Full Text Available The refractive treatment methods of aphakia include corrective glasses, contact lens correction and intraocular lens(IOLimplantation. It magnifies images highly and limits vision field with corrective glasses. For infant aphakia corrective glasses are more likely to be chosen because their eyes are still unable to tolerate IOL implantation in the developmental stage. With low magnification of images, contact lens includes soft contact lens and rigid contact lens. The former is rarely used because it is prone to ocular lesions due to its poor oxygen permeability. The latter is widely used due to its good oxygen permeability especially suitable for the eyes of irregular astigmatism or iris missing due to trauma. At present, the most commonly used in clinical work is IOL implantation. The eye of IOL may avoid anisometropia, aberrations and so on because of more physiological anatomy. According to the IOL implantation site, it is divided into the anterior chamber IOL implantation and the posterior chamber IOL implantation. The anterior chamber IOL implantation is divided into angle fixed IOL implantation and iris fixed IOL implantation. The posterior chamber IOL implantation is divided into secondary in-the-bag IOL implantation, the ciliary sulcus IOL implantation and transscleral suture fixed IOL implantation.
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.
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
Bothun, Erick D.; Cleveland, Julia; Lynn, Michael J.; Christiansen, Stephen P.; Vanderveen, Deborah K.; Neely, Dan E.; Kruger, Stacey J.; Lambert, Scott R.
Objective To evaluate the characteristics of strabismus in infants who underwent cataract surgery with and without intraocular lens (IOL) implantation. Design Secondary outcome analysis in a prospective, randomized clinical trial Participants The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n = 12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. Intervention Infants underwent cataract surgery with or without placement of an IOL. Main Outcome Measures The proportion of patients who developed strabismus during the first 12 months of follow-up was calculated using the life-table method, and compared across treatment groups and age strata using a log-rank test. Results Strabismus developed within the first 12 months of follow-up in 38 (life table estimate: 66.7%) pseudophakic infants and 42 (life table estimate: 74.5%) infants treated with contact lenses (p=0.59). The younger cohort (strabismus (29 of 50, life table estimate: 58.0%) than the older cohort (≥ 49 days) (51 of 64, life table estimate: 80.0%) (pstrabismus following congenital cataract surgery. However, strabismus was less likely to develop in infants whose cataract was removed at an earlier age. PMID:23419803
Sameh Mosaad Fouda
Full Text Available Purpose: This study aimed to evaluate the safety and efficacy of retropupillary fixation of an iris-claw intraocular lens (IOL; Verisyse polymethyl methacrylate IOL, Abbott Medical Optics [AMO], Netherlands for the surgical correction of aphakia in microspherophakic eyes without sufficient capsular support. Design: This was a prospective, interventional, noncomparative case series. Methods: This interventional case series comprised 17 eyes of 9 microspherophakic patients. Retropupillary fixation of the Verisyse iris-claw IOL (AMO was performed in all cases. The surgical time was measured. Corrected distance visual acuity, astigmatism, intraocular pressure (IOP, tissue reaction, pigment dispersion, and stability of the IOL were studied 1 day, 3 days, 1 week, 2 weeks, 1 month, and 6 months postoperatively. Results: Eight patients had familial microspherophakia and one patient had Marfan's syndrome. Eighty-two percent of the cases achieved a visual acuity of 0.3 or better. There was no significant postoperative inflammatory reaction. Transient elevation of IOP was recorded in two cases in the 1st week only. One IOL developed disengagement of one of the haptics from the iris and was successfully re-engaged. All the other IOLs were well centered and stable. The mean surgical time was 18.0 ± 4.5 min. Conclusions: Retropupillary fixation of an iris-claw IOL is a safe and effective procedure that provides early visual recovery. It is also a time-saving method for correcting aphakia in microspherophakic eyes without sufficient capsular support.
Celano, Marianne; Hartmann, E Eugenie; DuBois, Lindreth G; Drews-Botsch, Carolyn
To assess motor functioning in children aged 4 years 6 months enrolled in the Infant Aphakia Treatment Study, and to determine contributions of visual acuity and stereopsis to measured motor skills. One hundred and four children (53% female) with unilateral aphakia randomized to intraocular lens or contact lens treatment were evaluated at 4 years 6 months (age range 4y 6mo-4y 11mo) for monocular recognition visual acuity, motor skills, and stereopsis by a traveling examiner masked to treatment condition. Motor skills were assessed with the Movement Assessment Battery for Children--Second Edition (MABC-2). Visual acuity was operationalized as log10 of the minimum angle of resolution (logMAR) value for treated eye, best logMAR value for either eye, and intraocular logMAR difference. Student's t-tests showed no significant differences in MABC-2 scores between the intraocular lens and contact lens groups. The mean total score was low (6.43; 18th centile) compared with 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. Children with unilateral congenital cataract may have delayed motor functioning at 4 years 6 months, which may adversely affect their social and academic functioning. © 2015 Mac Keith Press.
Anjum, Iram; Eiberg, Hans; Baig, Shahid Mahmood
of the population in this region of Pakistan which has prevailed for many months. CONCLUSIONS: FOXE3 is responsible for the early developmental arrest of the lens placode, and the complete loss of a functional FOXE3 protein results in primary aphakia. It can also be deduced that this mutation is quite primitive...
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
Senthil, Sirisha; Badakare, Akshay
A 10-year-old girl underwent an Ahmed glaucoma valve (AGV) implantation as a primary procedure for glaucoma in aphakia due to congenital cataract surgery. Following an unintended accidental excision of AGV tube during bleb revision for hypertensive phase, AGV was explanted and a second AGV was implanted in the same quadrant after 2 weeks. This resulted in a rare complication of dynamic tube movement in the anterior chamber with tube corneal touch and localised corneal oedema. Excision of the offending unstable tube and placement of a paediatric AGV in a different quadrant led to resolution of this complication, stable vision and well-controlled intraocular pressure. This case highlights the possible causes of dynamic tube, related complications and its management. This case also highlights the importance of understanding the various physiological phases after glaucoma drainage device implantation and their appropriate management. PMID:24695662
Gawdat, Ghada I; Taher, Sameh G; Salama, Marwa M; Ali, Adel A
To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P IOL implantation for pediatric aphakia achieved a good visual outcome. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.
De Silva, Samantha R; Arun, Kikkeri; Anandan, Maghizh; Glover, Nicholas; Patel, Chetan K; Rosen, Paul
To evaluate the indications, postoperative visual efficacy, and complication rate after intraocular implantation of an iris-claw aphakic intraocular lens (IOL). Oxford Eye Hospital, Oxford, United Kingdom. Case series. This chart review comprised eyes with no capsule support that had anterior iris-fixation IOL implantation for aphakia between 2001 and 2009. The study comprised 116 eyes (104 patients). Iris-claw IOLs were inserted during primary lens surgery in 18 eyes (15.5%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 19 eyes (16.4%), and as a secondary procedure in 79 eyes (68.1%). The mean follow-up was 22.4 months (range 3 to 79 months). The final corrected distance visual acuity (CDVA) was 6/12 or better in 68.9% of all eyes and in 47 of 53 eyes (88.7%) with no preoperative comorbidity. Complications included wound leak requiring resuturing in 2.6% of eyes, postoperative intraocular pressure rise in 9.5% of eyes (glaucoma escalation 0.8%), and cystoid macular edema in 7.7% of eyes (0.8% chronic). Iris-claw IOL subluxation occurred in 6.0% of eyes from 5 days to 60 months postoperatively; all the IOLs were repositioned. Corneal decompensation occurred in 1.7% of eyes; 0.8% had retinal detachments. Iris-claw IOL implantation for aphakia gave a good visual outcome and can be used for a wide range of indications. Postoperative complication rates were comparable to, if not better than, those with conventional anterior chamber IOLs. Correct implantation technique is critical in avoiding postoperative IOL subluxation. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
twelve patients, 4 subluxation of the IOL was observed in one patient, and 5 macular edema was found in three eyes.Conclusion: The results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in complicated cases. Keywords: aphakia, retropupillary iris claw IOL, dislocated IOL
Full Text Available Occlusion therapy throughout early childhood is believed to be efficacious in treating deprivation amblyopia but has not been rigorously assessed in clinical trials. Further, tools to assess adherence to such therapy over an extended period of time are lacking. Using data from the Infant Aphakia Treatment Study, a randomized clinical trial of treatment for unilateral congenital cataract, we examined the use of quarterly 48-h recall interviews and annual 7-day prospective diaries to assess reported hours of patching in 114 children throughout the first 5 years of life. Consistency of data reported was assessed using correlation coefficients and intraclass correlation coefficients. Both interview and diary data showed excellent consistency with Cronbach’s Alpha’s ranging from 0.69 to 0.88 for hours of patching and 0.60 to 0.73 for hours of sleep. However, caregivers reported somewhat more adherence in prospective diaries than retrospective interviews. Completion rates, on the other hand, were substantially higher for telephone interviews than prospective diaries. For example, four years after surgery response rates to telephone interviews exceeded 75% versus completion rates of only 54% for diaries. In situations where occlusion dose monitors cannot be used for assessing adherence to occlusion therapy, such as in infants or over an extended period of time, quantitative assessments of occlusion therapy can be obtained by parental report, either as a series of prospective diaries or a series of recall interviews.
