Intraocular Pressure in Eyes with Intraocular Lens Dislocation and Pseudoexfoliation Syndrome.

PURPOSE: To investigate intraocular pressure in eyes with intraocular lens subluxation and pseudoexfoliation syndrome. METHODS: In this retrospective study conducted at one eye centre (tazz) in Zurich, Switzerland, we reviewed 85 eyes with intraocular lens subluxation and pseudoexfoliation syndrome. Intraocular lens exchange was carried out by two surgeons between 03/2016 and 12/2019 (45 months). Information on baseline characteristics and diagnosis of glaucoma was recorded. Intraocular pressure and best-corrected visual acuity were analysed preoperatively and at five time points up to 12 months after lens exchange. Data on antiglaucomatous medication was collected before surgery and at two different time points after surgery. Postoperative pressure lowering procedures and complications were further analysed. RESULTS: This study includes 85 pseudoexfoliation eyes with intraocular lens subluxation. The mean interval between cataract surgery and lens exchange was 8.9 ± 5.2 years. Intraocular pressure elevation in the event of intraocular lens subluxation was found in 54% (46/85) of eyes. Mean intraocular pressure decreased from 22.9 ± 9.4 mmHg preoperatively to 15.2 ± 3.4 mmHg at follow-up 12 months after lens exchange (p < 0.001). Postoperative topical antiglaucomatous drug requirements were comparable to preoperative levels (p = 0.520). Less systemic acetazolamide was required 12 months postoperatively (p = 0.018). A pressure lowering procedure was required in seven (8%) eyes in the postoperative period due to persistence of high intraocular pressure. Intermittent increase or persistence of high intraocular pressure occurred in 13 (15%) eyes. CONCLUSION: This study emphasises the connection between acute pressure elevation and intraocular lens subluxation in patients with pseudoexfoliation syndrome. Intraocular pressure decreases after lens exchange and decrease sustains for a postoperative period of 12 months. Postoperative pressure lowering procedures were not required in the majority of eyes. We therefore conclude that intraocular lens exchange is efficient in the management of lens subluxation and pressure elevation in patients with pseudoexfoliation syndrome.

Risk factors and surgical outcomes for the concurrence of intraocular lens dislocation with vitreoretinal diseases. / äººå·¥æ™¶çŠ¶ä½“è„±ä½åˆå¹¶çŽ»ç’ƒä½“è§†ç½‘è†œç–¾ç— çš„å±é™©å› ç´ åŠæ‰‹æœ¯ç–—æ•ˆ.

OBJECTIVES: The weakness and dialysis of lens zonule after cataract surgery may lead to dislocation of intraocular lens (IOL). It has been shown that cataract surgery could induce or aggravate posterior vitreous detachment (PVD) due to postoperative inflammation and increased volume of vitreous cavity. PVD is associated with the occurrence of several vitreoretinal diseases, such as rhegmatogenous retinal detachment and macular hole. This study aims to explore risk factors for dislocation of IOL concurring with vitreoretinal disease, such as retinal detachment and macular hole, and to evaluate the efficacy and complications of surgical intervention for these abnormalities concurrently. METHODS: Ten patients (10 eyes) who diagnosed as rhegmatogenous retinal detachment, traumatic macular hole, high myopic macular hole, and combined with IOL dislocation at the Department of Ophthalmology of Xiangya Hospital from January 2004 to December 2020 were enrolled. The patients received vitreoretinal surgery and reposition of IOL by scleral suturing. Medical records were reviewed to figure out the time and type of IOL dislocation. Preoperative and 1 year of postoperative best corrected visual acuity, intraocular pressure, corneal endothelial density, and complications of surgical management were analyzed. RESULTS: Ten patients including 4 high myopia, 4 ocular contusion, and 2 who experienced IOL dislocation during the posterior capsulotomy were included in this study. Coexistence of IOL dislocation and vitreoretinal abnormalities occurred in patients with high myopia, ocular contusion, and capsulotomy. IOL dislocation happened in the vitreoretinal surgery in patients with high myopia or intraoperative capsulotomy. IOL dislocation occurred preoperatively in patients with ocular contusion. IOL capsular bag complex dislocation and out-of-the-bag IOL dislocation were found in 4 and 6 patients, respectively. Surgical relocation of dropped IOL and repair of vitreoretinal disease improved the best corrected visual acuity from preoperative 1.79±0.39 to postoperative 1.13±0.45 (P<0.001). The density of corneal endothelial cells in patients was lower than that before surgery [(1 806.40±181.20) cells/mm2 vs (1 914.00±182.22) cells/mm2, P<0.001]. There was no significant difference in intraocular pressure before and after surgery (P=0.099). Postoperative complications included high intraocular pressure and recurrent retinal detachment. CONCLUSIONS: Dislocation of IOL may be concurrent with vitreoretinal disease. High myopia, blunt contusion, and capsulectomy might be the risk factors for intraocular lens dislocation. The surgical technique used in the present study is successful in manipulating these disorders with optimal functional results and less severe complications.

