Effect of lens surgery on health-related quality of life in preschool children with congenital ectopia lentis.

AIM: To evaluate the effect of lens surgery on health-related quality of life (HRQoL) of preschool children with congenital ectopia lentis (CEL). METHODS: A prospective self-controlled study was conducted in Zhongshan Ophthalmic Center. Children aged from 5 to 7y whom were diagnosed with CEL and underwent phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation and their parents were enrolled in this study. All of them completed the child and proxy (parental) PedsQL™ 4.0 before and after the surgery. Their preoperative scores were compared to their postoperative ones. Subgroup analyses were performed based on gender and preoperative bilateral presenting visual acuity of the children. RESULTS: Thirty-two children with CEL successfully underwent surgery without any complications, among whom 8 had monocular surgery and 24 had binocular surgery. Preoperative and postoperative questionnaires were completed by 32 child-parent pairs. Surgical intervention could significantly improve the vision of affected children (P<0.001). The medians of physical, psychosocial and total health scores self-reported by the children were 68.75 (62.50, 81.25), 65.00 (60.00, 80.00) and 67.39 (60.87, 78.26) preoperatively and were 93.75 (87.50, 100.00), 90.00 (83.33, 96.67) and 89.13 (85.32, 95.65) postoperatively. The preoperative scores of the affected children were significantly lower in all scales than age-matched healthy children (P<0.001). All the postoperative scores were significantly higher than the preoperative scores in affected children and their parents (P<0.001). In the physical functioning evaluation, the preoperative score reported by parents of girls was higher than parents of boys (P=0.041), and the postoperative score of girls was higher than that of boys (P=0.036). CONCLUSION: CEL is associated with significantly worse quality of life in preschool children. Surgical intervention can significantly improve the HRQoL in affected children from both personal and family perspective.

Agreement of corneal curvature and central corneal thickness obtained from a swept-source OCT and Pentacam in ectopia lentis patients.

AIM: To assess the inter-device consistency of corneal curvature and central corneal thickness between Pentacam and a swept-source Fourier-domain anterior segment optical coherence tomography (AS-OCT) in ectopia lentis patients. METHODS: Totally 72 eyes of ectopia lentis patients were recruited. Central corneal thickness (CCT), corneal curvature values and corneal astigmatism were obtained from both the Pentacam and AS-OCT (CASIA2). Repeatability was evaluated for both devices. The coefficient of repeatability (COR) and the relative COR was calculated. Bland-Altman plots were conducted to evaluate the inter-device agreement of measurement. Orthogonal linear regression was used to examine any proportional bias. RESULTS: The mean difference of CCT, steep anterior corneal curvature (anterior KS), flat anterior corneal curvature (anterior Kf), anterior corneal astigmatism (ACA), steep posterior corneal curvature (posterior KS), flat posterior corneal curvature (posterior Kf), posterior corneal astigmatism (PCA), steep true net power (TNP KS), flat true net power (TNP Kf) and total corneal astigmatism (TCA) between Pentacam and CASIA2 were 7.03±9.70 µm, -0.19±0.41 D, -0.27±0.35 D, 0.04±0.47 D, -0.17±0.23 D, -0.11±0.11 D, -0.02±1.02 D -0.41±0.43 D, -0.52±0.46 D, and -0.15±0.96 D, respectively. For measurement of TNP Kf with the Pentacam and CASIA2, a mean difference of 0.52 D and COR of 0.90 with P=0.02 was detected. There was no significant difference in CCT (P=0.393), anterior Kf (P=0.107), anterior Ks (P=0.414), ACA (P=0.131), posterior Kf (P=0.286), posterior Ks (P=0.418), PCA (P=0.105), TNP Ks (P=0.054), and TCA (P=0.977) between Pentacam and CASIA2. CONCLUSION: Our study reveals good agreement of CCT, corneal curvature and corneal astigmatism measured by CASIA2 and Pentacam in ectopia lentis patients. However, there was significant difference for CCT and corneal curvature values obtained by the two devices.

Effect of lens constants optimization on the accuracy of intraocular lens power calculation formulas for highly myopic eyes.

