Full Text Available We report a case of aniridia associated with congenital aphakia and secondary glaucoma. A 35-year-old male presented with aniridia, congenital aphakia and secondary glaucoma in both eyes. After an unsuccessful medical management, he underwent trabeculectomy with mitomycin C and anterior vitrectomy under local anesthesia in his left eye. Postoperatively, at the end of six months, intraocular pressure (IOP in his left eye was controlled without medications. This case highlights the rare association of aniridia with congenital aphakia and secondary glaucoma.
Conclusions: Although piggyback IOL implantation for infantile cataract is optically acceptable as a treatment option, there is no significant difference in visual outcomes compared to aphakia. The incidence in reoperation due to complications in patients aged 6 months or younger is higher than those treated with aphakia.
Felius, Joost; Busettini, Claudio; Lynn, Michael J.; Hartmann, E. Eugenie; Lambert, Scott R.
After early surgery for unilateral infantile cataract, both treatment groups in the Infant Aphakia Treatment Study (IOL or contact lens correction of aphakia) showed no difference in the occurrence of fixation instabilities at age 4.5 years. The overall incidence of nystagmus was relatively low.
Full Text Available Implantation of iris-claw Artisan intraocular lens (IOL is a surgical option for correction of aphakia; however, these IOLs have not been used in eyes with uveitis including Fuchs′ heterochromic iridocyclitis (FHI due to possible risk of severe postoperative intraocular inflammation. In the case reported here, we secondarily implanted an Artisan IOL in a 28-year-old man with FHI who had aphakia with no capsular support due to a previous complicated cataract surgery. Enclavation was easily performed and no intraoperative complication was noted. Postoperative course was uneventful with no significant anterior chamber inflammation during 12 months of follow-up. Although there were few deposits on the IOL surface, the patient achieved a best-corrected visual acuity of 20/20 without developing glaucoma or other complications. Therefore, Artisan IOL may be considered for correction of aphakia in patients with FHI. However, studies on large number of patients are required to evaluate safety of the procedure.
Molinari, J F; Semes, L
This study examines the validity of labeled parameters of aphakia-correcting soft contact lenses. The Nikon Projection Lensometer (NPL) and the Hydro-Vue Soft Lens Analyzer (HSLA) were used by two independent inspectors to measure 51 aphakia-correcting lenses. The contact lens power, diameter, and base curve were measured by each of the inspectors and compared to the labeled parameters. All parameter relations that were analyzed revealed that measurements made by the inspectors were not statistically different (p greater than 0.05) from each other and that their combined measurements were not statistically different (p greater than 0.05) from the labeled values. PMID:7137309
Full Text Available Microphthalmia is a severe ocular disorder, and this condition is typically caused by mutations in transcription factors that are involved in eye development. Mice carrying mutations in these transcription factors would be useful tools for defining the mechanisms underlying developmental eye disorders. We discovered a new spontaneous recessive microphthalmos mouse mutant in the Japanese wild-derived inbred strain KOR1/Stm. The homozygous mutant mice were histologically characterized as microphthalmic by the absence of crystallin in the lens, a condition referred to as aphakia. By positional cloning, we identified the nonsense mutation c.444C>A outside the genomic region that encodes the homeodomain of the paired-like homeodomain transcription factor 3 gene (Pitx3 as the mutation responsible for the microphthalmia and aphakia. We examined Pitx3 mRNA expression of mutant mice during embryonic stages using RT-PCR and found that the expression levels are higher than in wild-type mice. Pitx3 over-expression in the lens during developmental stages was also confirmed at the protein level in the microphthalmos mutants via immunohistochemical analyses. Although lens fiber differentiation was not observed in the mutants, strong PITX3 protein signals were observed in the lens vesicles of the mutant lens. Thus, we speculated that abnormal PITX3, which lacks the C-terminus (including the OAR domain as a result of the nonsense mutation, is expressed in mutant lenses. We showed that the expression of the downstream genes Foxe3, Prox1, and Mip was altered because of the Pitx3 mutation, with large reductions in the lens vesicles in the mutants. Similar profiles were observed by immunohistochemical analysis of these proteins. The expression profiles of crystallins were also altered in the mutants. Therefore, we speculated that the microphthalmos/aphakia in this mutant is caused by the expression of truncated PITX3, resulting in the abnormal expression of
Elfiky, Mohamed; Saad, Hisham; Elseht, Rabab; Selima, Adel
Purpose This is a prospective investigational study that was performed at Tanta University Eye Hospital, Tanta, Egypt to evaluate the role of ultrasound biomicroscopy (UBM) in planning secondary implantation of intra ocular lens (IOL) in aphakia. Methods Preoperative UBM was performed for the assessment of anterior segment of 30 aphakic eyes admitted for secondary IOL implantation with special attention to central corneal thickness (CCT), anterior chamber depth (ACD), ciliary sulcus (CS), anatomical changes, and posterior capsular (PC) integrity which had been assessed by measuring the remnants of PC with special attention to the 12, 3, 5, 6, 7, and 9 o'clock meridians. Results This study involved 30 eyes in 27 patients; 16 males and 11 females. The mean age was 8.39 ± 2.36 years. The causes of aphakia were: congenital cataract extraction in14 eyes (46.7 %); trauma in 14 eyes (46.7 %); and after extracapsular cataract extraction in 2 eyes (6.6 %). The mean CCT was 0.61 + 0.35 mm and the mean ACD was 3.03 + 0.41 mm. The ciliary sulcus was patent in 28 eyes (93.4 %). Posterior synechia was observed in 8 eyes (26.7 %), lens remnants in 11 eyes (36.7 %), corneal scars in 11 eyes (36.7 %), and vitreous in anterior chamber in 1 eye (3.3 %). The integrity of PC was illustrated with a diagram. Conclusions UBM is a useful device to evaluate aphakic eyes before secondary IOL implantation through good evaluation of the anterior segment with special attention to the posterior capsular integrity, ciliary sulcus, anterior chamber depth, corneal thickness, and detection of any structural changes in the anterior segment resulting from the remote cause of aphakia. PMID:26494475
Anjum, Iram; Eiberg, Hans; Baig, Shahid Mahmood;
PURPOSE: Aphakia is the complete absence of any lens in the eye, either due to surgical removal of the lens as a result of a perforating wound or ulcer, or due to a congenital anomaly. The purpose of this study was to elucidate the molecular genetics for a large consanguineous Pakistani family wi...... quite primitive in origin since the same mutation is responsible for the same phenotypic outcome in two families of geographically different descent.......PURPOSE: Aphakia is the complete absence of any lens in the eye, either due to surgical removal of the lens as a result of a perforating wound or ulcer, or due to a congenital anomaly. The purpose of this study was to elucidate the molecular genetics for a large consanguineous Pakistani family with...... a clear aphakia phenotype. METHODS: The initial homozygosity screening of the family was extended to all the known autosomal recessive cataract loci in order to exclude the possibility of surgical cataract removal leading to aphakia. The screening was performed using polymorphic nucleotide repeat...
