Risk factors for secondary ocular hypertension in silicone oil-filled eyes following transconjunctival sutureless vitrectomy - A prospective cohort study.

Purpose: Our aim was to determine the various risk factors for secondary ocular hypertension (OHT) following pars plana vitrectomy (PPV) with silicone oil (SO) injection. Methods: A prospective cohort study was performed on 46 eyes of 42 patients who underwent PPV with SO injection under a single surgeon between January 2020 and July 2021. Complete ophthalmological examination including gonioscopy and Goldmann applanation tonometry was performed preoperatively and on three postoperative visits, that is, day 7, day 30, and day 90. Axial length and lens thickness were measured at baseline using immersion A-scan. Anterior segment optical coherence tomography (OCT) was used for measuring anterior chamber depth (ACD) at baseline and at 3 months. Results: There was a statistically significant increase in intraocular pressure (IOP) (>21 mmHg) on day 7 (4.70 ± 7.754 mmHg), day 30 (5.24 ± 7.481 mmHg), and day 90 (2.39 ± 5.659 mmHg) (P<0.01 for all). Age <50 years, rhegmatogenous retinal detachment (RRD), and pseudophakia had a strong association with short-term OHT on day 7. Preexisting glaucoma was the only independent risk factor for long-term OHT (day 90). Higher baseline IOP and SO emulsification also contributed to long-term OHT. Conclusion: There was a statistically significant elevation in IOP at all postoperative visits. Short-term OHT was associated with younger age (<50 years), RRD, and pseudophakia. Patients with emulsified SO in the anterior chamber, higher baseline IOP, and preexisting glaucoma were at higher risk for long-term OHT.

Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation.

BACKGROUND: To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. METHODS: This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher's Exact test, Pearson Chi-square test, independent t-test, Mann-Whitney U-test, and a repeated ANOVA. RESULTS: The mean age of patients was 52.7 +/- 12.6 years in group 1 and 53.2 +/- 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 +/- 7.6 weeks in group 1 and 34.1 +/- 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 +/- 0.30 in group 1 and 0.72 +/- 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). CONCLUSION: ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity.

Light scatter on the surface of AcrySof intraocular lenses: part I. Analysis of lenses retrieved from pseudophakic postmortem human eyes.

BACKGROUND AND OBJECTIVE: To investigate the cause of light scatter measured on the surface of AcrySof intraocular lenses (Alcon Laboratories, Inc., Fort Worth, TX) retrieved from pseudophakic postmortem human eyes. MATERIALS AND METHODS: Ten intraocular lenses (Alcon AcrySofModel MA60BM) were retrieved postmortem and analyzed for light scatter before and after removal of surface-bound biofilms. RESULTS: Six of the 10 lenses exhibited light scatter that was clearly above baseline levels. In these 6 lenses, both peak and average pixel density were reduced by approximately 80% after surface cleaning. CONCLUSION: The current study demonstrates that a coating deposited in vivo on the lens surface is responsible for the light scatter observed when incident light is applied.

Sutureless amniotic membrane fixation with fibrin glue in symptomatic bullous keratopathy with poor visual potential.

PURPOSE: To report a sutureless method of amniotic membrane fixation using fibrin glue in two cases of symptomatic bullous keratopathy with poor visual potential. METHODS: Under topical anesthesia, the loose epithelium was debrided up to 1.0 mm from the limbus and fibrin glue was applied uniformly and thinly onto the corneal surface. Cryopreserved amniotic membrane was evenly placed over the cornea and once a firm and uniform adhesion was achieved, excess membrane was trimmed off. A bandage contact lens was applied. RESULTS: In both the cases, complete relief from symptoms was obtained and 3 weeks later, the ocular surface had completely re-epithelialized. At 6 months follow-up, both patients were symptom free without the need for any medication. No complications were observed. CONCLUSIONS: This technique of amniotic membrane fixation is a simple, effective, and safe procedure whereby a stable and secure adherence of the amniotic membrane with the corneal surface is achieved avoiding the use of sutures.

Posterior capsule opacification in myopic eyes.

