Impact of improved minimally invasive anterior vitrectomy on the prognosis of patients with malignant glaucoma.

BACKGROUND: The importance of communicating the anterior chamber and vitreous cavity for managing malignant glaucoma (MG) is widely recognized. This study investigated the impact of improved minimally invasive anterior vitrectomy (IAV) on the prognosis of MG. METHODS: This retrospective interventional study included patients with MG who underwent conventional surgery or improved minimally IAV in Nanchang Aier Eye Hospital between January 2011 and April 2021. For the improved step, a small amount of triamcinolone acetonide was injected into the vicinity of the iris. Then, the residual vitreous body adhering to triamcinolone acetonide was excised. Comparisons were made using repeated measures ANOVA, t-test, and chi-squared test. RESULTS: Thirty-one eyes from 26 patients were included: 15 eyes from 13 patients in the conventional group and 16 eyes from 13 patients in the IAV group. The 1-week, 1-month, and 3-month intraocular pressure (IOP) and the 3-month mean central anterior chamber depth were comparable between the two groups (all P > 0.05). The conventional group showed one eye with intraoperative vitreous hemorrhage and two eyes with postoperative re-shallowing of the anterior chamber; such events did not occur in the IAV group, and none developed corneal endothelial decompensation, IOL deviation, suprachoroidal hemorrhage, or retinal detachment during treatment and follow-up. CONCLUSION: Patients with MG who undergo improved minimally IAV might have similar postoperative IOP and central anterior chamber depth compared with conventional surgery but with reduced complications such as intraoperative vitreous hemorrhage and postoperative re-shallowing of the anterior chamber. Improved minimally IAV might be an alternative surgery for MG.

Incidence of Acute Endophthalmitis after Secondary Intraocular Lens Implantation: A Nationwide Cohort Study.

INTRODUCTION: In this study, we aimed to analyze the incidence of acute endophthalmitis after secondary intraocular lens (IOL) implantation in South Korea. METHODS: This study used information from the National Health Insurance Service (NHIS)-National Health Information Database (NHID). We identified patients who underwent secondary IOL implantation or IOL exchange surgeries during 2002-2021 due to diagnoses of IOL dislocation or mechanical complication of IOL. Postoperative endophthalmitis (POE) was defined as patients having received intravitreal antibiotic injection or vitrectomy for acute endophthalmitis diagnosed within 42 days after the claim for secondary IOL surgeries. All statistical analyses were performed with a significance level p < 0.05, and we used the univariate and multivariate Cox proportional hazard model to identify risk factors. RESULTS: From 2002 to 2021, 39,364 patients received secondary IOL implantation, and acute POE was diagnosed in 62 patients. The overall incidence of acute POE was 0.16% during the 20-year period. More than half of the patients were diagnosed with POE within the first week after surgery. In the univariate analysis, there was a higher incidence of endophthalmitis in the group with pre-existing glaucoma (hazard ratio [HR], 1.945; 95% confidence interval [CI], 1.036-3.652; p = 0.0385) and the group undergoing concurrent vitrectomy (hazard ratio [HR], 2.329; 95% confidence interval [CI], 1.003-5.405; p = 0.0491). CONCLUSIONS: The incidence of acute endophthalmitis after secondary IOL implantation in South Korea was similar to that of other countries. This is the largest retrospective claims data-based study of acute endophthalmitis after secondary IOL implantation in patients in South Korea.

Clinical Experience of Two Sutureless Intrascleral Fixation Techniques for Secondary Intraocular Lens Implantation.

INTRODUCTION: The aim of this study was to evaluate the outcome of the modified Carlevale intraocular lens (IOL) fixation technique, using two different vitrectomy ports (23- vs. 27-gauge) as anchor fixation. METHODS: Retrospective, consecutive study of 282 eyes (282 patients) who underwent a secondary IOL implantation using the Carlevale IOL (Soleko IOL Division, Italy) with two anchor haptics for intrascleral implantation with either 23- or 27-gauge (G) port. RESULTS: Transient post-operative ocular hypotonia (intraocular pressure ≤5 mm Hg) was observed less in the 27-G group (13 vs. 4 patients, p = 0.057) three requiring additional tunnel sutures (2 cases for 23-G; 1 case 27-G). Post-operative vitreous haemorrhage was recorded more often in the 23-G group (8 vs. 1 patient, p = 0.034), but all cases in both groups resolved without intervention. Visual acuity did improve post-operatively in the two groups. No post-operative complications such as retinal detachment, endophthalmitis, and IOL-dislocation tilt were observed in the follow-up. CONCLUSION: The 27-G modified technique for sutureless intrascleral implantation is simple and effective and causes less post-operative hypotony.

