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Objectives: To attain an understanding of pachyvein formation seen with central serous chorioretinopathy (CSC) by measuring the choroidal blood flow (CBF) velocity and to apply the findings to existing hydrodynamic theorems. Methods: Nineteen subjects with monocular CSC (mean age 51.8 ± 12.7 years) were included. Laser speckle flowgraphy measured the mean blur rate (MBR) in the foveal and perifoveal regions, and the findings were applied to the Equation of Continuity (Q = AV) and Bernoulli's theorem (1/2V2 + P/ρ = constant). Results: The mean foveal/perifoveal MBRs in the CSC eyes were 6.4 ± 3.2/9.6 ± 3.2 (p < 0.001). The mean MBRs in the non-CSC eyes were 8.3 ± 3.2/7.9 ± 2.4 (p = 0.37). The significant foveal CBF velocity decrease in CSC eyes occurs because of exudation from the hyperpermeable choriocapillaris. The subsequent decrease in blood volume due to the exudation elicits a decrease in the blood flow velocity in the inferior venules in accordance with the Equation of Continuity. The decrease in the blood flow velocity may result in an elevated blood flow pressure in the inferior venules and veins at the exudation site, in accordance with Bernoulli's theorem. Conclusion: A significant decrease in the foveal MBR may result from exudation from the hyperpermeable macular choriocapillaris. This decreased velocity may elicit a blood pressure elevation that can expand the inferior venules and veins at the exudation site, so-called pachyvein and pachychoroid formation. The application of hydrodynamic theorems to the measurement of ocular blood flow can provide new insights into the understanding of the pathogenesis of chorioretinal disease.
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PURPOSE: To verify the anterior capsule opacification (ACO) and contraction (ACC) of the ZCB00V intraocular lens (IOL), made of the same material as the AR40e with a high ACC rate. STUDY DESIGN: Retrospective cohort study. METHODS: We evaluated 35 patients at 1 week, 1, 3 and 6 months post phacoemulsification with either a ZCB00V (n = 35) or FY-60AD (n = 34) IOL implantation. The ACC rate was calculated using retroillumination images of the anterior segment, and the ACO was measured using anterior segment photographs and image analysis software. The contact grade between the IOL and anterior capsule was estimated from the Pentacam® images. RESULTS: The postoperative ACC rates (mean ± standard deviation) at 3 months were 1.03%±2.54% for the ZCB00V and, and 7.12%±9.47% for the FY-60AD. The ZCB00V-implanted eyes showed a significantly lower postoperative ACC at 1 week, 3 months, and 6 months (P < 0.01). On the other hand, the FY-60AD-implanted eyes had more pronounced ACO, and a significantly larger area of opacification (62.24%±21.32% vs. 16.90%±8.34%; P = 0.0005). Pentacam® analysis revealed a space between the anterior capsule and IOL surface in the ZCB00V-implanted eyes, whereas the anterior capsule firmly adhered to the IOL surface in the FY-60AD-implanted eyes. CONCLUSION: The ACC and ACO were significantly lower in eyes with ZCB00V IOLs compared to those with the FY-60AD. The anterior segment image analysis revealed that the elevated anterior rim of the ZCB00V IOL prevented adhesion between the anterior capsule and IOL optic surface, suggesting an open capsule effect.