PURPOSE: To determine whether posterior capsule opacification (PCO) is extensive in eyes with myopia or long axial length when an intraocular lens (IOL) of low-power, zero-power, or minus-power, is implanted. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: Ninety eyes of 90 patients scheduled for phacoemulsification surgery were recruited. These consisted of 30 eyes with high (> or =-8 diopters [D]) myopia, 30 eyes with moderate (<-8 D and > or =-3 D) myopia, and 30 eyes with low (<-3 D) myopia. All eyes had implantation of an acrylic IOL-low-power, zero-power, or minus-power-with a sharp optic edge (AcrySof MA60BM or MA60MA, Alcon Surgical). The PCO in these eyes was measured using a Scheimpflug videophotography system (EAS-1000, Nidek) 1, 3, 6, 12, 18, and 24 months after surgery. Visual acuity and the incidence of neodymium:YAG (Nd:YAG) laser posterior capsulotomy were also examined. RESULTS: No significant difference was observed in the mean PCO value or in the Nd:YAG capsulotomy rate between the high myopia, moderate myopia, or low myopia groups throughout the follow-up period. There was also no significant correlation between PCO value and the actual spherical power or axial length of the eye. Furthermore, although mean visual acuity tended to be worse in proportion to the degree of myopia, the difference was not statistically significant. CONCLUSION: When an acrylic IOL of low-power, zero-power, or minus-power with a sharp optic edge was implanted, high myopia and long axial length were not associated with the degree of PCO.

Explantation of an AcrySof Natural intraocular lens because of a color vision disturbance.

PURPOSE: To describe a patient who complained of color vision disturbance after implantation of a clear intraocular lens (IOL) in one eye and a yellow IOL in the other. DESIGN: Interventional case report. METHODS: A 50-year-old woman complained of binocular imbalance and "yellow vision" in her left eye after implantation of a visible blue light-filtering yellow IOL. A clear IOL had been implanted in her right eye 1 month before. She requested explantation of the yellow IOL. RESULTS: The yellow IOL was exchanged for a clear one, which resolved the unbalanced color vision. CONCLUSIONS: Patients may be intolerant of the color disturbance that results when dissimilarly colored IOLs are implanted. It is advisable to avoid this practice.

Signal quality of biometry in silicone oil-filled eyes using partial coherence laser interferometry.

PURPOSE: To assess the practical feasibility and signal quality of axial length measurements by partial coherence laser interferometry in silicone oil-filled eyes with previous complicated vitreoretinal surgery. SETTINGS: Department of Ophthalmology, University Cologne, Cologne, Germany. METHODS: Using a Zeiss IOLMaster, axial length measurements and signal-to-noise ratios of optical biometry in silicone oil-filled eyes (n=45) and contralateral eyes without tamponade (n=41) were analyzed. RESULTS: Axial length measurements with signal-to-noise ratio > or =2 were feasible in 41 of 45 silicone oil-filled eyes (91%) and 37 of 41 eyes without tamponade (90%). Cataract, central retinal detachment, vitreous hemorrhage, and emulsified oil droplets attached to the intraocular lens were reasons for failure of partial coherence laser interferometry. The signal-to-noise ratio of the first 2 measurements was significantly smaller (P=.04) in silicone-filled eyes (4.4 +/- 2.0) than in eyes without tamponade (5.5 +/- 3.0). Axial lengths of the oil-filled eye and the contralateral eye showed a significant intraindividual correlation (P<.0001, Spearman r=0.84). CONCLUSIONS: Partial coherence laser interferometry shows good clinical practicability in silicone oil-filled eyes with previous complicated vitreoretinal surgery. Further studies are needed to assess the reliability of these measurements with regard to postoperative refraction after combined oil removal and cataract surgery.

Elevated intraocular pressure in secondary piggyback intraocular lens implantation.