Celano, Marianne; Hartmann, E. Eugenie; DuBois, Lindreth G.; Drews-Botsch, Carolyn
Aim To assess motor functioning in 4.5 year olds enrolled in the Infant Aphakia Treatment Study, and to determine contributions of visual acuity and stereopsis to measured motor skills. Method Children with unilateral aphakia randomized to intraocular lens (IOL) or contact lens (CL) treatment were evaluated at 4.5 years for monocular recognition visual acuity, motor skills, and stereopsis by a traveling examiner masked to treatment condition. Motor skills were assessed with the Movement ABC-2. Visual acuity was operationalized as logMAR value for treated eye, best logMAR value for either eye, and intraocular logMAR difference. Results T-tests showed no significant differences in MABC-2 scores between the IOL and CL groups. The mean total score was low (6.43; 18th percentile) compared to the normative reference group. Motor functioning was not related to visual acuity in the treated eye or to intraocular logMAR difference, but was predicted in a regression model by the better visual acuity of either eye (usually the fellow eye), even after accounting for the influence of age at surgery, examiner, orthotropic ocular alignment, and stereopsis. Interpretation Children with unilateral congenital cataract may have delayed motor functioning at 4.5 years, which may adversely affect their social and academic functioning. PMID:26084944
V. N. Kanyukov
Full Text Available Purpose: Evaluation of the results of various treatment tactics of patients with post-traumatic retinal detachment pathology combined with aniridia and aphakia.Patients and methods.The analysis of four clinical cases of surgical treatment of post-traumatic retinal detachment in conjunction with aniridia and aphakia was carried out. There was used a gradual approach of optic-reconstructive surgery: vitreoretinal stage by the standard method 23‑25 Ga with tamponade of vitreous cavity with silicone oil in two different ways. In one case, full eyeball tamponade was made, and in the other one it was made up to the diaphragm formed of polypropylene sutures. At the final stage — iridolenticular diaphragm was implanted (Reper-NN, Russia.Results. In all cases, early postoperative reaction proceeded with the phenomena of fibrino-plastic iridocyclitis, which corresponded to the severity of the initial state and the volume of surgical intervention. Periods of observation of patients in the postoperative period ranged from 3 to 12 months. In three cases where the diaphragm was formed from polypropylene sutures there was noticed full retina adaptation, wherein silicone oil, introduced in the vitreous cavity, did not penetrate into the anterior chamber during the entire period of observation. In one case, where there was a complete eyeball tamponade with silicone oil epithelial and endothelial corneal dystrophy developed. Such an outcome of a clinical case, despite high functional results, is apparently related to the severity of the initial state, the need to re-intervention for recurrent retinal detachment and relatively early stages of iridolenticular diaphragm implantation.Conclusion. Reconstructive surgery of posttraumatic aniridia and aphakia combined with retinal detachment requires a multistage approach. Reconstruction of anterior segment of the eye is preferably to carry out in long-term periods as after the trauma so after surgical treatment
Full Text Available Maurice Schallenberg,1,2 Dirk Dekowski,1 Angela Hahn,1 Thomas Laube,1,3 Klaus-Peter Steuhl,1 Daniel Meller11Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; 2HELIOS Klinikum Wuppertal, Wuppertal, Germany; 3Zentrum für Augenheilkunde PD Dr Laube, Düsseldorf, GermanyPurpose: To evaluate the technique, safety, and efficacy of the retropupillary implantation of iris-claw intraocular lenses in a long-term follow-up study.Patients and methods: This retrospective study included 31 eyes of 31 patients who underwent an Artisan aphakic intraocular lens implantation between January 2006 and February 2011 at the University Hospital Essen, Essen, Germany and at the Zentrum für Augenheilkunde PD Dr Laube, Düsseldorf, Germany. Preoperative data collected included demographics, etiology of aphakia, previous surgeries, preoperative eye pathology, intraocular pressure, clinical signs of endothelial cell loss, and best corrected visual acuity. Operative data and postoperative outcomes included the best corrected visual acuity, lens position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, development of macular edema, and other complications.Results: Thirty-one patients were included. The mean follow-up was 25.2 months (range: 4–48 months. The mean best corrected visual acuity postoperatively was 0.64 logarithm of the minimum angle of resolution (logMAR and varied from 0 logMAR to 3 logMAR. Some patients had a low visual acuity preoperatively because of preoperative eye pathologies. In 22 patients the visual acuity improved, in two patients the visual acuity remained unchanged, and seven patients showed a decreased visual acuity. Complications were peaked pupils (n=10 and retinal detachment in one case. Four patients showed an iris atrophy and high intraocular pressure was observed only in one patient. Subluxation of the intraocular lens, endothelial cell loss, and
Umut Duygu Uzunel
Full Text Available We present a case of transpupillary argon laser cyclophotocoagulation (TALC in a patient with traumatic aniridia and aphakia secondary to blunt trauma who had previous bilateral trabeculectomy. Four months after the trauma the patient’s intraocular pressure (IOP rose to 35 mmHg despite topical antiglaucomatous medication. Inferior 180 degrees cyclophotocoagulation was performed with transpupillary argon laser in the first session and his IOP fell to values of 12-17 mmHg. Twelve weeks after TALC, his IOP rose to 22 mmHg and we had to apply TALC to the residual ciliary processes. Seven months later his IOP was 13 mmHg with topical dorzolamide/timolol and latanoprost administration. TALC may be an effective treatment alternative for lowering IOP in patients with visible ciliary processes who do not respond to conventional medical or laser treatment.
周建兰; 谢培英; 王丹; 常勇; 刘营
目的：探讨硬性透气性接触镜（CRGPCL）在先天性白内障患儿术后无晶体眼的视力矫正及视功能改善的临床效果。方法回顾性分析2010年5月至2012年10月7例先天性白内障术后无晶体眼的患儿验配Meni-con ZRGPCL，并观察戴镜后1个月、3个月、6个月、1年的戴镜视力及视功能提高的情况。结果1年观察期内均未出现严重的并发症而导致停戴。所有患儿配戴RGPCL1年时矫正视力均较框架镜矫正有提高，双眼视功能检查有部分改善。结论 RGPCL为先天性白内障术后无晶体眼的患儿在视力提高及视功能改善方面提供了一个良好的矫正方式，规范配戴与定期复查也同时降低了戴镜风险。%Objective To investigate clinic effects of corrected visual acuity and visual function using by Rigid Gas Permeable Contact lens(RGPCL) in infant aphakia after Cataract surgery. Methods A retrospective analysis of 7 cases infants aphakia who fitted Menicon Z RGPCL in our center. We inspected the corrected visual acuity and visual function during periods of wearing RGPCL 1m,3m,6m and 1y. Results All children’s RGPCL corrected visual acuity and partial visual function were improved at 1st year. With the schedule of parents lens care, standard lens wearing,regular lens check and amblyopia training,there were no serious applications in 7 cases. Conclusions Infants aphakia corrected by RGPCL after Cataract surgery which obtains good corrected visual acuity and visual function and standard lens wearing and regular lens check reduce risks of lens use.
刘立洲; 吕燕云; 彭丽
目的 评价软性虹彩片联合透气性半硬性角膜接触镜(RGPCL)对外伤性无虹膜无晶状体眼的矫治效果.设计回顾性病例系列.研究对象 角膜内皮细胞密度在2500个/mm2以上外伤性无虹膜无晶状体眼患者59例(59眼).方法患者联合戴用软性虹彩片和RGPCL,比较初诊时的插片视力和RGPCL矫正视力,随诊5年,非接触性角膜内皮计数仪检测角膜内皮细胞改变情况及裂隙灯下检查角结膜并发症情况.主要指标矫正视力,角膜内皮细胞计数,角结膜并发症.结果 外伤性无虹膜无晶状体眼配戴软性虹彩片联合RGPCL的平均矫正视力(0.64±0.23)明显高于初诊时的插片视力(0.33±0.21),差异有统计学意义(t=7.750,P=0.000);畏光症状减轻;初诊时平均角膜内皮细胞计数为(2695.5±125.4)个/mm2(n=59),戴镜1、2、3、4、5年分别平均为(2705.4±145.6)个/mm2(n=43),(2639.5±146.7)个/mm2(n=30),(2625.5±143.6)个/mm2(n=26),(2641.5±168.5)个/mm2(n=32),(2638.2±128.6)个/mm2(n=29),第5年与初诊相比平均减少(70.3±8.7)个/mm2.角膜、结膜未见严重并发症.结论 软性虹彩片联合RGPCL对角膜内皮细胞密度在2500个/mm2以上的外伤性无虹膜无晶状体眼在提高视力和解决畏光方面是一种有效方法,但要定期复查角结膜情况.%Objective To investigate the clinical effects of soft cosmetic contact lens combined with half-rigid gas permeable contact lens (RGPCL) for traumatic aniridia and aphakia. Design Retrospective case series. Participants 59 patients (59 eyes) with traumatic aniridia and aphakia,whose corneal endothelial cell density was above 2500 cells/mm2. Methods 59 patients (59 eyes) fitted with soft cosmetic contact lens combined with RGPCL were followed up for 5 years. The corrected visual acuity was compared between contact lens group and glasses group. The corneal endothelial changes were observed. The complications in cornea and conjunctiva were observed using slit
Jaya Biswas; Asim Chakrabarti; Debabrata Das
Aniridia is a rare congenital malformation that may be associated with various ocular and systemic manifestations. We describe two cases of familial total aniridia associated with microcornea, high myopia and dislocated lens. No systemic abnormality was noted in any of the cases.
