Management of Contact Lenses and Visual Development in Pediatric Aphakia.

Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.

Flange depth for scleral pocket vs no pocket techniques for intrascleral intraocular lens fixation.

PURPOSE: To compare flange depth for a modified scleral pocket (SP) vs no scleral pocket (NSP) technique (Yamane technique) for intrascleral intraocular lens (IOL) fixation. SETTING: Instituto de Oftalmología Santa Fe, Santa Fe, Argentina. DESIGN: Prospective, randomized, single-surgeon, observational study. METHODS: Eyes with aphakia and no capsular support were included. They were divided into 2 groups: one was programmed for a double-needle flanged intrascleral IOL fixation as originally described by Shin Yamane with NSP and the second group had a modified SP technique. Flange depth was measured with anterior-segment optical coherence tomography (AS-OCT) at 1 month, 3 months, 6 months, and 12 months postoperatively, and the results were compared. RESULTS: Each group comprised 18 eyes of 18 patients, giving a total of 36 flanges per group. The groups were comparable preoperatively. At 12 months, uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were not statistically different for both groups (P = .333; P = .448). Spherical equivalent (SEQ) was not significantly different between groups at 12 months postoperatively (P = .078). AS-OCT revealed a significantly deeper flange position for the SP group at 1 month, 3 months, 6 months, and 12 months postoperatively (P < .05). CONCLUSIONS: When performing a double-needle intrascleral IOL fixation in aphakic eyes with no capsular support, a modified scleral pocket technique provides a significantly deeper flange position with no difference in CDVA or SEQ 12 months postoperatively.

Fusion-Flanged Intrascleral Intraocular Lens Fixation Technique: Simple, Safe, Efficient.

PURPOSE: To develop a new, sutureless intrascleral intraocular lens (IOL) fixation technique based on the Yamane double-needle and Canabrava 4-flanged techniques. METHODS: The Fusion-Flanged technique involves using a 7-0 polypropylene suture loop threaded through the eyelets of the IOL. Afterward, both ends of the suture are passed outside the eye through a 27-gauge needle. This technique creates a single flange by joining the 2 suture ends through handheld cautery, and this flange is then embedded into the scleral tunnel to securely fix the IOL in place. RESULTS: This technique was performed on a total of 7 aphakic patients. Four of them had encountered complications following manual small incision cataract surgery, while the remaining 3 experienced complications after phacoemulsification. The results indicated a significant improvement in visual acuity, with mean preoperative and postoperative corrected distance visual acuities of 0.77 ± 0.11 and 0.27 ± 0.08 (logarithm of the minimum angle of resolution [logMAR] units), respectively. CONCLUSIONS: The Fusion-Flanged intrascleral IOL fixation technique offers improvements in simplicity, safety, and the overall efficiency when compared to existing sutureless intrascleral fixation techniques. Notably, this technique is versatile and can be applied to both non-foldable and foldable IOLs.

RETROPUPILLARY IRIS-CLAW INTRAOCULAR LENS AND PARS PLANA VITRECTOMY IN APHAKIA MANAGEMENT: A National Multicenter Audit.

PURPOSE: To evaluate the outcomes and safety of retropupillary iris-claw intraocular lens implantation and associated pars plana vitrectomy. METHODS: Multicenter, national audit of 325 eyes (325 patients). Demographics, surgical details, and complications are described. Visual acuity, intraocular pressure, and central retinal thickness assessed by optical coherence tomography were collected at 1, 3, 6, and 12 months after surgery. Kaplan-Meier curves were created to assess the cumulative probability of postoperative visual acuity and intraocular pressure levels, macular edema development, and corneal decompensation. RESULTS: The cumulative probability of the final visual acuity ≤0.3 logarithm of the minimum angle of resolution (≥20/40 Snellen) was 75.6% at 12-month follow-up. The probability of intraocular pressure >21, ≥25, and ≥30 mmHg was 48.1%, 33.1%, and 19.0%, and the probability of intraocular pressure-lowering drops was 50.9% at 12 months. Glaucoma surgery was required in 4.3% of the eyes (14/325). The cumulative probability of macular edema was 20.5% at 12 months and was greater in complicated cataract surgery than in intraocular lens-luxation eyes (26% vs. 16.7%, P = 0.04). Corneal transplantation was required in 2.8% of the eyes (9/325). CONCLUSION: This study on 325 eyes with aphakia or intraocular lens dislocation managed with the retropupillary iris-claw intraocular lens technique provides clinical outcomes in a real-world scenario, reporting relevant data for patient counseling and preoperative discussions.