We report 2 cases of postoperative intraocular pressure (IOP) elevation in secondary piggyback intraocular lens (IOL) implantation without history of glaucoma or ocular hypertension. A 74-year-old woman with myopic pseudophakia and a 68-year-old man with hyperopic pseudophakia received secondary piggyback AcrySof IOL implantation in their left eyes. In both patients, the left IOP gradually increased and sustained around 30 mm Hg for about 1 year. In the first, IOP continued elevating despite topical and systemic medications. There was an episode of pupillary block in the second. Gonioscopically, heavier trabecular meshwork pigmentation in their left eyes was observed. Because of this, the 2 IOLs implanted were removed and replaced by an adequate IOL and trabeculotomy was performed in the former. The AcrySof IOL has a truncated optic edge, which increases the risk for chafing the iris, resulting in pigment dispersion syndrome; thus, it would be a poor choice for a sulcus-placed piggyback implantation.

Posterior capsule opacity in Retinitis Pigmentosa according to different biomaterials of intraocular lenses: Our clinical experience.

BACKGROUND AND AIM: Complicated Cataract is frequently associated with Retinitis Pigmentosa (RP). This retinopathy is a great cause of visual impairment, and cataract surgery may resolve partially the situation and restore sight. Unfortunately, in this case there is a very high incidence of Posterior Capsule Opacity (PCO) ranging in several studies a percentage of 100% at six months. Our goal was to evaluate whether the high incidence of PCO is associated to specific type of Intraocular Lens (IOL) biomaterials. MATERIALS AND METHODS: This observational retrospective study deals with 75 eyes of 43 patients affected with RP who underwent to cataract surgery with posterior chamber IOL implants (40% ECCE and 60% Phaco). Selected biomaterials were: 30 Poly (methyl methacrylate) (PMMA), 11 silicone, 34 acrylic. Observations were performed with retro-illumination camera and when recorded capsular fibrosis a PCO YAG laser capsulotomy was made. The patients were controlled at 3-6-12 months after the initial surgical treatment. RESULTS: At three months of follow up, 80% of patients with PMMA, 81.8% silicone implants underwent to YAG capsulotomy while only 44% of acrylic type. At six months of follow-up 83.3% of patients with PMMA and 81.8% silicone implants underwent to YAG capsulotomy while only 49.88% of acrylic type. At 12 months of follow up 89.9% of patients with PMMA and 90.95 silicone implants underwent to YAG capsulotomy while only 52.82% of acrylic type. CONCLUSIONS: We could not be able to differentiate incidence between different brand type of lens in PMMA. For Acrylic lens instead we noted an incidence of PCO of 41.38% with hydrophobic material and 60.0% of hydrophilic material. In conclusion to avoid massive PCO in RP, our experience is statistically significant, in fact the protective action of smooth material hydrophobic lens avoids the epithelial growth and fibrosis towards the center of visual axis.

The correlation between various types of intraocular lens and laser wavelength.

PURPOSE: To analyze effects of the composition and the color of intraocular lenses (IOLs) on laser wavelength. DESIGN: A case control study. METHOD: Laser light rays at wavelengths ranging from 0.1 to 0.5 W were directed at a polymethymethacrylate ocular model fitted consecutively with three types of IOLs at various refractive powers. A laser detector was placed on the model beneath the lenses. The laser beam was passed through the IOLs and the output measured by a sensor. Attenuation rate was calculated. RESULTS: The colored IOL caused significantly more attenuation than did the noncolored IOLs (p <.01). A 30-diopter colored IOL showed an attenuation rate of up to 15% at a wavelength of 488 + 514 nm. CONCLUSIONS: Consideration of the wavelength and the output of a laser for a particular IOL is required when laser photocoagulation of the retina is performed in patients with pseudophakia.

Pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection.

PURPOSE: To describe pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection. DESIGN: Interventional case series. METHODS: Cases were collected from January 1997 to July 2000 from three tertiary referral centers. RESULTS: Seven phakic patients (seven eyes) and one pseudophakic patient (one eye) presented 1 to 90 days after vitrectomy and silicone oil injection with intraocular pressures of 36 to 70 mm Hg. Five patients had an observed or potential weakness of the iris-lens diaphragm. Treatment with Nd:YAG-laser peripheral iridotomy or inferior iridectomy provided a temporary reduction in intraocular pressure for some patients, but all eventually required removal of silicone oil. CONCLUSION: Pupil block glaucoma after silicone oil injection is well recognized in aphakic patients, but ophthalmologists should be aware that it can occur in phakic and pseudophakic patients, particularly in complicated cases and patients with a weakness of the iris-lens diaphragm.

