Early Clinical Outcomes of Intrascleral Fixation Using an Intraocular Lens with Hook-Shaped Haptics.

PURPOSE: In this study, we aimed to report on the early results of intrascleral intraocular lens (IOL) fixation using a hook-shaped haptic IOL (hsh-IOL). PATIENTS AND METHODS: We enrolled 27 consecutive eyes of 27 patients (mean age, 74±11.4 years) who underwent intrascleral IOL fixation with an hsh-IOL and were followed-up for 3 months postoperatively. The reasons for surgery included insufficient capsular support, including IOL dislocation, aphakia, or dislocated crystalline lens. The haptic of the hsh-IOL was externalized from the eye using forceps, and the hook was buried in the scleral tunnel. We investigated the preoperative and 3-month postoperative corrected visual acuity (VA), intraocular pressure (IOP), corneal endothelial cell density, refractive prediction error, postoperative intraocular astigmatism, surgically induced astigmatism, and intraoperative and postoperative complications. RESULTS: The mean postoperative corrected VA (logMAR, 0.083±0.18) was significantly better than the mean preoperative value (0.42±0.60, p=0.0007). The 3-month postoperative mean absolute prediction error was 1.00±0.96 D. The mean IOL-induced astigmatism was 0.95±0.70 D. Further, the mean postoperative corneal endothelial cell count (2036±644 cells/mm2) was significantly lower than the preoperative value (2316±527 cells/mm2) (p=0.009). No patient had a 1-month postoperative IOP <5 mmHg or >25 mmHg. There were no intraoperative or vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, due to postoperative haptics misalignment. CONCLUSION: Intrascleral IOL fixation using hsh-IOL is an effective option for eyes with insufficient capsular support.

Clinical Outcomes of Endoscope-Assisted Vitreous Surgery for Giant Retinal Tear Detachment.

INTRODUCTION: With the advent of perfluorocarbon liquid (PFCL), the success rate of refractory giant retinal tear (GRT) detachment has dramatically improved. PFCL is a very effective tool when used properly, but in GRT detachment, it may move under the retina through the tear, so it is necessary to devise ways to prevent PFCL from migrating under the retina. Ophthalmic endoscope-assisted vitrectomy may reduce the risk of subretinal migration of PFCL, facilitate safer use of PFCL, and increase the success rate of GRT detachment. The present study aimed to describe the clinical outcomes of endoscope-assisted vitreous surgery for giant retinal detachment. METHODS: Twenty consecutive eyes from 19 patients who had undergone endoscope-assisted vitreous surgery for treatment of a GRT detachment were enrolled. Subretinal fluid drainage, extension of the rolled GRT, and endophotocoagulation under air were performed with the aid of an endoscope, without the use of PFCL. Where necessary, extension of a fixed retinal fold and internal limiting membrane peeling was performed with PFCL. RESULTS: The initial and final retinal reattachment rates were 90 and 95%, respectively. In 3 eyes, a small amount of PFCL was used, and there were no PFCL remnants. The mean follow-up duration was 18 months (range, 3-69 months). After surgery, the mean best-correlated visual acuity significantly improved from 20/514 to 20/41 (p = 0.0008). DISCUSSION/CONCLUSION: Endoscope-assisted vitreous surgery for giant retinal detachment has favourable clinical outcomes for visual acuity and retinal detachment.

[Clinical Outcomes of Endoscope-Assisted 30-Gauge Single-Needle Technique for Intrascleral Intraocular Lens Fixation].

INTRODUCTION: We have developed an endoscope-assisted single-needle technique, which is an improvement of Yamane's double-needle technique of the intrascleral intraocular lens (IOL) fixation techniques. In this surgical procedure, the IOL is manipulated in the vitreous cavity, and the IOL haptic is externalized from the eye one by one with the aid of an ophthalmic endoscope. The purpose of this study was to report the postoperative visual function and safety of this new technique. METHODS: Overall, 19 consecutive eyes (16 patients; mean age, 75.1 ± 9.6 years; mean follow-up period, 5.7 months) that underwent intrascleral IOL fixation surgery with our new technique were included in the study. Manifest refraction, uncorrected/corrected visual acuity, and corneal endothelial cell density were measured before and after surgery. Tilt and decentration of IOL were analyzed using anterior segment optical coherence tomography. RESULTS: The mean absolute prediction error (spherical equivalent) was 0.82 ± 0.52. The mean postoperative best-corrected visual acuity had significantly improved at the final visits (p = 0.02). No significant differences in the mean corneal endothelial cell density were observed between the first (2,232 ± 751 cells/mm2) and final (2,099 ± 649 cells/mm2) visits (p = 0.35). The mean IOL tilt was 8.1 ± 3.2°. There were no vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, during or after surgery. CONCLUSIONS: The endoscope-assisted single-needle technique is a safe and effective method of intrascleral IOL fixation surgery.

