An intraocular eyelash after uneventful cataract surgery.
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ABSTRACT: Purpose
The finding of an anterior chamber cilium after small incision cataract surgery is rare, with only five prior cases being found on literature review. Strategies include observation if there is no evidence of inflammation or infection and prompt removal if the situation changes.1-5 This case adds to the number of case reports and highlights that unexpected findings such as this can be seen on the first postoperative day exam and the clinical decisions made to remove it promptly.Observations
A 69 year-old woman had uncomplicated phacoemulsification cataract extraction with posterior chamber intraocular lens implantation in the right eye using a superonasal corneal incision and inferotemporal paracentesis. Examination at 1 day noted a cilium in the anterior chamber. The cilium was removed the same day without complications.Conclusions and importance
This case report shows that intraocular cilia can occasionally be seen following routine small incision sutureless cataract surgery even when there is no evidence of it immediately following surgery.
SUBMITTER: Francis Stanley P
PROVIDER: S-EPMC7551982 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The presence of an eyelash in the anterior chamber after an uneventful phacoemulsification and intraocular lens implant surgery is exceedingly rare, with 8 cases reported globally. We present a patient in whom an eyelash was found trapped in the main cornea wound at postoperation week 1 after an uneventful surgery and unremarkable postoperation day 1 review. The eyelash was removed immediately. The patient denied rubbing his eye and there is video evidence of an uneventful surgery with no eyelash in the anterior chamber at the end of the surgery. Interestingly, the orientation of the eyelash supports previous reports that the eyelash tends to migrate intraocularly through the cornea wound in one direction (i.e., with proximal end/follicle first), purportedly due to the cellular arrangement of an eyelash. Management of such cases should be undertaken on a case-by-case basis. The treatment strategy includes observation or prompt removal, either at the slit lamp or at the operating theatre, depending on a few factors including extent of ocular inflammation, time of presentation, eyelash contact with the cornea endothelium, and location of the eyelash. Patients should be reminded not to rub their eyes after cataract surgery.
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Project description:Our purpose was to examine the value of the first postoperative day review after uneventful phacoemulsification cataract surgery.291 patients who underwent uneventful phacoemulsification were randomized into two groups (ClinicalTrials.gov Identifier: NCT01247155): i) Next day review (NDR group, n?=?146) and ii) No next day review (NNDR group, n?=?145). The rate of complications, percentage of patients seeking non-scheduled medical consultation up to postoperative day 14, presence of any inflammation-related sign and best corrected visual acuity (BCVA) on postoperative day 28 were analyzed.In the NDR group, 5.5% of patients developed a postoperative complication, whereas the respective rate was 6.2% in the NNDR group. The difference was not statistically significant (p?=?0.791). The most frequent complications were: elevated intraocular pressure, allergy to postoperative treatment, corneal abrasion, punctuate epitheliopathy, iris prolapse and postoperative hyphema, whose rates did not differ between the two groups. The rate of patients seeking non-scheduled medical consultation up to postoperative day 14, presence of any inflammation-related sign, as well as BCVA on day 28 did not exhibit any significant differences between the study groups.First postoperative day review could be omitted in cases of uneventful cataract surgery.
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Project description:IntroductionTo determine which day automated refraction stabilised the first week after uneventful cataract surgery.MethodsThis was a prospective, single-blinded, randomised cohort study of 148 eyes in 148 consecutive patients undergoing uneventful cataract surgery. Automated refraction was measured from days 2 to 7 after surgery and compared to automated refraction measured 6 weeks post-surgery. We compared measurements using a hierarchical mixed-effect model.ResultsOur adjusted results did not show a statistically significant change in spherical equivalent between the first week after surgery and 6 weeks after surgery (p-values: day 2: 0.914, day 3: 0.922, day 4: 0.168, day 5: 0.211, day 6: 0.457, day 7: 0.621). We measured the spherical error as stable except for day 5, where a statistically significant change of 0.32 dioptre (p = 0.049) was detected. Similarly, the cylindrical error was also stable on all days of measurements except on day 6, where a significant change of 0.28 dioptre (p = 0.034) was detected.ConclusionThe adjusted spherical equivalent was stable on days 2-7 after uneventful cataract surgery in our study population. However, as we observed a statistically significant difference in spherical and cylindrical errors on days 5 and 6, respectively, we could not conclude that automated refraction stabilised the first week after uncomplicated cataract surgery.