Mandal Anil; Netland Peter
Glaucoma is one of the most common causes of visual loss despite successful congenital cataract surgery. The overall incidence does not appear to have decreased with modern microsurgical techniques. The onset of glaucoma may be acute or insidious and notoriously refractory to treatment. Angle closure glaucoma may occur in the early postoperative period; but the most common type of glaucoma to develop after congenital cataract surgery is open angle glaucoma. Several risk factors have been iden...
Singh, Bhupinder; Wilson, Jean H.; Vasavada, Hema H; Guo, Zhenchao; Allore, Heather G.; Zeiss, Caroline J.
Like humans with Parkinsons disease (PD), the ak mouse lacks the majority of the substantia nigra pars compacta (SNc) and experiences striatal denervation. The purpose of this study was to test whether motor abnormalities in the ak mouse progress over time, and whether motor function could be associated with temporal alterations in the striatal transcriptome. Ak and wt mice (28 to 180 days old) were tested using paradigms sensitive to nigrostriatal dysfunction. Results were analyzed using a l...
David Yorston FRCS FRCOphth
The management of congenital cataract is very different to the treatment of a routine age-related cataract. In adults, surgery may be delayed for years without affecting the visual outcome. In infants, if the cataract is not removed during the first year of life, the vision will never be fully regained after surgery. In adults, if the aphakia is not corrected immediately, it can be corrected later. In young children, if the aphakia is not corrected, the vision will never develop normally.
Full Text Available der; Eye disease FOXE3 [HSA:2301] [KO:K09398] ICD-10: Q12.3 MeSH: C537786 OMIM: 610256 PMID:19708017 (description) Iseri SU, Osborn...lgros MP, Schwartz C, Delbosc B, Delpech M, Kantelip B Homozygous nonsense mutation in the FOXE3 gene as a c...H00676 Congenital primary aphakia Congenital primary aphakia (CPA) is a rare congenital eye disor...der characterized by the absence of lens. Formation of lens and lens-induced anterior structur...es does not take place in CPA, resulting in complete aplasia of the anterior segment of the eye. CPA is caus
... Federal Register on January 17, 2008 (73 FR 3316), or you may visit http://edocket.access.gpo.gov/2008/pdf.... Moore, 62, has had aphakia in his left eye since childhood due to trauma. The visual acuity in his right.... Moorhead, 52, has had complete loss of vision in his right eye since childhood due to trauma. The...
N. Ya. Senchenko; K. A. Nagaeva; E. K. Ayuyeva1; T.N. Iureva
Different approaches to surgical and pleoptic treatment of congenital cataract and amblyopia of obscure origin in children are represented. Main tendencies that determine the indications to surgical procedures and their terms are described. Current techniques of aphakia correction, their advantages and disadvantages as well as pleoptic methods of visual system stimulation are discussed
A Sahap Kükner
Full Text Available We aimed to evaluate the implantation of a posterior chamber intraocular lens (IOL in the anterior chamber (AC with the haptics passing through two iridectomies to the posterior chamber. A total of 33 eyes of 33 patients with inadequate posterior capsular support due to either previous aphakia or posterior capsular rupture during cataract extraction were included in the study. A double iridectomy was performed on all patients using a vitrectomy probe on the midperiphery of the iris. IOLs were implanted in the AC, and the haptics were passed through the iridectomies to the posterior chamber. The mean follow-up time was 25.3 months. AC hemorrhage occurred in five patients during the iridectomy procedure. Corneal edema was detected in eight of 14 patients with primary IOL insertions. Haptic dislocation was detected in only one patient. This technique may be a good alternative to scleral-fixated IOL implantation in eyes with aphakia.
Pina, S; Pedrosa, C; Azevedo, A.; Ramalho, M; Pêgo, P; Feijóo, B; Prieto, I
Purpose: To describe three different minimal invasive surgical approaches for correction of traumatic and congenital pupil abnormalities. Setting/Venue: Ophthalmology Department, Prof Dr. Fernando Fonseca Hospital EPE. Amadora, Lisboa, Portugal Methods: We describe three clinical cases with pupil abnormalities from different ethiology, all submitted to pupiloplasty in order to improve visual and aesthetic outcome. First patient presented a traumatic aphakia and ectopic pupil in his righ...
Glaucoma surgery can be classified as either cyclodestructive (reducing inflow) or filtering (increasing outflow). Filtration has traditionally been the procedure of first resort because of its efficacy and relative predictability, whereas ciliary destruction has been reserved for more refractory cases of glaucoma and in eyes which have little or no visual potential. Refractory glaucomas include neovascular glaucoma, post-traumatic glaucoma, glaucoma associated with aphakia, severe congenital...
Kang, Jae Hoon; Park, Kyung Ah; Shin, Woo Jae; Kang, Se Woong
Purpose Choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD) is a rare, but serious condition, which makes the prognosis worse. Previously reported risk factors for CD in RRD patients include high myopia, aphakia, pseudophakia, and advanced age. However, macular hole has not been discussed as an important factor in increasing the risk of CD in RRD patients. The purpose of this study was to evaluate macular hole as a risk factor for CD in eyes evidencing RRD. Metho...
