Lens subluxation combined with parry-romberg syndrome: case report.

BACKGROUND: Parry-Romberg syndrome (PRS) is a rare progressive degenerative disorder of unknown etiology. Here we report a rare case of PRS combined with lens subluxation in Eye and ENT hospital of Fudan University, Shanghai. To our knowledge, it is the first reported case of PRS combined with lens subluxation that has been managed surgically with phacoemulsification and CTR placement and IOL implantation in Shanghai. CASE PRESENTATION: A 60-year-old woman was referred for "right visual blur for 2 years" and had persistent right facial paralysis of unknown etiology since the age 12. She had right facial muscle atrophy and paralysis. Eye examination also showed the right eyelid pseudoptosis, enophthalmos, age-related cataract combined with lens subluxation existed in the right eye. The patient was diagnosed as age-related cataract and lens subluxation in the right eye and progressive hemifacial atrophy (Parry-Romberg syndrome). We conducted a combined phacoemulsification, IOL and CTR implantation and pupilloplasty surgery for the patient under general anesthesia and the postoperative UCVA was 20/30 and remained for 1 year's follow up. CONCLUSIONS: Here we reported a rare case of PHA combined with lens subluxation in China. After appropriate eye surgery, the patient achieved satisfying vision result in the right eye.

Zonular fibre Insertion-to-Limbus Distance (ZLD): normative data to assess lens position and diagnose ectopia lentis.

PURPOSE: Subluxation of the crystalline lens (Ectopia Lentis, EL) can lead to significant visual impairment and serves as a diagnostic criterion for genetic disorders such as the Marfan syndrome. There is no established criterion to diagnose and quantify EL. We prospectively investigated the distance between the zonular fibre insertion and the limbus (ZLD) in healthy subjects as a parameter to assess the position of the lens, quantify EL and provide normative data. METHODS: This prospective, observational, cross-sectional study includes one-hundred-fifty eyes of 150 healthy participants (mean age 28 years, range 4-68). Pupils were dilated with tropicamide 0.5% and phenylephrine 2.5% eyedrops. ZLD was measured in mydriasis at the slit lamp as the distance between the most central visible insertions of the zonular fibres on the lens surface and the corneoscleral limbus. Vertical pupil diameter (PD) and refractive error were recorded. If zonular fibre insertions were not visible, the distance between limbus and the pupillary margin was recorded as ZLD. RESULTS: 145 right and 5 left eyes were examined. 93% of study subjects were Caucasian, 7% were Asian. In eyes with visible zonular fibre insertions (n = 76 eyes), ZLD was 1.30 ± 0.28 mm (mean ± SD, range 0.7-2.1) and PD was 8.79 ± 0.57 mm (7.5-9.8). In the remaining 74 eyes, ZLD was 1.38 ± 0.28 mm (0.7-2.1), and PD was 8.13 ± 0.58 mm (6.7-9.4). For all eyes, ZLD was 1.34 ± 0.29 mm (0.7-2.1), and PD was 8.47 ± 0.66 mm (6.7-9.8). Refractive error and sex did not significantly affect ZLD. Smaller PD and older age were associated with larger ZLD (P < 0.001 and P = 0.036, respectively). CONCLUSION: Average ZLD was 1.34 mm in eyes of healthy subjects. Older age correlated with larger ZLD. These normative data will aid in diagnosing and quantifying EL.

[Transscleral fixation of intraocular lens in the treatment of lens subluxation in children]. / Transskleral'naya fiksatsiya intraokulyarnoi linzy v lechenii sublyuksatsii khrustalika u detei.

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.

Traction suture fixation technique using a capsular tension ring fragment for severe lens displacement during cataract surgery in dogs.