Evaluation of visual outcomes with toric intraocular lens implantation using digital marker during cataract surgery.

Objectives: To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS: The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS: The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS: Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.

The impact of preloaded intraocular lens implantation system (TECNIS iTec®) in routine cataract surgery in China: a time-motion analysis.

OBJECTIVE: To evaluate the impact on surgical efficiency and labor time cost of preloaded intraocular lens (IOL) implantation system compared with manual IOL implantation system in age-related cataract surgery in China. METHODS: This study was an observational, multicenter, prospective time-motion analysis. IOL preparation time, operation time, cleaning time, number and cost of cataract surgeries in eight participating hospitals were collected. The linear mixed model was used to explore factors associated with the difference in operation time between the preloaded IOL implantation system and the manual IOL implantation system. A time-motion model was constructed to convert the operation time cost saved by using preloaded IOL into economic benefits from hospital and social perspective, respectively. RESULTS: There were 2,591 cases included in the study (preloaded IOL: 1,591 cases; manual IOL: 1,000 cases). The preloaded IOL implantation system was significant time-saving in both preparation time and operation time compared to the manual IOL implantation system (25.48s vs. 47.04s, P < 0.001 and 353.84s vs. 367.46s, P = 0.004, respectively). An average total of 35.18s can be saved by using preloaded IOL per procedure. The results of linear mixed model showed that the type of IOL was the main factor leading to the difference in preparation time between preloaded IOL and manual IOL implantation system. By switching from manual IOL to preloaded IOL, the model projected additional 392 surgeries can be performed each year and an increase in revenue of $565,282 per hospital, a 9% increase from hospital perspective. And the annual productivity loss saved by using preloaded IOL was $3,006 in eight hospitals from perspective of society. CONCLUSION: Compared with manual IOL implantation system, the preloaded IOL implantation system reduces lens preparation time and operation time, which increases potential surgical volume and revenue, and reduces the loss of work productivity. This study provides real-world evidence to support the advantages of the preloaded IOL implantation system in improving efficiency of ophthalmic surgery in China.

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.

Refractive surgery after deep anterior lamellar keratoplasty: a review of the literature.

PURPOSE: The main objective of this work is to present an updated review of the different surgical procedures for the correction of residual refractive errors following deep anterior lamellar keratoplasty (DALK) surgery. METHODS: A review of the literature was conducted using PubMed, Web of Science, and Scopus databases. The search was conducted in January 2022 and was limited to articles published in peer-reviewed journals. The information extracted from each publication included sample size, mean follow-up time, pre- and post-operative uncorrected (UDVA) and corrected distance visual acuity (CDVA), pre- and post-operative refraction and spherical equivalent (SE), safety and efficacy indexes and complications. RESULTS: Residual ametropias, mainly high astigmatism and myopia, and the resulting anisometropia are likely to occur following DALK. They become a limiting factor and may lead to unsatisfactory visual restoration, therefore affecting patients' quality of vision and life. Alternative surgical interventions may be required to treat this residual ametropia, such as corneal refractive surgery or intraocular lens implantation. A total of 47 relevant articles were studied in detail. Different refractive surgery techniques have been shown to be effective and safe for the correction of ametropia following the DALK procedure and to improve the patient's quality of vision, although more research is needed to confirm long-term results. CONCLUSION: The final refractive technique will depend on different factors, such as the amount of ametropia, the condition of the cornea or the patient's individual needs, economics, and occupational demands.

[The effect of phacoemulsification of age-related cataract on intraocular pressure and iridocorneal angle parameters in primary open-angle glaucoma]. / Vliyanie fakoemul'sifikatsii vozrastnoi katarakty na uroven' oftal'motonusa i parametry iridokorneal'nogo ugla pri pervichnoi otkrytougol'noi glaukome.