Implantation of retropupillary iris-claw lenses: A review on surgical management and outcomes.

Iris-claw lenses have gained increasing popularity over the last years and are by many surgeons regarded as viable options in eyes with insufficient capsular or zonular support. The iris-claw lens has two haptics with fine fissures for folding (enclavating) the mid-peripheral part of the iris stroma and can either be placed in front of or posterior to the iris. In particular, the retropupillary implantation has been increasingly chosen probably due to having an anatomical position similar to that of the crystalline lens. The present review is based on a literature review and also on the authors' clinical experience with this lens, and it focuses on surgical techniques and outcomes especially related to the characteristics of this lens, having haptics with claws that fixate the lens to the posterior iris. Implanting retropupillary iris-claw lenses has a relatively short learning curve, and there are only few complications reported during surgery. Retropupillary iris-claw lenses have demonstrated generally favourable efficiency and safety. However, the outcomes are probably more influenced by the reason for surgery and eye comorbidity than the lens itself. Albeit seldom reported, the postoperative complications have mostly been related to atrophy of the iris at the site of the haptics, or IOL decentration or disenclavation of one of the haptics. To date, however, there are few randomized clinical trials comparing this lens to other lens alternatives in eyes exhibiting insufficient capsular or zonular support for placing the lens in the ciliary sulcus. In the future, prospective studies with large samples should be performed to gain insights into the long-term safety of retropupillary placed iris-claw lenses, and for comparisons with the various other techniques of lens fixation.

COMPARISON OF 25- AND 27-GAUGE SUTURELESS CANNULA-BASED INTRAOCULAR LENS SCLERAL FIXATION VISUAL ACUITY OUTCOMES AND COMPLICATION RATES.

PURPOSE: To compare the visual outcomes and complication rates of sutureless cannula-based intraocular lens scleral (SCILS) fixation performed with 25-gauge (25 G) versus 27-gauge (27 G) instrumentation. METHODS: A retrospective chart review of consecutive cases of eyes without capsular support that underwent SCILS fixation of a three-piece intraocular lens. Sutureless cannula-based intraocular lens scleral fixation was performed by transconjunctival use of either 25-G or 27-G trocar cannulas. During postoperative follow-up evaluations, visual acuity and intraocular pressure were measured, and slit-lamp and indirect ophthalmoscopy examinations were performed to assess for development of known complications. RESULTS: A total of 69 eyes underwent 25 G (27 eyes) or 27 G (42 eyes) SCILS fixation. The mean preoperative logarithm of the minimum angle of resolution visual acuity trended toward improvement from 0.95 ± 0.68 (20/178 Snellen equivalent) to 0.67 ± 0.64 (20/94 Snellen equivalent) for 25 G group at 1 year. Similar trend toward visual acuity improvement was seen in 27 G group with a mean preoperative logarithm of the minimum angle of resolution visual acuity of 1.43 ± 0.94 (20/538 Snellen equivalent) improving to 0.86 ± 1.00 (20/145 Snellen equivalent) at 1 year. Statistically significant improvement was seen as early as postoperative week one for 27 G group (P < 0.01), whereas statistically significant worsening was noted at the same time in 25 G group (P = 0.01). There was a statistically significant reduction in intraocular lens displacement (P = 0.01) and need for reoperation (P = 0.01) in 27 G group. CONCLUSION: Compared with 25 G SCILS fixation, eyes managed with 27 G SCILS fixation experienced more rapid visual acuity improvement. In addition, there was a lower rate of complications including intraocular lens displacement and need for reoperation.

Postoperative Changes in Central Corneal Thickness and Intraocular Pressure in a Prospective Cohort of Congenital Cataract Patients.

