Modified technique for sutured scleral fixated intraocular lens in a patient with post-traumatic aniridia and aphakia: a case report.

BACKGROUND: A modified surgical technique of sutured scleral fixated intraocular lens (SSF-IOL) was applied in a patient with post-traumatic aniridia and aphakia. CASE PRESENTATION: A 51-year-old man was referred to our clinic with decreased vision (finger count) in his right eye. This patient had previously undergone primary repair of the ruptured globe and pars plana vitrectomy to manage ocular trauma in the same eye. On presentation, the best corrected visual acuity in his right eye was 20/40. The slit lamp examination of his right eye revealed loss of total iris and lens. Corneal endothelial cell density was 1462 cells/mm2. Fundoscopic examination of the right eye revealed a retinal attachment. For IOL implantation, a rigid poly methyl methacrylate IOL was used with a 2-point scleral fixation performed using a polypropylene suture. One year postoperatively, the uncorrected distance visual acuity was 20/32, and the manifest refraction was - 0.5/-1.5 × 130 (20/20). Pentacam revealed that the astigmatism of the anterior corneal surface and the total cornea was 1.1 D (axis: 59.8°) and 1.0 D (axis: 35.6°), respectively. The horizontal (3°-183°) cross-section image displayed an IOL with a 1° tilt and 0.425 mm decentration. The patient reported no dysphotopsia or photophobia and was satisfied with the visual results. OPD-scan III revealed that higher-order aberrations in the right eye were slightly higher than those in the left eye. No suture-related or other serious complications were observed. CONCLUSION: The modified SSF-IOL technique can offer improved visual quality for patients with aniridia and aphakia by ensuring proper IOL positioning and reducing astigmatism.

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

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

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

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

Pound-shape Silicone Oil Retention Suture in Aphakic Eyes With Intact Iris.

PURPOSE: To introduce a surgical technique, "pound-shape silicone oil retention suture in aphakic eye with intact iris." METHODS: A retrospective analysis of medical records was performed. Each patient had an aphakic eye with intact iris and received the pound-shape silicone oil retention suture during vitrectomy combined with silicone oil injection. RESULTS: In the four patients who received the pound-shape silicone oil retention suture, the silicone oil was confined behind the suture for 3 months to 7 months without prolapse into the anterior chamber. Increased intraocular pressure was not observed in any patient, although peripheral iridectomy was not performed. CONCLUSION: Pound-shape silicone oil retention suture is a simple and effective surgical technique to prevent silicone oil prolapse into the anterior chamber.

Secondary in-the-bag Intraocular Lens Implantation in Aphakic Eyes After Vitrectomy and Silicone Oil Tamponade for Rhegmatogenous Retinal Detachment.

PURPOSE: To describe a novel technique for capsular bag reopening and secondary in-the-bag intraocular lens (IOL) implantation in aphakic eyes after vitreoretinal surgery and intraocular tamponade. METHODS: We enrolled 14 eyes of 14 patients who underwent primary vitreoretinal surgery with silicone oil tamponade for rhegmatogenous retinal detachment between September 2018 and September 2019. The novel technique was used for capsular bag reopening and foldable single-piece IOL implantation. Patients were followed up at least 24 weeks with routine ophthalmic examinations, corneal endothelial cell density, and IOL tilt and decentration measurement. RESULTS: The procedure was successfully completed in 13 cases; in one case, because of posterior capsular tear, the IOL was implanted with ciliary sulcus fixation. After a mean follow-up of 48.8 ± 14.8 (range, 24.9-65.9) weeks, the best-corrected visual acuity (before 20/76 Snellen, 0.63 ± 0.23 logarithm of the minimum angle of resolution equivalent and after 20/35 Snellen, 0.32 ± 0.32 logarithm of the minimum angle of resolution equivalent; P = 0.001) and spherical equivalent (before +8.22 ± 4.08, after -2.39 ± 1.77 D; P < 0.001) improved, intraocular pressure (before 15.93 ± 4.40, after 16.25 ± 4.25 mmHg; P = 0.743) remained unchanged. The IOL was well centered with a mean horizontal and vertical tilt of 0.5070 ± 0.3319° and 0.4652 ± 0.3465°, respectively, and decentration of 0.1705 ± 0.1334 mm and 0.1712 ± 0.1576 mm, respectively. CONCLUSION: With this technique, capsular bag reopening and secondary in-the-bag IOL implantation could be achieved in most cases with satisfactory visual outcome and IOL position.

