RESUMO
Purpose: To compare the clinical outcomes, feasibility, and safety between groups with sutured and sutureless wound closure in congenital ectopia lentis (CEL) patients. Methods: Patients with CEL who received phacoemulsification combined with intrascleral fixation of capsular hook (CH) and implantation of capsular tension ring (CTR) and in-the-bag intraocular lens (IOL) were included in this study. Results: A total of 68 eyes of 34 patients aged 18 years or younger were enrolled in this study. Incisions of 21 patients (34 eyes) did not require sutures while sutures were applied in 21 patients (34 eyes). Postoperative uncorrected distance visual acuity, best corrected distance visual acuity and intraocular pressure measurements were comparable on follow-up visits (P > 0.05). The magnitude of surgically induced astigmatism was significantly greater (P = 0.001) in the suture group (Median: 0.47; IQ: 1.63, 2.97) than in the sutureless group (Median: 0.88; IQ: 0.63, 1.35). No cases of endophthalmitis and retinal detachment were found postoperatively in either group, while suture-related complications were observed in the sutured group, including loose suture with discomfort in 5 (14.71%) eyes, loose suture with mucus infiltration in 3 (8.82%) eyes. In total, 22 sutures (64.71%) of 34 eyes required removal. Conclusions: Sutureless clear corneal incision in CEL patients can achieve satisfactory clinical results comparable to sutured wound closure in terms of the efficacy and safety. Advantages of this approach are the reduced risk of suture-related complications, no need for additional surgery under general anesthesia for suture removal, and less cost.
Assuntos
Córnea , Ectopia do Cristalino , Implante de Lente Intraocular , Procedimentos Cirúrgicos sem Sutura , Acuidade Visual , Humanos , Feminino , Masculino , Ectopia do Cristalino/cirurgia , Adolescente , Criança , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/métodos , Procedimentos Cirúrgicos sem Sutura/efeitos adversos , Córnea/cirurgia , Córnea/patologia , Facoemulsificação/métodos , Facoemulsificação/efeitos adversos , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , Estudos de Viabilidade , SuturasRESUMO
BACKGROUND: Retrospective cohort study of 561 adult patients undergoing secondary intraocular lens (IOL) implantation by vitreoretinal surgeons at a single institution from April 2015 to December 2020. METHODS: Patient historical factors, intraoperative/postoperative complications, and outcomes of IOL type (anterior chamber IOL versus scleral sutured IOL versus scleral fixated IOL versus. sulcus) were assessed. Primary outcomes were rates of postoperative retinal tears and rhegmatogenous retinal detachment. Secondary outcomes were rates of intraoperative endolaser, intraoperative retinal tear, and further IOL surgery. RESULTS: The incidence of intraoperative retinal tears was 7.3% and not significantly different between techniques. Rates of intraoperative endolaser use were 17.5% among all techniques and not significantly different between techniques. Rates of postoperative retinal tear were low (0%-2.7%). Rates of postoperative rhegmatogenous retinal detachment were not significantly different between techniques (anterior chamber IOL 9/198 [4.5%], SFIOL 1/54 [1.9%], scleral sutured IOL 14/274 [5.1%], sulcus 2/35 [5.7%], total 26/561 [4.6%], P = 0.79). Rates of repeat IOL surgery trended higher in sulcus lenses (anterior chamber IOL 5/198 [2.5%], SFIOL 4/54 [7.4%], scleral sutured IOL 16/274 [5.8%], sulcus 5/35 [14.3%], total 30/561 [5.3%], P = 0.12). CONCLUSION: Intraoperative endolaser use and intraoperative retinal tear are not uncommon in secondary IOL surgery and underscore the importance of careful vitreoretinal management among these patients.
