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Outcome of Single-piece Intraocular Lens Sulcus Implantation following Posterior Capsular Rupture during Phacoemulsification.

ABSTRACT: To assess the safety and outcome of single-piece posterior chamber intraocular lens (PC-IOL) implantation in the ciliary sulcus following posterior capsular rupture during cataract surgery.Patients with posterior capsular rupture during cataract surgery with a single-piece acrylic IOL implanted into the ciliary sulcus were studied. Complete ocular examinations were performed after 6 months postoperatively.Twenty-four eyes were included. Mean follow-up duration was 8.33 ± 2.33 months. There was no significant difference between preoperative and postoperative keratometric cylinder or intraocular pressure. Visual acuity of 87.50% of patients was ≥20/40 after surgery. Complications included foveopathy (10 eyes), iris transillumination defect (4 eyes), iris chafing (2 eyes), pigmented keratic precipitate (KP) (4 eyes), clinical IOL tilt (6 eyes), endothelial pigment dusting (14 eyes), IOL pigment dusting (17 eyes), iris bowing (6 eyes), IOL decentration (4 eyes), and IOL tilt detected with ultrasonography biomicroscopy (UBM) (4 eyes). IOL pigment dusting was significantly higher in eyes with short axial lengths, high IOL power, small sulcus-to-sulcus (STS) diameter, large STS IOL diameter mismatch, and small anterior chamber depth and angle. Significant relationships were observed between pigmented KP with small STS diameter and large STS IOL diameter mismatch, UBM and clinical IOL tilt with large anterior chamber depth and between iris transillumination defect and STS IOL diameter mismatch.This implantation is associated with higher incidence of complications. Single-piece acrylic IOLs are not designed for sulcus implantation. However, they may be used in eyes with longer axial length if the 3-piece IOL is not available.

SUBMITTER: Mohebbi M

PROVIDER: S-EPMC5525496 | biostudies-other | 2017 Jul-Sep

REPOSITORIES: biostudies-other

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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 ?m (193-310 ?m).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.

Project description:Cataract is the leading cause of visual impairment, and posterior capsular opacification (PCO) is the most common long-term complication of modern cataract surgery, which can cause severe visual impairment after surgery. The proliferation, migration, and epithelial-mesenchymal transition (EMT) of residual lens epithelial cells (LECs) stimulated by growth factors and cytokines, are the key pathological mechanisms involved in the development of PCO. This study demonstrated that non-steroidal anti-inflammatory drug (NSAID), bromfenac, was capable of effectively inhibiting cell migration, overexpression of EMT markers, such as fibronectin (FN), matrix metalloproteinase 2 (MMP2), α-smooth muscle actin (α-SMA), and transcription factor Snail, and extracellular signal-regulated kinase (ERK)/glycogen synthase kinase-3β (GSK-3β) signaling induced by transforming growth factor-β2 (TGF-β2) in vitro. The inhibitory effect of bromfenac on TGF-β2-induced EMT was also verified on a primary lens epithelial cell model using human anterior capsules. Furthermore, based on ultrasonic spray technology, we developed a drug-eluting intraocular lens (IOL) using poly (lactic-co-glycolic acid) (PLGA) with sustained bromfenac release ability for the prevention of PCO development. In the rabbit models of cataract surgery, bromfenac-eluting IOL exhibited remarkable PCO prevention and inflammation suppression effects with excellent biocompatibility. In conclusion, bromfenac can inhibit TGF-β2-induced cell migration and the EMT of LECs via ERK/GSK-3β/Snail signaling. The present study offers a novel approach for preventing PCO through PLGA-based drug sustained-release IOLs. Graphical abstract TGF-β2 promoted migration and EMT of lens epithelial cells (LECs) through activation of ERK/GSK-3β/Snail signaling, which could be suppressed by bromfenac. Novel bromfenac-based drug-eluting IOLs exhibited excellent PCO prevention in vivo.Image 1 Highlights • Bromfenac inhibited TGF-β2-induced migration and EMT of LECs through ERK/GSK-3β/Snail signaling.• Drug-eluting IOLs with sustained bromfenac release were developed based on ultrasonic spray technology.• Bromfenac-eluting IOLs exhibited remarkable PCO prevention and inflammation suppression effects in vivo.• Bromfenac-eluting IOLs hold great potential for clinical application of PCO prevention.

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Outcome of Single-piece Intraocular Lens Sulcus Implantation following Posterior Capsular Rupture during Phacoemulsification.

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