RESUMO
PURPOSE: The Reper device (Reper-NN LTD, Nizhny Novgorod, Russia), an acrylic iris diaphragm combined with an intraocular lens (IOL), may be adapted for patients with various iris defects and aphakia. We aim to present our experience using the Reper artificial iris-IOL device. SETTING: Tertiary medical center. METHODS: This study includes patients who underwent implantation of the Reper artificial iris-IOL device at a single tertiary medical center between 2017 and 2023. The non-parametric signed test was used to compare preoperative and postoperative outcomes. RESULTS: Fifteen patients with aphakia and partial aniridia were included (four females [27%], mean age: 68.3). Mean follow-up time was 7.87 ± 5.62 months (range: 1-20). Following surgery, 87% (13 patients) showed improvement in corrected distance visual acuity (CDVA), while 13% (two patients) maintained their preoperative CDVA. The mean improvement in CDVA was 0.68 ± 0.19 logMAR (P value = 0.0015 [95% confidence interval (CI): 0.28-1.08. Unpaired t-test]). Moreover, all patients (100%) expressed complete satisfaction with postoperative cosmetic outcomes. CONCLUSION: This study represents the largest reported series on Reper artificial iris-IOL implantation procedure and provides initial insights into its outcomes. No surgical complications were reported, and most patients experienced VA improvement and cosmetic satisfaction. These findings may assist ophthalmic surgeons in evaluating the benefits and risks of this implant. Larger, longer-term studies are needed to better establish its safety and efficacy.
Assuntos
Afacia Pós-Catarata , Doenças da Íris , Iris , Implante de Lente Intraocular , Lentes Intraoculares , Acuidade Visual , Humanos , Feminino , Iris/cirurgia , Iris/anormalidades , Masculino , Idoso , Desenho de Prótese , Estudos Retrospectivos , Seguimentos , Pessoa de Meia-Idade , Implante de Lente Intraocular/métodos , Resultado do Tratamento , Afacia Pós-Catarata/cirurgia , Doenças da Íris/cirurgia , Idoso de 80 Anos ou maisRESUMO
PURPOSE: To evaluate outcome and incidence of ocular hypertension after Descemet membrane endothelial keratoplasty (DMEK) and DMEK combined with cataract surgery (triple DMEK) after Nd:YAG laser iridotomy (IO) and surgical iridectomy (IE). METHODS: This is a single-center, retrospective cohort study of patients who underwent DMEK or triple DMEK surgery at the Department of Ophthalmology, University Hospital Düsseldorf, Germany, from January 2018 to June 2020 and had received either a prophylactic preoperative IO or an intraoperative IE. Patient demographic data; best corrected visual acuity; central corneal thickness; intraocular pressure (IOP); endothelial cell density; and complications such as occurrence of early postoperative IOP elevation, macular edema, rebubbling rate, and incidence of glaucoma were analyzed. RESULTS: A total of 75 patients were included in each study arm with a follow-up of 22.04 ± 12.8 months. Best corrected visual acuity significantly increased postoperatively in both cohorts without significant differences. Early postoperative IOP elevation due to pupillary block was significantly more common in eyes with IO (33.3%, n = 25) than with IE (2.67%, n = 2, P < 0.001). The incidence of de novo glaucoma was 5.34% in both cohorts without significant differences in prevalence at the last follow-up (YAG IO cohort: 17.3%, IE cohort: 14.7%, P > 0.05). Rebubbling was required in 16% (n = 12) of eyes in each cohort ( P > 0.999). CONCLUSIONS: Postoperative pupillary block after DMEK occurs significantly more often after preoperative Nd:YAG laser iridotomy compared with surgical intraoperative iridectomy but does not negatively affect long-term visual outcome or glaucoma incidence after DMEK.
Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Iridectomia , Iris , Terapia a Laser , Lasers de Estado Sólido , Hipertensão Ocular , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos , Masculino , Feminino , Lasers de Estado Sólido/uso terapêutico , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Hipertensão Ocular/epidemiologia , Hipertensão Ocular/etiologia , Hipertensão Ocular/fisiopatologia , Idoso , Incidência , Iridectomia/métodos , Acuidade Visual/fisiologia , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias/epidemiologia , Iris/cirurgia , Terapia a Laser/métodos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Seguimentos , Resultado do TratamentoRESUMO
Purpose: This study aimed to explore the possibility of the clinical application using anterior segment optical coherence tomography angiography (AS-OCTA)-guided laser peripheral iridotomy (LPI). Methods: AS-OCT/OCTA was performed before LPI and at 1 hour, 1 day, and 1 week post-LPI. All the right eyes of patients with primary angle-closure suspect (PACS) were assigned to the AS-OCTA-guided group, in which the peripheral site with the sparsest iris vasculature on AS-OCTA images was selected for LPI. The left eyes underwent LPI in the slit lamp-guided group, where the site was chosen based on the presence of an iris crypt by clinicians using the slit lamp. The two groups were compared for the incidence of anterior chamber bleeding observed by the LPI operator, anterior chamber particle (ACP) index, mean angle opening distance (AOD750), and anterior chamber depth (ACD) measured from AS-OCT images, as well as the vessel density and perfusion area obtained from AS-OCTA images. Results: A total of 30 patients with PACS were included in this study. The incidence of anterior chamber bleeding during LPI was 13.33% in the AS-OCTA-guided group, compared with 43.33% in the slit lamp-guided group (P = 0.010). The prominent difference was observed 1 hour after LPI, with the AS-OCTA-guided group showing significantly lower vessel density (P = 0.028), perfusion area (P = 0.003), and ACP (P = 0.004), but a larger AOD750 (P < 0.001) compared with the slit lamp-guided group. Conclusions: Utilizing AS-OCTA to guide the LPI procedure can significantly decrease the incidence of anterior chamber bleeding and mitigate inflammation. Translational Relevance: This study shows that the AS-OCTA-guided LPI procedure could bridge advanced imaging technology and clinical glaucoma management.
Assuntos
Glaucoma de Ângulo Fechado , Iridectomia , Iris , Terapia a Laser , Lâmpada de Fenda , Cirurgia Assistida por Computador , Tomografia de Coerência Óptica , Humanos , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Fechado/diagnóstico por imagem , Glaucoma de Ângulo Fechado/fisiopatologia , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Terapia a Laser/métodos , Iris/cirurgia , Iris/diagnóstico por imagem , Iridectomia/métodos , Cirurgia Assistida por Computador/métodos , Pressão Intraocular/fisiologia , Microscopia com Lâmpada de Fenda/métodosRESUMO
PURPOSE: To investigate the long-term efficacy and safety of selective laser trabeculoplasty (SLT) in patients who have previously undergone laser peripheral iridotomy (LPI). DESIGN: Single-center, retrospective cohort study. PATIENTS AND METHODS: Eyes with a history of LPI that subsequently underwent SLT at Wills Eye Hospital between 2013 and 2022, with at least one year of follow-up, were enrolled as the study group. The control group consisted of individuals diagnosed with primary open-angle glaucoma (POAG) who underwent SLT treatment during the same time period and had no history of LPI. Baseline characteristics and post-SLT data during the 1-year follow-up period were compared between groups. Primary success was defined as IOP reduction ≥ 20% without the addition of glaucoma medications. Secondary success was defined as IOP reduction < 20% but with a reduction in the number of glaucoma medications. Success was evaluated at 6 and 12 months. RESULTS: 73 eyes from 53 patients were included in the study group, along with 83 eyes from 79 patients in the control group. The study group had a similar primary success rate compared with the control group at 6 months (45.2 vs. 33.7%, P = 0.188), while significantly higher at 12 months (47.9 vs. 31.3%, P = 0.048). Secondary success was comparable in both groups at 6 and 12 months. Higher baseline IOP (P = 0.048) and narrower angle of approach (P = 0.005) were significantly associated with higher success. No complications, such as IOP spike exceeding 10 mmHg or prolonged inflammation, were observed in either group. CONCLUSIONS: SLT effectively and safely lowered the IOP in patients who have had previous LPI for narrow angle. SLT may be considered as a potential treatment option for selected patients with prior LPI and persistently elevated IOP.
Assuntos
Glaucoma de Ângulo Aberto , Pressão Intraocular , Iridectomia , Iris , Terapia a Laser , Trabeculectomia , Humanos , Trabeculectomia/métodos , Pressão Intraocular/fisiologia , Estudos Retrospectivos , Masculino , Feminino , Terapia a Laser/métodos , Iridectomia/métodos , Iridectomia/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/fisiopatologia , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Seguimentos , Iris/cirurgia , Tonometria Ocular , Malha Trabecular/cirurgiaRESUMO
BACKGROUND/OBJECTIVES: Intraocular lens (IOL) pupillary capture is a frequent and debilitating postoperative complication that can cause significant vision loss, discomfort, pain, and even endophthalmitis. It arises from factors such as pupil overdilation, IOL deviation, iris laxity, and reverse pupil block, leading to IOL entrapment within the pupil. Traditional management methods-including conservative observation, medication, YAG laser iridotomy, or surgical reset-have limitations such as high recurrence rates, surgical risks, and potential secondary damage. This study introduces a novel surgical technique, single suture interception, to provide a safer, more efficient solution for this challenging condition. METHODS: We intercepted and fixed the intraocular lens by using a 10-0 polypropylene suture which was threaded through the lateral incision of the corneal limbus into the iris to form two interception lines across the pupil. RESULTS: The single suture interception technique was used in 10 patients with intraocular lens pupillary capture, and none of them had postoperative recurrence and there were no other complications. CONCLUSIONS: Single suture interception is an effective method for solving intraocular pupillary capture. It is simple, convenient and safe.