Assuntos
Implante de Lente Intraocular , Complicações Pós-Operatórias , Descolamento Retiniano , Acuidade Visual , Vitrectomia , Humanos , Vitrectomia/métodos , Vitrectomia/efeitos adversos , Estudos Retrospectivos , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Feminino , Masculino , Idoso , Descolamento Retiniano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Pessoa de Meia-Idade , Perfurações Retinianas/cirurgia , Seguimentos , Complicações Intraoperatórias , Incidência , Reoperação , Lentes Intraoculares/efeitos adversosRESUMO
BACKGROUND: Toxic anterior segment syndrome (TASS) is a rare, noninfectious inflammation that occurs after anterior segment surgery. We report a case herein that developed presumed atypical late-onset TASS after V4c implantable collamer lens (ICL) implantation surgery. CASE PRESENTATION: A 26-year-old man underwent ICL implantation surgeries of both eyes on two separate days. The 1-day and 7-day postoperative routine follow-up visits revealed no abnormalities. However, one month after surgery, dense white spots attached to the posterior surface and scattered ones to the anterior surface of ICL in the left eye were noted on anterior segment examination. His uncorrected distance visual acuity (UDVA) was 20/16 in both eyes and the fundus examination was normal. Despite the absence of typical clinical manifestations, late-onset TASS was suspect and intense topical steroid was administered. After 6 weeks of tapering topical steroid therapy, the white spots disappeared and the patient had no subjective complains throughout the treatment period. CONCLUSIONS: This case suggested that the traditionally considered acute and serious TASS could also present as delayed and insidious onset after ICL implantation surgery. Due to its variabilities, the awareness of TASS should be raised to ophthalmologists and regular follow-up visits should be emphasized to patients. Once TASS was suspected, intensive steroid therapy should be implemented in time.
Assuntos
Segmento Anterior do Olho , Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Humanos , Masculino , Adulto , Segmento Anterior do Olho/diagnóstico por imagem , Segmento Anterior do Olho/patologia , Lentes Intraoculares Fácicas/efeitos adversos , Implante de Lente Intraocular/efeitos adversos , Acuidade Visual , Complicações Pós-Operatórias/diagnóstico , Síndrome , Glucocorticoides/uso terapêuticoRESUMO
PURPOSE: To report the refractive outcomes of long (≥25.00 mm) and short (≤22.00 mm) axial length (AL) eyes undergoing immediately sequential bilateral cataract surgery (ISBCS). METHODS: In this retrospective cohort study, patients who underwent ISBCS were identified and eyes of patients with bilateral long and short ALs were included. Pre- and postoperative biometry, autorefraction, and ocular comorbidities or complications were recorded. The primary outcome was the mean refractive prediction error. RESULTS: Thirty-seven patients (74 eyes) with long ALs and 18 patients (36 eyes) with short ALs were included. The means ± standard deviations of the ALs were 26.40 ± 1.38 mm and 21.44 ± 0.46 mm in the long and short AL groups, respectively. In long AL eyes, the mean absolute error from the biometry-predicted refraction was - 0.16 ± 0.46 D, corresponding to 74% of eyes achieving a refraction within ±0.50 D of the predicted value. In short AL eyes, the mean absolute error was - 0.63 ± 0.73 D, corresponding to 44% of eyes achieving a refraction within ±0.50 D of the predicted value. Eight (44.4%) patients with short AL eyes had a myopic deviation greater than ±0.50 D from the predicted result in both eyes. CONCLUSIONS: Compared to patients with long AL eyes, ISBCS in patients with short ALs had a wider variance in refractive outcome and a lower rate of achieving a postoperative refraction within ±0.50 D of the predicted target.
