allowed to be above 17 mm Hg at 1 control throughout the follow-up period. RESULTS: Preoperative intraocular pressure in the TOT group was 25.92 mm Hg (SD 6.58) and 26.32 mm Hg (SD 6.06) in the PIT group. The annual cumulative success rates with pressure-lowering medications for success criterion 1 were 92.8%, 82.5%, 70.5%, 52.7% and 26.1%. For success criterion 2 these were 97.9%; 94.9%, 93.2%, 91.3%, and 89%. We found no relevant difference in pressure reduction between TOT and PIT. Without pressure-lowering medications, success rates were significantly lower for both success criteria. No serious complications occurred. The most common postoperative complication was spontaneously resorbable hyphema. CONCLUSION: Performing TOT or PIT as a primary glaucoma procedure for chronic open-angle glaucoma in adults is reasonable, has a significant pressure-lowering effect and very low complication rate.

Decompensated cornea with epithelial and stromal edema.

A 66-year-old patient underwent surgery for congenital cataract in both eyes in her first year of life without implantation of an intraocular lens (IOL). In 1994, at the age of 39 years, both eyes received secondary Kelman multiflex-style angle-fixated anterior chamber IOLs (AC IOLs). The surgeries were followed by retinal detachments in both eyes, in the left eye in the same year and in the right eye 4 years later, which were successfully repaired. The patient presented with a decompensated cornea with epithelial and stromal edema in the left eye. The AC IOL axis was oriented from 5- to 8-o'clock position with the haptic contacting the cornea. The distal portion of the inferior-nasal haptic was deeply buried and entrapped in a broad iridocorneal synechia extending between 6- and 8-o'clock positions. The synechia also caused adjacent pupillary distortion and pigment leaf eversion (Figure 1JOURNAL/jcrs/04.03/02158034-202205000-00021/figure1/v/2022-04-22T173532Z/r/image-tiff). The AC IOL in the right eye was well positioned, and the cornea was clear with an endothelial cell count (ECC) of 2160 cells/mm2 and central corneal thickness (CCT) of 650 µm. No ECC was obtainable in the left eye, and CCT was 775 µm (Figure 2JOURNAL/jcrs/04.03/02158034-202205000-00021/figure2/v/2022-04-22T173532Z/r/image-tiff). Visual acuity was 0.8 corrected in the right eye and hand motion in the left eye. Both eyes were normotonic. On optical coherence tomography (OCT) imaging, a broad iridocorneal synechia was visible with a canal corresponding to the deeply buried haptic end of the AC IOL (Figure 3JOURNAL/jcrs/04.03/02158034-202205000-00021/figure3/v/2022-04-22T173532Z/r/image-tiff). Abundant condensed cortical material (Soemmerring's ring) was found behind the iris and above the ciliary body. What would be your surgical options to rehabilitate the patient's left eye considering corneal decompensation caused by haptic contact of an angle-fixated AC IOL and capture of 1 haptic within an iridocorneal synechia extending along 2 clock hours?

Electrical neurostimulation in glaucoma with progressive vision loss.

BACKGROUND: The retrospective study provides real-world evidence for long-term clinical efficacy of electrical optic nerve stimulation (ONS) in glaucoma with progressive vision loss. METHODS: Seventy glaucoma patients (45 to 86 y) with progressive vision loss despite therapeutic reduction of intraocular pressure (IOP) underwent electrical ONS. Closed eyes were separately stimulated by bipolar rectangular pulses with stimulus intensities up to 1.2 mA sufficient to provoke phosphenes. Ten daily stimulation sessions within 2 weeks lasted about 80 min each. Right before ONS at baseline (PRE), vision loss was documented by static threshold perimetry and compared to the same assessment approximately 1 year afterwards (POST). Mean defect (MD) was defined as primary outcome parameter. Perimetries with a reliability factor (RF) of max. 20% were considered. RESULTS: Perimetry follow-up of 101 eyes in 70 patients fulfilled the criterion of a max. 20% RF. Follow-up was performed on average 362.2 days after ONS. MD significantly decreased from PRE 14.0 dB (median) to POST 13.4 dB (p < 0.01). 64 eyes in 49 patients showed constant or reduced MD as compared to baseline (PRE 13.4 dB vs. POST 11.2 dB). In 37 eyes of 30 patients, MD increased from PRE 14.9 dB to POST 15.6 dB. CONCLUSIONS: Innovative treatments that preserve visual function through mechanisms other than lowering IOP are required for glaucoma with progressive vision loss. The present long-term data document progression halt in more than 63% of affected eyes after ONS and, thus, extend existing evidence from clinical trials.

