Iris Chafing Syndrome Secondary to Iridociliary Adhesions in a Patient with a Single-Piece Acrylic Intraocular Lens: Case Report
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PROVIDER: S-EPMC10715751 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:PurposeTo assess the refractive outcomes, intraocular centration and rotational stability of the enVista toric intraocular lens (IOL).Patients and methodsThis study was a prospective, multi-centre, double-masked, partially randomized and partially controlled clinical trial. A total of 191 participants were implanted with toric IOL (1.25, 2.00, or 2.75D) or non-toric IOL (control). The lowest range of corneal astigmatic eyes were randomized to 1.25D toric or control. Higher astigmatic powers were allocated to the treatment arm. Subjects were assessed immediately postoperatively, 1-2 (V1), 7-14 (V2), 30-60 (V3) and 120-180 (V4) days postoperatively. Unaided (UDVA) and distance corrected visual acuity (CDVA), manifest refraction and corneal curvature were assessed. Vector analysis was used to calculate surgically induced refractive correction (SIRC), correction ratio (CR), error magnitude (EM) and error vector (EV). Slit-lamp photography was used to measure centration and rotational stability.ResultsUDVA was better in the low toric IOL group in comparison with the control group at V4 (p<0.001). There was an undercorrection in the control group, whereas the average CR for all toric subjects was 1.00 ± 0.32: V2, 0.98 ± 0.34: V3 and 0.98 ± 0.35: V4. The absolute IOL rotational stability in comparison to the position of the IOL at V1 was 1.35° ± 0.97°: V2, 1.35° ± 1.07°: V3 and 1.38° ± 1.25°: V4. Decentration was generally inferior (V1: 0.04 ± 0.22mm, V2: 0.05± 0.20mm, V3: 0.08 ± 0.22mm, V4: 0.04 ± 0.21mm) and nasal (V1: 0.19 ± 0.23mm, V2: 0.20 ± 0.20mm, V3: 0.20 ± 0.21mm, V4: 0.17 ± 0.22mm).ConclusionParticipants with low levels of corneal astigmatism achieved superior vision and refractive outcomes in the low toric group over the control. Moderate and high levels of astigmatism achieved excellent refractive outcomes. The toric IOL demonstrated high levels of both rotational and centrational stability.
| S-EPMC9675354 | biostudies-literature
Project description:PurposeTo investigate refractive stability and characterize corneal incision repair up to 3 months after implantation of a new hydrophobic acrylic intraocular lens (IOL) with hydroxyethylmethacrylate using a new automated IOL delivery system.MethodsThis prospective case series included 50 eyes of 50 patients undergoing phacoemulsification and implantation of the Clareon® CNA0T0 IOL using the AutonoMe® automated delivery system in the Department of Ophthalmology, Keio University School of Medicine. The clinical data were collected from 46 eyes of 46 patients preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Endothelial-side incision gaping, posterior incision retraction, and Descemet's membrane detachment were recorded as present or absent using anterior-segment optical coherence tomography postoperatively.ResultsThe uncorrected distance and corrected distance visual acuities improved and stabilized 1 week postoperatively. The anterior chamber depth was stable from 1 week postoperatively. The subjective refraction was stable from 1 day postoperatively. Descemet's membrane detachments and endothelial-side wound gaping were seen in 19 (41.3%) eyes and 34 (73.9%) eyes 1 day postoperatively and decreased gradually. Posterior incision retraction was seen in eight eyes (17.4%) on day 1 and increased to 19 eyes (41.3%) 3 months postoperatively.ConclusionsThe Clareon IOL had excellent refractive stability from day 1 postoperatively. The AutonoMe automated delivery system enables safe IOL implantation through a 2.4-mm corneal incision, although the wound required longer than 1 month to heal postoperatively.