Assuntos
Iris , Implante de Lente Intraocular , Lentes Intraoculares , Complicações Pós-Operatórias , Técnicas de Sutura , Suturas , Humanos , Técnicas de Sutura/instrumentação , Lentes Intraoculares/efeitos adversos , Masculino , Feminino , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias/cirurgia , Acuidade Visual , Iris/cirurgiaRESUMO
PURPOSE: To demonstrate the efficacy and safety of iris-claw phakic intraocular lens (pIOL) in the treatment of postkeratoplasty astigmatism. SETTING: Cornea Unit, Ophthalmology Department, Unidade Local de Saúde de Santo António, Porto, Portugal. DESIGN: Retrospective longitudinal study. METHODS: Analysis of patients submitted to iris-claw pIOL implantation after previous penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) between January 2013 and December 2023. Patients submitted to other refractive procedures and without minimum 1-year follow-up were excluded. Demographic data, spherical equivalent, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were registered preoperatively, at the intermediate visit (12 to 18 months), 5 years, and 10 years postoperatively. Vector analysis to plot corneal surgically induced astigmatism was performed. Endothelial cell density (ECD) was evaluated at each visit using the same specular microscope. RESULTS: We enrolled 39 eyes of 29 patients submitted to keratoplasty due to keratoconus (71.8% [n = 28] DALK). At the intermediate visit, 19 eyes (49%) had a postoperative UDVA ≥20/32 and 6 (15%) had ≥20/20. The efficacy index was 0.83. 16 (11%) achieved full refractive correction without loss of CDVA, and 9 (23%) gained ≥1 lines of vision. 28 (72%) eyes were within ±1.00 diopter (D) of planorefraction. Globally, 25 (64%) eyes showed a residual astigmatism ≤1.00 D. Average annual ECD loss was 3.07% for DALK and 9.34% for PK ( P = .006). CONCLUSIONS: Iris-claw pIOL is effective for treating postkeratoplasty astigmatism. Given the risk for progressive endothelial cell loss, strict follow-up is mandatory, especially after PK.
Assuntos
Astigmatismo , Iris , Ceratoplastia Penetrante , Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Complicações Pós-Operatórias , Humanos , Astigmatismo/cirurgia , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Estudos Retrospectivos , Feminino , Masculino , Ceratoplastia Penetrante/efeitos adversos , Acuidade Visual/fisiologia , Adulto , Implante de Lente Intraocular/métodos , Iris/cirurgia , Refração Ocular/fisiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Seguimentos , Resultado do Tratamento , Adulto Jovem , Desenho de Prótese , Ceratocone/cirurgiaRESUMO
We describe a novel, simple and minimally invasive surgical technique for the repair of iridodialysis, which can be easily adopted by general ophthalmologists and cataract surgeons. Two eyes underwent this a new approach for iridodialysis repair using a 7-0 polypropylene (Prolene) suture. The 7-0 Prolene suture was used to pin the iris to the sclera, with a double flange resembling a dumbbell, one flange resting on the iris and the other on the sclera. With minimal instruments the technique was completed in a single surgical setting. Postoperative outcomes were favourable in both the cases, with improved visual acuity, near normal pupil contour and no hyphema. The technique was associated with minimal intraoperative time, good cosmetic outcomes and stable intraocular pressure. We conclude that this Dumb-Bell technique is a safe, simple, and efficient method for the repair of iridodialysis. It is minimally invasive with reduced risk of complications and can be readily performed by most ophthalmologists, including those with limited experience in complex iris repairs.
Assuntos
Traumatismos Oculares , Doenças da Íris , Iris , Procedimentos Cirúrgicos Oftalmológicos , Técnicas de Sutura , Suturas , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Oculares/cirurgia , Traumatismos Oculares/diagnóstico , Pressão Intraocular/fisiologia , Iris/lesões , Iris/cirurgia , Doenças da Íris/cirurgia , Doenças da Íris/diagnóstico , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Polipropilenos , Técnicas de Sutura/instrumentação , Acuidade VisualRESUMO
Persistent pupillary membranes are a common congenital anomaly that usually resolves spontaneously in early infancy. However, bilateral extensive persistent pupillary membranes that entirely obscure the pupils, involve the visual axis, and adhere firmly to the lens are rarely reported. This report presents a rare case of bilateral extensive persistent pupillary membranes in a young child, resulting in severe visual axis obstruction and firm adhesion to the anterior lens capsule. Surgical removal led to a substantial improvement in visual acuity without complications. This case highlights the importance of early diagnosis and timely surgical intervention to restore vision and prevent long-term complications such as deprivation amblyopia.
