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PubMed1997

Small incision trabeculectomy avoiding Tenon's capsule. A new procedure for glaucoma surgery.

BACKGROUND AND PURPOSE: Wound healing at the level of Tenon's capsule is a common cause of trabeculectomy failure. The purpose of this study is to present a new technique for glaucoma filtering surgery in which an injury to Tenon's capsule is minimized. METHODS: A 2.5-mm conjunctival peritomy was performed without cutting Tenon's capsule. A partial-thickness incision was made at the limbus and a scleral pocket was dissected 2 to 3 mm posteriorly. The subconjunctival space was entered with a cystotome passed through the scleral pocket, and balanced salt solution (BSS, Alcon Laboratories, Ft. Worth, TX) was injected, forming a subconjunctival bleb. In patients considered high risk, 5-fluorouracil (5 mg) was mixed with the BSS injected. The anterior chamber was entered at the initial limbal incision. A 1.5- by 1-mm fragment of the floor of the pocket was excised, followed by a peripheral iridectomy. The scleral wound, as well as the conjunctiva, was closed with separate 10-0 nylon sutures. This procedure was performed in 30 glaucomatous eyes. Seven high-risk eyes received four to seven postoperative injections of 5 mg of 5-fluorouracil. RESULTS: Preoperative intraocular pressure (IOP) was 34.5 +/- 8.1 mmHg. Postoperative IOP was 13.2 +/- 4.1 at 6 months (P < 0.01), and 90% of the eyes had IOP less than or equal to 18 mmHg without medication. Mean follow-up was 7.6 months (range, 6-14 months). Blebs were low-lying and diffuse. No serious complications were encountered. CONCLUSIONS: This new technique is a safe procedure that effectively reduces IOP. It is done through a small incision without sophisticated instruments. More cases and a prospective trial are needed to ascertain its potential advantages over those of conventional trabeculectomy.

Adult↗

PubMed2006

[Argon laser iridoplasty in the treatment of angle closure glaucoma with plateau iris syndrome].

INTRODUCTION: Plateau iris predisposes to the onset of an angle-closure glaucoma attack without pupillary block. This is a morphological anomaly of the iris characterized by anterior insertion, root thickness greater than the norm, and anterior rotation of the ciliary processes into the posterior chamber, pushing the base of the iris into the angle. Argon laser iridoplasty is useful to retract the peripheral iris using the thermal effect of the laser to widen the iridocorneal angle. MATERIALS AND METHODS: The study investigated nine eyes of five patients who had had iridoplasty for iris plateau angle-closure glaucoma, diagnosed by dynamic gonioscopy (or indentation gonioscopy) and confirmed by ultrasound biomicroscopy (UBM). There were four females and one male, with a mean age of 42.2 years (range, 30-53 years). The mean intraocular pressure (IOP) before iridoplasty was 21.1 mmHg. The number of antiglaucoma treatments was 1 or 2, with all patients receiving miotic treatment. All patients had undergone argon laser iridotomy beforehand to remove the pupillary block frequently associated with iris plateau. Iridoplasty was done in two sessions with postoperative IOP-lowering treatment. The laser parameters used were: duration, 0.3 s; power, 500 mW; diameter, 300 microm. RESULTS: The postoperative IOP evaluated at 1 month was 14.4 mmHg with a reduction in the hypotensive treatment. No treatment was prescribed for four eyes, a single hypotensive treatment for four eyes, and two hypotensive medications for one eye. DISCUSSION: Pure iris plateau syndrome, leading to closure of the angle, is very rare compared to pupillary block, but these two mechanisms often co-exist. The physiopathology explains that the mechanism of isolated iris plateau is not modified by iridectomy. However, the advantage of argon laser iridoplasty, which retracts the periphery of the iris so as to widen the iridocorneal angle, must be emphasized. This technique can alleviate the need for high-risk filtering surgery, but longer follow-up is necessary to evaluate its duration and efficacy.

Adult↗

PubMed2001

Translimbal approach for intravitreal injection in endophthalmitis after phacoemulsification.

We describe a corneal limbal technique of intravitreal injection for use in cases in which it is difficult to confirm the position of the needle. Using this translimbal approach, the needle's position is easily identified and the intravitreal injection can be given using topical anesthesia. This technique is an option in eyes with a cloudy cornea or a large iridectomy.

Adult↗

PubMed2002

Bipseudophakia: clinicopathological correlation of a dropped lens.

