Effectivity and safety of trifocal intraocular lenses and capsular tension rings implantation for cataract patients with axial high myopia

●AIM:To assess effectivity and safety of trifocal intraocular lenses(IOLs)and capsular tension rings in treating cataract patients with axial high myopia.●METHODS:A prospective nonrandomized controlled clinical trial was conducted.Totally 98 eyes(74 patients)who underwent femtosecond laser-assisted cataract surgery(FLACS)with trifocal IOLs were enrolled in the study and followed up for 2y after surgery:46 eyes(33 patients)with capsular tension ring implantation in the long axial lengths(AL)group(26<AL<29 mm)and 52 eyes(41 patients)in the normal AL group(22<AL<24.5 mm).Postoperative outcomes about effectivity and safety,including the subjective and objective visual quality,and postoperative complications were assessed.●RESULTS:Uncorrected distance visual acuity at 5 m and uncorrected intermediate visual acuity at 60 and 80 cm in the long AL group were significantly worse than those in the normal AL group at 3mo postoperatively(P<0.05).The differences in reading speed,spectacle independence and potential visual complaints between the two groups were not statistically significant(P>0.05).The dysfunctional lens index and total modulation transfer function(MTF)average height were similar between the two groups.The postoperative internal coma aberrations in the axial high myopia eyes were significantly higher than that in the normal AL group(P<0.05).The total satisfaction score in the long AL group(91.32±2.76)was slightly higher than that in the normal AL group(90.36±3.47),but there was no difference(P=0.136).A statistically negative correlation was found between corrected distance visual acuity(CDVA)and dysfunctional lens index(r=-0.382,P=0.009),and between CDVA and the total MTF average height(r=-0.374,P=0.01).But there was no significant correlation between CDVA and total satisfaction score(r=0.059,P=0.696).Postoperative complications mainly presented as posterior capsular opacity(PCO),retinal detachment and cystoid macular edema.There was no difference in the incidence of fundus disease(6.5%vs 3.8%,P=0.663)or PCO(17.4%vs 7.7%,P=0.217)between the two groups at two years.●CONCLUSION:The utilization of trifocal IOL and capsular tension ring implantation is beneficial for cataract patients with axial high myopia undergoing FLACS.This approach not only ensures excellent subjective feelings and objective visual quality,but also does not increase the incidence of postoperative complications.

Stability of neodymium:YAG laser posterior capsulotomy in eyes with capsular tension rings

·AIM: To evaluate the stability of neodymium(Nd):YAG laser posterior capsulotomy in eyes with capsular tension rings(CTRs).·METHODS: A total of 60 eyes that underwent cataract surgery and laser posterior capsulotomy postoperatively were included in this retrospective cohort study. To evaluate the safety and stability of capsulotomy, changes in the size of posterior capsulotomy and anterior chamber depth(ACD) in three groups: the group without CTR, the group with 12 mm CTRs, and the group with 13 mm CTRs, at 1wk, 3, 12, and 15mo after capsulotomy, were compared. ·RESULTS: In the group without CTR and the group with 12 mm CTR, there was no significant change in ACD at every post-laser follow-up. In the group with 13 mm CTR, the ACD change was significant until 3mo after capsulotomy. In all groups, there was a significant increase in the area of capsulotomy between 1wk and 3mo post-laser. Between 3 and 12mo post-laser, only the group with 13 mm CTR showed a significant increase in the area of capsulotomy(P<0.01). ·CONCLUSION: Laser posterior capsulotomy is safe in all three groups. The capsulotomy and ACD become stabilized and have not shown significant changes since 1y postlaser, even with larger CTRs. The maintenance of centrifugal capsular tension can last longer with larger CTRs, and the stability of the capsulotomy site can be reached about 12mo after capsulotomy in pseudophakic eyes with larger CTRs.

Comparative evaluation of rotational stability of toric IOLs with four-eyelet vs two-eyelet capsular tension rings in eyes with high myopia

AIM:To compare the rotational stability of Toric intraocular lens(IOLs)implantation combined with foureyelet or two-eyelet capsular tension rings(CTRs)in eyes with high myopia and cataract.METHODS:This prospective randomized controlled interventional study in cluded 33 eyes which had preoperative corneal astigmatism≥1.5 D and ocular axial length≥25.5 mm.These eyes were randomly divided into two groups to undergo phacoemulsification and toric IOL implantation with either four-eyelet CTR implantation(group A,n=16)or two-eyelet CTR implantation(group B,n=17).Uncorrected visual acuity(UCVA),best-corrected visual acuity(BCVA),phoropter examination results,and toric IOL rotation degrees were tested 6 mo after the surgery.RESULTS:In both groups,the toric IOL was in the capsular sac 6 mo after surgery.The difference between the two groups in terms of visual outcome was not found to be statistically significant(P>0.05)at a follow-up of 6 mo.The mean residual astigmatism values were 0.56±0.22 D and 0.92±0.24 D in A and B groups,respectively(P<0.001).The mean rotation degree of IOL was 1.00°±0.73°in group A and 3.53°±1.46°in group B(P<0.001).CONCLUSION:In cataract patients with high myopia and astigmatism,four-eyelet CTR can effectively increase the rotation stability of toric IOLs,achieving the desired goal of correcting corneal astigmatism.