Cataract phacoemulsification with intraocular lens implantation significantly affects the morphology of the anterior chamber angle (ACA) and contributes to a reduction of intraocular pressure (IOP). PURPOSE: This study investigates the changes in anterior chamber angle configuration and IOP level before and after cataract surgery in primary open-angle glaucoma (POAG) eyes, and assesses its possible relationship with the axial length of the eye. MATERIAL AND METHODS: The study included 38 patients with immature senile cataract and compensated unoperated stage I-II POAG. Patients underwent anterior segment optical coherence tomography (AS-OCT) with measurement of the angle opening distance (AOD750) and trabecular-iris space area (TISA750) before and six weeks after the surgery, as well as axial length and corneal-compensated IOP (IOPcc). RESULTS: After the surgery 92.11% of patients showed a decrease in IOPcc an average of 1.84±1.95 mm Hg (by 12.33±10.21% of the baseline); the maximum decrease in the IOPcc level was 8.35 mm Hg (by 40.97% of the baseline). AS-OCT data indicates that cataract phacoemulsification causes an increase in anterior chamber angle width: AOD750 increased from 0.510±0.175 to 0.771±0.156 mm, and TISA750 increased from 0.266±0.090 to 0.494±0.096 mm2. The strongest correlations were found between the axial length, postoperative TISA750 increase (Δ%TISA750) and postoperative IOPcc reduction (Δ% IOPcc). Postoperatively, specific changes could be observed in the trabecular meshwork in 28.95% of cases in the form of elongation and strain of the membrane. CONCLUSIONS: Cataract extraction contributes to a significant reduction in IOP due to anterior chamber angle expansion, trabecular meshwork stretching, and improved aqueous outflow.

Different lens power calculation formulas for the prediction of refractive outcome after phacoemulsification with silicone oil removal.

BACKGROUND: Formulas predicting intraocular lens power have not been compared in silicone oil-tamponaded eyes. The study aims to compare six intraocular lens power assessment formulas in silicone oil-tamponaded eyes. METHODS: This prospective study included patients with silicone oil-tamponaded eyes scheduled for silicone oil removal, phacoemulsification, and intraocular lens implantation at Chongqing Aier Eye Hospital (June 2019 to December 2019). Implanted intraocular lens power was used to predict postsurgical spherical equivalence using SRK/T, Holladay 1, Holladay 2, Haigis, Hoffer Q, and Barrett Universal II, and assess those formula's predictive accuracy with predictive error. RESULTS: The analysis included 47 eyes in 47 patients (28 and 19 eyes with normal and long axial length, respectively). Postoperative spherical equivalence at 6 months in normal and long axial length eyes was - 0.6 ± 0.96 and - 0.8 ± 1.52 D, respectively. Predictive error values for SRK/T, Holladay 1, Holladay 2, Haigis, and Hoffer Q and Barrett Universal II were - 0.18 ± 0.92, - 0.15 ± 0.88, - 0.06 ± 0.94, - 0.15 ± 0.87, and - 0.05 ± 0.90 D and - 0.06 ± 0.90, respectively, for normal axial length eyes and 0.15 ± 1.16, 0.46 ± 1.17, 0.28 ± 1.11, - 0.04 ± 1.12, 0.49 ± 1.09 D and 0.11 ± 0.99, respectively, for long axial length eyes. For normal axial length eyes, predicted outcomes were similar to actual outcomes for all formulas. For long axial length eyes, predicted outcomes differed significantly from measured postsurgical values for Holladay 1, Holladay 2, and Hoffer Q (P < 0.05) but not SRK/T or Haigis or Barrett Universal II . CONCLUSIONS: The formulas had comparable predictive accuracy in silicone oil-tamponaded eyes with normal axial length, but Haigis or SRK/T or Barrett Universal II may be preferable in long axial length eyes. TRIAL REGISTRATION: ChiCTR1900023215.

Effect of pupil dilation on IOLMaster® measurements in Pakistani Eyes.

