Sutured scleral fixation of existing subluxated/dislocated acrylic one-piece intraocular lenses

AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.

Intraocular lens selection in diabetic patients:How to increase the odds for success

The incidence of cataracts is significantly higher in diabetic individuals,particularly in younger age groups,with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics.Cataract surgery in diabetic patients poses many challenges:Poor epithelial healing,decreased corneal sensitivity,increased central corneal thickness,decreased endothelial cell count,variable topography,poor pupillary dilatation,anterior capsular phimosis,posterior capsular opacification(PCO),chances of progression of diabetic retinopathy(DR),zonular weakness,and vitreous prolapse and diabetic macular edema.Selection of an appropriate intraocular lens(IOL)is crucial for visual rehabilitation and monitoring DR.The choice of IOL in diabetic cataract patients is a challenging scenario.Square-edge IOLs are favored for their capacity to mitigate PCO,whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR.The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation,particularly in the presence of advanced retinopathy.Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications.Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes.This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

IOL Master 700与Lenstar LS900对高度近视合并白内障患者术前生物测量及人工晶状体计算的比较

目的:比较IOL Master 700与Lenstar LS900对高度近视合并白内障患者术前眼生物测量的差异性、相关性、一致性及人工晶状体(IOL)度数计算的准确性。方法:回顾性研究。收集2021-03/2023-03于陆军特色医学中心眼科行白内障超声乳化联合IOL植入手术的高度近视合并白内障患者136例136眼,平均年龄57.38±8.08岁。根据眼轴长度(AL)将患者分为3组:A组(26 mm≤AL≤28 mm)41眼,B组(28 mm30 mm)52眼。术前分别使用两种仪器测量AL、平均角膜曲率(Km)、前房深度(ACD)、晶状体厚度(LT)和白到白距离(WTW)。所有患者均采用Barrett UniversalⅡ公式计算IOL度数,个性化选择适宜的预留屈光度,比较两种仪器的预测屈光误差(PE)和绝对屈光误差(AE)。结果:三组患者中Lenstar LS900测量的AL和ACD均大于IOL Master 700测量值(均P<0.05),且两种仪器测量AL的平均差值C组>B组>A组。两种仪器测量LT、Km与WTW值均无差异(均P>0.05)。两种仪器所得各组生物参数均具有正相关性(均r>0.9,P<0.05)且一致性较好(95%LoA范围较窄)。两种仪器计算的AE无差异(P>0.05),但IOL Master 700计算的PE小于Lenstar LS900(P<0.05),且前者远视偏移百分比更低。结论:在高度近视合并白内障患者中,Lenstar LS900测量AL值大于IOL Master 700,且该差异随着AL的增加而增大,两种仪器对IOL的计算均具有良好的预测性,但IOL Master 700术后屈光误差更小,远视偏移百分比更低。

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.

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM:To evaluate the postoperative intraocular lens(IOL)rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL.METHODS:In this retrospective case series,32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter(D).A plate haptic toric IOL(AT Torbi 709M,Carl Zeiss Meditec AG)was implanted in all eyes.The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity(BCVA).RESULTS:Preoperative refractive astigmatism was 2.14±1.17 D,which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period(0.67±0.44 D at three months and 0.75±0.25 D at six months;for all groups:P<0.0001 compared to baseline).BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery(P=0.02).Mean IOL axis deviation from the target axis was 3.4°±2.9°after six to eight weeks and significantly decreased over time(2.4°±2.6°six months after surgery;P=0.04).In one patient IOL,re-alignment was performed.CONCLUSION:Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery.The plate haptic toric IOL position and axis remain stable during the observation period of six months.