[Surgical treatment of hypermature cataract in patients with lens subluxation and small pupil]. / Khirurgicheskoe lechenie perezreloi katarakty pri uzkom zrachke i podvyvikhe khrustalika.

Studying the possibilities of hybrid (femtosecond laser-assisted) phacoemulsification in complicated situations is a relevant problem in cataract surgery. PURPOSE: To develop a technique for hybrid (femtosecond laser-assisted) phacoemulsification in patients with a combination of hypermature cataract, small pupil and lens subluxation. MATERIAL AND METHODS: Hybrid (femtosecond laser-assisted) phacoemulsification of hypermature cataracts was performed in 36 patients (36 eyes) aged 63 to 78 years with grade I-II lens subluxation in combination with small pupil. The initial circular femtolaser capsulotomy was performed within the small pupil using the VICTUS system (Technolas Perfect Vision, Germany). After dilating the pupil with retractor hooks, the capsulorhexis was manually expanded to the required diameter. RESULTS: In all cases, the resulting capsulorhexis had a regular round shape with a smooth edge, without radial ruptures. This made it possible to apply modern methods of fixation and centration of the capsular bag in case of lens subluxation and to perform intracapsular implantation of an intraocular lens (IOL). Complete intracapsular fixation of the IOL with optics edge fully covered by the edge of the capsulorhexis in the postoperative period was achieved in 34 (94.4%) cases. In 2 (5.6%) cases in the postoperative period, the edge of the capsulorhexis exceeded the edge of the IOL optics. The loss of corneal endothelial cells 3 months after surgery was 8.8±1.9%. CONCLUSION: The use of the proposed combined technique of capsulorhexis made it possible to perform the most physiologically appropriate intracapsular IOL implantation in all patients with hypermature cataract, small pupil and lens subluxation.

[Optimization of phacoemulsification in complicated cataract with lens subluxation]. / Optimizatsiya tekhnologii fakoemul'sifikatsii pri oslozhnennoi katarakte s podvyvikhom khrustalika.