Apple, David J
Sir Harold Ridley invented and refined the modern miracle of replacing lenses obscured by cataracts with plastic optical lenses, thus rendering a complete cataract cure. This operation, broadly termed the cataract-intraocular lens (IOL) operation, has since brought sight to many millions of people throughout the world, and continues to improve the quality of life of more than 10 million patients worldwide each year. Ridley not only launched this powerful and irreversible forward movement in the field of ophthalmology and the visual sciences, but through it he also helped give birth to the exciting and new field of artificial biodevice implantation as well as transplantation techniques now applied to many other organs and tissues of the body. He has therefore been credited with healing to create the relatively new specialty of biomedical engineering. Few of the millions of patients worldwide who now enjoy the benefits of the modern cataract - IOL operation are aware of the origin of this innovation. Indeed, few eye care professionals - even ophthalmic surgeons who implant them almost daily - are aware of the origin of the IOL - an invention that, as Harold himself liked to say, 'cured aphakia'. (The word aphakia comes from teh Greek, meaning absence of lens, the situation that occurs when a cataractous lens is surgically removed.) PMID:18543467
Plotnikova, Iu A; Chuprov, A D; Volkov, D V
Results of surgical treatment of cataract complicated by medium and high myopia are analyzed. The main group consisted of 90 patients (96 eyes) subjected to extracapsular cataract extraction with implantation of posterior-chamber intraocular lenses and the reference group of 128 patients in whom cataract was extracted without implantation of artificial lens. The study included creation of a mathematical model of myopic eye with estimation of pressure fluctuations in various zones of the eye, developing during transposition of the vitreous during patient's movements (head movements, jumps, falling) and the damping effect of the lens in the ocular system. It was proven by mathematical calculations that transpositions of jelly fractions of the vitreous decreased by 70% in an eye with the lens in comparison with their transposition in aphakia. Clinical studies demonstrated the efficiency of intraocular correction of aphakia in high myopia: implantation of an intraocular lens decreases the risk of detachment of the retina during the postoperative period and helps attain the desired refraction. PMID:11765458
Naresh K Yadav
Full Text Available Scleral fixated intraocular lens (SFIOL is a safe and effective option for managing optical aphakia. Suture related complications like suture erosion, suture breakage, endophthalmitis, etc. are unique to SFIOL. The knots can be covered by partial thickness flaps or they can be rotated into scleral tissues without flaps to reduce the complications. We performed a recently described novel technique which obviates the need for knot and scleral flaps in securing the SFIOL. This novel 2-point Ab externo knotless technique may reduce the knot related problems. Twenty-three eyes undergoing this knotless SFIOL procedure were analyzed for intraoperative and postoperative complications. Twenty-two eyes either maintained or improved on their preoperative vision. All patients had a minimum follow-up of 24 months.
Full Text Available Daniel Gologorsky, Harry W Flynn Jr Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Cataract surgery in patients with pathologic myopia and high axial length can be challenging for a variety of reasons, including imprecise intraocular lens calculations in eyes with posterior staphylomas and intraoperative complications such as suprachoroidal hemorrhage, posterior capsular rupture, and retinal tears. Although most surgeons recommend standard phacoemulsification and preservation of the posterior capsule in these cases, an alternative approach presented in this series entails the removal of the lens through the pars plana and removal of formed vitreous during the concurrent procedure. Keywords: cataract surgery, pathologic myopia, high axial length, aphakia
Chiseliţă, D; Vancea, P P; Filimon, O; Brănişteanu, D; Bredetean, M; Poiata, I
The retrospective analysis of the postoperative course in 204 traumatic cataracts (140 isolated, simple cataracts and 64 aggravated ones) showed an apparent functional improvement in the simple cases (preoperative and postoperative visual acuity 0.0139 and 0.8520, respectively); the incidence of postoperative detachment of retina was of 4.9%, that of postoperative endophthalmitis that of cystoid macular edema of 3.2%; complications more commonly occurred in aggravated traumatic cataracts and partially accounted for the poorer functional results. During the investigated interval (1988-1992) a rapid shift to extracapsular cataract extraction and posterior chamber lens implants was made. The crystalline grafts preserved binocular vision in 92% of the cases and contact lens in 50% of the cases. Lens implant remains a matchless solution for the visual rehabilitation of the patients with aphakia. PMID:7654673
Camp, J J; Maguire, L J; Cameron, B M; Robb, R A
We developed a method that models the effect of irregular corneal surface topography on corneal optical performance. A computer program mimics the function of an optical bench. The method generates a variety of objects (single point, standard Snellen letters, low contrast Snellen letters, arbitrarily complex objects) in object space. The lens is the corneal surface evaluated by a corneal topography analysis system. The objects are refracted by the cornea by using raytracing analysis to produce an image, which is displayed on a video monitor. Optically degraded images are generated by raytracing analysis of selected irregular corneal surfaces, such as those from patients with keratoconus and those from patients having undergone epikeratophakia for aphakia. PMID:2330940
Roy, Avik Kumar
Full Text Available Introduction: Glaucoma in aphakia is a major long term complication following congenital cataract surgery. Implantation of glaucoma drainage device provides an effective approach to manage refractory paediatric glaucoma. However implant surgery in young individuals is not free of complications. The prompt detection and management of tube erosion is of utmost importance to prevent devastating sequel of endophthalmitis. Implantation cyst following repair of tube erosion has not been reported so far. This case illustrates the rare occurrence of inclusion cyst following repair of tube erosion, the possible causes and its consequences. Case description: A 2-year-old child with aphakia developed intractable glaucoma. Following a failed glaucoma filtering surgery he underwent sequential Ahmed Glaucoma Valve implantation in both the eyes. Six weeks following right eye surgery, the child presented with conjunctival erosion overlying the tube, which was treated with scleral patch graft and conjunctival advancement. One month after the repair of tube erosion, the child presented with implantation cyst under the scleral patch graft, which was treated by drainage with a 29G needle. The child presented with endophthalmitis of his right eye following an episode of bilateral conjunctivitis. This was managed by an emergency pars plana vitrectomy, intraocular antibiotics and tube excision. At the last follow up visit, the IOP was 20 mmHg with 2 topical antiglaucoma medications in the right eye following a trans scleral photocoagulation.Discussion: Lifelong careful follow-up of paediatric eyes with implant surgery is mandatory to look for complication such as tube erosion. It is important to place additional sutures to secure the patch graft during implantation of glaucoma drainage devices in children to prevent graft displacement and consequent tube erosion. During repair of tube erosion, it is crucial to remove all the conjunctival epithelium around the tube
Full Text Available Context: Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision. Aim: To ascertain the need for spectacles and magnifiers as low vision devices (LVD in children with useful residual vision, attending blind schools. Setting and Design: Cross-sectional study conducted in 13 blind schools in Delhi, North India. Materials and Methods: Of a total of 703 children (less than 16 years of age examined, 133 (18.91% with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO/ prevention of blindness (PBL eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science, version 10.0 was used for analysis. Results: Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI. 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%, improved with spectacles. Children with aphakia (17, coloboma (5, refractive error (5 and microphthalmos (4 benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1% were able to read N-10 unaided or with distance spectacles and 30 children (22.6% improved to N-10 with spectacle magnifiers and were prescribed the same. Conclusion: Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.
Full Text Available Purpose: To compare the outcomes of iris claw anterior chamber intraocular lens (ICACIOL with that of scleral fixation posterior chamber intraocular lens (SF-PCIOL implantation during pars plana vitrectomy (PPV as initial surgery to correct aphakia. Methods: Twelve patients with complicated cataract surgery or trauma who had suffered nucleus, whole crystalline lens or intraocular lens (IOL drop into the vitreous cavity, and undergone PPV with IC-ACIOL implantation over a period of one year were evaluated for the purpose of this study. Uncorrected visual acuity (UCVA, best corrected visual acuity (BCVA, central corneal thickness (CCT, spherical equivalent (SE refractive error, astigmatism and complications were recorded. The results were compared to outcomes of another group of 13 patients who had previously undergone PPV with SF-PCIOL implantation. Results: Mean improvement of UCVA was greater in IC-ACIOL eyes as compared to the SF-PCIOL group (-1.17±0.28 versus -0.89±0.21 logMAR, P=0.01, corresponding values for postoperative BCVA were 0.24±0.17 and 0.44±0.22 logMAR (P=0.041, respectively. Average postoperative SE was comparable in the IC-ACIOL and SFPCIOL groups at 0.6±1.03 and 0.56±1.23 diopters, respectively (P=0.290. However, 10 (83.3% IC-ACIOL eyes versus 6 (46.1% SF-PCIOL eyes had SE within 1 diopter of emmetropia (P=0.048. Mean postoperative increase in CCT was comaparble between the study groups (P=0.126. Conclusion: In the absence of sufficient capsular support, the use of an IC-ACIOL for correction of aphakia during PPV can be a good alternative and seems to entail better visual outcomes as compared to SF-PCIOL.
