Effect of Co-Implantation of a Capsular Tension Ring on Clinical Outcomes after Cataract Surgery with Monofocal Intraocular Lens Implantation

PURPOSE: The objective was to evaluate the effect of co-implantation of a preloaded capsular tension ring (CTR) and aberration-free monofocal intraocular lens (IOL) on clinical outcomes and visual quality after cataract surgery. MATERIALS AND METHODS: Patients who underwent cataract surgery were randomized into two groups that were implanted with a CTR and IOL (group 1, 26 eyes) or an IOL only (group 2, 26 eyes). At 1 and 3 months after surgery, visual acuity, refractive errors, refractive prediction errors, ocular aberrations, and modulation transfer function (MTF) were analyzed. At 3 months postoperatively, anterior chamber depth (ACD) and contrast sensitivity were evaluated. RESULTS: Group 1 showed greater hyperopic shift, which caused the refractive prediction error at 3 months after surgery to be significantly different between the two groups (p=0.049). Differences in ACD between the preoperative and postoperative periods tended to be greater in group 1 than in group 2. At 3 months postoperatively, internal MTF values at 20, 25, and 30 cycles per degree were significantly better in group 1 than in group 2 (p=0.034, 0.017, and 0.017, respectively). Contrast sensitivity showed comparable results at almost all spatial frequencies between the groups. CONCLUSION: Regarding visual acuity and quality, both groups showed comparable results. Co-implantation of a CTR and aberration-free monofocal IOL was associated with hyperopic refractive outcomes. Surgeons should consider the position of the IOL when planning co-implantation of a CTR and IOL.

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

PURPOSE: To investigate effects of a new push-through insertion method for donor lenticules using an injector system on endothelial viability ex vivo and in a clinical case series of endothelial keratoplasty. METHODS: An ex vivo delivery model was used with porcine corneoscleral rims. We compared the endothelial viability in a new push-through insertion method using the Visian Implantable Collamer Lens (ICL) injector versus that of standard forceps-assisted insertion for lenticule delivery. Twenty porcine corneal lenticules were divided into four groups by insertion method and wound size. Vital dye staining was performed and devitalized areas were semi-quantitatively assessed by digital imaging. In the clinical case series, Descemet's stripping endothelial keratoplasty (DSEK) using the push-through method was performed in seven patients and endothelial outcome was determined six months postoperatively. RESULTS: Mean devitalized areas for the push-through method were significantly lower than for forceps-assisted insertion through 3.2 mm incision (23.99 +/- 2.17% vs. 50.48 +/- 5.07%, p = 0.009) in the ex vivo model. Average endothelial cell counts of donor tissues of patients who underwent DSEK were 26.4% lower six months postoperatively. CONCLUSIONS: Push-through delivery of donor lenticules using the Visian ICL injector system appears to be less harmful to endothelial cells than conventional forceps-assisted delivery.

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

PURPOSE: To investigate effects of a new push-through insertion method for donor lenticules using an injector system on endothelial viability ex vivo and in a clinical case series of endothelial keratoplasty. METHODS: An ex vivo delivery model was used with porcine corneoscleral rims. We compared the endothelial viability in a new push-through insertion method using the Visian Implantable Collamer Lens (ICL) injector versus that of standard forceps-assisted insertion for lenticule delivery. Twenty porcine corneal lenticules were divided into four groups by insertion method and wound size. Vital dye staining was performed and devitalized areas were semi-quantitatively assessed by digital imaging. In the clinical case series, Descemet's stripping endothelial keratoplasty (DSEK) using the push-through method was performed in seven patients and endothelial outcome was determined six months postoperatively. RESULTS: Mean devitalized areas for the push-through method were significantly lower than for forceps-assisted insertion through 3.2 mm incision (23.99 +/- 2.17% vs. 50.48 +/- 5.07%, p = 0.009) in the ex vivo model. Average endothelial cell counts of donor tissues of patients who underwent DSEK were 26.4% lower six months postoperatively. CONCLUSIONS: Push-through delivery of donor lenticules using the Visian ICL injector system appears to be less harmful to endothelial cells than conventional forceps-assisted delivery.

Descemet's tear due to injector cartridge tip deformity.

