Change in Refractive Outcomes Following Custom, Flexible Iris Prostheses Placed Secondarily within the Capsular Bag.

Scleral fixation of intraocular lenses has become a popular procedure for treating aphakia in the absence of capsular support. However, the lens formulas used to predict refractive outcomes were designed for in-the-bag lens placement. This study evaluates the accuracy of the SRK/T formula in predicting a target postoperative refraction when suturing a scleral-fixated intraocular lens (IOL) implant 3mm posterior to the limbus. This is a retrospective, case series including 20 eyes of 20 patients who underwent scleral fixation of Akreos AO60 IOLs (Bausch & Lomb, Rochester, NY) by a single surgeon at the OSU Wexner Medical Center. Preoperative measurements were performed with optical biometry, and IOL power was calculated with the SRK/T formula. Following surgery, the actual refractive spherical equivalent (SE) was performed and compared with the preoperative prediction. Prediction error (PE), defined as the deviation of actual postoperative SE refraction in diopters (D) from preoperative predicted SE refraction, was the primary outcome measure. The mean attempted (predicted) SE was - 1.12 D (± 0.87). Mean achieved SE was - 0.96 D (± 1.04). Mean PE (actual postoperative SE versus predicted preoperative SE) was 0.16 D (± 0.69). A total of 9 eyes (45%) were within ± 0.5 D of the predicted SE, 16 eyes (80%) were within ± 1.0 D, and all 20 eyes (100%) were within ± 1.5 D. IOL power calculation using the SRK/T formula with optical biometry demonstrates reliable postoperative refractive outcomes in patients undergoing scleral fixation of an IOL (Akreos AO60). Further studies are needed to refine the predictive value of the SRK/T and other formulas for application in scleral fixation of IOLs.

To show surgical solutions in patients with traumatic and congenital aniridia, to evaluate the clinical improvement of these patients when iris prosthesis are implanted, and to examine safety and complications of these implants in a long-term follow-up. Eight patients were included in this retrospective noncomparative case series. Nine eyes had an artificial iris implantation for traumatic or congenital aniridia. Three eyes received a black diaphragm intraocular lens (IOL) in capsular bag after phacoemulsification. An aniridia prosthesis, sulcus sutured, in front of a previous IOL was implanted in two eyes. A black diaphragm IOL, sulcus sutured, in two eyes; two iris diaphragm rings, in front of the previous IOL, in one eye; and a sector iris prosthesis in front of an IOL in the last eye were implanted. Mean follow-up was 22.5 months (range 16 to 44 months). All patients had improved visual acuity (VA) and visual comfort after surgery. The glare disability was subjectively better in all cases. Two patients developed new ocular hypertension after surgery; one of them was controlled by medical treatment and the other needed cyclodiode. Two of the patients with glaucoma preoperatively also needed cyclodiode procedure and one of them an Ahmed valve. Several kinds of artificial iris implants are available. In all our patients with aniridia, iris artificial prostheses improved VA and diminished visual discomfort. Glaucoma is the most important complication after artificial iris implant. It is possible to implant the iris prosthesis in the capsular bag, but this requires a large capsulorrhexis and presents a surgical challenge.

Anterior segment optical coherence tomography in black‐on‐clear polypseudophakia

To evaluate the refractive outcomes of sutureless intrascleral fixation of intraocular lens with pars plana vitrectomy. A retrospective, consecutive cohort from multiple surgeons of a single center. Primary outcomes included spherical equivalent (SEQ) and change in SEQ (ΔSEQ) from preoperative intraocular lens power calculations. Secondary outcomes included refractive outcomes of fixation at 1.5 mm, 2 mm, and 2.5 mm posterior to the limbus. In total, 84 eyes of 80 patients were included. Preoperative logarithm of the minimum angle of resolution visual acuity was 1.21 ± 0.68 (20/320). The mean follow-up time was 2.33 ± 1.36 years. At 3 months, SEQ was -0.50 ± 1.59 D and ΔSEQ was 0.58 ± 1.49 D. At 1 year, SEQ was -0.55 ± 1.32 D and ΔSEQ was 0.39 ± 1.42 D. At the last follow-up, logarithm of the minimum angle of resolution visual acuity was 0.34 ± 0.34 (20/40), SEQ was -0.51 ± 1.44 D, and ΔSEQ was 0.57 ± 1.27 D. There was no difference between SEQ or ΔSEQ throughout follow-up (P = 0.97 and P = 0.96, respectively). At fixation distances more posterior to the limbus, mean ΔSEQ was more hyperopic at 3 months, 1-year, and the last follow-up (P = 0.02, P = 0.01, and P = 0.006, respectively). Refractive outcomes for sutureless intrascleral fixation of intraocular lens with pars plana vitrectomy were favorable and showed stability postoperatively. These results may aid surgeons achieve better desired refractive outcomes for this technique.