Assuntos
Extração de Catarata , Catarata , Lentes Intraoculares , Erros de Refração , Humanos , Acuidade Visual , Implante de Lente Intraocular/efeitos adversos , Estudos Retrospectivos , Lentes Intraoculares/efeitos adversos , Refração Ocular , Erros de Refração/etiologia , Biometria , Comprimento Axial do Olho , Catarata/complicações , Extração de Catarata/efeitos adversosRESUMO
BACKGROUND: Late-onset capsule block syndrome (CBS) is a rare complication of cataract phacoemulsification and the implantation of a posterior chamber intraocular lens (PCIOL), which manifests six months to years after surgery. The hallmark of CBS is the formation of an opaque liquid substance between the implanted intraocular lens (IOL) and the posterior capsule. However, its pathogenesis remains unclear. CASE PRESENTATION: A 64-year-old female patient with chronic angle-closure glaucoma (axis length < 21 mm) underwent trabeculectomy surgery combined with phacoemulsification and PCIOL. After a 4-year follow-up, a decline in visual acuity occurred in her right eye due to the location of opaque fluid in the visual axis and distension of the capsular bag. The initial course of action was to release the trapped fluid. Neodymium: yttrium-aluminum-garnet (Nd: YAG) laser capsulotomy could not be employed due to her non-dilating pupil and high extension of the posterior capsule. Subsequently, anterior capsule peeling and anterior segment vitrectomy surgery were performed. The depth of the anterior chamber (ACD), the distance between the face of the retro-IOL and the posterior capsule, the best-corrected visual acuity (BCVA), and the visual quality (VQ) were measured both before and after surgery. Inflammatory cytokine levels in the opaque substances (OS) trapped between the PCIOL and the posterior capsule were assessed using a flow cytometer and compared to normal statistical data in aqueous humor. After surgery, the patient experienced a significant improvement in BCVA and VQ. The distance between the face of the retro-IOL and the posterior capsule was on the verge of disappearing. However, ACD did not differ between pre- and post-operatively. Interleukin-8 (IL-8) and basic fibroblast growth factor (BFGF) concentrations were higher in the OS than in aqueous humor, especially in the former. However, the concentration of vascular cell adhesion molecule (VCAM) in the OS was lower than in aqueous humor. CONCLUSIONS: Anterior segment vitrectomy surgery proved to be a successful treatment for late-onset CBS, presenting a challenging case. In the human lens, inflammatory cytokines originating from the opaque substances may contribute to abnormal metabolism in the sealed area, a consequence of late-onset CBS.
Assuntos
Extração de Catarata , Traumatismos Oculares , Cápsula do Cristalino , Doenças do Cristalino , Facoemulsificação , Humanos , Feminino , Pessoa de Meia-Idade , Citocinas , Implante de Lente Intraocular/efeitos adversos , Doenças do Cristalino/diagnóstico , Doenças do Cristalino/etiologia , Doenças do Cristalino/cirurgia , Cápsula do Cristalino/cirurgia , Cápsula do Cristalino/patologia , Extração de Catarata/efeitos adversos , Facoemulsificação/efeitos adversos , Traumatismos Oculares/complicações , Complicações Pós-Operatórias/cirurgiaRESUMO
BACKGROUND: To report a case of cataract surgery in unintentional Ozurdex (Allergan, Inc., Irvine, California, USA) injection into the lens. CASE PRESENTATION: A 82-years old man reporting decreased visual acuity in his right eye came to our Ophthalmology service. Due to the clinical history, and on the basis of ophthalmoscopic and imaging examinations diabetic macular edema was diagnosed. Thus, intravitreal dexamethasone implant was scheduled and therefore performed. The following day Ozurdex appeared to be located into the lens. After careful evaluation and strict follow up examinations, due to the risks associated with the presence of the implant into the lens, phacoemulsification with Ozurdex removal and intraocular lens (IOL) implantation was scheduled and performed. CONCLUSIONS: In this case report we reported the surgical management of accidental into-the lens dexamethasone implant carefully taking into account the dexamethasone pharmacokinetic.
Assuntos
Dexametasona , Implantes de Medicamento , Glucocorticoides , Humanos , Dexametasona/administração & dosagem , Masculino , Idoso de 80 Anos ou mais , Glucocorticoides/administração & dosagem , Implantes de Medicamento/efeitos adversos , Cristalino/cirurgia , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Edema Macular/diagnóstico , Facoemulsificação , Implante de Lente Intraocular/efeitos adversos , Acuidade Visual , Injeções IntravítreasRESUMO
A Japanese woman in her 70s was referred to our hospital for the evaluation and treatment of high intraocular pressure (IOP) in her right eye. She had undergone bilateral cataract surgeries and the insertion of hydrophilic acrylic intraocular lenses (IOLs). We performed trabeculotomy and trabeculectomy to lower her right IOP; thereafter, a circular opacity was observed on the right eye's IOL surface. We removed the right IOL because that eye's vision had decreased due to IOL opacification. The analysis of the removed IOL revealed that the main opacity component was calcium phosphate. This is the first post-glaucoma-surgery IOL calcification case report.