SUBRETINAL ENDOSCOPIC SURGERY TO TREAT LARGE SUBRETINAL HEMORRHAGES SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the potential of subretinal endoscopic surgery as a novel treatment for large subretinal hemorrhage secondary to age-related macular degeneration. METHODS: Five patients with large subretinal hemorrhage secondary to age-related macular degeneration underwent subretinal endoscopic surgery, with a minimum follow-up of 12 months. RESULTS: The large subretinal hemorrhage was completely removed by subretinal endoscopic surgery without a large retinotomy in all cases. The fibrovascular pigment epithelial detachment including choroidal neovascularization was completely removed in four cases. In three of these cases, the bleeding was confirmed to be originating from one point of rupture in the Bruch membrane, which was treated by coagulation using intraocular diathermy. Although visual acuity improved in three cases, it deteriorated and remained stable in one case each. Fibrovascular pigment epithelial detachment persisted in one patient after surgery; he needed anti-vascular endothelial growth factor therapy, whereas the other four did not because their fibrovascular pigment epithelial detachment was removed. At the final follow-up, no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy, were noted. CONCLUSION: Subretinal endoscopic surgery can completely remove subretinal hemorrhage and fibrovascular pigment epithelial detachment including choroidal neovascularization without a large retinotomy. It also aids in the direct and detailed confirmation of subretinal lesions by ophthalmic endoscope.

NOVEL ENDOSCOPE-ASSISTED VITREOUS SURGERY COMBINED WITH ATMOSPHERIC ENDOSCOPIC TECHNIQUE AND/OR SUBRETINAL ENDOSCOPIC TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH GRADE C PROLIFERATIVE VITREORETINOPATHY.

PURPOSE: The purpose of this study was to investigate the clinical outcomes of novel endoscope-assisted vitreous surgery techniques in patients with rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy. METHODS: Eight consecutive patients who had undergone endoscope-assisted vitreous surgery for rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy were investigated. The peripheral vitreous was cut under air with the aid of endoscopic view (atmospheric endoscopic technique), and the subretinal proliferation was removed under subretinal endoscopic observation (subretinal endoscopic technique). RESULTS: Retinal reattachment was achieved after the primary surgery without a large retinotomy and scleral buckling in each case. The mean follow-up was 16.8 months (range, 8-28 months). Atmospheric endoscopic technique was performed in all cases, and subretinal endoscopic technique was performed in three cases. After surgery, the mean best-corrected visual acuity significantly improved from 20/778 to 20/111 (P = 0.014). Although microretinal breaks occurred during the removal of vitreous using atmospheric endoscopic technique in all cases, there were no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy. CONCLUSION: Endoscope-assisted vitreous surgery with atmospheric endoscopic technique and/or subretinal endoscopic technique is safe and effective in the treatment of rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy.

New surgical approach for intrascleral fixation using an intraocular lens with hook-shaped haptics.

We report a new surgical technique of intrascleral posterior chamber intraocular lens (PC IOL) fixation using a newly developed hook-shaped haptic IOL (NX-70CH) and a 25-gauge loop-shaped haptic manipulator. Previous techniques of intrascleral PC IOL fixation had 2 major technical challenges; that is, externalization of the haptic and fixation of the haptic into the scleral tunnel. The new IOL and manipulator can facilitate externalization and secure fixation of the IOL haptic and can be used for suture fixation or implantation in the capsular bag in cases with presumed subluxated lens.

Clinical outcomes of endoscope-assisted vitrectomy for treatment of rhegmatogenous retinal detachment.