OBJECTIVES: To describe the traction suture fixation technique for severely displaced lenses (≥180°) using a capsular tension ring (CTR) fragment during cataract surgery in dogs, and to retrospectively investigate its clinical outcomes. ANIMALS STUDIED: Eight dogs (nine eyes). PROCEDURES: The medical records of dogs with severe lens displacement (≥180°) due to cataracts that underwent traction suture fixation during cataract surgery using a CTR fragment at the Grand Animal Hospital (Hyogo, Japan) between November 2019 and September 2022 were retrospectively reviewed. The retrieved data included the signalment, type of CTR, and postoperative outcomes. RESULTS: A single CTR fragment was used to fix the capsular bag to the sclera in six eyes, and two CTR fragments were used at two sites in three eyes. The lengths of the CTR fragments used were 1 one-fifth fragment, 3 one-fourth fragments, and 8 one-third fragments. Postoperative complications included uveitis (nine eyes), glaucoma (one eye), posterior iris adhesion (one eye), corneal ulcer (one eye), and intracorneal stromal hemorrhage (one eye). Vision was maintained in all dogs during the follow-up period (2 months to 2 years and 8 months) without recurrent capsular bag displacement. CONCLUSIONS: This technique can correct and stabilize capsular bag displacement relatively easily through a small incision during cataract surgery in dogs with severe lens displacement. Intraocular lens implantation was also possible.

[Phaco surgery in disorders of the capsular-zonular apparatus of the lens]. / Fakokhirurgiya pri narusheniyakh svyazochno-kapsulyarnogo apparata khrustalika.

The article presents authors' original methods of phaco surgery that can be used in disorders of the capsular-zonular apparatus of the lens. The cataract surgery techniques for lens subluxation developed and introduced into clinical practice allow using the most physiologically correct intracapsular intraocular lens (IOL) fixation in the vast majority of cases. The introduction of femtosecond laser at key stages of phacoemulsification in complicated clinical situations reduces the dependence of the results on the human factor and allows performing removal of complicated cataracts at a qualitatively new level.

Zonular defects in loxl1-deficient zebrafish.

BACKGROUND: To investigate the roles of the lysyl oxidase-like 1 (loxl1) gene in zebrafish eye development and the potency of loxl1 deficiency in mimicking the ocular manifestations of exfoliation syndrome (XFS). METHODS: CRISPR/Cas9 technology was used to generate a frameshift coding deletion in zebrafish loxl1. Expression profiles and ocular manifestations of the wildtype, heterozygous mutant (loxl1+/- ) and homozygous mutant (loxl1-/- ) zebrafish were analysed in a range of developmental stages from zebrafish larvae to dissected adult zebrafish eyes. RESULTS: The loxl1 deficiency caused zonular bundling disorders in juvenile zebrafish and accumulation of pearl-like particles adhering to the adult zebrafish zonule. The bundles appeared to lack form and were thinner in both loxl1+/- and loxl1-/- zebrafish compared with the wildtype (p < 0.01 for all Bonferroni post-hoc analyses). The zonule of loxl1-/- zebrafish appeared stretched, ragged and torn, with isolated fibres also detected. The particles in loxl1-/- zebrafish were more numerous (counts: 92.33 ± 10.02/100 µm2 vs. 58.33 ± 5.03/100 µm2 , p = 0.006), but smaller in size (diameter: 0.21 ± 0.03 µm vs. 0.43 ± 0.04 µm, p = 0.002) compared with those in loxl1+/- . Transmission electron microscopy revealed thinning or even loss of elastic lamina in loxl1+/- Bruch's membrane (BM) (thickness of elastic lamina: 92.94 ± 18.19 nm in the wildtype vs 35.65 ± 14.76 nm in loxl1+/- , p = 0.003). The breakage of BM was observed in loxl1-/- . CONCLUSIONS: The loxl1-/- zebrafish is a promising animal model of XFS zonular pathology.

Trans-optic suture fixation of malpositioned intraocular lenses.

PURPOSE: To report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens material. METHODS: Cases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit-lamp examination. RESULTS: Fourteen cases were included in this series. In nine cases, the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In five cases, this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases, the lenses remained centered and stable at the end of follow-up, and no post-operative complications occurred. CONCLUSION: Trans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.

[Refractive outcomes of out-of-the-bag intraocular lens implantation]. / Refraktsionnye rezul'taty vnekapsul'noi implantatsii intraokulyarnykh linz.