Assuntos
Calcinose , Glaucoma , Lentes Intraoculares , Humanos , Feminino , Lentes Intraoculares/efeitos adversos , Calcinose/etiologia , Idoso , Glaucoma/cirurgia , Glaucoma/etiologia , Implante de Lente Intraocular/efeitos adversos , Complicações Pós-Operatórias/etiologiaRESUMO
In modern ophthalmic surgery, an intraocular lens (IOL) is commonly implanted into the patient's eye with an IOL injector. Many injectors are available, showing various technological differences, from the early manually loaded injector systems to the modern preloaded injectors. This review aims to give a concise overview of the defining characteristics of injector models and draws attention to complications that may occur during IOL implantation. One can differentiate injectors according to their preoperative preparation (manually loaded or preloaded), their implantation mechanism (push-type or screw-type or combined or automated), the size of the nozzle tip, the presence of an insertion depth control feature, and the injector's reusability. Potential complications are IOL misconfigurations such as a haptic-optic adhesion, adherence of the IOL to the injector plunger, an overriding plunger, uncontrolled IOL rotation, a trapped trailing haptic, or damage to the IOL. Additionally, during IOL implantation, the nozzle can become damaged with scratches, extensions, cracks, or bursts to the tip. While these complications rarely produce long-term consequences, manufacturers should try to prevent them by further improving their devices. Similarly, surgeons should evaluate new injectors carefully to ensure the highest possible surgical safety.
Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Humanos , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Desenho de Equipamento , Análise de Falha de Equipamento , Desenho de PróteseRESUMO
Background/Objectives: To evaluate how the surgical technique and type of implanted intraocular lens influence the postoperative visual acuity and complications in ectopia lentis associated to Marfan syndrome patients. Materials and Methods: The medical records and videos of ectopia lentis surgeries in patients (children and adults) with Marfan syndrome, were retrospectively reviewed and compared. The study included 33 eyes that underwent four different intraocular lens implantation (IOL) techniques: IOL in conjunction with a simple capsular tension ring, IOL in conjunction with a Cionni modified capsular tension ring (m-CTR), two-point scleral IOL fixation and IOL with one haptic in the bag and one haptic sutured to the sclera. Results: Vision significantly improved from a mean preoperative visual acuity of 0.1122 to a mean postoperative visual acuity of 0.4539 in both age groups (p < 0.0001), with no difference in the primary outcome between children and adults. The most common surgical technique used in both age groups was IOL in conjunction with an m-CTR. There was only one major postoperative complication requiring additional surgery. Conclusions: Zonular weakness mainly influenced by age was the most important selection criterion for the surgical approach. Regardless of the technique employed, the postoperative visual acuity was improved in both adults and children.
Assuntos
Ectopia do Cristalino , Implante de Lente Intraocular , Síndrome de Marfan , Acuidade Visual , Humanos , Síndrome de Marfan/complicações , Síndrome de Marfan/cirurgia , Síndrome de Marfan/fisiopatologia , Ectopia do Cristalino/cirurgia , Ectopia do Cristalino/etiologia , Adulto , Criança , Feminino , Masculino , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Adolescente , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , Pré-Escolar , Adulto JovemRESUMO
Comments about endothelial cell loss after posterior chamber phakic intraocular lens are provided, with a particular emphasis on the importance of determining progressive postoperative cell density reduction, excluding that related to surgical trauma.