High-order aberrations in pseudophakia with different intraocular lenses.

PURPOSE: To compare high-order aberrations in patients who had cataract surgery and implantation of different types of intraocular lenses (IOLs). SETTING: Sir Charles Gairdner Hospital and Lions Eye Institute, University of Western Australia, Perth, Australia. METHODS: Fifty eyes of 48 patients were included in this study. The optical aberrations were measured with the Hartmann-Shack wavefront sensor (Zyoptix, Bausch & Lomb) before and after surgery using a 5.0 mm wavefront aperture diameter for all comparisons. The eyes were divided into 4 groups according to the type of IOL (material and curvature). A fifth group of 10 eyes of 6 elderly patients with normal crystalline lenses had the same examination. RESULTS: There was no statistical difference in high-order aberrations between the 2 acrylic IOL groups with different curvatures (P>.05) or between the silicone and poly(methyl methacrylate) (PMMA) IOL groups (P>.05). However, the measured high-order aberrations were significantly higher (3rd through 5th order) in the 2 acrylic IOL groups than in the PMMA and silicone IOL groups (P<.05). CONCLUSIONS: An increase in IOL high-order aberrations contributed to the decline in retinal image quality. An IOL modifies the entire aberration pattern of the eye. There was a statistically significant increase in aberrations in patients with an acrylic IOL compared to those with a silicone or PMMA IOL. The exact mechanism is uncertain. Further study is required to optimize IOL design.

Contact zone of piggyback acrylic intraocular lenses.

In a hyperopic cataract patient, surgery was performed with implantation of 2 foldable, acrylic, posterior chamber intraocular lenses (IOLs) in the bag. The IOLs showed a central contact zone during surgery. This contact zone remained after surgery and was documented 2 months postoperatively. The contact zone may induce multifocality similar to that seen with multifocal IOLs.

Accurate determination of effective lens position and lens-capsule distance with 4 intraocular lenses.

PURPOSE: To measure effective lens position (ELP) of 4 intraocular lenses (IOLs) using high precision and high resolution dual-beam partial coherence interferometry (PCI) and to assess the tendency of these IOLs to produce a lens-capsule distance (LCD), a possible risk factor for posterior capsule opacification. SETTING: Department of Ophthalmology, Vienna General Hospital; Institute of Medical Physics, University of Vienna, Austria. METHODS: In a retrospective study, PCI was used to measure ELP and LCD in 139 pseudophakic eyes of 110 patients with 4 IOLs: acrylic 3-piece IOL (AcrySof MA60BM); silicone 3-piece IOL without a capsular tension ring (PhacoFlex SI30) and with a capsular tension ring (PhacoFlex SI30 and Morcher Type 14); silicone plate-haptic IOL (Staar AA4203VF); and a hydrogel plate-haptic IOL (logel 1103). RESULTS: The ELP and LCD were determined with a precision of approximately 3 to 4 microns. An LCD was detected in 21% eyes with the AcrySof, 20% of eyes with the SI30 without a capsular tension ring, 10% of eyes with a capsular tension ring, 21% of eyes with the Staar, and 17% of eyes with the logel. The LCDs detected by PCI, but not by slitlamp examination, were significantly smaller than those detected by both. CONCLUSION: The amount of LCD detected by PCI was approximately the same with all IOL types (approximately 20%) except the PhacoFlex SI30 with a capsular tension ring (10%).

Changes in intraocular lens position after neodymium: YAG capsulotomy.