For the moment, the refractive outcomes of out-of-the-bag intraocular lens (IOL) implantation remain insufficiently studied. PURPOSE: To study and compare the refractive outcomes of retropupillary implantation of an iris-claw lens and transscleral suture fixation of IOL in complicated phacoemulsification. MATERIAL AND METHODS: The study included 70 patients (73 eyes) after complicated phacoemulsification in combination with grade 2 lens subluxation. The first group included 36 patients (39 eyes) who underwent complicated phacoemulsification using torsional ultrasound and retropupillary implantation of an iris-claw lens. The second group included 34 patients (34 eyes) after complicated phacoemulsification using torsional ultrasound and transscleral suture fixation of an elastic hydrophobic IOL. In the postoperative period we performed a comparative evaluation of uncorrected visual acuity and best corrected visual acuity, the average absolute error of IOL optical power calculation, the precision of postoperative refraction within ±0.5 diopters, the degree of induced astigmatism, and the tilt of the IOL. RESULTS: At three months after surgery uncorrected visual acuity of 0.8-1.0 was achieved in 33.3% of cases in the first group and 17.6% in the second group, the average absolute error of IOL optical power calculation was 0.34±0.08 diopters in the first group and 0.63±0.19 diopters in the second group, the precision of postoperative refraction within ±0.5 diopters was 94.9% in the first group and 85.3% in the second group, the tilt of the IOL was 0.69±0.21° in the first group and 3.19±0.97° in the second group (p<0.05). There were no significant differences in best corrected visual acuity and the degree of induced astigmatism 3 months after surgery. CONCLUSION: Implantation of an iris-claw lens in the course of complicated phacoemulsification in lens subluxation significantly improves refractive outcomes of the implantation in comparison with transscleral IOL fixation.

Primary scleral-fixated posterior chamber intraocular lenses in patients with congenital lens subluxation.

OBJECTIVE: We investigated the long-term visual outcomes and ocular complications of primary scleral-fixated posterior chamber intraocular lenses (SF-PC-IOLs) in patients with congenital lens subluxation. METHODS: We enrolled 53 patients (77 eyes) with congenital lens subluxation caused by ectopia lentis, Marfan syndrome, and Weill-Marchesani syndrome who underwent primary implantation of a SF-PC-IOL. All patients underwent a complete ophthalmic examination include visual acuity (VA), intraocular pressure (IOP), intraocular lenses (IOL) position, intraoperative complications and postoperative complications. Cox regression analysis and survival analysis were used to evaluate the risk factors for postoperative complications. RESULTS: Seventy seven eyes from 53 patients were included. Mean age at surgery was 23 ± 20 years (5 to 67 years), with a mean follow-up of 39 ± 27 months (12 to 130 months). The best-corrected VA improved from 0.84 ± 0.55 to 0.26 ± 0.43 logarithms of the minimum angle of resolution (p < 0.001). Best-corrected VA improved postoperatively in 73 eyes (94%). The main causes of reduced vision after surgery were retinal pathologies and amblyopia. Complications included transient intraocular haemorrhage (2 eyes, 2.6%), early vitreous incarceration (2 eyes, 2.6%), retinal detachment (6 eyes, 7.8%) and IOL dislocation (3 eyes, 3.9%). Cox regression showed that postoperative eye trauma was a risk factor for long-term postoperative complications. CONCLUSION: SF-PC-IOLs provide good visual outcomes in patients with congenital lens subluxation. The SF-PC-IOLs showed good stability, except in patients suffering from postsurgical eye trauma.

[Optimization of phacoemulsification in complicated cataract with lens subluxation]. / Optimizatsiya tekhnologii fakoemul'sifikatsii pri oslozhnennoi katarakte s podvyvikhom khrustalika.

Purpose - to optimize the process of phacoemulsification in patients with cataract complicated by degree I-II lens subluxation by using the scaffold technique, and to determine the indications for its application. MATERIAL AND METHODS: The patients were divided into two groups: group 1 - the main group - included 29 patients (29 eyes; 47.54%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using the scaffold technique. Group 2 - the comparison group - included 32 patients (32 eyes; 54.46%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using standard technique. RESULTS: Patients' visual acuity improved up to 0.53 (0.35; 0.80) in group 1, and up to 0.50 (0.45; 0.80) in group 2 by the time of hospital discharge. At 6 months and 1 year follow-ups, visual functions were equal, in group 1 - 0.70 (0.65; 0.80), in group 2 - 0.70 (0.60; 0.90). The number of intraoperative complications decreased from 8.20% in standard phacoemulsification to 1.64% in scaffold technique. The latter reduces endothelial cell loss by 1.95% in comparison with traditional phacoemulsification over 1 year follow-up. With the scaffold technique, the number of intraoperative complications decreased from 15.63% in group 2 to 3.45% in group 1, the number of postoperative complications - from 43.75% to 31.04%, respectively. CONCLUSION: The scaffold technique is indicated in pseudoexfoliation syndrome with weakness of zonular apparatus, degree I-II lens subluxation, in hard nucleus with absence of posterior cortical layer, in intumescent cataract, Morgagnian cataract to stabilize the posterior capsule and protect it from rupture.

