Refractive Outcomes of Retropupillary Fixated Iris-Claw Lens for Exchange of the Dislocated Intraocular Lens Using Modified Scleral Incisions.

PURPOSE: To evaluate refractive outcomes after retropupillary iris-claw intraocular lens (IOL) implantation and to compare postoperative astigmatism from (1) a conventional 5.5-mm sclerocorneal incision, (2) an L-shaped scleral tunnel incision, and (3) a frown scleral tunnel incision. METHODS: This was a retrospective study of eyes undergoing dislocated IOL exchange for a retropupillary iris-claw IOL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and postoperative complications were evaluated until postoperative months 24. The refractive outcomes and the surgically induced astigmatism (SIA) vector were compared between groups. RESULTS: The medical records of 107 eyes from 107 patients with mean age of 65.31 ± 12.15 years were reviewed. Eyes with a frown incision showed the best UDVA, followed by those with L-shaped and conventional incisions (P = 0.003). Eyes with an L-shaped incision or frown incision had a lower SIA than that of the conventional incision group at postoperative 6 months (mean ± standard deviation [SD] SIA, 0.86 ± 0.85 D, 0.63 ± 0.37 D, and 1.70 ± 1.27 D for frown incision, L-shaped incision, and conventional incisions, respectively; P = 0.004). CONCLUSION: The frown incision and L-shaped incision induced a significantly smaller SIA than the conventional incisions, which was associated with better UDVA postoperatively.

Efficacy of different locations scleral tunnel incision in phacoemulsification on preoperative corneal astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy of different locations scleral tunnel incision in phacoemulsification cataract on preoperative corneal astigmatism. METHODS:Totally 90 patients (94 eyes) in our hospital who had undergone the phaco-surgery from March 2013 to October 2014 were divided into two groups. The group A was those with 3. 2mm scleral tunnel incision at the direction of 10:00 ~11:00 points. The group B was those with 3.2mm scleral tunnel incision at the steepest corneal meridian. Incision was not sutured. Corneal astigmatism status of preoperative and postoperative at different times were detected by corneal refractive. The impact of different surgical incision on postoperative corneal astigmatism was compared. In the two groups, patients with preoperative corneal astigmatism 2. 00D were compared respectively. The changes of the uncorrected visual acuity and corneal astigmatism at postoperative 1wk, 1 and 3mo were observed. RESULTS:The uncorrected visual acuity of the patients who were in the group B preoperative corneal astigmatism CONCLUSION: On the basis of preoperative corneal astigmatism, 3. 2mm scleral tunnel incision at the steepest corneal meridian to some extent can correct preoperative corneal astigmatism < 1. 00D, and accordingly improve the uncorrected visual acuity.

Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques

PURPOSE: In the present study we compared the intraocular pressure (IOP) after cataract surgery according to incisional techniques. METHODS: Patients who underwent phacoemulsification with intraocular lens implantation were divided into 2 groups: clear corneal incision group (CC group), and scleral tunnel incision group (ST group). All complicated cases were excluded. IOP was measured preoperatively and at 1 week, 1, 3, 6, 12, 18 and 24 months after surgery. RESULTS: Seventy-seven patients (100 eyes) were enrolled in the present study; CC group (28 patients, 33 eyes), ST group (49 patients 67 eyes). Preoperative IOPs in both groups were not significantly different (p = 0.908, student's t-test). IOP in the CC group at 1 week after surgery significantly decreased 2.22 +/- 2.57 mm Hg compared to preoperative IOP (p < 0.001, repeated-measures ANOVA with post hoc analysis), and the IOP of the ST group decreased 2.11 +/- 2.50 mm Hg (p < 0.001, repeated-measures ANOVA with post hoc analysis). The lowered IOP was maintained for 24 months postoperatively. There was no significant difference in IOP change after surgery depending on incisional techniques (p = 0.848, repeated measures ANOVA). CONCLUSIONS: There may be no difference in IOP lowering effect after surgery depending on incisional techniques.

Surgical-induced astigmatism via a 5.5mm superior scleral tunnel incision for implantation of an Artisan phakic intraocular lens / 中华实验眼科杂志