| S-EPMC7467255 | biostudies-literature
Project description:BackgroundImplantation of a single-piece-acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification complicated with posterior capsule tear (PCT) may be associated with severe complications. The purpose of this study was to report the efficacy and safety of sulcus implantation of a SPA-IOL, designed for both in-the-bag and sulcus positioning.MethodsA prospective cross-sectional study including 12 patients, who underwent phacoemulsification with PCT and sulcus implantation of SPA-IOL designed for both in-the-bag and sulcus positioning (Seelens AF, Hanita, Israel) between January 2009 and March 2012 (follow-up 12-37 months). Preoperatively corrected distance visual acuity (CDVA), subjective refraction and intraocular pressure (IOP) were recorded. Postoperative evaluation included anamnesis for IOL edge symptoms and transient visual obscurations (TVO) along with CDVA, subjective refraction IOP, anterior segment biomicroscopy, gonioscopy, assessment of IOL centration, fundus biomicroscopy and spectral-domain optical coherence tomography of the macula.ResultsPreoperatively, mean CDVA was 0.84 ± 0.60 LogMAR (Counting Finger-20/33) improving to 0.18 ± 0.13 LogMAR (20/40-20/20) at last examination (p = 0.004), as all the patients gained better CDVA. Mean preoperative spherical equivalent was -0.2 ± 2.5 Diopter (D) (-4.0D to +5.4D) reaching -1.9 ± 0.9 (-4.0D to -0.6D) at last examination (p = 0.12). Mean preoperative refractive astigmatism magnitude was 1.0 ± 0.6D (0.3D to 2.3D) changing to 1.1 ± 1.0D (0.0D to 3.0D) at last examination (p = 0.88). Mean preoperative IOP was 14.7 ± 3.2 mmHg (11-23 mmHg) without medications reaching 15.9 ± 3.3 mmHg (10-21 mmHg) at last follow up (p = 0.21). Postoperatively one patient required two medications for IOP control in his study and contralateral eyes. None of the patients had symptoms of IOL edge or TVO. There were no intraocular hemorrhages, inflammatory reactions, or pigment dispersion and the IOLs were well centered in all cases. Central foveal thickness was 280 ± 33 μm (193-310 μm).ConclusionsAppropriately designed SPA-IOL may be implanted in the ciliary sulcus during phacoemulsification with PCT rather than switching to another backup IOL demanding wound enlargement.
| S-EPMC4098571 | biostudies-literature
Project description:Purpose:To compare the visual outcome and complications of retropupillary fixated iris claw intraocular lens (IOL) and sutureless intrascleral IOL fixation using the flanged fixation technique at 1 year. Methods:In this retrospective study, eyes that underwent either iris claw or flanged SFIOL from January 2016 to July 2017 with a minimum of 1-year follow-up were enrolled. Improvement in visual acuity, intraocular pressure measurements, endothelial cell count, central macular thickness, and complications were compared between and within groups at 6 weeks, 3 months, and 1 year postoperatively. Results:Data from 150 eyes were analyzed (n = 90 in the iris claw group and n = 60 in the flanged SFIOL group). Posterior capsular rent was the most common indication for IOL implantation (n = 51, 34%). The iris claw and SFIOL groups were comparable in terms of demographics and baseline characteristics. There was significant improvement in uncorrected distance visual acuity (UCDVA) at 6 weeks in both groups (P = 0.77), and at 1 year, the UCDVA was comparable between groups (0.36 ± 0.32 in the iris claw group and 0.30 ± 0.28 in the SFIOL, P= 0.75). Transient elevation of intraocular pressure was seen slightly more in eyes with SFIOL (17%), while ovalization of the pupil was the main sequelae seen in the iris claw group (20%). Conclusion:Both iris claw IOL fixation and SFIOL using flange are viable options for surgical correction of aphakia. Visual outcomes are excellent at 6 weeks and are maintained till 1-year follow-up, and complication rates are acceptably low, although ovalization of pupil is common with iris claw IOLs.
| S-EPMC6836613 | biostudies-literature
Project description:Single haptic iris fixation technique is used where there is a loss of 6 clock hours anterior capsular support. It helps the anterior segment surgeon to fix the intraocular lens to the iris on the side of absent capsular support and place the other haptic over the capsular support. A 10-0 polypropylene suture on a long-curved needle is only used to take a suture bite on the side of capsule loss. Meticulous automated anterior vitrectomy is done. Then, the suture loop below the iris is taken out and the loops are twirled multiple times around the haptic. The leading haptic is then gently glided behind the iris, and the trailing haptic is gently placed on the other side using forceps. The suture ends are trimmed and internalized into the anterior chamber and then externalized through the paracentesis using a Kuglen hook, and the knot is tied and secured.
| S-EPMC10229913 | biostudies-literature
Project description:Aim of studyWith an ab-interno technique of transscleral suturing of current one-piece posterior chamber intraocular lenses (PC IOLs) by injector implantation in the absence of capsular support, we aimed to demonstrate the possibility of the implantation of one-piece acrylic PC IOLs that might be produced in the future for only scleral fixation through small clear corneal incision.Materials and methodsCase report and literature review.ResultsThis procedure has been performed in eight aphakic eyes with four different types of IOLs. Good centration was achieved with minimal technical effort. All patients had well-centered and stable lenses postoperatively during 9-18 months follow-up.ConclusionWe managed to decrease the risks of surgical trauma and intricate surgical maneuvers requirement. With this technique, excessive fluid leakage and consecutive hypotony can be minimized.