[Surgical treatment of hypermature cataract in patients with lens subluxation and small pupil]. / Khirurgicheskoe lechenie perezreloi katarakty pri uzkom zrachke i podvyvikhe khrustalika.

Studying the possibilities of hybrid (femtosecond laser-assisted) phacoemulsification in complicated situations is a relevant problem in cataract surgery. PURPOSE: To develop a technique for hybrid (femtosecond laser-assisted) phacoemulsification in patients with a combination of hypermature cataract, small pupil and lens subluxation. MATERIAL AND METHODS: Hybrid (femtosecond laser-assisted) phacoemulsification of hypermature cataracts was performed in 36 patients (36 eyes) aged 63 to 78 years with grade I-II lens subluxation in combination with small pupil. The initial circular femtolaser capsulotomy was performed within the small pupil using the VICTUS system (Technolas Perfect Vision, Germany). After dilating the pupil with retractor hooks, the capsulorhexis was manually expanded to the required diameter. RESULTS: In all cases, the resulting capsulorhexis had a regular round shape with a smooth edge, without radial ruptures. This made it possible to apply modern methods of fixation and centration of the capsular bag in case of lens subluxation and to perform intracapsular implantation of an intraocular lens (IOL). Complete intracapsular fixation of the IOL with optics edge fully covered by the edge of the capsulorhexis in the postoperative period was achieved in 34 (94.4%) cases. In 2 (5.6%) cases in the postoperative period, the edge of the capsulorhexis exceeded the edge of the IOL optics. The loss of corneal endothelial cells 3 months after surgery was 8.8±1.9%. CONCLUSION: The use of the proposed combined technique of capsulorhexis made it possible to perform the most physiologically appropriate intracapsular IOL implantation in all patients with hypermature cataract, small pupil and lens subluxation.

[Femtosecond laser-assisted phacoemulsification of hypermature cataract in patients with lens subluxation]. / Femtolazernaya fakoemul'sifikatsiya perezreloi katarakty u bol'nykh s podvyvikhom khrustalika.

Studying the modern capabilities of femtosecond laser in the treatment of complicated cataracts is a topical problem in cataract surgery. PURPOSE: To develop a technique for femtosecond laser-assisted phacoemulsification of hypermature cataract in patients with degree I-II lens subluxation. MATERIAL AND METHODS: Phacoemulsification of hypermature cataract with comorbid lens subluxation was performed in 78 patients (78 eyes) divided into two groups. In the 1st group (45 eyes), capsulorhexis was performed using a femtosecond laser. Patients of the 2nd group (33 eyes) underwent manual capsulorhexis. The study assessed the possible frequency of using modern methods of capsular bag fixation and complete all-in-the-bag intraocular lens (IOL) implantation, as well as the number of various types of intraoperative capsular bag ruptures. RESULTS: In all patients of the 1st group, capsulorhexis of the correct round shape and the required diameter was achieved, allowing the use of modern methods of fixation and centering of the capsular bag. Insignificant tear of the edge of the capsulorhexis after IOL implantation was detected only in 1 (2.2%) patient. Vitreous prolapse was noted in 1 (2.2%) case. In the 2nd group, manual technique resulted in oval capsulorhexis with a smooth edge, allowing the use of modern methods of fixation of the capsular bag only in 7 (21.2%) cases. Vitreous prolapse was noted in 4 (12.1%) cases. The complete in-the-bag IOL implantation was possible in 44 (97.8%) cases in the 1st group and only in 7 (21.2%) in the 2nd group. CONCLUSION: The use of femtosecond laser in patients with hypermature cataract and lens subluxation allows achieving capsulorhexis of ideally round shape with a smooth edge. This creates the necessary conditions for the use of modern methods of fixation of the capsular bag and provides the possibility of complete all-in-the-bag IOL implantation.

[Results of hybrid (femtosecond laser-assisted) phacoemulsification of hypermature cataract in patients with lens subluxation]. / Rezul'taty gibridnoi (femtolazernoi) fakoemul'sifikatsii perezreloi katarakty pri podvyvikhe khrustalika.

