Full-vision maintenance in extra-high myopia from implantable collamer lens to trifocal intraocular lens implantation

Dear Editor,I am Dr.Ye Shen from the Department of Ophthalmology,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou,China.I write to share my experience of full-vision maintenance in patient with extrahigh myopia from implantable collamer lens （ICL） to trifocal intraocular lens （IOL） implantation.

Commentary review:challenges of intraocular lens implantation for congenital cataract infants

As an indispensable part of congenital cataract surgery,intraocular lens(IOL)implantation in infantile patients has long-term positive impacts on visual rehabilitation,as well as postoperative complications inevitably.Timing of IOL implantation in infantile congenital cataract patients is not simply a point-in-time but a personalized decision that comprehensively takes age at surgery,risks of postoperative complications,and economic condition of family in consideration,and combines with choosing suitable IOL type and power.For infants with well-developed eyeballs and good systemic conditions,IOL implantation at six months of age or older is safe and effective.Otherwise,secondary IOL implantation may be a safer choice.

Ciliary body detachment after secondary intraocular lens implantation in childhood

Dear Sir,Iam Dr.Li-Na Meng,from the Qingdao Eye Hospital,Shandong Eye Institute,Shandong Academy of Medical Sciences,Qingdao,China.I want to present a rare case of secondary intraocular lens(IOL)implantation in an11-year-old boy who developed the complication of ciliary body detachment.When he was 2 years old,the boy underwent bilateral cataract extraction for congenital cataract in the other

Rhegmatogenous retinal detachment after intraocular lens implantation in high myopia:A case report and literature review

Objective:To observe the changes of diagnosis and treatment of a patient with rhegmatogenous retinal detachment(RRD)after phakic intraocular lens implantation in high myopia,and analyze its mechanism and treatment combined with the literature.Methods:To report a case of rhegmatogenous retinal detachment(RRD)after phakic intraocular lens implantation.Result:Two months after the patient underwent scleral cerclage+pad pressing+vitrectomy+silicone oil filling,the fundus color photos showed that the vitreous cavity was filled with silicone oil,the fundus retina was flat,the cerclage ridge was obvious,and a large number of old laser spots.After the silicone oil in the eye was removed,the eye examination:the naked visual acuity of the left eye was 0.12,the corrected visual acuity was-3.25ds/-1.50dc*180=0.4,the intraocular pressure was 19mmHg,the ring ridge was seen in the fundus after mydriasis,a large number of old laser spots and flat retina;The OCT showed that the macular structure of the left eye was complete and there was no subretinal fluid.Conclusion:Scleral cerclage+padding+vitrectomy+silicone oil filling is an effective treatment for retinal detachment(RD)after PIOL.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

A novel ophthalmic viscosurgical devicefree phakic intraocular lens implantation makes myopic surgery safer

Purpose:To assess the efficacy and safety of a novel ophthalmic viscosurgical device-free(OVD-free)method for posterior chamber phakic intraocular lens(PIOL)implantation in myopic eyes.Methods:In this retrospective cohort study,the medical records of myopic eyes that underwent PIOL(Implantable Collamer Lens,ICL)implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed.A total of 49 eyes with complete data that met follow up requirements(2 h,1 day,1 week,3 months postoperatively)were recruited.Based on the surgical techniques used,the eyes were divided into the OVD-free method group and the standard method group.The clinical data,including intraocular pressure(IOP),corrected distance visual acuity(CDVA)and spherical equivalent(SE),at each follow-up were collected for comparison.Endothelial cell loss and complications were also investigated.Results:Twenty-one eyes received the standard method,and 28 eyes received the OVD-free method.A rise in IOP>22 mmHg at 2 h was noted in 14 eyes(66.7%)in the standard group and none(0%)in the OVD-free group(p<0.001).The rise in IOP from baseline was significantly higher at 2 h in the standard group(10.5±5.2 mmHg vs.2.2±3.3 mmHg,difference:8.3,95%CI 5.8 to 10.8;p<0.001).There was a significant difference in the time course of LogMAR CDVA changes between the two groups(p=0.047).The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day(−0.076,95%CI−0.134 to−0.018;p=0.012),1 week(−0.071,95%CI−0.135 to−0.007;p=0.03),but not at 3 months(−0.046,95%CI−0.107 to 0.015;p=0.134).There was no significant difference in the time course of SE changes between the two groups(p=0.471;p=0.705).In the OVD-free group,mean endothelial cell loss was 4.6%at 3 months(2522±281 vs.2407±226 cells/mm^(2),difference:-115,95%CI−295 to 65;p=0.187).No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period.Conclusions:The OVD-free method is safe and efficient for ICL implantation.It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devicesrelated complications without causing additional complications.

