Intraocular lens implantation performed first to protect the posterior capsule in Morgagnian cataracts during phacoemulsification

This study evaluated the safety of a modified method to implant an intraocular lens (IOL) into the capsular bag immediately after capsulorhexis with a whole or partial nucleus to protect the posterior capsule (PC) during phacoemulsification in a series of 12 Morgagnian cataracts. For 3 cases of hypermature cataracts with smaller and rigid nuclei, after a complete capsulorhexis, an IOL was directly inserted into the capsular bag, which protected the PC during the subsequent phacoemulsification process in the iris plate. For the other 9 cases with larger and softer nuclei, after the nucleus was partially emulsified, the IOL was inserted into the bag. Even with an obvious surge for some cases, the surgeries were uneventful in all 12 cases, with no PC rent or vitreous loss. IOL implantation into the capsular bag with a whole or partial nucleus can provide effective protection for the PC for hypermature cataract during phacoemulsification.

Trocar opening: silicone oil removal with phacoemulsification and intraocular lens implantation

AIM: To evaluate the efficacy and safety of a modified technique [trocar opening(TO)] for silicone oil removal(SOR) in combination with phacoemulsification and intraocular lens(IOL) implantation.METHODS: A total of 60 eyes of 60 patients with cataract and silicone oil-filled eyes were enrolled in this study. The patients were divided into two groups: the patients in the control group underwent 23-gauge pars plana active SOR surgery with phacoemulsification and IOL implantation, while the patients in the TO group underwent TO methods during surgery. Best corrected visual acuity(BCVA), surgery time, intraocular pressure, and operative complications were observed 6 mo after surgery.RESULTS: There was no significant difference between the two groups in terms of age, gender, preoperative, intraocular pressure, or time of silicone oil stay. Prior to surgery, the mean BCVA for the control and TO groups was 1.34±0.44 and 1.36±0.42. At 6 mo following surgery, the mean BCVA improved to 0.74±0.36 and 0.77±0.32, respectively(P<0.001). There was no significant difference between the two groups. The mean SOR time was 6.9±2.3 min and 4.8±1.2 min in the control and TO groups(P=0.008). The total operation time was 28.2±8.5 min and 24.6±6.4 min, respectively(P=0.035). Posterior capsule rupture occurred in four eyes of control and none of TO group(P<0.01). Late recurrent retinal detachment occurred in one eye in the control group(2 mo after surgery) and in one eye in the TO group(4 mo after surgery). CONCLUSION: TO is a simple, effective, time-saving, and safe method for SOR combined with phacoemulsification and IOL implantation.

New Management of Angle-closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective:To investigate the management of angle-closure glaucoma by phacoemulsification with foldable posterior chamber intraocular lens(PC-IOL)implantation.Design:Retrospective,noncontrolled interventional case series.Participants:In36eyes with angle-closure glaucoma(ACG),there were18eyes with primary acute angle-closure glaucoma(PACG),14eyes with primary chronic angle-closure glaucoma(PCCG),3eyes with secondary acute angle-closure glaucoma(SACG)and 1eye with secondary chronic angle-closure glaucoma(SCCG).Intervention:Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures:Postoperative visual acuity,IOP,axial anterior chamber depth.Results:After a mean postoperative follow-up time of 8.81±7.45months,intraocular pressure was reduced from a preoperative mean of 23.81±17.84mmHg to a postoperative mean of 12.54±4.73mmHg(P=0.001).Mean anterior hamber depth was1.75±0.48mm preoperatively and2.29±0.38mm postoperatively(P=0.000).Best spectacle-corrected visual acuith in 36eyes ranged from0.01to0.7(20/200to20/30)postoperatively,which was better than preoperative VA ranging from hand movement to 0.4(20/50)(P=0.000).Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation can be a good alternative in treating angle-closure glaucoma,Eye Science 2000;16:22-28.