PURPOSE: To examine postmortem human globes containing an anterior chamber and a posterior chamber intraocular lens (IOL). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Charleston, South Carolina, USA. METHODS: The globes were sectioned at the equator, and the anterior and posterior segments were macroscopically examined. Gross photographs were taken using the Miyake-Apple posterior photographic technique. Histological sections were cut and stained with hematoxylin and eosin, periodic acid-Schiff, and Masson's trichrome. RESULTS: Histopathological findings included a large Soemmering's ring, a tear in the posterior capsule, 1 haptic of the anterior chamber IOL displaced into the iridectomy, thin and atrophic corneal epithelium, separation of Bowman's layer and stroma by fibrovascular tissue, and atrophy of the retinal ganglion cell layer and nerve fiber layer. CONCLUSION: In cases in which secondary IOL implantation is indicated, removing the dislocated IOL appears to be a reasonable choice.

Aged↗

PubMed2002

Iris synechia after laser goniopuncture in a patient having deep sclerectomy with a collagen implant.

Neodymium:YAG (Nd:YAG) goniopuncture is an efficient and safe treatment for low filtration through the trabeculo-Descemet's membrane after deep sclerectomy with a collagen implant (DSCI). The only reported complication of this procedure is choroidal detachment. However, we found an iris synechia in a patient whose intraocular pressure (IOP) was elevated again 1 month after Nd:YAG goniopuncture. Synechiolysis and peripheral iridectomy with Nd:YAG and argon lasers effectively removed the iris synechia, and IOP immediately dropped to the normal range. We believe that iris synechia is a potential complication that may cause elevated IOP after laser goniopuncture in patients having DSCI.

Adult↗

PubMed2003

Four-point fixation of posterior chamber intraocular lenses in children with unilateral aphakia.

PURPOSE: To evaluate the results of 4-point scleral fixation of posterior chamber intraocular lenses (PC IOLs) in children. SETTING: Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. METHODS: This retrospective study comprised 20 aphakic eyes of 20 children. Preoperative investigations proved the absence of adequate posterior capsule support. All patients had ab externo 4-point scleral fixation of a PC IOL. All preoperative and postoperative data were studied and analyzed. RESULTS: The mean preoperative age was 7.7 years (range 4 to 11 years). The mean follow-up was 19.35 months (range 13 to 30 months). The preoperative findings included a best corrected visual acuity of 6/18 or better in 8 eyes (40%), corneal scarring in 18 eyes, sector iridectomy in 7 eyes, and after-cataract in 4 eyes. The intraoperative complications included vitreous hemorrhage in 2 eyes and slippage of 1 suture in 1 eye. Postoperative complications included mild anterior uveitis in 12 eyes and severe fibrinoid reaction in the anterior chamber in 8 eyes. There were no cases of suture exposure, IOL malpositioning, or infection. Twelve patients (60%) had a visual acuity of 6/18 or better. The cause of the poor visual outcome in many patients was preexisting amblyopia. CONCLUSIONS: The results suggest that 4-point scleral fixation is an option to correct aphakia in children. However, long-term follow-up is important to assess the procedure's safety.

Aphakia, Postcataract↗

PubMed2003

Clear lens extraction with intraocular lens implantation for hyperopia.

PURPOSE: To analyze the results of clear lens extraction (CLE) with posterior chamber intraocular lens (IOL) implantation to correct hyperopia. SETTING: Eye Research Center and Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 20 hyperopic eyes of 12 patients between 19 and 50 years who had CLE with posterior chamber IOL implantation. Five patients had peripheral iridectomy during CLE as the angles were occludable. RESULTS: The mean hyperopic spherical equivalent refraction was +6.66 diopters (D) +/- 2.17 (SD) (range +4.75 to +13.00 D). The IOL power was calculated using the Holladay 2 formula. The mean follow-up was 16.96 months (range 6 to 35 months). The mean postoperative uncorrected visual acuity was 0.45 +/- 0.25 (range 0.10 to 1.00), a mean improvement of 3 Snellen lines from preoperatively. The mean postoperative best corrected visual acuity (BCVA) was 0.63 +/- 0.30, a mean improvement of 1 Snellen line. Three patients gained 2 lines of BCVA and 2 patients, 1 line. One patient lost 1 line of BCVA. Seventy percent of patients were within +/-0.50 D of the intended refraction. CONCLUSION: The results indicate that CLE with posterior chamber IOL implantation is safe, predictable, and effective.

Adult↗

PubMed2003

Angle-supported phakic intraocular lenses in eyes with keratoconus and myopia.