Flapless one-knot suture:a novel surgical technique for transscleral fixation of C-loop intraocular lenses

AIM:To describe a novel suture approach for transscleral fixation of C-loop intraocular lenses(IOL)and to compare the surgical outcomes with the four-haptics posterior chamber(PC)-IOL technique.METHODS:We retrospectively analyzed 16 eyes of 16 patients who underwent transscleral fixation of C-loop PCIOLs using a flapless one-knot suture technique,which were followed up for longer than 17mo.In this technique,the capsulorless IOL was suspended using a single suture for transscleral fixation of four feet.Then we compared its surgical outcomes and complications with the four-haptics PC-IOLs using the Student's t test and Chi-square test.RESULTS:Sixteen patients of 16 eyes with a mean age of 58.3±10.1y(42-76y)who received transscleral C-loop IOL implantation due to trauma,vitrectomy,or cataract surgery with inadequate capsule support showed improved visual acuity.The difference was not significant between two IOLs except the surgery time(P>0.05).The mean operation times of C-loop IOL surgery was 24.1±1.83min and 31.3±4.47min of the four-haptics PC-IOL method(P<0.0001).In the C-loop IOLs group,there was statistical difference between the preoperative and the postoperative UCVA(log MAR,1.20±0.50 vs 0.57±0.32,P=0.0003).There was no statistical difference between the preoperative and the postoperative BCVA(log MAR,0.66±0.46 vs 0.40±0.23,P=0.056).However,there was no statistically significant difference in postoperative UCVA and BCVA between the two IOLs(P>0.05).We did not detect any optic capture,IOL decentration or dislocation,suture exposed,or cystoid macular edema in patients underwent C-loop IOLs surgery.CONCLUSION:The novel flapless one-knot suture technique for transscleral fixation of C-loop IOL is a simple,reliable,and stable technique.

Bimanual microincision cataract surgery with implantation of the new Incise~? MJ14 intraocular lens through a 1.4 mm incision

AIM：To analyze the visual outcomes and the posterior capsule opacification（PCO）with the new Incise？MJ14intraocular lens（IOL）implanted through a 1.4 mm clear corneal incision（CCI）in patients who underwent bimanual microincision cataract surgery（B-MICS）.METHODS：Eighty eyes which underwent cataract surgery using B-MICS technique performed by the same experienced surgeon were included in the study：40 eyes were implanted with an Incise？MJ14 IOL through a 1.4 mm CCI（group A）without enlargement of the main CCI,while 40 eyes were implanted with an Akreos？MI60 IOL with enlargement of the main CCI to 1.8 mm（group B）.Best corrected visual acuity（BCVA）,astigmatism and endothelial cell loss were evaluated before and after surgery at 7,30d and 6mo.Anterior segment-optical coherence tomography（AS-OCT）of CCI was performed at 1,3,7,30d,6 and 18mo.PCO incidence was evaluated at 18mo using EPCO 2000 Software.RESULTS：Mean BCVA improvement and endothelial cell loss were statistically significant at 18mo in both groups with no difference between the two groups;no statistically significant difference in surgically induced astigmatism（SIA）was noticed in the two groups.At AS-OCT the only significant alterations in the CCI were endothelial gaping and local detachment of Descemet’s membrane at 1 and 7d after surgery;no statistically significant alterations were found at 1,6 and 18mo.PCO score at 18mo was 0.03±0.07for group A and 0.08±0.18 for group B（P=0.11）with no sign of central optic plate invasion in both groups.CONCLUSION：The implant of the new Incise？MJ14 IOL through a 1.4 mm CCI and B-MICS technique appeared to be a safe and effective procedure with rapid visual recovery.PCO rate resulted very low and the CCI presented few morphological alterations which were only detectable in the first days postoperatively and achieved fast corneal healing during the long-term follow-up.