Determination of valid benchmarks for outcome indicators in cataract surgery: a multicenter, prospective cohort trial.

OBJECTIVE: To evaluate a systematic approach to derive valid benchmarks for 2 outcome indicators intended to ascertain quality in cataract surgery and to propose benchmark levels drawn from the study results. DESIGN: Prospective, multicenter cohort trial. PARTICIPANTS: A total of 1685 patients (206-239 eyes per trial site) were recruited consecutively at 7 study sites. The patients featured age-related cataracts and were undergoing unilateral cataract surgery in the period between January 2007 and August 2008. METHODS: Only patients with uncomplicated age-related cataracts were included. Cataract surgery was performed by phacoemulsification. The SN60AT (Alcon, Inc., Fort Worth, TX) intraocular lens (IOL) was used as a study lens. The IOL power was calculated using the SRK-T formula with a standardized A constant. Biometry was performed with the IOL Master (Carl Zeiss Meditex, Jena, Germany). Only highly experienced senior surgeons were involved. MAIN OUTCOME MEASURES: The outcome indicators 1 month and 3 months after surgery were the respective achievement of: (1) maximum absolute deviation of 0.5 diopter (D) between target refraction and postoperative spherical equivalent (primary end point, refractive accuracy); (2) best-corrected visual acuity of at least 0.8 (secondary end point, visual acuity outcome). RESULTS: In the pooled data, maximum absolute deviation of ± 0.5 D from target refraction was achieved in 80% (95% confidence interval, 78%-82%) of cases. Visual acuity of 0.8 or more was reached in 87% (95% confidence interval, 80%-93%) of cases. The results from the trial centers differed significantly in the outcomes of the primary and secondary end points (P<0.001). CONCLUSIONS: The study quantified benchmark levels for 2 outcome indicators in a standardized cataract surgery procedure. External confounding factors such as the comorbidity of patients, which cannot be influenced by the surgeon, were excluded. The derived benchmarks selectively illustrate the quality of the surgery and are superior to success rates published in the literature from unspecific data collections. This method is more suited for improving outcome quality by benchmarking. General methodologic problems are discussed, leading to recommendations for future study designs. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The impact of vitrectomy on outcomes achieved with 0.19 mg fluocinolone acetonide implant in patients with diabetic macular edema.

BACKGROUND: There is a lack of consensus on the use of intravitreal corticosteroid therapies in patients with diabetic macular edema (DME) and prior vitrectomized eyes in clinical practice. METHODS: Retro-IDEAL was a 3-year retrospective, multicenter study in patients with chronic DME (i.e. DME that persists or recurs despite treatment) treated with ILUVIEN® (0.2 µg daily fluocinolone acetonide intravitreal implant), who had suboptimal outcomes with first-line vascular endothelial growth-factor inhibitors and other DME therapies. RESULTS: A total of 81 eyes (63 patients) were included of which 39 eyes had undergone prior vitrectomy (PV group) while 42 eyes had not undergone prior vitrectomy (NPV). Baseline characteristics were balanced; however, more patients had proliferative diabetic retinopathy in the PV group vs. the NPV group (21.62% vs 9.38%, respectively). Over 36 months, mean visual acuity (VA) increased in both groups with a tendency for more ETDRS letters being gained in the NPV group (+5.33) vs. the PV group (+2.42). By month 36, central retinal thickness was reduced to ⩽300 µm in two-thirds of the eyes in both groups and the mean change from baseline in intraocular pressure was similar in both groups (+0.50 mmHg -0.75 mmHg; NPV and PV group). CONCLUSIONS: These long-term data suggest that the 0.2 µg/day FAc implant is effective in both vitrectomized and non-vitrectomized patients, with a manageable safety profile, and improved VA and reduced supplemental therapies for patients with a suboptimal response to first-line DME therapies. Clinicians may consider utilizing the FAc implant earlier in the DME disease process.

