ABSTRACT
PURPOSE: To compare the anterior lens capsulotomy edge tear strength created by manual continuous curvilinear capsulorhexis (CCC), femtosecond laser capsulotomy (FSLC), and a new automated precision pulse capsulotomy (PPC) device. DESIGN: A 3-arm study in paired human cadaver eyes. PARTICIPANTS: A total of 44 eye specimens from 22 donors in the United States. METHODS: Capsulotomy was performed in all eye specimens using manual CCC, a femtosecond laser (LenSx, Alcon, Fort Worth, TX), or an automated PPC device (Zepto, Mynosys Inc., Fremont, CA). The first study arm consisted of 8 pairs of eyes in which 1 eye received PPC and the fellow eye received FSLC. The second study arm consisted of 8 pairs of eyes, with 1 eye receiving PPC and the fellow eye receiving manual CCC. The third study arm consisted of 6 pairs of eyes, with 1 eye receiving a manual CCC and the fellow eye receiving FSLC. After phacoemulsification, 2 capsulotomy edge retractors attached to force transducers were used to stretch the capsulotomy edge of each eye and to measure the resisting force until the capsulotomy edge was torn. MAIN OUTCOME MEASURES: Capsulotomy edge tear strength in millinewtons. RESULTS: The PPC edge tear strength was greater than that of FSLC for all 8 pairs of eyes by an average factor of 3.1-fold (PPC mean 73.3±24.9 mN vs. femtosecond laser mean 26.1±6.8 mN; P = 0.012, Wilcoxon matched-pairs, signed-ranks test). The PPC tear strength was greater than that of manual CCC for all 8 pairs of eyes by an average factor of 4.1-fold (PPC mean 95±35.2 mN vs. manual CCC mean 29.1±23.1 mN; P = 0.012, Wilcoxon matched-pairs signed-ranks test). There was no significant difference in the tear strength of capsulotomies produced by manual CCC (mean 21.3±4.9 mN) and FSLC (mean 24.5±11.4 mN) (P = 0.75, Wilcoxon matched-pairs signed-ranks test). CONCLUSIONS: The strength of the PPC capsulotomy edge was significantly stronger than that produced by femtosecond laser or manual CCC.
Subject(s)
Anterior Capsule of the Lens/surgery , Capsulorhexis/methods , Elasticity/physiology , Laser Therapy/methods , Tensile Strength/physiology , Aged , Anterior Capsule of the Lens/physiology , Female , Humans , Laser Therapy/instrumentation , Male , Middle Aged , Phacoemulsification , Tissue DonorsABSTRACT
PURPOSE: To report two cases of spontaneous, late-onset haptic disinsertion from a three-piece posterior chamber intraocular lens (IOL). DESIGN: Interventional case reports. METHODS: Two eyes of two patients had uncomplicated phacoemulsification and presented 16 and 20 years after surgery with spontaneous, nontraumatic haptic disinsertion from a three-piece IOL. RESULTS: In one case, the disinserted haptic dislocated into the anterior chamber while the IOL optic-single haptic complex remained centered and supported within the capsular bag. Cystoid macular edema was present, but resolved after removal of the disinserted haptic. In the second case, the disinserted haptic remained within the capsular bag while the IOL optic dislocated into the anterior chamber. Removal of the IOL and exchange with a sulcus-fixated single piece IOL was required. CONCLUSIONS: Nontraumatic haptic disinsertion from a three-piece IOL is a rare long-term complication after phacoemulsification.
Subject(s)
Anterior Chamber/pathology , Foreign-Body Migration/etiology , Lenses, Intraocular , Postoperative Complications , Aged , Device Removal , Female , Foreign-Body Migration/surgery , Humans , Lens Implantation, Intraocular , Male , Phacoemulsification , ReoperationABSTRACT
Amyloidosis is a term to describe extracellular deposition of insoluble beta-fibrillar proteins. Here we describe a patient who was confirmed to have amyloidosis after right heart biopsy and was found to have DNA change 114T > A (codon change D18E). Ophthalmic examination showed increasing vitreous sheet-like opacities in the left eye and she subsequently underwent vitrectomy. The vitrectomy specimen was confirmed to have amyloid involvement. To our knowledge this is the first report of vitreous involvement of a patient with the Asp18Glu mutation of the transthyretin (TTR) gene with DNA change 114T > A.
Subject(s)
Amyloidosis/genetics , Eye Diseases/genetics , Point Mutation/genetics , Prealbumin/genetics , Vitreous Body/pathology , Amyloidosis/pathology , Eye Diseases/pathology , Female , Humans , Middle Aged , VitrectomyABSTRACT
CASE REPORT: A 59-year-old patient with a coexisting primary choroidal melanoma and colorectal cancer was treated with external beam radiation (EBR) of his choroidal melanoma and systemic chemotherapy with leukovorin/5 fluorouracil (FU) for treatment of his metastatic colorectal cancer. Eight months following EBR, he showed evidence of radiation retinopathy with macular edema. Optical coherence tomography (OCT) showed macular edema and subretinal fluid. Subsequently, systemic bevacizumab (5 mg/kg) was added to his leukovorin/5FU chemotherapy. After the addition of bevacizumab, OCT showed complete resolution of the macular edema and subretinal fluid. COMMENTS: Bevacizumab may have a role in the treatment of radiation retinopathy, but further investigation is needed before any definitive conclusions can be made.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Choroid Neoplasms/radiotherapy , Colonic Neoplasms/drug therapy , Macular Edema/etiology , Melanoma/radiotherapy , Radiation Injuries/complications , Adult , Antibodies, Monoclonal, Humanized , Antimetabolites, Antineoplastic/therapeutic use , Bevacizumab , Choroid Neoplasms/pathology , Colonic Neoplasms/pathology , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/pathology , Fluorouracil/therapeutic use , Follow-Up Studies , Humans , Leucovorin/therapeutic use , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Macular Edema/drug therapy , Macular Edema/pathology , Male , Melanoma/pathology , Neoplasms, Second Primary/drug therapy , Neoplasms, Second Primary/pathology , Neoplasms, Second Primary/radiotherapy , Radiation Injuries/drug therapy , Radiation Injuries/pathology , Radiotherapy/adverse effects , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A , Vitamin B Complex/therapeutic useABSTRACT
BACKGROUND AND OBJECTIVE: To compare astigmatism after suture removal in a retrospective sequential series of patients who had penetrating keratoplasty with either a double running suture technique or an adjustable single running suture technique. During the first year postkeratoplasty, when sutures were in place, the latter technique had produced less astigmatism. MATERIALS AND METHODS: Keratometry and keratometric astigmatism were measured before and after suture removal. We compared these variables in 30 grafts with the double running suture technique to the same variables in 24 grafts with the single running suture technique. RESULTS: The final portion of the double running suture was removed 408 +/- 177 (mean +/- SD) days after keratoplasty, whereas the single running suture was removed 611 +/- 224 days after keratoplasty (P<0.001). After suture removal, there was no difference between the double running and single running groups in either mean keratometry [46.5 +/- 1.8 diopters (D) versus 45.6 +/- 2.0 D, P=0.09, minimum detectable difference (MDD)=1.5D] or mean astigmatism (4.6 +/- 2.7 D versus 5.2 +/- 3.2D, P=0.72, MDD=2.3). CONCLUSION: In this consecutive series of corneal transplants performed by one surgeon, the results suggest no difference in astigmatism between the two suturing techniques after all sutures have been removed.