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Project description:Intraocular lens (IOL) exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. The incidence of IOL exchange has not been consistently estimated. Such information is invaluable when counseling patients prior to cataract surgery. We examined the incidence of, and indications and risk factors for, IOL exchange after cataract surgery. We also assessed visual outcome of eyes that had an IOL exchange. A cohort design was used to estimate the incidence of IOL exchange and a case-control design to identify factors associated with it. All phacoemulsification surgeries with IOL (n = 17415 eyes) during 2010-2017 and those that had a subsequent IOL removal or replacement during the same time period were identified (n = 34 eyes). The incidence of IOL exchange was 2 per 1000 surgeries (95% confidence interval [CI] 1 to 3) over 8 years. Eyes that underwent subsequent IOL removal or replacement were compared with eyes that had cataract surgery only (n = 47) across demographic and clinical characteristics. In a binary logistic regression analysis, two factors were significantly associated with IOL exchange/removal: an adverse event during cataract surgery (adjusted odds ratio [aOR] 19.45; 95% CI 4.89-77.30, P < 0.001) and a pre-existing ocular comorbidity (aOR 10.70; 95% CI 1.69-67.63, P = 0.021). The effect of gender was marginally significant (P = 0.077). Eyes that underwent IOL exchange or explantation were nearly two and a half times more likely to have a final best-corrected visual acuity of <20/60 compared to those that had cataract surgery alone (adjusted RR 2.60 95% CI, 1.13-6.02; P = 0.025).
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Project description:PurposeTo report a case with macular edema associated with uveitis, a decreased corneal endothelial cell density, and vitreous opacity caused by migrated intraocular antibiotic ointment after uneventful cataract surgery.ObservationsA 63-year-old man underwent uneventful sutureless superior clear corneal phacoemulsification and implantation of an intraocular lens in his right eye. Eleven months later, he complained of blurred vision when he gazed downward. Three months later, uveitis, vitreous opacity, and retinal hemorrhage were noted. Optical coherence tomography and fluorescein angiography demonstrated macular edema in the right eye. A slit-lamp examination revealed many tiny oily deposits on the iris surface. One month later, a globular oily droplet was detected at the 12 o'clock position of the iridocorneal angle. Because the corneal endothelial cell density appeared to be progressively decreased, the oily droplet was removed, and the anterior chamber was irrigated with a balanced salt solution using an irrigation-aspiration cannula. After surgery, the macular edema, vitreous opacity, and retinal hemorrhage disappeared.Conclusions and importanceIn this case, ofloxacin ointment had presumably migrated into the anterior chamber through a corneal incision after cataract surgery. The fact that the droplet of ointment was able to be detected more than one year after the cataract surgery suggests that dispersed tiny droplets can slowly coalesce into a globular droplet and wander between the anterior and posterior chambers, thereby causing uveitis, corneal endothelial cell damage, and macular edema. The removal of the intraocular ointment resolved these complications. This is the second report of intraocular ointment causing macular edema.
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Project description:PurposeTo assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients.MethodsA post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery.ResultsAqueous flare increase of <50%, ≥50%, ≥100%, and ≥200% associated in central subfield macular thickness (CSMT) increase across the groups at 28 days and three months after surgery. Increase of aqueous flare ≥100% compared to those with <100% was associated with increased CSMT (P = 0.022 at 28 days, and P = 0.027 at three months). At three months, macular thickening (at least 10% CSMT increase) was observed in 12.7% compared to 4.6% of eyes when using a cutoff value of 100% increase in aqueous flare (P = 0.033). Although diabetic patients presented higher aqueous flare levels at baseline compared to nondiabetic patients (12.9 ± 11.8 vs. 9.8 ± 8.2 photon units/ms P < 0.001), the postoperative levels illustrated a similar profile in aqueous flare increase between the two groups.ConclusionsAt 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy.Translational relevanceA 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.