Assuntos
Perda de Células Endoteliais da Córnea , Endotélio Corneano , Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Humanos , Lentes Intraoculares Fácicas/efeitos adversos , Perda de Células Endoteliais da Córnea/etiologia , Perda de Células Endoteliais da Córnea/diagnóstico , Endotélio Corneano/patologia , Contagem de Células , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Miopia/cirurgia , Acuidade VisualRESUMO
PURPOSE: Phakic intraocular lenses treat higher degrees of myopia not possible previously with conventional refractive surgery. The aim of this study is to report the incidence and risk factors of retinal complications after posterior chamber PIOL implantation and assess the differences in biometric parameters between patients who developed such complications versus those who did not. METHODS: This retrospective study recruited 514 patients who underwent ICL implantation to correct myopia at a tertiary eye hospital center in the Eastern province of Saudi Arabia. Follow up period was at least one year. Medical records of the patients were reviewed to obtain the required data. Associations between respondents' characteristics and retinal complications were evaluated using the Chi-squared test. RESULTS: The mean (SD) age was 27.7 (± 6.5) years ranging from 18 to 47. Laser treatment was performed in 14 cases (2.7%). Retinal complications occurred in six cases (1.2%). The risk of retinal complication was significantly higher among patients with high axial length (OR = 1.3, 95% CI 1.2, 1.4) and patients with high pre-spherical equivalent before ICL (OR = 1.09, 95% CI 1.03, 1.4). CONCLUSION: Patients with higher axial length and higher pre-spherical equivalent before ICL implantation are at high risk of retinal complications.
Assuntos
Miopia , Lentes Intraoculares Fácicas , Humanos , Adulto Jovem , Adulto , Implante de Lente Intraocular/efeitos adversos , Acuidade Visual , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Refração Ocular , Miopia/epidemiologia , Miopia/cirurgia , Miopia/etiologia , Lentes Intraoculares Fácicas/efeitos adversos , Hospitais , SeguimentosRESUMO
PURPOSE: To clarify the characteristics of intraocular lens (IOL) dislocation requiring IOL suture or intraocular scleral fixation. METHODS: This retrospective consecutive case series included 21 eyes (21 patients) who required sutured or sutureless intrascleral IOL fixation following IOL extraction owing to IOL dislocation at the outpatient clinic in the Department of Ophthalmology, Saitama Red Cross Hospital, Japan, between January and December 2019. Medical records were retrospectively reviewed for background diseases, location of the dislocated IOL (intracapsular/extracapsular), insertion of a capsular tension ring (CTR), and the period from IOL insertion to dislocation. RESULTS: We included 21 eyes of 21 patients who required IOL suture or intrascleral fixation for IOL dislocation at our clinic from January to December 2019 were included. The most common background disease was pseudoexfoliation syndrome (four cases), followed by atopic dermatitis, dysplasia/dehiscence of the zonule, post-retinal detachment surgery, high myopia, and uveitis (three cases each). At the time of dislocation, the IOLs were either intracapsular (16 cases, including 3 cases with CTR insertion) or extracapsular (5 cases). The time from IOL insertion to IOL dislocation was 13.7 ± 8.1 years (maximum: 31.3 years, minimum: 1.7 years). CONCLUSIONS: In this study, all 21 cases represented late IOL dislocations occurring after 3 months postoperatively. Among these late IOL dislocation cases, IOL dislocation occurred in a short-medium period of time, especially in those with CTR insertion and weakness/dehiscence of the zonule, with an average of 3 to 5 years postoperatively. We propose referring to these cases as intermediate-term IOL dislocation.
