A Case of Personal Identification Via Postmortem Computed Tomography Confirmation of Aphakic Eyes.

Postmortem computed tomography (PMCT) is used commonly in forensic medicine. Postmortem computed tomography of the head provides information on the eyes and orbits and may reveal intraocular abnormalities. We present a case in which the identity of a deceased man was confirmed by the presence of aphakic eyes detected on PMCT. A decomposed body was found in a house and suspected to be a man in his 40s who lived alone. Autopsy identified pontine hemorrhage as the cause of death. Although signs of previous dental treatment were evident, the storage period of the householder's dental records had expired. He had no family members to provide DNA for a comparative DNA analysis. Postmortem computed tomography before autopsy revealed aphakia (ie, the absence of eye lenses) suggestive of previous ocular surgery. His medical records revealed that he had undergone ocular surgery for secondary glaucoma due to uveitis, which had resulted in artificial aphakia. Peripheral iridectomy scars fully matched the findings in his medical records, thus identifying the body. The unusual finding of artificial aphakia in a man in his 40s facilitated the personal identification in this case. In conclusion, PMCT provides additional information, and the correct interpretation of intraocular PMCT findings by forensic pathologists is crucial.

The effects of complicated cataract surgery on iris structure and anterior chamber angle.

PURPOSE: To evaluate iris structure in aphakic eyes scheduled for placement of a secondary intraocular lens. METHODS: Twenty-eight aphakic eyes of 28 patients who were scheduled for secondary intraocular lens implantation between January 2012 and January 2017 at Beyoglu Eye Training and Research Hospital after a complicated cataract surgery were recruited in this study. The phakic fellow eyes of the patients were defined as a control group. Iris thickness was assessed using anterior segment optical coherence tomography at 750µm (IT750) and 2000µm (IT2000) from the scleral spur. Moreover, maximum iris thickness (ITM) and anterior chamber angle parameters such as trabecular iris surface area at 500 and 750µm (TISA500, TISA750), angle opening distances at 500 and 750µm (AOD500, AOD750) and anterior chamber depth (ACD) were also evaluated. RESULTS: Mean IT750, IT2000 and ITM readings and were significantly lower in the aphakic eyes compared to the healthy eyes (P=0.04, P=0.01, P=0.01 respectively). Anterior chamber parameters (TISA500, TISA750, AOD500 and AOD750) and ACD were significantly increased in aphakic eyes following complicated cataract surgery compared to healthy fellow eyes (all P<0.001). CONCLUSIONS: Complicated cataract surgery leading to aphakia results in decreased iris thickness and increased anterior chamber depth. These findings might be helpful in the selection of the type of surgery for placement of a secondary IOL.

[Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]. / Évaluation de l'astigmatisme associé à l'implant ARTISAN Aphakia fixé à l'iris en face antérieure versus face postérieure : étude du suivi postopératoire sur un an.

PURPOSE: The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris. RESULTS: We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P. CONCLUSION: Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.

Capsular Outcomes After Pediatric Cataract Surgery Without Intraocular Lens Implantation: Qualitative Classification and Quantitative Measurement.