Foldable intraocular lens (IOL) implantation using an injector system through 2.8-mm clear corneal incision following phacoemulsification provides excellent speedy postoperative recovery. In our reported case, a Sensar AR40e IOL (Abbott Medical Optics, USA) was loaded into Emerald C cartridge, outside the view of the operating microscope, by the first assistant. The surgeon proceeded with the IOL injection through a 2.8-mm clear corneal incision after uneventful phacoemulsification, immediately following which he noted a Descemet's tear with a rolled out flap of about 2 mm near the incision site. Gross downward beaking of the bevelled anterior end of the cartridge was subsequently noticed upon examination under the microscope. We suggest careful preoperative microscopic inspection of all instruments and devices entering the patient's eyes to ensure maximum safety to the patient.

A truly knotless technique for scleral fixation of intraocular lenses: Two-year results.

Scleral fixated intraocular lens (SFIOL) is a safe and effective option for managing optical aphakia. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. are unique to SFIOL. The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. We performed a recently described novel technique which obviates the need for knot and scleral flaps in securing the SFIOL. This novel 2-point Ab externo knotless technique may reduce the knot related problems. Twenty-three eyes undergoing this knotless SFIOL procedure were analyzed for intraoperative and postoperative complications. Twenty-two eyes either maintained or improved on their preoperative vision. All patients had a minimum follow-up of 24 months.

Primera evaluación LIOS multifocales RESTOR versus TECNIS / Comparation of visual results and subjective satisfaction between ReSTOR and Tecnis multifocal IOLs

Objetivo: Comparar resultados visuales y satisfacción subjetiva entre los LIOs Multifocales Restor® y Tecnis®. Material y Métodos: En 136 ojos con Restor® y 35 con Tecnis®, operados de facoemulsificación por un mismo cirujano, se analiza y compara: complicaciones AV pl con y sin corrección, AV pc, predictibilidad y subjetivamente, mediante una encuesta, independencia de anteojos, visión de halos, dificultad en visión intermedia y satisfacción. Resultados: Hubo mejor AV pc con Tecnis® 0,02 vs 0,07 logMAR, p=0,0045) y tanto menor visión de Halos (22 por ciento vs 56 por ciento, p=0,0001) como menos complicaciones durante la implantación de Restor®. No se encontró diferencias significativas en el resto de las variables estudiadas. Conclusión: Con ambos lentes se obtiene buena AV pl con y sin corrección, excelente AV pc, similar predictibilidad, satisfacción, visión intermedia e independencia de lentes. El grupo Tecnis® obtiene mejor AV pc, mayor visión de halos y más complicaciones durante su implante.

Purpose: To compare visual results and subjective satisfaction between Restor® and Tecnis® multifocal IOLs. Method: In 136 operated eyes with Restor® and 35 with Tecnis®, surgery performed by the same surgeon with phacoemulsification technique, we asses and compare: complications, distance VA with and without correction, near VA, predictability and subjective intermediate VA, spectacle dependence, haloes and global satisfaction. Results: There were no statistical differences between multifocal IOLs and monofocals regarding the majority of the variables studied but there was better near VA with Tecnis® (0,02 vs 0,07 logMAR, p=0,0045) and less haloes (22 percent vs 56 percent, p=0,0001) and complications during the IOL implantation in the Restor® group. Conclusion: Both lenses obtained good distance BCVA and UCVA, excellent near VA and similar predictability, intermediate VA, independence of glasses and general satisfaction. The Tecnis® Group obtained better near VA but more haloes and more complications during its implantation.

Intravitreal bevacizumab for ahmed glaucoma valve implantation in neovascular glaucoma: a case report.