Background Surgical induced astigmatism induced by a 5.5mm of superior scleral tunnel incision is a key cause of influencing vision outcome in the high myopic eyes after implantation of Artisan phakic intraocular lens(IOL).Objective This study was to evaluate the surgical induced astigmatism through a 5.5mm superior scleral tunnel incision during the implantation of Artisan phakic IOL.Methods This was a case observational study.The clinical data of 202 eyes of 111 patients with Artisan IOL implantation for high myopia from October 2004 through October 2008 was collected.The patients were followed-up for 12 months.The uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BCVA),spherical equivalent(SE),cylinder equivalent(CE) and cylinder axis were examined before surgery and postoperative 1,3,6,12 months.The patients were divided into with rule group and against rule group according to the cylinder axis.Surgery-induced astigmatism value was calculated using Holladay vector analysis formula.This clinical trial was approved by the Ethics Committee of Guangdong General Hospital.Written informed consent was obtained from each patient prior to the surgery.Results The UCVA of 195 eyes(94.1%) was 0.5 or better in postoperative 12 months,and that of 172 eyes(85.1%) showed the improvement of BCVA during the follow-up duration.The mean CE values were reduced in 1,3,6,12 months after surgery in comparison with before surgery(t=-4.30,P=0.00;t=-2.27,P=0.01;t=-2.04,P=0.04;t=-2.79,P=0.01).Vector analysis of total surgically induced astigmatism revealed that the mean incision-induced astigmatism value was +1.94D,+2.26D,+2.29D,+2.25D at 171°,170°,181°,175° in 1,3,6,12 months after surgery.The surgery-induced astigmatism was(+1.97±1.84)D,(+2.25±1.75)D,(+2.27±1.76)D,(+2.24±1.75)D in with rule group at postoperative 1,3,6,12 months respectively;while those in against rule group was(+1.75±1.88)D,(+2.35±1.74)D,(+2.38±1.76)D,(+2.34±1.74)D respectively.No significant differences were found between the two groups(t=0.54,-0.29,-0.27,-0.29;P=0.59,0.78,0.79,0.78).Conclusion Implantation of Artisan IOL is an effective approach for correction of high myopia.A 5.5mm superior scleral tunnel incision in operation induces a +2.25D astigmatism at 175° meridian.

Comparison of Scleral Tunnel and Clear Cornea Incision in Phacoemulsification Combined with Pars Plana Vitrectomy

PURPOSE: To compare the results of two different incision METHODS: scleral tunnel vs clear cornea in cases phacoemulsification and posterior chamber intraocular lens implantation combined with pars plana vitrectomy. METHODS: Between August 2003 and August 2005, 61 eyes with cataract and vitreoretinal diseases were treated by phacoemulsification combined with pars plana vitrectomy and PC-IOL implantation. Preoperative demographic data and postoperative best-corrected visual acuity (BCVA), astigmatism change, and complications were analyzed. RESULTS: The mean age of patients in the scleral tunnel incision (Group 1) and clear corneal incision (Group 2) was 57.09+/-13.72 and 58.83+/-11.83 years respectively. Diabetes mellitus was the most common underlying disease resulting in vitreous opacity. Vision improved in 82% of Group 1 and 78% of Group 2. There was a significant difference in the postoperative astigmatic changes between Group 1 and 2 (1.37+/-1.13D vs 0.78+/-0.67D). No discernible differences such as recurrent vitreous hemorrhage, inflammation in anterior chamber, increased intraocular pressure or iris changes were noted between the two groups. CONCLUSIONS: Although there was no difference in the postoperative BCVA, two different incision methods yielded significant different postoperative astigmatic changes.

Clinical Results of Sutureless Phacotrabeculectomy

We performed the prospective study on the clinical result of sutureless phacotrabeculectomy using 3.0mm ~ 6.5mm self-sealing scleral tunnel incision. This study included 9 eyes of 8 patients who have been suffering from chronic angle-closure glaucoma or chronic open-angle glaucoma with coexisting cataract. The mean preoperative intraocular pressure(IOP) was 28.55mmHg and mean postoperative IOP was 15.55mmHg. The IOP maintained below 19mmHg in all cases after 6 months. The number of medications decreased from 1.77 preoperatively to 0.33 postoperatively. No medication needed in 7 eyes postoperatively. The mean preoperative cup-disc ratio was 0.64. Visual acuity improved in 8 eyes and 5 eyes recovered to 20/40 or better. The blebs were visible in 8 cases which shows low diffuse in character in most cases. Postoperative complications were hypotony in 5 cases, hyphema in 1 case, partial posterior capsular rupture in 1 case and posterior capsular opacification in 1 case respectively. This result suggests that sutureless phacotrabeculectomy may be performed as safe and effective combined procedure in the management of coexisting cataract and glaucoma.

Corneal Astigmatic Change after 3.2mm Temporal Clear Corneal Incision in Cataract Surgery: Comparative Study with 3.2mm Superior Scleral Incision

The short-term changes in corneal astigmatism and visual acuity after phacoemulsification with foldable intraocular lens implantation through a 3.2mm temporal clear corneal incision (group 1) and these through a 3.2mm superior scleral incision(group 2) were compared.Corneal topographic measurement were obtained preoperatively and at poeroperative 1 day, 2 months. Scalar and vector astigmatism in group 1 and group 2 were compared by simple subtraction method, Cravy method and Holladay method.The surgically induced astigmatism in both groups showed no difference in with-the-rule change(0.57D-0.10D) and uncorrected visual acuity also showed no different results in both groups. In the group 1, preoperative with-the-rule astigmatism were changed 0.18D toward with-the rule and preoperative against-the -rule astigmatism were shifted 0.64D toward with-the-rule direction.Conclusively. both incisions offered satisfactory short-term astigmatic results and rapid visual rehabilitation and change of astigmatism in the wyws with preoperative against-the-rule astigmatism was greater than those with peroperative with-the-rule astigmatism in temporal clear corneal incision group.