This study aimed to compare ocular wavefront aberrations for pupil diameters of 4 mm and 6 mm, and contrast sensitivity, in eyes with AcrySof IQ and AcrySof Natural intraocular lenses (IOLs). Sixty eyes of 60 patients were enrolled in this prospective randomized study. After phacoemulsification the eyes received either AcrySof IQ SN60WF or AcrySof Natural SN60AT IOLs. One month after surgery, all patients underwent complete ophthalmological examination including corneal topography, wavefront analysis for pupil diameters of 4 mm and 6 mm, and contrast sensitivity measurements with the CSV 1000E instrument under photopic and mesopic conditions with and without glare. There was no statistically significant difference between groups in age, sex or other preoperative ocular characteristics (p > 0.05). Patients with AcrySof IQ IOLs had higher contrast sensitivity at 6 c.p.d. under photopic conditions, at 6 c.p.d. and 18 c.p.d. under mesopic conditions, and at 6 c.p.d., 12 c.p.d. and 18 c.p.d. under mesopic conditions with glare (p < 0.05). Corneal spherical aberration was 0.273 ± 0.074 μm in the AcrySof Natural group and 0.294 ± 0.086 μm in the AcrySof IQ group (p = 0489). Ocular spherical aberration was 0.362 ± 0.141 μm and 0.069 ± 0.043 μm (p < 0.001) for 6-mm diameter pupils and 0.143 ± 0.091 μm and 0.017 ± 0.016 μm (p < 0.001) for 4-mm diameter pupils, with AcrySof Natural and AcrySof IQ IOLs, respectively. There were no significant differences in other higher-order aberrations between the groups (p > 0.05). Aspherical AcrySof IQ IOLs significantly reduced spherical aberration for pupil diameters of both 4 mm and 6 mm and also improved contrast sensitivity more than spherical AcrySof Natural IOLs, especially in mesopic conditions.

