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Intraoperative capsular marking for toric intraocular lens placement

ABSTRACT: Preoperatively, the surgeon instills two drops of 0.5% proparacaine and then marks the 0° and 180° points at the limbus using a Gentian violet marker and 26G needle edge. Intraoperatively, after phacoemulsification and irrigation and aspiration of the cortex are complete, the surgeon inspects the previously marked 0°–180° points on the limbus. In case the steeper astigmatic meridian needs to be marked, a Mendez Ring is used and the meridian is marked using a Gentian violet marker and 26G needle edge. The desired markings (2 mm in length only) on the anterior lens capsule can be made using 26G needle bent at the bevel or using micro-vitreoretinal scissors. The toric intraocular lens (IOL) is then rotated in the bag in the desired meridian (customized-toric IOL in 0°–180° meridian and noncustomized toric IOL in steeper marked meridian), viscoelastic substance is aspirated and corneal wounds are hydrated.

SUBMITTER: Sethi H

PROVIDER: S-EPMC7787088 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Toric Lentis Mplus intraocular lens opacification: A case report.

Project description:Purpose:To present the case of a patient with Toric Lentis Mplus intraocular lens (IOL) (Oculentis, Berlin, Germany) opacification after vitrectomy and his follow-up. Observations:A 44-year-old man with high myopia and right optic neuritis history complained of visual impairment due to cataract in the right eye. We performed uneventful phacoemulsification and implanted a Toric Lentis Mplus IOL in his right eye. Six months later, he came to us with a retinal detachment in the nasal area of the right eye. We performed a 25-gauge vitrectomy with gas tamponade and endolaser treatment. Ten months after the vitrectomy, he complained of blurred vision in the right eye again. On slit-lamp examination, we observed a wide opacification localized to the anterior surface of the IOL. We explanted the IOL from the right eye and replaced it with a Clareon IOL (Alcon, Fort Worth, TX). The explanted IOL was examined under light microscopy and scanning electron microscopy. Conclusions and importance:We described a case of postoperative opacification of Toric Lentis Mplus IOL after vitrectomy. We found calcium aggregate deposits on the anterior surface of the IOL. Given the higher frequency of fundus disease observed in patients with high myopia, hydrophilic acrylic IOLs should be used with caution in patients with high myopia and in young patients. To our knowledge, this is the first report of Toric Lentis Mplus IOL opacification after the 2017 Field Safety Notice by Oculentis in response to the Food and Drug Administration's recall.

| S-EPMC7149404 | biostudies-literature

Rotational Stability of a New Posterior Chamber Toric Phakic Intraocular Lens.

Project description:Purpose:To evaluate the refractive results and rotational stability of Eyecryl toric phakic intraocular lens (pIOL). Methods:In this retrospective single-surgeon case series, manifest refraction, visual acuities, endothelial cell density (ECD), and pIOL rotation were evaluated over 6 months. Results:43 eyes from 23 patients were included. At 6 months, the SE was within ±0.50? D of emmetropia in 30 (70%) eyes and within ±1.00? D of emmetropia in 39 (91%) eyes. The efficacy and safety indices were 1.25?±?0.38 and 1.41?±?0.34, respectively. Mean ECD was 2719?±?296?cells/mm2 at the preoperative visit and 2779.42?±?422?cells/mm2 at the 6-month visit (p > 0.05). The mean value of absolute axis orientation error was 4.95?±?5.28°. Mean absolute change in axis orientation between visits was less than 3° for all visit intervals. Ninety percent or more of lenses were found to rotate 5° or less between all visit intervals. None of the patients experienced a vision-threatening complication, and no patient required secondary IOL repositioning. Conclusion:The pIOL appears to effectively reduce subjective manifest astigmatism and provide good visual acuity. Its position was found to be stable throughout the follow-up.

| S-EPMC7171658 | biostudies-literature

Toric intraocular lens versus limbal relaxing incisions for corneal astigmatism after phacoemulsification.

Project description: Not available

| S-EPMC6916141 | biostudies-literature

Four-flanged prolene fixation for a toric trifocal intraocular lens of the double C-Loop design in an eye with severe capsular phimosis.