A Clinical Analysis of 120 Cases with Traumatic Cataract Treated by Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation

Extracapsular cataract extraction was performed combined with posterior chamber intraocular lens implantation on 120 inpatients (122 eyes) with traumatic cataract from 1992 to 1997. The results revealed that this combined operation can make most of them get useful visual acuity, although they were often accompanied with several comlicated eye injuries. We think the most important thing is to choose suitable opertion time, the reasonable operation method and take close followup after operation.

Combined pars plana vitrectomy and suture less scleral fixation of foldable intraocular lens:single surgery visual rehabilitation of dislocated lens/intraocular lens

Background:To evaluate efficacy and safety of combined pars plana vitrectomy(PPV)and scleral fixated intraocular lens(SFIOL)surgery as a single procedure.Methods:Retrospective interventional case series done at a tertiary eye care center in Northern India.Eleven patients who underwent combined PPV and SFIOL surgery were included and analyzed retrospectively.Results:Mean age of the patients was 43.36±15.12 years(range,22-64 years).Eight were male.Mean baseline best corrected visual acuity(BCVA)was 0.78±0.63 logMAR units while the mean post-operative BCVA at 6 months follow-up was 0.37±0.29 logMAR units,the visual gain being statistically significant(P=0.021).None of the patients had a drop in BCVA with nine patients having final BCVA better than 0.48 logMAR units.Choroidal detachment(CD)was the only notable complication,seen in three patients.Other complications included two cases of intraoperative retinal breaks,a case each of reversible corneal edema,ocular hypertension and cystoid macular edema.Conclusions:Combined PPV and SFIOL is an efficacious procedure for managing IOL/lens dislocation and aphakia in a single surgery.There may be short-term reversible complications with no impact on final visual gain.

Multifocal and extended depth of focus intraocular lenses

Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number of focal points that each lens provides,which in turn leads to different visual outcomes.Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs.In this review,we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance,intermediate and near vision,contrast sensitivity,and reading performance.Finally,we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.

Severe prelenticular membrane formation on the surface of a hydrophilic acrylic intraocular lens after cataract surgery in an eye with an Ahmed valve implant

【正】Dear Sir,Iam Yong-Sun Ahn,from the Department of Ophthalmology of St.Vincent Hospital of Suwon,Kyungki-do,South Korea.Cataracts are a common problem in eyes with a glaucoma drainage device(GDD),because tube shunt surgery increases the incidence and progression of cataracts[1].An Ahmed valve,the most commonly inserted GDD,is composed of a silicone tube connected to a flat plate sewn to the sclera,and aqueous humor flows from the

Considerations in the management of single-piece intraocular lenses outside the capsular bag