PURPOSE: To evaluate changes in central corneal thickness (CCT) and intraocular pressure (IOP) in children after surgery for congenital cataracts and to investigate the association between CCT and IOP. METHODS: For this prospective observational cohort study, we recruited patients undergoing surgery for unilateral or bilateral congenital cataracts. CCT and IOP were measured before surgery and 1, 3, 6, 12, and 24 months after surgery. RESULTS: Seventy-six children (152 eyes) were enrolled; 33 eyes were unaffected by cataracts, 77 were aphakic, and 42 were pseudophakic. In aphakic eyes, mean CCT increased by 31.14 ± 44.32 µm at 12 months postoperation and 33.09 ± 35.42 µm at 24 months postoperation; this increase was significantly higher than that in pseudophakic eyes 12 months after surgery (8.36 ± 19.91 µm; P < 0.001) and 24 months after surgery (0.31 ± 14.19 µm; P = 0.024). However, no significant differences in IOP were found between the different phakic states at 12 and 24 months postoperation (P = 0.672 and P = 0.080, respectively). There were also no significant differences in CCT and IOP before and after surgery in the unaffected eyes. CONCLUSIONS: Mean CCT peaked at 12 months, and the mean IOP remained normal in both the aphakic and pseudophakic eyes during this study. CCT and IOP were positively correlated, regardless of the phakic status or age, a relationship which suggests that both parameters should be monitored closely in postsurgical patients for up to 12 months and in this time, may impact the ability to diagnose glaucoma.

Extended Depth-of-Field Intraocular Lenses: An Update.

Extended depth-of-focus (EDOF) is a new intraocular lens (IOL) technology in the treatment of presbyopia. In contrast to multifocal (MF) IOLs, EDOF lenses create a single elongated focal point, rather than several foci, to enhance depth of focus. In this way, EDOF IOLs aim to reduce photic phenomena, glare, and halos, which have been reported in MF IOLs. A potential disadvantage is a decrease of retinal image quality if the amount of the aberrations is excessively increased. Frequently, EDOF IOLs are combined with MF optical designs; for this reason, EDOF IOLs are commonly a subject of confusion with optical multifocality concepts. The aim of this article is to clarify what an EDOF IOL is and to discuss the recently reported outcomes with these IOLs. We propose naming lenses that have combined optical designs as "hybrid IOLs."

Comparison of visual acuity and complications between primary IOL implantation and aphakia in patients with congenital cataract younger than 2 years: a meta-analysis.

To analyze the visual acuity and complications between primary intraocular lens (IOL) implantation and contact lens wearing, this literature search was performed with data on patients with congenital cataract younger than 2 years published in March 2019. Seven identified studies enrolling 675 eyes were selected for analysis. Patients with primary IOL implantation owned better visual acuity than those with aphakia who wore the contact lens (weighted mean difference = 0.161; 95% CI, 0.108-0.214). For visual axis opacification (VAO), primary IOL implantation increases the incidence of VAO compared with contact lens wearing (relative risk = 0.23; 95% CI, 0.13-0.42). No statistically significant difference was found between the 2 groups about the prevalence of glaucoma and strabismus. Primary IOL implantation achieved better visual outcomes after cataract extraction in patients younger than 2 years. In addition, no higher risk for complications among primary IOL implantation compared with contact lens wearing was noted. Therefore, implanting a primary IOL during congenital cataract surgery is a better therapy for children younger than 2 years than wearing a contact lens.

A Simple Modified Way of Glueless, Sutureless Scleral Fixation of an IOL: A Retrospective Case Series.

PURPOSE: To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL). DESIGN: Retrospective interventional case series. METHODS: A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3 mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt. RESULTS: Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P < 0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt. CONCLUSIONS: This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.

Long-term Effect of Intraocular Lens vs Contact Lens Correction on Visual Acuity After Cataract Surgery During Infancy: A Randomized Clinical Trial.

Importance: Although intraocular lenses (IOLs) are often implanted in children, little is known whether primary IOL implantation or aphakia and contact lens correction results in better long-term visual outcomes after unilateral cataract surgery during infancy. Objective: To compare long-term visual outcomes with contact lens vs IOL correction following unilateral cataract surgery during infancy. Design, Setting, and Participants: This multicenter randomized clinical trial enrolled 114 infants with a unilateral congenital cataract who underwent cataract surgery with or without primary IOL implantation between 1 and 6 months of age. Data on long-term visual outcomes were collected when the children were age 10.5 years (July 14, 2015, to July 12, 2019) and analyzed from March 30 through August 6, 2019. Interventions: Intraocular lens implantation at the time of cataract surgery. Main Outcomes and Measures: Best-corrected visual acuity using the electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS) testing protocol. Analysis was performed on an intention-to-treat basis. Results: Best-corrected visual acuity was measured at age 10.5 years for 110 of the 114 patients (96%) enrolled as infants. The participants included 58 girls (53%) and 52 boys (47%). Overall, 27 of the children (25%) had good (logMAR 0.30 [Snellen equivalent, 20/40] or better) visual acuity in the treated eye (12 [22%] in the IOL group and 15 [27%] in the aphakia group), but 50 children (44%) had a visual acuity of logMAR 1.00 (Snellen equivalent, 20/200) or worse (25 [44%] in the IOL group and 25 [44%] in the aphakia group). The median logMAR acuity in the treated eye was similar in children randomized to receive an IOL at the time of cataract extraction (0.89; interquartile range [IQR], 0.33-1.43 [Snellen equivalent, 20/159]) and those who remained aphakic (0.86; IQR, 0.30-1.46 [Snellen equivalent, 20/145]) (IQR, 0.30-1.46; P = .82). Although the overall difference in median visual acuity between the 2 groups was small, the estimate was imprecise (99% CI for the difference in medians was -0.54 to 0.47). Conclusions and Relevance: As in previous phases of the study, visual acuity outcomes were highly variable with only 27 children (25%) achieving excellent visual acuity in their treated eye and 50 children (44%) having poor vision in the treated eye. Implanting an IOL at the time of cataract extraction was neither beneficial nor detrimental to the visual outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT00212134.