OBJECTIVE: To report the short-term efficacy and safety of intravitreal Bevacizumab injection in conjunction with implantation of Ahmed glaucoma valve in a patient with refractory neovascular glaucoma (NVG) caused by proliferative diabetic retinopathy (PDR). MATERIAL AND METHOD: A patient with NVG and vitreous hemorrhage caused by PDR was initially treated with 1.25 mg intravitreal Bevacizumab injection. One week after injection, intraocular pressure (IOP) did not improve with partial regression of the anterior segment new vessels. The patient underwent pars planar vitrectomy with panretinal photocoagulation (PRP) combined with trabeculectomy. Despite the initial good response, the patient developed recurrent hyphema and vitreous hemorrhage with uncontrolled IOP on full medications. Ahmed glaucoma valve implantation combined with the second intravitreal injection of 1.25 mg Bevacizumab was performed. RESULTS: At 48 hours postoperative, IOP markedly decreased. Iris neovascularization was not visible. The rapid resolution of hyphema and vitreous hemorrhage was noted. At 6 weeks follow-up, the patient gained visual acuity (VA) from hand motion to 20/100. The IOP was 8 mmHg with no recurrence of iris rubeosis. Vitreous hemorrhage had cleared revealed the view of fundus with full PRP and no new retinal vessels. At 8 weeks postoperative, there was small recurrent iris neovascularization without any rise in IOP. No intervention was done except careful follow-up. At 3 months, the patient retained VA of 20/100 with the IOP of 9 mmHg. Small iris rubeosis presented with no changes in appearance. No serious ocular or systemic adverse effects occurred after intravitreal Bevacizumab injections. CONCLUSIONS: Ahmed glaucoma valve implantation in combination with intravitreal Bevacizumab injection is effective in controlling IOP in refractory neovascular glaucoma. This approach may increase visual outcome in cases with extensive neovascularization, before PRP takes effect, weeks later The long-term efficacy and safety of this anti-proliferative agent in glaucoma drainage implants still requires further investigation.

Performance of conventional biometry vs. integrated laser interferometry with keratometry device in intraocular lens measurement.

OBJECTIVE: To compare the performance of the Conventional Biometry (CB) (Applanation Ultrasound and Keratometry) and the Integrated Laser Interferometry with Keratometry Device (LI) in the measurement of Intraocular Lens (IOL). MATERIAL AND METHOD: A prospective study of 100 eyes in 50 cataract patients was conducted. The IOL measurement using the LIfollowed by the CB was done on all eyes. The keratometry (K), axial length (AL), IOL power, and time required for both methods were compared in the same subject by ANOVA with repeated measurement. RESULTS: The LI could not obtain the AL in 14%. There were 21% that the signal to noise ratio was below 1.6. The AL obtained by the LI was significant higher compared to the CB by mean of 0.28 mm (p < 0.05). The K showed no statistically significant difference (p = 0.05). There was statistically significantly higher IOL power calculated by the LI compared to the CB by mean of 0.63 D (p < 0.05). The time required for the LI was 2.77 +/- 1.44 min and the CB was 9.63 +/- 3.82 min (p < 0. 05). CONCLUSION: The LI required less time than the CB in measurement of the IOL but could not measure the AL in the group of patients with dense cataracts. The LI give a higher IOL power compared to the CB.

Avaliação do uso do anel endocapsular modificado em casos de subluxação traumática do cristalino / Evaluation of the modified capsular tension ring in cases of traumatic lens subluxation

OBJETIVO: Avaliar o comportamento do anel modificado de tensão capsular em cataratas traumáticas com subluxação, analisando a acuidade visual, centração do saco capsular, pseudofacodonese, seguimento pós-operatório, e complicações intra e pós-operatórias. LOCAL: Cincinnati Eye Institute, Cincinnati, Ohio, USA. MÉTODOS: Vinte e dois olhos de 22 pacientes com perda traumática de suporte zonular foram submetidos à facoemulsificação utilizando lente intra-ocular de câmara posterior e o implante do anel capsular modificado. O exame pré-operatório incluiu melhor acuidade visual corrigida (MAVC), a presença ou ausência de facodonese, descentração do cristalino e prolapso vítreo. A avaliação pós-operatória incluiu MAVC, presença de pseudofacodonese, centração do implante, necessidade de vitrectomia e outras complicações. RESULTADOS: Vinte e um olhos (95,45 por cento) tiveram melhora da MAVC. O exame pré-operatório revelou facodonese em 11 olhos (50 por cento) e nenhum olho apresentou pseudofacodonese. No exame pré-operatório, a descentração sintomática estava presente em 10 olhos (45,45 por cento). Todos os olhos apresentaram centração do complexo saco capsular/LIO no pós-operatório. Prolapso vítreo foi diagnosticado antes da cirurgia em 9 olhos (40,90 por cento) e a vitrectomia foi necessária em 11 olhos (50 por cento). CONCLUSÃO: O uso do anel modificado de tensão capsular resultou em boa centração do complexo saco capsular/lente intra-ocular nos olhos estudados com catarata traumática e perda de suporte zonular.