AIM: To investigate the outcomes of off label singlepiece acrylic intraocular lenses(SPA-IOL) ciliary sulcus placement compared to three-piece IOL(3P-IOL). METHODS: The charts of eight consecutive eyes of patients who received sulcus-placed SPA-IOLs between 2006 and 2009 were reviewed. None of the patients underwent IOL exchange. Charts of six age-matched patients who received sulcus placed 3P-IOLs were reviewed as a control group. RESULTS: Mean follow up was 16 mo for SPA-IOL and 23 mo for 3P-IOL. Five of 8 patients in the SPA-IOL group required chronic use of IOP lowering medications at final follow up. Of these, one patient needed glaucoma implant surgery for uncontrolled IOP. One patient in the 3P-IOL group used chronic aqueous suppression pre- and postoperatively. Four of eight eyes with SPAIOL were treated with chronic topical steroids and or non-steroidal anti-inflammatory drugs for cystoid macu-la edema, chronic uveitis, pigment dispersion syndrome or a combination of the above, compared to none in the control group. Mean best-corrected visual acuity was 20/35 in the SPA-IOL group and 20/47 in the 3PIOL group.CONCLUSION: Sulcus placed SPA-IOLs are associated with increased ocular morbidity. In select cases good visual acuity may be achieved. Due to postoperative rotation of sulcus placed toric SPA-IOLs stable astigmatism correction cannot be achieved. Alternative intraocular lenses should be considered when in-the-bag placement of SPA-IOL is not possible.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients

BACKGROUND Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation,blood supply,metabolism,and the microenvironment.Traditional phacoemulsification may not fully tackle these issues,especially in instances with substantial preoperative astigmatism.The utilization of femtosecond laser-assisted phacoemulsification,in conjunction with Toric intraocular lens(IOL)implantation,offers a potentially more efficient strategy.This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients.AIM To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients,comparing it with traditional phacoemulsification methods.METHODS This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021.The patients were divided into two groups:the control group underwent traditional phacoemulsification and Toric IOL implantation,while the treatment group received Len Sx femtosecond laser-assisted treatment.Outcome measures included naked eye vision,astigmatism,high-level ocular phase difference detection,clinical efficacy,and complication.RESULTS There were no significant preoperative differences in astigmatism or naked eyesight between the two groups.However,postoperative improvements were observed in both groups,with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure.High-level corneal phase difference tests also indicated significant differences in favor of the treatment group.CONCLUSION This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Analysis of macular microvasculature and thickness after ICL implantation in patients with myopia using optical coherence tomography

AIM:To investigate changes in macular vessels and thickness in myopic eyes after intraocular collamer lens(ICL)implantation using quantitative optical coherence tomography angiography(OCTA).METHODS:This retrospective included 73 myopic eyes of 73 patients(average age,27.53±6.16 y)who underwent ICL implantation(28 eyes were Toric ICL).Axial length(AL),uncorrected visual acuity(UCVA),refractive dioptre(RD),intraocular pressure(IOP)and OCTA were measured and compared with before and 1 wk,1,and 3 mo after surgery.OCTA was used to image vessel density(VD)and skeleton density(SD)in both the superficial(SCP)and deep capillary plexus(DCP).Central retinal thickness(CRT)and ganglion cellinner plexiform layer thickness(GCT)were also measured.Changes between pre-and postoperative measurements were analysed by repeated measures analysis of variance.RESULTS:Compared with preoperative data,postoperative data on UCVA revealed significant improvements in all patients(P<0.05).However,there was no significant difference in IOP.After the operation,CRT and GCT exhibited significant changes(P<0.05).Among these measures,CRT was significantly higher at one and three months postoperative(all P<0.01).GCT was significantly higher at 1 wk,1,and 3 mo postoperative(all P<0.01).Changes in VD and SD were nonsignificant in both the SCP and DCP.There was no difference in postoperative changes between the ICL and Toric ICL groups.CONCLUSION:ICL and Toric ICL implantation both have good efficacy and safety for myopic eyes,but macular area changes that occur after surgery need attention.