Studying the use of femtosecond laser in patients with complicated cataracts remains a topical issue in phaco surgery. PURPOSE: To comparatively analyze the results of using hybrid (femtosecond laser-assisted) phacoemulsification in hypermature cataract in patients with lens subluxation. MATERIAL AND METHODS: The study included 78 patients (78 eyes) with hypermature cataract in combination with lens subluxation of I-II degree. In the 1st group (45 eyes) capsulorhexis was performed using a femtosecond laser. In the 2nd group (33 eyes) manual capsulorhexis was performed. RESULTS: On the first day after surgery, best corrected visual acuity of 0.8-1.0 was obtained in 57.8% of cases in the 1st group and 33.3% in the 2nd group. Transient corneal edema during the first 1-3 days was noted in 4.4% of cases in the 1st group and in 15.2% - in the 2nd group of patients. Pachymetry in the center of the cornea showed an increase in its thickness on the 1st day after surgery from 0.564±0.027 mm to 0.591±0.033 mm in the 1st group and from 0.561±0.023 mm to 0.637±0.043 mm (p<0.05) in the 2nd group of patients. The loss of corneal endothelial cells amounted to 10.9±1.8% in the 1st group and 17.4±2.9% in the 2nd group (p<0.05). Macular edema with decreased visual acuity confirmed by OCT was detected in the 1st group of patients in 2.2% of cases, in the 2nd group - in 9.1% of cases. With a follow-up period of up to 3 years, IOL optics decentration by more than 1 mm was detected in 2.2% of cases in the 1st group of patients and in 12.1% of cases in the 2nd group. CONCLUSION: Femtosecond laser-assisted capsulorhexis significantly improves the results of surgery in patients with hypermature cataract combined with lens subluxation.

[Optimization of intraocular lens power calculation in pseudoexfoliation syndrome]. / Optimizatsiya rascheta intraokulyarnykh linz pri psevdoeksfoliativnom sindrome.

PURPOSE: To assess the impact of pseudoexfoliation syndrome (PEX) on the accuracy of intraocular lens (IOL) power calculation. MATERIAL AND METHODS: The study included 243 patients who underwent phacoemulsification (PE); they were divided into the control (no PEX signs, n=131) and study (signs of PEX, n=112) groups. Barrett Universal II formula was used for IOL calculation by optical biometry (IOL-Master 500). Obtained refraction (autorefractometer Topcon-8800) was compared with target refraction to assess IOL calculation accuracy 1 month after PE. RESULTS: Patients with PEX had significantly shallower anterior chamber compared to the control group (2.86±0.43 versus 3.0±0.43 mm, p=0.003) and steeper corneal curvature (44.31±1.5 versus 43.7±2.59 D, p=0.052). There was significant difference in absolute error of IOL calculation between the groups (-0.02±0.45 versus 0.17±0.55 D for control and study groups, respectively, p=0.004). There was no difference in IOL calculation error depending on the implanted IOL models (AcrySof SA60AT and Akreos Adapt AO) in the control group. However, implantation of SA60AT in the study group showed significant difference in IOL calculation error compared with Akreos (0.3±0.57 versus 0.04±0.51 D, p=0.01). Using linear regression, optimized A-constants were suggested for these types of IOLs for patients with PEX (118.83 for SA60AT and 118.44 for Akreos).

Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy.

BACKGROUND: Both ectopia lentis and retinal injury are common results of blunt ocular trauma. Here, we investigated the incidence and characteristics of retinal breaks associated with ectopia lentis caused by blunt ocular trauma. METHODS: Patients who underwent pars plana vitrectomy to treat traumatic lens subluxation and dislocation were retrospectively reviewed. The incidence, characteristics, and outcomes of retinal breaks were analyzed. RESULTS: Forty-five eyes from 45 patients were included in the study. Seventeen eyes (37.7%) were complicated by retinal breaks or detachment, but only four (8.9%) were identified pre-operation. Our study revealed that retinal breaks were more frequently located at the superior (72.7%) and peripheral (81.8%) retina. All patients achieved anatomic recovery post-surgery. The eyes with and without retinal breaks did not differ significantly with respect to initial or final visual acuity. The final visual outcomes were independently and significantly associated with visual acuity at presentation (P = 0.001). CONCLUSIONS: Retinal breaks occurred in approximately one-third of patients with traumatic ectopia lentis and were difficult to observe pre-operation. Complete ophthalmic evaluation and timely intervention may help achieve favorable outcomes.