PURPOSE: To evaluate the behavior of the modified capsular tension ring (MCTR) in traumatic subluxated cataracts analyzing the visual acuity, centration of the capsular bag, pseudophacodonesis, postoperative follow-up and intra- and postoperative complications. SETTING: Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: Twenty-two eyes of 22 patients with traumatic loss of zonular support had phacoemulsification using PCIOL and MCTR implantation. The preoperative examination included best correct visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration and vitreous prolapse. The postoperative evaluation included BCVA, the presence of pseudophacodonesis, PCIOL centration, necessity of vitrectomy and other complications. RESULTS: 21 eyes (95.45 percent) had an improvement in BCVA. The preoperative examination disclosed phacodonesis in 11 eyes (50 percent) and no eye presented pseudophacodonesis in the postoperative period. Preoperatively, symptomatic decentration was presented by 10 eyes (45.45 percent) and 22 eyes (100 percent) had no decentration after surgery. The preoperative examination revealed vitreous prolapse in the anterior chamber in 9 eyes (40.90 percent). Vitrectomy was required in 11 eyes (50 percent). CONCLUSIONS: The use of the MCTR resulted in a good centration of the capsular bag and the PC IOL in 22 eyes with traumatic cataract and loss of zonular support.

Unilateral dysphotopsia after bilateral intraocular lens implantation using the AR40e IOL model: case report

The authors report a recent complication during the postoperative period of cataract surgery. A patient was submitted to cataract surgery in both eyes with IOL implantation (Sensar®) inside the capsular bag. The postoperative period of right eye was uneventful, however, in the left eye the patient noted a dark shadow at the temporal visual field at the first postoperative week. This diagnosis was confirmed with the presence of a temporal scotoma revealed by the computerized visual field (first reported in this study) and also reducing the pupil area with miotic drops. The treatment of this complication was performed by using brimonidine tartrate and after 6 months this symptom completely disappeared as confirmed by the computerized visual field. The treatment should be based on reducing the pupil area with miotic drops and we also recommend to observe these cases until the 6th postoperative month before indicating an IOL exchange since the capsular edge that overlaps the IOL may opacify creating an optical barrier reducing or eliminating negative dysphotopsia.

Os autores relatam uma complicação no período pós-operatório relativamente recente na cirurgia de catarata. Trata-se de paciente que foi submetido à cirurgia de catarata bilateral não simultânea com implante sacular da lente intra-ocular (Sensar®). O pós-operatório do olho direito evoluiu sem nenhuma queixa, entretanto, no olho esquerdo o paciente referiu a presença de uma sombra em campo visual temporal na primeira semana de pós-operatório sendo diagnosticado disfotopsia negativa após exclusão de outras causas oculares, principalmente retinianas. Este diagnóstico foi confirmado com a presença de um escotoma temporal na campimetria visual computadorizada (relatado na literatura pela primeira vez neste estudo) e também com a redução medicamentosa do tamanho da pupila. Seu tratamento foi realizado com a administração de tartarato de brimonidina e após 6 meses o sintoma desapareceu sendo também documentado com o campo visual (ausência de escotoma). A disfotopsia negativa deve ser tratada visando reduzir a área pupilar e observar por pelo menos 6 meses antes de indicar a troca do lente intra-ocular, uma vez que a cápsula anterior que cobre a LIO pode opacificar criando uma barreira óptica reduzindo ou eliminando esta complicação.

A retrospective analysis of the first Indian experience on Artisan phakic intraocular lens.

PURPOSE: To evaluate the efficacy, safety, predictability and stability of implanting a polymethylmethacrylate phakic intraocular lens (PIOL) in high myopia. MATERIALS AND METHODS: A retrospective analysis of the data of patients who underwent Artisan phakic IOL implantation between 2002 and 2003 with a follow-up of at least 24 months. RESULTS: An Artisan myopia lens was implanted in 60 eyes of 36 patients with preoperative myopia ranging from -5.0 to -24.0 D. Mean patient age was 22.6 years. Mean spherical equivalent of manifest refraction stabilized by the first postoperative week. At three months follow-up, 54 eyes (90%) had a postoperative refraction within +/- 1D emmetropia and 45 eyes (75%) had uncorrected visual acuity of 20/40 or better. Seven eyes (11.6%) had loss of one Snellen line and none had loss of two Snellen lines or more at three months. The mean endothelial cell loss was 3.8% at three months, 5.2% at six months, 5.25% at 12 months and 6.38% at two years, which was not significant. Postoperative complications included anterior chamber reaction in two eyes (3.3%), rise in intraocular pressure in six eyes (10%) and dislocation of PIOL in two eyes (3.3%). CONCLUSION: Implantation of Artisan myopia lens to correct high myopia resulted in a stable and fairly predictable refractive outcome with few complications. Significant endothelial damage was not detected in two years of follow-up.