ZHU Jian-feng; ZOU Hai-dong; HE Xian-gui; LU Li-na; ZHAO Rong; XU Hong-mei; LIANG Qing-feng
Background The control of blindness in children is a high priority within the VISION 2020 initiative.To determine the causes of severe visual impairment and blindness in children from Shanghai Blind Children School (SBCS) can provide useful information on childhood blindness in Shanghai.Methods A cross-sectional investigation of students in SBCS was conducted in May 2010.The World Health Organization/Prevention of Blindness (WHO/PBL) eye examination record system for children with low vision and blindness was used.The results were further compared with the findings of two previous investigation studies conducted in 1986 and 2004,respectively in SBCS.Results Of the 146 children observed,80 children (54.8％) were blind (best corrected best visual acuity less than 0.05),27 children (18.5％) had severe visual impairment (best corrected visual acuity less than 0.1 but better than or equal to 0.05),and 34 children (23.3％) had moderate visual impairment (best corrected visual acuity less than 0.3 but better than or equal to 0.1).The major affected anatomic sites in the 107 children with severe visual impairment and blindness (SVI/BL) were retina (47.7％),whole globe (16.8％),optic nerve (13.1％) and lens (9.3％).The leading causes of SVI/BL were retinopathy of prematurity (ROP,25.2％),followed by retinal dystrophy (15.9％),optic nerve atrophy (9.3％) and microphthalmos (9.3％).The two leading etiologic categories of SVI/BL were perinatal/neonatal (36.4％) and congenital/hereditary groups (29.0％).The leading cause of moderate visual impairment was aphakia after cataract surgery (congenital cataract,44.1％).Compared with the findings in two previous investigations in SBCS,the proportion of ROP in visual impairing diseases increased,while the proportion of disorders of the lens (cataract and aphakia)significantly decreased.Conclusions The leading cause of childhood blindness in SBCS nowadays is ROP.It is projected that without improvement in perinatal medical
Full Text Available We examined 23 consecutive cases of unilateral aphakia reporting to the contact lens office for endothelial count and morphology, corneal thickness and toricity. The fellow eye served as a control in all the cases. It was found that there is a significant drop in the central endothelial cell density, and change in the size and shape of the cells. These observations indicate a thermodynamically unstable state. The aphakic corneas were thicker than the controls but not to a significant extent. The cell count and pachymetry had no statistical correlation. Toricity of the aphakic corneas make successful fitting of a lens difficult. Since prolonged use of extended wear gas permeable as well as hydrogel lenses have a deleterious effect on the endothelium it is suggested that a careful case selection be made and strict monitoting carried out at follow up. These corneas are liable for decompensation with only mild noxious stimuli. This article is intended to acquaint the ophthalmologist with the pitfalls in aphakic contact lens fitting so that a cautious follow up may be planned.
Full Text Available Purpose: The purpose of this study was to evaluate the clinical efficacy and safety of modified posterior chamber intraocular lens (PCIOL implantation with transscleral fixation. Design and Setting: This is a study, which is conducted at Department of Ophthalmology, Jinan Eye Hospital, Jinan Second People′s Hospital. Materials and Methods: A total of 82 patients who were scheduled for sutured PCIOL were divided randomly into modified and conventional groups. The former underwent PCIOL through pars plana fixation with knot buried and without scleral flap and the latter underwent transscleral fixation of PCIOL in the ciliary sulcus. The main outcome measures included operative time, postoperative visual acuity, and postoperative complications. Results: The mean operative time of the modified group was 39.95 ± 5.87 min, which was significantly less than that of the conventional group (45.77 ± 5.21 min; P < 0.05. No difference was found in postoperative visual acuity between the two groups. There were no significant postoperative complications, including knot exposure, endophthalmitis, and retinal detachment in either group. The optical clamping of PCIOL was prone to occur in the conventional group. Conclusion: Modified sutured PCIOL implantation is a safe, effective, and feasible technique for the correction of aphakia in eyes without adequate posterior capsular support.
It is well-known that flying dots (muscae volitantes) in posterior vitreous detachment gradually disappear. An analogy for this phenomenon is the optical effect of planets casting conic shadows as they are lighted by the sun (in this case the pupil serves as the light source) and these shadows shrink as the planets near the sun. When the opacities move forward in the vitreous cavity, their shadows are not long enough to reach the retina, so the flying dots disappear. They can also disappear when their shadows fall on the optic disk or when they are mixed with the random pattern of bright and dark areas of the retinal image in ordinary conditions. Pupil dilatation makes the conoid shadow shorter; thus, the flying dots became fainter. In advanced cataract, stray light makes the retinal image less sharp, reducing the perception of dots. Replacement of the opacified lens by an intraocular lens restores the sharpness of the retinal image, because the light entering the eye becomes less diffuse, making the flying dots more obvious. The same reasoning explains similar phenomena in aphakia and large ametropias with and without corrective spectacles, as well as opacities of any etiology in the vitreous. PMID:9265706
Mouse mutants affecting lens development are excellent models for corresponding human disorders. The mutant aphakia has been characterised by bilaterally aphakic eyes (Varnum and Stevens, J Hered 1968;59:147-50); the corresponding gene was mapped to chromosome 19 (Varnum and Stevens, Mouse News Lett 1975;53:35). Recent investigations in our laboratory refined the linkage of 0.6 cM proximal to the marker D19Mit10. Several candidate genes have been excluded (Chuk1, Fgf8, Lbp1, Npm3, Pax2, Pitx3). The Cat3 mutations are characterised by vacuolated lenses caused by alterations in the initial secondary lens fibre cell differentiation. Secondary malformations develop at the cornea and iris, but the retina remains unaffected. The mutation has been mapped to chromosome 10 close to the markers D10Mit41 and D10Mit95. Several candidate genes have been excluded (Dcn, Elk3, Ldc, Mell8, Tr2-11). The series of Cat2 mutations have been mapped close to the gamma-crystallin genes (Cryg; Löster et al., Genomics 1994;23:240-2). The Cat2nop mutation is characterised by a mutation in the third exon of Crygb leading to a truncated gamma B-crystallin and the termination of lens fibre cell differentiation. The Cat2 mutants are interesting models for human cataracts caused by mutations in the human CRYG genes at chromosome 2q32-35. PMID:10627821
Young (less than 1 year) and old (greater than 15 years) Rhesus monkeys were utilized in this study in order to determine whether ultraviolet (UV) radiation at ambient levels induces psoralen photobinding in primate eyes (in particular the lens and retina). Unilateral aphakia or pseudophakia was induced surgically and the eyes were allowed to heal. The animals then were given a single intraperitoneal injection of 3H 8-methoxypsoralen (8-MOP) and immediately exposed to BLB lights (of measured radiation intensity at the corneal surface). The animals were killed at varying time periods (2-6 weeks), and the eyes were removed immediately. One-half of each cornea and lens was frozen for subsequent optical spectroscopy and the remaining ocular tissues were fixed for histopathologic studies and autoradiography. These data demonstrate that low level UV radiation (less than 0.4 mW/cm2) can cause 8-MOP photobinding to lens proteins and DNA and to aphakic, pseudophakic, and young phakic primate retinas. The older phakic primate lens serves as a protective UV filter and prevents psoralen photobinding within the retina. These data suggest that older aphakes and pseudophakes may require UV radiation protection to prevent direct as well as photosensitized retinal photodamage
Vijaya, Lingam; George, Ronnie; A, Rashima; Raju, Prema; Arvind, Hemamalini; Baskaran, Mani; Ve, Ramesh S
Purpose: To assess the visual outcome after cataract surgery in a south Indian population. Materials and Methods: Population-based cross-sectional study of subjects aged 40 years or more. Three thousand nine hundred and twenty-four rural subjects from 27 contiguous villages and 3850 urban subjects from five randomly selected divisions were studied. All subjects underwent a comprehensive ophthalmic examination that included visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and dilated retinal examination. Statistical Analysis: Chi square test, t test and multivariate analysis were used. Results: Five hundred and twenty-eight (216 males, 312 females, 781 eyes) rural subjects (13.5%, 95% confidence interval (CI) 12.4% to 14.6%) and 406 (197 males, 209 females, 604 eyes) urban subjects (10.5%, 95% CI 9.6-11.5%) had undergone cataract surgery. Outcome of cataract surgery was defined based on visual acuity. Using best-corrected visual acuity for classification, the single most important cause for visual impairment was cystoid macular edema in the aphakic group and posterior capsule opacification in the pseudophakic group. Aphakia (visual acuity of visual acuity of visual acuity of visual acuity of visual impairment. The urban cataract-operated population had significantly more pseudophakics (P visual impairment. Conclusions: Surgery-related complications were major causes for visual acuity of <20/60. PMID:20413926
Camila Ribeiro Koch Pena
Full Text Available Pediatric cataract is the most common treatable cause of blindness in children. Prevalence, etiology and morphology vary with the socioeconomic development. The treatment goal is to reduce amblyopia, being difficult management especially in unilateral cases. The decision on aphakia or primary intraocular lens should be individualized as well as correction with contact lens or spectacles. The intraocular lens single-piece hydrophobic acrylic are the most implanted in children and the preferably is in the capsular bag. The Sanders-Retzlaff-Kraff theoretic (SRK/T stressing that is described as more predictable, following Holladay I and SRK II and the recommendation is to under correction +6.0 or +8.0 dioptrias expecting the growth of the eye. The posterior capsule opacity is the most frequent complication and varies with the material choice of the lens. Glaucoma is the most serious postoperative complication and depends on the timing of the surgery, primary lens implantation and time of post surgical follow-up. The adherence to occlusion therapy with patching is critical to the visual prognosis and is determined by the child’s age and laterality of the cataract. There was significant improvement in the surgery and in IOLs, however the final visual prognosis is still not desirable.