Pupillary capture following sutureless scleral-fixated intraocular lens in children with Marfan syndrome

AIM:To compare the clinical outcomes between two approaches for sutureless scleral-fixated intraocular lens(SFIOL)in children with Marfan syndrome(MFS).METHODS:The study included 15 children(26 eyes)with lens subluxation due to MFS.These children underwent lensectomy,anterior vitrectomy,and sutureless SFIOL.According to the position of placement of intraocular lens(IOL)haptics,two study groups were reviewed for best corrected visual acuity(BCVA)and postoperative complications:group A,14 eyes with haptics fixated at 2.0 mm from the limbus;group B,12 eyes with the haptics fixated at 2.5 mm from the limbus.RESULTS:The mean axial length for all patients was 25.66±2.35 mm.Postoperative BCVA in logMAR were significant improved in both groups(0.77±0.32 to 0.17±0.12 in group A,0.66±0.25 to 0.24±0.12 in group B,both P<0.001)while no significant difference between two groups(P>0.05).Pupillary capture was main postoperative complication,occurring between 3d and 18mo.It occurred in 7 eyes in group A and one eye in group B(P=0.02).CONCLUSION:Sutureless SFIOL is an effective treatment approach for lens subluxation in children with MFS.Pupillary capture is the main postoperative complication.Fixated IOL haptics at 2.5 mm from the limbus can reduce the occurrence of pupillary capture.

Long-term vision-threatening complications of phakic intraocular lens implantation for high myopia

AIMTo report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia.

Posterior chamber phakic intraocular lens implantation for high myopia

AIM:To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens implantation for the correction of high myopia.METHODS:Retrospective case review of 82 eyes(43patients)undergoing implantable Coliamer lens(ICL)placement by a single surgeon(Xiao-Wei Gao)to correct preoperative mean spherical equivalents between-9.00diopter(D)and-23.00D.Main outcome measures included uncorrected visual acuity(UCVA),refraction,best spectacle-corrected visual acuity(BSCVA),endothelial cell density(ECD),intraocular pressure(IOP),lens transparency,postoperative uveitis.Visante anterior segment optical coherence tomography(AS-OCT)was used to measure anterior chamber depth(ACD)and the position of ICL.RESULTS:Mean follow-up was 6.54±3.26 months(range 3-12 months).Predictability of the manifest spherical equivalent(SE)refraction to within±1.OOD was achieved in 88%of eyes and±0.50D in 72.5%of eyes.The mean postoperative manifest SE refraction was-1.85±0.72D,with 96.34%of eyes maintaining or gaining≥1 line(s)of BSCVA.The mean 3-month postoperative ECD decreased but had no statistically difference compared with the preoperative ECD.Of the 7 eyes(8.54%)with a mild transient increase in intraocular pressure(up to 30mmHg),none required a second surgical procedure or prolonged topical medication.There was no loss of lens transparency.Pigmented precipitates were observed in 5 eyes(6.09%).The mean preoperative ACD measured with AS-OCT was 3.28±0.14mm,three months after surgery,the mean ACD was2.45±0.22mm.Anterior chamber depth showed astatistically significant reduction.One eye(1.22%)had ICL spontaneous rotation,81 eyes(98.78%)of the lens remained correctly centered.CONCLUSION:The implantation of ICL is an effective surgical option for the management of high myopia.But its long time effect and safety still need more time to prove.

Visual performance after implantation of two types of phakic foldable intraocular lenses for correction of high myopia

AIM: To compare Visian lens(model V4 c) and Artiflex lens regarding quality(contrast sensitivity) and quantity(efficacy, predictability, safety and stability) of vision in correcting high myopia with recording and analysis of complications. METHODS: The comparative prospective study included 39 eyes of 23 patients with high myopia, 19 eyes had Visian lens implantation(model V4 c) and 20 eyes had Artiflex lens implantation. The inclusion criteria were high myopia(higher than 6.0 D) and stable refraction(<0.5 D change over one year). Outcomes included assessment of safety and efficacy indices, predictability, stability, contrast sensitivity and analysis of complications at postoperative 1 d, 1 wk and 1, 3, 6 and 12 mo. Selection of the type of phakic intraocular lens for patients was based on surgeons' preferences, which was no specific selection criteria. RESULTS: After 12 mo of follow up, difference in uncorrected and corrected distant visual acuity(CDVA) between both groups was statistically insignificant(UDVA for VisianV4 c and Artiflex lens were 0.33±0.2 logMAR and 0.37±0.2 logMAR respectively, P=0.59, CDVA for VisianV4 c and Artiflex lens were 0.155±0.1 logMAR and 0.147± 0.1 logMAR respectively, P=0.87). The efficacy index was 1.25 for VisianV4 c lens and 0.8 for Artiflex lens, 78.9% of eyes were within one diopter spherical equivalent in Visian V4 c lens group compared to 70% in the Artiflex lens group. No eye lost lines of CVDA proving a good safety index for both lenses(safety index was 1.67 for VisianV4 c lens and 1.34 for Artiflex lens). Difference in contrast sensitivity between both groups was statistically insignificant(P=0.15, 0.88, 0.27, 0.32 and 0.82 at five spatial frequencies). CONCLUSION: Both Visian ICL V4 c and Artiflex lensesare safe and effective with stable and predictable refraction and they have comparable contrast sensitivity outcomes with no vision threatening complications.