The objective of this study was to investigate capsular outcomes 12 months after pediatric cataract surgery without intraocular lens implantation via qualitative classification and quantitative measurement.This study is a cross-sectional study that was approved by the institutional review board of Zhongshan Ophthalmic Center of Sun Yat-sen University in Guangzhou, China.Digital coaxial retro-illumination photographs of 329 aphakic pediatric eyes were obtained 12 months after pediatric cataract surgery without intraocular lens implantation. Capsule digital coaxial retro-illumination photographs were divided as follows: anterior capsule opening area (ACOA), posterior capsule opening area (PCOA), and posterior capsule opening opacity (PCOO). Capsular outcomes were qualitatively classified into 3 types based on the PCOO: Type I-capsule with mild opacification but no invasion into the capsule opening; Type II-capsule with moderate opacification accompanied by contraction of the ACOA and invasion to the occluding part of the PCOA; and Type III-capsule with severe opacification accompanied by total occlusion of the PCOA. Software was developed to quantitatively measure the ACOA, PCOA, and PCOO using standardized DCRPs. The relationships between the accurate intraoperative anterior and posterior capsulorhexis sizes and the qualitative capsular types were statistically analyzed.The DCRPs of 315 aphakic eyes (95.8%) of 191 children were included. Capsular outcomes were classified into 3 types: Type I-120 eyes (38.1%); Type II-157 eyes (49.8%); Type III-38 eyes (12.1%). The scores of the capsular outcomes were negatively correlated with intraoperative anterior capsulorhexis size (R = -0.572, P < 0.001), but no significant correlation with intraoperative posterior capsulorhexis size (R = -0.16, P = 0.122) was observed. The ACOA significantly decreased from Type I to Type II to Type III, the PCOA increased in size from Type I to Type II, and the PCOO increased from Type II to Type III (all P < 0.05).Capsular outcomes after pediatric cataract surgery can be qualitatively classified and quantitatively measured by acquisition, division, definition, and user-friendly software analyses of high-quality digital coaxial retro-illumination photographs.

Femtosecond cataract laser capsulotomy enabling optic capture and secondary sulcus iol insertion in an eye with traumatic aniridia and aphakia.

PURPOSE: To describe a surgical technique and intraoperative modifications to create a secondary capsulotomy using the femtosecond cataract laser in an eye with traumatic aphakia and aniridia. METHODS: The expanded use of the femtosecond cataract laser (Catalys Precision Laser System; Optimedica, Sunnyvale, CA) for creation of a well-centered and circular secondary capsulotomy in the capsular remnants of an eye with traumatic aphakia and aniridia. RESULTS: Using software modifications based on intraoperative anterior segment spectral-domain optical coherence tomography imaging, and customizing the capsulotomy settings, the femtosecond cataract laser was able to penetrate through most of the fused anterior and posterior capsular leaflets and a circular capsulotomy was achieved. The latter permitted optic capture and excellent centration of a three-piece intraocular lens placed in the sulcus with good postoperative visual rehabilitation. CONCLUSION: The femtosecond cataract laser can be customized to create a well-centered and circular secondary capsulotomy in aniridic and aphakic eyes where optic capture is critical for long-term intraocular lens stability.

[Implantation of intraocular lenses in the ciliary sulcus]. / Implantation von Intraokularlinsen in den Sulcus ciliaris.

Implantation of an intraocular lens (IOL) into the ciliary sulcus is the second most common implantation site after the regular capsular bag (in the bag) placement of an IOL. Although mainly not primarily intended, it is very often used in both complicated cataract surgery and secondary implantation due to IOL dislocation or aphakia. In most cases stable positioning is possible, especially when using optic capture techniques. A variety of difficulties can occur with sulcus implantation depending on the anatomical and surgical conditions present at the time of implantation. The most anterior position of the sulcus lense has to be considered for calculation of the refractive power of the IOL.

Central corneal thickness and intraocular pressure in children undergoing congenital cataract surgery: a prospective, longitudinal study.

AIM: To investigate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after congenital cataract surgery, as well as risk factors associated with these changes. METHODS: 37 eyes of 26 children with congenital cataract undergoing surgery were prospectively recruited. IOP and CCT measurements were performed before the surgery and 6, 12, 18, 24 and 36 months after the procedure. RESULTS: Among the 37 eyes, 15 became aphakic and 22 pseudophakic. Mean CCT significantly increased from 556.24 ± 44.19 to 585.07 ± 56.45 µm (p=0.003) after 3 years, whereas mean IOP significantly increased from 12.05 ± 2.3 to 13.89 ± 2.96 mm Hg (p=0.037). Aphakic eyes underwent surgery at an early age (15.16 ± 32.02 months) compared with pseudophakic eyes (71.48 ± 53.14 months) (p<0.001). After 3 years, mean CCT change in aphakic eyes (56.10 ± 46.97 µm) was significantly higher than in pseudophakic eyes (12.71 ± 38.41 µm) (p=0.015). Age at the time of surgery was inversely correlated to CCT change (r=-0.34, p=0.04), but not to IOP change (r=-0.18, p=0.27). When surgery was performed between 0 and 1 year of age, mean CCT change at 3 years was 70.11 ± 42.3 µm, compared with 6.27 ± 28.09, -17.0 ± 8.04 and 48.33 ± 34.99 µm when surgeries were performed at 1-5, 5-10 and >10 years old, respectively (p<0.001). IOP change was not correlated to CCT change (r=0.31, p=0.06). CONCLUSIONS: CCT increases in eyes undergoing congenital cataract surgery, especially when the surgery is performed at an early age.