Khokhar, Sudarshan; Gupta, Shikha; Tewari, Ruchir; Agarwal, Renu; Gogia, Varun; Sinha, Gautam; Agarwal, Tushar
Cataract surgery in eyes with microcornea is associated with frequent complications such as corneal edema, posterior capsular rent, and risk of unplanned aphakia. We describe an improved surgical technique for the creation of surgical incisions during phacoemulsification in eyes with cataract associated with microcornea. A retrospective analysis of eight patients (8 eyes) operated at our center was undertaken. The mean age of the patients was 29.5 ± 10.9 years. All eyes were operated using the scleral pocket incision for phacoemulsification. This scleral pocket incision was tangential to the limbus and created approximately 2.5 mm behind limbus through which phacoemulsification probe was inserted. Because of the posterior placement of incision, the anterior chamber crowding was minimized. There was no incidence of port-site peripheral corneal edema. Fifty percent eyes developed transient central corneal edema, the intraocular lens in bag was implanted in 5/8 eyes, and none developed Descemet's membrane detachment. Mean best-corrected visual acuity improved from 1.85 ± 0.38 logarithm of minimum angle of resolution (LogMAR) to 1.26 ± 0.70 LogMAR postoperatively (P = 0.01; paired t-test). Posterior incision placement during phacoemulsification in microcornea helps achieve favorable postoperative outcomes in contrast to outcomes using clear corneal approach described in literature. PMID:27221687
Full Text Available Background: The northeastern region (NER of India is geographically isolated and ethno-culturally different from the rest of the country. There is lacuna regarding the data on causes of blindness and severe visual impairment in children from this region. Aim: To determine the causes of severe visual impairment and blindness amongst children from schools for the blind in the four states of NER of India. Design and Setting: Survey of children attending special education schools for the blind in the NER. Materials and Methods: Blind and severely visually impaired children (best corrected visual acuity < 20/200 in the better eye, aged up to 16 years underwent visual acuity estimation, external ocular examination, retinoscopy and fundoscopy. Refraction and low vision workup was done where indicated. World Health Organization′s reporting form was used to code anatomical and etiological causes of visual loss. Statistical Analysis: Microsoft Excel Windows software with SPSS. Results: A total of 376 students were examined of whom 258 fulfilled the eligibility criteria. The major anatomical causes of visual loss amongst the 258 were congenital anomalies (anophthalmos, microphthalmos 93 (36.1%; corneal conditions (scarring, vitamin A deficiency 94 (36.7%; cataract or aphakia 28 (10.9%, retinal disorders 15 (5.8% and optic atrophy 14 (5.3%. Nearly half of the children were blind from conditions which were either preventable or treatable (48.5%. Conclusion: Nearly half the childhood blindness in the NER states of India is avoidable and Vitamin A deficiency forms an important component unlike other Indian states. More research and multisectorial effort is needed to tackle congenital anomalies.
cataract, aphakia, pseudophakia
Full Text Available Purpose: To evaluate the effect of silicone oil (SO on the corneal endothelium in SO filled phakic and pseudophakic vitrectomizied eyes. Methods: This prospective comparative consecutive case-control study evaluated the corneal endothelial characteristics of 64 SO filled vitrectomizied eyes (case group as compared to 46 vitrectomizied eyes without SO injection (control group. Endothelial cell densities (ECD, coefficient of variation (CV, and percentage of hexagonal cells (hexagonality at the corneal center were evaluated preoperatively, 1 month and 6 months after surgery using noncontact specular microscopy and were compared between the two groups. Exclusion criteria were previous vitreoretinal surgery, aphakia, any degree of anterior chamber inflammation, SO bubbles in the anterior chamber and increased intraocular pressure in the postoperative period. Results: Six months after SO injection, mean ECD was 2,438.2±327.6 cell/mm 2 in the case group and 2,462.6±361.7 cell/mm 2 in the control group (P = 0.714 and mean hexagonality was 49.6 ± 6.8 and 54.6 ± 8.9, in the case and control groups, respectively (P = 0.004. Six months after operation, CV in the case group was 39.3 ± 5.6 and that in the control group was 35.7 ± 6.4 (P = 0.003. Conclusion: Although the presence of SO in the vitreous cavity of phakic and pseudophakic eyes causes slight reduction in the number of endothelial cells, however it leads to significant changes in endothelial cell morphology. Thus, removal of SO after reaching the desired tamponade effect is recommended.