SUMMARY: We evaluated the clinical outcomes for ophthalmic endoscope-assisted vitrectomy in consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD). The primary success rate was 98.4% (125/127) without performing a posterior drainage retinotomy or using perfluorocarbon liquids (PFCL) for subretinal fluid drainage. PURPOSE: To investigate the clinical outcomes of endoscope-assisted vitrectomy in patients with uncomplicated RRD. METHODS: We examined 127 eyes from consecutive patients who underwent repair of RRD by 23- or 25-gauge endoscope-assisted vitrectomy, with a minimum follow-up of 3 months. Eyes with the following criteria were excluded: Giant retinal tears, grade C proliferative vitreoretinopathy, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. All cases underwent subretinal fluid drainage, endolaser photocoagulation and fundus inspection were performed under ophthalmic endoscopic observation. Success rate, visual acuity, surgery time and complications were evaluated. RESULTS: Primary and final success rate was 98.4% (125/127) and 100% (127/127), respectively, Surgery time was 59.6±26.3 minutes. The best-corrected visual acuity significantly improved from 20/100 to 20/20 (P<0.0001). There were 2 cases (1.6%) of creation of a peripheral drainage retinotomy and 4 cases (3.1%) of using PFCL to suppress movement of the detached retina, but there were no cases of creation of a posterior drainage retinotomy or using PFCL for subretinal fluid drainage. There was 1 case of presumed endophthalmitis after surgery. There were 12 hypotonous cases at postoperative day 1 and one of them needed additional scleral sutures at postoperative day 4 for prolonged hypotony. CONCLUSION: The present study demonstrated the efficacy of endoscope-assisted vitrectomy for patients with uncomplicated RRD. To perform endoscope-assisted vitrectomy safely, sufficient closure of sclerotomies is necessary at the end of surgery.

[Comparison of central visual field visualization while using a combination of spherical intraocular lenses with vitreous contact lenses].

OBJECTIVE: To investigate intraocular lens (IOL) and vitreous contact lens (VCL) combinations that provide good central visual field visualization in vitreous surgery. METHOD: ZEMAX optical design software was used to perform optical simulations using the ray tracing method on a Gullstrand eye model. The implanted IOL was assumed to consist of material with a refractive index of 1.550 (high refractive index acrylic IOL), 1.470 (low refractive index acrylic IOL) and 1.413 (silicon IOL), and was set as a biconvex spherical lens (optical diameter 6 mm, 23.5 D). The VCL was assumed to have a refractive index of 1.900 (HEMA VCL), 1.490 (PMMA VCL) and 1.413 (silicon VCL), and was set as a concave lens (optical diameter 10 mm) with a flat anterior surface and a posterior surface with a radius of curvature of 7.70 mm. The spherical aberration of the overall optical system, including the IOL-implanted eyeball and the VCL, was calculated. RESULTS: Spherical aberration was lowest with the silicon VCL for the high refractive index acrylic IOL and with the PMMA VCL for the low refractive index acrylic and silicon IOLs. CONCLUSION: The combinations providing the best central visual field visualization in vitreous surgery are a silicon VCL for implantation of a high refractive index acrylic IOL and a PMMA VCL for implantation of a low refractive index acrylic or silicon IOL.

Incidence of, risk factors for, and combined mechanism of late-onset open-angle glaucoma after vitrectomy.

PURPOSE: To estimate the incidence of and identify the risk factors for late-onset open-angle glaucoma (OAG) after uncomplicated pars plana vitrectomy (PPV). METHODS: All patients who underwent PPV at the Edward Harkness Eye Institute between January 1998 and January 2004 had at least 6 months of follow-up and did not have preexisting glaucoma or reason for secondary development of glaucoma were included. Retrospective cohort and matched case-control study designs were used. RESULTS: Of 285 vitrectomized eyes that met enrollment criteria, 11.6% (n = 33) developed glaucoma after vitrectomy. In the matched case-control analysis, the only variable that had a statistically significant association with the development of OAG was cataract extraction (CE), as compared with phakic status at the last follow-up (odds ratio = 16.4; 95% confidence interval, 2.1-127.4; P = 0.007). There was no difference in OAG development between eyes that had CE before or at the time of PPV and those that had it after PPV. The overall incidence of OAG development after PPV among all eyes, phakic eyes, and nonphakic eyes was 11.6%, 1.4%, and 15.0%, respectively. The difference in incidence between phakic and nonphakic eyes was statistically significant (P = 0.001). CONCLUSION: Lens extraction is a strong risk factor for the development of late-onset OAG after uncomplicated PPV. While the overall incidence of OAG development after PPV is substantial, it is more so among eyes that have had CE. The absence of substantial OAG incidence in phakic patients points toward a combined mechanism for late-onset post-PPV OAG involving PPV and CE at any time. Preoperative PPV counseling should include the risk of glaucoma development in addition to cataract development and the connection between the two. Patients who have undergone PPV, and especially those who also had CE in the same eye, should be carefully monitored for glaucoma.

Evaluation of axial length measurement of the eye using partial coherence interferometry and ultrasound in cases of macular disease.