Static and dynamic rotational eye tracking during LASIK treatment of myopic astigmatism with the Zyoptix laser platform and Advanced Control Eye Tracker.

PURPOSE: To evaluate the amount of cyclotorsion and the effect of static and dynamic rotational eye tracking with the Advanced Control Eye Tracker (Bausch & Lomb) based on iris recognition in the treatment of myopic astigmatism with LASIK. METHODS: All patients with myopic LASIK and attempted cylinder correction >0.75 diopters (D) on the Zyoptix 217z100 excimer laser platform between May 2005 and May 2007 were identified retrospectively through the existing databank. Pre- and postoperative refraction and the amount of cyclotorsion during treatment were extracted and analyzed in 828 eyes with >3-month follow-up. RESULTS: Preoperative mean manifest refraction spherical equivalent (MRSE) was -4.31+/-1.84 D (range: -0.37 to -9.50 D), and mean cylinder was -1.27+/-0.87 D (range: -0.75 to -6.75 D). Mean static rotation was 3.96+/-2.96 degrees (maximum 14.8 degrees ). Median dynamic rotation was 1.32+/-1.85 degrees (maximum 24 degrees). At 3 months postoperatively, MRSE was -0.10+/-0.36 D (range: -2.25 to +1.25 D), and mean cylinder was -0.33+/-0.35 D (range: -2.00 to 0 D). Predictability was 90.2% within +/-0.50 D and 98.2% within +/-1.00 D (MRSE), and 82.5% within +/-0.50 D and 96.9% within +/-1.00 D (cylinder). The efficacy ratio was 0.99. Safety was 99.4% (5 dry eyes), reaching 100% at 12 months. Stability from 3 to 12 months (n=275) was 98.2% for sphere, 95.3% for cylinder, and 96.0% for MRSE. CONCLUSIONS: Our study demonstrates that significant cyclotorsion occurs before and during treatment. By using the dynamic rotational eye tracker presented, the efficacy of cylinder correction can be improved compared to those studies not performing cyclotorsional correction.

Cataract surgery and aniridia.

PURPOSE OF REVIEW: In the past years, several new options have been developed for the surgical management of aniridia in the course of cataract surgery. RECENT FINDINGS: The lens capsule may be altered - thinned - in aniridia, requiring particular attention in order to avoid complications with possible consequences for the surgical plan. Iris prosthetic devices for complete or partial restoration of an iris diaphragm have been developed and their use described. There are options for intracapsular placement as well as for fixation without using a capsular bag and options for improved cosmetic appearance have been created. Corneal tattooing is still an option for selected cases and has been refined technically. Complications attributable with the iris prostheses are relatively infrequent and manageable. SUMMARY: Cataract surgery offers an opportunity to manage associated partial or (sub)total aniridia of all origins with good to excellent functional and esthetic results with a relatively low and manageable complication potential.

Three-year results from the Retro-IDEAL study: Real-world data from diabetic macular edema (DME) patients treated with ILUVIEN® (0.19 mg fluocinolone acetonide implant).

INTRODUCTION: The Retro-IDEAL (ILUVIEN Implant for chronic DiabEtic MAcuLar edema) study is a retrospective study designed to assess real-world outcomes achieved with the ILUVIEN® (0.19 mg fluocinolone acetonide (FAc)) in patients with chronic diabetic macular edema (DME) in clinical practices in Germany. METHODS: This study was conducted across 16 sites in Germany and involved 81 eyes (63 patients) with persistent or recurrent DME and a prior suboptimal response to a first-line intravitreal therapy (primarily anti-VEGF intravitreal therapies). RESULTS: Patients were followed-up for 30.8 ± 11.3 months (mean ± standard deviation) and had a mean age of 68.0 ± 10.4 years. Best-recorded visual acuity (BRVA) improved by +5.5 letters at month 9 (P ⩽ 0.005, n=56; from a baseline of 49 letters) and this was maintained through to month 30 (P ⩽ 0.05, n = 42). There was a concurrent improvement in central macular thickness with a reduction from 502 µm at baseline to 338 µm at year 1 (P ⩽ 0.0001, n = 43). This effect was sustained to year 3 (i.e. 318 µm; P ⩽ 0.0001, n = 29). Mean intraocular pressure (IOP) remained constant between baseline and year 3 with a peak change of 1.9 mm Hg occurring at year 1. Elevated IOP was observed in a similar percentage of patients prior to (22.2% of cases) and following (27.2%) treatment with the FAc implant. In the majority of cases, these elevations were managed effectively with IOP medications. CONCLUSIONS: Despite substantial amounts of prior intravitreal treatments - primarily with anti-vascular endothelial growth factor (VEGF) drugs - this real-world study showed that sustained structural and functional improvements can last for up to 3 years with a single FAc implant.