Dear Sir, I am Dr. Yun Li, from the Second Hospital Affiliated to Nanchang University, Jiangxi Province, China. I write to present a case report of IOL implantation in anterior megalophthalmos. Anterior megalophthalmos (AM) is the term suggested by Vail [1] to define bilateral enlargement of the anterior segment of the eyeball in the absence of an increased intraocular pressure. It is a rare hereditary condition characterized by megalocornea (diameter greater than 12.0mm), enlarged ciliary ring, stromal atrophy, iris hypoplasia, lens subluxation or dislocation, and cataract formation at an early age. The most common cause of visual impairment is the development of premature cataract, the extraction of which is prone to complications ,especially when the crystalline lens is luxated or subluxated. The enlarged ciliary ring and capsular bag are deterrents to easy insertion of standard posterior chamber intraocular lenses (IOLs) which are likely to decenter. Since its first description as a distinct entity by Vail in 1931, there have been a few reports about different techniques of cataract surgery and IOL implantation in Europe. However, to our knowledge, no reports of cataract extraction and IOL implantation in megalophthalmos have been reported in Asia. Here we report a case of AM and describes how we managed the anterior megalophthalmos and present a new technique of standard posterior chamber IOL implantation which resulted in successful visual rehabilitation. A 57-year-old man was referred to our department with bilateral progressive loss of vision and family history of ocular disease was negative. Visual acuity was light sensation without correction in the right eye and 20/40 with -6.50-2.00 伊85 in the left. Horizontal and vertical corneal diameters (measured with a pair of callipers under anesthesia) were 13.0mm and 12.0mm in both eyes, respectively. Axial lengths were 25.10mm in the right eye and 25.52mm in the left eye. The anterior chambers were 3.65mm deep in the right eye and 3.94mm deep in the left eye measured by UBM which showed that the anterior chamber angle was widely open. Bilaterally, localized corneal opacity was seen and irides showed marked moderate stromal atrophy and transillumination defects with iridodonesis. The pupil of either eye could not be fully dilated after pharmacologic mydriasis. The lens in the right eye was severely opaque and intumescent while the lens in the left eye showed moderate nuclear sclerosis (Figure 1). The fundus of the right eye could not be seen because of severe nuclear sclerotic cataract. The cup-to-disc (c/d) ratio in the left eye was 0.3 with healthy neuroretinal rim, and the retina was normal. Intraocular pressure was normal in both eyes. An uneventful planned extracapsular cataract extraction was performed in the right eye. A 4.0mm 2-plane limbus tunnel incision was constructed. DisCoVisc (Alcon) was used as the viscoelastic agent to maintain the anterior chamber, and can-opener anterior capsulotomy was performed. The nucleus was hydrodissected and delivered by manual expression, and the cortex was removed with a silicone irrigation/aspiration tip. Because of the larger diameter of the ciliary ring of anterior megalophthalmos, it is suggested to implant a posterior chamber IOL with a lens diameter of 16.0 to 18.0mm [7]. However, such an IOL was not available. Under the circumstances, a posterior chamber IOL (Matrix Acrylic Aurium) with a 6.0mm optic and an overall length of 12.5mm was selected. The intraocular lens had a power of 19.50 diopters (D) determined by the SRK formula. After placing the IOL in the capsular bag, we let the patient sit up for 2 minutes, discovering that the IOL was dislocated temporally (Figure 2). As a result, we pulled the IOL from the capsular bag into the anterior chamber and made a haptic of the IOL outside the eye. From the limbus tunnel incision, one end of a double-armed 10-0 nylon suture was passed through the iris and the anterior capsule at 12 o'clock and passed from within the capsular bag, to emerge through IOL implantation in anterior megalophthalmos

To theoretically calculate refractive changes in eyes with reversed intraocular lenses (IOLs). Nara Medical University, Nara, Japan. With the ray-tracing method, the refractive changes in a theoretical eye model with a reversed IOL in the capsular bag were calculated. Data for 3 models, anterior biconvex (MA60AC, Alcon), posterior biconvex (MA60BM, Alcon), and convex plano (UV2565T, Menicon), were provided by the manufacturer and used in the analysis. Using the assumption that the axial length varied from 22 to 27 mm, the anterior-biconvex IOLs elicited small refractive changes when reversed. The posterior-biconvex IOLs elicited a significant myopic shift (up to 0.90 diopter [D]) when reversed. The convex-plano IOLs elicited a significant hyperopic shift (up to 2.01 D) when reversed. Anterior-biconvex IOLs with similar anterior and posterior radii of curvature will not cause large diopter surprises when reversed. High-power posterior-convex IOLs will cause significant myopic diopter surprises when reversed. Both these changes shift toward myopic if the postoperative anterior chamber depth (ACD) becomes shallow. Medium- to high-power convex-plano IOLs will cause a large hyperopic shift when reversed. This hyperopic shift decreases if the postoperative ACD becomes shallower.