Purpose - to optimize the process of phacoemulsification in patients with cataract complicated by degree I-II lens subluxation by using the scaffold technique, and to determine the indications for its application. MATERIAL AND METHODS: The patients were divided into two groups: group 1 - the main group - included 29 patients (29 eyes; 47.54%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using the scaffold technique. Group 2 - the comparison group - included 32 patients (32 eyes; 54.46%) who underwent cataract phacoemulsification with implantation of iris retractors and capsular ring using standard technique. RESULTS: Patients' visual acuity improved up to 0.53 (0.35; 0.80) in group 1, and up to 0.50 (0.45; 0.80) in group 2 by the time of hospital discharge. At 6 months and 1 year follow-ups, visual functions were equal, in group 1 - 0.70 (0.65; 0.80), in group 2 - 0.70 (0.60; 0.90). The number of intraoperative complications decreased from 8.20% in standard phacoemulsification to 1.64% in scaffold technique. The latter reduces endothelial cell loss by 1.95% in comparison with traditional phacoemulsification over 1 year follow-up. With the scaffold technique, the number of intraoperative complications decreased from 15.63% in group 2 to 3.45% in group 1, the number of postoperative complications - from 43.75% to 31.04%, respectively. CONCLUSION: The scaffold technique is indicated in pseudoexfoliation syndrome with weakness of zonular apparatus, degree I-II lens subluxation, in hard nucleus with absence of posterior cortical layer, in intumescent cataract, Morgagnian cataract to stabilize the posterior capsule and protect it from rupture.

[Results of hybrid (femtosecond laser-assisted) phacoemulsification of hypermature cataract in patients with lens subluxation]. / Rezul'taty gibridnoi (femtolazernoi) fakoemul'sifikatsii perezreloi katarakty pri podvyvikhe khrustalika.

Studying the use of femtosecond laser in patients with complicated cataracts remains a topical issue in phaco surgery. PURPOSE: To comparatively analyze the results of using hybrid (femtosecond laser-assisted) phacoemulsification in hypermature cataract in patients with lens subluxation. MATERIAL AND METHODS: The study included 78 patients (78 eyes) with hypermature cataract in combination with lens subluxation of I-II degree. In the 1st group (45 eyes) capsulorhexis was performed using a femtosecond laser. In the 2nd group (33 eyes) manual capsulorhexis was performed. RESULTS: On the first day after surgery, best corrected visual acuity of 0.8-1.0 was obtained in 57.8% of cases in the 1st group and 33.3% in the 2nd group. Transient corneal edema during the first 1-3 days was noted in 4.4% of cases in the 1st group and in 15.2% - in the 2nd group of patients. Pachymetry in the center of the cornea showed an increase in its thickness on the 1st day after surgery from 0.564±0.027 mm to 0.591±0.033 mm in the 1st group and from 0.561±0.023 mm to 0.637±0.043 mm (p<0.05) in the 2nd group of patients. The loss of corneal endothelial cells amounted to 10.9±1.8% in the 1st group and 17.4±2.9% in the 2nd group (p<0.05). Macular edema with decreased visual acuity confirmed by OCT was detected in the 1st group of patients in 2.2% of cases, in the 2nd group - in 9.1% of cases. With a follow-up period of up to 3 years, IOL optics decentration by more than 1 mm was detected in 2.2% of cases in the 1st group of patients and in 12.1% of cases in the 2nd group. CONCLUSION: Femtosecond laser-assisted capsulorhexis significantly improves the results of surgery in patients with hypermature cataract combined with lens subluxation.

Biometric indicators of eyes with occult lens subluxation inducing secondary acute angle closure.

BACKGROUND: To compare the anterior biometrics in eyes with secondary acute angle closure induced by occult lens subluxation (ASAC-LS), misdiagnosed as acute primary angle closure (APAC) at the first visit with APAC, chronic primary angle closure glaucoma (CPACG), and cataract. METHODS: This retrospective case study included 17 eyes with angel closure due to occult LS, who were misdiagnosed as APAC on their first visit, 56 APAC eyes, 54 CPACG eyes, and 56 cataract eyes. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of ocular biometrics. RESULTS: The ASAC-LS patients had a longer ocular axial length than APAC and CPACG patients. Central corneal thickness of the ASAC-LS patients was not significantly different from APAC patients, but was significantly different from CPACG and cataract patients. The APAC patients had the smallest ACD, while the ASAC-LS patients had the smallest AD. The ASAC-LS patients had the largest lens thickness. According to ROC curve analysis, RLP, ACD, AD, CLP, LP had high power of discrimination. CONCLUSIONS: This study revealed that LS secondary PAC patients had a shallower AD, thicker CCT comparing to those of APAC, CPACG and cataract patients. For patients with acute angle-closure glaucoma, it is necessary to exclude lens zonula relaxation. TRIAL REGISTRATION: NCT03752710, retrospectively registered.