Forlini, Cesare; Forlini, Matteo; Rejdak, Robert; Prokopiuk, Agata; Levkina, Oxana; Bratu, Adriana; Rossini, Paolo; Cagampang, Perfecto R; Cavallini, Gian Maria
Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia. Four consecutive cases of combined post-traumatic lesions of iris and lens, corrected with complex device ArtificialIris and foldable IOL. In two cases, the compound implant was sutured to the sclera in sulcus during the penetrating keratoplasty; in another case, it was positioned through a corneal incision of about 5.0 mm with transscleral fixation, and in one patient with preserved capsular support and possibility of IOL in-the-bag implantation the ArtificialIris was placed in sulcus sutureless through a clear corneal tunnel. Maximal follow-up was 6 months. The complex device was placed firmly fixed within the sulcus, including in the eye implanted without sutures, and showed a stable and centered position without any tilt or torque. Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0-5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result.
Faria, Mun Yueh; Ferreira, Nuno Pinto; Pinto, Joana Medeiros; Sousa, David Cordeiro; Leal, Ines; Neto, Eliana; Marques-Neves, Carlos
Nowadays, dislocated intraocular lenses (IOLs) and inadequate capsular support are becoming a challenge for every ophthalmic surgeon. Explantation of dislocated IOL and iris claw IOL (ICIOL) are the techniques that have been used in our ophthalmic department. The aim of this study is to report our technique for retropupillar ICIOL. This study is a retrospective case series. A total of 105 eyes with dislocated IOL from the patients at the Department of Ophthalmology in Santa Maria Hospital, a tertiary reference hospital in Lisbon, Portugal, from January 2012 until January 2016, had been analyzed. Of these 105 eyes, 66 eyes had dislocated one-piece IOL and 39 eyes had dislocated three-piece IOL. The latter underwent iris suture of the same IOL and were excluded from this study. The remaining 66 eyes with dislocated one-piece IOL underwent pars plana vitrectomy, that is, explantation of dislocated IOL through corneal incision and an implantation of retropupillary ICIOL. Operative data and postoperative outcomes included best corrected visual acuity, IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and anterior chamber depth. The mean follow-up was 23 months (range: 6-48 months). The mean preoperative best corrected visual acuity was 1.260±0.771 logMAR, and postoperative best corrected visual acuity was 0.352±0.400 logMAR units. Mean vision gain was 0.909 logMar units. The patients had the following complications: 1) retinal detachment was found in one patient, 2) corneal edema was found in three patients, 3) high intraocular pressure was observed in twelve patients, 4) subluxation of the IOL was observed in one patient, and 5) macular edema was found in three eyes. The results demonstrate that retropupillary ICIOL is an easy and effective method for the correction of aphakia in patients not receiving capsule support. The safety of this procedure must be interpreted in the context of a surgery usually indicated in
Freedman, Sharon F.; Lynn, Michael J.; Beck, Allen D.; Bothun, Erick D.; Orge, Faruk H.; Lambert, Scott R.
Importance Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy, yet their relationship to aphakia versus primary intraocular lens (IOL) implantation remains unsettled. Objective To identify and characterize cases of glaucoma and glaucoma-related adverse events (glaucoma+glaucoma suspect) among children in the Infant Aphakia Treatment Study (IATS) by the age of five years. Design, Setting, and Participants A multicenter randomized controlled trial of 114 infants with unilateral congenital cataract who were between age 1–6 months at surgery. Interventions Participants were randomized at cataract surgery to either primary IOL, or no IOL implantation (contact lens [CL]). Standardized definitions of glaucoma and glaucoma suspect were created for IATS and applied for surveillance and diagnosis. Main Outcome Measures Development of glaucoma and glaucoma+glaucoma suspect in operated eyes up to age five years, plus intraocular pressure, visual acuity, and axial length at age five years. Results Product limit estimates of the risk of glaucoma and glaucoma+glaucoma suspect at 4.8 years after surgery were 17% (95%CI=11%–25%) and 31% (95%CI=24%–41%), respectively. The CL and IOL groups were not significantly different for either outcome: glaucoma (hazard ratio(HR)=0.8[95%CI=0.3–2.0],p=0.62); glaucoma+glaucoma suspect: (HR=1.3[95%CI=0.6–2.5],p=0.58). Younger (versus older) age at surgery conferred increased risk of glaucoma (26% versus 9%, respectively at 4.8 years after surgery (HR=3.2[95%CI=1.2–8.3]), and smaller (versus larger) corneal diameter showed increased risk for glaucoma+glaucoma suspect (HR=2.5[95%CI=1.3–5.0]). Age and corneal diameter were significantly positively correlated. Glaucoma was predominantly open angle (19/20 cases, 95%), most eyes received medication (19/20, 95%), and 8/20 (40%) eyes had surgery. Conclusions and Relevance These results suggest that glaucoma-related adverse events
[Management of post-traumatic aphakia and aniridia: Retrospective study of 17 patients undergoing scleral-sutured artificial iris intraocular lens implantation. Management of aphakia-aniridia with scleral-sutured artificial iris intraocular lenses].
Villemont, A-S; Kocaba, V; Janin-Manificat, H; Abouaf, L; Poli, M; Marty, A-S; Rabilloud, M; Fleury, J; Burillon, C
To evaluate the long-term outcomes of artificial iris intraocular lenses sutured to the sclera for managing traumatic aphakia and aniridia. All consecutive cases receiving a Morcher ® combination implant from June 2008 to February 2016 in Edouard-Herriot Hospital (Lyon, France) were included in this single-center retrospective study. Visual acuity, subjective degree of glare, quality of life and surgical complications were evaluated. Seventeen eyes of 17 patients were included, among which 82% were male. The mean age was 42 years. The injuries consisted of 23.5% contusion and 70.5% open globe injuries, of which 41% were globe ruptures. There was one postoperative case. A penetrating keratoplasty was performed at the same time for eight eyes. The mean follow-up was 32 months. Best-corrected visual acuity improved in 41.2%, remained the same in 17.6% and decreased in 41.2% of our cases. Distance vision averaged 1±0.25 line better and near vision 2.2±0.32 lines better when visual acuity was quantifiable before surgery. Glare improved in 80% of patients and remained stable in 20%, decreasing on average from 3.3/5 [min. 3-max. 4; SD: 0.48] before surgery to 1.9/5 [min. 0-max. 4; SD: 1.197] after surgery. Regarding the esthetic results, 78% of the patients declared themselves reasonably to very satisfied; 57% reported no limitation of activities of daily living, and 43% reported mild limitation. Ocular hypertension and glaucoma, found in 40% of eyes, were the main postoperative complications. Implantation of prosthetic iris device combined with an intraocular lens appears to be safe and effective in reducing glare disability and improving visual acuity. Close, long-term monitoring is essential for the success of this surgery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
van den Munckhof, P.
De neurotransmitter dopamine (DA) is betrokken bij hersenfuncties als beweging, cognitie en emotioneel- en beloningsgerelateerd gedrag. Het afsterven van DA-neuronen in de substantia nigra in de hersenen veroorzaakt de ziekte van Parkinson. DA-stoornissen in andere hersengebieden worden in verband
De Novelli, Fernando José; Neto, Theodomiro Lourenço Garrido; de Sena Rabelo, Gabriel; Blumer, Marcel Eduardo; Suzuki, Ricardo; Ghanem, Ramon Coral
This paper describes a modified surgical technique for intraocular lens implantation in aphakic eyes with no capsular support. Retrospective 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. In 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). This 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.
Thanaa H Mohamed
Conclusion Primary IOL implantation was found to be safe and effective in the management of congenital cataract; it leads to lower incidence of complications and better visual outcomes compared with aphakia and secondary IOL implantation.
10.5%] patients. Conclusion: The study showed that myopia, ocular trauma, pseudophakia and aphakia in decreasing frequency were the main risk factors associated with RRD among Ethiopians attending a tertiary eye care centre.
low incidence of retinal detachment in black patients is not known. ... a retinal break. Predisposing factors include peripheral retinal degenerations, myopia, aphakia and trauma. Delay in presentation increases the difficulty in achieving adequate surgical ... On examination, note was taken of the visual acuity in both eyes, the ...
countries of Asia, Africa, and Latin. America (3,4). With an estimated 12,000 bilaterally blind people ... (OMA's). 1 general medical practitioner. Loptometry technician. 1 general nurse and. 3 health assistants. Ocular morbidities cataract and aphakia corneal scarring/phthisis glaucoma refractive errors others. Percent. 52.4.
.... Qualifications of Applicants Steven L. Albert Mr. Albert, age 46, has had aphakia in his right eye since 1991. The visual acuity in his right eye is 20/200, and in his left eye, 20/ 20. Following an examination in... shows two crashes for which he was cited and no additional convictions for moving violations in a CMV...