Assuntos
Anormalidades do Olho , Iris , Distúrbios Pupilares , Humanos , Lactente , Anormalidades do Olho/cirurgia , Anormalidades do Olho/diagnóstico , Anormalidades do Olho/fisiopatologia , Iris/cirurgia , Iris/anormalidades , Distúrbios Pupilares/cirurgia , Acuidade VisualRESUMO
OBJECTIVE: To evaluate the complications, management, and outcomes associated with cosmetic iris implants. DESIGN: Single-center retrospective interventional case series. SUBJECTS: 30 eyes of 15 patients who presented to Moorfields Eye Hospital, London, UK with complications related to cosmetic iris implants between January 2008 and December 2023. Mean age at implantation was 34.13 ± 9.51 years, with predominantly Asian ethnicity (53%) and male gender (60%). METHODS: Medical records were reviewed for patient demographics, pre-explantation parameters, complications, management, and outcomes. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell count (ECC), and central corneal thickness (CCT) were analyzed before and after explantation. Secondary interventions were documented, and statistical analyses were performed using paired t-tests and Pearson correlation coefficients. MAIN OUTCOME MEASURES: BCVA, IOP, ECC, CCT, presence of uveitis, glaucoma, corneal decompensation, cataract formation, and need for secondary surgical interventions. RESULTS: Median time to explantation was 45.5 months (range: 6.0-140.1 months). The most common complications included uveitis (60%), elevated IOP requiring glaucoma surgery (33.3%), corneal decompensation requiring Descemet's Membrane Endothelial Keratoplasty (20%), and cataract formation requiring phacoemulsification (13.3%). A statistically significant positive correlation was found between time to explantation and corneal decompensation (r = 0.392, P = .048). In patients who underwent DMEK (n=6), ECC increased significantly from 778.33 ± 191.53 cells/mm² to 1107.33 ± 17.96 cells/mm² postoperatively (P = .009), and mean CCT decreased from 783.17 ± 293.93 µm to 508.83 ± 48.94 µm (P = .1). Despite these interventions, a considerable proportion of patients experienced persisting symptoms requiring secondary surgery. CONCLUSIONS: This case series demonstrates that cosmetic iris implants are associated with serious sight-threatening complications including corneal decompensation, glaucoma, and uveitis. Many patients required multiple surgical interventions after explantation, highlighting the long-term morbidity associated with these devices. The authors recommend that cosmetic iris implantation should be banned worldwide given the substantial risks and lack of therapeutic value, and greater regulatory oversight is needed to prevent further harm to patients.
Assuntos
Iris , Complicações Pós-Operatórias , Próteses e Implantes , Implantação de Prótese , Humanos , Masculino , Estudos Retrospectivos , Feminino , Iris/cirurgia , Adulto , Acuidade Visual/fisiologia , Pressão Intraocular/fisiologia , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Remoção de Dispositivo , Adulto Jovem , Glaucoma/etiologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Implantação de Prótese/efeitos adversos , Seguimentos , Contagem de Células , Endotélio Corneano/patologiaRESUMO
OBJECTIVE: To evaluate the efficiency and safety of iris retractor-assisted cataract surgery with modified scleral fixation for treating subluxated lenses. METHODS AND ANALYSIS: We developed a modified technique combining iris retractors with intrascleral intraocular lens (IOL) fixation for the treatment of moderate or severe lens subluxation due to non-progressive or progressive zonular defects. A retrospective case series study was conducted, including patients diagnosed with severe zonular dialysis who underwent this technique. Clinical data were collected and analyzed, including comprehensive ophthalmic examinations, anterior segment optical coherence tomography, surgical procedures, and outcome measures such as visual acuity and IOL positioning. RESULTS: Fourteen eyes from fourteen patients (four females and ten males), with a mean age of 56.36 ± 17.74 years and severe zonular loss, were enrolled in the study. All patients were followed up for a mean of 22.5 ± 15.4 months (range 4-49 months). The mean visual acuity improved significantly after surgery (p < 0.001), and the IOLs were well-centered. Postoperative transient intraocular hypertension was observed in one patient. CONCLUSION: This modified technique simplifies the surgical procedures for treating severe lens subluxation and reduces postoperative complications.
