Visual Outcomes, Endothelial Loss, and Complications Following Iris-Claw Intraocular Lens Implantation and Trocar-Assisted Sutureless Scleral Fixation of Intraocular Lenses.

Objectives: Iris-claw intraocular lens (IC-IOL) implantation and sutureless scleral fixation of intraocular lenses (SSF-IOL) are two commonly preferred surgical approaches for the management of aphakic patients without sufficient capsular support. The aim of this study was to compare the outcomes of IC-IOL implantation and trocar-assisted SSF-IOL implantation. Methods: The medical records of secondary IOL implantation patients were retrospectively reviewed. All patients had a detailed ophthalmological examination, including LogMAR best-corrected distance visual acuity (CDVA), intraocular pressure (IOP), and endothelial cell density (ECD) preoperatively and postoperatively. SPSS 21.0 software was used for the statistical analysis. Results: There were 15 patients in the IC-IOL group and 12 patients in the SSF-IOL group. Age and gender distributions were similar between the groups (p=0.456 and p=0.398, respectively). Similarly, patients in both groups had similar CDVA preoperatively and postoperatively (p=0.51, p=0.48, respectively). Both IC-IOL and SSF-IOL implantation significantly increased CDVA (p=0.001 and p=0.005, respectively). IOP remained unchanged in both groups. However, ECD reduced significantly following both IC-IOL and SSF-IOL implantation (p=0.001 and p=0.005, respectively) and trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation (439.5±89 vs. 164.4±53, p=0.013). Conclusion: Both surgical approaches increased CDVA significantly and at similar levels. However, trocar-assisted SSF-IOL implantation resulted in significantly more endothelial loss compared to IC-IOL implantation. None of the patients developed bullous keratopathy, but this difference should be kept in mind, especially in patients with critically low ECD.

Clinical outcome and endothelial loss following prepupillary and retropupillary implantation of iris claw intraocular lenses.

PURPOSE: Iris claw intraocular lenses (IOLs) were successfully used for the management of aphakia in patients that lack capsular support. The aim of this study was to compare the clinical outcome of prepupillary and retropupillary implantation of these IOLs. METHODS: The files of the 26 patients that had an iris claw IOL implantation between 2010 and 2020 were retrospectively reviewed. Detailed ophthalmological examination findings including corrected distance visual acuity (CDVA), intraocular pressure, endothelial cell counts, slit lamp and dilated fundus examination findings were specifically tabulated. Intraoperative and postoperative complications were also specifically recorded. RESULTS: There were 18 patients in the prepupillary implantation group and eight patients in the retropupillary implantation group. Age and gender distribution were similar between the groups. CDVA significantly increased in prepupillary and retropupillary implantation groups (p = 0.001 and p = 0.012, respectively). Median endothelial cell loss was 6.7% in prepupillary group and 7.2% in retropupillary group. The only intraoperative complication was iridodialysis (n = 1). Postoperative complications included retinal detachment (n = 1), cystoid macular edema (n = 2) and IOL tilt (n = 1). All of these complications occurred in the prepupillary implantation group. CONCLUSION: Prepupillary and retropupillary implantation of iris claw IOLs resulted with similar visual gain and endothelial loss rates in a follow-up time of 6 months. There was an insignificant trend toward a reduced complication rate following retropupillary implantation.

Comparison of intra- and postoperative complications of phaco between sequential and combined procedures of 23-gauge vitrectomy and phaco.

PURPOSE: To evaluate the intra- and postoperative complications of phacoemulsification in sequential and combined procedures of 23-gauge vitrectomy and cataract surgery. METHODS: The medical records of 376 patients who underwent phacoemulsification in a vitrectomized eye (sequential group) and 458 patients who underwent combined vitrectomy and phacoemulsification (combined group) were retrospectively reviewed. Main outcome measures were intra- and postoperative complications of phacoemulsification surgery. Surgical indications were a progressed cataract with various retinal conditions. RESULTS: The most common intraoperative complication during phacoemulsification was posterior capsule rupture in both groups. The rate of this complication was higher in the sequential group (18 eyes, 4.8%) than in the combined group (7 eyes, 1.5%) (p = 0.006). The most common early postoperative complication was transient high intraocular pressure (68 eyes, 14.8%) and late postoperative complication was pupillary in the synechia combined group (82 eyes, 17.9%). The most common early postoperative complication was transient high intraocular pressure (29 eyes, 7.7%) and late postoperative complication was posterior capsule opacification (27 eyes, 7.2%) in the sequential group. Fibrinous exudation occurred more in the combined group (57 eyes, 12.4%) than in the sequential group (19 eyes, 5.1%) (p = 0.000). CONCLUSION: Both sequential and combined cataract surgeries seemed to be safe. Combined surgery could be preferred in harder cataracts and zonular dehiscence.

Surgical therapy versus observation for lamellar macular hole: a retrospective comparison study.