Full Text Available Objectives: To compare the results of scleral buckling surgery with and without use of operating microscope for primary rhegmatogenous retinal detachment (RRD. Materials and Methods: This comparative study consisted of 74 eyes of 74 patients who underwent scleral buckling for primary RRD. Group 1 consisted of 35 patients (17 male and 18 female who were operated using operating microscope and Group 2 consisted of 39 patients (19 male and 20 female who were operated without operating microscope. Patients with post-equatorial breaks, retinal breaks greater than 90°, proliferative vitreoretinopathy (≥C2, and those with follow-up period of less than sıx months were excluded from the study. The two groups were compared based on age, sex, etiology, anatomic success, and surgical complications (scleral perforation, iatrogenic retinal breaks, vitreous hemorrhage, buckle malposition, and vortex vein damage. Results: Mean age was 64.11±7.91 years (range, 55-79 years in Group 1 and 65.20±6.15 years (range, 56-80 years, in Group 2. Mean age and gender were not statistically significantly different between the groups (p=0.508 and p=0.990, respectively. Etiological causes were revealed as myopia, peripheral retinal degeneration, pseudophakia, aphakia, trauma, and idiopathic. Etiological causes were not significantly different between the two groups (p>0.05, for all. Surgical complication rates were higher in Group 2, however, the differences were not statistically significant (p>0.05, for all. Anatomical success rates was similar between the two groups (80% in Group 1 and 79.5% in Group 2, p=0.956. Conclusion: The results of scleral buckling surgery with and without use of operating microscope were not significantly different; However, operating microscope should be used especially in presence of risk factors for scleral complications. (Turk J Ophthalmol 2014; 44: 175-8
To determine the changes in visual acuity in patients undergoing Trans-Scleral Sutured Posterior Chamber Intra-Ocular Lens (TSSPCIOL) implantation at a tertiary care hospital in Karachi, Pakistan. Study Design: Case series. Place and Duration of Study: LRBT Tertiary Eye Hospital, Karachi, from January 2006 to December 2010. Methodology: Records of all patients undergoing implantation of TSSPCIOL were reviewed. Patients with diagnosed glaucoma, diabetic retinopathy, macular degeneration, history of recurrent uveitis, corneal haze or central corneal scars were excluded. For the final analysis, 70 eyes out of a total of 75 were selected. Main outcomes of interest were pre and postoperative visual acuities and surgical complications. SPSS 21 was used for data analysis. Results: Pre-operatively, the average Best Spectacle-Corrected Visual Acuity (BSCVA) was 6/36 on the Snellen chart. This improved to 6/12 postoperatively. The mean improvement seen was 2.4 lines on the Snellen chart (p < 0.05). Complications include transient intraocular pressure elevation in 25 eyes (36%), IOL tilt in 4 eyes (7.1%), Cystoid Macular Edema (CME) in 4 eyes (5.7%), vitreous haemorrhage in 2 eyes (2.9%), hyphema in 2 eyes (2.9%), uveitis in 1 eye (1.4%), and retinal detachment 1 eye (1.4%). No IOL subluxation, suture erosion, iris capture, choroidal effusion or endophthalmitis was encountered and no re-operations were needed. Conclusion: TSSPCIOLs are a good management option for patients with aphakia in whom PC IOLs cannot be placed. (author)
Objective To investigate the causes and measurements of intraocular pressure (IOP) elevation after vitrectomy. Methods To retrospectively analyze clinical data of thirty-one eyes out of one hundred and sixty patients (one hundred and seventy-eight eyes) which had IOP elevation in early period after vitrectomy from January,2010 to December, 2010. Results The causes of postoperative IOP elevation ate uveitic inflammation (eighteen eyes, 58. 1% ), aphakia (four eyes, 12.9%), steroids ((our eyes, 12.9%), silicon oil tamponade excess (three eyes, 9.7%) and endoph-thalmitis (two eyes, 6.5%). After various treatments such as IOP-lowering medication, stop using of steroids, taken-out part of silicon oil, paracentesis of anterior chamber and change to hign-grade antibiotics, the IOP of all eyes returned to normal. Conclusion The incidence of IOP elevation after vitrectomy is 17.4% and uveitic inflammation is the common cause. Timely prevention and proper measurement can reduce visual damage.%目的 探讨玻璃体切除硅油填充术后高眼压的原因及处理.方法 回顾性分析2010年1月到2010年12月本院160例(178只眼)玻璃体切除硅油填充术后早期发生高眼压31例(31只眼)的临床资料.结果 术后高眼压发生原因如下:葡萄膜炎症反应(18只眼,58.1％)、无晶状体眼(4只眼,12.9％)、激素引发(4只眼,129％)、硅油填充过量(3只眼,9.7％)、眼内炎(2只眼,6.5％).给予降眼压药物、停用激素类药物、硅油部分取出、前房穿刺或换用敏感抗生素等治疗后,眼压均降至正常.结论 玻璃体切除硅油填充术后高眼压在本研究的发生率为17.4％,术后葡萄膜炎症反应为常见原因,及时的预防和处理能减少视功能的损害.
Full Text Available OBJECTIVE: We investigated whether previously reported single nucleotide polymorphisms (SNPs of EPHA2 in European studies are associated with cataract in India. METHODS: We carried out a population-based genetic association study. We enumerated randomly sampled villages in two areas of north and south India to identify people aged 40 and over. Participants attended a clinical examination including lens photography and provided a blood sample for genotyping. Lens images were graded by the Lens Opacification Classification System (LOCS III. Cataract was defined as a LOCS III grade of nuclear ≥4, cortical ≥3, posterior sub-capsular (PSC ≥2, or dense opacities or aphakia/pseudophakia in either eye. We genotyped SNPs rs3754334, rs7543472 and rs11260867 on genomic DNA extracted from peripheral blood leukocytes using TaqMan assays in an ABI 7900 real-time PCR. We used logistic regression with robust standard errors to examine the association between cataract and the EPHA2 SNPs, adjusting for age, sex and location. RESULTS: 7418 participants had data on at least one of the SNPs investigated. Genotype frequencies of controls were in Hardy-Weinberg Equilibrium (p>0.05. There was no association of rs3754334 with cataract or type of cataract. Minor allele homozygous genotypes of rs7543472 and rs11260867 compared to the major homozygote genotype were associated with cortical cataract, Odds ratio (OR = 1.8, 95% Confidence Interval (CI (1.1, 3.1 p = 0.03 and 2.9 (1.2, 7.1 p = 0.01 respectively, and with PSC cataract, OR = 1.5 (1.1, 2.2 p = 0.02 and 1.8 (0.9, 3.6 p = 0.07 respectively. There was no consistent association of SNPs with nuclear cataract or a combined variable of any type of cataract including operated cataract. CONCLUSIONS: Our results in the Indian population agree with previous studies of the association of EPHA2 variants with cortical cataracts. We report new findings for the association with PSC which is
Faria, Mun Yueh; Ferreira, Nuno; Neto, Eliana
Objective To report visual outcomes, complication rate, and safety of retropupillary iris-claw intraocular lens (ICIOL) in ectopia lentis in Marfan syndrome (MFS). Design Retrospective study. Methods Six eyes of three MFS patients with ectopia lentis underwent surgery for subluxation lens and retropupillary ICIOL implantation from October 2014 to October 2015 at the Department of Ophthalmology, Santa Maria Hospital in Lisbon, Portugal. Demographics, preoperative and postoperative best-corrected visual acuity (BCVA), and intraocular pressure were evaluated. Endothelium cell count was assessed using specular microscopy; anterior chamber depth was measured using Pentacam postoperatively; and intraocular lens position was viewed by ultrasound biomicroscopy. All patients were female; mean age was 20±14.264 years (range: 7–38 years). Results The average follow-up period was 6.66 months (range: 4–16 months). Preoperative BCVA was 0.568±0.149 logMAR units, and postoperative BCVA was 0.066±0.121 logMAR units. The mean BCVA gain was −0.502±0.221 on the logMAR scale. Postoperative average astigmatism and intraocular pressure were 1.292±0.697 mmHg (range: 0.5–2.25 mmHg) and 16 mmHg (range: 12–18 mmHg), respectively. The average endothelial cell density decreased from 3,121±178 cells/mm2 before surgery to 2,835±533 cells/mm2 after surgery (measured at last follow-up visit) and in the last follow-up, representing an average endothelial cell loss of 9.16%. Mean anterior chamber depth was 4.01 mm (±0.77 mm), as measured by Pentacam. No complications were found intra- or postoperatively in any of the six studied eyes. Conclusion Retropupillary ICIOL implantation is a safe and effective procedure in the treatment of aphakia in MFS eyes, without capsular support after surgery for ectopia lens. The six eyes that underwent lensectomy and retropupillary ICIOL implantation have had excellent visual outcomes with no complications so far. PMID:27382335
