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Extended wear of hydrophilic contact lenses in aphakia - an alternative to intraocular lens implantation.

Since not every patient will be a candidate for an intraocular lens, there will always be a portion of aphakic patients who are candidates for extended wear hydrophilic lenses. Aphakic patients to be fitted successfully with extended wear contacts must be motivated, aware of the risks, and require frequent lens cleaning and replacement on an individual basis. While future improvement of hydrophilic lenses is to be expected and anticipated, the extent of these improvements is still uncertain. However, preliminary reports are encouraging. Extended wear contact lenses are not the only answer to aphakia. They are but one alternative available to the ophthalmologist for maximizing the visual rehabilitation of the aphakic patient. Even with the increasing use and acceptance of intraocular lenses, the use of extended soft lens wear has a place in this rehabilitation.

Aphakia, Postcataract↗

[Diplopia in monocular aphakia].

In monocular aphakia, diplopia results from disparities between the two retinal images in form, size, outline, luminous intensity and colour. If one wishes to give the best binocular vision possible to a monocular aphake, it is important to recognize the different factors which may give rise to diplopia.

Aniseikonia↗

[Interaction of the mutant aphakia, fidget and ocular retardation genes in mice].

The phenogenetic analysis of the effects of aphakia (ak) gene and its interaction with the ocular retardation (or) and fidget (fi) genes suggests that the ak gene acts in the lens cells with the result of arresting lens fibre differentiation. In mice homozygous for ak, the lens failure leads to secondary retina defects, in particular, to formation of retinal folds. In ak/ak or/or mice, the lens and retina morphogenesis stops at the optic cup stage, the eye is strongly reduced in size and more affected, compared to the corresponding single homozygotes. Unlike ak/ak or/or, in the ak/ak fi/fi mice the eyes are more regular in shape than those in the ak/ak +/+ condition. The fi gene inhibition of the retina anlage growth leads to some improvement of the eye development in double ak/ak fi/fi homozygotes, due to the absence of extensive retina folding.

Animals↗

Extended wear soft contact lenses in the correction of aphakia.

This paper reports the study over a 2-year period of forty patients with uniocular aphakia fitted with spherical extended wear hydrophilic lenses: Sauflon 85 per cent and Duragel 72 per cent. The patients' ages ranged from 17 to 87 years (mean 52). They were unable to handle a daily wear soft lens or tolerate a hard lens. The success rate was 85 per cent.

Adolescent↗

Peter's anomaly with congenital aphakia.

An Inuit boy was born with microphthalmia and a central corneal opacity of the right globe. Histopathologic examination revealed a central adherent corneal leukoma (Peter's anomaly) as well as absence of the lens. We are not aware of other well documented histopathologic reports of congenital aphakia and Peter's anomaly occurring in the same eye.

Aphakia↗

[Intraocular metallic crystalline lens for correction of aphakia].

Technological characteristics of a new in principle intraocular lens (IOL) consisting of a leukosaphire lens and elastic tantalum haptics are presented. The advantages of metallic crystal IOLs are validated: complete chemical and biological inertness, longevity, high transparency, and easy implantation in the capsular sac. Surgical recommendations are offered and highly positive results of clinical trials analyzed (more than 600 implantations followed up for up to 4 years). Metallic crystal IOLs for intracapsular correction of aphakia developed at the S. I. Vavilov All-Russian Research Center and St. Petersburg Division of the Moscow Research and Technological Complex "Ocular Microsurgery" and manufactured by the IOL Joint Stock Company are recommended for wide clinical use.

Aphakia, Postcataract↗

A case-control study of risk factors for proliferative vitreoretinopathy in aphakia.

A case-control study was performed to elucidate the risk factors of proliferative vitreoretinopathy (PVR) in aphakia. Twenty-five aphakic eyes with rhegmatogenous retinal detachment accompanied by PVR were compared with the control group of 156 aphakic eyes with rhegmatogenous retinal detachment without PVR. Unconditional logistic regression analysis identified the following risk factors for developing PVR in order of significance: choroidal detachment (odds ratio 15.41, 95% confidence interval 3.29-72.09), duration of retinal detachment longer than one month (odds ratio 12.07, 95% confidence interval 3.53-41.26), occurrence of retinal detachment within one year following cataract surgery (odds ratio 6.2, 95% confidence interval 1.64-23.47), and history of vitreous loss in cataract surgery (odds ratio 3.91, 95% confidence interval 1.28-11.92).

Adolescent↗

[Correction of aphakia with transcleral fixation of the lens in the ciliary sulcus].

The posterior chamber intraocular lens particularly for ciliary sulcus fixation is a very good solution of correction of aphakia in cases when any part of capsule is missing. With proper surgical technique the obtained results are very good and the number of complications reported can be minimized. The authors demonstrate it in a group of 38 eyes with ciliary sulcus fixation. A very low occurrence of complications and good visual acuity including long follow-up confirm, that this method can be successfully used in the case od correction of aphakic patients.

Adult↗

[The results of correcting aphakia by an artificial lens implant].

The author shows the efficacy of correction in aphakia by intraocular lenses in the absence of ocular biometry and using of viscoelastic substance on a group of 258 cases hospitalised and operated in the Department of Ophthalmology of the University of Medicine from Cluj-Napoca. The study includes also the immediate and late complications of intraocular lenses and causes for removal of intraocular lens.

Adolescent↗

[Visual rehabilitation in aphakia with air lenses].

