Biomedical subjects

D J Apple

Publications and source records attributed to D J Apple.

At least 91 records · Page 5Linked to original sources

PubMed1999

Effect of expandable full-size intraocular lenses on lens centration and capsule opacification in rabbits.

PURPOSE: To study the effects of expandable, hydrogel, full-size lenses (FSLs) on lens centration and posterior capsule opacification (PCO) in the rabbit model. SETTING: Center for intraocular Lens Research, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Small FSLs designed for human eyes were implanted unilaterally in 20 rabbit eyes. Lens centration and PCO in these eyes were compared with those in eyes with conventional poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) or aphakia in the fellow eyes. In a second experiment, medium-size or large FSLs designed for rabbit eyes were implanted in 20 rabbit eyes and the results compared with those in eyes with conventional PMMA IOLs. Slitlamp examination of all eyes was performed regularly, after enucleation, gross inspection and microscopic studies were performed. RESULTS: Decentration of FSLs occurred in the presence of an anterior capsule tear or very large capsulorhexis. Posterior capsule opacification developed only at sites where the implanted lens was not in contact with the capsule. Aphakic eyes and looped IOLs developed Soemmering's rings peripherally. In eyes with small FSLs, PCO developed between the lens and the center of the posterior capsule, whereas in eyes with large FSLs, only small amounts of central PCO developed. Retained high-viscosity viscoelastic material had no effect on PCO development. CONCLUSIONS: Complete refilling of the capsular bag by a full-size IOL was associated with excellent centration and only a small degree of PCO. Elastic lenses may thus serve as a starting point for the development of an artificial lens with accommodative function.

Animals↗

PubMed1999

Pathological examination of an explanted phakic posterior chamber intraocular lens.

PURPOSE: To report the clinicopathological correlation of an explanted phakic posterior chamber intraocular lens (PPC IOL) and to study the conformation of this lens implanted into human eyes obtained postmortem. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Three silicone PPC IOLs were explanted. One lens, explanted from a 38-year-old woman with complicated cataract, was submitted for pathological analysis. In addition to gross and scanning electron microscopy (SEM), the lens was studied after experimental implantation in human eyes obtained postmortem using frontal, posterior, and side-view techniques. RESULTS: Although gross and SEM showed that the IOL was well polished, examination of the lens in human cadaver eyes showed it was oversized and poorly fixated. It was relatively bulky in its anterior-posterior dimension and revealed evidence of significant contact with the iris and crystalline lens. CONCLUSIONS: This study illustrates many pitfalls to be avoided in the design of a plate PPC IOL. The lens in this report was too large, and instead of ciliary sulcus fixation, it showed poor fixation through the zonules onto the posterior face of the pars plicata. Present and future PPC IOLs should be submitted for similar preclinical studies to clarify the type and site of fixation.

Adult↗

PubMed1998

Posterior capsular plaque: a common feature of cataract surgery in the developing world.

PURPOSE: To study the histopathologic findings of posterior capsular plaque, a lesion that is discovered frequently in eyes undergoing cataract surgery in the developing world. METHODS: Two hundred human crystalline lenses removed from 200 eyes of 200 patients who underwent intracapsular cataract extraction at Sagarmatha Choudhary Eye Hospital in Nepal were analyzed histopathologically. RESULTS: Forty-nine lenses (24.5%) had a posterior capsular plaque. We confirm that the posterior plaques are composed of collagen that stains positively for Masson trichrome stain and that forms after pseudofibrous metaplasia of lens cells along the posterior capsule. The plaques form in a fashion analogous to a healing process. CONCLUSIONS: We postulate that posterior capsular plaques result from posterior migration of epithelium and pseudofibrous metaplasia of lens epithelium. Most of the posterior capsular plaques are minute and not likely to affect vision. However, a small percentage of plaques are thicker and are likely to impair vision after extracapsular cataract surgery.

Adult↗

PubMed1998

Anterior shift of zonular insertion onto the anterior surface of human crystalline lens with age.