Assuntos
Migração do Implante de Lente Intraocular , Lentes Intraoculares , Humanos , Estudos Retrospectivos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Migração do Implante de Lente Intraocular/cirurgia , Migração do Implante de Lente Intraocular/etiologia , Migração do Implante de Lente Intraocular/diagnóstico , Lentes Intraoculares/efeitos adversos , Idoso de 80 Anos ou mais , Fatores de Tempo , Acuidade Visual , Adulto , Esclera/cirurgia , Técnicas de Sutura , Seguimentos , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Complicações Pós-OperatóriasRESUMO
PURPOSE: To determine the incidence, risk factors and clinical outcomes in patients with nucleus drop (ND) following phacoemulsification surgery at a tertiary care ophthalmic institute. METHODS: Medical records of patients with ND during phacoemulsification between January'2019 and December'2022 were reviewed retrospectively. Incidence of ND was calculated overall, and according to surgical expertise levels and surgical steps. Associated pre- and intra-operative risk factors were assessed. Clinical outcome parameters [best-corrected visual acuity (BCVA) and intraocular pressure (IOP)] were compared with respect to timing of PPV (immediate vs early vs delayed), location (sulcus vs scleral fixated-IOL) and timing of IOL placement (primary vs secondary). RESULTS: Among 93,760 phacoemulsifications, ND was noted in 130 patients (0.1%). Significant direct and associated pre-operative risk factors were advanced cataract, glaucoma, posterior polar cataract, and diabetes mellitus. Junior medical consultants had 40 ND (mostly in non-complex cases), whereas senior medical consultants had 90 ND (mostly in complex cases). ND most frequently occurred during emulsification of nuclear fragments. Sulcus placement of IOL during primary surgery yielded significantly better visual outcome compared to secondary procedures, although timing of PPV had insignificant effect. 77.1% had BCVA of 6/12 or better at final follow-up. Timing of IOL implantation, PPV, and type of IOL did not have any significant effect on IOP. CONCLUSIONS: Though the incidence of ND is low, it is a dreaded complication. Accurate pre-operative evaluation, risk stratification, distribution of cases among surgeons based on their surgical expertise, and immediate or early management of ND yields better anatomical and functional outcomes.
Assuntos
Pressão Intraocular , Facoemulsificação , Complicações Pós-Operatórias , Acuidade Visual , Humanos , Facoemulsificação/efeitos adversos , Masculino , Incidência , Feminino , Estudos Retrospectivos , Fatores de Risco , Idoso , Complicações Pós-Operatórias/epidemiologia , Pressão Intraocular/fisiologia , Pessoa de Meia-Idade , Seguimentos , Idoso de 80 Anos ou mais , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversosRESUMO
PURPOSE: To report the long term visual outcomes and complications with use of the novel CM-T Flex scleral fixated intraocular lens (CMT-SFIOL). MATERIALS AND METHODS: 116 eyes that underwent CMT-SFIOL were reviewed and 57 eyes with CMT-SFIOL that completed a 2-year follow-up were included. Main outcome measures noted were best-corrected visual acuity (BCVA) and complications. Postoperatively, follow-ups were done at 1 week (1w), 1 month (1 m), 1 year (1y) and 2-year (2y) intervals. RESULTS: 40 (70.17%) of 57 eyes received CMT-SFIOL for surgical aphakia. Mean follow up was 39.77 ± 8.44 months. BCVA for distance & near improved from 1.26 ± 0.84 to 0.76 ± 0.77, 0.50 ± 0.72 and 0.51 ± 0.73 & 1.28 ± 0.58 to 0.98 ± 0.49, 0.92 ± 0.44 and 0.89 ± 0.40 at 1 m, 1y and 2y respectively (p < 0.001 for all). At 1w, 10 eyes (17.54%) had corneal edema (CE) and 8 eyes (14.03%) had anterior chamber (AC) reaction. Two eyes (3.50%) had IOP > 30 mm Hg and 1 eye (1.75%) had vitreous hemorrhage (VH). At 1 m, 3 eyes (5.26%) had CE and 5 eyes (8.77%) had AC reaction. Two eyes (3.50%) had IOP > 30 mm Hg and 1 eye (1.75%) had VH. Cystoid macular edema was noted in 3 eyes (5.26%). At 1y and 2y, 2 eyes (3.5%) and 1 eye (1.75%), had CE. No decentration, dislocation, haptic exposure or retinal detachment was noted. No eyes required resurgery. CONCLUSION: CM-T Flex SFIOL is an effective method to correct aphakia, with reliable and safe long-term results.
Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Desenho de Prótese , Esclera , Acuidade Visual , Humanos , Feminino , Masculino , Esclera/cirurgia , Lentes Intraoculares/efeitos adversos , Pessoa de Meia-Idade , Seguimentos , Estudos Retrospectivos , Idoso , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Adulto , Complicações Pós-Operatórias/epidemiologia , Idoso de 80 Anos ou mais , Fatores de Tempo , Resultado do Tratamento , Afacia Pós-Catarata/cirurgia , Afacia Pós-Catarata/fisiopatologiaRESUMO
PURPOSE: To evaluate the magnitude of IOL transversal shift (ITS) after phacoemulsification and to analyse the factors contributing to IOL decentration and ITS. METHODS: 94 consecutive patients who underwent cataract surgery and IOL implantation was enrolled. Each patient underwent anterior segment optical coherence tomography with CASIA 2 (Tomey, Nagoya, Japan) to assess crystalline lens decentration, thickness and diameter seven days preoperatively and at one and sixty days postoperatively. Univariate and multivariate linear regression analysis were performed to evaluate the determinants of ITS and final decentration. RESULTS: The preoperative crystalline lens diameter was associated with the ITS and with the IOL final decentration. A positive association between the final IOL decentration and the first post-surgical day decentration was found (p < 0.0001). CONCLUSION: Greater crystalline lens diameter was associated with greater decentration and with greater ITS. Day-one IOL decentration seems to be the main determinant of final IOL decentration.
Assuntos
Segmento Anterior do Olho , Facoemulsificação , Tomografia de Coerência Óptica , Humanos , Facoemulsificação/efeitos adversos , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Idoso , Segmento Anterior do Olho/diagnóstico por imagem , Lentes Intraoculares/efeitos adversos , Pessoa de Meia-Idade , Acuidade Visual , Idoso de 80 Anos ou mais , Migração do Implante de Lente Intraocular/diagnóstico , Migração do Implante de Lente Intraocular/etiologia , Implante de Lente Intraocular/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Cristalino/diagnóstico por imagem , Estudos ProspectivosRESUMO
PURPOSE: This retrospective study investigated the impact of corneal parameters on surgically induced astigmatism (SIA) in eyes with prior myopic correction undergoing cataract surgery. SETTING: Department of Ophthalmology, San Marino Hospital, San Marino, Republic of San Marino. DESIGN: This case-control study analyzed existing data retrospectively, without randomization or masking. METHODS: Eighty eyes divided in group 1 (40 eyes previous underwent refractive surgery for myopia) and group 2 ( 40 myopic eyes) that underwent cataract surgery with intraocular lens (IOL) implantation were included. SIA was calculated using values from the IOL Master Zeiss 700 and mean pupil power (MPP) derived from the CSO Sirius Topographer (based on 3 mm pupil size) with vectorial analysis from doctor Hill software. RESULTS: No significant difference in SIA was observed between eyes with prior myopic photorefractive keratectomy and the control group (p > 0.05). SIA calculations using the IOL Master and CSO Sirius Tomographer yielded similar results. There was no significant correlation between SIA and axial length, corneal curvature, peripheral corneal thickness, or anterior chamber depth (p > 0.05). However, an inverse correlation was found between SIA and horizontal corneal diameter (p < 0.05). CONCLUSIONS: Corneal parameters, such as axial length, corneal curvature, peripheral corneal thickness, and anterior chamber depth, showed no significant influence on SIA. The inverse correlation between SIA and horizontal corneal diameter in study group suggests potential influence of white-to-white distance on SIA. These findings highlight the importance of considering corneal parameters for optimizing surgical outcomes.
Assuntos
Astigmatismo , Córnea , Topografia da Córnea , Miopia , Humanos , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Astigmatismo/diagnóstico , Estudos Retrospectivos , Masculino , Feminino , Miopia/cirurgia , Miopia/fisiopatologia , Córnea/patologia , Córnea/cirurgia , Córnea/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos de Casos e Controles , Topografia da Córnea/métodos , Idoso , Extração de Catarata/efeitos adversos , Acuidade Visual , Implante de Lente Intraocular/efeitos adversos , Refração Ocular/fisiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Facoemulsificação/efeitos adversosRESUMO
Posterior chamber phakic intraocular lens implantation is a type of intraocular surgery. With advancements in implant materials and design, this procedure has seen rapid adoption and widespread use in ophthalmology clinics in recent years. However, the changes in surgical techniques and the occurrence of postoperative complications have raised safety concerns that require significant attention in clinical practice. This paper aims to address the key factors influencing the safety of posterior chamber phakic intraocular lens implantation, exploring relevant characteristics, mechanisms, and current challenges. By emphasizing the importance of this surgery and proposing effective measures, it aims to provide guidance for clinical practice, enhance the safety of posterior chamber phakic intraocular lens implantation, and foster the healthy advancement of this surgical technique.