PURPOSE: The present study evaluated the accuracy of using partial coherence interferometry (PCI) and ultrasound (US) to measure axial length in eyes with macular disease, the nature of the double peak (DP) in PCI measurements, and the applicability of intraocular lens (IOL) power calculation. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: We studied 132 eyes with macular edema, epiretinal membrane, and macular hole in 132 patients who underwent combined cataract and vitrectomy surgery. METHODS: Axial length was measured using PCI and US. If a DP was observed in the PCI measurement, the posterior peak was used for the IOL calculation. The central retinal thickness (CRT) was measured using optical coherence tomography. MAIN OUTCOME MEASURES: Measurements were made of the frequency of DP observation in PCI measurement and the postoperative refractive errors when either PCI or US measurements were applied. RESULTS: A DP was observed in 25 (18.7%) of 132 eyes in the axial length measurement using PCI. There was a significant correlation between the interpeak distance and the CRT (P<0.001, r(2)=0.3869). The 6-month postoperative refractive errors in the DP and single peak (SP) groups were predicted correctly within +/-0.5 diopters in 56.0% (DP) and 61.7% (SP) of the cases and within +/-1.0 diopters in 92.0% (DP) and 92.2% (SP) of the cases. The accuracy of the axial length measurement was similar between PCI and US. CONCLUSIONS: Our results suggest that the longer axial length of the DP observed in PCI represents retinal pigment epithelium. If a DP was observed in PCI measurement, application of the longer peak for the IOL calculation resulted in a refractive error similar to that in the SP group.

Topography-guided custom ablation for irregular corneal astigmatism using the NIDEK NAVEX Laser System.

PURPOSE: To determine whether topography-guided custom ablation produces acceptable outcomes in the treatment of irregular corneal astigmatism caused by previous corneal surgery or corneal disease. METHODS: Thirteen eyes of nine patients who had irregular corneal astigmatism from previous corneal surgery or corneal disease were treated with customized aspheric treatment zone (CATz) ablations using the NIDEK Advanced Vision Excimer Laser System (NAVEX). Changes in corneal surface regularity index, surface asymmetry index, asymmetry component, corneal and ocular higher order aberrations, uncorrected visual acuity, and best spectacle-corrected visual acuity (BSCVA) were analyzed using Wilcoxon and paired t tests. A P value < .05 was considered statistically significant. RESULTS: After CATz treatment, 62% of eyes (8 of 13) showed an increase in BSCVA. Improvements in both the surface asymmetry index and asymmetry components were statistically significant after CATz treatment (P < .05). CONCLUSIONS: Topography-guided custom ablation can be safe and effective in the management of irregular corneal astigmatism due to previous corneal surgery or corneal disease.

Long-term dynamics of freshwater red tide in shallow lake in central Japan.

OBJECTIVE: The aim of this study is to clarify the long-term dynamics of the red tide occurring in Lake Kawaguchi. METHODS: The measurement of environmental factors and water sampling were carried out monthly at a fixed station in Lake Kawaguchi's center basin from April 1993 to March 2004. On June 26, 1995, the horizontal distribution ofPeridinium bipes was investigated using a plastic pipe, obtaining 0∼1-m layers of water column samples at 68 locations across the entire lake. RESULTS: P. bipes showed an explosive growth and formed a freshwater red tide in the early summer of 1995, when the nutrient level was higher than those in the other years, particularly the phosphate concentration in the surface layer. The dissolved total phosphorus (DTP) concentration was sufficient forP. bipes growth in that year. In the study of its horizontal distribution,P. bipes was found at all the locations. The numbers of cells per milliliter ranged from 67 to 5360, averaging 1094±987 cells/ml, with particularly high densities along the northern shore. Since then,P. bipes has annually averaged about 25 cells/ml in Lake Kawaguchi. CONCLUSION: We observed that the red tide caused byP. bipes correlates with a high DTP concentration in Lake Kawaguchi.

Management of severe hypotony with intravitreal injection of viscoelastic.

PURPOSE: To investigate the effect of an intravitreal injection of sodium hyaluronate 1.4% and 2.3% in the treatment of hypotony. DESIGN: Interventional case series. METHODS: Intravitreal injection of sodium hyaluronate 1.4% was performed to treat persistent hypotony in three eyes after the successful repair of retinal detachment and in one eye with uveitis. Injection of sodium hyaluronate 2.3% was performed in one eye after the successful repair of retinal detachment with removal of silicone oil. RESULTS: At the last follow-up examination (2-16 months), intraocular pressure increased to at least 5 mm Hg (5-14 mm Hg) in all eyes that had been injected with sodium hyaluronate. Intraocular pressure increased to 38 mm Hg in the eye that had been injected with sodium hyaluronate 2.3% on postoperative day 1 and was 10 mm Hg at three months. Vision improved in all patients. CONCLUSION: Intraocular injection of sodium hyaluronate 1.4 and 2.3% appears to be efficacious in reversing hypotony in some eyes. Functional and structural findings can also improve.