To evaluate and compare 1-year postoperative visual acuity, refractive results, endothelial cell density (ECD), and complications in a consecutive group of patients who underwent deep lamellar endothelial keratoplasty (DLEK) with those who underwent penetrating keratoplasty (PK) performed by 1 surgeon. We prospectively analyzed results of 20 consecutive patients with Fuchs dystrophy and pseudophakia who underwent small-incision DLEK surgery and retrospectively compared these results with those of 23 consecutive patients with Fuchs dystrophy and pseudophakia who underwent standard PK surgery during the same period. Main outcome measurements were best spectacle-corrected visual acuity (BSCVA); refractive, keratometric, and topographic astigmatism; topographic irregular astigmatism; absolute change in spherical equivalent; and ECD. Postoperative complications in the 2 groups were also analyzed. Preoperative BSCVA was significantly better in the DLEK group than the PK group (P = 0.013). Postoperative BSCVA was significantly better in the DLEK group than the PK group at 6 months (P = 0.025) and similar in each group at 12 months. Twelve-month postoperative refractive, keratometric, and topographic astigmatism was significantly less in the DLEK group than the PK group (P < 0.001). Surface asymmetry index and change in keratometric spherical equivalent was significantly less in the DLEK group than the PK group at 12 months postoperatively (P < 0.001). Preoperative ECD was significantly higher in the DLEK group (3072 +/- 307 cells/mm) than the PK group (2779 +/- 413 cells/mm). Twelve-month postoperative ECD was similar in the DLEK group (1293 +/- 469 cells/mm) compared with the PK group (1303 +/- 454 cells/mm; P = 0.949, not significant). Twelve-month percent endothelial cell loss was higher than reported in previous studies but was similar in the DLEK group (57.9%) compared with the PK group (53.1%). Twelve months postoperatively, all grafts were clear in the DLEK and PK groups. DLEK surgery resulted in more rapid vision recovery, significantly less regular and irregular astigmatism, and less change in spherical equivalent than PK surgery. Endothelial cell loss was significant in both groups but was not significantly different in the DLEK group from the PK group. DLEK surgery has significant advantages over PK surgery, but long-term ECD and graft survival in DLEK surgery should be studied.

PurposeTo investigate preoperative ocular risk factors and indications for secondary intraocular lens (IOL) implantation and compare postoperative complications, visual and refractive outcomes in a tertiary referral center.MethodsPatients older than 14 years that underwent secondary IOL implantation and had a minimum follow-up of 3 months were enrolled in this retrospective case series. Preoperative ocular risk factors, indications for surgery, postoperative complications, and visual and refractive outcomes including prediction error (PE) and absolute error (AE) were evaluated. IOLs were fixated in following positions: anterior chamber (AC), retropupillary iris-claw (IC), sulcus, and capsular bag or sclera.ResultsOne-hundred eighty-two eyes of 174 patients with mean follow-up of 17 ± 13.6 months were evaluated. Leading cause for surgery was IOL dislocation (75%), followed by secondary aphakia (19%) and IOL opacifications (6%). Previous vitrectomy was the major preoperative ocular risk factor (43%). Mean corrected distance visual acuity improved from preoperative 0.68 ± 0.55 to 0.42 ± 0.31LogMAR by the last follow-up (p = 0.001). PE and AE differed highly depending on the indication for surgery (p = 0.041 and p = 0.008, respectively) and the IOL fixation (p = 0.011 and p = 0.028, respectively), with IC-IOLs showing the lowest PE and AE. Postoperative AC-hemorrhage occurred mainly after IC-IOLs (p = 0.003), and postoperative hypotony was significantly higher in eyes with previous uveitis (p = 0.026).ConclusionsPrevious vitrectomy seems to be a major underreported risk factor in eyes that undergo secondary IOL implantation. Refractive outcomes depend on indication for surgery and fixation type, with retropupillary IC-IOLs providing the best refractive results, though not statistically significant compared to other IOL positions.

To establish a fully human in vitro culture model with which to test the putative effects of intraocular lens (IOL) designs in preventing posterior capsule opacification (PCO) after cataract surgery. A sham cataract operation was performed to prepare human capsular bags from donor lenses. In one capsular bag of a donor pair, an intraocular lens (PMMA round-edge IOL or acrylic IOL) was implanted while the other capsular bag remained aphakic. Bags were transferred to a Petri dish and secured anterior-face down using entomological pins. Capsular bags were maintained in Eagle's minimum essential medium supplemented with 2% human serum and 10 ng/mL TGF-β to drive growth and matrix contraction. In the absence of an IOL, cells appeared within the central posterior capsule at 4.38 ± 0.26 days, whereas in the presence of a PMMA round-edge IOL or an acrylic IOL they appeared at 8 ± 0.41 days and 11 ± 0.7 days, respectively. Immunocytochemical analysis showed an accumulation of cells at the edge of the acrylic IOL and a less evident accumulation with the PMMA round-edge IOL. Moreover, matrix contraction was more prominent in the absence of an IOL but was still apparent, to a lesser degree, in the presence of a PMMA round-edge IOL. The acrylic IOL greatly suppressed matrix contraction. The authors have developed a fully human in vitro capsular bag system that relates well to clinical observations and permits the testing of novel intraocular lenses.