... that we received your comments, please include a self-addressed, stamped envelope or postcard or print... amblyopia, cataracts, no light perception, retinal detachment, open angle glaucoma, macular scar, aphakia... Statistics, April 1952). Other studies demonstrated theories of predicting crash proneness from crash history...
Wilson, R P; Javitt, J C
Five patients with aphakia, glaucoma, and chronic inflammation were treated with ab interno sclerostomy by using the continuous wave Nd:YAG laser focused through a sapphire probe. After a follow-up period of 24 to 28 months, three of five patients had good intraocular pressure control. The sclerostomy failed in one patient when it was occluded by vitreous. The second failure was attributed to closure of the sclerostomy because of chronic intraocular inflammation.
Bhatt, Rupal; Jethani, Jitendra; Saluja, Praveen; Bharti, Vinay
Congenital anomalies of the lens include a wide range from lens coloboma to primary aphakia and doubling of lens. There have been few case reports of double lens; the etiology suggested is metaplastic changes in the surface ectoderm that leads to formation of two lens vesicles and hence resulting in double lens. We report a case with bilobed lens, which raises the possibility of explaining the etiology of double lens.
Mostafa, Yehia S; Osman, Amr A; Hassanein, Dina H; Zeid, Ashraf M; Sherif, Ahmed M
To discuss the limitations and benefits of the BrightOcular prosthetic artificial iris device in management of aniridia associated with aphakia or cataract. This is a retrospective study including 5 eyes of 4 patients who underwent implantation of the BrightOcular iris prosthesis (Stellar Devices) for total or partial aniridia. The cases included 2 eyes of 1 patient with congenital aniridia associated with congenital cataract and 3 eyes with traumatic aniridia: 1 with subluxated cataractous lens and 2 with aphakia. In all cases, the iris prosthesis was implanted after a 3-piece acrylic intraocular lens was implanted. We evaluated the clinical course with a minimum follow-up period of 6 months, the intraoperative and postoperative complications, and the cosmetic satisfaction of patients. All patients had improved uncorrected distance visual acuity and best-corrected distance visual acuity. All patients had a transient corneal edema that resolved within the first postoperative week. Only the patient with congenital aniridia had a permanent increase in intraocular pressure and developed a band keratopathy throughout a 2-year follow-up period. The prosthesis was well-centered in all eyes except for one case that required scleral suture fixation after 3 months. All patients had a satisfactory cosmetic appearance. BrightOcular iris prosthesis is a safe and useful tool to correct aniridia associated with pseudophakia or aphakia. Being foldable, it is easy to be implanted through a small incision and placed in the ciliary sulcus without sutures when properly sized. Cosmetic results are satisfactory. Sizing methods should be improved.
Moritz D. Brandt
Full Text Available The generation of new neurons in the adult dentate gyrus has functional implications for hippocampal formation. Reduced hippocampal neurogenesis has been described in various animal models of hippocampal dysfunction such as dementia and depression, which are both common non-motor-symptoms of Parkinson's disease (PD. As dopamine plays an important role in regulating precursor cell proliferation, the loss of dopaminergic neurons in the substantia nigra (SN in PD may be related to the reduced neurogenesis observed in the neurogenic regions of the adult brain: subventricular zone (SVZ and dentate gyrus (DG. Here we examined adult hippocampal neurogenesis in the Pitx3-mutant mouse model of PD (aphakia mice, which phenotypically shows a selective embryonic degeneration of dopamine neurons within the SN and to a smaller extent in the ventral tegmental area (VTA. Proliferating cells were labeled with BrdU in aphakia mice and healthy controls from 3 to 42 weeks of age. Three weeks old mutant mice showed an 18% reduction of proliferating cells in the DG and of 26% in the SVZ. Not only proliferation but also the number of new neurons was impaired in young aphakia mice resulting in 33% less newborn cells 4 weeks after BrdU-labeling. Remarkably, however, the decline in the number of proliferating cells in the neurogenic regions vanished in older animals (8–42 weeks indicating that aging masks the effect of dopamine depletion on adult neurogenesis. Region specific reduction in precursor cells proliferation correlated with the extent of dopaminergic degeneration in mesencephalic subregions (VTA and SN, which supports the theory of age- and region-dependent regulatory effects of dopaminergic projections. Physiological stimulation of adult neurogenesis by physical activity (wheel running almost doubled the number of proliferating cells in the dentate gyrus of 8 weeks old aphakia mice to a number comparable to that of wild-type mice, abolishing the slight
Ozturk, Taylan; Er, Duygu; Yaman, Aylin; Berk, A Tulin
To discern treatable and preventable causes of childhood blindness by evaluating the aetiologic factors, and to compare the distribution of the most commonly affected anatomic sites of severe visual impairment (SVI) with our previous published data. The charts of 11 871 patients followed between June 2002 and May 2014 were reviewed retrospectively, and 695 patients (5.9%) who had SVI or blindness in accordance with WHO criteria were enrolled. The results of ophthalmologic examinations and coexistence of any systemic disease were documented and checked against our published clinic data concerning the aetiology of childhood blindness before 2002. χ(2) test was used for statistics. Mean age was 47.0±51.9 months (median: 24 months). Cortical visual impairment (CVI) was present in 212 cases (30.5%) and 20.3% of those had a history of premature birth. The most common anatomic sites of SVI were retina (24.6%) and crystalline lens (17.1%). When compared with our previous data, we found a significant increase in the prevalence of CVI (p=0.046) and decrease in the frequency of SVI due to uveal disorders (pblindness secondary to retinopathy of prematurity reduced by a third (p=0.280), and a significant decrease in aphakia-related SVI (p=0.028) was achieved within the last decade. The prevalence of CVI was found to be relatively increased due to the significant reduction in the frequency of preventable causes of SVI. Furthermore our clinical practice for visual rehabilitation in aphakia has resulted in a considerable decrease in SVI in the last decade. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Deml, Brett; Reis, Linda M; Lemyre, Emmanuelle; Clark, Robin D; Kariminejad, Ariana; Semina, Elena V
Anophthalmia and microphthalmia (A/M) are developmental ocular malformations defined as the complete absence or reduction in size of the eye. A/M is a highly heterogeneous disorder with SOX2 and FOXE3 playing major roles in dominant and recessive pedigrees, respectively; however, the majority of cases lack a genetic etiology. We analyzed 28 probands affected with A/M spectrum (without mutations in SOX2/FOXE3) by whole-exome sequencing. Analysis of 83 known A/M factors identified pathogenic/likely pathogenic variants in PAX6, OTX2 and NDP in three patients. A novel heterozygous likely pathogenic variant in PAX6, c.767T>C, p.(Val256Ala), was identified in two brothers with bilateral microphthalmia, coloboma, primary aphakia, iris hypoplasia, sclerocornea and congenital glaucoma; the unaffected mother appears to be a mosaic carrier. While A/M has been reported as a rare feature, this is the first report of congenital primary aphakia in association with PAX6 and the identified allele represents the first variant in the PAX6 homeodomain to be associated with A/M. A novel pathogenic variant in OTX2, c.651delC, p.(Thr218Hisfs*76), in a patient with syndromic bilateral anophthalmia and a hemizygous pathogenic variant in NDP, c.293 C>T, p.(Pro98Leu), in two brothers with isolated bilateral microphthalmia and sclerocornea were also identified. Pathogenic/likely pathogenic variants were not discovered in the 25 remaining A/M cases. This study underscores the utility of whole-exome sequencing for identification of causative mutations in highly variable ocular phenotypes as well as the extreme genetic heterogeneity of A/M conditions.
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
Roy, Avik Kumar; Senthil, Sirisha
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. 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. 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, thus not to incorporate epithelial tissue within the surgical
Full Text Available Mun Yueh Faria,1 Nuno Ferreira,2 Eliana Neto,1 1Vitreo Retinal Department, 2Ophthalmology Department, Santa Maria Hospital, Lisbon, Portugal 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
Tafida, A; Kyari, F; Abdull, M M; Sivasubramaniam, S; Murthy, G V S; Kana, I; Gilbert, Clare E
Poverty can be a cause and consequence of blindness. Some causes only affect the poorest communities (e.g. trachoma), and poor individuals are less likely to access services. In low income countries, cataract blind adults have been shown to be less economically active, indicating that blindness can exacerbate poverty. This study aims to explore associations between poverty and blindness using national survey data from Nigeria. Participants ≥40 years were examined in 305 clusters (2005-2007). Sociodemographic information, including literacy and occupation, was obtained by interview. Presenting visual acuity (PVA) was assessed using a reduced tumbling E LogMAR chart. Full ocular examination was undertaken by experienced ophthalmologists on all with PVA blind (PVA blindness were 8.5% (95% CI 7.7-9.5%), 2.5% (95% CI 2.0-3.1%), and 1.5% (95% CI 1.2-2.0%) in poorest, medium and affluent households, respectively (p = 0.001). Cause-specific prevalences of blindness from cataract, glaucoma, uncorrected aphakia and corneal opacities were significantly higher in poorer households. Cataract surgical coverage was low (37.2%), being lowest in females in poor households (25.3%). Spectacle coverage was 3 times lower in poor than affluent households (2.4% vs. 7.5%). In Nigeria, blindness is associated with poverty, in part reflecting lower access to services. Reducing avoidable causes will not be achieved unless access to services improves, particularly for the poor and women.