PURPOSE: To evaluate the visual results and complications of angle-supported phakic intraocular lenses (IOLs) to correct myopia associated with early-stage keratoconus. SETTING: Private practice, Siena, Italy. METHODS: In a prospective noncomparative single-surgeon interventional case series, outcomes in 12 consecutive eyes of 8 patients with stage I to II keratoconus, myopia from -6.50 to -14.00 diopters (D), and astigmatism from -1.00 to -5.00 D were analyzed after the implantation of angle-supported phakic IOLs (ZSAL-4, Morcher). The minimum follow-up was 12 months. Implantation was performed through a sclerocorneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, after which a surgical basal iridectomy was created. RESULTS: The spherical error in all cases was corrected within +/-1.00 D. Astigmatism magnitude did not significantly improve. The uncorrected visual acuity (UCVA) was 20/40 or better in all cases. The best spectacle-corrected visual acuity (BSCVA) was equal or improved in all cases. The safety index (postoperative BSCVA/preoperative BSCVA) was 1.18; the efficacy index (postoperative UCVA/preoperative BSCVA) was 0.77. Three eyes had significant halos that improved considerably over 3 months. Spectacles were permanently used by 1 patient (2 eyes in the study) and only for driving by 5 patients. Complications were limited to 3 cases of mild pupil ovalization and 1 case of IOL rotation. Endothelial loss at 12 months was 7.2%. CONCLUSIONS: Implantation of angle-supported phakic IOLs to correct myopia in patients with keratoconus stage I to II was an effective procedure. Although astigmatism did not improve by the creation of the incision, it was well tolerated by most patients. Long-term endothelial safety must be assessed.

Adult↗

PubMed1990

Management of subluxated and posteriorly dislocated intraocular lenses using pars plana vitrectomy instrumentation.

Thirty-four patients with subluxated and posteriorly dislocated intraocular lenses (IOLs) had repositioning, replacement, or removal of the IOL using pars plana instrumentation. Of the 25 cases posteriorly dislocated into the formed vitreous, ten posterior chamber IOLs were repositioned into the ciliary sulcus, one anterior chamber IOL was repositioned into the anterior chamber angle, and eight posterior chamber IOLs were exchanged for anterior chamber IOLs through a limbal incision. In the remaining six cases, the IOL was removed but was not replaced because of concurrent ocular pathology. In nine cases with subluxation of an anterior chamber IOL into a large basal iridectomy, a pars plana approach after vitrectomy was used for repositioning the IOL into the anterior chamber angle. Complications included each of the following: intraoperative retinal dialysis, postoperative extension of a pre-existing subclinical retinal detachment, recurrent subluxation of an anterior chamber IOL, breakdown of chronic cystoid macular edema to form a macular hole, and pseudophakic pupillary block requiring laser iridotomy.

Aged↗

PubMed1992

Evaluation of 200 consecutive IOGEL 1103 capsular-bag lenses implanted through a small incision.

We evaluated 200 consecutive IOGEL 1103 capsular bag intraocular lenses. We performed a 5 to 6 mm capsulorhexis and inserted the intraocular lens (IOL) through a 3.5 to 4.0 mm scleral tunnel with a Faulkner folder. Twenty-two cases were combined with trabeculectomy and ten with keratoplasty using a temporary keratoprosthesis. Mean follow-up was six months. The implant centered well and resisted capsular shrinkage. Iris touch to the optic was rare and did not provoke persistent pigment dispersion. In one third of the cases a cleft was discernible between the posterior convex IOL surface and the extended capsule despite thorough aspiration of viscoelastic and debris from the retrolental space. In 8% of cases, white flakes of unknown origin were observed at the IOL-capsule interface. In cases associated with pre-existing iritis or intraoperative iris trauma (iris manipulation, iridectomy, or synechiolysis in glaucoma patients), fibrin exudation as well as iridocapsular synechial formation and macrophage precipitation often ensued. Cellular precipitates, as evaluated by biomicroscopy and specular microscopy, were less pronounced and more transient than on poly(methyl methacrylate) IOLs. Best case visual acuity results were comparable to those with conventional implants; all eyes attained 20/40 or better and 97% achieved 20/25 or better. The 1103 was easier to implant through a capsulorhexis opening and suited the dimensions of the capsular bag better than the PC-12 model.

Aged↗

PubMed1986

Neodymium:YAG laser therapy for pseudophakic pupillary block.

Pupillary block occurred in six patients with anterior chamber intraocular lens implants. After medical therapy failed, the Nd:YAG laser was used to break the hyaloid face in the pupillary and iridectomy apertures. Iridotomies were also produced at the sites of bulging iris. Following laser treatment the anterior chambers deepened and there were no further signs or symptoms of pupillary block. The Nd:YAG laser proved to be a useful treatment for pseudophakic pupillary block.

