Luxación posterior bilateral del cristalino en una paciente agitada, ¿causa o consecuencia? / Posterior bilateral lens luxation in an agitated patient: Cause or consequence?

Las luxaciones posteriores completas del cristalino son entidades clínicas poco frecuentes. Los traumatismos son la principal causa de luxación secundaria del cristalino no iatrogénica. La mayor parte de los casos son unilaterales, siendo los casos de luxación bilateral muy poco frecuentes. Presentamos el inusual caso clínico de una mujer de 70 años que presentó una luxación bilateral posterior del cristalino en el contexto de un cuadro de instauración aguda de síndrome confusional. Discutimos acerca de la privación sensorial como un factor desencadenante de cuadros de confusión aguda y agitación en pacientes con enfermedades predisponentes. Además, describimos los beneficios que, en nuestra experiencia, nos aporta la técnica de reflotamiento con perfluorocarbono para el abordaje quirúrgico de estos casos

Complete posterior lens dislocation is an infrequent clinical entity. Trauma is the first cause of secondary lens dislocation. Most of the cases are unilateral, and bilateral cases are unusual. We report the uncommon case of a 70-year-old woman with evidence of a posterior bilateral dislocation of the lens in the context of an acute onset of confusional syndrome. We discuss about sensory deprivation as a trigger for acute confusion and agitation in patients with predisposing conditions. In addition, we describe the benefits that, in our experience, the refloating technique with perfluorocarbon liquid provides for the surgical approach to these cases

Three-Dimensional Assessments of Intraocular Lens Stability With High-Speed Swept-Source Optical Coherence Tomography.

PURPOSE: To evaluate the effect of intraocular lens (IOL) optic overlapping on IOL stability and to determine the relationship between the capsulorhexis and IOL movement with the three-dimensional method of swept-source optical coherence tomography (SS-OCT). METHODS: This study identified patients with age-related cataracts and divided them into two groups according to their anterior capsule and IOL optic relationship: total anterior capsule overlap (360°) and partial anterior capsule overlap (< 360°). Standard SS-OCT radial scanning was performed in all eyes at 1 day, 1 week, 1 month, and 3 months after cataract surgery, respectively. The obtained photographs were used for the postoperative position measurements of capsulorhexis and IOL after three-dimensional reconstruction. RESULTS: This study included 46 eyes of 34 patients: total overlap group (n = 29) and partial overlap group (n = 17). The postoperative aqueous depth significantly decreased in the first week after surgery (P < .001). The IOL tilt was greater in the partial overlap group than that in the total overlap group (P = .014). The IOL moved significantly in the first week postoperatively (both P < .001). IOL decentration in the x-axis was greater in the partial overlap group than that in the total overlap group (P = .024). The IOL and capsulorhexis both moved sharply in the first week (both P < .05). The IOL moved consistently with the capsulorhexis in the 3 months after surgery (all P > .05). CONCLUSIONS: The total overlap group showed better IOL centrality and stability. IOL movement may be driven by capsular bag contraction and fibrosis. Thus, it was demonstrated that postoperative IOL position and IOL performance were closely linked with proper size of central continuous curvilinear capsulorhexis. [J Refract Surg. 2020;36(6):388-394.].

Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer.

PURPOSE: To evaluate crystalline lens and intraocular lens (IOL) tilt using a swept-source optical coherence tomography (SS-OCT) biometer (IOLMaster 700). SETTING: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. DESIGN: Retrospective case series. METHODS: The study patients were evaluated for 1) repeatability of the crystalline lens tilt measurement, 2) preoperative crystalline lens and postoperative IOL tilt in right eyes, 3) mirror symmetry between right eyes and left eyes, 4) the correlation between preoperative crystalline lens and postoperative IOL tilt, and 5) the correlation between the magnitude of lens tilt and ocular parameters. RESULTS: The study comprised 333 patients. The repeatability was 0.1 degrees for tilt magnitude and 3.0 degrees for tilt direction. Both the crystalline lens and IOL had anterior tilt of the nasal portion with mean tilt magnitudes of 3.7 degrees ± 1.1 (SD) (range 0.4 to 6.9 degrees) for the crystalline lens and 4.9 ± 1.8 degrees (range 1.6 to 10.7 degrees) for the IOL. There was mirror symmetry between right eyes and left eyes. The mean IOL tilt magnitude exceeded crystalline lens tilt by 1.2 ± 1.1 degrees (range -3.2 to 4.0 degrees), and the 2 values were significantly correlated (all P < .01). The magnitude of crystalline lens tilt significantly increased with decreasing axial length and with increasing angle α (all P < .05). CONCLUSIONS: The repeatability of crystalline lens tilt measurements using the SS-OCT biometer was excellent. There was mirror symmetry between the right eyes and left eyes. Preoperative crystalline lens tilt could be used to predict the postoperative IOL tilt. The lens tilt magnitude was greater in short eyes and in eyes with larger angle α.

Surgical approach affects intraocular lens decentration.