Phakic posterior chamber intraocular lens for unilateral high myopic amblyopia in Chinese pediatric patients

AIM： To assess the outcomes of posterior chamber implantable collamer lens （ICL） implantation in Chinese pediatric patients with unilateral high myopic amblyopia.METHODS： Eleven eyes of 11 amblyopic patients aged 11.02±3.34y underwent ICL （model V4, Staar Surgical Inc.） implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure （IOP）, vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1, 3mo and the last follow-up time （mean 8.18±2.82mo） after surgery.RESULTS： The mean myopic anisometropia was -13.70±3.25 D preoperatively and ＋0.69±2.63 D at 8mo postoperatively. The logMAR corrected distance visual acuity （CDVA） of the amblyopic eye was 1.51±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%, 64%, respectively. The contrast sensitivity of 0.5, 1 and 2 cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at 1mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively.CONCLUSION： This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.

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.

Posterior chamber phakic intraocular lens for the correction of high myopic anisometropic amblyopia in adults

This study aims to evaluate the clinical results of posterior chamber implantable collamer lens（ICL） implantation in adults with high myopic anisometropic amblyopia. Thirteen patients aged 27.04±7.24 y（range 19.2 to 42.5） were studied. ICL implantation was performed in 13 amblyopic eyes. The mean myopic anisometropia was significantly dropped from-10.70±3.02 D preoperatively to ＋0.09±1.67 D at 1 mo postoperatively. The logMAR CDVA at 3 d, 1, 3 and mean 9 mo postoperatively improved by a mean of 1.69, 2.50, 3.01 and 3.00 lines and gained more than 2 lines accounted for 23.08%（3 eyes）, 41.67%（5 eyes）, 63.63%（7 eyes） and 55.56%（5 eyes）, respectively. The contrast sensitivity of amblyopic eyes was significantly increased after surgery. Four patients partially recovered near stereopsis（400＂ to 100＂）. There was no severe complications were observed. ICL implantation alone can improve vision, contrast sensitivity, and partial restoration of binocular vision in adult patients with high myopic anisometropia.

AcrySof phakic angle-supported intraocular lens for the correction of high to extremely high myopia:one-year follow-up results

AIM: To assess the safety, efficacy and predictability of the AcrySof phakic angle-supported intraocular lens (IOL) (Alcon Inc., U.S.A.) for correction of high-to-extremely high myopia in adults. METHODS: In this prospective study performed in Tianjin Medical University Eye Center & College of Optometry, Tianjin, China, 25 eyes of 13 patients were implanted with AcrySof phakic angle-supported IOLs and followed for 1 year postoperatively. Preoperative manifest refractive sphere was (-12.08 +/- 2.44) diopters (D) and cylinder was (-1.35 +/- 0.62)D. Visual acuity, predictability and stability of manifest refraction spherical equivalent (MRSE), adverse events, and endothelial cell density were analyzed during 1-year of follow-up. RESULTS: After 1 year of follow-up, no eyes lost 1 line (best spectacle-corrected visual acuity)BSCVA; an uncorrected visual acuity (UCVA) of 20/20 or better was achieved in 60% of eyes; 100% had an UCVA of 20/40 or better; a BSCVA of 20/30 or better was achieved by 100% of eyes; 84% had a BSCVA of 20/20 or better. The overall mean percentage change in endothelial cell density 1 year after surgery was (-0.27 +/- 3.60)%. Two eyes (8%) had increased intraocular pressure (IOP) on the day of surgery. No pupil ovalization, pupillary block, or retinal detachment events were observed. CONCLUSION: After 1 year of follow-up, the implantation of AcrySof phakic angle-supported IOL is proved to be safe, effective and predictable with minimal complications in patients with high-to-extremely high myopia. Due to the limitation of visiting time, long-term of clinical investigation is necessary to verify the safety and efficacy of this IOL.