Effect of sutureless scleral fixed intraocular lens implantation on aphakic eyes: a system review and meta-analysis.

BACKGROUND: Sutureless scleral fixed intraocular lens implantation (SF-IOL) has become one of the mainstream schemes in clinical treatment of aphakic eyes because of its advantages, such as avoiding dislocation of intraocular lens or subluxation caused by suture degradation or fracture and significant improvement of postoperative visual acuity. However, a consensus on the relative effectiveness and safety of this operation and other methods is still lacking. This study aimed to compare the efficacy and safety of sutureless SF-IOL with other methods. Aphakia means that the lens leaves the normal position and loses its original function, including absence or complete dislocation and subluxation of the lens which could cause anisometropic amblyopia, strabismus, and loss of binocular function in children and adolescents. For adults, the loss of the lens could lead to high hyperopia and affect vision. Above all this disease can seriously affect the quality of life of patients. METHODS: Literature about sutureless SF-IOL in PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, China Technical Journal VIP database, and Wanfang database published from 2000 to 2022 was reviewed. The weighted average difference was calculated by RevMan5.3 software for analysis. Two researchers independently selected the study and used the Cochrane collaboration tool to assess the risk of errors. Cochrane bias risk tool was used to evaluate the quality of evidence. This study is registered on PROSPERO (CRD42022363282). RESULTS: The postoperative IOL-related astigmatism of sutureless SF-IOL was lower than that of suture SF-IOL, and there was statistical difference when we compared the absolute postoperative spherical equivalent after sutureless SF-IOL and suture SF-IOL. Indicating that the degree of refractive error after sutureless SF-IOL was lower. Meanwhile, the operation time of sutureless SF-IOL was shorter than that of suture SF-IOL. The subgroup analysis showed that the absolute postoperative spherical equivalent and astigmatism values in Yamane technique were lower than those in suture SF-IOL. CONCLUSION: Sutureless SF-IOL has the advantages of stable refraction, short operation time, and less postoperative complications. However, high-quality literature to compare these technologies is lacking. Some long-term follow-up longitudinal prospective studies are needed to confirm the findings.

Preferred surgical techniques for secondary intraocular lens implantation in adults with aphakia.

AIM: To identify the current surgical management of aphakia and the outcomes and complications of each technique. METHODS: This cross-sectional study included ophthalmic surgeons with at least one-year experience in surgery for aphakia. A study questionnaire was formulated to collect data in Saudi Arabia and other regional countries. The questionnaire included 22 questions on demographics, preferred surgical techniques, complications and the factors related to surgeon decision and the choice for managing aphakia. RESULTS: The study included 145 participants (111; 76.6% were males) with mean age of 46.7 ± 11.5 years. The mean duration of cataract surgery experience was 17.6 ± 11.1 years. Most participants (86.2%) were trained in cataract surgery. Scleral fixation of intraocular lens (SFIOL) was the most commonly preferred technique, followed by iris fixation IOL, and anterior chamber IOL (75.2%, 9%, and 15.9%, respectively). The main determinants for selection of a surgical technique were simplicity (56.6%), surgical instrument availability (48.3%), and training on the technique (47.6%). The most frequent postoperative complications were pupil distortion, high intraocular pressure (IOP), pupillary capture of the IOL, and IOL decentration. CONCLUSIONS: SFIOL is the preferred surgical technique for managing aphakia. The decision to choose one technique over another is complex and is based on several factors, including technical difficulty, previous training, anatomical variations, ocular comorbidities, and the potential complications. The most frequent complications after surgical correction of aphakia are pupil distortion, high IOP, pupillary capture of the IOL, and decentered IOLs.