Corneal refractive surgery and phakic intraocular lens for treatment of amblyopia caused by high myopia or anisometropia in children

Objective A systematic review of literature was performed to compare various visual function parameters including the final visual acuity outcome and/or adverse events between corneal refractive surgery （CLRS） and phakic intraocular lens implantation （p-IOLi） in the treatment of refractive amblyopic children.Data sources Two reviewers independently searched the PubMed,EMBASE,and Controlled Trials Register databases for publications from 1991 to 2013.Study selection There were 25 articles,including 597 patients and 682 eyes,was included in CLRS group.Among them,21 articles reported the use of CLRS in the treatment of myopic anisometropia for 318 patients （13 photorefractive keratectomy or laser epithelial keratomileusis and eight laser in situ keratomileusis）.And 11 articles had the results of CLRS in treating hyperopic anisometropic amblyopia children.Eleven articles reported the effect of p-IOLi for treating high myopia or anisometropic amblyopia,including 61 patients （75 eyes）.Age,pre-and postoperation best-corrected vision acuity （BCVA）,and spherical equivalent （SE） were compared in CLRS and p-IOLi groups.Results The average age of CLRS group and p-IOLi group has no statistically significant difference.The SE in CLRS group for myopic anisometropia amblyopia patients was （-10.13±2.73） diopters （D） and for hyperopic anisometropia amblyopia patients was （5.58±1.28） D.In p-IOLi group the SE was （-14.01±1.93） D.BCVA was improved significantly in both groups,and even better in p-IOLi group.Refractive errors were corrected in both groups,but there was no clinically significant difference in final SE between each group.More than one-half of the children had improved binocular fusion and stereopsis function in both groups.Conclusions Both CLRS group and p-IOLi group showed their advantage in treating refractive amblyopia in children.In comparing p-IOLi with CLRS for treatment of refractive amblyopia,no statistically significant difference in final BCVA was observed.

Five‑year outcomes of EVO implantable collamer lens implantation for the correction of high myopia and super high myopia

Background:To evaluate the long-term safety,efficacy,predictability,and stability of implantable collamer lens with a central hole(EVO ICL)implantation for correcting high myopia(HM)and super high myopia(SHM).Methods:This prospective study evaluated 83 eyes of 46 patients who were divided into groups based on their spherical equivalent refractive error(SE):HM group(−12 D≤SE<−6 D)and SHM group(SE<−12 D).They were followed up for 5 years after ICL implantation;assessments of uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),manifest refractive error,axial length,intraocular pressure,corneal endothelial cell density,and vault were conducted,and a questionnaire was administered.ResuIts:At 5 years postoperatively,the safety indices of the HM and SHM groups were 1.03±0.10 and 1.32±0.39,and the efficacy indices were 0.83±0.25 and 0.86±0.32,respectively.In the HM group,60.47%and 79.07%of the eyes were within±0.50 D and±1.00 D of the attempted correction,while it was achieved for 22.50%and 47.50%of the eyes in the SHM group,respectively.The SE of the HM group decreased from−9.72±1.41 D preoperatively to 0.04±0.39 D 1 month postoperatively and−0.67±0.57 D 5 years postoperatively,while in the SHM group,it decreased from−15.78±3.06 D preoperatively to−0.69±0.97 D 1 month postoperatively and−1.74±1.19 D 5 years postoperatively.Conclusion:EVO ICL implantation is safe,effective,and predictable for correcting HM and SHM.CDVA improved more after surgery for SHM,but the growth of axial length still needs attention.

Refractive outcomes after vitrectomy combined with phacoemulsification of idiopathic macular holes

