Long-term assessment of tilt of glued intraocular lenses: an optical coherence tomography analysis 5 years after surgery.

PURPOSE: Long-term assessment of the optic position of glued transscleral fixated intraocular lens (IOL) with optical coherence tomography (OCT). DESIGN: Prospective observational case series. PARTICIPANTS: Patients with a minimum 5 years' follow-up after glued IOL surgery were included. METHODS: Postoperatively, IOL position was examined by anterior segment OCT (Carl Zeiss Meditec) and the scans were analyzed in 2 axes (180°-0° and 270°-90°) using MatLab (Mathworks). Best-corrected visual acuity (BCVA; Snellen's charts), Orbscan, retinoscopy, refraction, and slit-lamp biomicroscopy were performed. MAIN OUTCOME MEASURES: The distance between the iris margin and the anterior IOL optic (D1, D2), slope of the line across the iris and IOL, the slope ratio between the IOL and iris, IOL tilt, and optic surface changes were determined and correlated with the astigmatism and vision. RESULTS: A total of 60 eyes (mean follow-up of 5.9±0.2 years; range, 5-6 years) were evaluated. There was a significant correlation (P = 0.000) between the slope of iris and the IOL in horizontal and vertical axes. The mean D1 and D2 were 0.94 ± 0.36 and 0.95 ± 0.36 mm, respectively. Nine of 60 eyes (15%) had pigment dispersed on the IOL surface. Twenty-one eyes (35%) had optic tilt detected on OCT and 65% of eyes had no optic tilt. The mean angle between the IOL and the iris was noted to be 3.2 ± 2.7° and 2.9 ± 2.6° in horizontal and vertical axes, respectively. The mean ocular residual astigmatism (ORA) was 0.53 ± 0.5 diopters. There was no difference in the ORA between the eyes with and without tilt (P = 0.762). There was no correlation (P = 0.348) between the ORA and BCVA. Position of the IOL was not dependent on the type of lens, age of the patient, or the preoperative surgical indication. CONCLUSIONS: Long-term analysis with OCT demonstrated good IOL positioning without any significant optic tilt in patients with glued IOL fixation.

Dynamic tracking of Purkinje images for the comparison of pseudophakodonesis between in-the-bag and secondary fixated intraocular lenses.

PURPOSE: To compare the pseudophakodonesis of in-the-bag intraocular lens (IOL) and a secondary fixated IOL by tracking the Purkinje image IV. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective case series. METHODS: The IOL movement was recorded via slitlamp videography (DC3), streamed in video editor (Pinnacle), and evaluated by ImageJ analysis. The positional difference of Purkinje IV in relation to the stationary image Purkinje I at 3 random timeframes was measured. Pseudophakodonesis was quantified, compared, and correlated clinically. RESULTS: The study comprised 127 eyes that had posterior chamber IOLs (PC IOLs) (n = 50), anterior chamber IOLs (AC IOLs) (n = 20), iris-claw IOLs (n = 20), glued IOLs (n = 30), and sutured scleral-fixated IOLs (n = 7). The iris-claw IOL showed significant difference in Purkinje IV at various timeframes (P = .0418) whereas others showed no significant change. On comparison of the Purkinje IV difference, there was a significant difference between the PC IOL and the iris-claw IOL (P = .0001), the glued IOL and the iris-claw IOL (P = .0020), and the AC IOL and the iris-claw IOL (P = .0302). The iris-claw IOL showed significant exaggeration of the position of Purkinje IV (P = .0395) after saccade. Pseudophakodonesis seemed mild (difference < 0.5 mm) in the PC IOL (68%), glued IOL (53.3%), and AC IOL (50%); moderate in the scleral-fixated IOL (71.4%); and severe (≥ 1.0 mm) in the iris-claw IOL (55%). CONCLUSION: Positional difference in Purkinje IV was highest in iris-claw IOLs and lowest in PC IOLs.

Height-, extent-, length-, and pupil-based (HELP) algorithm to manage post-phacoemulsification Descemet membrane detachment.