Assuntos
Extração de Catarata , Iris , Implante de Lente Intraocular , Subluxação do Cristalino , Esclera , Humanos , Masculino , Feminino , Esclera/cirurgia , Estudos Retrospectivos , Pessoa de Meia-Idade , Acuidade Visual , Iris/cirurgia , Idoso , Subluxação do Cristalino/cirurgia , Subluxação do Cristalino/diagnóstico , Adulto , Extração de Catarata/métodos , Implante de Lente Intraocular/métodos , Seguimentos , Tomografia de Coerência Óptica , Técnicas de Sutura , Resultado do Tratamento , Lentes IntraocularesRESUMO
PURPOSE: To evaluate the effects of prophylactic sequential argon- Nd:YAG laser peripheral iridotomy (pLPIsequential) on the corneal endothelial cell density (CECD) over 5 years in Japanese eyes with narrow angles (NA-eyes). STUDY DESIGN: Prospective observational study METHODS: The CECD of NA-eyes before and after pLPIsequential and of untreated NA-eyes were assessed annually over 5 years with non-contact specular microscopy. Routine ophthalmic examinations and measurements using anterior-segment imaging devices were performed at baseline. The time courses of the CECD were analyzed using a multivariable linear mixed-effect model and factors obtained at baseline. RESULTS: Sixty-nine pLPIsequential-treated NA-eyes (69 subjects; mean age, 68.9 years) and 67 pLPIsequential-untreated NA-eyes (67 subjects; mean age, 64.4 years) were enrolled. In the pLPIsequential-untreated NA-eyes, no baseline factors were correlated significantly with the time course of the CECD, and its decline rate - 4.7 (95% Confidence interval (I: - 13.3 to 4.0) cells/mm2 was not significant (p = 0.267). In the pLPIsequential-treated NA-eyes, the CECD declined with marginal significance - 12.2 (- 24.7 to 0.3) cells/mm2/year (p = 0.0513) over 5 years. Higher laser energy used, thicker iris, and shallower central anterior chamber depth (cACD) at baseline were significantly negatively correlated with the post-laser CECD (p = 0.0092, 0.0119, and 0.0158). No significant difference was seen in the baseline factors-adjusted CECD decline rate (p = 0.262) between both the groups. CONCLUSION: Prophylactic sequential argon-Nd:YAG pLPIsequential had no clinically significant effects on the time course of the CECD over 5 years in Japanese NA eyes. However, higher laser energy used, thicker iris, and shallower cACD significantly negatively affected the post-laser CECD.
Assuntos
Endotélio Corneano , Glaucoma de Ângulo Fechado , Pressão Intraocular , Iridectomia , Iris , Terapia a Laser , Lasers de Estado Sólido , Humanos , Masculino , Estudos Prospectivos , Feminino , Idoso , Endotélio Corneano/patologia , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/fisiopatologia , Contagem de Células , Iridectomia/métodos , Iris/cirurgia , Lasers de Estado Sólido/uso terapêutico , Pessoa de Meia-Idade , Japão/epidemiologia , Pressão Intraocular/fisiologia , Seguimentos , Fatores de Tempo , Terapia a Laser/métodos , Resultado do Tratamento , População do Leste AsiáticoRESUMO
PURPOSE: We aimed to investigate the effect of haptic design, direction of suture passage, and distance between flanges on the haptic-iris distance after four-flanged scleral fixation of a single-piece intraocular lens with four eyelets. METHODS: After marking the 3 and 9 o'clock positions on the limbus, each 26-G needle was positioned 2.0 mm posterior to the limbus and passed 2.0, 3.0, and 4.0 mm away from the markings at 3 o'clock and 9 o'clock, respectively. We passed each end of a 5-0 polypropylene suture anteroposteriorly or posteroanteriorly through two unilateral eyelets. The haptic-iris distance was evaluated using anterior-segment optical coherence tomography. RESULTS: Passing the suture through the eyelets in the posteroanterior direction yielded a wider haptic-iris distance than that achieved by passing the suture in the anteroposterior direction (p < 0.001, respectively). A wider distance between the polypropylene flanges correlated with reduced distortion of haptic structures. Fixation of the Akreos AO with a 4.0-mm suture spacing induced a wider haptic-iris distance (p < 0.001). CONCLUSION: Passing sutures through the eyelet in the posteroanterior direction during intrascleral fixation proved to be more effective in securing a sufficient haptic-iris distance. A wider distance between flanges was beneficial in preventing structural distortion of the haptic and ensuring a proper distance between the haptic and iris.
Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Esclera , Técnicas de Sutura , Humanos , Esclera/cirurgia , Implante de Lente Intraocular/métodos , Tomografia de Coerência Óptica , Desenho de Prótese , Masculino , Suturas , Polipropilenos , Feminino , Iris/cirurgia , IdosoRESUMO
PURPOSE: To evaluate the clinical indications and long-term outcomes-specifically efficacy, safety, predictability, and stability-of iris-fixated anterior chamber phakic intraocular lenses (pIOLs) in patients with low myopia spherical equivalent (SE) <-6.00 diopters (D). DESIGN: Retrospective, single-center case series. SUBJECTS: A total of 155 eyes from 96 patients with SE < -6.00 D underwent implantation with either Artisan or Artiflex pIOLs between 2009 and 2019. For long-term analysis, only eyes without prior intraocular surgery that received Artiflex lenses were included (n = 103). METHODS: Preoperative and annual postoperative assessments included uncorrected (UDVA) and corrected distance visual acuity (CDVA); efficacy index (postoperative UDVA/preoperative CDVA) and safety index (postoperative CDVA/preoperative CDVA); manifest refraction, SE, endothelial cell density (ECD), and intraocular pressure (IOP). Clinical indications for implantation were recorded. Descriptive statistics were conducted. MAIN OUTCOME MEASURES: Frequency of clinical indications for implantation, visual acuity (UDVA, CDVA), manifest refraction including SE and astigmatism, refractive predictability and long-term stability, ECD, IOP, and incidence of adverse events. RESULTS: The mean preoperative SE was -4.64 ± 0.92 D and cylinder -0.86 ± 0.76 D. The average follow-up was 6.55 ± 4.08 years (range, 1-15 years). Topographic alterations (40.4%), central corneal thickness <500 µm (21.1%), and stable keratoconus (8.5%) were the most common indications. At final follow-up, 71% and 87% of eyes were within ±0.50 D and ±1.00 D of the attempted SE correction, respectively. Postoperative astigmatism was <1.00 D in 93% of eyes. Efficacy and safety indices were 0.90 and 1.02 at 1 year and remained stable over time (P = .140 and P = 1.000, respectively). The mean annual ECD loss was 38.6 cells/mm²/y, corresponding to an annualized percentage loss of 1.11%. IOP remained stable throughout follow-up. Four eyes (2.58%) required IOL explantation. CONCLUSIONS: Over more than 10 years of follow-up, long-term results indicate that Artiflex pIOL implantation is effective, predictable, stable, and safe in patients with low myopia <-6 D of SE.
Assuntos
Iris , Implante de Lente Intraocular , Miopia , Lentes Intraoculares Fácicas , Refração Ocular , Humanos , Estudos Retrospectivos , Acuidade Visual/fisiologia , Feminino , Masculino , Refração Ocular/fisiologia , Miopia/cirurgia , Miopia/fisiopatologia , Seguimentos , Iris/cirurgia , Adulto , Implante de Lente Intraocular/métodos , Adulto Jovem , Resultado do Tratamento , Pressão Intraocular/fisiologia , Adolescente , Pessoa de Meia-Idade , Câmara Anterior/cirurgia , Desenho de PróteseRESUMO
We report a novel three-step technique that incorporates microscope-integrated optical coherence tomography (mi-OCT) guidance, controlled cyst aspiration, fibrin glue instillation, and en bloc excision. This approach was applied in two pediatric patients, a six-month-old female and a three-month-old male, with primary iris cysts obscuring the visual axis. Both patients underwent cyst excision with no intraoperative complications. Visual axis clarity was restored, and no recurrence was noted at 2 and a half years and 3 months of follow-up, respectively. This technique offers a promising alternative for the pediatric population, providing a minimally invasive, safe, and effective approach for complete cyst excision with enhanced intraoperative visualization.
Assuntos
Cistos , Adesivo Tecidual de Fibrina , Doenças da Íris , Iris , Procedimentos Cirúrgicos Oftalmológicos , Cirurgia Assistida por Computador , Adesivos Teciduais , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Masculino , Adesivo Tecidual de Fibrina/farmacologia , Adesivo Tecidual de Fibrina/administração & dosagem , Cistos/cirurgia , Cistos/diagnóstico , Feminino , Doenças da Íris/cirurgia , Doenças da Íris/diagnóstico , Lactente , Cirurgia Assistida por Computador/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Iris/cirurgia , Iris/diagnóstico por imagem , Iris/patologiaRESUMO
AIMS: This study aimed to examine the impact of laser peripheral iridotomy (LPI) on subgroups of primary angle closure eyes based on swept-source optical coherence tomography (SS-OCT). METHODS: SS-OCT was used to image 115 eyes with primary angle-closure disease (PACD) at prior to LPI, 1 week, 4 weeks and 12 weeks after LPI. A hierarchical cluster analysis was conducted to classify PACD eyes into subgroups based on pre-LPI SS-OCT parameters. The primary parameters were then compared after LPI to assess any variations in the outcomes among the identified subgroups. A mixed-effects model was used to evaluate the difference between subgroups and the effect of LPI. RESULTS: The hierarchical cluster analysis resulted in the identification of two distinct clusters. Cluster 1 (56 eyes) exhibited larger lens vault, pupil distance, iris volume, iris area, iris thickness 2000, as well as narrower angles (p < 0.05 for all). Cluster 2 (59 eyes) had smaller anterior chamber width and anterior chamber volume (p < 0.05 for all). Following LPI, there was an observed increase in the angle size and a decrease in irido-trabecular contact index (ITCI) in both clusters (p < 0.05 for all). Over a period of 3 months, the cluster 1 exhibited stability in angle size and ITCI, whereas cluster 2 exhibited a gradual decline in angle size and a gradual increase in ITCI (p < 0.05 for all). CONCLUSION: This study successfully identified two distinct subgroups of PACD eyes based on SS-OCT parameters. Smaller eyes demonstrated a declining response to LPI over a period of 3 months.