Coexistent primary open-angle glaucoma and cataract: interim analysis of a trabecular micro-bypass stent and concurrent cataract surgery.

PURPOSE: To evaluate the safety and efficacy of the iStent Trabecular Micro-bypass Stent in patients undergoing concurrent cataract and glaucoma surgery. METHODS: Prospective, 24-month, uncontrolled, multicenter, multicountry evaluation of 58 patients with uncontrolled primary open-angle glaucoma (including pseudoexfoliation and pigmentary) and cataract. Patients underwent clear cornea phacoemulsification followed by ab interno gonioscopically guided implantation of the iStent. Of the 48 per protocol population, 42 patients completed 12 months of the 24-month study, and their data are included in this interim analysis. RESULTS: At baseline, mean (+/-SD) intraocular pressure (IOP) was 21.7+/-3.98 mmHg. At 12 months, mean IOP was reduced to 17.4+/-2.99 mmHg, a mean IOP reduction of 4.4+/-4.54 mmHg (p<0.001, 18.3%). At baseline, patients were taking a mean 1.6+/-0.8 medications. By 12 months, the mean number of medications was reduced to 0.4+/-0.62 (p<0.001). Half the patients achieved an IOP < or =18 mmHg and were able to discontinue hypotensive medication by the 12-month visit. The most commonly reported device-related adverse events were the appearance of stent lumen obstruction (7 eyes) and stent malposition (6 eyes). None of the adverse events were deemed serious. CONCLUSIONS: In patients undergoing concurrent cataract and glaucoma surgery, the iStent was safe and efficacious for the reduction of IOP and medication therapy.

Refractive outcomes of femtosecond laser-assisted secondary arcuate incisions in patients with residual refractive astigmatism after trifocal intraocular lens implantations.

PURPOSE: To evaluate the refractive and visual outcomes of arcuate incisions performed with the femtosecond laser in patients with a residual refractive astigmatism after refractive lens exchange (RLE) with trifocal intraocular lenses (IOLs). SETTING: EuroEyes Clinical Group, Hamburg, Germany. DESIGN: Retrospective interventional case series. METHODS: Pseudophakic patients with remaining refractive astigmatism after RLE with a trifocal IOL were treated with femtosecond laser-assisted corneal arcuate incisions. Patients who had a previous corneal treatment were excluded. Outcome measures were uncorrected (UDVA) and corrected distance visual acuities, manifest refraction, and a power vector analysis. RESULTS: The study enrolled 95 eyes of 70 patients. The mean follow-up was 5.6 months ± 4.9 (SD). Constructing an astigmatic power vector (APV) with Jackson cross-cylinder axes at 180 degrees and 90 degrees and Jackson cross-cylinder axes at 45 degrees and 135 degrees, the mean preoperative vector length was 0.46 ± 0.16 diopter (D). The mean postoperative APV was 0.17 ± 0.16 D. This difference was statistically significant (P < .001). The difference between the UDVA preoperatively (0.17 ± 0.15) and postoperatively (0.08 ± 0.10) was statistically significant (P < .001). No intraoperative or postoperative complications were observed. CONCLUSION: Femtosecond laser-assisted corneal arcuate incisions were safe, efficient, and feasible to reduce refractive astigmatism after trifocal IOL implantation.

Telemetric Intraocular Pressure Monitoring after Boston Keratoprosthesis Surgery Using the Eyemate-IO Sensor: Dynamics in the First Year.