Project description:PurposeTo report a rare case of severe capsular phimosis after toric trifocal intraocular lens implantation, in a patient who was already on systemic immunosuppression and to present a modified fixation technique, based on the four-flanged prolene technique, which could be adapted for fixation of intraocular lenses of the double-C-loop design.ObservationsA 33 year old gentleman, who underwent uneventful, sequential, bilateral phacoemulsification with implantation of toric trifocal intraocular lenses, presented 6 weeks post-operatively, with severe capsular phimosis, causing decentration of the IOL and deformation of the haptics in both eyes. The left eye was successfully managed by Nd-YAG laser anterior capsulotomy, while the right eye required surgical intervention.Conclusion and importanceIn the present case report, we describe a novel technique to successfully reposition and realign a decentered toric trifocal intraocular lens of the double C-loop haptic design, after severe capsule phimosis.

| S-EPMC7811043 | biostudies-literature

Surgical Synechiolysis of Iridocapsular Adhesion and Sulcus Placement of a Rigid Intraocular Lens on an Oversized Residual Capsular Rim.

Project description:PurposeTo report the surgical outcomes of surgical synechiolysis of iridocapsular adhesion and sulcus placement of a polymethyl methacrylate scleral-sutured intraocular lens (IOL) in aphakic eyes with an oversized residual capsular rim.MethodsEight aphakic eyes from eight consecutive patients were studied retrospectively. Synechiolysis was performed to maximally expose the residual capsulorhexis. Then, the rigid IOL was placed on the preserved capsulorhexis into the ciliary sulcus.ResultsSynechiolysis of iridocapsular adhesion was achieved in all eight eyes intraoperatively. Six eyes had extensive dissection to facilitate IOL sulcus placement. Consequently, seven of the eight eyes had the IOL secured by the residual capsulorhexis, and the other eye had the IOL haptics supported by the narrow residual capsular rim. A visual acuity of 0.25 or above was achieved in four of eight patients, and a well-centered IOL was observed in seven of the eight eyes 26 to 53 months after surgery. A mild IOL decentration was detected in the eye whose capsular rim was not securing the IOL optic.ConclusionsA large-optic and rigid IOL in the sulcus is a feasible alternative when a sulcus-based IOL is considered for aphakic eyes with an oversized residual capsulorhexis. A preserved capsulorhexis after sufficient synechiolysis, which can secure the IOL optic intraoperatively, may yield better stability of the IOL position.

| S-EPMC6157174 | biostudies-literature

Decentration of a toric intraocular lens implant in a patient with simple megalocornea.

Project description:PurposeTo describe a patient who developed radial displacement of the capsular bag and toric intraocular lens implant within approximately 5 weeks after surgery.ObservationsA patient underwent uncomplicated cataract extraction and implantation of a toric IOL for 2.5 diopters (D) of preoperative corneal astigmatism. Uncorrected visual acuity (UCVA) on postoperative day 1 was 20/20. Blurriness developed 5 weeks after surgery when UCVA was 20/70 but corrected to 20/20 with 2 D of cylinder in a new axis. The IOL was in the proper axis, but it and the capsular bag were radially displaced. Dilated examination revealed posterior capsular opacification superotemporally, outside the visual axis. The patient's biometry revealed axial myopia and megalocornea (white-to-white measurement of 13.44 mm), suggesting a larger than average capsular bag. Surgery was performed at postoperative week 6 to expand the capsular bag using a capsular tension ring and to re-center the IOL keeping the same axis. The patient recovered UCVA of 20/25 after the IOL was recentered.Conclusions and importanceIt is important to review biometry for large white-to-white measurements. Eyes with megalocornea may require capsular tension rings at time of toric IOL implantation so as to maintain IOL centration and good UCVA.

| S-EPMC7287240 | biostudies-literature

Long-term changes in the refractive effect of a toric intraocular lens on astigmatism correction.