New Management of Malignant Glaucoma by Phacoemulsification with Posterior Chamber Foldable Intraocular Lens Implantation

Objective:To investigate the feasibility of phacoemulsification with posterior chamber foldable intraocular lens implantation in the management of malignant glaucoma. Patients and Methods:Fourteen patients with malignant glaucoma diagnosed in the Department of Glaucoma were enrolled in the study.12 patients developed malignant glaucoma after filtration surgery.1 developed after peripheral iridectomy.1 patient developed malignant glaucoma without any clear cause.Cataract phacoemulsification was performed.Posterior chamber intraocular foldable lens was implanted in 10 cases of patients.Results:All 14 patients were cured wiht normal intraocular pressure,normal anterior chamber depth and increased visual acuity.Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation is a good alternative in treating malignant glaucoma.

The Changes of Quality of Life in the Patients after Phacoemulsification with IntraocularLens Implantation

Purpose:To investigate the improvement and maintenance of the quality of life in the patients after phacoemulsification with intraocular lens implantation.Methods:The study population consisted of 116 patients receiving phacoemulsification with intraocular lens implantation. They were interviewed using the quality of life questionnaire, and the clinical outcomes were evaluated before surgery and at 1 week, 1 month, 3 months, 6 months after surgery respectively.Results:Patients reported similar scores of quality of life and all the four subscales among 1-week ,1-month ,3-month and 6-month follow-up visit after surgery, all of which were higher than the scores before surgery.Conclusion:Patients receiving phacoemulsification reported rapid improvement in quality of life after surgery, and the quality of life scores were not changed significantly from 1 week to 6 months after surgery.

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.

Comparison of Visual Quality after Implantation of Big Bag and Akreos Adapt Intraocular Lenses in Patients with High Myopia

Purpose: To compare vision quality following phacoemulsification cataract extraction and implantation of a Big Bag or Akreos Adapt intraocular lens(IOL) in patients diagnosed with high myopia complicated with cataract.Methods:.This was a randomized prospective control study.The patients with high myopia complicated with cataract, with axial length ≥28 mm,.and corneal astigmatism ≤1D were enrolled and randomly divided into the Big Bag and Akreos Adapt IOL groups. All patients underwent phacoemulsification cataract extraction and lens implantation..At 3 months after surgery,.intraocular high-order aberration was measured by a Tracey-i Trace wavefront aberrometer at a pupil diameter of 5mm in an absolutely dark room and statistically compared between two groups. The images of the anterior segment of eyes were photographed with a Scheimpflug camera using Pentacam three-dimensional anterior segment analyzer..The tilt and decentration of the IOL were calculated by Image-pro plus 6.0imaging analysis software and statistically compared between two groups.Results:.In total,.127 patients(127 eyes),..including 52 males and 75 females, were enrolled in this study. The total high-order aberration and coma in the Akreos Adapt group(59 eyes)were significantly higher compared with those in the Big Bag(P <0.05)..The clover and spherical aberration did not differ between the two groups(P>0.05). The horizontal and vertical decentration were significantly smaller in the Big Bag lens group than in the Akreos Adapt group(both P<0.05), whereas the tilt of IOL did not significantly differ between the two groups(P>0.05).Conclusion:.Both Big Bag and Akreos Adapt IOLs possess relatively good intraocular stability implanted in patients with high myopia. Compared with the Akreos Adapt IOL, the Big Bag IOL presents with smaller intraocular high-order aberration. Coma is the major difference between the two groups.