AIM: To evaluate the effect of different lens constant optimization methods on the accuracy of intraocular lens (IOL) power calculation formulas for highly myopic eyes. METHODS: This study comprised 108 eyes of 94 consecutive patients with axial length (AL) over 26 mm undergoing phacoemulsification and implantation of a Rayner (Hove, UK) 920H IOL. Formulas were evaluated using the following lens constants: manufacturer's lens constant, User Group for Laser Interference Biometry (ULIB) constant, and optimized constant for long eyes. Results were compared with Barrett Universal II formula, original Wang-Koch AL adjustment method, and modified Wang-Koch AL adjustment method. The outcomes assessed were mean absolute error (MAE) and percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 diopter (D). The nonparametric method, Friedman test, was used to compare MAE performance among constants. RESULTS: Optimized constants could significantly reduce the MAE of SRK/T, Hoffer Q, and Holladay 1 formulas compared with manufacturer's lens constant, whereas the percentage of eyes with IOL prediction errors within ±0.25, ±0.50, and ±1.0 D had no statistically significant differences. Optimized lens constant for long eyes alone showed non-significant refractive advantages over the ULIB constant. Barrett Universal II formula and formulas with AL adjustment showed significantly higher accuracy in highly myopic eyes (P<0.001). CONCLUSION: Lens constant optimization for the subset of long eyes reduces the refractive error only to a limited extent for highly myopic eyes.

Trends and characteristics of congenital ectopia lentis in China.

AIM: To elucidate the trends and characteristics of congenital ectopia lentis (CEL) in southern China. METHODS: CEL patients from China admitted to Zhongshan Ophthalmic Center (ZOC) from January 2006 to December 2015 were recruited in our study. Residence, gender, hospitalization time, age at surgery, and the presence of other ocular abnormalities and system disease were statistically analyzed in different subgroups. RESULTS: Four hundred and thirty-seven hospitalizations (306 in-patients) diagnosed with CEL from a total of 283 308 hospitalizations were identified, which accounted for 0.15% of the total in-patients. Of the identified CEL in-patients, the total ratio of boys to girls was 2.22:1. Based on a subgroup analysis according to age, patients aged 12-18 years old constituted the highest proportion (31.70%) of all hospitalized CEL patients, and those 0-3 year old constituted the lowest proportion (8.82%) of the total number. The number of CEL increased from 18 to 72 and the hospital based prevalence increased from 8.60% to 18.10% from 2006 to 2015, and the average age at surgery decreased from 9 years old in 2006 to 7.6 years old in 2015. CONCLUSION: The results reveal upward trends in both the number of CEL hospitalizations and hospital based prevalence of CEL in this 10-year study period, but a reduction in the age at surgery, which may reflect the increase of public awareness of children's eye care in China.

Increased aquaporin-1 levels in lens epithelial cells with primary angle-closure glaucoma.

AIM: To determine the levels of aquaporin-1 (AQP-1) in the lens epithelial cells (LECs) of primary glaucoma and to clarify its correlation with lens thickness. METHODS: This study comprised 64 eyes of 64 patients with primary glaucoma, who were divided into 3 groups: 25 eyes of 25 patients with acute primary angle-closure glaucoma (APACG), 19 eyes of 19 patients with chronic primary angle-closure glaucoma (CPACG) and 20 eyes of 20 patients with primary open angle glaucoma (POAG). This study also included 12 eyes of 12 patients with senile cataract as controls. The levels of AQP-1 in LECs were examined by real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemistry. The lens thickness was measured by A-scan ultrasonography. RESULTS: The AQP-1 mRNA levels of LECs were 0.84±0.27, 0.69±0.34, 0.44±0.19 and 0.51±0.21 in APACG, CPACG, POAG and senile cataract group, respectively. The levels of AQP-1m RNA were significantly higher in PACG groups compared with those in senile cataract and POAG group (all P<0.05). The immunohistochemistry showed the AQP-1 expression were strong-positive in PACG groups, but weak-positive in senile cataract and POAG group. A positive correlation was found between AQP-1 mRNA levels and the lens thickness (r=0.645, P<0.001). CONCLUSION: These findings show that the higher expression of AQP-1 in LECs may contribute to increased lens thickness, which might be associated with the occurrence and development of PACG.