Technique of using Cionni-modified capsular tension ring in the management of severely traumatic lens subluxation

AIM:To investigate the effect of Cionni-modified capsular tension ring(CTR)implantation in patients with severely traumatic subluxated cataracts.METHODS:All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed.Corrected distance visual acuity(CDVA),extent of zonulysis,intraocular lens(IOL)position,intraoperative presentation,and complications were assessed.The primary outcomes included IOL centration stability and other postoperative complications.RESULTS:Twenty patients(20 eyes)were included in this study.The mean age in this study was 58.0±11.3y,and the average follow-up time was 17.3±12.8mo.Capsule bags were saved by Cionni-modified CTR.Nine eyes(45%)underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber.The preoperative mean CDVA was 0.83±0.24 log MAR,and the postoperative average CDVA was 0.23±0.30 log MAR(P<0.05).The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm,respectively;the vertical and horizontal IOL tilt after surgery was 5.5°±2.5°and 6.1°±2.2°,respectively.None of the eyes had obvious IOL decentration during the follow-up time.Eight eyes(40%)had posterior capsule opacification(PCO)that was severe enough to cause poor vision.Neodymium:YAG laser capsulotomy were performed on these eyes when the CTR was stabilized.CONCLUSION:With the help of Cionni-modified CTR,capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

Placement of dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis

Background:To evaluate the efficacy and safety of placing dual capsular tension rings for the combined management of traumatic cyclodialysis cleft and zonular dialysis.Methods:A modified capsular tension ring was inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring was inserted into the capsular bag in 20 eyes in 20 consecutive patients showing signs of ocular hypotony and ectopia lentis.Outcome measures included intraocular pressure,best-corrected visual acuity,and postoperative complications.Results:Dual capsular tension ring placement was performed in 20 patients with a mean age of 48.7 years.The cyclodialysis cleft extended over 2.9 clock hours(range 0.5-6.5).The modified capsular tension ring was successfully inserted into the ciliary sulcus and a capsular tension ring or modified capsular tension ring in the capsular bag in all eyes.At the last follow-up,the cyclodialysis cleft was closed in 16/20(80.0%)eyes.The intraocular lens was stable in all patients postoperatively.Best-corrected visual acuity,in terms of the logarithm of the minimal angle of resolution,improved from 1.3±0.8 before surgery to 0.4±0.3 after surgery(P<0.001).Intraocular pressure increased significantly from 10.6±3.2 mmHg before surgery to 13.0±4.8 mmHg after surgery(P=0.040).Postoperative complications included a painful reversible intraocular pressure spike in four patients(20.0%).Logistic regression revealed no significant factors associated with successful cleft closure and a stable final intraocular pressure of≥10 mmHg.Conclusions:The placement of two capsular tension rings into the ciliary sulcus and the capsular bag is a safe,successful procedure combined for repairing a traumatic cyclodialysis cleft and managing zonular dialysis.

“NIR-triggered ROS storage”photodynamic intraocular implant for high-efficient and safe posterior capsular opacification prevention

Posterior capsular opacification(PCO)is the leading cause of vision loss after cataract,mainly caused by the adhesion,proliferation and trans-differentiation of post-operative residual lens epithelial cells(LECs).Effective PCO prevention remains a huge challenge to ophthalmologists and researches for decades.Herein,we developed a“NIR-triggered ROS storage”intraocular implant(CTR-Py-Pp IX)based on capsular tension ring(CTR),which is concurrently linked with photosensitizer protophorphyrin IX(Pp IX)and energy storage2-pyridone derivative(Py),to guarantee instantaneous and sustainable ROS generation for LECs killing,aiming to achieve more efficient and safer photodynamic therapy(PDT)to effectively prevent PCO.The silylated Pp IX-Si and Py-Si were covalently conjugated to the plasma activated CTR surface to obtain CTR-Py-Pp IX.Results demonstrated that CTR-Py-Pp IX had dual functions of PDT and battery,in which Pp IX could generate ROS extracellularly under irradiation,with one part directly inhibiting LECs by lipid peroxidation(LPO)induction of cell membranes.Meanwhile,the excess ROS stored in Py could be continuously released to amplify LPO levels after the irradiation was removed.Ultimately,the proliferation of LECs in capsular bag was completely inhibited under mild irradiation conditions,achieving a sustainable and controlled PDT effect for effective PCO prevention with good biocompatibility.This NIR-triggered ROS storage intraocular implant would provide a more efficient and safer approach for long-term PCO prevention.

Efficacy of haptic sutured in-the-bag intraocular lens for intraocular lens-capsule complex stability:a comparison of three insertion methods

·AIM:To evaluate the efficacy and stability of haptic sutured in-the-bag intraocular lens(IOL)in eyes with zonular instability.·METHODS:A total 60 eyes of 60 patients were included in this retrospective cohort study.Postoperative stability in three groups[haptic sutured IOL in the bag,IOL in the bag insertion with haptics oriented toward areas of zonulysis,IOL with capsular tension ring(CTR)in the bag insertion]were compared according to the IOL insertion methods.To evaluate the IOL stability,the changes of anterior chamber depth(ACD),refraction,contraction of anterior continuous curvilinear capsulotomy(CCC)area,and tilt of IOL were compared.·RESULTS:There was no significant difference in change of ACD(-0.04±0.01 mm in group of haptic sutured IOL,-0.07±0.01 mm in group of CTR insertion)and refraction(0.05±0.05 D in group of haptic sutured IOL,0.37±015 D in group of CTR insertion)between the group of haptic sutured IOL in the bag and CTR insertion group.But in comparison of CCC contraction and IOL tilt,CTR insertion group showed less contraction(1.00%±0.52%)and less IOL tilt(2.66°±0.11°)than the group of haptic sutured IOL in the bag(6.32%±1.36%,3.47°±0.11°,respectively).The CTR insertion group showed the least CCC contraction and the least tilt.·CONCLUSION:In eyes with zonular instability,the method of haptic sutured IOL in-the-bag shows comparable stability in ACD and refraction in comparison with IOL with CTR in the bag insertion.The method of IOL only in-thebag insertion shows the largest contraction of CCC and the largest tilt of IOL.