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Opacificação da Cápsula , Catarata , Lentes Intraoculares , Facoemulsificação , Humanos , Opacificação da Cápsula/diagnóstico , Opacificação da Cápsula/etiologia , Opacificação da Cápsula/prevenção & controle , Implante de Lente Intraocular/métodos , Estudos Retrospectivos , Desenho de Prótese , Complicações Pós-Operatórias/prevenção & controleRESUMO
We wish to demonstrate that theorems of fluid dynamics may be employed to hydrodynamically analyze the clinical presentations seen within the pachychoroid-spectrum diseases (PSD). Methods: We employed both the Equation of Continuity Q = A · V in which Q represents blood flow volume, A the sectional area of a vessel, and V blood flow velocity as well as Bernoulli's Principle 1/2 V2 + P/ρ = constant where V represents blood flow velocity, P static blood pressure and ρ blood density. The Equation of Continuity states that a decrease in flow volume occurs simultaneously with a decrease in the flow velocity and/or sectional area, and vice versa. Bernoulli's Principle states that a decrease in the velocity of a fluid occurs simultaneously with an increase in static pressure, and vice versa. Results: Hyperpermeability of the choriocapillaris, as visualized on fluorescein angiography and indocyanine green angiography (ICGA), causes a fluid exudation and, therefore, a decrease in the blood flow volume Q which elicits a simultaneous decrease in the blood flow velocity V clinically observable in filling delay into the choriocapillaris on ICGA. An increase in the static blood pressure P will simultaneously occur in venules in accord with Bernoulli's Principle. Conclusions: A decrease in the blood flow velocity in the choriocapillaris due to its hyperpermeability will hydrodynamically elicit an increase in the blood pressure in venules. This blood pressure rise may expand Sattler and Haller veins, forming pachyveins. The primary lesion of PSD can be in pigment epithelium and choriocapillaris.
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PURPOSE: To examine the retinal morphologic features of metamorphopsia caused by epiretinal membrane (ERM) and to determine whether spectral-domain optical coherence tomography (SD-OCT) correlated with metamorphopsia. DESIGN: Retrospective case series. PARTICIPANTS: This study included 19 eyes of 19 patients with ERM diagnosed by clinical ophthalmic findings and SD-OCT. METHODS: The 19 eyes were classified into 3 groups based on Amsler chart results: no metamorphopsia (n = 4), local metamorphopsia (n = 8), and broad metamorphopsia (n = 7). The thickness of the 3 inner retinal layers: inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL), on 5 horizontal SD-OCT cross-sections (1 line through the fovea, 2 regularly spaced lines superior to the fovea, and 2 regularly spaced lines inferior to the fovea) were measured using the electronic calipers of the SD-OCT system. MAIN OUTCOME MEASURES: Correlation between INL, OPL, and ONL thickness with metamorphopsia and visual acuity. RESULTS: Metamorphopsia was detected in the same position as edematous areas of the INL with a thickness >50 mum. The maximum INL thickness was relatively significantly different between the subjects with no metamorphopsia and those with local or broad metamorphopsia (vs local, P = 0.06; vs broad, P = 0.04). Visual acuity significantly correlated with both maximum INL thickness (A = -0.681; P = 0.001) and maximum ONL thickness (A = -0.708; P<0.001) in metamorphopsia. CONCLUSIONS: Metamorphopsia induced by ERM may be related to the edematous areas of the INL detected with SD-OCT. The classification of ERM based on INL thickness is a potentially useful indication for surgery. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Membrana Epirretiniana/diagnóstico , Edema Macular/diagnóstico , Neurônios Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/complicações , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transtornos da Visão/etiologia , Testes Visuais/instrumentação , Acuidade VisualRESUMO
PURPOSE: To describe a capsular bag refilling procedure using an accommodating intraocular lens (IOL). SETTING: Jinshikai Medical Foundation Nishi Eye Hospital, Osaka, Japan. METHODS: A disk-shaped anterior foldable silicone accommodating IOL that serves as an optical device and as a mechanical device to prevent leakage of the injected silicone polymers was developed. The IOL optic is 6.0 mm and the overall diameter, 9.0 mm. After a 3.5 to 4.0 mm continuous curvilinear capsulorhexis (PCCC) is created, phacoemulsification and aspiration are performed in the usual manner. Then, a posteriorly placed accommodating IOL with sharp edges is implanted in the capsular bag to prevent posterior capsule opacification (PCO) and leakage of the injected silicone polymer. A PCCC is an option at this point. Then, an anterior accommodating IOL is piggybacked over the existing IOL and silicone polymers are injected between the 2 IOLs. RESULTS: Experiments in numerous pig cadaver eyes and in 10 rabbit eyes showed minimal to no silicone leakage. In cases in which a PCCC was not created, 2 eyes had no PCO and 3 showed slight to moderate PCO. None of the 5 eyes with a PCCC had no PCO 5 to 8 weeks after surgery within the PCCC. CONCLUSION: The procedure in rabbit eyes overcame 2 problems of lens-refilling techniques: leakage of the injectable silicone polymer and capsule opacification.