Central corneal thickness in microphthalmic eyes with or without history of congenital cataract surgery.

PURPOSE: To determine the central corneal thickness (CCT) in microphthalmic aphakic or pseudophakic eyes as well as in microphthalmic eyes without any history of eye surgery. METHODS: Thirty-two patients with a mean age of 6.41±5.24 years after congenital cataract surgery with absolute microcornea, i.e., horizontal corneal diameter (HCD)<10 mm, or relative microcornea, i.e., HCD 10-11 mm but in the affected eye at least 0.5 mm smaller compared to the fellow eye, formed group A. Thirteen patients of mean age 0.94±1.22 years with absolute or relative microcornea plus another developmental anomaly of an eye without any history of eye surgery formed group B. The patients with corneal edema or scars were excluded. The control group consisted of 124 healthy school-aged children. Horizontal corneal diameter was measured with caliper and CCT with an ultrasound pachymeter. In infants, these measurements were performed under general anesthesia. RESULTS: In 48 eyes in group A and in 16 eyes in group B, the mean CCT was 635.13±65.35 µm and 642.31±93.07 µm, respectively, which was significantly greater (p<0.0001 and p=0.0018) in comparison with the mean CCT (553.58±33.12 µm) in the control group. Regression curve demonstrated the significant increase of CCT values along with the decrease of HCD in microphthalmic eyes. CONCLUSIONS: Small corneas in microphthalmic eyes either with or without congenital cataract surgery have significantly higher CCT. The results demonstrate significant negative correlation between horizontal corneal diameter and CCT.

[Pathogenesis of posterior capsule opacification in pseudophakia]. / Patogeneza zmetnienia torebki tylnej soczewki w pseudofakii.

The lens epithelial cells of A and E type are involved in pathogenesis of posterior capsule opacification (PCO). They undergo metaplasia into microfibroblasts, then migrate towards posterior capsule where they proliferate and form opacification. These processes are stimulated by cytokines and interleukines. The extracellular matrix which constitutes a scaffold for migration and attachment of epithelial cells plays an important role in PCO formation. Integrines intercede in this process.

Intrascleral-fixated intraocular lenses for aphakic correction in the absence of capsular support.

PURPOSE: To present results of experience with the authors" technique for intrascleral fixation of intraocular lenses for the correction of aphakia in the absence of capsular support. METHODS: Eleven patients (four children and seven adults) underwent surgery with the use of the method proposed by the authors (11 operations). The patients ranged in age from 11 to 75 years. The equatorial remnants in the lower segment of the capsular bag were revealed in 5 patients (45.5%). Absence of the capsular bag was observed in 6 patients (54.5%). RESULTS: During long-term follow-up evaluation, visual acuity without correction (mean 0.33+/-0.05) corresponded to the preoperative corrected one. Better visual acuity outcome of 0.41+/-0.06 was achieved with added correction. With intrascleral fixation, a mean refractive error of 1.48+/-0.39 D should be taken into account when calculating intraocular lens power with use of the SRK II formula. CONCLUSIONS: The results indicate that posterior chamber intraocular lens implantation with intrascleral fixation of haptics is a safe and effective technique for aphakic correction in the absence of capsular support and the presence of its defects. The technique used in the present study offers safety and stability of the intraocular lens position.

