Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes

AIM:To compare the efficacy and complications of Artisan iris-claw intraocular lens(IOL)implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy.METHODS:A prospective study of 45 cases was conducted.Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy(PPV)combined lens extraction were divided into two groups.Group A:25 eyes received Artisan iris-claw IOL implantation.Group B:20 eyes received posterior chamber IOL sulcus fixation.The corrected distance visual acuity(CDVA)and intraocular pressure(IOP),corneal endothelial cell loss rate,surgical time and complications were compared between the two groups.Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group.RESULTS:The mean surgical time of Artisan group was significantly shorter(P【0.05).No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point(P】0.05).CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery(P【0.05)and there was no statistically significant difference 1 and 3mo after surgery(P】0.05).Mean IOP showed no significant differences between groups before and after surgery.The postoperative complications of Artisan group were anterior uveitis,iris depigmentation,pupillary distortion and spontaneous lens dislocation.The complications of sulcus fixation group include choroidal detachment,intraocular haemorrhage,tilt of IOL optic part and retinal detachment.CONCLUSION:Secondary Artisan IOL implantation canbe performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL.This technique is an effective and safe procedure.It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.

Predictors of visual outcome in traumatic cataract

Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.

Vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception

AIM: To evaluate the efficacy of surgical treatment of vitrectomy combined with silicone oil tamponade in the treatment of severely traumatized eyes with the visual acuity of no light perception (NLP).METHODS: This was a retrospective uncontrolled interventional case-series of 19 patients of severely traumatized eyes with NLP who underwent vitrectomy surgery at the Affiliated Hospital of Medical College, Qingdao University (Qingdao, China) during a 3-year period. We recorded perioperative factors with the potential to influence functional outcome including duration from the injury to intervention; causes for ocular trauma; open globe or closed globe injury; grade of vitreous hemorrhage; grade of endophthalmitis; grade of retinal detachment; size and location of intraocular foreign body (IOFB); extent and position of retinal defect; grade of proliferative vitreoretinopathy (PVR); type of surgery; perioperative complications and tamponade agent. The follow-up time was from 3 to 18 months, and the mean time was 12 months.RESULTS: After a mean follow-up period of 12 months (3-18 months) 10.53% (2/19) of eyes had visual acuity of between 20/60 and 20/400, 52.63% (10/19) had visual acuity less than 20/400 but more than NLP, and 36.84% (7/19) remained NLP. Visual acuity was improved from NLP to light perception (LP) or better in 63.16% (12/19) of eyes and the rate of complete retinal reattachment was 73.68% (14/19). Good visual acuity all resulted from those patients of blunt trauma with intact eyewall (closed globe injury). The perioperative factors of poor visual acuity prognosis included delayed intervention; open globe injury; endophthalmitis; severe retinal detachment; large IOFB; macular defect; a wide range of retinal defects andsevere PVR.CONCLUSION: The main reasons of NLP after ocular trauma are severe vitreous hemorrhage opacity; refractive media opacity; retinal detachment; retinal and uveal damages and defects, especially defects of the macula; PVR and endophthalmitis. NLP after ocular trauma in some cases does not mean permanent vision loss. Early intervention of vitrectomy combined with silicone oil tamponade and achieving retinal reattachment of the remaining retina, may make the severely traumatized eyes regain the VA of LP or better.

Traumatic endophthalmitis and the outcome after vitrectomy in young children

AIM:To explore the traumatic endophthalmitis in young children and the outcome of pars plana vitrectomy(PPV).METHODS:Twenty-two eyes of 22 cases of young children consecutive pediatric traumatic endophthalmitis treated and followed up between September 2014 and May 2018 were included.Aqueous humor or vitreous samples were taken for bacterial culture and sensitivity tests.Intravitreal antibiotics(norvancomycin and ceftazidime)injection,combined with 23-gauge PPV,were administered in 22 eyes.Silicone oil(SO;5000 centistoke)tamponade or perfluoropropane gas(C3F8)was used in all patients.Main outcome measures were best-corrected visual acuity(BCVA)and retinal attachment,the ratio of penetrating injury,and the existence of intraocular foreign body.RESULTS:The mean age of patients was 6.9±2.2(range,3-10)y.All injured eyes suffered from penetrating ocular injury with retained intraocular foreign body in one eye.Bacterial culture was positive in only 2 eyes.The mean follow-up time was 21.1±4.7(range,12-30)mo.In the primary PPV,intravitreal antibiotics was administrated in all eyes,SO in 18 eyes,and C3F8 in 4 eyes.The secondary operation of SO removal and C3F8 endotamponade was performed in 16 eyes and a second SO endotamponade due to emulsification of the oil and retinal detachment(RD)was operated in 7 eyes underwent 3 to 11.5 mo after primary PPV.A third operation was done in 7 eyes.The final intraocular pressure(IOP)was 8.9±1.8(range,6.9-11.4)mm Hg.The final BCVAs were 20/200 or better in 5,counting fingers in 2,and light perception to hand movement in 8 eyes.Whose(66.7%)had retinal injury exhibited worse BCVA(P=0.019,Fisher’s exact test).Eyes underwent SO tamponade exhibited worse final BCVA than that with C3F8 in the primary PPV(P=0.026,Fisher’s exact test).CONCLUSION:Traumatic endophthalmitis in children is generally more severe and associated with more complicated surgical procedures.Most patients have retinal injury need multiple operations and the final BCVA is poor.Prevention of ocular trauma,especially in children,is still critical.