PURPOSE: To analyze the dynamics of telemetrically measured intraocular pressure (IOP) during the first year after implantation of a Boston keratoprosthesis type I (BI-KPro) cornea and to compare agreement of telemetric IOP measurements with finger palpations. DESIGN: Prospective, open-label, multicenter, single-arm clinical trial. METHODS: In the ARGOS (NCT02945176) study, 12 individuals underwent implantation of an Eyemate-IO intraocular system. Follow-up after surgery took place 12 months later with 13 visits planned per patient. During BI-KPro surgery, an electromagnetic induction sensor ring enabling telemetric IOP data transfer to a hand-held reading device outside the eye was implanted into the ciliary sulcus with or without trans-scleral suture fixation. Comprehensive ophthalmic examinations and IOP assessments through the telemetric system were compared to IOP assessed by finger palpation by 2 experts. RESULTS: Preoperative IOP measured by Goldmann tonometry was 13.4 ± 6.2 mm Hg. Telemetric IOP peaked at 23.1 ± 16.5 mm Hg at the first postoperative day. On day 5, mean IOP was 16.0 ± 5.2 mm Hg and 20.95 ± 6.5 mm Hg after 6-12 months. IOP estimation by finger palpation was grouped in 4 categories: normal, A; soft/hypotonic, B; borderline, C; and hypertonic, D. Mean telemetric IOP was 18.2 ± 6.1 mm Hg in category A, 8.9 ± 2.8 mm Hg in B, 22.4 ± 4.9 mm Hg in C, and 34.3 ± 11.0 mm Hg in D. Differences in mean telemetric IOPs per category were statistically significant (P < .001). Daily IOP fluctuations and peaks could be identified. CONCLUSIONS: Telemetric IOP assessment seems to be able to identify postoperative IOP peaks and a longitudinal increase of IOP after BI-KPro surgery. IOP measurements using the telemetric Eyemate-IO sensor showed a satisfactory agreement with those of finger palpations by 2 experts.

Online optical coherence pachymetry as a safety measure for laser in situ keratomileusis treatment in 1859 cases.

PURPOSE: To evaluate the reliability and applicability of online optical coherence pachymetry (OCP) (OCPonline, Heidelberg Engineering GmbH) integrated into the Zyoptix 217z100 excimer laser platform (Bausch & Lomb) under routine clinical conditions. SETTING: Private laser clinic, Munich, Germany. METHODS: Between July 2004 and June 2006, 1859 consecutive eyes having laser in situ keratomileusis (LASIK) using the Zyoptix 217z100 excimer laser platform had preoperative pachymetry with the Orbscan II (Bausch & Lomb) and DGH II (Pachette 2, DGH Technology, Inc.) and continuous intraoperative online OCP with the OCPonline. Preoperative pachymetry values and actual flap thicknesses with the Hansatome and Zyoptix XP microkeratomes (both Bausch & Lomb) and the IntraLase FS30 femtosecond laser keratome (IntraLase Corp.) were evaluated. RESULTS: Preoperative pachymetry values showed a high correlation between the OCPonline device and the Orbscan II (R(2) = 0.78, difference = 0.37%) and DGH II (R(2) = 0.77, difference = 0.69%). The OCPonline measurements resulted in a mean flap thickness of 121.4 microm +/- 19.1 (SD) with the Hansatome (160 microm head), 126.5 +/- 15.5 microm with the Zyoptix XP (120 microm head), and 121.7 +/- 14.7 microm with the IntraLase FS30 (110 microm flap thickness). A correlation between the calculated laser ablation depth and the measured stromal thinning was established. CONCLUSION: OCPonline technology provided reliable intraoperative noncontact pachymetry measurements integrated into a clinical flow, indicating the technology has the potential to improve the safety of corneal ablation procedures.

Retinal detachment after phacoemulsification in high myopia: analysis of 2356 cases.