AIM:To report the refractive outcomes after vitrectomy combined with phacoemulsification and intraocular lens(IOL)implantation(phaco-vitrectomy)in idiopathic macular holes(IMH).METHODS:A total of 56 eyes with IMH(IMH group)that underwent phaco-vitrectomy and 44 eyes with age-related cataract(ARC group)that underwent cataract surgery were retrospectively reviewed.The best corrective visual acuity(BCVA),predicted refractive error(PRE),actual refractive error(ARE),axial length(AL),were measured in both groups before and 6 mo after operation.The power calculation of IOL and the predicted refractive error(PRE)were calculated according to the SRK/T formula.The difference of PRE and ARE between the two groups were compared and analyzed.RESULTS:In the IMH group,the diameters of macular holes were 271.73±75.85μm,the closure rate was 100%.The pre-and post-operative BCVA were 0.80±0.35 and 0.40±0.35 log MAR.The PRE of A-ultrasound and IOL Master in the IMH group was-0.27±0.25 and 0.10±0.66 D.The postoperative mean absolute prediction error(MAE)was observed to be 0.58±0.65 and 0.53±0.37 D in the IOL Master and A-ultrasound(P=0.758).The PRE and ARE of the IMH group were 0.10±0.66 D and-0.19±0.64 D(P=0.102).The PRE and ARE of the ARC group was-0.43±0.95 and-0.31±0.93 D(P=0.383).The difference between PRE and ARE was-0.33±0.81 and 0.09±0.64 D in the IMH and ARC groups(P=0.021).The proportion of myopic shift was 67.9%in the IMH group and 27.3%in the ARC group(P=0.004).CONCLUSION:The myopic shift can be observed in patients with IMH after phaco-vitrectomy.

Utilizing dexamethasone intravitreal implant to control postoperative inflammation in refractory uveitis undergoing cataract surgery

AIM:To report the effectiveness of intravitreal implantation of dexamethasone implant(Ozurdex)after phacoemulsification and intraocular lens implantation in refractory uveitis patients.METHODS:This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation.The main outcome measurements were bestcorrected visual acuity(BCVA),central retinal thickness(CRT),grade of anterior chamber cell(AAC),intraocular pressure(IOP),and systemic/ocular adverse events.RESULTS:Ten eyes of 7 patients were included.BCVA showed significant improvement at 1 mo(P=0.004),3 mo(P=0.0004),and 6 mo(P=0.001)post operation.There were no statistically significant differences in the postoperative CRT among follow-up groups(P>0.05).No significant differences were observed in the baseline IOP when compared to 1,3,and 6 mo(all P>0.05)post operation.One patient developed a transient elevated IOP post injection.Two eyes(20%)developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy.In six patients(8 eyes,71.4%),the systemic steroid usage was reduced to below 10 mg/d.The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6 mo before operation and 0.7±0.48 in the 6 mon post operation.The mean recurrence time was 13±0.58 wk(range 12-14 wk)post operation.In five of seven patients(7 out of 10 eyes),inflammation relapse was developed postoperatively.Only one patient(2 eyes)needed increased amounts of oral corticosteroids.Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids.CONCLUSION:Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study.After the disappearance of Ozurdex’s antiinflammatory effects over time,in most cases the recurrent inflammation can be controlled by topical steroids.

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous

AIM：To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous（PHPV）.METHODS：This retrospective study included patients with cataract and PHPV treated with various strategies.Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization,posterior capsulotomy,anterior vitrectomy,and intraocular lens（IOL）implantation. Posterior PHPV was treated with lensectomy,posterior vitrectomy,retinal photocoagulation,and IOL implantation or silicone oil tamponade. Visual acuity（VA）,pattern visual evoked potential（P-VEP）,anatomic recovery,postoperative complications,and amblyopia outcome were examined.Subjects were followed-up for 3-48 mo after surgery.RESULTS：Of the 30 patients（33 eyes）with congenital cataract and PHPV included（average age,39.30±35.47mo）,9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage（6 eyes）and twostage（3 eyes）implantation. Postoperative complications included retinal detachment（1 eye）and recurrent anterior chamber hemorrhage（1 eye）. In eyes with posterior PHPV,6 and 11 eyes received IOLs in one-and two-stage procedures,respectively. Silicone oil was retained in 2 eyes,and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48 mo of amblyopia treatment. P-VEP P_（100） was improved following surgery in both PHPV types.CONCLUSION：Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.