Filiz Avsin Ozdemir Sarioglu
Full Text Available A 55-year-old female with an aphakic nanophthalmic eye underwent a secondary intraocular lens implantation (IOL with double Artisan aphakia iris claw IOLs (ICIOLs and was evaluated in this research. The patient's preoperative best-corrected visual acuity (BCVA of the right eye was 0.4 (0.4 logMAR (with + 21.00 D, postoperative 1st and 3rd month, 1st year, and 3 years BCVAs were 0.4 (0.4 logMAR. The intraocular pressure was 15 mmHg preoperatively, and 14, 12, 12, and 15 mmHg postoperatively at 1st and 3rd month, 1st year, and 3 years, respectively. The preoperative endothelial cell density (ECD was 2372 cells/mm2, and postoperative ECDs were 2352, 2391, 2246, and 2240 cells/mm2 at 1st and 3rd months, at 1st year, and 3 years respectively. In aphakic nanophthalmic eyes with inadequate capsular support, which require high IOL dioptry, the implantation of double ICIOLs (one in front of the iris and the other behind the iris seems to be safe and provides good visual rehabilitation.
A. Yu. Brezhnev
Full Text Available Purpose: to study the informativeness of pseudoexfoliation syndrome (PES signs for early diagnosis improvement.Methods: 250 patients with PES were included in the study. Exclusion criteria consisted of aphakia, pseudophakia, previous eye surgery and diseases which can complicate PES diagnostics (uveitis, corneal pathology, ocular injury etc.. Each patient underwent complete ophthalmic examination, including slit-lamp examination under mydriasis, gonioscopy. Confocal microscopy was used as an additional diagnostic method in several patients (Confoscan-4, Nidek.Results: Pseudoexfoliation material was found at the pupillary margin in 64.8% of patients, and on the lens capsule (central disc in 71% of the test subjects. Peripheral depositions were present in almost all PES patients under mydriasis. Pupil dilation has been allowed to establish the diagnosis of PES additionally in 16% of patients. At the «mini-PES»-stage PES material was most frequently found in the superior-nasal quadrant of lens capsule (85.6%. Clinical asymmetry of several signs (pupil diameter, anterior chamber angle pigmentation, IOP level should be taken into consideration in early PES diagnostics.Conclusion: Examination under mydriasis and knowledge of PES micro-signs in some cases has been allowed to suspect PESeven at the preclinical stage.
Lazaridis, A; Messerschmidt-Roth, A; Sekundo, W; Schulze, S
The ReLEx® technique allows correction of refractive errors through the creation and extraction of refractive stromal lenticules. Contrary to excimer laser corneal refractive procedures, where the stromal tissue is photoablated, the extracted lenticules obtained with ReLEx® can be preserved. Recent studies and case reports have described autologous re-implantation and allogeneic implantation of refractive lenticules into femtosecond-laser created stromal pockets in order to reverse the refractive outcome of a myopic corneal refractive procedure, correct hyperopia, aphakia, presbyopia and treat keratoconus. The use of stromal lenticules has also been described for therapeutic purposes, with an allogenic lenticule being transplanted under a LASIK flap in order to restore corneal volume and reduce the refractive error in a case of excessive stromal tissue removal after LASIK. This review summarises the results of the latest case reports and studies that describe the implantation of cryopreserved or fresh refractive stromal lenticules and discusses the feasibility, safety and refractive outcomes of the procedure, on the basis of published literature as well as our own experience. Georg Thieme Verlag KG Stuttgart · New York.
Anand, Deepti; Agrawal, Smriti A; Slavotinek, Anne; Lachke, Salil A
Mutations in the transcription factor genes FOXE3, HSF4, MAF, and PITX3 cause congenital lens defects including cataracts that may be accompanied by defects in other components of the eye or in nonocular tissues. We comprehensively describe here all the variants in FOXE3, HSF4, MAF, and PITX3 genes linked to human developmental defects. A total of 52 variants for FOXE3, 18 variants for HSF4, 20 variants for MAF, and 19 variants for PITX3 identified so far in isolated cases or within families are documented. This effort reveals FOXE3, HSF4, MAF, and PITX3 to have 33, 16, 18, and 7 unique causal mutations, respectively. Loss-of-function mutant animals for these genes have served to model the pathobiology of the associated human defects, and we discuss the currently known molecular function of these genes, particularly with emphasis on their role in ocular development. Finally, we make the detailed FOXE3, HSF4, MAF, and PITX3 variant information available in the Leiden Online Variation Database (LOVD) platform at https://www.LOVD.nl/FOXE3, https://www.LOVD.nl/HSF4, https://www.LOVD.nl/MAF, and https://www.LOVD.nl/PITX3. Thus, this article informs on key variants in transcription factor genes linked to cataract, aphakia, corneal opacity, glaucoma, microcornea, microphthalmia, anterior segment mesenchymal dysgenesis, and Ayme-Gripp syndrome, and facilitates their access through Web-based databases. © 2018 Wiley Periodicals, Inc.
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.
Daniela da Silva Verzoni
Full Text Available Abstract Objective: To determine the main causes of visual impairment and blindness in children enrolled at Instituto Benjamin Constant blind school (IBC in 2013, to aid in planning for the prevention and management of avoidable causes of blindness. Methods: Study design: cross-sectional observational study. Data was collected from medical records of students attending IBC in 2013. Causes of blindness were classified according to WHO/PBL examination record. Data were analyzed for those children aged less than 16 years using Stata 9 program. Results: Among 355 students attending IBC in 2013, 253 (73% were included in this study. Of these children, 190 (75% were blind and 63 (25% visually impaired. The major anatomical site of visual loss was retina (42%, followed by lesions of the globe (22%, optic nerve lesions (13.8%, central nervous system (8.8% and cataract/pseudophakia/aphakia (8.8%. The etiology was unknown in 41.9% and neonatal factors accounted for 30,9% of cases. Forty-eight percent of cases were potentially avoidable. Retinopathy of prematurity (ROP was the main cause of blindness and with microphthalmia, optic nerve atrophy, cataract and glaucoma accounted for more than 50% of cases. Conclusion: Provision and improvement of ROP, cataract and glaucoma screening and treatment and programs could prevent avoidable visual impairment and blindness.
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.
Full Text Available Propensity for increased postoperative inflammation and capsular opacification, a refractive state that is constantly in a state of flux due to growth of the eye, difficulty in documenting anatomic and refractive changes due to poor compliance, and a tendency to develop amblyopia, makes management of cataract in the child different from that in the adult. The recent past has unraveled several caveats of pediatric cataract management - the importance of atraumatic surgery and complete removal of lens matter, benefits of in-the-bag intraocular lens(IOL implantation, role of titrating IOL power to counter refractive changes due to growth of the eye, prudery of continuously following these eyes for early detection of aphakic glaucoma and benefits of some surgical innovations. Although these promise to significantly improve our management of pediatric cataract, their long-term benefits are yet to be determined. We will also have to harness newer techniques, especially in the areas of wound construction and capsule management, and will have to develop effective strategies for the refractive management of infantile aphakia.
During a 4-year period, 1978-1981, 312 patients were operated on for unilateral rhegmatogenous detachment of the retina. Of the fellow eyes, 11% showed moderate (VA 0.15-0.4) and 5% severe (VA less than or equal to 0.1) visual impairment. Of the fellow eyes 49% were myopic (- 1.0 D. or more), and aphakia was present in 14%. Details of the peripheral fundus were adequately recordable for 260 fellow eyes. Degenerations considered to predispose to retinal detachment were found in 98 eyes (38%): lattice degeneration in 54 (21%), granular tuft in 17 (7%), retinal tear(s) in 12 (5%), and retinoschisis in 15 (6%). Prophylactic treatment of predisposing degenerations was performed in 91 of the 98 eyes using cryo- or photocoagulation (argon laser). No intra- or permanent post-operative complications were noticed. One of the treated fellow eyes (1.1%) detached 10 months after prophylactic treatment due to new tears. In the untreated group, 6 of the 221 eyes detached (2.7%). The difference was not statistically significant, but the groups were not comparable because 93% of the eyes showing predisposing degenerations were treated. None of the eyes treated for retinal breaks or lattice degeneration has detached. In these cases prophylactic treatment of the fellow eye is recommended. In most eyes cryocoagulation seems to be preferable to photocoagulation.