PURPOSE: To quantify changes in intraocular lens (IOL) position caused by neodymium: YAG (Nd:YAG) capsulotomy with 3 IOL styles. SETTING: Department of Ophthalmology, University of Vienna, Austria. METHODS: In a prospective study, anterior chamber depth (ACD) was measured by dualbeam partial coherence interferometry (PCI) in 32 pseudophakic eyes of 32 patients with posterior capsule opacification before and immediately after planned capsulotomy under mydriasis. Patients were divided into 3 groups with the following IOL styles: 1-piece poly(methyl methacrylate) (PMMA), 3-piece foldable, and plate haptic. RESULTS: The capsulotomy induced a backward IOL movement in all 32 eyes (mean 25 microns; range 9 to 55 microns). It was more pronounced in eyes with plate-haptic IOLs than in those with the other styles. Precision of ACD measurement by PCI was 4 microns. Changes in ACD correlated significantly with capsulotomy size but not with preoperative lens-capsule distance. CONCLUSION: Capsulotomy caused a backward movement of the IOL, which was more pronounced with plate-haptic IOLs than with 1-piece PMMA and 3-piece foldable IOLs. Since the magnitude of IOL movement in this study population was small, a hyperopic shift in refraction after capsulotomy will usually be small and not clinically relevant.

Retained IOL fragment and corneal decompensation after pseudophakic IOL exchange.

A 72-year-old man had exchange of a foldable silicone multifocal intraocular lens (IOL) by transection, removal, and monofocal IOL replacement. One month after the exchange, irreversible corneal edema developed and penetrating keratoplasty was performed. At the time of the corneal transplant, a small silicone fragment was discovered in and removed from the anterior chamber. Histologic evaluation of the patient's cornea demonstrated an absence of corneal endothelium, suggesting the fragment was the etiology of the corneal decompensation.

Posterior capsular opacification in pseudophakic eyes with a silicone or acrylic intraocular lens.

PURPOSE: To compare posterior capsular opacification in eyes with IOL of two different materials--silicone or acrylic. METHODS: Eighty consecutive eyes undergoing cataract surgery were prospectively randomized in two groups, 40 eyes receiving a silicone (Sl--30NB) and 40 eyes an acrylic (Acrysof MA60BM) intraocular lens (IOL). The same surgeon performed phacoemulsification and the intraocular lens (PHACO IOL) operation in all cases. Patients were re-examined on the first postoperative day, after one week, four months, and 1-2.4 years. Seven eyes were lost to late control. RESULTS: Clinically significant posterior capsular opacification (PCO) (including eyes with capsulotomy already performed) was equally common in both groups; 25% in the silicone group and 19% in the acrylic group (p=0.53). The posterior capsule remained clear in 61% of the silicone and 76% of the acrylic IOL eyes (p=0.18). In the whole study group, 29% of eyes with and 14% without concurrent ocular diseases had significant PCO (p=0.13). In the silicone IOL group, PCO was more common in eyes with concurrent ocular diseases (44%) than eyes without other diseases (10%) (p=0.049). Eyes with acrylic IOL showed no difference in significant PCO, with or without other diseases (18% and 20%, respectively). CONCLUSIONS: In a consecutive series of 80 cataract eyes central PCO was equally common in eyes receiving a silicone or an acrylic IOL. In the silicone IOL group, however, significant PCO was more common if there was concurrent ocular disease, while with the acrylic IOL concurrent ocular disease did not seem to increase the risk of PCO.

Cystoid macular edema associated with latanoprost therapy in a pseudophakic vitrectomized patient after removal of silicone oil endotamponade.

PURPOSE: To describe the occurrence of cystoid macular edema in a pseudophakic vitrectomized patient following use of latanoprost (0.005%). METHODS: A 58-year-old patient underwent routine cataract surgery with posterior chamber lens implantation complicated by rhegmatogenous retinal detachment three months later. A pars plana vitrectomy was performed with silicone oil endotamponade which was removed six months later. Five months after oil removal, the patient presented with secondary open-angle glaucoma treated with latanoprost 0.005% eye drops once daily. RESULTS: Two weeks after initiation of latanoprost treatment, visual acuity dropped from 0.8 to 0.3 due to cystoid macular edema confirmed by fluorescein angiography. After discontinuing latanoprost therapy and with topical corticosteroid treatment, cystoid macular edema slowly resolved, and within 6 months, visual acuity improved to 0.8. CONCLUSIONS: Despite its marked ocular hypotensive effect, latanoprost should be carefully used in patients after uncomplicated cataract surgery if the vitreous body was removed by pars piana vitrectomy.