Spontaneous late dislocation of intraocular lens within the capsular bag in pseudoexfoliation patients

In-the-bag secondary intraocular lens implantation in children

To investigate the effect of different intraocular lenses (IOLs) on lens epithelial cells (LECs) and on human capsular bags in vitro and to evaluate the transferability of this model to clinical situations. Sham cataract surgery, including IOL-into-the-bag implantation, was performed on 38 donor eyes after removal of the cornea. The capsular bag including the IOL was removed, pinned on a culture dish, covered with medium, and incubated. Two different IOLs were compared per pair of donor eyes. In each pair of donor eyes, the two different IOLs to be compared were implanted individually into capsular bags. The time required for complete coverage of the posterior capsule by a confluent monolayer of LECs was documented. The following IOLs were compared: three-piece acrylic IOLs of different sizes and single-piece polymethylmethacrylate (PMMA) versus acrylic IOLs. A complete monolayer of LECs on the posterior capsule was observed to form at times varying from 8 days (PMMA IOLs) to more than 60 days (three-piece hydrophobic acrylic IOLs). A significant difference between PMMA IOLs and hydrophobic acrylic IOLs was found. The human capsular bag model employed allows short-term evaluation of secondary cataract formation for different IOLs. This model's correlation with clinical results is good.

Incidence of Dislocation of Intraocular Lenses and Pseudophakodonesis 10 Years after Cataract Surgery

To compare the accuracy of intraocular lens (IOL) power calculation based on standard keratometry (K) and the new Total Keratometry (TK). A post-hoc analysis of study data based on 145 pseudophakic astigmatic eyes was conducted. The absolute prediction error (APE) of spherical equivalent (SE) and cylinder (CYL) was calculated based on K and TK (including posterior corneal surface) data recorded 6 weeks after IOL implantation. APE was calculated as the difference between the postoperative refraction and the refractive error predicted by three classic IOL calculation methods (Haigis/Haigis-T, Barrett Universal II, Barrett Toric Calculator) and two new formulas developed for TK (Barrett TK Universal II, Barrett TK Toric). For APE in SE, the Haigis-T (K versus TK) and Barrett Universal II (K) versus Barrett TK Universal II (TK) were compared. For APE in CYL, the Haigis-T (K versus TK) and Barrett Toric Calculator (K) versus Barrett TK Toric formula (TK) were compared. Mean APE in SE and CYL was lower based on TK values compared to K, with a mean APE difference (K - TK) of 0.011 ± 0.107 diopters (D) (SE Haigis-T; 95% confidence interval [CI]: -0.004 to infinity), 0.016 ± 0.113 D (SE: Barrett Universal II versus Barrett TK Universal II; 95% CI: 0.0005 to infinity), 0.103 ± 0.173 D (CYL: Haigis-T; 95% CI: 0.0791 to infinity), and 0.020 ± 0.148 D (CYL: Barrett Toric versus Barrett TK Toric; 95% CI: -0.0002 to infinity). APE in SE was within ±0.50 D in 86% (Barrett TK Universal II) versus 84% (Barrett Universal II) of eyes. APE in CYL was within ±0.50 D in 58% (Haigis from TK) versus 44% (Haigis from K) of eyes. In comparison to standard K, a higher prediction accuracy can be expected by using TK values along with the two newly developed formulas. TK values are compatible with standard IOL power calculation formulas and existing optimized IOL constants. [J Refract Surg. 2019;35(6):362-368.].