Messmer, E P
The necessity for prophylactic treatment for degenerative disease in the peripheral retina cannot be evaluated merely on the basis of the ophthalmoscopic findings. Factors such as the patient's history, refraction, the status of the vitreous, and prospective future cataract extraction all have a major impact on the risk of developing retinal detachment. The latter condition can be classified in to three groups: (1) low risk (patients with no history of retinal detachment, intraocular surgery or posterior vitreous detachment, myopia less than three diopters): treatment of atrophic holes and lattice degeneration is not justified, treatment of flap tears according to the circumstances; (2) medium risk (patients with no history of retinal or posterior vitreous detachment; however, myopia of more than three diopters and/or aphakia): the treatment of lattice degeneration is not justified; treatment of breaks according to the circumstances; (3) high risk: (patients with symptoms of posterior vitreous detachment): the treatment of lattice degeneration and atrophic holes is not justified: treatment of tears is necessary; fellow eyes: the treatment of retinal breaks is necessary; treatment of lattice degeneration seems advisable in cases with bilateral symmetric findings or prior to cataract extraction. Treatment of senile retinoschisis is only justified in cases with large and centrally located holes in the outer wall or in the presence of symptomatic schisis detachment.
Neuhann, I; Fleischer, F; Neuhann, T
This study was performed to analyse the reasons for explantation/exchange of intraocular lenses (IOL), which had originally been implanted for the correction of aphakia during cataract extraction. All cases with IOL explantation, which had been performed at one institution between 1/2008 and 12/2009 were analysed retrospectively. A total of 105 eyes of 100 patients were analysed. The median time interval between implantation and explantation of the IOL was 5.9 years (min. 0, max. 29.6). The most frequent cause for the intervention was subluxation/dislocation of the implant in 55.2% of cases. This group comprised 21% of cases with subluxation within the capsular bag in pseudoexfoliation syndrome. Other reasons were optical problems/incorrect IOL power (21%), calcification of hydrophilic acrylic IOL (7.6%), corneal decompensation associated with an anterior chamber lens (4.8%), and single cases with varying problems. The reasons for IOL exchange presented in this study are comparable to those of other series in the literature. Explantations due to optical problems may gain weight in the future due to a rise in refractive procedures and demands. © Georg Thieme Verlag KG Stuttgart · New York.
Background To assess the efficacy, clinical outcomes, visual acuity (VA), incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany) were analyzed. Findings The final CDVA was 20/40 or better in 8 eyes (62%), 20/60 or better in 12 eyes (92%), and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. Conclusions We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method. PMID:23050659
Lennington, Jessica B; Pope, Sara; Goodheart, Anna E; Drozdowicz, Linda; Daniels, Stephen B; Salamone, John D; Conover, Joanne C
Coordinated regulation of the adult neurogenic subventricular zone (SVZ) is accomplished by a myriad of intrinsic and extrinsic factors. The neurotransmitter dopamine is one regulatory molecule implicated in SVZ function. Nigrostriatal and ventral tegmental area (VTA) midbrain dopamine neurons innervate regions adjacent to the SVZ, and dopamine synapses are found on SVZ cells. Cell division within the SVZ is decreased in humans with Parkinson's disease and in animal models of Parkinson's disease following exposure to toxins that selectively remove nigrostriatal neurons, suggesting that dopamine is critical for SVZ function and nigrostriatal neurons are the main suppliers of SVZ dopamine. However, when we examined the aphakia mouse, which is deficient in nigrostriatal neurons, we found no detrimental effect to SVZ proliferation or organization. Instead, dopamine innervation of the SVZ tracked to neurons at the ventrolateral boundary of the VTA. This same dopaminergic neuron population also innervated the SVZ of control mice. Characterization of these neurons revealed expression of proteins indicative of VTA neurons. Furthermore, exposure to the neurotoxin MPTP depleted neurons in the ventrolateral VTA and resulted in decreased SVZ proliferation. Together, these results reveal that dopamine signaling in the SVZ originates from a population of midbrain neurons more typically associated with motivational and reward processing.
Full Text Available Abstract Background To assess the efficacy, clinical outcomes, visual acuity (VA, incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany were analyzed. Findings The final CDVA was 20/40 or better in 8 eyes (62%, 20/60 or better in 12 eyes (92%, and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. Conclusions We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.
Lerman, S.; Megaw, J.; Gardner, K.; Takei, Y.; Franks, Y.; Gammon, A.
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 3 H 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
Full Text Available Ricardo Alexandre Stock, Thaís Thumé, Luan Gabriel Paese, Elcio Luiz Bonamigo Universidade do Oeste de Santa Catarina, Rua Getúlio Vargas, Joaçaba, Santa Catarina, Brazil Purpose: To analyze patient satisfaction and difficulties with bilateral multifocal intraocular lenses (IOLs implantation and aspheric monofocal IOLs implantation using monovision, after cataract surgery.Materials and methods: A total of 61 participants were included in the study, 29 with monovision and 32 with multifocal lenses. The inclusion criteria were patients undergoing phacoemulsification for bilateral visual impairment due to cataracts and presenting with postoperative visual acuity of 20/30 or better for distance and line J3 or better for near vision.Results: The 2 groups had similar results regarding difficulties with daily activities such as distance vision, near vision, watching television, reading, cooking, using a computer or cellphone, shaving/putting on makeup and shopping. There were differences in responses between the groups regarding difficulty with night vision (P=0.0565 and night driving (P=0.0291. Degree of satisfaction in terms of distance vision without glasses was statistically significantly better in monovision group (P=0.0332, but not for near (P=0.9101.Conclusion: Both techniques yielded satisfactory results regarding visual acuity for different activities without the need to use glasses. Multifocal lenses are a good option for patients with the exception of night driving, and who desire independence from glasses. Keywords: cataract extraction, aphakia, postcataract, patient satisfaction, night vision
David, R; Davelman, J; Mechoulam, H; Cohen, E; Karshai, I; Anteby, I
Purpose To evaluate the prevalence and risk factors of strabismus in children undergoing surgery for unilateral or bilateral cataract with or without intraocular lens implantation. Methods Medical records of pediatric patients were evaluated from 2000 to 2011. Children undergoing surgery for unilateral or bilateral cataract with at least 1 year of follow-up were included. Children with ocular trauma, prematurity, or co-existing systemic disorders were excluded. The following data were evaluated: strabismus pre- and post-operation; age at surgery; post-operative aphakia or pseudophakia; and visual acuity. Results Ninety patients were included, 40% had unilateral and 60% had bilateral cataracts. Follow-up was on average 51 months (range: 12–130 months). Strabismus was found preoperatively in 34.4% children, and in 43.3% children at last follow-up. Strabismus developed in 46.2% of children who were orthotropic preoperatively, whereas 32.3% of children who had strabismus before surgery became orthotropic. Strabismus occurred after unilateral or bilateral cataract surgery in 63.9% and 29.6% children, respectively. At the last follow-up, strabismus was found in 46.7% of aphakic and 58.7% of pseudophakic children (P=0.283). Children who developed strabismus were generally operated at a younger age as compared with those without strabismus (mean of 25.9 vs 52.7 months, Pstrabismus. Conclusion Strabismus is a frequent complication after cataract surgery in children. Risk factors include unilateral cases and young age at surgery. No correlation was found between prevalence of strabismus and use of intraocular lens. Strabismus was more common in children with poor final visual acuity. PMID:27472210
Ivanov, G; Cuşnir, V; Septichina, Natalia; Cuşnir, Vitalie
The work deals with the results of surgical treatment of 155 patients, who had uveal cataract, by method of facoemulsification with artificial crystalline lens transplanting. The age of the sick varied from 3 to 15 as a result of a complex treatment, involving determination of ethnic factor in the development of uveal cataract, before- and after-operation conservative medical treatment, surgical treatment of abscuration ambliopia 78.1% children and the keenness of sight 0.4 and 68.7% got binocularious sight. The study lot of posttraumatic cataract affected children included 189 patients, from them 68 with stationary cataract, 87 with intumescent cataract and 34 with postoperatorial aphakia. Age from 2 to 15 years. 76.3% cases of evolution without postoperatorial complications, in 13.7% intraoperatorial were observed different complications. The work presents the results of surgical treatment 196 of children, who had innate cataract, by the method of facoasoriation with soft intra-eyepiece lens transplanting from 133 patients who had two-sided cataract, 63 had monolateral cataract. All children underwent laser simulation and videocomputer auto-training in post-operation period. As a result of the treatment, 66.8% patients got the amelioration of sight with 0.4, and 58% got binocular sight. The children's age varied between 6 months and 15 years. This article presents a review of the treatment results of 213 children with posttraumatic, congenital and complicated cataracts. The rehabilitation of the patients with the lens pathology includes a complex of measures of early diagnosis, surgery, optimal correction, medical treatment before and after surgery, the prophilaxis and treatment of complications. This approach permits to increase the visual acuity in 83.8% and to restore the binocular vision in 71.4% patients.
Mahmood, S.A.; Zafar, S.