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Cápsula do Cristalino/cirurgia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Elastômeros de Silicone , Acomodação Ocular , Animais , Capsulorrexe , Catarata/prevenção & controle , Facoemulsificação , Complicações Pós-Operatórias/prevenção & controle , Coelhos , Elastômeros de Silicone/administração & dosagem , Deiscência da Ferida Operatória/prevenção & controle , SuínosRESUMO
PURPOSE: To determine whether a capsular bending ring (CBR) with a rectangular cross-section and sharp edges moves the barrier to the very equator and avoids contact between the capsulorhexis and optic to prevent posterior capsule opacification (PCO) and anterior capsule fibrosis. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A 0.7 mm high, open poly(methyl methacrylate) CBR was implanted in 60 eyes (patients) in a prospective randomized intraindividual trial. The impact of additional CBR implantation on PCO and anterior capsule fibrosis was compared to that of intraocular lens (IOL) implantation alone using objective scoring. RESULTS: No CBR-related surgical complications occurred. The objective PCO score and area were statistically significantly reduced in the CBR group. In patients with complete follow-up, the mean PCO score (scale 1 to 10) at 1, 2, and 3 years was 0.8, 1.7, and 2.1, respectively, in the CBR group and 2.6, 3.9, and 4.6, respectively, in the no-CBR group. The number of quadrants affected by PCO was 0.9, 1.5, and 1.8 versus 3.2, 3.8, and 3.8. Barrier failures with the CBR were caused by the inherent slight edge blunting and occasional eyelet gaping. Laser capsulotomies were performed in the no-CBR group only. Capsule stress folds and fibrotic anterior capsule opacification were also greatly reduced. The best corrected visual acuity was better in the CBR group. CONCLUSIONS: Capsular bending ring implantation was an effective and safe adjunct to in-the-bag IOL fixation. With improvements in technology and design securing exquisitely sharp edges and circumferential capsular bending independent of the capsular bag diameter, this concept has the potential to prevent PCO and anterior capsule fibrosis.
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Catarata/prevenção & controle , Cápsula do Cristalino/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes , Implantação de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Segurança de Equipamentos , Feminino , Fibrose/prevenção & controle , Humanos , Cápsula do Cristalino/patologia , Implante de Lente Intraocular/instrumentação , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato , Estudos Prospectivos , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: To demonstrate the utility of optical coherence tomography angiography (OCTA) in visualizing the choroidal vasculature in bilateral diffuse uveal melanocytic proliferation (BDUMP), so as to elucidate pathophysiology and also aid in diagnosis. Additionally, to recommend autofluorescence (AF) over traditional angiography for purposes of noninvasive diagnosis. OBSERVATIONS: Three BDUMP cases are examined using AF, and two are examined using OCTA. Additionally, the cases vary in etiology and include a case with iris cysts, which we believe to have only been recorded once before in scientific literature, steroids were successfully used to treat two cases and anti-tumor drugs were used to treat the third case. OCTA revealed altered choroidal vasculature in the two cases tested, and AF was successfully used to diagnose all three cases regardless of etiology. CONCLUSIONS AND IMPORTANCE: We believe the OCTA findings are potentially elucidative regarding the pathophysiology at the choroidal layer, where BDUMP lesions primarily exist. Given the limited number of recorded BDUMP cases and relatively unknown pathophysiology, OCTA may prove to be invaluable in visualizing disease progression. Also we were able to use AF to diagnose all three cases ranging from extremely rare iris cysts to a more conventional presentation, indicating its utility regardless of etiology.