Topical delivery of nerve growth factor for treatment of ocular and brain disorders

Neurotrophins are a family of proteins that support neuronal proliferation, survival, and differentiation in the central and peripheral nervous systems, and are regulators of neuronal plasticity. Nerve growth factor is one of the best-described neurotrophins and has advanced to clinical trials for treatment of ocular and brain diseases due to its trophic and regenerative properties. Prior trials over the past few decades have produced conflicting results, which have principally been ascribed to adverse effects of systemic nerve growth factor administration, together with poor penetrance of the blood-brain barrier that impairs drug delivery. Contrastingly, recent studies have revealed that topical ocular and intranasal nerve growth factor administration are safe and effective, suggesting that topical nerve growth factor delivery is a potential alternative to both systemic and invasive intracerebral delivery. The therapeutic effects of local nerve growth factor delivery have been extensively investigated for different ophthalmic diseases, including neurotrophic keratitis, glaucoma, retinitis pigmentosa, and dry eye disease. Further, promising pharmacologic effects were reported in an optic glioma model, which indicated that topically administered nerve growth factor diffused far beyond where it was topically applied. These findings support the therapeutic potential of delivering topical nerve growth factor preparations intranasally for acquired and degenerative brain disorders. Preliminary clinical findings in both traumatic and non-traumatic acquired brain injuries are encouraging, especially in pediatric patients, and clinical trials are ongoing. The present review will focus on the therapeutic effects of both ocular and intranasal nerve growth factor delivery for diseases of the brain and eye.

Intralenticular metallic foreign body: a case report

A case of retained intralenticular iron piece with signs of mild anterior uveitis at the time of presentation is reported in a 45 year-old man. His vision improved with topical cycloplegics and corticosteroids. After six months, his vision deteriorated grossly due to cataract formation. He regained good vision following removal of foreign body, extracapsular extraction with posterior chamber intraocular lens implantation. This case highlights the conservative management of the condition till the patient develops cataract resulting in visual disability; and good visual recovery following cataract surgery with intraocular lens implantation.

Anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy for scarring of the central cornea following pterygium excision

AIM:To report the outcomes of patients undergoing anterior segment optical coherence tomography-guided transepithelial phototherapeutic keratectomy(ASOCT T-PTK)for central corneal scarring after pterygium excision.METHODS:The charts of 11 eyes of 10 patients that underwent ASOCT T-PTK following excision of visual axisinvolving pterygia were retrospectively reviewed from a single private practice institution.The visual outcomes and corneal topographic findings were evaluated 4±1 mo after pterygium excision and 6±2 mo after transepithelial phototherapeutic keratectomy(T-PTK).RESULTS:All 11 eyes tolerated both the pterygium excision and T-PTK procedure well without any significant intraoperative or postoperative complications.Uncorrected distance visual acuity(UDVA)and manifest refraction corrected distance visual acuity(CDVA)improved after pterygium excision(P=0.03 and P=0.05,respectively).The UDVA and CDVA improved further after T-PTK(P=0.004 and P=0.002,respectively).The topographic surface asymmetry index,topographic surface regularity index,and topographic projected visual acuity significantly improved after T-PTK(P=0.0092,P=0.0022,and P=0.0002,respectively).None of the subjects lost any lines of CDVA,developed recurrence of pterygia or required keratoplasty during the postoperative period.CONCLUSION:ASOCT T-PTK can provide excellent visual and anatomic outcomes in patients with central corneal scarring after excision of visual axis-involving pterygia.

Management and treatment of bizarre open globe trauma in three steps:a case report

This is a case presentation of a very bizarre open globe trauma with anterior segment foreign body-fishing hook stuck in the cornea and iris. Complications due to this kind of eye trauma might be very hazardous and with serious impact on visual function. We are representing our approach and experience of three step management of this kind of eye injury: first-extract the foreign body, close and reconstruct the eyeball, second-fight inflammation, and third-restore the visual function by cataract surgery.

Trauma of the globe＂ State of art in global and in China

Current states of traumatic eye injury are reviewed in terms of epidemiology in the developing countries and developed countries, causes of the trauma, eye injury types, traumatic eye injury diagnostic methods and treatments. Trauma-caused vision-threatening conditions such as open global injury, traumatic optic neuropathy and proliferative vitreoretinopathy are particularly discussed. Also the most updated clinic research in China as Eye Injury Vitrectomy Study is discussed. At the end, the current achievements and research in traumatic eye injury in the world are summerized.

外伤性无晶状体眼改良微创人工晶状体悬吊术

目的 评价改良微创人工晶状体悬吊术的临床疗效.方法 收集眼外伤所致无后囊或后囊严重破损的无晶状体眼36例（36眼）,通过3.2 mm切口进行微创人工晶状体睫状沟悬吊术.术后随访3-12个月,观察视力及并发症情况.结果 术后1 d裸眼视力≤0.2者7眼（19.45%）,0.3-0.5者13眼（36.11%）,0.6-1.0者16眼（44.44%）.术后1、3及6个月裸眼视力均达到或超过术前最佳矫正视力.无明显并发症发生.结论 外伤性无后囊支持的无晶状体眼,进行改良微创人工晶状体睫状沟悬吊术,效果良好.