Clinical outcomes of glued transscleral fixated intraocular lens in functionally one-eyed patients.

PURPOSE: To analyze the indications, visual outcome, mental status, and quality of life after glued transscleral fixated intraocular lens (IOL) in functionally one-eyed individuals. SETTING: Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Prospective observational comparative case series. METHODS: Patients with one functioning eye with surgical indications (aphakia, luxated IOL, or dislocated lens) and the fellow eye with no perception of light were included. Indications, uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), mental status (Amsterdam Preoperative Anxiety and Information Scale) and quality of life (visual function scoring VF-14) were assessed. Outcomes of nonsurgical and surgical management were evaluated and compared. RESULTS: Of 22 patients, 10 (45.4%) patients underwent glued IOL (group A) and 12 (54.5%) wore spectacles (group B). There was a strong association between the initial clinical presentation and management (χ, P=0.000). Subluxated cataract and dislocated lens (or IOL) required surgical treatment. Postoperative aphakia with adequate spectacle correction were conservatively treated. There was change (P=0.005) in UDVA and CDVA after glued IOL surgery. There was no loss of CDVA. There was difference between the 2 groups in reading small prints (P=0.021), sporting activities (P=0.000), and night driving (P=0.000). Surgical anxiety was higher in group B (P=0.014). Females were more anxious than the males (P=0.014). There was an association of increasing age and the decision for nonsurgical management (χ, P=0.005). CONCLUSION: Glued transscleral fixated IOL can be safely performed in one-eyed patients for specific indications to provide good functional results.

Parenting stress in the infant aphakia treatment study.

OBJECTIVE: To evaluate parenting stress following infants' cataract extraction surgery, and to determine if levels of stress differ between 2 treatments for unilateral congenital cataract in a randomized clinical trial. METHODS: At surgery, an intraocular lens (IOL) was implanted or children were left aphakic, treated with contact lens (CL). Stress measures were administered 3 months after surgery and at the first visit after the visual acuity (VA) assessment done at 12 months of age. RESULTS: Caregivers in the IOL group reported higher levels of stress than those in the CL group 3 months after surgery, but there were no group differences in stress scores at the post-VA assessment. Stress scores did not change differentially for participants assigned to IOL versus CL treatments. CONCLUSIONS: Treatment assignment did not have a significant impact on caregiver stress during infancy or on the change in stress during the child's first 2 years of life.

[Aniridia intraocular lenses in eyes with traumatic iris defects]. / Aniridie-Intraokularlinsen bei Augen mit traumatischen Irisdefekten.

BACKGROUND: Globe injuries frequently are the cause of permanent loss of visual function. Especially ruptures of the globe have a 50 times lower chance of achieving a final visual acuity better than 20/200 as compared to contusions of the globe. Besides injury to the retina and choroids, injury of the iris-lens diaphragm plays an important role for visual rehabilitation (10% iris defects and 1% aniridia after blunt trauma). Against this background the surgical results after implantation of aniridia intraocular lenses were investigated. PATIENTS AND METHODS: Eleven patients (41.9+/-19.6 years of age) after globe injury (three ruptures of the globe, eight penetrating injuries with trauma of the iris) were implanted with an aniridia IOL. RESULTS: The implantation of an aniridia IOL was performed on average 1.0+/-0.6 years (range: 0.4-2.3 years) after the primary injury. In ten eyes an aniridia IOL model HMK ANI 2 (Ophtec/Polytech) was implanted and in one eye an aniridia IOL model 67 (Morcher). Most patients were very satisfied with the results achieved (average corrected visual acuity 0.48; 0.05-1.0). Of the operated eyes, 63% reached a visual acuity > or = 0.4. All patients noticed a significant reduction in glare disability as compared to the preoperative condition. The incidence of secondary glaucoma remained unchanged after the secondary implantation. One patient demonstrated retinal detachment 3 months after receiving the secondary implant, which was successfully treated with vitrectomy and gas tamponade. CONCLUSIONS: The implantation of aniridia IOLs seems to be a beneficial therapeutic option in post-traumatic eyes with partial or complete aniridia and aphakia with good visual recovery. During the postoperative follow-up special attention must be paid to sufficient regulation of intraocular pressure and to the retinal situation.

Teaching young children to use contact lenses.

Young children with surgically removed lenses and extreme nearsightedness can benefit from contact lenses, but their parents may need instruction to teach their children to accept lenses. In this study, 4 children under the age of 5 years were taught contact lens wear using a shaping procedure. Compliance was rewarded with praise and tangibles, and noncompliance was followed with brief time-out for 3 of the children and restraint for the 4th. Three children showed high compliance during an initial shaping procedure, with a decrease in compliance during initial insertion of the lenses. At 3- to 10-month follow-up, levels of compliance were high. Insertion and removal of lenses were accomplished in substantially less time, with little crying and no need for time-out. All 3 children continue to use the lenses daily, and 2 have shown improved visual acuity. The 4th child, who has Down syndrome, showed low levels of compliance with need for physical restraint throughout. Although his parents reported high compliance when he first went home, fitting difficulties and an infection resulted in plummeting of compliance, and contact lens use was discontinued. This procedure has been used successfully at the same hospital with 11 of 13 other children between the ages of 14 months and 7 years 4 months. Implications for selection of suitable candidates for this intervention and ways to decrease costs are discussed.