Evaluating newer generation intraocular lens calculation formulas in manual versus femtosecond laser-assisted cataract surgery

AIM:To determine the refractive accuracy of the Haigis,Barrett Universal II(Barrett),and Hill-radial basis function 2.0(Hill-RBF)intraocular lens(IOL)power calculations formulas in eyes undergoing manual cataract surgery(MCS)and refractive femtosecond laser-assisted cataract surgery(Re LACS).METHODS:This was a REB-approved,retrospective interventional comparative case series of 158 eyes of 158 patients who had preoperative biometry completed using the IOL Master 700 and underwent implantation of a Tecnis IOL following uncomplicated cataract surgery using either MCS or ReLACS.Target spherical equivalence(SE)was predicted using the Haigis,Barrett,and Hill-RBF formulas.An older generation formula(Hoffer Q)was included in the analysis.Mean refractive error(ME)was calculated one month postoperatively.The lens factors of all formulas were retrospectively optimized to set the ME to 0 for each formula across all eyes.The median absolute errors(MedAE)and the proportion of eyes achieving an absolute error(AE)within 0.5 diopters(D)were compared between the two formulas among MCS and ReLACS eyes,respectively.RESULTS:Of the 158 eyes studied,64 eyes underwent MCS and 94 eyes underwent ReLACS.Among MCS eyes,the MedAE did not differ between the formulas(P=0.59),however among ReLACS eyes,Barrett and Hill-RBF were more accurate(P=0.001).Barrett and Hill-RBF were both more likely to yield AE<0.5 D among both groups(P<0.001).CONCLUSION:The Barrett and Hill-RBF formula lead to greater refractive accuracy and likelihood of refractive success when compare to Haigis in eyes undergoing Re LACS.

Corneal injection track: an unusual complication of intraocular lens implantation and review

Phacoemulsification is the main gold standard for cataract operation in the developed world together with foldable intraocular lens(IOL) implantation by injection,allowing for stable wound construction and less postoperative astigmatism. It is a safe procedure with high success rate with the advancement in machines,improvement of IOL injection systems and further maturation of surgeons’ techniques. Despite the large number of operations performed every day, foldable IOL injection leading to an intra-stromal corneal track is a very rare complication. We report a case of this unusual finding in a 70-year-old gentleman who has undergone cataract operation in November 2011 in our hospital and will review on the complications related to foldable IOL injection.

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM:To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens(IOL)in eyes with low degrees of corneal astigmatism.METHODS:Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL(FineVision PODFT,PhysIOL s.a.,Liege,Belgium)were enrolled.Phacoemulsification with femtosecond laser,capsular tension ring insertion and intraoperative aberrometry were performed in all cases.All IOLs used showed a cylinder power of 1.00 D.Main outcome measures were refractive error and corrected-distance visual acuity(CDVA)and uncorrected-distance visual acuity(UDVA)values.Eyes were evaluated at 4 mo post-surgery.RESULTS:Totally 50%of eyes showed a spherical equivalent(SE)within±0.13 D and all of them within±0.50 D.The mean SE and refractive cylinder were-0.02±0.23 and-0.16±0.22 D,respectively.Vector analysis revealed that 100%of eyes were within±0.50 D for the SE and cylindrical components(J0 and J45).Refractive changes were not correlated with keratometric changes(P>0.05)showing that the reduction in astigmatism comes from the trifocal toric IOL.Of 81%and 96%of eyes showed UDVA and CDVA of 20/20,respectively.The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02(about 20/20),respectively.CONCLUSION:Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

Millions of cataract surgeries with intraocular lens(IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.

The Preliminary Clinical Observation of Array Multifocal Intraocular Lens Implantation

Purpose : To evaluate the clinical effects of implantation of Array multifocal intraocular lenses.Methods : Thirty-one cases (37 eyes) of cataract patients, including 15 males(19 eyes)and 16 females(18 eyes), were involved in this study. All patients underwent standard phacoemulsification with Array multifocal intraocular lens implantation. The complications during operation, postoperative distant visual acuity, near visual acuity,corneal curvature and visual symptoms were observed.Results : the mean value of best postoperative visual acuity was recorded as follows: uncorrected distant visual acuity was 0. 8, the best-corrected distant visual acuity was 0.9, uncorrected near visual acuity was 0. 5, near visual acuity with distant-corrected was 0.6, the best-corrected near visual acuity wss 0.9. The astigmatism of cornea was less than 1.5 D pre-operatively and post-operatively. One patient complained of glare. Conclusion : Array multifocal intraocular lens can provide good distant and near visual acuity. With observation of more cases and follow-up of longer time, we can draw a further conclusion. Eye Science 2001; 17 : 57 - 60.