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)
Hashimoto, N [Nagoya City Univ. (Japan). Faculty of Medicine
Pregnant ddN mice were subjected to a single whole-body x radiation at a dose of 150 R on day 7 of pregnancy. The offspring were examined on day 18 of gestation or at the age of 4 weeks. In the fetuses on day 18 of gestation, microphthalmus, aphakia, faulty closure of the fetal fissure, corneal abnormalities, and corneo-lenticular adhesion were found. 4-week old mice (4W-M), developed microphthalmus, congenital corneal opacity, choroidal coloboma, corneolenticular adhesion, iris coloboma, retinal dysplasia and anophthalmus. Congenital corneal opacity in 4W-M by gross examination showed microscopically the corneal epithelial plug penetrated through a discontinuous corneal stroma. The corneal abnormalities in the 18-day fetuses (18-F) showed the same findings. Corneolenticular adhesion in the fetuses and 4W-M had the same pathological findings. Projection from the anterior surface of the lens extended into the stromal gap and the lens fibers penetrated the proximal region of the projection. Choroidal coloboma with microphthalmus in 4W-M had the same pathological findings as typical coloboma seen in humans. Thus, choroidal coloboma in mice may be caused by faulty closure of the fetal fissure as typical coloboma in human. Some cases of microphthalmus in 4W-M had the same pathological findings as the clinically so-called ''Retinal dysplasia''. It was suspected if they were caused by faulty closure of the fetal fissure. It may be that on day 18 fetuses with microphthalmus had pathological findings, i.e., retinal folding, retinal eversion, choroidal coloboma caused by faulty closure of the fetal fissure, and excessive persistent primary vitreous. Incidence of microphthalmus in 18-F was almost the same as that in 4W-M. Anophthalmus was secondary anophthalmus, which showed some remnants of ocular tissue.
Arya, Priyanka; Rainey, Mark A.; Bhattacharyya, Sohinee; Mohapatra, Bhopal; George, Manju; Kuracha, Murali R; Storck, Matthew D.; Band, Vimla; Govindarajan, Venkatesh; Band, Hamid
The C-terminal Eps15 homology domain-containing (EHD) proteins play a key role in endocytic recycling, a fundamental cellular process that ensures the return of endocytosed membrane components and receptors back to the cell surface. To define the in vivo biological functions of EHD1, we have generated Ehd1 knockout mice and previously reported a requirement of EHD1 for spermatogenesis. Here, we show that approximately 56% of the Ehd1-null mice displayed gross ocular abnormalities, including anophthalmia, aphakia, microphthalmia and congenital cataracts. Histological characterization of ocular abnormalities showed pleiotropic defects that include a smaller or absent lens, persistence of lens stalk and hyaloid vasculature, and deformed optic cups. To test whether these profound ocular defects resulted from the loss of EHD1 in the lens or in non-lenticular tissues, we deleted the Ehd1 gene selectively in the presumptive lens ectoderm using Le-Cre. Conditional Ehd1 deletion in the lens resulted in developmental defects that included thin epithelial layers, small lenses and absence of corneal endothelium. Ehd1 deletion in the lens also resulted in reduced lens epithelial proliferation, survival and expression of junctional proteins E-cadherin and ZO-1. Finally, Le-Cre-mediated deletion of Ehd1 in the lens led to defects in corneal endothelial differentiation. Taken together, these data reveal a unique role for EHD1 in early lens development and suggest a previously unknown link between the endocytic recycling pathway and regulation of key developmental processes including proliferation, differentiation and morphogenesis. PMID:26455409
Bhalerao, Sushank Ashok; Tandon, Mahesh; Singh, Satyaprakash; Dwivedi, Shraddha; Kumar, Santosh; Rana, Jagriti
Information on eye diseases in blind school children in Allahabad is rare and sketchy. A cross-sectional study was performed to identify causes of blindness (BL) in blind school children with an aim to gather information on ocular morbidity in the blind schools in Allahabad and in its vicinity. A cross-sectional study was carried out in all the four blind schools in Allahabad and its vicinity. The students in the blind schools visited were included in the study and informed consents from parents were obtained. Relevant ocular history and basic ocular examinations were carried out on the students of the blind schools. A total of 90 students were examined in four schools of the blind in Allahabad and in the vicinity. The main causes of severe visual impairment and BL in the better eye of students were microphthalmos (34.44%), corneal scar (22.23%), anophthalmos (14.45%), pseudophakia (6.67%), optic nerve atrophy (6.67%), buphthalmos/glaucoma (3.33%), cryptophthalmos (2.22%), staphyloma (2.22%), cataract (2.22%), retinal dystrophy (2.22%), aphakia (1.11%), coloboma (1.11%), retinal detachment (1.11%), etc. Of these, 22 (24.44%) students had preventable causes of BL and another 12 (13.33%) students had treatable causes of BL. It was found that hereditary diseases, corneal scar, glaucoma and cataract were the prominent causes of BL among the students of blind schools. Almost 38% of the students had preventable or treatable causes, indicating the need of genetical counseling and focused intervention.
Balekudaru, Shantha; Vadalkar, Juhie; George, Ronnie; Vijaya, Lingam
To assess the intraocular pressure control (IOP), changes in visual acuity, complications, reoperation rates and risk factors for failure following Ahmed glaucoma valve implantation in pediatric eyes with glaucoma. The medical records of consecutive patients with glaucoma who underwent Ahmed glaucoma valve implantation from January 2000 to December 2009) were retrospectively reviewed. Only one eye of each patient was included. Subgroup analysis was performed in three groups; group 1 included phakic eyes with primary congenital glaucoma, juvenile open-angle glaucoma, or glaucoma associated with ocular anomalies; group 2 included eyes with glaucoma in aphakia or pseudophakia; group 3 included eyes with other diagnoses. A successful outcome was defined as final IOP between 6 mm Hg and 18 mm Hg without loss of light perception or reoperation for glaucoma. A total of 71 eyes in 71 patients: 15 (21%) in group 1, 47 (66%) in group 2, and 9 (13%) in group 3 were included Successful IOP control was achieved in 44 eyes of 44 patients (62%). Cumulative probabilities of success by Kaplan-Meier analysis at 12 and 24 months was 97% and 80% for the entire group, 100% and 82% for group 1, 95% and 86% for group 2, and 90% and 42% for group 3. Reoperation was necessary for 18 patients (25%), either for tube-related complications or for IOP control. The only significant risk factor for failure was the category of diagnosis (P = 0.029). Ahmed glaucoma valve implantation is an option in the management of pediatric glaucoma; however, reoperations for tube related complications or for persistent elevated IOP is frequently needed. Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.
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.
Sushank Ashok Bhalerao
Full Text Available Background/Aims: Information on eye diseases in blind school children in Allahabad is rare and sketchy. A cross-sectional study was performed to identify causes of blindness (BL in blind school children with an aim to gather information on ocular morbidity in the blind schools in Allahabad and in its vicinity. Study Design and Setting: A cross-sectional study was carried out in all the four blind schools in Allahabad and its vicinity. Materials and Methods: The students in the blind schools visited were included in the study and informed consents from parents were obtained. Relevant ocular history and basic ocular examinations were carried out on the students of the blind schools. Results: A total of 90 students were examined in four schools of the blind in Allahabad and in the vicinity. The main causes of severe visual impairment and BL in the better eye of students were microphthalmos (34.44%, corneal scar (22.23%, anophthalmos (14.45%, pseudophakia (6.67%, optic nerve atrophy (6.67%, buphthalmos/glaucoma (3.33%, cryptophthalmos (2.22%, staphyloma (2.22%, cataract (2.22%, retinal dystrophy (2.22%, aphakia (1.11%, coloboma (1.11%, retinal detachment (1.11%, etc. Of these, 22 (24.44% students had preventable causes of BL and another 12 (13.33% students had treatable causes of BL. Conclusion: It was found that hereditary diseases, corneal scar, glaucoma and cataract were the prominent causes of BL among the students of blind schools. Almost 38% of the students had preventable or treatable causes, indicating the need of genetical counseling and focused intervention.
Full Text Available AIM: To evaluate the causes and associations of missed retinal breaks (MRBs and posterior vitreous detachment (PVD in patients with rhegmatogenous retinal detachment (RRD. METHODS: Case sheets of patients undergoing vitreo retinal surgery for RRD at a tertiary eye care centre were evaluated retrospectively. Out of the 378 records screened, 253 were included for analysis of MRBs and 191 patients were included for analysis of PVD, depending on the inclusion criteria. Features of RRD and retinal breaks noted on examination were compared to the status of MRBs and PVD detected during surgery for possible associations. RESULTS: Overall, 27% patients had MRBs. Retinal holes were commonly missed in patients with lattice degeneration while missed retinal tears were associated with presence of complete PVD. Patients operated for cataract surgery were significantly associated with MRBs (P=0.033 with the odds of missing a retinal break being 1.91 as compared to patients with natural lens. Advanced proliferative vitreo retinopathy (PVR and retinal bullae were the most common reasons for missing a retinal break during examination. PVD was present in 52% of the cases and was wrongly assessed in 16%. Retinal bullae, pseudophakia/aphakia, myopia, and horse shoe retinal tears were strongly associated with presence of PVD. Traumatic RRDs were rarely associated with PVD. CONCLUSION: Pseudophakic patients, and patients with retinal bullae or advanced PVR should be carefully screened for MRBs. Though Weiss ring is a good indicator of PVD, it may still be over diagnosed in some cases. PVD is associated with retinal bullae and pseudophakia, and inversely with traumatic RRD.