Evaluation of the effects of hydrodissection with antimitotics using a rabbit model of Soemmering's ring formation.

BACKGROUND: Regeneration/proliferation of lens material within the capsular bag still is the most frequent complication after cataract surgery. We aimed to evaluate the effects of hydrodissection with low doses of antimitotics on the overall regeneration/proliferation of lens material in rabbit eyes, using a model allowing the lens material to be confined to the equatorial region of the capsular bag, facilitating its quantification. METHODS: Twelve albino rabbits underwent bilateral phacoemulsification. Their eyes were randomized to receive 0.4 cc of balanced salt solution, 5-fluorouracil (12.5 mg/mL) or mitomycin C (0.1 mg/mL) during hydrodissection. They were left aphakic, so the capsulorhexis would fuse with the posterior capsule postoperatively. After 4 weeks, killing/enucleation was performed. Regeneration/proliferation of lens material within the equatorial capsular bag (Soemmering's ring) was graded from the Miyake-Apple view (0-4). Its area was also calculated (microm(2)) from direct measurements performed on histological sections. RESULTS: The capsulorhexis margin fused with the peripheral posterior capsule, so the central posterior capsule remained clear. There was no significant difference among the groups (Kruskal-Wallis test) regarding Soemmering's ring gross grading (P = 0.511), number of lens epithelial cell layers lining the inner surface of the capsular bag (P = 0.310) and Soemmering's ring microscopic cross-sectional area (P = 0.638). CONCLUSIONS: The effect of different solutions on after-cataract should be assessed in terms of overall regeneration/proliferation of lens material within the capsular bag, in addition to posterior capsule opacification. When administered in low doses during hydrodissection, 5-fluorouracil and mitomycin C did not show a significant inhibitory effect on after-cataract formation in rabbit eyes.

Glaucoma and increased central corneal thickness in aphakic and pseudophakic patients after congenital cataract surgery.

AIM: To compare the mean central corneal thickness (CCT) among aphakic and pseudophakic patients following congenital cataract surgery with age matched controls. METHODS: This study included 43 eyes of 43 aphakic and pseudophakic patients following congenital cataract surgery. 44 healthy, age and sex matched volunteers were recruited for comparison with the patients. After a complete eye examination, corneal thickness and intraocular pressure were measured. RESULTS: In the study group, 33 eyes were aphakic, and the remaining 10 eyes were pseudophakic. The median CCT was 556.0 microm (range 490-640 microm) in the control group and 626 microm (range 523-870 microm) in the study group (p<0.05). There was a significant difference in CCT between aphakic and pseudophakic eyes in which an intraocular lens (IOL) had been implanted at the time of congenital cataract surgery (p = 0.011). The same difference was not observed between aphakic and pseudophakic eyes in which an IOL had been implanted secondarily (p = 0.835). The median age of the patients at the time of lensectomy was 24 months (range 1 week to 120 months). There was a negative correlation between the age at lensectomy and CCT (r = -0.485, p = 0.001). CONCLUSION: Aphakic and pseudophakic patients have significantly thicker corneas than age matched controls. This difference can have an important effect on interpreting intraocular pressures in these patients. It is also important to assess the effects of early surgery for congenital cataracts, as well as those of primary and secondary IOL implantation, on CCT.

Corneal and total optical aberrations in a unilateral aphakic patient.