Comparison on Visual Function after Implantation of an Apodized Diffractive Aspheric Multifocal or Monofocal Intraocular Lens

Purpose:To evaluate visual outcomes after implantation of an aspheric multifocal /intraocular lens.(MIOL).or an aspheric monofocal intraocular lens (IOL).Methods:This was a prospective nonrandomized study.During 3-months of post-operative follow-up,the following outcomes for SN6AD1 MIOL.(multifocal group).and SN60WF IOL (monofocal group) were compared:uncorrected (UDVA) and corrected (CDVA) distance visual acuity,uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity,Chinese character near visual acuity,uncorrected intermediate visual acuity (UIVA) under high (100% contrast) and low contrast.(10% contrast),UIVA for different IOL powers,and a quality-of-life questionnaire.Results:UNVA,DCNVA,and UIVA under high contrast in the multifocal group were significantly better than those in the monofocal group (P<0.05).UDVA,CDVA and UIVA under low contrast did not differ between groups at 63 cm and 100 cm (P >0.05).In most cases,Chinese character near visual acuity was significantly better in the multifocal group.(P < 0.05).UNVA and UIVA at 63 cm improved over time during 3 months post-operatively.Better UIVA was found in emmetropic and mild myopic eyes as compared to hyperopic ones.The patients in the multifocal group had a higher degree of satisfaction and performed better on near and intermediate tasks,although with greater complaints of visual disturbance.Conclusion:The SN6AD1 MIOL provides significantly better UNVA,DCNVA and UIVA under high contrast conditions,and better Chinese character near visual acuity.Patients receiving the SN6AD1 MIOL reported a better quality of vision in spite of more serious visual disturbances.Better UIVA was observed in emmetropic and mildly myopic eyes.

Application of Foldable Intraocular Lens in Multiple Types of Cataract

Objective: To evaluate the clinical results of implantation of foldable intraocular lens inmultiple types of cataract.Methods: This retrospective study comprised 162 eyes of 148 patients undergoingphacoemulsification and implantation of foldable intraocular lens, some of whom under-went combined pars plana vitrectomy or trabeculectomy or silicone oil removal. Theperiod of follow-up was from 3 months to 17 months.Results: There is slight reaction postoperatively in all cases. The postoperative uncorrectedvisual acuites was from 0. 05 to 1.2, patient with 0.6 or above acuity were 70.98%. Aneodymium: YAG capsulotomy was required in 5 eyes. Posterior capsule ruptured in 1eyes, and a PMMA intraocular lens was implanted in ciliary sulcus. In one eye, a lenswas removed because of recurrence of retina detachment.Conclusions: The application of foldable intraocular lens in multiple types of cataract issafe, and there is a slight postoperative reaction. less complications , and fast visualacuity recovery.

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM:To assess the early surgical outcomes of quickchop phacoemulsification technique in patients with high myopia.METHODS:The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens(IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk,1mo. Early postoperative best corrected visual acuity(BCVA), preoperative and postoperative corneal endothelial cell density(ECD), central corneal thickness(CCT) and postoperative complications were assessed.Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data.· RESULTS:There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion.· CONCLUSION:Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.

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.