Facial Trauma: Delayed Development of a Subluxated Traumatic Cataract as Visualized on a Panoramic Image.

The immediate and long-term consequences of blunt orbital trauma leading to a subluxated lens and its subsequent calcification and opacification are reviewed. The accompanying panoramic image documents the process.

[Distortion of vitreous structure in eyes with lens dislocation].

AIM: to study the range of structural changes in the vitreous and to determine spatial position of the lens in case of its dislocation. MATERIAL AND METHODS: A total of 47 patients (94 eyes) with so-called senile cataract aged from 59 to 83 years were examined. The state of the vitreous was evaluated by means of digital ultrasound examination. RESULTS: Combined structural changes in the basis and cortex of the vitreous in eyes with lens and/or its elements dislocation have been analyzed. The possibility of lens evaluation in terms of its integrity and topography as well as spatial position of its elements has been shown. The relationship between the vitreous and lens changes has also been established. CONCLUSION: Digital ultrasound examination is capable of producing a 3D image of the eye, thus, allowing to assess spatial defects of the vitreous and to determine the position of the lens in case of its dislocation.

[Artisan iris-claw IOL implantation in cases of bilateral lens luxation into the vitreous body].

A clinical case of bilateral retropupillary implantation of iris-fixated lenses (Worst iris-claw intraocular lenses) in a patient with bilateral complete native lens dislocation into the vitreous body is presented. Despite native lens in the vitreous, the patient did not develop ocular hypertension in either eye after the surgery during a long-term follow-up period. Visual acuity significantly improved and there was no necessity in removing the dislocated lenses.

Retrolental cohesive ophthalmic viscoelastic injection in severely subluxated cataracts: The "Viscolift technique".

INTRODUCTION: To describe a novel surgical approach in the management of subluxated cataracts. METHODS: A 70-year-old Caucasian male with a subluxated cataract in the left eye was referred to our clinic at the Azienda Ospedaliero-Universitaria di Bologna- Ophthalmology Unit. The ophthalmic examination revealed a best-corrected visual acuity (BCVA) of 20/200 in the left eye with monocular diplopia and a severely subluxated NO6/NC6 cataract and the fundus examination did not reveal any vitreoretinal abnormalities. The right eye had 20/20 BCVA and was pseudophakic. After a 300° conjunctival peritomy, a single 25-gauge valved trocar 4 mm was inserted from the limbus in the inferotemporal quadrant, where the cataract was mainly dislocated and a corneal paracentesis to reduce the anterior chamber intraocular pressure was performed. Subsequently cohesive viscoelastic was progressively injected in the retrolental space through the trocar, to recenter and elevate the subluxated cataract. Thereafter, a complete centered capsulorhexis was performed, four capsular hooks were inserted to stabilize the bag, and complete phacoemulsification was performed with intact posterior capsular support. In the end, given the lack of capsular support elements such as the Cionni ring or Ahmed segment, a sutureless scleral fixated intraocular lens was implanted. RESULTS: One week after surgery, the BCVA was 20/25, and the final BCVA at 6 months was 20/20, without any complications. CONCLUSIONS: Retrolental cohesive ophthalmic viscoelastic injection could represent a novel effective surgical approach in recentering and elevating subluxated cataracts, facilitating the capsulorhexis, and reducing the risk of a pars plana approach.

Late spontaneous posterior capsule rupture with single-piece hydrophobic acrylic intraocular lens dislocation.