PURPOSE: To measure corneal and total optical aberrations in the normal and treated eye of a unilateral aphakic patient to (1) cross-validate techniques in an eye in which corneal and total aberrations should be almost identical (aphakic eye) and (2) compare the interactions of corneal and internal aberrations in the normal eye with those in the aphakic eye. SETTING: Instituto de Optica, Consejo Superior de Investigaciones Científicas, Madrid, Spain. METHODS: Aberrations in both eyes of a unilateral aphakic patient were measured using laser ray tracing. Corneal aberrations were obtained from corneal elevation data measured with a corneal videokeratoscope (Humphrey Instruments) using custom software that performs virtual ray tracing on the measured front corneal surface. RESULTS: There was a 98.4% correspondence between the total and corneal aberration pattern in the aphakic eye (6.5 mm pupil). In the normal eye, the total spherical aberration was much lower than the corneal spherical aberration; this did not occur in the aphakic eye. CONCLUSIONS: The posterior corneal surface contributed slightly to the aberrations in the normal cornea (2% at most). The crystalline lens appears to play a compensatory role in the total spherical aberration in normal eyes.

Effect of cataract surgery on ocular axial length elongation in young children.

PURPOSE: To evaluate the influence of cataract surgery on eyes of children between 1-5 years old. MATERIALS AND METHODS: Forty-seven cases of pediatric cataract, including 31 cases of bilateral congenital cataract and 16 cases of unilateral posttraumatic cataract, were retrospected. Of the 31 cases of congenital cataract, 19 cases (group 1) had undergone cataract extraction with intraocular lens (IOL) implantation, 12 (group 2) had undergone cataract extraction without IOL implantation. Each of them had their two eyes operated separately at an interval of 1 year or longer. Of the 16 cases of posttraumatic cataract, 6 (group 3) had undergone cataract extraction with IOL implantation and 10 (group 4) had undergone cataract extraction without IOL implantation. Mean age at the time of interested surgery was 2.9 years (range from 1.1 to 5.1 years). Ocular axial length of both eyes measured by A-scan ultrasonography before and after the surgery of the earlier operated eye in the congenital groups and the operated eye in the post-traumatic groups was recorded. The elongation of axial length of the earlier operated eye in the congenital groups and the operated eyes in the posttraumatic groups of each case were compared with that of the fellow eye statistically with paired t-test. RESULTS: The mean follow-up was 2.6 years (ranged from 1.0 to 6.4 years). In all the 4 groups, the elongation of axial length between the earlier operated eye and later operated eye in the congenital groups and between the operated and unoperated eyes in the posttraumatic groups of each case was not significantly different (p > 0.05). CONCLUSION: Cataract surgery, either extraction with or without IOL implantation, did not retard axial elongation in children above 1 year old.

Permalens hydrogel intracorneal lenses for spherical ametropia.

PURPOSE: To assess the efficacy, stability, and safety of Permalens hydrogel intracorneal lenses for the correction of spherical ametropia 6 years after implantation. METHODS: Implantation of intracorneal hydrogel lenses was performed by the same surgeon (JIBM) in five aphakic and five high myopic eyes. The lens closet to corneal vertex refraction was used. Refractive outcomes, keratometry, keratography, endothelial cell count, and corneal topography were studied. RESULTS: Corneal tolerance to the hydrogel implants was maintained throughout for 6 years with no alteration in endothelial cell count. All myopic eyes showed regression of achieved correction. The aphakic eyes showed no statistically significant difference between the results at 1 month and those obtained at 1 and 6 years. CONCLUSIONS: Hyrdogel intracorneal lenses are well tolerated and the refractive results are stable in aphakic patients. They may be considered when intraocular lenses cannot be placed in aphakic patients, but are not now in clinical use.

Eye growth in the aphakic newborn rabbit.

PURPOSE: To examine growth in unilaterally lensectomized newborn rabbits. SETTING: S:t Erik Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Unilateral lensectomy was performed in 18 randomly selected 23-day-old rabbits. Corneal incision was performed in 2 other rabbits, and the aqueous humor was replaced with balanced salt solution in one eye. Axial length, corneal diameter, corneal thickness, intraocular pressure (IOP), and refraction were measured in all eyes preoperatively and 1, 2, and 3 months postoperatively. The wet mass of the after-cataract was measured 3 months after surgery. RESULTS: The growth of the aphakic eye, as indicated by axial length and corneal diameter, was significantly less than that of the control eye in 14 rabbits. No significant difference in IOP or corneal thickness was found between the lensectomy and control eyes. Four animals had elevated IOP with secondary glaucoma and were excluded from the study. No difference in eye growth was found between the two eyes when no lensectomy was performed. Refraction in the unoperated eye showed a myopic shift. After lensectomy, the operated eye became hyperopic with a myopic shift 3 months after surgery. No correlation was found between eye growth and the wet mass of the after-cataract. CONCLUSIONS: Our results suggest that removal of the rabbit crystalline lens at an early age reduces eye growth.