OBJECTIVE: This study aimed to investigate the age-related changes in the position of zonular insertion onto the anterior lens capsule. DESIGN: The study design was an experimental cadaveric eye study. PARTICIPANTS: Two hundred twenty-three cadaveric eyes (range, 16-100 years old) from eye banks in the United States were studied. INTERVENTION: The zonular insertion onto the anterior capsule was detected using a modified posterior photographic technique. MAIN OUTCOME MEASURES: The distances from the anterior zonular insertion (AZI) to the lens equator and to the ciliary sulcus, size of zonular-free zone, lens diameter, ciliary sulcus diameter, and axial length of the globe were measured. RESULTS: Multiple regression analysis showed that age, lens diameter, and axial length of the globe had significant correlations with AZI (r2 = 0.748), among which age showed the highest relevance with AZI. Multiple regression equation was expressed as AZI = (0.0079 x age) + (0.202 x lens diameter) - (0.041 x axial length of the globe) + 0.0114. The increase in AZI was accompanied by a decrease in the size of zonular-free zone with age (r = -0.206, P < 0.001). CONCLUSION: Aging correlates with an increase in the distance from the anterior zonular insertion to the lens equator and a decrease in zonular-free zone.

Accommodation, Ocular↗

PubMed1998

Fixation elements on plate intraocular lens: large positioning holes to improve security of capsular fixation.

OBJECTIVE: This study aimed to evaluate in rabbit eyes the effects of large positioning holes in one-piece silicone plate-haptic intraocular lenses (IOLs) with respect to security of capsular bag fixation. Mechanical strength of capsular fixation is correlated with the histologic findings of regenerating lens material and fibrous tissue ingrowth through the positioning holes on silicone plate IOLs, comparing capsules implanted with large-hole style plate IOLs to fellow capsules implanted with small-hole style plate IOLs. DESIGN: The study design was a prospective, randomized, experimental study. PARTICIPANTS: A total of 40 fellow capsular bags from 20 New Zealand white rabbits were examined. Capsules implanted with conventional small-hole silicone plate IOLs were used as the control in all pairs of fellow capsules. INTERVENTION: Phacoemulsification and implantation of a silicone plate IOL with small positioning holes in one eye and implantation of a silicone plate IOL with large positioning holes in the fellow eye were measured. All rabbits were killed at 2 months. The force required to extract the IOLs from the capsular bag was measured. All capsular bags underwent histopathologic analysis. MAIN OUTCOME MEASURES: Extraction force measurements and histopathologic examination, comparing capsules implanted with small-hole plate IOLs with fellow capsules implanted with large-hole plate IOLs, were measured. RESULTS: The large-hole style IOL required significantly more force to extract from the capsular bag compared to the conventional small-hole style (P = 0.003). Histologically, proliferating lens epithelial material and fibrous tissue were observed growing through all of the large positioning holes (synechia formation) but not through any of the small positioning holes. CONCLUSIONS: Silicone plate IOLs with large positioning holes become affixed more firmly within the capsular bag compared to conventional small-hole plate IOLs. These findings suggest that large holes in silicone plate IOLs allow for superior capsular bag fixation. This should reduce the rates of decentration and dislocation.

Animals↗

PubMed1998

Evaluation of in situ fracture versus phaco chop techniques.

PURPOSE: To quantify and compare the phaco time required using in situ nucleofracture and phaco chop techniques. SETTING: Center for Research on Ocular Therapeutics and Biodevices and Miyake Laboratory, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Thirty human eyes obtained postmortem were randomly divided into 2 groups of 15 eyes each. In situ nucleofracture or phaco chop was performed in each group. The phaco time required for each technique was determined. RESULTS: The mean phaco time was 0.91 minutes +/- 0.37 (SD) for the phaco chop and 1.56 +/- 0.89 minutes for the in situ fracture technique (P < .015). CONCLUSIONS: The phaco chop technique reduced phaco time and total phaco power consumed during phacoemulsification without imposing a risk of intraoperative complications.

Aged↗

PubMed1998

Mini-haptics to improve capsular fixation of plate-haptic silicone intraocular lenses.