25G玻璃体切除联合超声乳化手术中散光人工晶状体的应用

目的观察25G玻璃体切除联合超声乳化手术中植入环曲面人工晶状体(Toric intraocular lens,Toric IOL)的临床效果及稳定性。方法回顾分析武汉市第一医院行白内障超声乳化吸出+ToricIOL植入患者58例(58眼),其中A组20例(20眼)为1期行25G玻璃体切除联合白内障超声乳化吸出+ToricIOL植入患者。B组18例(18眼)为25G玻璃体切除术后,2期行白内障超声乳化吸出+ToricIOL植入患者。C组20例(20眼)为单纯白内障超声乳化吸出+ToricIOL植入患者。术后随访6月。观察三组患者术前及术后视力、残余散光度、术后ToricIOL在眼内的旋转度、偏心量及像差。结果术后6月,三组患者裸眼远视力(uncorrected distance visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)均显著高于术前,差异有统计学意义(均P<0.05)。术后1周、1月、3月及6月,A组散光分别为(0.95±0.34)D、(1.01±0.34)D、(1.23±0.35)D、(1.21±0.32)D,B组散光分别为(0.92±0.31)D、(1.14±0.33)D、(1.21±0.31)D、(1.22±0.33)D,均明显高于C组各时间点[(0.65±0.29)D、(0.73±0.24)D、(0.91±0.34)D、(0.96±0.37)D],差异有统计学意义(均P<0.05)。术后6月,A组IOL平均旋转(4.85±1.23)°,B组IOL平均旋转(4.78±1.56)°,显著高于C组[(3.80±1.20)°](均P<0.05),A组与B组间比较差异没有统计学意义。A组与B组全眼总像差、全眼总低阶像差(不包括离焦)、全眼总高阶像差差异没有统计学意义,但均高于C组,差异有统计学意义(均P<0.05)。A组、B组、C组平均偏心量分别为(0.284±0.060)mm、(0.278±0.069)mm、(0.265±0.047)mm,差异无统计学意义(P>0.05)。结论对于伴有角膜散光和玻璃体疾病的白内障患者,选择ToricIOL植入,能够实现较好的旋转稳定性,偏心程度小,从而获得更好的视觉质量。1期行玻璃体切除联合白内障手术与2期白内障手术比较,植入ToricIOL的稳定性没有明显差异。

超声乳化吸除术联合房角分离术治疗PACG滤过术后眼压失控的临床疗效观察

目的探讨超声乳化吸除术(Phaco)+人工晶状体(IOL)植入联合房角分离术治疗原发性闭角型青光眼(PACG)滤过术后眼压失控的临床疗效。方法回顾性病例研究。对2020年8月至2022年5月收治的24例(25只眼)PACG滤过术后眼压失控患者,采用Phaco+IOL植入联合房角分离术治疗,比较术前、术后1 d、1周、1个月、3个月、6个月的眼压情况,术前及6个月最佳矫正视力(BCVA)、房角粘连性关闭(PAS)范围变化情况。记录术中、术后并发症情况。结果术后1 d、1周、1个月、3个月、6个月眼压、PAS范围均显著低于术前,差异具有统计学意义(均P<0.05);术后6个月视力较术前21例(22只眼)BCVA提高,3例(3只眼)BCVA无变化;术中10只眼发生前房出血,术后6只眼发生短暂性前房出血,15只眼发生前房渗出,8只眼发生角膜水肿。结论Phaco+IOL植入联合房角分离术治疗PACG滤过术后眼压失控能够有效降低眼压,提高患者视力,是安全有效的治疗方法。

超声乳化人工晶状体植入术对高度近视白内障患者的疗效

目的:分析超声乳化人工晶状体植入术对高度近视白内障患者的疗效。方法:选取2020年1月至2023年1月收治的86例患者分组手术,试验组采用超声乳化联合人工晶状体植入,常规组采用白内障囊外摘除联合人工晶状体植入,比较两组手术耗时及术后多项指标。结果:试验组手术时间低于常规组(P<0.05);术后,试验组BCVA和裸眼远视力改善,前房深度及容积、ECD、BUT、6A及视觉质量评分均较高,CV较低(P<0.05);术后两组并发症发生率无显著差异(P>0.05)。结论:超声乳化人工晶状体植入术较囊外摘除术手术时间更短,术后视功能、眼前节参数和视觉质量改善更显著,安全性高,值得推广。