Project description:PurposeTo examine the long-term changes in the astigmatism-correcting effect of a toric intraocular lens (IOL) after stabilization of surgically induced astigmatic changes due to cataract surgery.MethodsUnilateral eyes of 120 patients that received a toric IOL for against-the-rule (ATR) or with-the-rule (WTR) astigmatism were enrolled. Manifest refractive and anterior corneal astigmatism, and ocular residual astigmatism which is mainly derived from internal optics were examined preoperatively, at approximately 2 months postoperatively (baseline) and at 5 ~ 10 years postbaseline. The astigmatism was decomposed to vertical/horizontal (Rx) and oblique components (Ry), which was compared between baseline and 5 ~ 10 years postbaseline.ResultsIn the eyes having ATR astigmatism, the mean Rx and Ry of the manifest refractive and corneal astigmatism significantly changed toward ATR astigmatism between the baseline and 5 ~ 10 years postbaseline (p ≤ 0.0304), but those of ocular residual astigmatism did not change significantly between the 2 time points. In the eyes having WTR astigmatism, the Rx and Ry of refractive, corneal, and ocular residual astigmatism did not change significantly between the 2 time points. Double-angle plots revealed an ATR shift in refractive and corneal astigmatism and no marked change in the ocular residual astigmatism in the eyes with ATR astigmatism, and there is no change in this astigmatism in the eyes with WTR astigmatism.ConclusionThe long-term changes with age in the effect of a toric IOL significantly deteriorated due to an ATR shift of corneal astigmatism in the eyes having ATR astigmatism, while it was maintained in eyes having WTR astigmatism, suggesting that ATR astigmatism should be overcorrected.

| S-EPMC8786790 | biostudies-literature

Net technique for intraocular lens support in aphakia without capsular support.

Project description:BackgroundThis paper describes a modified surgical technique for intraocular lens implantation in aphakic eyes with no capsular support.MethodsRetrospective case series. Seventeen eyes of 17 aphakic patients with no capsule support underwent intraocular lens (IOL) implantation using a standardized technique in which a net was created at the ciliary sulcus plane with two threads forming a net pattern. The net was used as support for the IOL. Follow-up ranged from 6 to 38 months, with an average of 23 months.ResultsIn all cases, the IOL was safely implanted and remained stable during the follow-up. In 16 eyes, the IOL remained well centered; in one eye, slight decentration was observed. Distance-corrected visual acuity improved by a mean of 4 lines, from 1.13 (LogMAR) to 0.52 (P = 0.01).ConclusionThis technique might be especially useful in cases of insufficient capsular support associated with tissue loss or iris atrophy. In these cases, iris fixation is not feasible; thus, the only surgical alternative is IOL scleral fixation.

| S-EPMC5572154 | biostudies-literature

Extended focal length intraocular lens implantation in posttraumatic posterior capsular rupture.

Project description:We present a case of posterior capsular defect with traumatic cataract after blunt trauma in which an extended focal length intraocular lens (IOL) was implanted in the bag after conventional phacoemulsification and anterior vitrectomy. Anterior segment optical coherence tomography performed preoperatively aided in the confirmation and documentation of the capsular integrity. Intraoperative trocar anterior chamber (AC) maintainer allowed AC maintenance without further complications. IOL was well centered postoperatively at 6 months, and the unaided visual acuity was 20/20 for distance and N8 for near. The report showed that an extended depth of focus IOL can be placed in eyes with ruptured posterior capsule for good visual outcome in posttraumatic young eyes and it may not be considered as a relative contraindication for it.

| S-EPMC5939171 | biostudies-literature

Jagat and Bala intraocular lens supporting system: An artificial platform for intraocular lens implantation in an aphakic patient with inadequate capsular support.

Project description:We describe a novel device, Jagat and Bala Intraocular lens Supporting System (JBISS), an artificial Intraocular lens (IOL) platform that facilitates IOL fixation in an aphakic patient with poor capsular support and also facilitates IOL exchange in case of myopic shift or refractive surprise. Implantation of JBISS along with IOL was carried out in four patients and results are promising without any adverse events.

| S-EPMC8302291 | biostudies-literature

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