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

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

Functional outcomes after combined iris and intraocular lens implantation in various iris and lens defects.

BACKGROUND: To assess the functional outcomes after combined iris and intraocular lens (IOL) repair in aniridia patients. METHODS: Retrospective observational study in 59 aniridic and aphakic eyes for ArtificialIris (AI) and IOL reconstruction. The iris prostheses were placed together with the IOL in the capsular bag using an injection system or were fixed by transscleral suturing of the IOL and AI. The primary outcomes measured were visual acuity, contrast and glare sensitivity (Pelli-Robson chart for photopic and dark adaptometer for mesopic conditions), intraocular pressure, endothelial cell density (ECD) and patient impairment. RESULTS: Blunt trauma (37 eyes) and penetrating injuries (16 eyes) were observed more frequently than congenital aniridia (1 eye), iatrogenic causes (1 eye), aniridic state after severe iritis (2 eyes) or iris tumor (2 eyes). Monocular CDVA improved significantly (p < 0.0001) from median 0.7 logMAR (0.0-1.98) to 0.3 logMAR (- 0.08-2.0). Median pupillary area could significantly (p < 0.0001) be reduced by 79.3% from 51.27 mm2 (17.91 to 98.23) to 8.81 mm2 (4.16 to 8.84). Median ECD decreased from 2646.0 mm2 to 2497.5 mm2 (p = 0.007). Contrast and glare sensitivity improved significantly (p = 0.008) in photopic light conditions from 0.9 (0.0-1.95) to 1.35 (0.0-1.8). Patients reported to be highly satisfied with the functional improvement. CONCLUSION: The flexible ArtificialIris seems to be a safe and effective iris prosthesis in combination with an IOL having functionally and cosmetically exceptional reconstruction options.

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

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

Calculation of iris-claw IOL power for correction of late in-the-bag IOL complex dislocation.

BACKGROUND: To assess the constants and formula for aphakia correction with iris-claw IOLs to achieve the best refractive status in cases of late in-the-bag IOL complex dislocation. METHODS: A literature search was performed. The following data were obtained: Iris-claw IOL model, Iridal or retroiridal enclavation, A-constant, ultrasound or optical biometry, formula employed and refractive outcomes. Acceptable emmetropia was considered if the resulting spherical equivalent (SE) was within ±1.00 D. RESULTS: The majority of the studies used SRK/T formula (66.6%). The 88.9% of the reports obtained a SE within ±1.00 D. Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, the emmetropia (±1.00 D) of SE, was able to get near 100% of reported cases over the pupil implantation. However, the emmetropia decreased to 80% when the enclavation is retropupilar using the same formula. The A-constant can vary from 116.7 to 117.5 for retropupilar enclavation. CONCLUSIONS: Using A-115 for ultrasound biometry and A-115.7 for optical biometry and SRK/T formula, ±1.00 D of SE, is able to get near 100% of cases. Nevertheless, ±1.00 D of SE decreased to 80% of the cases when the enclavation is retropupilar.

Transscleral Suture-Fixated Versus Intrascleral Haptic-Fixated Intraocular Lens: A Comparative Study.