Assuntos
Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Complicações Pós-Operatórias , Humanos , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Miopia/cirurgiaRESUMO
Congenital subluxation of the lens as a complication of Marfan syndrome, Weill-Marchesani syndrome, microspherophakia, etc. leads to the development of amblyopia and requires timely surgical treatment with removal of the subluxated lens and implantation of an artificial intraocular lens (IOL). IOL implantation in children with pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery due to the lack of a consensus regarding the IOL fixation method among practitioners. PURPOSE: This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation. MATERIAL AND METHODS: The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated. RESULTS: All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors. CONCLUSIONS: The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.
Assuntos
Implante de Lente Intraocular , Subluxação do Cristalino , Lentes Intraoculares , Esclera , Acuidade Visual , Humanos , Masculino , Feminino , Subluxação do Cristalino/cirurgia , Subluxação do Cristalino/etiologia , Subluxação do Cristalino/diagnóstico , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Pré-Escolar , Lentes Intraoculares/efeitos adversos , Esclera/cirurgia , Técnicas de Sutura , Resultado do Tratamento , Criança , Complicações Pós-Operatórias/etiologiaRESUMO
Background and Objectives: Posterior capsular opacification (PCO) is the most common long-term complication of successful cataract surgery and can cause visual impairment. We aimed to investigate the effects of intraocular lens (IOL) characteristics on PCO by comparing the incidence of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy for different types of intraocular lenses. Materials and Methods: A retrospective analysis was performed on 2866 eyes that underwent cataract surgery between January 2010 and December 2017, with at least 5 years of follow-up. The IOLs used for surgery were the hydrophobic lenses SN60WF (Alcon, Fort Worth, TX, USA), ZCB00 (Johnson & Johnson Vision, Santa Ana, CA, USA), and MX60 (Bausch & Lomb, Rochester, NY, USA), and the hydrophilic lens MI60 (Bausch & Lomb, Rochester, NY, USA). We analyzed the incidence of Nd:YAG laser capsulotomy according to the type of IOL used. Results: The incidence of Nd:YAG laser capsulotomy was significantly higher with MI60 lenses (31.70%, 175/552 eyes) compared to SN60WF (7.90%, 113/1431 eyes), ZCB00 (10.06%, 64/636 eyes), and MX60 (10.57%, 13/123 eyes; p < 0.001) lenses. The incidence of Nd:YAG laser capsulotomy was significantly lower with the hydrophobic IOLs (8.68%, 190/2190 eyes) than with the hydrophilic IOL (31.70%, 175/552 eyes; p < 0.001). Over time, the rate of increase in the cumulative number of Nd:YAG laser capsulotomy cases was the highest with MI60. The cumulative rate of Nd:YAG laser capsulotomy during the first 3 years was 4.90% with SN60WF (70/1431 eyes), 6.76% with ZCB00 (43/636 eyes), 8.94% with MX60 (11/123 eyes), and 26.10% with MI60 (144/552 eyes) lenses. Conclusions: The incidence of PCO is influenced by the material of the IOLs. The hydrophilic IOL was associated with a higher rate of Nd:YAG laser capsulotomy than the hydrophobic IOLs, with a shorter time to Nd:YAG laser capsulotomy.
Assuntos
Opacificação da Cápsula , Catarata , Lasers de Estado Sólido , Lentes Intraoculares , Facoemulsificação , Humanos , Implante de Lente Intraocular/efeitos adversos , Lasers de Estado Sólido/efeitos adversos , Incidência , Estudos Retrospectivos , Lentes Intraoculares/efeitos adversos , Opacificação da Cápsula/epidemiologia , Opacificação da Cápsula/etiologia , Opacificação da Cápsula/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Catarata/etiologia , Facoemulsificação/efeitos adversosRESUMO
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.