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PURPOSE: To investigate whether the lens epithelial cells (LECs) at the capsular bend created by a sharp-edged intraocular lens (IOL) are in the G(0) phase of the cell cycle. SETTING: Nishi Eye Hospital, Osaka, Japan. METHOD: A CeeOn Edge silicone IOL (AMO) with sharp edges was implanted in 1 eye and a PhacoFlex II silicone IOL (AMO) with rounded edges in the contralateral eye after standard cataract surgery in 6 rabbits. Immunohistochemical staining for the Ki-67 antibody was performed 1 day, 3, 4, and 7 weeks after surgery. RESULTS: In eyes with the sharp-edged IOL, LECs with thin, elongated nuclei accumulated at, but did not extend beyond, the capsular bend and stained negative for the Ki-67 antibody, indicating that they were in the G(0) phase of the cell cycle. In contrast, in the eye with the round-edged IOL, continuous migration of a predominantly monolayer of LECs over the IOL and onto the posterior capsule occurred. These cells were Ki-67 positive, indicating that they were proliferating. CONCLUSIONS: Lens epithelial cells at the capsular bend of sharp-edged IOLs were in the G(0) phase of the cell cycle, indicating that they were contact inhibited. These findings support the theory the sharp posterior optic edge of the IOL inhibits LEC migration, reducing formation of posterior capsule opacification. Whether these LECs can reactivate when the capsular bend is eliminated by later formation of a Soemmerring's ring requires further studies.
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Movimento Celular/fisiologia , Inibição de Contato/fisiologia , Células Epiteliais/fisiologia , Cápsula do Cristalino/citologia , Lentes Intraoculares , Fase de Repouso do Ciclo Celular/fisiologia , Animais , Extração de Catarata , Técnicas Imunoenzimáticas , Antígeno Ki-67/metabolismo , Implante de Lente Intraocular , Antígeno Nuclear de Célula em Proliferação/metabolismo , Desenho de Prótese , Coelhos , Elastômeros de SiliconeAssuntos
Extração de Catarata , Catarata , Anti-Inflamatórios não Esteroides , Citocinas , Humanos , Lasers , ProstaglandinasRESUMO
PURPOSE: To introduce a new procedure for evaluating posterior capsule opacification (PCO) in rabbit eyes and to perform a comparative study of the single-piece and 3-piece acrylic intraocular lenses (IOLs) on PCO using the new evaluation method. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: A single-piece or 3-piece acrylic IOL was implanted in 1 eye and the other in the contralateral eye of 5 rabbits. Three weeks after surgery, PCO was scored by Evaluation of Posterior Capsule Opacification (EPCO) in posterior view. Before the posterior view was photographed, the anterior capsule was removed from the whole optic area to eliminate disturbing anterior capsule opacification (ACO) for the PCO evaluation. RESULTS: Posterior capsule opacification could be well observed and viewed in the posterior view so that it could be scored by EPCO without confusion with ACO. The mean PCO score of the single-piece and 3-piece acrylic IOLs was 3.12 +/- 0.19 and 2.41 +/- 0.70, respectively (P < .05 and P = .03, respectively). CONCLUSION: The removal of ACO allowed scoring of PCO by EPCO in rabbit eyes. The single-piece acrylic IOL showed significantly more PCO than the 3-piece acrylic IOL at least 3 weeks after surgery in rabbits.