Kumar, Dhivya Ashok; Agarwal, Amar; Packiyalakshmi, Sathiya; Jacob, Soosan; Agarwal, Athiya
To evaluate the complications and visual outcomes of glued intrascleral-fixated foldable intraocular lens (IOL) in eyes with deficient capsules. Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, India. Case series. Data were evaluated from the records of patients with a primary glued foldable IOL for intraoperative capsular loss or subluxated lens or secondary glued foldable IOL for aphakia. Exclusion criteria included preoperative glaucoma, aniridia, macular scar, traumatic subluxation, combined surgeries, incomplete operative medical records, and postoperative follow-up less than 6 months. The intraoperative and postoperative complication rates, reoperation rate, and visual outcomes were analyzed. The study comprised 208 eyes (185 patients). The mean follow-up was 16.7 months ± 10.2 (SD). The intraoperative complications were hyphema (0.4%), haptic breakage (0.4%), and deformed haptics (0.9%). Early complications occurred in 29 eyes (13.9%) and included corneal edema (5.7%), epithelial defect (1.9%), and grade 2 anterior chamber reaction (2.4%). Late complications occurred in 39 eyes (18.7%) and included optic capture (4.3%), IOL decentration (3.3%), haptic extrusion (1.9%), subconjunctival haptic (1.4%), macular edema (1.9%), and pigment dispersion (1.9%). Reoperation was required in 16 eyes (7.7%). Haptic position was altered in eyes with IOL decentration. Corrected distance visual acuity (CDVA) improved or remained unchanged in 84.6% of eyes. The postoperative CDVA was 20/40 or better and 20/60 or better in 38.9% and 48.5% of eyes, respectively. The foldable glued-IOL procedure showed satisfactory visual outcomes without serious complications. Intraocular lens decentration was due to haptic-related problems. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Yamane, Shin; Sato, Shimpei; Maruyama-Inoue, Maiko; Kadonosono, Kazuaki
To report the clinical outcomes of a new technique for transconjunctival intrascleral fixation of an intraocular lens (IOL). Prospective, noncomparative, interventional case series. One hundred eyes of 97 consecutive patients with aphakia, dislocated IOL, or subluxated crystalline lens who underwent posterior chamber sutureless implantation of an IOL were studied. Two angled incisions parallel to the limbus were made by 30-gauge thin-wall needles. Haptics of an IOL were externalized with the needles and cauterized to make a flange of the haptics. The flange of the haptics were pushed back and fixed into the scleral tunnels. Best-corrected visual acuity (VA), corneal endothelial cell density, IOL tilt, and complications were determined. The IOLs were fixed with exact centration and axial stability. The mean preoperative best-corrected VA was 0.25 logarithm of the minimum angle of resolution (logMAR) units; after surgery, it improved significantly to 0.11 logMAR, 0.09 logMAR, 0.12 logMAR, and 0.04 logMAR at 6, 12, 24, and 36 months, respectively (P IOL tilt was 3.4°±2.5°. The postoperative complications included iris capture by the IOL in 8 eyes (8%), vitreous hemorrhage in 5 eyes (5%), and cystoid macular edema in 1 eye (1%). There were no incidents of postoperative retinal detachment, endophthalmitis, or IOL dislocation. We have developed a new technique for intrascleral IOL fixation. The flanged IOL fixation technique is a simple and minimally invasive method for achieving good IOL fixation with firm haptic fixation. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Kumar, Dhivya Ashok; Agarwal, Amar; Prakash, Dimple; Prakash, Gaurav; Jacob, Soosan; Agarwal, Athiya
To evaluate the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular support. Noncomparative retrospective observational case series. Institutional practice. Forty-one eyes of 33 children who underwent glued IOL implantation were retrospectively evaluated. The indications were postsurgical aphakia, subluxated cataract, ectopia lentis, traumatic subluxation, and decentered IOL. Visual acuity (VA), endothelial cell changes, intraoperative and postoperative complications. The mean age at the time of glued IOL was 10.7±3.6 years (range 5-15). The mean duration of follow-up after surgery was 17.5±8.5 months (range 12-36). The mean postoperative best spectacle-corrected visual acuity (BCVA in decimal equivalent) was 0.43±0.33 and there was significant change noted (P20/60 BCVA was obtained in 17.1% and 46.3% of eyes respectively. BCVA improvement more than 1 line was seen in 22 eyes (53.6%). The mean postoperative refraction was myopic (-1.19±0.7 diopters [D]) in 19 eyes and hyperopic (+1.02±0.7 D) in 22 eyes. The mean endothelial loss was 4.13% (range 1.3%-5.94%). The 3 causes of reduced BCVA were the preexisting corneal, retinal pathology, and amblyopia. Postoperative complications included optic capture in 1 eye (2.4%), macular edema in 2 eyes (4.8%), and clinical decentration in 2 eyes (4.8%). There was no postoperative retinal detachment, IOL dislocation, endophthalmitis, or glaucoma. Short-term results in children after glued IOL were favorable, with a low rate of complications. However, regular follow-ups are required since long-term risks are unknown. Copyright Â© 2012 Elsevier Inc. All rights reserved.
Chew, Emily Y; SanGiovanni, John Paul; Ferris, Frederick L; Wong, Wai T; Agron, Elvira; Clemons, Traci E; Sperduto, Robert; Danis, Ronald; Chandra, Suresh R; Blodi, Barbara A; Domalpally, Amitha; Elman, Michael J; Antoszyk, Andrew N; Ruby, Alan J; Orth, David; Bressler, Susan B; Fish, Gary E; Hubbard, George B; Klein, Michael L; Friberg, Thomas R; Rosenfeld, Philip J; Toth, Cynthia A; Bernstein, Paul
Age-related cataract is a leading cause of visual impairment in the United States. The prevalence of age-related cataract is increasing, with an estimated 30.1 million Americans likely to be affected by 2020. To determine whether daily oral supplementation with lutein/zeaxanthin affects the risk for cataract surgery. The Age-Related Eye Disease Study 2 (AREDS2), a multicenter, double-masked clinical trial, enrolled 4203 participants, aged 50 to 85 years, at risk for progression to advanced age-related macular degeneration. Participants were randomly assigned to daily placebo; lutein/zeaxanthin, 10mg/2mg; omega-3 long-chain polyunsaturated fatty acids, 1 g; or a combination to evaluate the effects on the primary outcome of progression to advanced age-related macular degeneration. Cataract surgery was documented at annual study examination with the presence of pseudophakia or aphakia, or reported during telephone calls at 6-month intervals between study visits. Annual best-corrected visual acuity testing was performed. A secondary outcome of AREDS2 was to evaluate the effects of lutein/zeaxanthin on the subsequent need for cataract surgery. A total of 3159 AREDS2 participants were phakic in at least 1 eye and 1389 of 6027 study eyes underwent cataract surgery during the study, with median follow-up of 4.7 years. The 5-year probability of progression to cataract surgery in the no lutein/zeaxanthin group was 24%. For lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratios for progression to cataract surgery was 0.96 (95% CI, 0.84-1.10; P = .54). For participants in the lowest quintile of dietary intake of lutein/zeaxanthin, the hazard ratio comparing lutein/zeaxanthin vs no lutein/zeaxanthin for progression to cataract surgery was 0.68 (95% CI, 0.48-0.96; P = .03). The hazard ratio for 3 or more lines of vision loss was 1.03 (95% CI, 0.93-1.13; P = .61 for lutein/zeaxanthin vs no lutein/zeaxanthin). Daily supplementation with lutein/zeaxanthin had no statistically
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
Full Text Available PURPOSE: To determine interocular grating acuity difference in children treated for unilateral infantile cataract. METHODS: A group of 27 children previously treated for unilateral infantile cataract, had their monocular visual acuity measured by sweep visual evoked potentials. Interocular grating acuity difference was calculated as the absolute subtraction of monocular acuity scores. Lens status, opacity severity and eye alignment were considered for analysis. RESULTS: Mean interocular grating acuity difference obtained from unilateral cataract patients was 0.58 ± 0.20 logMAR. This result was significantly larger than 0.10 logMAR used as normative data. Children with severe opacities had a more pronounced amblyopia than the moderate ones. No significant correlation between amblyopia and strabismus or aphakia was found. CONCLUSIONS: Interocular acuity difference in this group of unilateral congenital cataract was more pronounced than previous reports, mainly because of delay in diagnosis, surgery and optical correction.OBJETIVOS: Determinar a diferença interocular da acuidade visual de resolução de grades em crianças operadas de catarata congênita unilateral. MÉTODOS: Um grupo de 27 pacientes operados de catarata congênita unilateral tiveram mensurada sua acuidade visual monocular pelo potencial visual evocado de varredura. A diferença interocular foi calculada pela subtração absoluta das acuidades monoculares. A intensidade da opacificação, implante ou não de lente intraocular e presença de estrabismo foram consideradas para análise. RESULTADOS: A média da diferença interocular foi de 0,58 ± 0,20 logMAR. Esse resultado foi significantemente maior que 0,10 logMAR, valor considerado como média normal nos estudos normativos. Crianças com opacidades intensas tiveram ambliopia mais pronunciada que os casos moderados. Não houve correlação significante entre a intensidade da ambliopia com estrabismo e afacia. CONCLUSÕES: A