Short and long-term outcomes of angle supported phakic intraocular lens implantation in high myopic eyes

This cohort study included 36 eyes of 21 patients with high myopia treated with angle supported phakic intraocular lens（p IOL）.Endothelial cell density（ECD） at baseline,6 mo and 3 y were 3017±296,2775±265 and 2558±299 cells/mm^2 respectively.ECD loss at 6 mo was 7.2% and annual ECD loss was 3% over 36 mo.Corrected distance visual acuity at 36 mo was 0.4 log MAR or better in 32（88.9%） eyes.Intraocular pressure did not change（P=0.9）.No eyes developed cataract,retinal detachment or pupillary distortion.Angle supported p IOL gives good visual outcome.Endothelial cell loss should be monitored.

Effect of incision types for Artisan phakic intraocular lens implantation on ocular higher order aberrations

AIM： To evaluate the effect of incision types for Artisan phakic intraocular lens （PIOL） implantation on ocular higher-order aberrations （HOAs）.METHODS： A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type： cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter （D） were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity, special equivalents, astigmatism, predictability （±1 D from target refraction）, HOAs （coma, trefoil, spherical aberration）, and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively.RESULTS： At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square （RMS） total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group.CONCLUSION： Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.

Ultrasound Biomicroscopy of Iris-claw Phakic Intraocular Lens Implantation

Purpose: To study in situ the intraocular position of iris-claw phakic intraocular lens (ICPIOL) in myopic eyes using ultrasound biomicroscopy (UBM). Methods: UBM echograms of the anterior segment were taken preoperatively and 62 to 115 days postoperatively in 6 eyes implanted with the Verisys ICPIOL (AMO). The echograms were assessed for the effect of the ICPIOL on iris tissue. Results: The preoperative distance between the corneal endothelium and the lens ranged from 2.96 to 3.09 mm, and the postoperative distance between the ICPIOL and the corneal endothelium, from 1.86 to 2.03 mm. The distance between the lens and the posterior surface of the ICPIOL ranged from 0.61 to 0.76 mm. The distance between the superior, inferior optic edge and the iris ranged from 0.49 to 1.00 mm, 0.21 to 0.51 mm respectively. The shortest distance between the ICPIOL haptics and the angle of anterior chamber ranged from 1.25 to 1.65 mm. The indentation of iris tissue by the ICPIOL haptics without pigmentary dispersion and distortion of posterior curvature of iris was observed. Conclusion : Adequate space is maintained between the Verisyse myopic ICPIOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris without pigment erosion and distortion of iris curvature is noted. The ICPIOL implanted in phakic eyes is a safe alternative for treatment of high myopia.

Black diaphragm intraocular lens implantation and penetrating keratoplasty in aphakic eyes with traumatic aniridia

AIM:To evaluate the long-term outcome of implantation of black diaphragm intraocular (BDI) lens combined with penetrating keratoplasty (PKP) for managing aphakic eyes with traumatic aniridia and corneal damage. METHODS: Six aphakic eyes of six patients with traumatic aniridia and corneal damage had BDI lens implantation at Qingdao Eye Hospital, Shandong Eye Institute from June 2008 to November 2011. Medical records of the patients were reviewed. Three patients received PKP and after 12-18months were implanted with BDI lens. The other three patients completed PKP and BDI lens implantation at the same time. The corrected visual acuity, intraocular pressure and number of corneal endothelial cells were monitored. RESULTS: The patients were followed up for an average of 24.3 ±12.1months (range 14-48 months). All BDI lenses were located well. The best corrected visual acuity got improved in 5 patients (0.1-1.0) and decreased in 1 patient from 0.4 to 0.2. Three patients had normal intraocular pressure (IOP) after implantation. Two patients required antiglaucoma medications to control IOP within the normal range and 1 patient implanted Ahmed glaucoma valve to control IOP. The corneal grafts kept transparent in all eyes and the corneal endothelial counting 】1 000/mm2 , although two patients experienced acute graft rejection and loss more than 30% corneal endothelial cells.CONCLUSION: Implantation of BDI lens combined with PKP is an effective option for managing aphakic eyes with traumatic aniridia and corneal damage. Although the results in our study are encouraging, additional studies of the long -term safety and efficacy are required. Alarger study population and longer follow-up may be beneficial.