Biometric indicators of eyes with occult lens subluxation inducing secondary acute angle closure.

BACKGROUND: To compare the anterior biometrics in eyes with secondary acute angle closure induced by occult lens subluxation (ASAC-LS), misdiagnosed as acute primary angle closure (APAC) at the first visit with APAC, chronic primary angle closure glaucoma (CPACG), and cataract. METHODS: This retrospective case study included 17 eyes with angel closure due to occult LS, who were misdiagnosed as APAC on their first visit, 56 APAC eyes, 54 CPACG eyes, and 56 cataract eyes. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of ocular biometrics. RESULTS: The ASAC-LS patients had a longer ocular axial length than APAC and CPACG patients. Central corneal thickness of the ASAC-LS patients was not significantly different from APAC patients, but was significantly different from CPACG and cataract patients. The APAC patients had the smallest ACD, while the ASAC-LS patients had the smallest AD. The ASAC-LS patients had the largest lens thickness. According to ROC curve analysis, RLP, ACD, AD, CLP, LP had high power of discrimination. CONCLUSIONS: This study revealed that LS secondary PAC patients had a shallower AD, thicker CCT comparing to those of APAC, CPACG and cataract patients. For patients with acute angle-closure glaucoma, it is necessary to exclude lens zonula relaxation. TRIAL REGISTRATION: NCT03752710, retrospectively registered.

Prediction error in iris suture fixated intraocular lenses and long-term stability.

IMPORTANCE: Little evidence exists for prediction error in iris-sutured intraocular lenses. BACKGROUND: To determine the magnitude of prediction error in iris-sutured intraocular lenses, associated factors and their long-term stability. DESIGN: Retrospective, nonrandomized, noncomparative case series conducted at the Wilmer Eye Institute (Baltimore, Maryland, United States). PARTICIPANTS: Adult patients with subluxated intraocular lenses that underwent iris-suture fixation between January 2000 and December 2014 by a single surgeon. Pregnant women, children (below the age of 18) and cases with follow-up under 1 month were excluded. METHODS: Prediction error was calculated in 60 eyes and survival analysis was performed on 99 eyes. MAIN OUTCOME MEASURES: Prediction error (the difference between the postoperative manifest refraction in spherical equivalent and the spherical equivalent predicted by the Barrett Universal II, Holladay 2 and SRK/T formulas), preoperative and postoperative distance-corrected visual acuity, manifest refraction, frequency of postoperative complications and time until re-subluxation. RESULTS: Mean prediction error using the Barrett formula was -0.35 ± 1.0 D. Higher axial length (≥25.5 mm) was associated with greater prediction error (-0.72 ± 1.11 D vs -0.18 ± 0.91 D, P = .048). Twelve re-subluxations occurred over a mean follow-up period of 30.28 ± 41.86 months. The predicted 50% survival of iris-sutured lenses was 114.25 months. CONCLUSIONS AND RELEVANCE: Iris-suture fixation may require moderate lens power adjustment to compensate for prediction error, especially in eyes with higher axial length. Longer follow-up demonstrates that iris-suture fixation remains a viable technique, yet re-subluxations require routine monitoring of such eyes.

[Comparative evaluation of positional stability of the «capsular bag + intraocular lens¼ complex in patients with lens subluxation]. / Sravnitel'naya otsenka stabil'nosti polozheniya kompleksa «kapsul'nyi meshok + intraokulyarnaya linza¼ u bol'nykh s podvyvikhom khrustalika.