[Clinical study of the auxiliary management with iris retractor for subluxated lens combined with cataract].

OBJECTIVE: To study the clinical effects and safety of the auxiliary management with iris retractor for subluxated lens combined with cataract. METHODS: Thirty-one eyes lens subluxation with cataract come from 27 patients were reviewed, all of them were 30 - 78 years old and III - IV grade of nuclear. Among these patients, 14 were traumatic cataracts, 12 Marfan syndromes, two over-mature phase of cataracts, one caused suspensory ligament broken during phacoemulsification, and one unclear reason. 1 to 4 iris retractors were used during surgeries, according to the extension of zonular loss and nuclear hardness. Anterior vitrectomy would be taken if vitreous prolapsed. Visual acuities and reactions post-operative were observed, too. And correlation analysis would be used to study the relationship of those objections. RESULTS: There were no serious complications during the surgeries such as tearing of capsular, falling of nuclear, bleeding of intraocular, and so on. Only 9 of 31 eyes (29.0%) had vitreous prolapsed interoperation, which appeared a significant correlated with range of zonular loss (Spearman r = 0.453, P = 0.010). However, none of them happened during the phacoemulsification for lens nucleus and only 6 eyes took the anterior vitrectomy. The best corrected postoperative visual acuity of these patients attended to 0.2 - 1.2 at a half to 1 month, increased by 1 - 12 lines [average of (6.0 ± 2.7) lines] compared with preoperative. Twenty-three eyes visual acuity of them were no less than 0.5. Corneal edema postoperatively appeared a significant correlated with vitrectomy (Spearman r = 0.398, P = 0.026), while seemed no associated with the range of zonular loss, the number of iris retractors, energy and duration of ultrasound burst or type of intraocular lens (IOL) (P > 0.05). CONCLUSIONS: Phacoemulsification assists with iris retractor can simplify the process of cataract surgery of subluxated lens. Individualized surgical planning and flexible and decisive measures intra-operative achieved good results and well safety in these dangerous and complex lens diseases.

Out-of-the-bag intraocular lens dislocation: outcomes of posterior chamber intraocular lens exchange, risk factors, and prevention.

BACKGROUND: Dislocation of posterior chamber intraocular lens is one of the most common complications of intraocular lens implantation. Lens exchange is an effective solution to this unsatisfactory status. This study was conducted to analyze the possible predisposing factors for out-of-the-bag posterior chamber intraocular lens dislocation and to study the outcomes of lens exchange surgery. METHODS: Thirty-six consecutive patients (36 eyes) with out-of-the-bag intraocular lens dislocation who underwent posterior chamber intraocular lens exchange in Zhongshan Ophthalmic Center of Sun Yat-sen University (Guangdong, China) from January 2003 to October 2009 were included. A 6-month follow-up was completed. The causes for out-of-the-bag intraocular lens dislocation and visual outcomes of posterior chamber intraocular lens exchange were analyzed. The out-of-the-bag intraocular lens dislocation was diagnosed on the basis of the findings from slit-lamp microscope and B-ultrasound. The dislocated intraocular lens was explanted. Reimplantation of a new posterior chamber intraocular lens was performed in each case using standardized surgical procedures. RESULTS: In this study, a total of thirty-six consecutive patients (36 eyes) with out-of-the-bag intraocular lens dislocation underwent posterior chamber intraocular lens exchange surgery. Causes for out-of-the-bag intraocular lens dislocation included posterior capsule rupture during the initial cataract extraction procedure (23 eyes, 63.8%), trauma (5 eyes, 13.9%),neodymium-doped yttrium aluminium garnet (Nd:YAG) laser-induced dislocation (2 eyes, 5.6%), the status after vitrectomy (2 eyes, 5.6%) and unidentifiable etiology (4 eyes, 11.1%). Symptoms of these patients mainly included decrease in visual acuity (17 cases, 47.2%), blurred vision (16 cases, 44.4%), glare (1 case, 2.8%), diplopia (1 case, 2.8%), and halo (1 case, 2.8%). Intraocular lens dislocation into the posterior vitreous cavity (29 eyes, 80.5%), anterior chamber (1 eye, 2.8%) and anterior vitreous cavity (6 eyes, 16.7%) was found in this series. The foldable intraocular lenses (acrylic or silicone) were explanted from 27 eyes (75%) and rigid intraocular lenses (poly methyl methacrylate, PMMA) from 9 eyes (25%). The most common explanted intraocular lens material was single-piece acrylic (13 pieces, 36.1%), followed by 3-piece acrylic (9 pieces, 25%), single-piece PMMA (9 pieces, 25%), and 3-piece silicone (5 pieces, 13.9%). Uncorrected visual acuity postoperatively improved in 29 eyes (81%), unchanged in 4 eyes (11%), and worsened in 3 eyes (8%) in comparison to that before exchange operation (P = 0.006). Best corrected visual acuity tended to improve, but the improvement was not significant (P = 0.206). Complications related to lens exchange surgery were mainly intraocular lens redislocation (1 eye), retinal detachment (1 eye), vitreous hemorrhage (1 eye), and cystoid macular edema (1 eye). CONCLUSIONS: Out-of-the-bag intraocular lens dislocation was mainly caused by posterior capsule rupture during the initial cataract extraction procedure and the foldable lens was the most common dislocated intraocular lens. In most cases, posterior chamber intraocular lens exchange surgery could provide satisfied final visual outcomes.