Full Text Available 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 < 20/60 to ≤ 20/400 - odds ratio (OR 1.8; 95% CI 1.3 to 2.6%, visual acuity of < 20/400 - OR 6.2; 95% 4.0 to 9.8%, rural residence (visual acuity of < 20/60 to ≤ 20/400 - OR 3.2; 95% CI 2.2 to 4.5% and visual acuity of < 20/400 - OR OR 3.5; 95% CI 2.3 to 5.5% were associated with visual impairment. The urban cataract-operated population had significantly more pseudophakics ( P < 0.001, men ( P = 0.02 and literates ( P < 0.001. In the rural group the prevalence of cataract surgery (13.5% vs. 10.5%, P < 0.001 and number of people that had undergone cataract surgery within three years prior to examination ( P < 0.001 were significantly greater. In 30% of rural and 16% of urban subjects uncorrected refraction was the cause of visual impairment. Conclusions: Surgery
Lockington, David; Ali, Noor Q; Al-Taie, Rasha; Patel, Dipika V; McGhee, Charles N J
To evaluate the outcomes of transscleral sutured posterior chamber intraocular lens (PC IOL) implantation. Public university hospital, Auckland, New Zealand. Retrospective case series. A modified no-touch transscleral sutured PC IOL implantation technique with a 1-piece monofocal IOL (Alcon CZ70BD) or an aniridia IOL (type 67G, Morcher) was assessed. Seventy-eight cases (80.8% men; 53.9% aphakic) were identified. The mean follow-up was 35.5 months and the mean age at surgery, 41 years±21 (SD). The preoperative corrected distance visual acuity (CDVA) was worse than 6/30 in 66.7%. Indications included ocular trauma (46.2%), nontraumatic crystalline lens subluxation (16.7%), post-complicated cataract surgery (10.3%), idiopathic IOL dislocation (10.3%), and congenital cataract/aphakia (10.3%). An aniridia IOL was required in 39.7% of eyes. There were no significant intraoperative complications in 74.4% of eyes. Postoperative complications included transient corneal edema (15.4%), wound leak requiring resuturing (7.7%), retinal detachment (7.7%), and cystoid macular edema (6.4%). One eye (1.3%) developed suture breakage-related late IOL dislocation. Overall, 91.3% of eyes had improved visual acuity or were within 1 line of the presenting CDVA. In eyes with a guarded prognosis, 34.8% achieved a CDVA of 6/12 or better and 43.5% a CDVA of 6/15 to 6/48. In the better prognosis group, 73.9% achieved a CDVA of better than 6/12 and all achieved better than 6/30. Scleral-sutured IOLs achieved good visual outcomes in a public hospital setting. The rate of complications was moderate in this series with a high proportion of severe ocular trauma and a large percentage of aniridia IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Nirmalan, P K; Thulasiraj, R D; Maneksha, V; Rahmathullah, R; Ramakrishnan, R; Padmavathi, A; Munoz, S R; Ellwein, L B
Aims: To assess the prevalence of vision impairment, blindness, and cataract surgery and to evaluate visual acuity outcomes after cataract surgery in a south Indian population. Methods: Cluster sampling was used to randomly select a cross sectional sample of people ≥50 years of age living in the Tirunelveli district of south India. Eligible subjects in 28 clusters were enumerated through a door to door household survey. Visual acuity measurements and ocular examinations were performed at a selected site within each of the clusters in early 2000. The principal cause of visual impairment was identified for eyes with presenting visual acuity India) was found in 11.0%, and in 4.6% with best correction. Presenting blindness was associated with older age, female sex, and illiteracy. Cataract was the principal cause of blindness in at least one eye in 70.6% of blind people. The prevalence of cataract surgery was 11.8%—with an estimated 56.5% of the cataract blind already operated on. Surgical coverage was inversely associated with illiteracy and with female sex in rural areas. Within the cataract operated sample, 31.7% had presenting visual acuity ≥6/18 in both eyes and 11.8% were <6/60; 40% were bilaterally operated on, with 63% pseudophakic. Presenting vision was <6/60 in 40.7% of aphakic eyes and in 5.1% of pseudophakic eyes; with best correction the percentages were 17.6% and 3.7%, respectively. Refractive error, including uncorrected aphakia, was the main cause of visual impairment in cataract operated eyes. Vision <6/18 was associated with cataract surgery in government, as opposed to that in non-governmental/private facilities. Age, sex, literacy, and area of residence were not predictors of visual outcomes. Conclusion: Treatable blindness, particularly that associated with cataract and refractive error, remains a significant problem among older adults in south Indian populations, especially in females, the illiterate, and those living in rural areas. Further
Full Text Available We investigated whether previously reported single nucleotide polymorphisms (SNPs of EPHA2 in European studies are associated with cataract in India.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.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.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 particularly prevalent in Indians.
Mangione, C M; Seddon, J M; Cook, E F; Krug, J H; Sahagian, C R; Campion, E W; Glynn, R J
To determine medical, ophthalmologic, and demographic predictors of cognitive function scores as measured by the Telephone Interview for Cognitive Status (TICS), an adaptation of the Folstein Mini-Mental Status Exam. A secondary objective was to perform an item-by-item analysis of the TICS scores to determine which items correlated most highly with the overall scores. Cross-sectional cohort study. The Glaucoma Consultation Service of the Massachusetts Eye and Ear Infirmary. 472 of 565 consecutive patients age 65 and older who were seen at the Glaucoma Consultation Service between November 1, 1987 and October 31, 1988. Each subject had a standard visual examination and review of medical history at entry, followed by a telephone interview that collected information on demographic characteristics, cognitive status, health status, accidents, falls, symptoms of depression, and alcohol intake. A multivariate linear regression model of correlates of TICS score found the strongest correlates to be education, age, occupation, and the presence of depressive symptoms. The only significant ocular condition that correlated with lower TICS score was the presence of surgical aphakia (model R2 = .46). Forty-six percent (216/472) of patients fell below the established definition of normal on the mental status scale. In a logistic regression analysis, the strongest correlates of an abnormal cognitive function score were age, diabetes, educational status, and occupational status. An item analysis using step-wise linear regression showed that 85 percent of the variance in the TICS score was explained by the ability to perform serial sevens and to repeat 10 items immediately after hearing them. Educational status correlated most highly with both of these items (Kendall Tau R = .43 and Kendall Tau R = .30, respectively). Education, occupation, depression, and age were the strongest correlates of the score on this new screening test for assessing cognitive status. These factors were
Kurawa, Musbahu Sani; Abdu, Lawan
Objective/Purpose: To describe the demographic and baseline ocular characteristics, prevalence of blindness and visual impairment among patients undergoing extracapsular cataract extraction for age related cataract at the study hospital over a one year period. Materials/Patients: All consecutive patients aged 40 years and above identified with age related cataract in one or both eyes who voluntarily agree to participate were included. The study adhered to the tenets of the Helsinki declaration. Written informed consent was obtained from all eligible patients. All patients underwent basic eye examination by the ophthalmologist. Visual impairment was determined for each eye according to the standard WHO categorizations. Information obtained also included age, sex and history of previous cataract surgery. Data were recorded in manual tally sheets and on modified computer Cataract Surgery Record forms. Analyses were done using SPSS (version 16, SPSS Inc., Chicago, USA). The participation rate was 91.2%. There were 495 eyes of 487 consecutive patients. This include 212 males and 275 females (M:F, 1:1.3). The age range was 40 to 99 years with a mean age of 62.76 ± 10.49 years (61.35 ± 9.75 years in men and 63.85±10.9 years in females). Most of the patients (n = 451; 92.6%, 95% CI: 89.9-94.6%) were aged 50 years and above. Sixty patients (12.3%, 95% CI: 9.6-15.5%) had cataract in both eyes, 427 (87.7%, 95% CI: 84.5-90.3%) were in one eye. Among these, preoperatively 16 (3.3%, 95% CI: 2.0-5.3%) had aphakia, 21 (4.3%, 95% CI: 2.8-6.5%) had uniocular pseudophakia. About 63.2% (95% CI: 58.9-67.4%) of patients had normal vision in the better eye (presenting VA ≥6/18). Overall 9.5% (95% CI: 7.3-12.7%) were bilaterally blind. About 96.8% of eyes (95% CI: 94.5-98.0%) undergoing cataract surgery were blind (presenting VAConclusion: The study highlights preponderance of females and high incidence of blinding cataract. Education and early disease awareness may play an important
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.