Assuntos
Glaucoma de Ângulo Fechado , Iridectomia , Iris , Terapia a Laser , Tomografia de Coerência Óptica , Humanos , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Fechado/diagnóstico , Tomografia de Coerência Óptica/métodos , Masculino , Iridectomia/métodos , Feminino , Iris/cirurgia , Iris/diagnóstico por imagem , Terapia a Laser/métodos , Pressão Intraocular/fisiologia , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Gonioscopia , Estudos ProspectivosRESUMO
PURPOSE: To describe the ideal size of a laser iridotomy and to discuss its importance. DESIGN: Perspective. METHODS: Articles in ophthalmology literature on this topic were reviewed, and commentary is provided based on the authors' experiences. RESULTS: An ideal laser iridotomy size is 200 µm or larger, especially in eyes with uveitis. The final size of an iridotomy must be confirmed after the effects of the pilocarpine has worn off and the pupil is not being constricted by light. A location of the iridotomy furthest from the lid margin may reduce the chances of dysphotopsias and thus allow for an adequate-sized iridotomy. CONCLUSIONS: An iridotomy of an ideal size is needed to reduce the pressure differential on both sides of the iris so as to be effective in eliminating pupillary block.
Assuntos
Iridectomia , Iris , Terapia a Laser , Humanos , Iris/cirurgia , Terapia a Laser/métodos , Iridectomia/métodos , Pressão Intraocular/fisiologiaRESUMO
PURPOSE: To compare the efficacy and safety of capsule support hooks and iris hooks in stabilizing the capsular bag during cataract surgery in patients with significant zonular weakness. METHODS: This retrospective comparative study included 46 eyes of 39 patients with zonular weakness exceeding 90 degrees who underwent cataract surgery at a tertiary clinic. Patients were divided into two groups due to intraoperative usage of capsule support hooks (Group 1) or iris hooks (Group 2) for capsular stabilization. Intraoperative complications such as capsular tears and vitreous loss, as well as postoperative visual outcomes and intraocular lens (IOL) centration, were evaluated. RESULTS: There was no significant difference in terms of postoperative visual acuity and intraocular pressures between the two groups (p = 0.370, p = 0.250 respectively). Anterior capsular tear occurred in 4 eyes in the iris hook group compared to none in the capsule support hook group (p = 0.017). Vitreous loss was observed in 4 eyes in the capsule hook group and 7 eyes in the iris hook group (p = 0.122). Cystoid macular edema developed in 1 patient in each group (p = 0.849). CONCLUSIONS: Capsule support hooks provide a safer and more stable option for capsular stabilization for zonular weakness during cataract surgery with a lower incidence of intraoperative complications compared to iris hooks. Despite their higher cost and limited availability, capsule support hooks should be preferred to enhance surgical outcomes and patient safety. Iris hooks, while less optimal, remain a viable alternative when capsule support hooks are not available.
Assuntos
Cápsula Anterior do Cristalino , Extração de Catarata , Catarata , Iris , Instrumentos Cirúrgicos , Estudos Retrospectivos , Catarata/patologia , Catarata/terapia , Extração de Catarata/efeitos adversos , Extração de Catarata/instrumentação , Extração de Catarata/métodos , Cápsula Anterior do Cristalino/cirurgia , Iris/patologia , Iris/cirurgia , Instrumentos Cirúrgicos/efeitos adversos , Resultado do Tratamento , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Incidência , Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Facoemulsificação/instrumentação , Facoemulsificação/métodosRESUMO
PURPOSE: We present a novel office-based technique using a 25-gauge needle to reopen closed peripheral iridotomies in aphakic eyes filled with silicone oil. METHODS: We use a 25-gauge needle to enter the clear cornea and reopen the closed peripheral iridotomy, allowing for aqueous humor and silicone oil to escape and relieve elevated intraocular pressure. RESULTS: This minimally invasive office-based approach provides immediate relief of elevated intraocular pressure due to silicone oil-induced pupillary block, avoiding the need for more invasive surgical intervention. CONCLUSION: Our technique is a simple, cost-effective, and accessible way to combat silicone-oil induced pupillary block in aphakic patients and may be a good first-line approach for a difficult-to-manage condition.