PURPOSE: To compare the clinical outcomes between sutured transscleral-fixated and intrascleral haptic-fixated posterior chamber intraocular lens (IOL). SETTING: Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. DESIGN: A comparative case series. METHODS: Forty eyes of 40 patients were included; 20 in each group. Patients in group 1 underwent sutured transscleral-fixated IOL and those in group 2 underwent intrascleral haptic-fixated IOL augmented by fibrin glue. Parameters evaluated were uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), IOL tilt on ultrasound biomicroscopy (UBM), and pseudophakodonesis on slitlamp and UBM. RESULTS: The most common cause of aphakia was complicated cataract surgery (50%). The mean preoperative UCVA in logarithm of minimum angle of resolution (logMAR) was 1.59±0.24 and 1.63±0.26 in group 1 and 2, respectively (P=0.45). There was significant improvement in UCVA in both groups (P=0.001) at 6 months (group 1: 0.33±0.17; group 2: 0.22±0.10); the improvement being greater in group 2 (P<0.05). Mean percentage endothelial cell loss and IOP change were comparable. Mean CMT (µm) was 250.95±23.98 and 225.85±21.13 in group 1 and 2, respectively (P=0.009). Pseudophakodonesis was more in group 1 as assessed on slitlamp (P=0.037) and as assessed on UBM (P=0.046). Macular edema was the most common complication seen more in group 1. CONCLUSIONS: Intrascleral haptic-fixated IOL provides more stable fixation, better visual outcome, and lesser complication in comparison with sutured transscleral-fixated IOL.

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

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

Visual outcomes of posterior chamber intraocular lens intrascleral fixation in the setting of postoperative and posttraumatic aphakia.

BACKGROUND: Several techniques for fixation of the posterior chamber intraocular lens (IOL) have been developed. We evaluate long-term functional outcomes and safety of posterior chamber IOL implantation using Hoffman scleral haptic fixation and sutureless Sharioth technique in patients with posttraumatic and postoperative aphakia. METHODS: This retrospective case-series included 42 eyes operated by one surgeon. The data including demographic data, ocular history, preoperative, early postoperative and final best corrected visual acuity (BCVA), rate of complications as well as postoperative IOL position were collected. The mean follow-up was 14.5 months. Hoffman haptic scleral fixation was performed in 31 eyes, Sharioth technique-in 11 eyes. Aphakia was due to eye trauma (19) or complicated cataract surgery (23). RESULTS: Overall, the final BCVA improved in 26 eyes, did not change in 5 eyes, and worsened in 11 eyes. No significant differences in BCVA were found between groups operated with Hoffman scleral fixation and Sharioth technique. Postoperatively, we noticed two dislocations of IOL fixated using Sharioth technique and none after Hoffman technique. No severe complications were observed. CONCLUSION: Both transscleral fixation techniques are feasible methods of secondary IOL implantation in posttraumatic and postoperative aphakia. with low incidence of complications, however visual outcomes are diverse.

Role of ultrasound biomicroscopy in the planning for secondary implantation of intra ocular lens in aphakia.

Purpose This is a prospective investigational study that was performed at Tanta University Eye Hospital, Tanta, Egypt to evaluate the role of ultrasound biomicroscopy (UBM) in planning secondary implantation of intra ocular lens (IOL) in aphakia. Methods Preoperative UBM was performed for the assessment of anterior segment of 30 aphakic eyes admitted for secondary IOL implantation with special attention to central corneal thickness (CCT), anterior chamber depth (ACD), ciliary sulcus (CS), anatomical changes, and posterior capsular (PC) integrity which had been assessed by measuring the remnants of PC with special attention to the 12, 3, 5, 6, 7, and 9 o'clock meridians. Results This study involved 30 eyes in 27 patients; 16 males and 11 females. The mean age was 8.39 ± 2.36 years. The causes of aphakia were: congenital cataract extraction in14 eyes (46.7 %); trauma in 14 eyes (46.7 %); and after extracapsular cataract extraction in 2 eyes (6.6 %). The mean CCT was 0.61 + 0.35 mm and the mean ACD was 3.03 + 0.41 mm. The ciliary sulcus was patent in 28 eyes (93.4 %). Posterior synechia was observed in 8 eyes (26.7 %), lens remnants in 11 eyes (36.7 %), corneal scars in 11 eyes (36.7 %), and vitreous in anterior chamber in 1 eye (3.3 %). The integrity of PC was illustrated with a diagram. Conclusions UBM is a useful device to evaluate aphakic eyes before secondary IOL implantation through good evaluation of the anterior segment with special attention to the posterior capsular integrity, ciliary sulcus, anterior chamber depth, corneal thickness, and detection of any structural changes in the anterior segment resulting from the remote cause of aphakia.