In this study, we described and discussed the late onset spontaneous posterior capsule rupture with intraocular lens (IOL) dislocation years after uncomplicated cataract surgery and implantation of hydrophobic acrylic IOLs. Eight patients presented with spontaneous posterior capsule rupture and IOL dislocation 5-20 years after uncomplicated phacoemulsification and IOL (AcrySof, Alcon, US) implantation. None of the patients had undergone posterior capsulotomy in the past. Four of the patients admitted habitual eye rubbing. An intact and well-centered continuous curvilinear capsulotomy edge was observed in all cases. IOLs were dislocated or displaced behind the anterior capsulotomy with a significant decrease in vision. A large rupture with a curled edge of the broken posterior capsule was visible. Dislocated IOLs were removed, and a three-piece IOL was inserted in the sulcus in six cases and suture fixated to the sclera in two cases. Improved vision was achieved in all cases. Although the mechanism underlying this late complication is unclear, habitual eye rubbing or IOL design may play a role. Further investigation is needed to prevent this complication in the future.

Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications.

INTRODUCTION: The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS: Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS: 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS: The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.

[Clinical study of the auxiliary management with iris retractor for subluxated lens combined with cataract].

OBJECTIVE: To study the clinical effects and safety of the auxiliary management with iris retractor for subluxated lens combined with cataract. METHODS: Thirty-one eyes lens subluxation with cataract come from 27 patients were reviewed, all of them were 30 - 78 years old and III - IV grade of nuclear. Among these patients, 14 were traumatic cataracts, 12 Marfan syndromes, two over-mature phase of cataracts, one caused suspensory ligament broken during phacoemulsification, and one unclear reason. 1 to 4 iris retractors were used during surgeries, according to the extension of zonular loss and nuclear hardness. Anterior vitrectomy would be taken if vitreous prolapsed. Visual acuities and reactions post-operative were observed, too. And correlation analysis would be used to study the relationship of those objections. RESULTS: There were no serious complications during the surgeries such as tearing of capsular, falling of nuclear, bleeding of intraocular, and so on. Only 9 of 31 eyes (29.0%) had vitreous prolapsed interoperation, which appeared a significant correlated with range of zonular loss (Spearman r = 0.453, P = 0.010). However, none of them happened during the phacoemulsification for lens nucleus and only 6 eyes took the anterior vitrectomy. The best corrected postoperative visual acuity of these patients attended to 0.2 - 1.2 at a half to 1 month, increased by 1 - 12 lines [average of (6.0 ± 2.7) lines] compared with preoperative. Twenty-three eyes visual acuity of them were no less than 0.5. Corneal edema postoperatively appeared a significant correlated with vitrectomy (Spearman r = 0.398, P = 0.026), while seemed no associated with the range of zonular loss, the number of iris retractors, energy and duration of ultrasound burst or type of intraocular lens (IOL) (P > 0.05). CONCLUSIONS: Phacoemulsification assists with iris retractor can simplify the process of cataract surgery of subluxated lens. Individualized surgical planning and flexible and decisive measures intra-operative achieved good results and well safety in these dangerous and complex lens diseases.

Visual outcomes of lens subluxation surgery with Cionni modified capsular tension rings in Marfan syndrome.

Marfan syndrome (MFS) is a hereditary disease with an incidence of 0.3% in the general population. Approximately 60% of MFS patients with FBN1 gene mutation will suffer ectopia lentis (EL) from the age of 3. With the development of EL, severe loss of vision will accrue because of lens tilt and glaucoma. Cionni modified capsular tension rings (MCTR) has been applied in the surgery for EL in MFS patients. To evaluate visual acuity and safety of using MCTR during lens subluxation surgery in MFS patients, 66 MFS patients (110 eyes) were included in our study, with the mean duration of follow-up of 4.7 months (SD 1.76 months). The capsular bags were preserved in 101 eyes (91.81%) with MCTR implantation. There was an overall significant improvement in BCVA at 1-month follow-up which was maintained at 3 months. Multivariable linear regression revealed that older age at first visit was associated with greater postoperative BCVA at the 1-month follow-up (P = 0.007). A significant difference was found between different degrees of lens subluxation and the length of surgical time and complications. At follow-up, only two eyes (1.98%) were identified to have developed retinal detachments. In conclusion, better visual outcomes can be achieved when patients received an early operation with MCTR implantation.