Objectives: To analyse the effect of pupil dilation on intraocular lens instrument IOLMaster 500 biometric measurements, and to determine the effect of these measurements on intraocular lens power calculations in Asian eyes. METHODS: The prospective study was conducted at the Aga Khan University Hospital, Karachi, between January and April 2017, and comprised all patients scheduled for cataract surgery who underwent scanning with IOLMaster 500. For each patient, pre-dilation and post-dilation measurements were taken. The intraocular lens power was determined through Sanders/Retzlaff/Kraff Theoretical, Holladay, and Hoffer Q formulae. Data was analysed using SPSS 24. RESULTS: There were 276 eyes of 138 participants who had a mean age of 59.7±11.1 years. Anterior chamber depth changed significantly with pupil dilation (p=0.001). No significant changes were observed in the axial length (p=0.410), keratometry measurements (p=0.931), and intraocular lens power calculations (p>0.05). CONCLUSIONS: The change in anterior chamber depth, though significant, was perhaps clinically non-significant.

Astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus Toric intraocular Lens Impantation with conventional phacoemulsification.

BACKGROUND: To compare the efficacies in astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus toric intraocular lens (IOL) implantation with conventional phacoemulsification in moderate astigmatism. METHODS: A retrospective chart review was conducted for patients who had undergone cataract surgery by one surgeon. We identified patients with preoperative corneal astigmatism from + 0.75 to + 2.00 diopters (D) who had undergone astigmatic correction with FLACS with ISAK or toric IOL implantation with conventional phacoemulsification. We measured the visual acuity, intraocular pressure, automated keratometer, manifest refraction, and topography preoperatively and 1-day, 1-month, 3-month, and 6-month postoperatively. The vector analysis of refractive astigmatism was performed. RESULTS: Of a total of 48 eyes of 48 patients, 27 eyes of 27 patients had FLACS with ISAK (AK group), and 21 eyes of 21 patients had conventional cataract surgery with toric IOL implantation (toric IOL group). Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. Corneal astigmatism from topography and the automated keratometer were significantly lower in the AK group 6-month postoperatively compared to toric IOL group (0.94 ± 0.40 vs. 1.53 ± 0.46 D, P = 0.018 for topography; and 0.98 ± 0.69 vs. 1.37 ± 0.41 D, P = 0.032 for the automated keratometer). CONCLUSIONS: FLACS with ISAK could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.

Clinical differences between toric intraocular lens (IOL) and monofocal intraocular lens (IOL) implantation when myopia is determined as target refraction.

BACKGROUND: The aim of this study is to analyze and compare the clinical results of toric intraocular lens (IOL) and monofocal IOL implantation when the target refraction value is -3 diopter (D) in cataract patients with corneal astigmatism > 1.5 diopters (D). METHODS: We performed a retrospective chart review for patients with corneal astigmatism > 1.5D who underwent cataract surgery and their target refraction is -3D. 100 eyes (100 patients; monofocal IOL, 60; toric IOL, 40) were enrolled in the current study. Near and distant uncorrected visual acuity (UCVA), corrected VA, spherical equivalent and refractive, corneal astigmatism were evaluated before and after surgery. RESULTS: The near UCVA of the toric IOL group (0.26 ± 0.33) after cataract surgery was significantly better than that of the monofocal IOL group (0.48 ± 0.32) (p = 0.030). The distant UCVA of the toric IOL group (0.38 ± 0.14) was also significantly better than that of the monofocal IOL group (0.55 ± 0.22) (p = 0.026). Best-corrected visual acuity (p = 0.710) and mean spherical equivalent (p = 0.465) did not show significant differences between the toric IOL group and the monofocal IOL group. In the toric IOL group, postoperative refractive astigmatism was - 0.80 ± 0.46D and postoperative corneal astigmatism was - 1.50 ± 0.62D, whereas the corresponding values in the monofocal IOL group were - 1.65 ± 0.77D and - 1.45 ± 0.64D; residual refractive astigmatism was significantly lower with toric IOL implantation compared with monofocal IOL implantation (p = 0.001). There were no postoperative complications. CONCLUSIONS: When myopic refraction such as -3D was determined as the target power in patients with corneal astigmatism, toric IOL implantation led to excellent improvement in both near and distant UCVA.

Use of Techniques for Scleral and Iris Fixation in Secondary Implantation of Intraocular Lenses.

Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does not present appropriate capsular support. However, there is no consensus in the literature about which of these 2 methods is safer and better. The authors performed a literature review searching the main postoperative outcomes obtained with the use of each surgical method. Scleral and iris fixation of IOL are efficient in correction of the patients' visual acuity, even though each technique presents distinct complications which depend especially on the experience of the surgeon with the performed surgical method. It is important to understand that individuals submitted to scleral or iris fixation present previous preoperative complications in their eyes. Besides, both procedures are very complex, involving intense manipulation of the eye globe. The success rate of these surgical techniques is highly variable and has a close relation to the preoperative conditions of the patient's eye and the improvement of the surgeon's learning curve.

Clinical outcome and endothelial loss following prepupillary and retropupillary implantation of iris claw intraocular lenses.

PURPOSE: Iris claw intraocular lenses (IOLs) were successfully used for the management of aphakia in patients that lack capsular support. The aim of this study was to compare the clinical outcome of prepupillary and retropupillary implantation of these IOLs. METHODS: The files of the 26 patients that had an iris claw IOL implantation between 2010 and 2020 were retrospectively reviewed. Detailed ophthalmological examination findings including corrected distance visual acuity (CDVA), intraocular pressure, endothelial cell counts, slit lamp and dilated fundus examination findings were specifically tabulated. Intraoperative and postoperative complications were also specifically recorded. RESULTS: There were 18 patients in the prepupillary implantation group and eight patients in the retropupillary implantation group. Age and gender distribution were similar between the groups. CDVA significantly increased in prepupillary and retropupillary implantation groups (p = 0.001 and p = 0.012, respectively). Median endothelial cell loss was 6.7% in prepupillary group and 7.2% in retropupillary group. The only intraoperative complication was iridodialysis (n = 1). Postoperative complications included retinal detachment (n = 1), cystoid macular edema (n = 2) and IOL tilt (n = 1). All of these complications occurred in the prepupillary implantation group. CONCLUSION: Prepupillary and retropupillary implantation of iris claw IOLs resulted with similar visual gain and endothelial loss rates in a follow-up time of 6 months. There was an insignificant trend toward a reduced complication rate following retropupillary implantation.

Pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes. METHODS: In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. RESULTS: This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively. CONCLUSION: The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.

Analysis of factors associated with vision after cataract surgery in chronic renal failure patients on dialysis.

BACKGROUND: To analyze the related factors of visual acuity after phacoemulsification and intraocular lens implantation in chronic renal failure (CRF) patients. METHODS: We retrospectively analyzed 42 patients (51 eyes) with CRF (failure, uremia) on hemodialysis or peritoneal dialysis and 40 patients (50 eyes) without CRF as a control group. Each individual underwent physical and laboratory examinations including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure, corneal endothelial cell count, fundus examination and optical coherence tomography (OCT) for macular examination. The patients with abnormal platelet, liver and kidney function, coagulation function received treatment accordingly to reduce the perioperative risk. All patients underwent phacoemulsification with IOL implantation. Follow-up examinations were performed at 1 week, 1 month and 3 months after surgery and included BCVA, slit lamp examination, noncontact IOP, dilated fundus examination and OCT of the macula. RESULTS: In control group the preoperative RBC, HB, Cr, and urea values were not associated with the pre- or postoperative BCVA. The RBC, HB, Cr, urea, SBP, DBP, preoperative BCVA and postoperative BCVA values were all significantly different between CRF and control group(P < 0.05). CONCLUSION: In CRF patients, the RBC, HB, Cr and Urea indexes should be monitored before the cataract operation for guarded visual outcome. The pre-existing ocular comorbidities could significantly compromise the vision. The CRF patients could achieve relatively good visual outcome after cataract surgery when the underlaying diseases are effectively managed.

The effect of intraocular lens tilt on visual outcomes in scleral-fixated intraocular lens implantation.