Assuntos
Afacia Pós-Catarata , Tamponamento Interno , Iridectomia , Iris , Agulhas , Óleos de Silicone , Humanos , Óleos de Silicone/efeitos adversos , Óleos de Silicone/administração & dosagem , Pressão Intraocular/fisiologia , Iris/cirurgia , Iridectomia/métodos , Iridectomia/instrumentação , Afacia Pós-Catarata/cirurgia , Masculino , Feminino , ReoperaçãoRESUMO
PURPOSE: To retrospectively analyze the clinical characteristics and therapeutic outcomes of congenital fibrovascular pupillary membrane (CFPM). METHODS: Twelve children (13 eyes) diagnosed as having CFPM between November 2017 and January 2024 in Qingdao Eye Hospital were retrospectively reviewed. Basic information and ophthalmic examination results were analyzed. Different treatment outcomes were monitored. Pathological analysis was performed using hematoxylin-eosin staining. RESULTS: Three eyes (25%) received conservative treatment, whereas 10 eyes (83.3%) underwent membranectomy. Compared to fellow eyes, the affected eyes exhibited increased central corneal and lens thickness, with decreased central anterior chamber depth (all P < .05). No significant difference was observed in mean preoperative intraocular pressure between the affected and fellow eyes, both within normal range. The median best corrected visual acuity (BCVA) for non-surgical cases was 0.9 llogarithm of the minimum angle of resolution (og-MAR) (Snellen equivalent of 0.125) with miosis. Surgical treatment improved the natural pupil size and median BCVA to 0.4 logMAR (Snellen equivalent of 0.4). Postoperative amblyopia was 100% and 33.3% in patients who underwent surgery after age 3 years and at or before 3 years, respectively (P = .035). No surgery-induced cataracts or recurrence in cases of unilateral involvement was noted. Histopathological analysis revealed that the excised tissue consisted of proliferative fibrous and vascular tissues with infiltrated inflammatory cells. CONCLUSIONS: Affected eyes in CFPM exhibit a thickened cornea and lens with a shallow anterior chamber, typically without glaucoma. Surgery is a safe and effective treatment with low recurrence and fewer complications compared to limited conservative treatment. Performing surgery before age 3 years reduces amblyopia risk. CFPM may be linked to chronic inflammation from incomplete degeneration of fetal eye vasculature. [J Pediatr Ophthalmol Strabismus. 2025;62(4):286-296.].
Assuntos
Iris , Procedimentos Cirúrgicos Oftalmológicos , Distúrbios Pupilares , Acuidade Visual , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pré-Escolar , Lactente , Procedimentos Cirúrgicos Oftalmológicos/métodos , Iris/cirurgia , Iris/anormalidades , Distúrbios Pupilares/congênito , Distúrbios Pupilares/cirurgia , Distúrbios Pupilares/diagnóstico , Seguimentos , Resultado do Tratamento , Criança , Pressão Intraocular/fisiologiaRESUMO
PURPOSE: To evaluate the two-year outcomes of combined surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG) without cataract. DESIGN: Multicenter prospective study. METHODS: The study included patients who received a combined SPI +â¯GSL +â¯GT for advanced PACG without cataract, all completed a 24-month follow-up. Outcome measures included changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), use of anti-glaucoma medications, surgical success, and postoperative complications over the 24-month period. RESULTS: A total of 63 eyes from 51 patients with advanced PACG were included in the study. Among these, 37 eyes (58.7â¯%) achieved complete success, and 55 eyes (87.3â¯%) achieved qualified success. The mean IOPs at baseline and after 24 months were 28.8⯱â¯7.51â¯mm Hg and 15.8⯱â¯4.40â¯mm Hg, respectively (Pâ¯<â¯0.001). The average number of anti-glaucoma medications decreased from 1.9⯱â¯1.4-0.8⯱â¯1.2 over the 24-month period (Pâ¯<â¯0.001). The overall BCVA was stable during the follow-up period (Pâ¯=â¯0.225). The primary complications observed included IOP spike (nâ¯=â¯9), hyphema (nâ¯=â¯7), and shallow anterior chamber (nâ¯=â¯3), all of which occurred within the first month postoperatively. Regression analysis showed that older age was positively associated with both complete success [odds ratio (OR) =â¯1.05; Pâ¯=â¯0.030] and qualified success (OR = 1.08; Pâ¯=â¯0.024). CONCLUSIONS: SPI +â¯GSL +â¯GT demonstrated safety and effectiveness in treating advanced PACG without cataract over the 24-month study period. This combined surgical approach should be considered a viable alternative to trabeculectomy for these patients.