[Effects of acupuncture on different acupoints in combination with rehabilitation on hemiplegic muscle spasticity in hemiplegia patients].

OBJECTIVE: To observe the clinical effect of hemiplegic muscle spasticity treated with acupuncture on different acupoints in combination with rehabilitation. METHODS: Ninety cases of post-stroke muscle spasticity were randomized into a corresponding and central axis acupuncture group (group A), a conventional acupuncture group (group B) and a rehabilitation group (group C), 30 cases in each one. In group A, the acupoints on the Governor Vessel were mainly selected, as well as those on Hand-Shaoyang meridian and Foot-Taiyang meridian. In group B, the conventional needling and rehabilitation training were applied in combination, of which, the acupoints were mainly from Hand and Foot-Yangming meridians, associated with the acupoints of Shaoyang meridian. In group C, only rehabilitation training was applied. The assessments according to modified Ashworth scale and CSS score were performed before treatment, after 2 weeks and 4 weeks treatment respectively. RESULTS: The level of modified Ashworth scale of the flexor of elbow and wrist was reduced apparently after treatment in group A as compared with that before treatment (P < 0.01). The level of modified Ashworth scale of the flexor of elbow was reduced apparently after treatment in group C as compared with that before treatment (P < 0.05). There was significant difference on the level change in modified Ashworth scale for the flexor of elbow between group A and group C after 4 weeks treatment (P < 0.05). CSS score decreased significantly in group A as compared with that before treatment (P < 0.01), the improvement after treatment in group A was apparent as compared with the other two groups (P < 0.01). CONCLUSION: The corresponding and central axis acupuncture can improve muscle tone of hemiplegic limb, which is superior to the effect achieved by the conventional acupuncture in combination with rehabilitation training and the simple rehabilitation training.

[Comparison of clear corneal on-axis and temporal incisions for Acrysof Toric intraocular lens implantation].

OBJECTIVE: To investigate whether there are some differences in the accuracy of Acrysof Toric intraocular lens (IOL) implantation and the ability to correct astigmatism between 2 types of clear corneal incisions used in phacoemulsification: the on-axis (i.e on the steeper corneal meridian) and the temporal clear corneal incision (OCCI and TCCI, respectively). METHODS: In this prospective study, thirty-nine eyes with cataract and mild to moderate corneal astigmatism (1.00 - 2.26 diopters on corneal curvature) were recruited and divided into OCCI group (20 eyes) and TCCI group (19 eyes) respectively. All of these patients underwent phacoemulsification and an Acrysof Toric IOL implantation (single surgeon, 3.2 mm incision). Main outcome measurements included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), corneal curvature, surgically induced astigmatism (SIA), deviation of lens axis (LAD), index of corrected astigmatism (CAI) and accuracy of astigmatism correction (ACA) at 3 months postoperatively. RESULTS: At 3 months postoperatively, simple algebraic difference showed a mean increase in the astigmatism magnitude of (0.28 + or - 0.27) D in the TCCI group and a mean reduction in the astigmatism magnitude of (0.31 + or - 0.26) D in the OCCI group (t = 5.756, F = 0.000). The average LAD was 0 degrees + or - 0 degrees in the OCCI group and 2.22 degrees + or - 2.99 degrees in the TCCI group(t = 3.860, P = 0.000). The average CAI were 1.04 + or - 0.27 and 0.59 + or - 0.44 respectively (t = 3.187, P = 0.004). The ACA were 0.838 and 0.484 respectively (Z = 1.970, P = 0.049). CONCLUSIONS: Compared with the TCCI, the OCCI could correct some corneal astigmatism and reduce IAD induced by the SIA shift. As a result, the OCCI could improve the accuracy of Acrysof Toric lens implantation and the ability to correct astigmatism.

