Long-Term Suture Breakage After Scleral Fixation of a Modified Capsular Tension Ring with Polypropylene 10-0 Suture.

AIM: To investigate the long-term risk of suture breakage after implantation of a modified capsular tension ring (MCTR) fixated to the sclera with polypropylene 10-0 suture. METHODS: Retrospective case series of operations for subluxated phakic lenses in 2007-2015 with implantation of an MCTR secured with a 10-0 polypropylene suture as part of an intraocular lens (IOL)-capsular bag complex. RESULTS: We identified 132 eyes (92 patients) operated on with an MCTR. Of these eyes, 26 (20%) had suture breakage requiring re-operation, while another eight eyes (6%) had suture breakage that did not require surgery. The re-operations occurred after a mean 4.8±3.3 years. Suture breakage occurred in patients with a mean age of 34.0±23.3, as compared to 43.2±26.0 years for patients who did not experience this complication (p=0.36). In patients aged 40 years or younger at the time of surgery, 47% experienced suture breakage in one or both eyes, as compared to 19% in the age group 41-69 years and 13% in the age group 70 years and older (p=0.004). Of the 132 eyes that were operated on, we registered one case (0.8%) of possible suture-related late endophthalmitis. CONCLUSION: The long-term risk of suture breakage was quite high after scleral fixation of the MCTR in this patient cohort, and it seems as the risk is increased with young age.

Marfan syndrome: Evolving organ manifestations-A 10-year follow-up study.

The age-dependent penetrance of organ manifestations in Marfan syndrome (MFS) is not known. The aims of this follow-up study were to explore how clinical features change over a 10-year period in the same Norwegian MFS cohort. In 2003-2004, we investigated 105 adults for all manifestations in the 1996 Ghent nosology. Ten years later, we performed follow-up investigations of the survivors (n = 48) who consented. Forty-six fulfilled the revised Ghent criteria. Median age: females 51 years, range 32-80 years; males 45 years, range 30-67 years. New aortic root dilatation was detected in patients up to 70 years. Ascending aortic pathology was diagnosed in 93 versus 72% at baseline. Sixty-five percent had undergone aortic surgery compared to 39% at baseline. Pulmonary trunk mean diameter had increased significantly compared to baseline. From inclusion to follow-up, two patients (three eyes) developed ectopia lentis, four developed dural ectasia, four developed scoliosis, three developed incisional or recurrent herniae, and 14 developed hindfoot deformity. No changes were found regarding protrusio acetabuli, spontaneous pneumothorax, or striae atrophicae. The study confirms that knowledge of incidence and progression of organ manifestations throughout life is important for diagnosis, treatment, and follow-up of patients with verified or suspected MFS.

Ten-year reinvestigation of ocular manifestations in Marfan syndrome.

IMPORTANCE: Long-term follow-up of Marfan syndrome (MFS) patients. BACKGROUND: Investigate changes in ocular features in MFS patients fulfilling the Ghent-2 criteria following a period of 10 years. DESIGN: Repeated cross-sectional study with two observations. PARTICIPANTS: Eighty-four MFS patients were investigated in 2003-2004 (baseline). Forty-four of these patients (52%) were examined after 10 years. METHODS: A comprehensive ocular examination performed at baseline and follow-up. MAIN OUTCOME MEASURES: Development or progression of ectopia lentis (EL). RESULTS: At follow-up, mean age was 50.1 ± 11.9 years (range: 30-80 years), 74% were female and 70% of the patients were diagnosed with EL compared to 66% at baseline. Two patients (3 eyes) had developed EL over the decade, representing a 13% risk. Furthermore, one eye had progressed from a subtle tilt of the lens to dislocation. We found no significant change in the axial length (P = 0.96), the corneal curvature (P = 0.64) or the spherical equivalent (P = 0.23). Best corrected visual acuity was improved at follow-up (P = 0.02). There were 7% and 33% risks for development of retinal detachment and cataract between baseline and follow-up, respectively. CONCLUSIONS AND RELEVANCE: Our study indicates that even though EL typically occurs at an early stage in most MFS patients, there is still a risk of developing EL in adulthood. The risk of developing vision-threatening complications such as retinal detachment and cataract was much higher than in the normal population, but even so, the visual potential of the MFS patients was relatively good.