PURPOSE: To evaluate the effects of a new mini-haptic design on the strength and stability of capsular bag fixation of plate-haptic silicone intraocular lenses (IOLs) and determine whether this design encourages the growth of regenerating lens material or fibrous tissue around the haptic biomaterial and thus improves lens fixation in the capsular bag. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Department of Ophthalmology, Charleston, South Carolina, USA. METHODS: Six rabbits had bilateral continuous curvilinear capsulorhexis, phacoemulsification, and plate-haptic silicone IOL implantation. Each rabbit had a small-hole plate IOL (Chiron C10UB) implanted in the right eye and a mini-haptic plate IOL (Chiron C40UB) in the left eye. All rabbits were killed at 2 months. The force required to extract one haptic from the capsular bag was measured with a digital force gauge. Histopathologic analysis was performed on all specimens. RESULTS: The mini-haptic style IOLs required significantly more extraction force than the small-hole design (P = .011). Histopathologically, proliferating lens epithelial cells were observed growing circumferentially around the mini-haptics, causing a 360 degree synechia formation. This formation did not occur with the conventional small-hole plate IOLs used as the control. CONCLUSIONS: Lens epithelial cell proliferation around the mini-haptics significantly improved capsular bag fixation of the plate-haptic silicone IOL. This should decrease the incidence of clinical decentration and dislocation.

Animals↗

PubMed1998

Analysis of zonular-free zone and lens size in relation to axial length of eye with age.

PURPOSE: To evaluate the anatomical relationships of the zonular-free zone (ZFZ) of the anterior capsule and crystalline lens diameter in relation to the axial length of the eye with age. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea, and Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHOD: Various ocular structures in 122 eyes obtained post-mortem were measured without prior preparation. The correlation between age, anterior-posterior (A-P) length and globe size, and diameters of the cornea, crystalline lens, and ZFZ were analyzed. RESULTS: The average A-P globe length, and corneal, lens, and ZFZ diameters were 24.48, 11.67, 9.65, and 6.93 mm, respectively. There was no significant relationship between A-P length and globe size and corneal diameter in different age groups. The ZFZ size varied negligibly among age groups. There was a statistically significant correlation between lens diameter and age (correlation coefficient = 0.2647; P < .01) and lens diameter and A-P globe length (correlation coefficient = 0.3183; P < .001). CONCLUSIONS: When choosing an intraocular lens, one should consider the patient's age and the A-P globe length. Six eyes (5%) showed unusual anterior insertion of zonular attachment, which reminds us to be prudent with a large paracentral capsulorhexis.

Adult↗

PubMed1998

Ideal size of an intraocular lens for capsular bag fixation.

PURPOSE: To determine the ideal size of an intraocular lens (IOL) for proper capsular bag fixation in different sizes of evacuated capsular bags. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea, and Storm Eye Institute Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Fifteen eyes obtained post-mortem were divided by crystalline lens size into three groups. Intraocular lenses of five different sizes were implanted in each capsular bag. The arc of contact between the haptics and capsular equator and the capsular bag distortion with each IOL were measured and compared using posterior-view analysis. RESULTS: The arc of contact was directly proportional to the IOL size and inversely related to the lens size. The smallest arc of contact was 2.0 mm with the smallest IOL implanted in the largest lens group. The maximum capsular bag distortion was 2.6 mm in the case of the largest IOL implantation in the smallest lens group. CONCLUSION: Implanting an IOL smaller than 12.5 mm in a large capsular bag can result in unstable fixation, while implanting an IOL larger than 12.5 mm in a small capsular bag can result in excessive stretching and distortion of the capsular bag and surrounding zonules.

Aged↗

PubMed1997

Topical 0.5% ketorolac vs 0.03% flurbiprofen for inhibition of miosis during cataract surgery.