Flattened flanged intrascleral intraocular lens fixation technique.

AIM: To evaluate the visual outcomes of the patients who had undergone sutureless scleral fixated IOL implantation operation in which a new modified Yamane technique called flattened flanged intrascleral intraocular lens fixation technique was applied. MATERIALS AND METHODS: Forty-two eyes of 42 patients who had undergone scleral IOL fixation operation with Yamane technique comprised Group 1. The mean age of this group was 60.24 ± 14.3 (20-77) years. Out of 42 patients, 25 of them (60%) were males and 17 of them (40%) were females. Forty-three eyes of 43 patients who had undergone scleral IOL fixation operation with flattened flange technique comprised Group 2. The mean age of this group was 55.35 ± 15.77 (18-79) years. Out of 43 patients, 23 (53.4%) of them were males and 20 (46.6%) were females. RESULTS: There were no significant differences between two groups in respect to mean preoperative UCVA, postoperative UCVA, preoperative BCVA, and postoperative BCVA (p values 0.35, 0.11, 0.28, and 0.16, respectively). The mean postoperative UCVA and preoperative BCVA were significantly higher than those of preoperative values in both groups (p < 0.05). Intraoperative haptic sliding occurred in three eyes (7%) in the first group, and there was no intraoperative haptic sliding in the second group (0%) (p = 0.05). Postoperative IOL dislocation occurred in one eye (2.5%) in the first group, and there was no postoperative IOL dislocation in the second group (0%) (p = 0.32). CONCLUSION: In conclusion, this technique does not require sutures, decreases intraoperative haptic sliding, may provide more IOL stability and less tilt, and facilitates the implantation of the second haptic. For long-term results, further studies should be conducted.

Long-term results of aphakia management by scleral fixation intraocular lens placement with knotless transscleral Z-suture method.

PURPOSE: To evaluate the long-term refractive outcomes and complications of posterior chamber intraocular lens placement by scleral fixation surgery (SF-IOL) with the knotless Z-suture method. METHODS: The authors retrospectively reviewed the medical records of patients who underwent SF-IOL placement with the Z-suture method between January 2010 and December 2018 and who attended a follow-up after at least 1 year. Preoperative and postoperative best-corrected visual acuity (BCVA), anterior segment biomicroscopy, fundus examinations, and postoperative complications were evaluated. Lenticular astigmatism was calculated through the vector analysis method. RESULTS: One hundred thirty-six eyes of 136 patients (mean age 57.78 ± 22 years, 98 male/38 female) were included in the study. Of the 136 patients, 67 (49.3%) had a complicated cataract, 50 (36.8%) had pseudoexfoliation syndrome, and 19 (14%) had a trauma history. The mean follow-up period was 50.83 ± 27 months. The mean preoperative BCVA was 0.65 ± 0.24 LogMAR, and the postoperative BCVAs were: 0.40 ± 0.30 (p < 0.001) at 1 year; 0.40 ± 0.30 (p < 0.001) at 2 years; 0.41 ± 0.31 (p < 0.001) at 3 years; 0.43 ± 0.32 (p < 0.001) at 5 years; and 0.47 ± 0.24 (p = 0.03) at 8 years. Complications included retinal detachment in 2 patients (1.5%), cystoid macular edema in 4 patients (2.9%), increase in intraocular pressure in 5 patients (3.6%), suture loosening in 3 patients (2.2%), and IOL dislocation in 3 patients (2.2%). CONCLUSION: Scleral fixation of IOL with knotless Z-suture technique is an effective method to correct aphakia, with reliable long-term results.