Measuring the depth of crosslinking demarcation line in vivo: Comparison of methods and devices.

PURPOSE: To assess the interrelationship of different methods of measuring the demarcation line depth after corneal collagen crosslinking (CXL). SETTING: University eye clinic, Oslo, Norway. DESIGN: Prospective case series. METHODS: Eyes having CXL for progressive keratoconus were evaluated 1 month after CXL by in vitro confocal microscopy (IVCM), optical coherence tomography (OCT), and Scheimpflug imaging. When applying IVCM, the depth of the CXL demarcation line was measured with 2 methods; that is, IVCM keratocyte disappearance and IVCM intensity increase. With OCT, the evaluations were made by measuring the depth of the corneal stromal demarcation line. Scheimpflug imaging was used with 2 depth-measuring methods; that is manual Scheimpflug and objective Scheimpflug intensity change. The demarcation line depths in the central cornea were compared by the intraclass correlation coefficient (ICC) and pairwise comparison of the measured treated depth. If acceptable correlations (ICC > 0.7) were found, Bland-Altman analysis was performed. RESULTS: Twenty eyes of 20 patients were evaluated. Acceptable correlations were found between depth measurements using OCT-IVCM keratocyte disappearance (ICC = 0.80), OCT-IVCM intensity increase (ICC = 0.75), and IVCM intensity increase-IVCM keratocyte disappearance (ICC = 0.91). The Bland-Altman plots of these 3 pairs showed sufficient levels of agreement. Using pairwise comparison of these pairs, the measured depths were in the same level by the OCT-IVCM intensity increase only (P = .529). CONCLUSIONS: Scheimpflug images were inaccurate for measuring the CXL demarcation line depth. The 2 confocal microscopy methods and OCT images showed good correlation. Of these 3 pairs, only measurements with OCT and IVCM intensity increase depths were in the same level.

Does cataract surgery reduce the long-term risk of glaucoma in eyes with pseudoexfoliation syndrome?

PURPOSE: To compare glaucoma development and intraocular pressure (IOP) in the longer term following phacoemulsification cataract surgery in eyes with and without pseudoexfoliation syndrome (PEX). METHODS: Fifty-one patients with PEX were compared with 102 age- and gender-matched controls without PEX. Patients were re-examined a mean of 76 (SD 5.4) months after cataract surgery, recording IOP, glaucoma diagnosis, glaucoma treatment and LogMAR. Data from the preoperative visit (baseline) and IOP on the first postoperative day were obtained from medical records. A glaucoma parameter was predefined as patients developing glaucoma or needing increased glaucoma treatment during the postoperative time period. RESULTS: One new glaucoma case in each group was diagnosed postoperatively, yielding glaucoma incidences of 0.47 cases per 100 person-years [95% confidence interval (CI) 0.006-2.61] and 0.17 cases per 100 person-years (CI 0.002-0.95) in the PEX and control groups respectively (p = 0.53). IOP declined by 2.6 (SD 4.0) mmHg in the PEX group (p < 0.001) and 1.9 (SD 3.5) mmHg in the control group (p < 0.001) from baseline to the re-examination, with a non-significant group difference (p = 0.310). IOP spike (≥6 mmHg increase) was significantly associated with the glaucoma parameter, both within the PEX (p = 0.034) and the control group (p = 0.044). CONCLUSION: The number of newly diagnosed glaucoma cases was lower than expected 6-7 years following cataract extraction, especially in the PEX group, which indicates that PEX eyes benefit particularly from cataract surgery in terms of IOP and glaucoma development.