Full Text Available Peter Heiner,1 Edoardo Ligabue,2 Alex Fan,3 Dennis Lam31Vision Eye Institute, Southport, QLD, Australia; 2Ophthalmic Center, San Siro Clinic, Milan, Italy; 3Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong KongPurpose: To evaluate the safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (IOL (enVista® MX60; Bausch and Lomb Incorporated, Rochester, NY, USA following implantation to correct aphakia subsequent to extracapsular cataract extraction in adults.Subjects and methods: This was an open-label, non-interventional, observational study conducted in 19 university and private-practice settings in Europe and the Asia-Pacific region to investigate clinical outcomes of the MX60 IOL in standard practice. Eligible subjects were at least 18 years of age and had undergone standard phacoemulsification and extracapsular cataract extraction with implantation of the MX60 IOL. The primary safety endpoint was the occurrence of adverse events, and the primary effectiveness endpoints included visual and refractive outcomes and stability, with data collected up to 2 years post-procedure.Results: In this multicenter study, pooled data of 255 eyes were collected and analyzed. Excellent visual and refractive outcomes and stability were demonstrated. At postoperative visit 4 (61–180 days postoperative, 62.2% of subjects achieved a Snellen best-corrected distance visual acuity (CDVA of 20/20 (decimal 1.00, and 97.8% of subjects achieved a CDVA of 20/40 (decimal 0.50 or better. One eye (1.0% underwent neodymium:yttrium aluminum garnet capsulotomy at 12 months post-procedure. No glistenings of any grade were reported for any subject at any visit. Adverse events were infrequent and were consistent with incidences generally reported with cataract surgery.Conclusion: This study, which enrolled all comers, provided evidence of the excellent safety and effectiveness of the MX60
Full Text Available Mark Packer,1 Luther Fry,2 Kevin T Lavery,3 Robert Lehmann,4 James McDonald,5 Louis Nichamin,6 Brian Bearie,7,† Jon Hayashida,8 Griffith E Altmann,8 Omid Khodai8 1Department of Ophthalmology, Oregon Health and Science University, Eugene, OR, USA; 2University of Kansas Medical Center, Kansas City, KS, USA; 3Wayne State University, Detroit, MI, USA; 4Baylor College of Medicine, Houston, TX, USA; 5University of Arkansas for Medical Sciences, Little Rock, AR, USA; 6Laurel Eye Clinic, Brookville, PA, USA; 7Grand Rapids Eye Institute, Grand Rapids, MI, USA; 8Bausch & Lomb, Aliso Viejo, CA, USA †Brian Bearie passed away on March 9, 2011 Purpose: To evaluate the safety and effectiveness of a single-piece hydrophobic acrylic intraocular lens (IOL; enVista model MX60; Bausch & Lomb, Rochester, NY, USA when used to correct aphakia following cataract extraction in adults. Methods: This was a prospective case series (NCT01230060 conducted in private practices in the US. Eligible subjects were adult patients with age-related cataract amenable to treatment with standard phacoemulsification/extracapsular cataract extraction. With follow-up of 6 months, primary safety and effectiveness end points included the rates of US Food and Drug Administration (FDA-defined cumulative and persistent adverse events and the percentage of subjects who achieved best-corrected visual acuity (BCVA of 20/40 or better at final visit. To evaluate rotational stability, subjects were randomized (1:1:1:1 to have the lens implanted in one of four axis positions in 45° increments. Results: A total of 122 subjects were enrolled. The rate of cumulative and persistent adverse events did not significantly exceed historical controls, as per FDA draft guidance. At the final postoperative visit, all subjects (100% achieved a BCVA of 20/40 compared with the FDA historical control of 96.7%. Rotation of the IOL between the two final follow-up visits was ≤5° for 100% of eyes, and refractive
André Luiz Alves Salame
standard deviation of 2.42. The most common diagnosis was aphakia, in 16 (21.9% cases. Keratoconus was present in 14 (19.1%, leucoma in 11 (15%, anisometropia in 10 (13.7%, refractive errors in 9 (12.3%, irregular astigmatism in 7 (9.5%, ectopia lentis in 4 (5.4%, high myopia in one case (1.3% and one child (1.3% had no ocular pathology, just wishing to change eye color. 52 (71.2% had medical indication, 9 (12.3% had optical indication and 12 (16.4% had cosmetic indication. Contact lenses were fitted in 103 eyes, the most tested lens was rigid gas permeable in 43 (41.7%, soft lens in 41 (39.8% and cosmetic soft lens in 11 (10.6%. CONCLUSION: Aphakia was the most common diagnosis among children in use of contact lens. The incidence of medical indication was higher than the others and the most tested lens was the rigid gas permeable one.
目的：评价小梁切除术联合生物羊膜治疗难治性青光眼的临床疗效。 方法：包括29例29眼具有高危因素如新生血管、葡萄膜炎、无晶状体、人工晶状体和发育性的难治性青光眼。13例行小梁切除术联合羊膜移植，16例行小梁切除术。术后观察、比较的指标包括：术后眼压、抗青光眼药物使用数量、滤过泡形态特点以及术后并发症。所有研究对象随访12 mo。 结果：术后6mo，手术完全成功：羊膜组11／13（84．6％），对照组10／16（62．5％）（P＜0．05）；术后12mo，手术完全成功：羊膜组10／13（76．9％），对照组10／16（62．5％）（P＜0.05）。术后12mo，羊膜组和对照组眼压分别从术前50．3±11．3，49．7±10．7mmHg降至15．7±1．1，19．8±2.3mmHg （P＜0．05）。由于滤过过强，对照组术后早期出现低眼压3例（18．8％），羊膜组无1例发生；对照组出现包裹性滤过泡6例（37．5％），羊膜组仅出现1例（7．7％）。 结论：小梁切除术联合羊膜移植治疗难治性青光眼与单纯小梁切除术相比，具有手术成功率高，术后眼压控制良好、平稳，术后并发症发生率低的特点。%AIM: To evaluatethe clinical efficacy of trabeculectomy combined with amniotic membrane transplantation for refractory glaucoma. METHODS:This study included 29 cases (29 eyes) with developmental refractory glaucoma at such high risks as neovascular, uveitis, aphakia, pseudophakic.Trabeculectomy with amniotic membrane transplantation was performed in 13 cases and trabeculectomy without amniotic membrane transplantation in 16 cases. The outcome measurements included postoperative intraocular pressure ( IOP ) , the used quantity of antiglaucoma medications, the morphologic characteristics of the filtering blebs and complications. All patients were followed for 12mo. RESULTS: Complete success was seen 11/13 (84.6%) in
medical examination and treatment.SCH was occurred in 10 eyes during intraocular surgery,while the SCH was diagnosed in other 5 eyes 1-3 days after operation.Surgical drainage was carried out in 8 eyes,of which 3 eyes combined with vitrectomy besides surgical drainage and other 5 eyes were treated with medication alone.Results SCH was completely removed and absorbed in 12 eyes.The visual acuity was improved in 6 eyes,unchanged in 6 eyes and decreased in 3 eyes.Nine eyes complicated with retinal detachment and reattached in 6 eyes after treatment.Seven eyes combined with hypermyopia,6 eyes combined with glaucoma,and 1 eye was aphakia.Four patients combined with hypertension,and 2 patients had diabetes mellitus. Conclusions SCH induced by intraocular surgery develops rapidly and violently,and it can result in vision loss without effective treatment.Suturing surgical incision immediately,applying hypertonic agents and sclerotomy drainage are the urgent approaches to treat SCH.Medicines and/or sclerotomy could be optional according to the amount of bleeding and other ocular complication.The risk factors of SCH include myopia,glaucoma and the instantly dropping of intraocular pressure.