Prevention of decentration and dislocation of the "capsular bag + intraocular lens" (IOL) complex in the late postoperative period is an actual problem of surgical treatment of patients with pronounced lens subluxation. PURPOSE: To conduct a comparative clinical study of positional stability of the "capsular bag + IOL" complex in the late postoperative period after application of a combined technique of capsular bag fixation in patients with subluxation of the lens. MATERIAL AND METHODS: Phacoemulsification (PE) with in-the-bag IOL implantation and postoperative observation was performed in 213 patients (234 eyes) with cataract and pronounced lens subluxation. The 1st group consisting of 138 patients (153 eyes) underwent capsular bag fixation of the combined technique with simultaneous use of 4 modified iris-retractors and one or two capsular tension rings (CTRs). The 2nd group included 75 patients (81 eyes) who in the course of PE had their capsular bag fixed beyond the edge of capsulorhexis with only 4 modified iris-retractors. Preoperative state of the lens and the evaluation of the frequency and degree of decentration of the «capsular bag + IOL¼ complex in the postoperative period were performed using data acquired with ultrasound biomicroscopy (UBM). RESULTS: Significant (more than 1 mm according to UBM) IOL's optic decentration was observed in the 1st group after applying the combined capsular bag fixation technique in 12 (7.8%) cases, and in the 2nd group after isolated use of modified iris-retractors in 48 (59.3%) cases. CONCLUSION: The use of the combined capsular bag fixation technique not only improves the conditions for carrying out PE with in-the-bag IOL implantation in patients with pronounced lens subluxation, but also contributes to a substantial (an average of 8 times) reduction in the incidence of significant decentration of the «capsular bag + IOL¼ complex in the late postoperative period.

[Differentiated method of surgical prophylaxis against anterior capsular contraction syndrome during phacoemulsification]. / Differentsirovannaya metodika khirurgicheskoi profilaktiki kapsulyarnogo kontraktsionnogo sindroma v khode fakoemul'sifikatsii.

Prevention of the anterior capsular contraction syndrome (ACCS) in the late postoperative period in patients with lens subluxation is a current problem of phacoemulsification (PE). PURPOSE: To develop and clinically evaluate a differentiated method of surgical prophylaxis against ACCS during PE in patients with lens subluxation. MATERIAL AND METHODS: Phacoemulsification surgery with in-the-bag IOL implantation and postoperative follow-up were carried out in 192 patients (192 eyes) with cataract and lens subluxation. In all patients, complete anterior capsulorhexis at the beginning of the surgery was not possible. A differentiated approach was used for capsulorhexis extension at the final stage of the operation after in-the-bag IOL implantation. Three groups of patients were formed according to the three most common clinical situations. RESULTS: There were no signs of ACCS development in as many as 189 (98.4%) cases. In 3 (1.6%) cases, slight narrowing of the anterior capsulorhexis opening was noted, however, with no effect to the IOL position and functional results of the operation. CONCLUSION: The differentiated approach to anterior capsulorhexis in patients with lens subluxation allowed to perform phacoemulsification with in-the-bag IOL implantation and to avoid ACCS development in the late postoperative period.

Combined 23-gauge transconjunctival vitrectomy and scleral fixation of intraocular lens without conjunctival dissection in managing lens complications.

BACKGROUND: To evaluate the safety and efficacy of combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of intraocular lens (IOL) without conjunctival dissection. METHODS: A retrospective study in Chang Gung Memorial Hospital, Keelung and Taoyuan, Taiwan. Patients receiving combined 23-gauge transconjunctival pars plana vitrectomy and scleral fixation of IOL without conjunctival dissection were enrolled. The ocular findings, causes of lens complication, surgical procedures, type of IOL used, and complications were documented. RESULTS: We included 40 eyes from 39 patients (27 male, 12 female) with a mean age of 59.5 [standard deviation (±) 14.8] years old. The mean follow-up duration was 6.8 ± 5.4 months. The cause of lens complications was ocular trauma in 24 (60%) eyes, cataract surgery complications in 11 (28%) eyes, and spontaneous subluxation of crystalline lens in 5 (13%) eyes. The overall best corrected visual acuity (BCVA) (logMAR) improved from 1.359 ± 0.735 to 0.514 ± 0.582 (p < 0.001). The BCVA also improved significantly in each group with different causes of lens complications. Preoperative BCVA was the only factor associated with the postoperative visual outcome (p = 0.008). Most surgery-related complications were self-limited, including mild vitreous hemorrhage (5%), microhyphema (5%), transient elevated intraocular pressure (3%), and transient hypotony (3%). Cystoid macular edema and IOL decentration was found in 3 (8%) eyes and 1 (3%) eye respectively. CONCLUSIONS: Combined 23-gauge transconjunctival vitrectomy and scleral fixation of IOL without conjunctival dissection is effective and safe in managing a wide variety of lens complications, with good postoperative comfort and visual recovery. TRIAL REGISTRATION: Retrospective study, not applicable.