| S-EPMC4185163 | biostudies-literature
Project description:PurposeThis meta-analysis aims to evaluate the differences in performance of posterior capsular opacification (PCO) between hydrophobic acrylic intraocular lens (IOLs) and hydrophilic acrylic IOLs.SettingTianjin Medical University, Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China.DesignSystematic review of randomized controlled trials (RCTs) or meta-analysis.MethodsAn electronic literature search was performed using the PubMed, EMBASE and Cochrane Library database before May in 2013 to identify prospective RCTs comparing hydrophobic acrylic IOLs and hydrophilic acrylic IOLs in patients after phacoemulsification with IOL implantation with a follow-up time of at least 1 year. Pertinent studies were selected by meeting predefined criteria and reviewed systematically by meta-analysis. The PCO scores and YAG capsulotomy rate, as indicator of PCO, were measured and discussed in a meta-analysis. Standardized mean differences (SMD), relative risk ratio (RR), and the pooled estimates were computed according to a random effect model or fixed effect model.ResultsNine prospective RCTs involving 861 eyes were included in the current meta-analysis. The hydrophobic acrylic IOLs were favored and the pooled SMD of PCO severity was 1.72 (95% confidence interval (CI), 0.20 to 1.23, P = 0.0002) and 1.79 (95% CI, 0.95 to 2.64, P<0.0001) with 1-year follow-up and 2-year follow-up respectively. The pooled RR of Nd:YAG laser capsulotomy rates at postoperative 2-year follow-up was 6.96 (95% CI, 3.69 to 13.11, P<0.00001) comparing hydrophilic acrylic IOLs with hydrophobic acrylic IOLs.ConclusionsCompared with hydrophilic acrylic IOLs, the hydrophobic acrylic IOLs showed superior reduction in rates of PCO and laser capsulotomy in 2-year follow-up. More RCTs with standard methods for longer follow-up are needed to validate the association.
| S-EPMC3818402 | biostudies-literature
Project description:AIMS: To compare the postoperative performance of single and three piece acrylic foldable intraocular lenses (IOLs). METHODS: 20 patients underwent bilateral cataract surgery with a single piece SA30AL IOL in one eye and a three piece MA30BA IOL in the other eye. The eyes were randomly assigned to either a single or three piece lens. The amount of IOL decentration and tilt, area of anterior capsule opening, and degree of posterior capsule opacification were measured using the Scheimpflug anterior segment analysis system (Nidek EAS-1000). Visual acuity and contrast sensitivity were examined. Measurements were performed by masked examiners before and 1 day, 1 week, 1, 3, 6, and 18 months after surgery. RESULTS: There were no significant differences between the two groups (p>0.05, paired t test) in the amount of IOL decentration, IOL tilt, area of anterior capsule opening, degree of posterior capsule opacification, best corrected visual acuity, and contrast sensitivity throughout the 18 month follow up period. CONCLUSION: The single and three piece acrylic foldable IOLs are equally stable in the eye after surgery.
| S-EPMC1772204 | biostudies-other
Project description:This study compared the visual outcomes and complications between sutureless scleral-fixated intraocular lens and iris claw intraocular lens implantation in aphakia without adequate capsule and/or zonule support. Studies comparing the clinical outcomes of scleral-fixated intraocular lens and iris claw intraocular lens implantation published until April 2022 were retrieved from the PubMed, EMBASE, Cochrane Library, and Google Scholar databases. The outcomes included postoperative final visual acuity, surgical time, surgery-induced astigmatism, and complications. The weighted mean difference and odds ratio were calculated. Two randomized controlled trials and five cohort studies, including 244 and 290 eyes in the scleral-fixated intraocular lens group and iris claw group, respectively, were included. Scleral-fixated intraocular lens implantation results in a better postoperative final corrected distance visual acuity compared with iris claw intraocular lens implantation; however, it is more time-consuming. Scleral-fixated intraocular lens implantation seems to have lesser incidences of surgery-induced astigmatism. Furthermore, both procedures have a similar complication rate. Therefore, based on current best evidence, these two procedures should be considered according to patient's conditions.
| S-EPMC10808084 | biostudies-literature
Project description:Background Spontaneous bilateral intraocular lens dislocation of the vitreous cavity is a rare ocular disorder. This article aims to comprehensively describe bilateral spontaneous intraocular lens dislocation with unilateral lamellar macular hole and retinoschisis in a Chinese woman with homocystinuria. Case presentation A 72-year-old Chinese woman with homocystinuria presented with a painless bilateral blurring of vision. The slit lamp showed the absence of lenses in both eyes. B-ultrasound and orbital computed tomography (CT) demonstrated bilateral posterior dislocation of the crystalline lenses, and spectral-domain optical coherence tomography (SD-OCT) revealed a lamellar macular hole and retinoschisis in the right eye. Biochemical examination demonstrated that the total homocysteine level was moderately elevated. Conclusion This report is the first to present an extensive and valuable description of bilateral intraocular lens dislocation with unilateral lamellar macular hole and retinoschisis secondary to homocystinuria. We have demonstrated that this case was spontaneous and chronic. CT is an effective diagnostic tool for patients with ectopia lentis. Early diagnosis and suitable management of patients with homocystinuria are essential to prevent these complications.
| S-EPMC9515901 | biostudies-literature