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

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

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

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

Silicone oil pupillary block after laser retinopexy in aphakic eyes with presumed closed peripheral iridectomy: report of three cases.

Closure of the peripheral iridectomy (PI) may lead to forward displacement of silicone oil (SO) in some but not all SO-filled aphakic eyes. In this study, we report three patients with a history of a combined three-port pars plana vitrectomy and cataract surgery, SO injection and inferior PI who underwent laser retinopexy a few months postoperatively. The postoperative courses of these patients were unremarkable except for the closure of the PI without anterior displacement of SO; however, a few hours after laser therapy the SO was displaced to the anterior chamber, leading to acute glaucoma in one of the cases. Yttrium aluminium garnet (YAG) laser was successfully used to reopen the PI in all three patients. The induction of a pupillary block following laser retinopexy in SO-filled aphakic eyes with a closed PI and no forward displacement of SO underscores the necessity of a follow-up examination after laser therapy in such patients and the importance of the prophylactic use of a YAG laser to reopen the PI before laser therapy.

[Artisan iris claw intraocular lens implantation for the correction of aphakia after pars plana vitrectomy].

OBJECTIVE: To compare the efficacy and complications of Artisan iris claw intraocular lens implantation with those of posterior chamber intraocular lens implantation with ciliary sulcus suture fixation for correction of aphakia in vitrectomized eyes without capsular support. METHODS: This was a prospective interventional case series. From Jan 2009 to Feb 2012, 53 aphakic vitrectomized eyes without sufficient capsular support were divided into two groups according to the condition of residual capsule. Group one:28 eyes received Artisan iris claw intraocular lens implantation. Group two: 25 eyes received posterior chamber intraocular lens implantation with ciliary sulcus suture fixation. The best corrected visual acuity and intraocular pressure, corneal endothelial cell loss rate, duration of surgery and complications were compared between two groups. Two-independent t-test,Mann-Whitney test and χ² test were used to analyze measurement data of normal distribution, non-normal distribution and count data respectively. RESULTS: The mean duration of surgery in group one [(11.23 ± 1.54) min] was much shorter (t = -26.60, P < 0.05) than that in group two [(31.68 ± 3.15) min]. The endothelial cell loss rate of group one were (4.39 ± 1.85)%, (4.76 ± 2.06)% and (6.30 ± 2.71)% at 3 months, 6 months and 1 year after surgery, and the data of group two were (3.92 ± 1.85)%, (4.33 ± 1.80)% and (5.73 ± 2.12)% . No statistically significant difference was noted between two groups at any time point (t = 0.77,0.66, 0.69; P > 0.05). The best corrected visual acuity of group one (0.40, 0.12-0.80) was better than that of group two (0.30, 0.08-0.60) at 1 day after surgery(t = -2.16, P < 0.05).However, there was no statistically significant difference at 1 month and 3 months after surgery (P > 0.05). The intraocular pressure of group two [ (11.63 ± 2.29) mmHg, 1 mmHg = 0.133 kPa] was much lower (t = 2.34, P < 0.05) than that of group one [(13.61 ± 3.37) mmHg] at 1 day after surgery. There was no statistical significant difference at 1 month and 3 months after surgery between two groups(P > 0.05). The postoperative complications of group one were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. Those of group two were choroidal detachment, intraocular haemorrhage, intraocular lens decentration and retinal detachment. CONCLUSIONS: Iris claw intraocular lens implantation is a simple, fast, less complications and minimally invasive method for the correction of aphakic eyes after vitrectomy. There were on difference in stability and safety between these two implantation methods. Due to the difference of indication choice, either of them can be a viable complement for the other.