PURPOSE: To analyze the functional and anatomic outcomes of management of Descemet membrane detachment after phacoemulsification using a protocol based on the detachment's height, extent, and chord length and its relation to the pupil. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective comparative case series. METHODS: Eyes with post-phacoemulsification Descemet membrane detachment were managed surgically or medically based on the detachment's height, extent, length (chord), and relation to the pupil (HELP protocol). Central corneal thickness (CCT), chord length, and detachment height were determined by anterior segment optical coherence tomography (AS-OCT) (Visante). RESULTS: Of 161 eyes, 96 were treated surgically (Group 1) and 65 medically (Group 2). The mean length and mean height of Descemet membrane detachment were 2.4 mm ± 1.4 (SD) and 266 ± 189.8 µm, respectively, in Group 1 and 1.03 ± 0.4 mm and 153.3 ± 60.8 µm, respectively, in Group 2. The complete reattachment rate was 95.8% in Group 1 and 96.9% in Group 2. The corrected distance visual acuity (CDVA) was 20/40 or better in 83.3% of eyes in Group 1 and 92.3% of eyes in Group 2. No eye lost CDVA as a result of a Descemet membrane scar in the central 5.0 mm of the cornea. The AS-OCT allowed visualization of the detachment in all eyes with a CCT of more than 800 µm. There was no difference in the final CDVA between Group 1 and Group 2. CONCLUSIONS: The AS-OCT-based algorithm was effective for managing post-surgical Descemet membrane detachment in eyes with dense corneal edema. Early surgical intervention for detachments in the central cornea can reduce scarring-induced visual loss. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Implantation of glued intraocular lenses in eyes with microcornea.

PURPOSE: To evaluate the intraoperative modifications for and vision outcomes after implantation of glued intraocular lenses (IOLs) in eyes with microcornea. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective case series. METHODS: Eyes with a horizontal cornea of 10.0 mm or less were evaluated for intraoperative modifications and postoperative vision after implantation of a glued IOL. The type of surgery, type of IOL, incision and optic sizes, haptic length modifications, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and postoperative complications were analyzed. RESULTS: A glued IOL was implanted in 15 eyes to treat subluxated cataract (9 eyes), aphakia (5), and intraoperative capsule loss (1). In cases involving a subluxated cataract, implantation of the glued IOL was followed by lensectomy (7 eyes) or intracapsular cataract extraction (2 eyes). The mean follow-up was 22.4 months ± 17.2 (SD). The mean horizontal corneal diameter and axial length were 8.0 ± 0.6 mm and 21.0 ± 2.4 mm, respectively. The mean amount of IOL haptic trimmed intraoperatively was 1.54 ± 0.33 mm. There was significant correlation between the horizontal corneal diameter and the amount of haptic trimmed (P = .000). The mean size of the main incision was 3.70 ± 0.98 mm. Three-piece foldable IOLs with a 6.0 mm optic were used. There were no cases of haptic extrusion or subconjunctival haptic placement. There was statistically significant improvement in CDVA (P = .032) and UDVA (P = .012) after surgery. CONCLUSION: Glued IOLs were safely implanted in eyes with microcornea using modifications such as custom haptic trimming and 6.0 mm optic foldable IOLs. FINANCIAL DISCLOSURE: Dr. Amar Agarwal is a paid consultant to Staar Surgical Co. No other author has a financial or proprietary interest in any material or method mentioned.

Aqueous reaction quantification after phacoemulsification: Fourier-domain optical coherence tomography versus slitlamp biomicroscopy.

PURPOSE: To compare anterior chamber cell detection after phacoemulsification between Fourier-domain optical coherence tomography (OCT) and slitlamp biomicroscopy. DESIGN: Observational prospective comparative case series. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. METHODS: Eyes with preoperative nuclear opalescence (NO) grades 1 to 3 that had phacoemulsification with posterior chamber intraocular lens implantation were included. Slitlamp biomicroscopy and Fourier-domain OCT (Cirrus HD) of the anterior chamber were performed 1 day postoperatively. The results were evaluated, and a correlation analysis between the results and preoperative NO, effective phacoemulsification time (EPT), postoperative central corneal thickness (CCT), and intraocular pressure (IOP) was performed. RESULTS: The preoperative NO grade was 1 in 20 eyes, 2 in 55 eyes, and 3 in 42 eyes. Anterior chamber grading was possible by slitlamp biomicroscopy and Fourier-domain OCT in 106 eyes (90.5%) and 117 eyes (100.0%), respectively. A positive correlation between slitlamp biomicroscopy and OCT grading was noted (R(2) = 0.986, P=.000). Slitlamp grading was not possible in 11 eyes (9.4%) with corneal edema (mean CCT 754 µm ± 44.2 [SD]); OCT detected cells in all 11 eyes. There was a difference in slitlamp grading and OCT grading in 7 eyes (6.6%). There was a significant correlation between the OCT cell count and the EPT (P=.000) and NO (P=.000). CONCLUSION: Fourier-domain OCT was as reliable as slitlamp biomicroscopy in assessing postoperative anterior chamber cells.