Outcomes of Bilateral Cataracts Removed in Infants 1 to 7 Months of Age Using the Toddler Aphakia and Pseudophakia Treatment Study Registry.

PURPOSE: To evaluate outcomes of bilateral cataract surgery in infants 1 to 7 months of age performed by Infant Aphakia Treatment Study (IATS) investigators during IATS recruitment and to compare them with IATS unilateral outcomes. DESIGN: Retrospective case series review at 10 IATS sites. PARTICIPANTS: The Toddler Aphakia and Pseudophakia Study (TAPS) is a registry of children treated by surgeons who participated in the IATS. METHODS: Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement during IATS enrollment years 2004 through 2010. MAIN OUTCOME MEASURES: Visual acuity (VA), strabismus, adverse events (AEs), and reoperations. RESULTS: One hundred seventy-eight eyes (96 children) were identified with a median age of 2.5 months (range, 1-7 months) at the time of cataract surgery. Forty-two eyes (24%) received primary IOL implantation. Median VA of the better-seeing eye at final study visit closest to 5 years of age with optotype VA testing was 0.35 logarithm of the minimum angle of resolution (logMAR; optotype equivalent, 20/45; range, 0.00-1.18 logMAR) in both aphakic and pseudophakic children. Corrected VA was excellent (<20/40) in 29% of better-seeing eyes, 15% of worse-seeing eyes. One percent showed poor acuity (≥20/200) in the better-seeing eye, 12% in the worse-seeing eye. Younger age at surgery and smaller (<9.5 mm) corneal diameter at surgery conferred an increased risk for glaucoma or glaucoma suspect designation (younger age: odds ratio [OR], 1.44; P = 0.037; and smaller cornea: OR, 3.95; P = 0.045). Adverse events also were associated with these 2 variables on multivariate analysis (younger age: OR, 1.36; P = 0.023; and smaller cornea: OR, 4.78; P = 0.057). Visual axis opacification was more common in pseudophakic (32%) than aphakic (8%) eyes (P = 0.009). Unplanned intraocular reoperation occurred in 28% of first enrolled eyes (including glaucoma surgery in 10%). CONCLUSIONS: Visual acuity after bilateral cataract surgery in infants younger than 7 months is good, despite frequent systemic and ocular comorbidities. Although aphakia management did not affect VA outcome or AE incidence, IOL placement increased the risk of visual axis opacification. Adverse events and glaucoma correlated with a younger age at surgery and glaucoma correlated with the presence of microcornea.

Results of a clinical evaluation of a trifocal intraocular lens in Japan.

PURPOSE: To evaluate the effectiveness and safety of a new trifocal intraocular lens (IOL) after cataract removal in patients living in Japan. STUDY DESIGN: Prospective multicenter clinical study. METHODS: One hundred and thirty-five eyes of 68 patients (19 men, 49 women; mean age, 66.3 ± 7.4 years) were followed for 6 months. Trifocal IOLs with focal points at near, intermediate, and distance were implanted bilaterally in eyes with less than 1 diopter of corneal astigmatism. The visual acuity (VA) at distance, 60 and 40 centimeters (cm), and contrast sensitivities were measured. Patients completed quality-of-life questionnaires preoperatively and postoperatively. RESULTS: The mean bilateral logarithm of the minimum angle of resolution VA at 5 meters (m), 60 cm, and 40 cm were, respectively: uncorrected, - 0.104 ± 0.095, - 0.065 ± 0.111, and - 0.042 ± 0.105; and distance-corrected, - 0.197 ± 0.076, - 0.112 ± 0.111, and - 0.073 ± 0.111. The contrast sensitivities at distance and near were within the normal range at all spatial frequencies under photopic conditions. Patients reported complete spectacle independence in 75.0% of cases. Total use of spectacles was reported by 1.5% and partial by 20.6%; the purpose of spectacle use was primarily for near visual tasks. Mild-to-moderate glare was reported by 65.7% of patients and halos by 70.1%; only 1.5% of subjects reported severe glare and halos. CONCLUSIONS: This new trifocal IOL provides equally good uncorrected VAs at distance, intermediate, and near, and decreases spectacle dependence in daily life. Patients frequently report mild-to-moderate glare and halos, and patients should be informed about these before implantation.

Glaucoma following cataract surgery in the first 2 years of life: frequency, risk factors and outcomes from IoLunder2.