[Investigation of corneal astigmatism in phacoemulsification surgery candidates with cataract].

OBJECTIVE: To investigate the characters of corneal astigmatism in cataract surgery candidates. METHODS: IOLMaster 5.0 was adopted in this study to measure preoperative corneal keratometry. The first suffered eye was taken as the observed eye when both eyes were involved. Descriptive statistics of keratometric cylinder data were analyzed. The mean of corneal astigmatism, distribution of astigmatism and the cumulated distribution were calculated. The relationship between age, axial length and astigmatism was analyzed respectively. The symmetry of binocular astigmatism was also studied. RESULTS: Preoperative keratometric data were obtained from 1389 patients (1389 eyes) with age related cataract (mean age 67.75 years, range from 40 to 79 years). The median of astigmatism was 0.84 D (0.12-4.36 D). The percentage of corneal astigmatism of 1.0 diopters (D) or higher was 32.9% (457 eyes), of which 243 eyes (53.2%) were against-the-rule (ATR) astigmatism. With aging, the amount of ATR astigmatism was increasing. Axial length was not correlated with the amount of astigmatism (r=0.179, P=0.203). Corneal astigmatism was mirror symmetry in both eyes of one person. CONCLUSIONS: Astigmatism, especially mild astigmatism, was common in patients with cataract, which suggests the importance of astigmatism correction. The symmetry of astigmatism should be considered when both eyes need cataract surgery. Axial length is not related to astigmatism, indicating that the measurement and correction of astigmatism are important even in emmetropia eyes.

[Iris hooks and modified capsular tension ring for subluxation lens in patients with Marfan's syndrome].

OBJECTIVE: To evaluate clinical efficiency and safety of the iris hooks and modified capsular tension ring (MCTR) for the treatment of subluxation lens in patients with Marfan's syndrome. METHODS: This study comprised 5 patients (7 eyes) with Marfan's syndrome and subluxation lens. After 3.2 mm clear cornea incision and continuous curvilinear capsulorhexis (CCC), 2 - 4 disposable nylon iris hooks were inserted through the stab incisions and placed in the capsulorhexis to support the capsule and enlarged the CCC. Following irrigation/aspiration, a MCTR with suture in its eyelet was placed in the capsule bag. After tightening and tying the suture of MCTR, the capsular bag was centered and fixed. A foldable AcrySof one-piece intraocular lens (IOL) was then placed in the capsule bag. RESULTS: Twelve months after the operation, the best corrected visual acuity was >/= 0.8 in six eyes and 0.7 in one eye. The scheimpflug images obtained from the Pentacam demonstrated that the IOL were well centered. UBM showed that all the MCTR and the haptics of the IOL were in the capsule bag, the eyelet of the MCTR was rested stably between the capsulorhexis margin and the iris. The retroillumination photograph indicated that only one eye had obvious posterior capsular opacification. No intraoperative and postoperative complications such as prolapse of vitreous and retina detachment was occurred. CONCLUSIONS: The iris hooks can provide excellent intraoperative capsule-lens stability and facilitate the manipulation during operation. MCTR allows additional suture fixation to the eye wall without damaging the capsular bag and maintains the long-term stability of the intraocular lens. Furthermore, MCTR is helpful for avoiding dislocation of the IOL due to progressive weakening of the zonular fibers in some patients and provides long-term safety.