Schwartz-Jampel syndrome.

This is a report of a very rare case of Schwartz Jampel syndrome, with few unusual findings, in a 13 years girl from Nepal, who concurrently also had superotemporal subluxation of the crystalline lens along with blepharophimosis syndrome.

Long-term effects of phacoemulsification and intraocular lens implantation in a patient with pathologic myopia and extremely long axial length: A case report.

RATIONALE: To report a rare case of phacoemulsification cataract surgery and intraocular lens implantation that improved visual acuity and capsular stability in a patient with pathologic myopia and axial length >38 mm. PATIENT CONCERNS: A 51-year-old Chinese man with high myopia since childhood who had lost sight in his left eye at the age of 25 due to retinal detachment. He was referred for ophthalmological assessment due to decreased vision in the right eye, in which the best-corrected visual acuity at distance was hand motion. DIAGNOSES: The patient was diagnosed with cataract, high myopia, subluxated lens, and loose zonules in the right eye. The left eyeball showed atrophy. INTERVENTIONS: The patient underwent uneventful phacoemulsification. An intraocular lens (Sensar AR40M) and capsular tension ring were implanted within the capsular bag. After surgery, the patient was given eye drops containing tobramycin and dexamethasone eye drops for 1 month and eye drops containing 0.1% sodium diclofenac for 2 months. OUTCOMES: There were no postoperative complications. During 1-year follow-up, uncorrected visual acuity was 20/80 and the manifest refraction was -2.50DS/-1.00DC*80, with corrected distance visual acuity of 20/60. Cataract surgery maintained adequate vision for daily living. LESSONS: Implantation of specific lens and capsular tension ring as well as prolonged use of non-steroidal anti-inflammatory drugs may help prevent capsular contraction and posterior capsule opacification in patients with pathologic myopia and extremely long axial length.

Intraoperative optical coherence tomography-guided release of lenticulo-corneal adhesion and lens aspiration in anterior dislocation of lens with corneal edema.

Purpose: To describe the outcome of microscope integrated optical coherence tomography (MiOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of the crystalline lens and corneal edema. Methods: MiOCT-guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal edema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MiOCT. Results: In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication such as Descemet tear or worsening in corneal edema. Improvement in visual acuity was noted in all cases with resolution in corneal edema by 1 week. Conclusion: MiOCT-guided ILLA can be extremely useful in cases of lenticulo-corneal adhesion especially in cases with corneal edema.

Clinical characteristics and surgical outcomes of pediatric retinal detachments with lens disorders.

PURPOSE: To describe the clinical characteristics and outcomes of eyes with retinal detachments with lens disorders and compare them to eyes with retinal detachments without lens disorders. METHODS: A retrospective chart review of 42 eyes of 37 children who had retinal detachments with lens disorders was performed. Eyes were compared based on epidemiological data, characteristics of retinal detachment, and anatomical and functional surgical outcomes and were then compared to 254 eyes with retinal detachment without lens disorders. RESULTS: In eyes with lens disorders, the retina was reattached after the first operation in 13 (31%) eyes and at the end of the intervention in 22 (52%) eyes. Surgical and visual outcomes appeared to be slightly better in the subluxation and dislocation group compared with cataract and aphakia or pseudophakia groups. In eyes without lens disorders, the retina was reattached in 202 (80%) eyes after the first intervention and in 228 (90%) eyes at the end of the intervention. CONCLUSION: Pediatric retinal detachment with a lens disorder is associated with unsatisfactory surgical and visual outcomes compared to those without lens disorders. Primary internal and external approaches are suggested in children with complicated retinal detachment with lens disorders.