Ocular axial length changes in a pediatric patient with aphakia and pseudophakia.

Excessive eye elongation can be induced in experimental animals by visual deprivation. A tendency toward myopic refraction or shift in pediatric aphakia has been recorded in some children. In this report, we present the case of an 18-year-old patient who had developmental cataracts treated at seven years of age with bilateral cataract extraction and implantation of an intraocular lens in one eye only. Axial length of the eye with a contact lens increased compared with the eye with the intraocular lens.

[Study of the fundus oculi periphery in patients with posterior- chamber lenses]. / Badanie obwodu dna oka u osób z soczewka tylnokomorowa.

Evaluation of the eye fundus after an extracapsular cataract extraction with posterior chamber lens implantation was performed in 50 patients 1 month after surgery and in 50 another patients 2 years after surgery. In the earlier period a very good inspection was possible in 88 p.c. of cases, 2 years after cataract extraction in 78 p.c. The usefulness of bilateral ophthalmoscopy was emphasized.

A prospective study on the implantation of anterior chamber intraocular lenses during keratoplasty for pseudophakic and aphakic bullous keratopathy.

Between April 1986 and April 1989, the authors conducted a prospective study of the use of open-loop anterior chamber intraocular lenses (AC IOLs) in patients undergoing penetrating keratoplasty for pseudophakic bullous keratopathy or monocular aphakic bullous keratopathy. All patients underwent the same operation--a penetrating keratoplasty combined with insertion of an open-loop AC IOL. Pseudophakic patients had an IOL exchange at the time of surgery. Thirty-six patients have been followed an average of 15 months. Thirty-two (89%) of the grafts are clear. Preoperatively, 100% of eyes had visual acuity less than 20/200. Postoperatively, 11 eyes (31%) have visual acuity better than 20/40 and 23 eyes (64%) have visual acuity better than 20/100. The most common causes for visual acuity less than 20/200 were cystoid macular edema, glaucoma, and immunologic graft failure. Using open-loop AC IOLs in patients with pseudophakic or aphakic bullous keratopathy can give good postoperative results and functional vision.

Liquefaction of human vitreous in model aphakic eyes by 300-nm UV photolysis: monitoring liquefaction by fluorescence.

After the lens is removed in cataract surgery, the vitreous presumably receives all of the ambient 300-nm light that has filtered through the cornea. Using this model for aphakic eyes, we progressively irradiated intact vitreous samples of a 49-year-old human with 300-nm light and monitored changes in absorption, fluorescence, and circular dichroism (CD) properties. CD and fluorescence measurements of unirradiated vitreous samples showed a) a strong tryptophan fluorescence band of non-collagenous protein at 336 nm and a very weak band around 430 nm due to N-formylkynurenine (N-FK), a photoproduct of tryptophan, and b) a strong, negative CD band below 250 nm representing a composite spectrum of hyaluronic acid, collagen, and non-collagenous protein. Upon irradiation, the tryptophan emission band at 336 nm progressively decreased with time and the band maximum was concomitantly red-shifted; the N-FK fluorescence band at 430 nm, on the other hand, continually increased with the time of irradiation. A significant increase in the fluidity (liquefaction) of the vitreous gel also was noted upon irradiation, a change that was monitored successfully by measuring the progressive decrease in the polarization value of tryptophan fluorescence. The extent of liquefaction, measured spectroscopically, was found to be 40% upon irradiation for 10 hr. In addition, CD measurements indicated a partial loss in the secondary structure of the non-collagenous protein.