Macular hole following phakic intraocular lens implantation:A case report

BACKGROUND Phakic intraocular lens(pIOL)implantation has been commonly prescribed and is considered as a safe and effective option for correcting high myopia.However,it is associated with multiple complications.CASE SUMMARY This report describes a case of full-thickness macular hole(MH)in a patient with a history of bilateral pIOL implantation for the correction of myopia of–12.00 diopters in both eyes 7 mo ago.The MH closed after pars plana vitrectomy with internal limiting membrane removal and the best-corrected visual acuity improved to 20/40 in the left eye.CONCLUSION In rare cases,MH can occur following pIOL.In this present case report,we analyzed the formation process of MH following the surgery and emphasized that it is important to inform highly myopic patients about the risk of MH occurrence while being aware of the symptoms of this complication.

Iris Repair after Long-Term Complications of Angle-Supported Phakic Intraocular Lenses

We report the case of a high myopic patient who had been implanted with angle-supported phakic intraocular lenses (pIOL) in 1990 and who subsequently and gradually developed complications in both eyes including endothelial cell loss, chronic glaucoma, cataract, pupil ovalization and severe iris atrophy. The patient was impaired by photophobia, glare, halo, loss in visual acuity and concerned about the cosmetically deforming aspect of her eyes. Cataract surgery was performed after explantation of the pIOL followed by combined implantation of a standard IOL in the capsular bag and a Dr Schmidt artificial iris in the sulcus. There were no intraoperative and postoperative complications except slight bilateral corneal oedema which resolved completely within 1 month after surgery. Uncorrected and corrected visual acuity improved progressively to reach 0.3 and 0.6 at the last follow-up visit (±1 year), respectively. The patient was very satisfied with the functional and aesthetical outcomes.

Coreoplasty and Artisan Intraocular Lens Implantation for Mydriasis and Aphakic Correction in Post-traumatic Vitrectomized Eyes

Purpose:.To evaluate the efficacy and safety of using coreoplasty,.and an iris-supported Artisan intraocular lens (IOL), for mydriasis and aphakic correction in post-traumatic vitrectomized eyes. Methods:.A total of 17 aphakic patients were admitted between April 2009 and April 2010 to the ophthalmologic department of Xiamen Eye Centre..All eyes had previously received lens removal and vitrectomy. After the retina stabilized and corrected visual acuity improved,.the iris was sutured. The Artisan IOL was fixated onto the iris surface..Patients were followed-up at one day, one week,.one month and three months postoperatively..The following outcomes were assessed: symptoms of photophobia and glare, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell density (ECD). The diameter of pupil and the anterior chamber depth (ACD) were measured by the anterior segment optical coherence tomography (OCT). Results:.Artisan IOLs were successfully implanted in all aphakic eyes. Postoperatively, improvement was observed in photophobia and glare symptoms..UCVA was enhanced in all patients.(six eyes had better UCVA postoperatively than BCVA preoperatively)..However,.there were no significant changes in IOP. Mean loss of ECD was 336.06/mm2. Mean postoperative pupil diameter was 3.67±0.41 mm, compared with 5.67±0.57 mm preoperatively(P<0.05). Mean ACD was reduced by 0.88 mm.(3.38±0.33 mm preoperatively vs 2.50±0.35 mm postoperatively, P<0.05). Conclusion:.Surgery that combined coreoplasty and Artisan IOL implantation was a safe and effective treatment for correcting aphakia and mydriasis in post-traumatic vitrectomized eyes.