BACKGROUND/PURPOSE: This study aims to quantify and identify risk factors for intraocular lens (IOL) tilt and decentration early after surgery using Scheimpflug imaging. METHODS: We prospectively included 268 eyes of 253 patients who underwent uneventful cataract surgery and one-piece IOL implantation using a superior or temporal approach. Scheimpflug imaging was used to evaluate the tilt and decentration of IOLs at 1 week, 1 month, and 3 months postoperatively. Differences in IOL tilt and decentration between the approaches were examined. Correlations of age and axial length with the magnitudes of IOL decentration and tilt were also examined. RESULTS: In total, 139 right and 129 left eyes were included. IOL displacement averaged 150 µm upward and 150 µm to the nasal side of the pupil. Over 50% of the eyes were tilted upward and approximately 90% to the temporal side. The surgical approach was significantly associated with horizontal decentration in both eyes, but significantly associated with only vertical decentration in the right eye 1 week postoperatively. In the left eyes, IOLs were shifted to the nasal side in 57.1% and 36.8% of the eyes that received the temporal and the superior approach, respectively, compared with 75.8% and 50% in the right eyes. The differences were significant only at 1-week follow-up (p = 0.035 and p = 0.003, respectively). Age or axial length was not associated with IOL tilt or decentration in either eye. CONCLUSION: Scheimpflug imaging can be used as a quantitative tool to evaluate IOL position. The incision site affected the IOL position, this finding was significant at 1 week postoperatively only.

Long-term ultrasound biomicroscopy observation of position changes of a copolymer posterior chamber phakic intraocular lens.

PURPOSE: To evaluate longitudinal changes in Implantable Collamer Lens phakic intraocular lens (pIOL) position after implantation. SETTING: Department of Ophthalmology, Zhejiang University, Hangzhou, China. DESIGN: Retrospective case series. METHODS: Myopic eyes that had pIOL implantation with a follow-up of at least 24 months were evaluated. Ultrasound biomicroscopy examinations were performed at each visit. RESULTS: The study enrolled 62 eyes (31 patients; 22 women, 9 men) ranging in age from 21 to 46 years. The manifest spherical equivalent ranged from -8.25 to -18.75 diopters. A significant increase (mean 36 µm±50 [SD]) in the endothelium-anterior pIOL distance occurred between 1 month and 3 months (P=.000); afterward, the distance decreased slowly (P>.05). The largest decrease (mean 47±17 µm) in central vault occurred between 1 month and 3 months (P=.009). The largest decrease (mean 21±14 µm) in peripheral vault occurred between 1 month and 3 months (P=.000). CONCLUSIONS: A significant increase in the endothelium-anterior pIOL distance occurred from 1 month to 3 months postoperatively, after which a slight decrease occurred over time. Central vault and peripheral vault had a tendency to decrease over time. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

In vivo analysis of glued intraocular lens position with ultrasound biomicroscopy.

PURPOSE: To report ultrasound biomicroscopic (UBM) findings of glued transscleral-fixated posterior chamber intraocular lenses (IOLs) in eyes with inadequate capsules. SETTING: Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. DESIGN: Case series. METHODS: Eyes with glued IOLs for inadequate capsule support were examined with UBM. Optic tilt was measured in relation to the iris plane. Haptic location, iris-IOL contact, vitreous incarceration, and central anterior chamber depth (ACD) were measured and correlated clinically with vision and refractive error. RESULTS: The mean follow-up was 24.6 months ± 14.3 (SD). Of the 46 eyes, 8 (17.4%) showed optic tilt and 38 (82.6%) showed no optic tilt. Of 92 haptics examined, 85 (92.4%) were in the ciliary sulcus and 7 (7.6%) in the pars plicata. There was no significant association between the presence of optic tilt and haptic location (P=.585, chi-square test). The mean ocular residual astigmatism (ORA) was 0.5 ± 0.2 diopter (D). There was no significant difference in ORA between eyes with tilt and eyes without tilt (P=.079). There was no significant correlation between ORA and IOL position. There was no correlation of optic tilt and postoperative vision or cylinder. Other features included iris-IOL contact (6.5%), vitreous incarceration (5.4%), and ACD difference (P=.002). CONCLUSIONS: No significant IOL optic tilt affecting the postoperative vision was detected with glued transscleral-fixated IOLs. The technique reliability was good, with the haptics located in the intended position in more than 90% of eyes. FINANCIAL DISCLOSURE: Dr. Amar Agarwal is a paid consultant to Staar Surgical Co. No other author has a financial or proprietary interest in any material or method mentioned.

Ultrasound biomicroscopic study of the stability of intraocular lens implants after phacoemulsification cataract surgery.

PURPOSE: To assess the postoperative stability of three-piece intraocular lens (IOL) implants using ultrasound biomicroscopy (UBM). METHODS: This is a prospective observational cohort case series. Best-corrected visual acuity (BCVA) assessment, slit lamp examination, refraction and UBM evaluation were performed preoperatively and at 1, 6, 12, 18 and 24 months postoperatively. The anterior chamber depth (ACD) and IOL tilt angles at the 12, 6, 3 and 9 o'clock meridians were assessed. RESULTS: Twenty-one consecutive adult patients (21 study eyes) were recruited, but two dropped out from the study. The average age during cataract surgery was 71.7 years (60-83, SD 6.0). There were very slight changes in the refraction and IOL stability characteristics at all the postoperative follow-up time points. These were not found to be statistically significant, apart from the increase in ACD from months one (3.85 ± SD 0.29) to six (3.91 ± SD 0.26) (p = 0.01, paired t-test). CONCLUSION: There was a small but statistically significant increase in ACD between the first and sixth postoperative month, but ACD remained stable thereafter. This was not associated with any significant changes in refraction or BCVA. In contrast, IOL optic tilt remained statistically unchanged throughout the 24-month study duration.