BACKGROUND: The purpose of this study was to compare anatomic and visual changes in patients with lamellar macular hole undergoing pars plana vitrectomy with those in patients undergoing follow-up only. METHODS: In this retrospective consecutive case series study, we evaluated two groups of eyes, comprising 19 eyes from 19 patients with lamellar macular hole who underwent pars plana vitrectomy with internal limiting membrane peeling and 21 eyes from 21 patients with lamellar macular hole who had follow-up only. Corrected distance visual acuity (CDVA, in logMAR) and optical coherence tomography findings, including measurements of maximum diameter of lamellar defect and foveal thickness, and whether the inner segment/outer segment band was intact or not were documented at initial and follow-up examinations. RESULTS: At initial examination, mean CDVA was 0.54 logMAR in the study group and 0.51 logMAR in the control group, and 0.33 logMAR and 0.55 logMAR, respectively, on final examination. In the study group, postoperative optical coherence tomography images were found to be normalized in ten patients (52.6%), improved in six (31.5%), unchanged in two (10.5%), and to have progressed to full-thickness macular hole in one (5.2%) in the intervention group, while all patients in the control group were found to have deteriorated within the follow-up period between March 2004 and June 2010. CONCLUSION: In patients with lamellar macular hole, combination treatment with pars plana vitrectomy and internal limiting membrane peeling appears to be effective, but further studies are required to establish new treatment modalities for patients who do not have a satisfactory outcome from treatment.

Analysis of retinal ganglion cell complex thickness after Brilliant Blue-assisted vitrectomy for idiopathic macular holes.

PURPOSE: The purpose of this study was to evaluate retinal ganglion cell complex (GCC) thickness changes in eyes undergoing Brilliant Blue-assisted macular hole surgery (MHS) using Fourier-domain optical coherence tomography (FD-OCT). MATERIALS AND METHODS: This is a prospective, comparative, and observational case series of 70 eyes in 70 consecutive patients with idiopathic macular holes who underwent vitrectomy between December 2010 and October 2011. The study group consisted of 44 eyes in 44 patients, who underwent MHS with Brilliant Blue-assisted internal limiting membrane (ILM) peeling; 26 eyes in 26 patients, who underwent MHS without ILM peeling, constituted the control group. In both groups, complete ophthalmologic examinations and quantitative analysis of the GCC and retinal nerve fiber layer (RNFL) thicknesses were performed before and after the procedures using OCT. The findings from both groups were compared. RESULTS: Six months after surgery, the rate of closure of macular holes evaluated by OCT was 80.7% in the control group and 97% in the study group. There was no significant difference between preoperative and postoperative GCC and RNFL thickness values in both groups. CONCLUSIONS: No significant decrease was observed in the thickness values of the retinal GCC and RNFL after Brilliant Blue-assisted ILM peeling for MHS. Therefore, this surgical procedure can be performed safely for the treatment of macular holes.

Intravitreal triamcinolone acetonide versus pars plana vitrectomy for pseudophakic cystoid macular edema.

PURPOSE: To compare the efficacy of intravitreal triamcinolone acetonide injection versus 23-gauge pars plana vitrectomy with internal limiting membrane peeling for the treatment of chronic pseudophakic cystoid macular edema (CME) after uncomplicated cataract surgery. METHODS: This retrospective, comparative, consecutive case series study included 39 patients with chronic pseudophakic CME. Twenty eyes in 20 patients were treated with intravitreal triamcinolone acetonide injection (IVT group), and 19 eyes in 19 patients were treated with pars plana vitrectomy with internal limiting membrane peeling (PPV group). In both groups, complete ophthalmologic examinations were performed before and after procedures. Findings were compared between the groups. RESULTS: Both groups experienced a significant improvement in visual acuity and macular thickness after 12 months follow-up. At months 1 and 2, the IVT group showed a significant improvement in visual acuity and a significant reduction in macular thickness compared with the PPV group (p < 0.05), but these differences were not statistically significant between the groups after the 12-month period. CONCLUSION: Both intravitreal steroid injection and pars plana vitrectomy with internal limiting membrane peeling had a favorable effect on visual and anatomic results in patients with chronic pseudophakic CME. However, surgical treatment had no advantage over intravitreal triamcinolone acetonide injection after 12-months follow-up.

Outcomes of 23-gauge pars plana vitrectomy and internal limiting membrane peeling with brilliant blue in macular hole.

PURPOSE: The evaluation of anatomic and visual outcomes in macular hole cases treated with internal limiting membrane (ILM) peeling, brilliant blue (BB), and 23-gauge pars plana vitrectomy (PPV). MATERIALS AND METHODS: Fifty eyes of 48 patients who presented between July 2007 and December 2009 with the diagnosis of stage 2, 3, or 4 macular holes according to Gass Classification who had undergone PPV and ILM peeling were included in this study. Pre- and postoperative macular examinations were assessed with spectral-domain optical coherence tomography. 23 G sutureless PPV and ILM peeling with BB was performed on all patients. RESULTS: The mean age of patients was 63.34 ± 9.6 years. Stage 2 macular hole was determined in 17 eyes (34%), stage 3 in 24 eyes (48%), and stage 4 in 9 eyes (18%). The mean follow-up time was 13.6 ± 1.09 months. Anatomic closure was detected in 46/50 eyes (92%), whereas, in four cases, macular hole persisted and a second operation was not required due to subretinal fluid drainage. At follow-up after 2 months, persistant macular hole was detected in one case and it was closed with reoperation. At 12 months, an increase in visual acuity in 41 eyes was observed, while it remained at the same level in six eyes. In three eyes visual acuity decreased. There was a postoperative statistically significant increase in visual acuity in stage 2 and 3 cases (P < 0.05), however, no increase in visual acuity in stage 4 cases was observed. CONCLUSION: PPV and ILM peeling in stage 2, 3, and 4 macular hole cases provide successful anatomic outcomes, however, in delayed cases, due to photoreceptor loss, it has no effect on functional recovery. BB, used for clarity of ILM, may be beneficial due to its low retinal toxicity.