PURPOSE: To investigate the effect of scleral-fixated intraocular lens (IOL) tilt on visual outcomes. METHODS: Ninety-four eyes of consecutive 94 patients who underwent scleral-fixated IOL implantation with Z-suture technique were included in this prospective study. The values of pre- and postoperative 12th month uncorrected visual acuity (UCVA), cylindrical refractive error, best-corrected visual acuity (BCVA) and corneal and lenticular astigmatism were recorded. The position of the implanted IOL was evaluated with anterior segment optical coherence tomography (AS-OCT). The relationships between the AS-OCT measurements and the visual acuity or refractive errors were investigated. RESULTS: The IOL position was evaluated as tilted in 68 (72.3%) patients: 29 (30.8%) in both vertical + horizontal axes, 30 (31.9%) in the horizontal axis and 9 (9.6%) in the vertical axis. There were no significant differences between patients with and without tilt IOL position in terms of the UCVA, BCVA, cylindrical refractive error and lenticular astigmatism (p > 0.05, for each). The mean BCVA was significantly higher in the no-tilt group than in the both horizontal + vertical tilt and the vertical tilt groups (p = 0.03, p = 0.04, respectively). The mean lenticular astigmatism was significantly higher in the vertical tilt group than the other groups (p = 0.04). CONCLUSION: Tilting in IOL position occurs commonly; however, IOLs with tilting on any of the axes do not have significantly worse outcomes when compared with IOLs with no tilt, in terms of visual results and refractive errors. On the other hand, tilting on the vertical axis is observed less commonly, yet is more effective on visual results and refractive errors, when compared with tilting on the horizontal axis.

Comparison of outcomes of scleral fixation with and without pars plana vitrectomy for the treatment of dislocated intraocular lens.

PURPOSE: To investigate the surgical outcomes of scleral fixation with either pars plana vitrectomy (ppV) or anterior vitrectomy (AV) for the treatment of dislocated intraocular lens (IOL). METHODS: By retrospective review of electronic medical records, patients with in-the-bag spontaneous IOL dislocation who underwent IOL exchange with scleral fixation were included and grouped according to the vitrectomy method: ppV (group 1) and AV (group 2). Post-operative surgical outcomes including visual acuity (log MAR), spherical equivalent, and surgically induced astigmatism (SIA) and complications were investigated and analyzed. RESULTS: After 6 months, post-operative measurements showed an average visual acuity of 0.16 ± 0.20, spherical equivalent of -1.48 ± 1.53D (diopters), and refractive shift of -0.19 ± 0.44D in group 1 (n = 19). There was no statistically significant difference between the measurements of group 1 and group 2 (n = 20) (0.10 ± 0.12, -2.00 ± 1.71D, -0.39 ± 0.57D, respectively) (p = 0.51, p = 0.29, p = 0.16, respectively). When analyzed by the algebraic and vector methods, group 1 did show a higher magnitude of surgically induced astigmatisms (1.61 ± 1.50D, 2.10 ± 1.03D, respectively) than did group 2 (0.49 ± 1.02D, 1.31 ± 0.83D respectively) (both p's = 0.01). There was no significant difference in the incidence of complications except for vitreoretinal complications, which were higher in group 2 (25%), compared with group 1 (0%) (p = 0.047). CONCLUSIONS: Both ppV and AV are appropriate options in patients who need IOL exchange with scleral fixation based on visual outcomes, refractive shifts, and complication rates. In terms of managing astigmatism, the AV procedure may be the better option.

Risk factors of persistent diplopia following secondary intraocular lens implantation in patients with sensory strabismus from uncorrected monocular aphakia.

PURPOSE: We aimed to compare clinical characteristics between diplopia-free and diplopia-persistent patients after successful strabismus surgery, when patients complained of diplopia following secondary intraocular lens (IOL) implantation after prolonged aphakia accompanied by sensory strabismus. METHODS: Retrospective review of medical records of patients who complained of diplopia following secondary IOL placement with sensory strabismus after prolonged uncorrected monocular aphakia from isolated ocular trauma was done. We classified patients into two groups according to persistency of diplopia, 6 months after successful strabismus surgery. Clinical characteristics were compared between groups. RESULTS: A total of 31 patients were included. The diplopia-persistent group showed longer duration of uncorrected aphakia (p = 0.02), less severe corneal astigmatism (p = 0.04), a smaller exodeviation angle (p = 0.02), and more frequent vertical deviation (p = 0.015), extorsion (p = 0.022) and monocular nystagmus (p = 0.028) than the diplopia-free group. In all patients in the diplopia-free group, diplopia could be eliminated prior to strabismus surgery using loose prisms in free space, whereas seven patients in the diplopia-persistent group prior to surgery could not resolve diplopia. CONCLUSIONS: Our data will be helpful for ocular surgeons in determining whether to insert secondary IOL in prolonged aphakia with sensory strabismus, or whether strabismus surgery will eliminate diplopia that develops following secondary IOL placement in this situation.

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.