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Resinas Acrílicas , Catarata/patologia , Cápsula do Cristalino/patologia , Lentes Intraoculares/efeitos adversos , Complicações Pós-Operatórias , Animais , Catarata/etiologia , Implante de Lente Intraocular , Modelos Animais , Facoemulsificação , Desenho de Prótese , CoelhosRESUMO
PURPOSE: To compare the preventive effect of a second-generation silicone intraocular lens (IOL) on posterior capsule opacification (PCO) with that of a soft acrylic IOL. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: After phacoemulsification, a silicone IOL (PhacoFlex II) was implanted in 1 eye and an acrylic IOL (AcrySof) in the contralateral eye of 5 rabbits. RESULTS: The posterior view 3 weeks after surgery showed slightly more PCO in 3 eyes with the PhacoFlex II lens than in eyes with the AcrySof IOL, with the PCO obscuring the iris structures. In 2 eyes with an AcrySof IOL, slightly more PCO was seen. Histopathological examination revealed that a bend and complex folds in the posterior capsule were formed with both the PhacoFlex II and AcrySof IOLs. However, the capsular bend formed by the PhacoFlex II lens, which was caused by its blunt edge, was not as sharp as that with the AcrySof IOL and more PCO was seen in all eyes with a PhacoFlex II lens. CONCLUSIONS: Capsular bend formation does not necessarily require a sharp optic edge. A truncated optic rim of a certain thickness appears to form a bend. The capsule-bending does not appear to be an all-or-nothing effect. There seems to be a transition. That a capsular bend forms despite a blunt rather than a sharp optic edge may explain why the second-generation PhacoFlex II IOL prevents PCO better than first-generation and PMMA IOLs.
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Catarata/prevenção & controle , Cápsula do Cristalino/patologia , Implante de Lente Intraocular , Lentes Intraoculares , Complicações Pós-Operatórias/prevenção & controle , Elastômeros de Silicone , Resinas Acrílicas , Animais , Catarata/patologia , Facoemulsificação , Complicações Pós-Operatórias/patologia , Desenho de Prótese , CoelhosRESUMO
PURPOSE: To investigate the effect of the optic size of an intraocular lens (IOL) with sharp optic edges on posterior capsule opacification (PCO). SETTING: Nishi Eye Hospital, Osaka, Japan. METHODS: In 5 rabbits, a single-piece 5.5 mm optic AcrySof IOL (Alcon Laboratories) was implanted in 1 eye and a specially fabricated single-piece 7.0 mm optic AcrySof IOL was implanted in the contralateral eye. Histopathological examinations were performed 3 weeks after surgery. RESULTS: On posterior views, less PCO was noted with the 5.5 mm optic in all rabbits except 1. Histopathological sections demonstrated adhesion of the anterior and posterior capsules between the haptic and optic and the formation of a sharp capsular bend at the posterior optic edge in 3 eyes with the 5.5 mm optic but in no eye with the 7.0 mm optic. Abundant PCO was noted when a sharp capsular bend had not formed. CONCLUSIONS: Capsular adhesion is a prerequisite of capsular-bend formation. The sharp optic edge alone does not provide a substantial barrier when a capsular bend is not formed. Bulky haptics such as those of the single-piece AcrySof and large optics may hamper capsular adhesion and bend formation.
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Resinas Acrílicas , Materiais Biocompatíveis , Catarata/patologia , Cápsula do Cristalino/patologia , Lentes Intraoculares , Animais , Catarata/prevenção & controle , Implante de Lente Intraocular , Desenho de Prótese , Coelhos , Aderências TeciduaisRESUMO
PURPOSE: To evaluate how and how fast a capsular bend is created clinically at the optic edge of an intraocular lens (IOL) after cataract surgery. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: Capsular bend formation was observed by slitlamp after maximum pupil dilation in 45 eyes of 45 patients with senile cataract. Fifteen eyes each received an AcrySof MA60BM acrylic (Alcon), PhacoFlex II SI-40NB silicone (Allergan), or UV26T poly(methyl methacrylate) (PMMA) (Menicon) IOL. Patients were evaluated prospectively at 1 day and 1, 2, and 4 weeks and retrospectively (15 eyes per IOL) 1 year after cataract surgery. A capsular bend index was developed to document and categorize the capsular bend formation process at the IOL optic edge. RESULTS: The anterior and posterior capsules adhered, with the latter attracted to the former. The adhesion always progressed from the periphery to the optic edge so that the posterior capsule eventually wrapped around the posterior optic edge, although not fully circumferentially in all cases. The process took place in 4 stages. Capsular bend formation was complete 1 month after surgery with the foldable IOLs (AcrySof, PhacoFlex II) but was significantly delayed with the PMMA IOL. After 1 year, the capsular wrapping was firm and fully circumferential at the optic edge with all IOL types in all cases. CONCLUSIONS: Capsular bend formation progressed in the same fashion but at significantly different speeds among the IOLs, suggesting that the process depends on IOL material and design. Fast, early capsular bend formation may be 1 reason AcrySof and PhacoFlex II IOLs prevent PCO statistically better than PMMA IOLs. The results indicate that PCO is prevented by the sharp capsular bend created by sharp optic edges and by quick bend formation.