OBJECTIVE: To compare the effects of topical 0.5% ketorolac tromethamine ophthalmic solution (Acular, Allergen Pharmaceuticals, Irvine, Calif) with topical 0.03% flurbiprofen sodium ophthalmic solution (Ocufen, Allergen Pharmaceuticals) on the inhibition of surgically induced miosis during phacoemulsification cataract surgery. DESIGN: One hundred eighteen patients were prospectively randomized to receive 0.5% topical ketorolac or 0.03% topical flurbiprofen at 3 preoperative intervals. The flurbiprofen-treated group served as the control group. The surgeon was masked as to patient selection. Horizontal pupillary diameter measurements were obtained at the start of surgery, just before phacoemulsification, before lens implantation, and after lens implantation. RESULTS: Mean horizontal pupillary diameter measurements for both medications were similar at the start of surgery. However, a consistent trend of larger pupillary diameter was seen in all subsequent surgical intervals in the ketorolac-treated group. Changes from baseline measurements also indicated a more significant inhibition of miosis at all subsequent intervals, and a more stable mydriasis throughout the procedure in the ketorolac-treated group. CONCLUSIONS: Topical ketorolac is an effective inhibitor of miosis during phacoemulsification cataract surgery, and provides a more stable mydriatic effect throughout the surgical procedure.

Administration, Topical↗

PubMed1997

Security of capsular fixation: small-versus large-hole plate-hepatic lenses.

PURPOSE: To assess the effect of relatively large positioning holes on the security of capsular bag fixation of plate-haptic silicone intraocular lenses (IOLs). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This study tested the hypothesis that larger holes allow ingrowth of lens material, fibrous tissue, or both through them, which helps fixate the lens more firmly in the capsular bag. Five rabbits had bilateral continuous curvilinear capsulorhexis, phacoemulsification, and implantation of a plate-haptic silicone IOL. An IOL with a small, round positioning hole (Staar AA-4203V) was implanted in the right eye in each rabbit, and a large-hole IOL (Staar AA-4203VF) was implanted in the left eye. After 2 months, all rabbits were killed. The force required to extract one haptic from the capsular bag was measured with a digital force meter. All eyes had histopathological analysis. RESULTS: It was slightly more difficult to extract a large-hole IOL from the capsular bag, although this trend was not statistically significant. However, histopathological analysis consistently showed 360 degree synechia formation through the holes, showing that the IOL could be securely fixed in position. CONCLUSIONS: Proliferation of lens epithelial cells through a large positioning hole in a plate-haptic silicone IOL may improve the long-term security of capsular bag fixation. This will help reduce the incidence of IOL decentration and dislocation.

Animals↗

PubMed1997

Effect of surface photorefractive keratectomy and laser in situ keratomileusis on the corneal endothelium.

PURPOSE: To investigate endothelial cell loss in pairs of fresh human autopsy globes following high-diopter myopic photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK). SETTING: Center for Research on Ocular Therapeutics and Biodevices and Magill Laser Center for Vision Correction, Storm Eye Institute, Charleston, South Carolina, USA. METHODS: In the first part of the study, 12 globes had either -10 diopters (D) multizone surface PRK or -10 D single-zone LASIK. In the second part, three groups of 5 globes each had -15 D, -20 D, or -25 D multizone-blend LASIK procedures. Fellow globes in both groups were used as untreated controls. Corneoscleral buttons were excised from all globes. Following 7 days in corneal organ culture, the endothelial surface was stained with two vital dyes: calcein-AM and ethidium homodimer. Fluorescence microscopy was used to obtain endothelial cell counts. RESULTS: The mean dead cells per square millimeter (cells/mm2) were 0.94 in the -10 D PRK treated corneas compared with 0.91 in the fellow untreated eyes (P = 0.06(. The mean dead cells/mm2 in the -10 D single-zone LASIK-treated corneas and in the fellow untreated eyes were 0.61 (P = 0.88). The mean dead cells/mm2 in the -15 D, -20 D, and -25 D multizone-blend LASIK-treated corneas were 3.08, 2.33, and 5.55, respectively, compared with 3.49, 1.92, and 5.01 in the fellow untreated eyes (P = 0.276, P = 0.339, and P = 0.427, respectively). Dead cell counts for treated and control paired corneas were highly correlated in all treatment groups. CONCLUSIONS: No significant endothelial cell loss occurred after -10 D PRK or LASIK corrections up to -25 D. Although this study has limitations that prevent direct extrapolation to the clinical situation, it does afford a comparable clinical correlate for endothelial cell toxicity following a typical excimer laser ablations.

