Posterior Chamber IOL Implantation in Traumatic Cataract with Injured Complications

Twenty-five cases of posterior chamber IOL implantation intraumatic cataract with complications associated with primary injury werereported.The operating methods were described and the post-operative com-plications were discussed.Seventy-two percent of patients have the correctvision over 20/40.It is suggested that the posterior chamber IOL can be im-planted in traumatic cataract with some injured complications.EYE SCIENCE1992;8:111-112.

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.

Evaluation of the Effectiveness of Preloaded IOL Injectors in Surgical Time

Background: The implantation of the intraocular lens (IOL) is still subject to error and complication, as it can result in traumatic opening of the IOL leading to rupture of the posterior capsule and zonular dialysis, it takes time to train paramedic teams to assemble such IOLs with the manual injectors. Moreover, there is a potential risk of comtamination and endophthalmitis as there is manipulation of the IOL and cartridge. The preloaded IOLs tend to reduce those unwanted results and may optimize the surgical time. Purpose: The aim of this study is to compare the effectiveness and implantation time between three injectors and three intraocular lenses, two pre-loaded and one conventional. Methodology: Videos of thirty patients undergoing cataract surgery from December 2019 to December 2020 at the Hospital Oftalmológico de Brasília (HOB), Brasília, Brazil were included in this observational, analytical retrospective study, non randomized. All patients had their surgeries recorded, from which the time of injection and opening of the intraocular lens (IOL) was extracted, 20 eyes were implanted with preloaded intraocular lens, and 10 eyes with conventional IOL implant. The patients were divided into three groups with similar eye characteristics. The first received the AutonoMeTM (CE) injector with the Clareon® IOL, the second the IsertTM injector (I) with the Hoya® IOL, and the third was injected with Johnson & Johnson Platinum 1 Series injector used to deliver Sensar® One AAB00 lens. The Welch test and Tukey’s Post Hoc test were used in the statistical analysis. Results: It was observed that there was a statistical significance regarding the presence of a haptic stuck (5 Clareon vs 0 Sensar and Hoya), between the mean opening time of the IOL optics Sensar One, Hoya and Clareon (25.00 vs 31.40 vs 11.70 s, p < 0.001) and between the total time (the injection time more the opening time of the IOL) in relation to Hoya and Clareon lenses (39.50 s vs 19.60 s, p < 0.001);the total time of the Sensar IOL was 31.30 s. The opening time of the IOL optics was significantly longer for the Sensar One and Hoya groups compared to Clareon group, and the total time of Hoya group was significantly longer compared to the total time of the Clareon group. Conclusion: The study demonstrated that the choice of injector and IOL set can significantly affect the total time of IOL implantation. However, there was no difference regarding complications and collateral damage depending on the set chosen for the implant.

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.