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Resinas Acrílicas , Cápsula do Cristalino/fisiologia , Lentes Intraoculares , Facoemulsificação , Polimetil Metacrilato , Regeneração/fisiologia , Elastômeros de Silicone , Adesividade , Idoso , Adesão Celular/fisiologia , Células Epiteliais/fisiologia , Humanos , Implante de Lente Intraocular , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Fatores de TempoRESUMO
PURPOSE: To compare the preventive effect of 4 types of design- and material-matched intraocular lenses (IOLs) on posterior capsule opacification (PCO). SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: After phacoemulsification, 1 of 2 matched IOLs in 3 groups was implanted in 1 eye and the other IOL in the contralateral eye of 4 to 6 rabbits. Three weeks postoperatively, posterior view and histopathological evaluations were performed and the capsular bending effect and amount of PCO evaluated. RESULTS: The capsular bending effect was similar between a sharp-edged acrylic IOL (Sensar 40e, AMO) and a sharp-edged silicone IOL (ClariFlex, AMO) and between the Sensar 40e IOL and a sharp-edged acrylic IOL (AcrySof, Alcon Laboratories). There was no significant difference between IOL types in the amount of PCO. The capsular bend effect was slightly better and the PCO amount slightly less with the ClariFlex IOL than with the round-edged silicone PhacoFlex II IOL (AMO). CONCLUSIONS: There was no substantial difference in PCO prevention between IOLs with sharp posterior optic edges, regardless of the IOL's material composition. The anterior edge design appeared to have no preventive effect. These results confirm that a sharp posterior optic edge is the main factor in preventing PCO.
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Materiais Biocompatíveis , Catarata/prevenção & controle , Cápsula do Cristalino/patologia , Lentes Intraoculares , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Resinas Acrílicas , Animais , Implante de Lente Intraocular , Facoemulsificação , Coelhos , Elastômeros de SiliconeRESUMO
PURPOSE: To evaluate whether a new capsular bag-refilling procedure provides some accommodation in monkey eyes and to assess the difference in accommodation with different volumes of capsular bag refilling. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. DESIGN: Experimental study. METHODS: A central 3.0 to 4.0 mm continuous curvilinear capsulorhexis was created, after which phacoemulsification was performed in the usual manner. A new accommodating-membrane intraocular lens (IOL) for sealing the capsular opening was implanted in the capsular bag. Silicone polymers were injected beneath the IOL into the capsular bag through the delivery hole. In 3 study groups, each with 6 monkey eyes, the lens capsule was refilled with 0.080 mL of silicone polymers, corresponding to a 65% bag volume; 0.100 mL, corresponding to an 80% bag volume; or 0.125 mL, corresponding to a 100% bag volume. To calculate the accommodation amplitudes achieved, automated refractometry was performed before and 1 hour after topical pilocarpine 4.0% application preoperatively and 4 weeks postoperatively. RESULTS: The refilling technique was successful without polymer leakage in all monkeys. Four weeks after surgery, the mean accommodation amplitudes were 2.56 diopters (D) ± 0.74 (SD), 2.42 ± 1.00 D, and 2.71 ± 0.63 D, respectively, in the 3 study groups. CONCLUSIONS: The technique provided some accommodation in young monkey eyes. Leakage of the injectable silicone polymers and anterior capsule opacification in the visual axis were avoided. The results suggest that the capsular bag-refilling procedure warrants further study for possible clinical application. FINANCIAL DISCLOSURE: All authors have a proprietary interest in the accommodating membrane IOL mentioned in the article.