Aged↗

PubMed1997

Silicone oil adhesion to intraocular lenses: an experimental study comparing various biomaterials.

PURPOSE: To perform an in vitro experimental study comparing the degree of adherence of silicone oil to various rigid and foldable intraocular lens (IOL) designs and to the human lens capsule. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Seven IOL styles comprising various biomaterials were studied: fluorine-treated (Fluorlens), heparin-surface-modified (HSM), hydrogel, Memory-Lens, Poly(methyl methacrylate) (PMMA), soft acrylic, and silicone lenses; the human crystalline lens was also studied. Each lens was immersed in silicone oil for 12 hours, than photographed, studied by scanning electron microscopy (except the crystalline lens), and subjected to computer-generated image analysis to determine the silicone oil coverage. RESULTS: Silicone oil coverage of dry silicone lenses was 100% and of lenses immersed in normal saline, 82.5%. The least coverage was on the heparin-surface-modified lens (mean score 9.4%). Coverage of the other four lenses ranged from approximately 15.1% to 33.7%. Mean coverage of the human lens capsule was 10.9%. CONCLUSION: Although a silicone IOL shows maximal adherence to silicone oil, other lens biomaterials are not immune to this complication. Silicone oil coverage was related to the dispersive energy component of the surface charge of the IOL biomaterial. Low dispersive energy materials had less silicone oil coverage, while those with higher dispersive energy had more oil coverage.

Adhesiveness↗

PubMed1996

Irreversible silicone oil adhesion to silicone intraocular lenses. A clinicopathologic analysis.

PURPOSE: To report a newly defined complication of foldable intraocular lenses (IOLs), namely silicone oil-silicone IOL interaction. This is a complication not generally seen by the implanting cataract surgeon but, rather, at a later stage in a patient's postoperative course, by a vitreoretinal surgeon. METHODS: Three clinical case histories, including two explanted silicone IOLs, were submitted for analysis. The submitted silicone lenses were photographed under water, and the nature of the silicone oil coating was documented. RESULTS: In each instance, the silicone coating was manifest as a thick coating with droplet formation on the lens surface that was tenaciously adherent and could not be dislodged by instruments or injection of viscoelastics. CONCLUSION: The use of silicone IOLs in patients with current vitreoretinal disease or those who are at high risk for future vitreoretinal disease that may require silicone oil as part of the therapy should be reconsidered. The authors recommend that information regarding the existence and significance of this complication be printed on all silicone oil and silicone IOL packages and inserts (if not as a warning, at least as an informative comment regarding the existence of this condition). This is a rare but clinically significant complication that will affect the occasional patient treated with both of these modalities.

Adult↗

PubMed1996

A modified preparation technique for closed-system ocular surgery of human eyes obtained postmortem: an improved research and teaching tool.

PURPOSE: In addition to use for corneal transplantation, human autopsy eyes also are used for teaching and vision research. The valuable posterior video technique of Miyake usually is done with an "open-sky" preparation. Closed-system surgery in postmortem eyes is difficult because of postmortem decrease of corneal clarity and myosis. The authors have developed an improved preparation technique that allows closed-system ocular surgery in human postmortem eyes. METHOD: The cornea is dehydrated using a hyper osmolar (15 percent) dextran solution (Swinger-Kornmehl solution), which clarifies the cornea for several hours. The pupil is dilated mechanically by injecting dextran solution into the anterior chamber, and the iris is fixated using formaldehyde (10 percent) and Karnovsky solution. RESULTS AND CONCLUSIONS: This technique can be used in autopsy eyes up to 4 days postmortem without other fixation. Incision techniques, capsulorhexis, phacoemulsification, and intraocular lens implantation, as well as other surgical procedures such as glaucoma surgery, transcleral fixation of posterior chamber lenses and vitrectomies, can be performed. Neodymium:YAG laser capsulectomies or other laser surgical procedures are also possible. This technique is not only excellent for residency training and postgraduate wet laboratories, but is also a viable tool for research purposes.