Keratometric Cylinder Changes following Phacoemulsitication using Frown Incision and Linear Scleral Tunnel Incision with 10-0 nylon Interrupted Sutures

To evaluate surgically induced astigmatism in cataract surgery, we studied retrospectively a series of 30 eyes with 6.5mm sutureless frown incision(Group 1) and 30 eyes with linear scleral tunnel incision and 3 interrupt sutures using 100 nylon(Group 2). In all cases phacoemulsifications were performed and posterior chamber lenses were implanted. Group 1 showed the against-the-rule astigmatism at postoperative 2 week, and then the change of the astigmatism was minimal and still against-the-rule by postoperative 6 week and 3 month. In contrast, Group 2 showed with-therule astigmatism at postoperative 2 week and then showed the against-the-rule by postoperative 6 week and 3 month. There was no significant difference in the proportion of corrected visual acuity of 0.5 or better between two groups at postoperative 3 month, while uncorrected visual acuity of 0.5 or better was 93.3% in group 2, and 30.0% in group 1 at postoperative 3 month. In this study, it was found that the pattern of surgically induced astigmatism and uncorrected visual outcome in cataract surgery were different according to incision and suture techniques.

Effect of the Length of scleral Tunnel Incision on Postoperative Intraocular Pressure after Sutureless Cataract Surgery

A prospective study was conducted to evaluate the effect of length of scleral tunnel incision on postoperative intraocular pressure(IOP)after sutureless phacoemulsification and intraocular lens implantation in otherwise normal cataract patients. IOPs were measured preoperatively and postoperatively at 6 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, 3 months and 6 months respectively. A total 130 patients(141eyes) completed 6 months follow-up period and were divided into group 1 (3.5mm group, 74 eyes of 69 patients)and group 2(6.0mm group, 67 eyes of 61 patients) according to the length of scleral tunnel incision. A mean preoperative IOP was 14.0mmHg and increase of IOP was noted to 3.1mmHg compared to preoperative value but decreased after 1 day and maintained up to 6 month postoperatively. At 6 months mean IOP was 12.7mmHg and IOP decrease of 1.3mmHg was noticed compared to preoperative value. There were no statistically significant differences in mean IOP between groups during follow-up periods (p<0.05). Number of cases with IOP rise over 22mmHg was 11(14.8%) in group 1 and 11 (6.4%) in group 2 at 6 hour postoperatively but reduced to 3(2.1%). At 6 months no case showed IOP over 22mmHg. This study revealed that the length of scleral tunnel incision did not affect the degree and frequency of postoperative IOP rise fter sutureless cataract surgery.

Changes of Astigmatism after Sutureless Cataract Surgery Through 3.2mm and 5.1mm Incisions

To evaluate the changes of surgically induced astigmatism in sutureless small incision cataract surgeries, we divided our cases into two groups. In group 1 (38 eyes), we performed phacoemulsification and implanted foldable silicone intraocular lenses (IOLs) through 3.2mm clear corneal incisions. In group 2 (30 eyes), we did phacoemulsification and implanted PMMA IOLs through 5.1mm scleral tunnel incisions. We analyzed the early postoperative astigmatism in two groups. The average surgically induced astigmatism in group 1 was 0.1D at one day, 0.36D at six months. In group 2, it was 0.6D at one day, and 0.36D six months after surgery. There was no statistically significant difference between the two groups(p>0.05). In the superior incision cases, the average surgically induced astigmatism in group 1 was 0.47D against the rule(-0.47D) at one day, -0.07D at six months. In group 2, it was 0.42D at one day, 0.44D six months after surgery. There was no statistically significant difference between the two groups(p>0.05). In the temporal incision cases, the mean surgically induced astigmatism in group 1 was 0.31D at one day, 0.59D at six months. In group 2, it was 0.83D at one day, 0.24D six months postoperatively. Also, there was no statistically significant difference between the two groups(p>0.05). Percentages of uncorrected visual acuity above 0.5 reached over 90% in group 1 at one month postoperatively, and in group 2 at two months postoperatively. In conclusion, both the 3.2mm clear corneal incision group and the 5.1mm scleral tunnel incision group revealed good visual rehabilitation in early postoperative period and their mean surgically induced astigmatism was not statistically significant.

One Year Surgically Induced Astigmatism and Uncorrected Visual Acuity in 5.5 mm Unsutured Scleral Tunnel Incision

We evaluated postoperative changes of astigmatism and uncorrected visual acuity in 5.5 mm unsutured scleral tunnel incision, phacoemulsification and oval shape intraocular lens(IOL) implantation. Average surgically induced astigmatic changes were 0.09D against the rule(-0.09D) at one week, -0.25D at one month, -0.28D at two months in 55 patients as well as -0.21D at six months(n=25) and -0.38D over one year(n=25). The average uncorrected visual acuities improved from 0.07 preoperatively to 0.67 at one week, 0.75 at one month, 0.75 at two months in 48 patients as well as 0.72 at six months(n=25) and 0.64 over one year(n=25) postoperatively. There were no statistic~lly significant changes from one week over one year in both variables(p>0.05). Our results suggest that change of surgically induced astigmatism is little and stable as a well as rehabilitation of postoperative visual acuity is rapid in cataract operation using the 5.5 mm unsutured scleral tunnel technique.