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Project description:Topical antibiotic and steroid ointments are sometimes used topically at the conclusion of intraocular surgery, and inadvertent entry into the eye has been reported. Dispersed ointment droplets or consolidated globules in the anterior chamber (AC) can sometimes be visualized on exam. Occasionally, intraocular ointment is found incidentally without apparent toxic effect, but retained ointment usually presents with early or delayed intraocular inflammation, pressure rise, macular edema, or corneal edema. The usual treatment for toxicity from retained ointment is removal of the ointment. While the complication of ointment-induced cystoid macular edema has been reported, there is paucity of literature on the anatomical response and eventual visual outcome of patients who have been treated for long-standing edema from retained ointment. We present a case of a patient who presented with history of poor vision since the time of cataract surgery 33 months prior, who had cystoid macular edema, reduced endothelial cell count, and apparent Maxitrol ointment (neomycin, polymyxin B sulfate, and dexamethasone in paraffin vehicle; Novartis Pharmaceuticals UK) floating in the AC. The patient was treated with AC washout and sub-Tenon injection of triamcinolone. His vision, retinal architecture by optical coherence tomography, endothelial cell count, and pachymetry has been followed for 9 months following this treatment.
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Project description:PurposeWe previously reported that macular pigment optical density (MPOD) levels decreased during a long follow-up period after clear intraocular lens (IOL) implant surgery presumably due to excessive light exposure. We examined changes in MPOD levels in the eyes that received yellow-tinted IOL implant surgery.Subjects and methodsThis was a prospective, observational study. Fifty-five eyes of 35 patients were studied. MPOD levels were measured with a dual-wavelength autofluorescence technique on day 4; months 1, 3, and 6; and years 1 and 2 postoperatively. The average optical densities at 0°- 2° eccentricities (local MPODs) and total volumes of MPOD (MPOVs) in the area within 1.5° and 9° eccentricities were analyzed.ResultsThe mean local MPOD at baseline (on day 4) was 0.79 at 0°, 0.71 at 0.5°, 0.68 at 0.9°, and 0.32 at 2°. The mean MPOV within 1.5° and 9° at baseline was 2950 and 18,897, respectively. Local MPOD at 0.9° and 2° and MPOVs were slightly decreased at month 1 and increased after that. The increase reached statistical significance in local MPOD at 0.5° and 2° and MPOVs (Tukey-Kramer test). The changes in MPOV within 9° at year 2 [(MPOV on year 2 - MPOV on day 4) / MPOV on day 4] were from -0.21 to 1.18 (mean and standard deviation: 1.14 ± 0.28). The MPOV of 15 eyes increased more than 10% from the initial value, was maintained within 10% in 21 eyes, and deteriorated more than 10% in only 3 eyes.ConclusionsLocal MPOD and MPOV tended to slightly decrease month 1 postoperatively and gradually increased after that, but the rates of increases in MPOD levels were small. Yellow-tinted IOLs that have a lower transmittance of blue light might be preferable for preserving MPOD levels after surgery.
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Project description:Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.
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Project description:Purpose:To evaluate the clinical handleability and acceptability of a novel preloaded intraocular lens (IOL) delivery system for implantation of the TECNIS ZCB00 IOL (Johnson & Johnson Surgical Vision, Inc., Santa Ana, CA, USA) during routine small-incision cataract surgery. Subjects and Methods:In this prospective, open-label, noncomparative, unilateral or bilateral, multicenter study, adult subjects with unilateral or bilateral cataracts scheduled for IOL implantation were enrolled. Surgeons and surgical technicians completed per-eye day-of-surgery and end-of-surgical-day questionnaires. The primary endpoint of the study was the rate of acceptable overall clinical performance of the preloaded IOL delivery system. Other endpoints included additional responses from the questionnaires, preimplantation incision size, and safety. Results:The study included 91 eyes that underwent cataract surgery and IOL implantation using the preloaded delivery system and were available for the 1-day postoperative visit. Five surgeons and 14 surgical technicians from four investigational sites participated in the study. The rate of acceptable overall clinical performance was 100% (91/91) of eyes, with most responses (78/91; 85.7%) being the highest possible rating of 5 (very satisfied). Favorable responses by most surgeons and surgical technicians regarding additional endpoints further highlighted the handleability and acceptability of the preloaded delivery system. No ocular adverse events or lens findings (ie, no cases of IOL instability, haptic breakage, IOL marking, or crimping) were reported. Conclusion:The results of this study demonstrated that this preloaded IOL delivery system was safe and effective during routine small-incision cataract surgery. Trial Registration:German Clinical Trials Register identifier, DRKS00014757.
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