Education, Medical↗

PubMed1996

Centration and fixation of silicone intraocular lenses: clinicopathological findings in human autopsy eyes.

PURPOSE: To analyze centration and fixation of three-piece and one-piece silicone intraocular lenses (IOLs) in human autopsy eyes. SETTING: Center for Intraocular Lens Research, Medical University of South Carolina, Charleston. METHODS: Thirty eyes among those submitted to the center between 1986 and 1994 were evaluated. The globes were sectioned at the equatorial plane and photographed from a posterior view. Gross examination was performed to determine IOL type, fixation, centration, and additional pathology. The results were compared with those of a control group of autopsy eyes implanted with one-piece and three-piece poly(methyl methacrylate) (PMMA) IOLs. The control group matched the silicone group in patient age, fixation site, and duration of implantation. RESULTS: Twenty-three eyes (79.3%) had three-piece silicone IOLs and 7 eyes (20.7%), one-piece plate IOLs. Average patient age in the three-piece group was 77.3 years +/- 6.7 (SD) and in the one-piece group, 74.3 +/- 3.8 years. The 30 IOLs were symmetrically fixated in the bag. Average decentration of the three-piece and one-piece IOLs did not differ significantly, 0.37 +/- 0.31 mm and 0.26 +/- 0.13 mm, respectively (P = .37). There was also no significant difference in decentration between the silicone groups and the PMMA groups (P = .93). CONCLUSION: Centration and fixation of silicone IOLs were equivalent to those of standard PMMA IOLs.

Aged↗

PubMed1996

Clinicopathological findings in human autopsy eyes with an Anis circular lens.

PURPOSE: To evaluate the long-term performance of the Anis circular intraocular lens (IOL). SETTING: Center for IOL Research, Storm Eye Institute, Charleston, South Carolina. MATERIALS: Fifteen human autopsy eyes with an Anis circular IOL submitted between 1985 and 1993 were evaluated. The eyes were sectioned at the equatorial plane, and the anterior segment containing the capsular bag and the IOL was photographed from the posterior perspective. Fixation, centration, capsular bag shape, zonular damage, central posterior capsule opacification (PCO), and Soemmering's ring formation were analyzed. The results were compared with those of a control group comprising human autopsy eyes with a one-piece (n = 15) or three-piece (n = 15) poly(methyl methacrylate) IOL with a C-loop design. RESULTS: All 15 Anis IOLs showed symmetrical in-the-bag fixation. Mean decentration in the Anis IOL eyes was significantly lower than in the control eyes (P = .02). Eyes with the Anis IOL had fewer zonular defects (P = .0005) and a better circular extension of the capsular bag (P = .003). There were no statistically significant differences in PCO (P = .29) or Soemmering's ring formation (P = .67). CONCLUSION: The Anis IOL with a circular haptic design had better centration and capsular bag morphology than the control eyes, although a difference in PCO and Soemmering's ring formation could not be shown.

Aged↗

PubMed1996

Centration and fixation of posterior chamber intraocular lenses in eyes with pseudoexfoliation syndrome. An analysis of explanted autopsy eyes.

Pseudoexfoliation syndrome is an important risk factor in cataract surgery. We examined decentration of posterior chamber intraocular lenses in a series of 24 autopsy eyes with pseudoexfoliation syndrome that had undergone cataract surgery and intraocular lens implantation. The results were compared to a control group of 25 normal autopsy eyes that matched the pseudoexfoliation collection for age distribution, implant duration and further anatomical parameters. The mean lens decentration in all pseudoexfoliation eyes (0.75 +/- 0.38 mm) was significantly higher than in the control group (0.40 +/- 0.29 mm) (p = 0.0008). Analysis of subgroups with symmetrical bag/bag fixated intraocular lenses showed a significantly higher decentration in the pseudoexfoliation group (p = 0.04). The main reason for decentration was a decentration of the entire capsular bag in pseudoexfoliative eyes (p = 0.001), which was related to zonular weakness and damage. The results indicate that in patients with pseudoexfoliation syndrome alternative fixation sites, like sulcus or transscleral fixation, should also be considered.

Aged↗