PURPOSE: To determine the incidence of and risk factors for rhegmatogenous retinal detachment (RD) in highly myopic eyes after cataract surgery. SETTING: Two ophthalmology centers in Munich and Ahaus, Germany. METHODS: This retrospective medical chart review comprised 1519 consecutive patients (2356 eyes) with an axial length (AL) greater than 27.0 mm who had planned phacoemulsification and intraocular lens implantation in the capsular bag. In addition, all patients and/or the referring ophthalmologist were contacted regarding the occurrence of RD and laser capsulotomy and the date of occurrence. RESULTS: Follow-up was longer than 24 months in 84% of eyes. Because some cases of RD were questionably related to the preceding cataract surgery, the absolute incidence of postoperative RD was determined as highest (2.2%) and lowest (1.5%). Sex, history of laser capsulotomy, and increasing AL had no statistically significant effect on the rate of RD. The risk for postoperative RD was significantly higher in eyes of younger patients and eyes with preoperative prophylactic treatment for retinal degeneration. CONCLUSIONS: The risk for postoperative RD in this study (1.5% to 2.2%) corresponds to the incidence of pseudophakic RD and idiopathic RD in myopia described in the literature. The risk profile for postoperative RD in this series cannot be distinguished from the risk profile for idiopathic RD in myopia of this extent. The true effect of prophylactic treatment of degenerative lesions remains to be elucidated.

Age-related behavior of posterior chamber lenses in myopic phakic eyes during accommodation measured by anterior segment partial coherence interferometry.

PURPOSE: To evaluate age-related position shifts of the crystalline lens and the implantable contact lens (ICL, Staar Surgical) by a new, commercially available, anterior segment partial coherence interferometer, the ACMaster (Carl Zeiss Meditec), during accommodation in myopic eyes. SETTING: ALZ Augenklinik, Munich, Germany. METHODS: Fifty-three eyes of 29 consecutive patients were measured after myopic ICL implantation before and during subjective accommodation to a stimulus of 3 diopters (D) by anterior segment partial coherence interferometry (PCI). Nine eyes were also measured with a 5.00 diopters (D) stimulus; 14 eyes were measured repeatedly at different visits. The mean patient age was 33 years +/- 9 (SD) (range 21 to 59 years). The preoperative mean sphere was -7.6 +/- 1.9 D (range -5.0 to -11.5 D) and the cylinder, -1.4 +/- 1.1 D (range 0 to -4.25 D). RESULTS: Older patients had a tendency toward smaller vaults on desaccommodation between the ICL and the crystalline lens compared to younger individuals. In younger patients, there was a decrease of the vault on accommodation, whereas it increased in older persons (P = .005). During accommodation, the more the anterior lens surface shifted forward, the more the ICL bulged (P = .005). The change in vaulting was significantly larger at 5.00 D than at 3.00 D accommodation stimulus (P = .012). CONCLUSIONS: The behavior of ICLs in relation to the crystalline lens during accommodation varied with age and could be shown by PCI. The position shift of the ICL depended on the initial vault at desaccommodation and the ability of the anterior lens surface to bulge forward. Even though the crystalline lens stiffened, and therefore accommodation deteriorated with age, there was still a movement of the ICL, pointing to the role of the ciliary muscle movement in accommodation.

Clinical presentation of intraocular lens schisis.

PURPOSE: To analyze the clinical presentation and implications of cavity or schisis formation in the MemoryLens (CIBA Vision) intraocular lens (IOL) optic. SETTING: Eye Department, Red Cross Hospital, Munich, Germany. METHODS: This study was a retrospective chart review and slitlamp photography analysis of IOL schisis. RESULTS: Four patients with IOL schisis were identified and their charts analyzed. Clinically, the schisis presented as a sharply demarcated round structure. The aspect was clear on coaxial illumination, but on tangential illumination the schisis area was opaque. Patients experienced glare, foggy vision, and deteriorated visual function or had no symptoms. One patient lost visual acuity, and the IOL was explanted. CONCLUSIONS: Clinically, IOL schisis was easily differentiated from cases of IOL opacification due to calcification. The clinical implication was not uniform, ranging from no symptoms to great visual disturbance leading to explantation of the IOL. The cause of this complication remains unclear. A possible explanation is the impact of solvent-induced tensile stress on the IOL optic material during the manufacturing process.

Cocooning of an iris-fixated intraocular lens in a 3-year-old child after perforating injury: clinicopathologic correlation.

We present a 3-year-old patient who developed extensive noninflammatory fibrous membrane formation in the anterior chamber involving the present iris-fixated intraocular lens (IOL), with subsequent need for explantation. The child had had repair of a corneal injury, crystalline lens extraction and Artisan iris-claw IOL (Ophthec) implantation after a penetrating injury 2 months before. Histopathologic analyses were consistent with a retrocorneal membrane that originated from the corneal stroma and formed a "cocoon" membrane on the iris-claw IOL.