The article shows a comparative study between two groups of 50 patients operated for cataract in 1990 and 1995. In both of these groups aphakia was corrected with aerian lenses. The study was made to demonstrate the visual problems due to strong convergent lenses, to shows the difficult adaptation to this kind of spectacles and to determine the degree of dissatisfaction of the spectacles wear aphak.

Aged↗

Aphakia (ak), a mouse mutation affecting early eye development: fine mapping, consideration of candidate genes and altered Pax6 and Six3 gene expression pattern.

The homozygous mouse mutant aphakia (ak) has been characterized by bilaterally aphakic eyes without a pupil [Varnum DS, Stevens, LC (1968): J Hered 59:147-150]. The mutation was mapped to chromosome 19 [Varnum DS, Stevens, LC (1975): Mouse News Lett 53:35]. Our linkage studies yielded a precise localization of the ak gene 0.6 +/- 0.3 cM proximal to the microsatellite marker D19Mit10 and 0.7 +/- 0.4 cM distal to D19Mit4 and D19Mit91. No recombination was found with the marker D19Mit9 among 418 backcross offspring tested. The developmental control gene Pax2 mapped 11.0 +/- 3.5 cM proximal to ak and is excluded as a candidate gene. Sequence analysis of Fgf8 and Chuk1, which are localized close to the marker D19Mit10, detected no mutations in the ak/ak mutants. Histological analysis of homozygous mutants suggested the arrest of lens development at the lens stalk stage, a transient morphological structure during the formation of the lens vesicle. In the lens remnants, Pax6 and Six3 are expressed, whereas in the persisting lens stalk only Pax6 was detected. The expression pattern of Pax2 appeared normal; Cryaa expression could not be detected. As a consequence of the arrested lens development, other ocular tissues that require for their development information from the intact lens, such as iris, ciliary muscle, retina, and vitreous body, are absent or formed abnormally.

Animals↗

Malorientation of mitotic figures in the early lens rudiment of aphakia mouse embryos.

In early embryonic epithelia most cell divisions are oriented with their cleavage furrows perpendicular to the free surface of the tissue. This results in the generation of two daughter cells, which are equivalent with regard to their apical surface. Mitotic figures, in which the long axis through the centers of the chromosome plates (chromatin masses) is perpendicular to the surface, are seen only occasionally. The lens placode and early lens cup of mouse embryos homozygous for the gene aphakia show significantly greater numbers of maloriented mitoses than normal control lenses. The axis connecting the centers of the chromosomal plates is frequently perpendicular or oblique to the surface. This may result in the production of daughter cells, which are unequal as far as their position at the tissue surface is concerned. Later, the lumen of the mutant lens vesicle fills up with cells, which are apparently released from the lens epithelium. Further development of the lens and the eye is grossly disturbed. The release of these cells may be a consequence of the malorientation of their divisions, or both may be the result of a defect in the spatial organization of the lens tissue, possibly due to abnormal cellular adhesion.

Animals↗

Primary congenital aphakia and the rubella syndrome.

Four embryos from women infected by rubella virus early in pregnancy were investigated histologically. In three of the patients the serological tests were positive; in the fourth the diagnosis of rubella was based solely on the clinical picture. Three of the four embryos showed unilateral severe microphthalmia and primary congenital aphakia. In addition to this defect the right eye of one of the embryos showed a central liquefaction of the lens (cataract). Damage to the internal ear in the form of discontinuities in the epithelium of the cochlear duct were also observed (in two of the three embryos; in the fourth both internal ears were absent in the curettage material). In three of the four hearts there were cells in the myocardium with a markedly eosinophilic cytoplasm.

Abnormalities, Multiple↗

Correction of aphakia with contact lenses.

The correction of unilateral and bilateral aphakia with contact lenses has given good results. The contact lens of choice today is either the hard corneal lens or the soft hydrophilic lens. High-water-content lenses have excellent oxygen permeability which permits continuous wear. Experience with the 'Sauflon 85' lens is described.

Cataract↗

Calculating magnification differences in monocular aphakia.

The calculation of magnification differences is treated well in a number of texts, 1, 3, 4, 5, 7 but the formulas are not always presented in their most convenient form. Because of this, many complex schemes have been illustrated 2 and many different versions have been published. 3, 4, 5. The purpose of this paper is to present the pertinent equations in a simplified manner and to illustrate them by a specific example, namely, the case of monocular aphakia.

Aniseikonia↗

The use of contact lenses in children with unilateral traumatic aphakia.

Seveteen children under the age of ten years with unilateral traumatic aphakia, who had been fitted with contact lenses, were reviewed by an ophthalmologist and an orthoptist, on average three years after the injury. Thirteen children were still using their lenses. Of the seventeen, none were deeply amblyopic. Only one had orthophoria. Twelve of the seventeen had heterotropia, which in most cases was moderate. Six of the children achieved stereopsis in the synoptophore, only four by the Titmus sterotest, all of these were six years old or more at the time of the injury, and had had lenses fitted within the first six months of the injury. All the patients, as well as their parents, were motivated for lens-wearing, and the lens played an important part in the treatment of amblyopia. It is concluded that the sooner the contact lens is supplied, the better are the changes of obtaining binocular function. Beginning with a soft lens a few weeks after achieving clear pupil is recommended.

Amblyopia↗

Stereopsis and aniseikonia in uniocular aphakia.

Uniocular aphakia in the adult when corrected with a contact lens is in most patients no obstacle to binocular function. The long-term result is a balance between binocular function obtained and the comfort of the contact lens, and in this respect the advent of the soft lens, and especially the continuous-wear lens, appears to be most promising.

Adult↗