BACKGROUND: We investigated glaucoma related adverse events, predictors and impact at 5 years following surgery in the IoLunder2 cohort METHODS: Population based observational cohort study of children undergoing cataract surgery aged 2 years or under between January 2009 and December 2010. Glaucoma was defined using internationally accepted taxonomies based on the consequences of elevated intraocular pressure (IOP). Glaucoma related adverse events were any involving elevated IOP. Multivariable analysis was undertaken to investigate potential predictors of secondary glaucoma with adjustment for within-child correlation in bilateral cataract. Unilateral and bilateral cataract were analysed separately. RESULTS: Complete follow-up data were available for 235 of 254, 93% of the inception cohort. By 5 years after primary cataract surgery, 20% of children with bilateral cataract and 12% with unilateral had developed secondary glaucoma. Glaucoma related complications had been diagnosed in 24% and 36% of children, respectively. Independent predictors of glaucoma were younger age at surgery (adjusted OR for reduction of week in age: 1.1, 95%C I 1.1 to 1.2, p<0.001); the presence of significant ocular comorbidity (adj OR 3.2, 95% CI 1.1 to 9.6, p=0.01); and shorter axial length (adj OR for each mm 1.7, 95% CI 10.0 to 1, p=0.05) for bilateral cataract. Shorter axial length was the single independent factor in unilateral disease (adj OR 9.6, 95% CI 1.7 to 52, p=0.009) CONCLUSIONS: Both younger age at surgery (the strongest marker of ocular 'immaturity') and smaller ocular size (a marker of both immaturity and developmental vulnerability) can be used to identify those at greatest risk of glaucoma due to early life cataract surgery.

ONE-YEAR OUTCOMES OF A NOVEL SURGICAL TECHNIQUE FOR SUTURELESS INTRASCLERAL FIXATION OF A THREE-PIECE INTRAOCULAR LENS USING A 30-GAUGE NEEDLE.

PURPOSE: To present the 1-year results of a surgical technique for the sutureless intrascleral fixation of a 3-piece intraocular lens using a 30-gauge needle. METHODS: A retrospective chart review of a consecutive series of 9 eyes of 8 patients who underwent sutureless intrascleral fixation of posterior chamber intraocular lens using a 30-gauge needle was performed. Patients were required to have at least 1 year of follow-up to be included in the analysis. Short-term data were collected 1 month after surgery, and long-term data were collected 1 year after surgery. Data collected included visual acuity, lens stability, intraocular pressure, and the development of complications. RESULTS: Visual acuity improved from Snellen 20/309 preoperatively to Snellen 20/27 at postoperative Month 12 (P = 0.03). Short-term complications included increased intraocular pressure (n = 4) and corneal edema (n = 2). Long-term complications included exposed superior haptic (n = 1) and recurrent anterior chamber inflammation (n = 1). CONCLUSION: The novel surgical technique for sutureless intrascleral fixation of a 3-piece intraocular lens is well tolerated 1 year after surgery.

Long-term outcome of scleral-sutured posterior chamber intraocular lens: a case series.

PURPOSE: Purpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage. SETTING: Barraquer Institute in Barcelona, Spain. DESIGN: Retrospective study of consecutive cases. METHODS: Study of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis. RESULTS: 345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79. CONCLUSIONS: Scleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.

Anterior chamber angle and intraocular pressure changes after eventless phacoemulsification surgery in non-glaucomatous Egyptian patients.

PURPOSE: The purpose was to evaluate the angle of the anterior chamber (ACA) and intraocular pressure (IOP) changes following eventless phacoemulsification surgery done for non-glaucomatous Egyptian patients. METHODS: A prospective, interventional study involved 126 cataractous patients undergoing phacoemulsification with intraocular lens implantation. Patients were investigated for ACA and IOP preoperatively and postoperatively at 1 month and 6 months. Anterior chamber angles were evaluated by Scheimpflug camera, and IOP was measured by Goldmann applanation tonometer. RESULTS: A total of 144 eyes from 126 patients were enrolled: 65 males and 79 females; mean age was 59.72 years. At 6 months after phacoemulsification, there was highly significant decrease in IOP (P = 0) and anterior chamber angle (P = 0). The change in IOP did not correlate statistically with patient age, preoperative IOP, preoperative ACA or ACA widening. CONCLUSION: Phacoemulsification reduced significantly IOP which was maintained for 6 months and widened significantly the anterior chamber angle. None of the studied parameters in our study has proved to be a reliable predictive factor to the amount of IOP drop after phacoemulsification.