Incidência de opacificação de cápsula posterior em pacientes submetidos à facoemulsificação e implante de lentes intra-oculares acrílicas hidrofílicas expansíveis / Incidence of posterior capsule opacification in patients submitted to phacoemulsification and expandable acrylic intraocular lens implantation

OBJETIVO: Avaliar prospectivamente os resultados das lentes intra-oculares de polímeros expansíveis implantadas em pacientes submetidos à facoemulsificação, quanto à incidência de opacificação de cápsula posterior, levando em consideração a biocompatibilidade das lentes expansíveis. MÉTODOS: O grupo de estudo foi composto por 830 pacientes, 1.200 olhos, que foram submetidos a facoemulsificação, utilizando a mesma técnica, variando-se apenas o diâmetro da capsulorrexe, pelo mesmo cirurgião, no período de 1998 a 2002, com implante de lente intra-ocular hidrofílica expansível. O acompanhamento médio foi de 2,4 anos, variando de seis meses a quatro anos. RESULTADOS: O número total de opacificação de cápsula posterior foi de 54 casos. CONCLUSÃO: A incidência de opacificação de cápsula posterior encontrada no grupo foi de 4,6 por cento.

Estudio prospectivo de implante de lente intraocular multifocal Array en pacientes hipermétropes présbita / Intraocular lens implantation multifocal Array in hypermetropic patients prospective studies

Evaluación del implante de lente intraocular (LIO) multifocal Array como cirugía refractiva en pacientes hipermétropes présbitas. Método: Estudio prospectivo de resultados visuales objetivos y subjetivos en hipermétropes présbitas sometidos a cirugía de cristalino claro con implante de LIO Array desde enero 2001. Resultados: Informe con 2 ojos de 13 pacientes con edad promedio 61,7 años. La agudeza visual (AV) no corregida preoperatoria fue 0,14 con equivalente esférico +2,84 dioptrías y AV corregida 1. Se colocó LIO para emetropía (grupo E), salvo en 4 ojos de 2 pacientes que se planeó leve hipertropía (grupo H). La AV no corregida para lejos fue mejor en el grupo E comparado con el grupo H (p<0,05) durante el seguimiento (AV 0,97 en E y 0,63 en H a la primera semana; 0,95 en E y 0,69 en H al primer mes y 0,96 en E y 0,65 en H a los seis meses). También la AV no corregida para cerca fue mejor en el grupo E comparado con el grupo H (p<0,5) durante el seguimiento (AV para cerca 0,70 en E y 0,45 en H a la primera semana; 0,8 en E y 0,5 en H al primer mes, y 0,9 en E y 0,5 en H a los seis meses). El equivalente esférico obtenido fue +0,10 para E y + 0,72 para H (p<0,05). La AV corregida en ambos grupos fue 1 para lejos y para cerca. En conjunto la calificación subjetiva de visión fue 6,5 para lejos, 6,8 para distancia intermedia y 6,2 para cerca. El efecto colateral más frecuente fue la visión de halos en ambos grupos. Conclusión: Esta técnica refractiva otorga AV útil para cerca junto con buena AV para lejos sin corrección. El resultado hipermetrópico disminuye AV no corregida para lejos y cerca, por lo que su beneficio para disminuir afectos ópticos indeseados requiere mayor evaluación.

Análise refracional na fixaçäo escleral de LIO na ausência de suporte capsular / Residual refractive erros in intraocular lens scleral fixation

Nos analisamos 33 olhos submetidos a implante de LIO com fixaçäo escleral, na ausência de suporte capsular, para estudar os resultados refracionais. A parte háptica da LIO foi amarrada na esclera a 1,0-1,5mm do limbo com prolene 10-0. A média de acompanhamento foi de 15 meses. Embora a programaçäo fosse para que os pacientes apresentassem pequena miopia pós-operatória, os resultados obtidos com essa técnica mostraram uma tendência á hipermetropia: 66 por cento dos pacientes com refraçäo em torno de -0,75 a plano, diferindo daqueles em que a LIO foi implantada em condiçöes anatômicas normais (p=0,05).