Aged↗

PubMed1989

Results of secondary anterior chamber intraocular lens implants with iridoplasty and pars plana vitrectomy.

A combined three-part procedure to permit aphakic patients with full iridectomies to receive secondary anterior chamber intraocular lens implants is described. Pars plana vitrectomy leaves the anterior chamber free of vitreous, thus preparing the eye for the iridoplasty and implant. Iridoplasty is performed using a special micro needle that permits good visualization in the eye. The results of ten cases are discussed.

Aged↗

PubMed1996

Collamer intraocular contact lens to correct high myopia.

PURPOSE: To determine the feasibility of using posterior chamber intraocular contact lenses to treat myopia. SETTING: Ambulatory surgery centers in Torino, Ancona, and Ivrea, Italy. METHODS: The phakic intraocular contact lens is made of a collagen copolymer. We implanted 15 of these lenses in 14 patients with preoperative spherical equivalents ranging from -10.8 to -24.0 diopters (D); average myopia was -15.3 D +/- 3.1 (SD). Average follow-up was 7.0 +/- 1.95 months. RESULTS: Mean postoperative spherical equivalent was -2.0 +/- 1.6 D. Uncorrected visual acuity improved in 14 eyes. Best spectacle-corrected acuity was maintained or improved in all but one eye. No iritis or cataracts were observed. Six months postoperatively, the mean endothelial cell loss was 4%. A pupillary block requiring a superior peripheral iridectomy occurred in one eye. CONCLUSIONS: Because of the incomplete follow-up, we cannot draw conclusions about the long-term safety of the implantable contact lens. The intimate contact between the contact lens and the natural lens raises the possibility of cataract formation. However, examination by Scheimpflug photography and ultrasound biomicroscopy showed no progressive lens opacities.

Biocompatible Materials↗

PubMed1997

Preoperative ultrasound biomicroscopy to assess ease of haptic removal before penetrating keratoplasty combined with lens exchange.

PURPOSE: To evaluate a method of assessing anterior chamber intraocular lens (IOL) haptics before combined penetrating keratoplasty and IOL exchange in eyes with poor corneal clarity resulting from pseudophakic bullous keratopathy (PBK). SETTING: Department of Ophthalmology, Toronto Hospital, Ontario, Canada. METHODS: Twelve eyes (25 haptics) with PBK were studied using ultrasound biomicroscopy (UBM). The degree of haptic encasement was graded. The result was compared with the degree of difficulty and the complications encountered in removing the IOL at the time of surgery. The surgeons were masked as to the UBM results. RESULTS: All haptics were easily visualized with UBM, with 23 in the angle and 2 passing through a peripheral iridectomy. On UBM, 9 haptics were noted to lie free in the angle, and 16 were encased by fibrotic tissue. Eight were covered by less than 100 microns and 8 by more than 100 microns of tissue. Calculations using Kappa statistics found a strong predictive value for the UBM in identifying the presence or absence of fibrotic encasement and degree of difficulty in removing the anterior chamber IOL haptics. Ultrasound biomicroscopy also allowed assessment of the adjacent angle for synechias. CONCLUSION: Ultrasound biomicroscopy provides an alternative method for evaluating anterior chamber IOL haptics when gonioscopy is not possible because of corneal opacity. This method allows the surgeon to predict preoperatively the degree of difficulty that will be encountered in explanting the IOL.

Anterior Chamber↗

PubMed1998

Pupillary block after pupillary capture of an AcrySof intraocular lens.

A 54-year-old man developed pupillary block resulting from pupillary capture 2 months after uneventful phacomulsification and AcrySof intraocular lens (IOL) implantation. The IOL was placed in the bag through a 6.0 mm continuous curvilinear capsulorhexis. The glaucoma was treated with intravenous drip infusion of a hyperosmotic diuretic, followed by peripheral iridectomy, iridocapsular synechiolysis, and IOL repositioning. The IOL loops were located completely in the bag. However, pupillary capture recurred 3 weeks after the surgery, at which time intraocular pressure was normal. The flexibility of the IOL optic and its large overall length and rigid, low-angulated loops were the probable causes for the recurrence of the pupillary capture. The IOL was exchanged for a sulcus-fixated, single-piece poly(methylmethacrylate) lens with 10 degree angulated loops. Pupillary capture did not recur during the follow-up.

Acrylic Resins↗

PubMed2000

Five year study of astigmatic stability after cataract surgery with intraocular lens implantation: comparison of wound sizes.

PURPOSE: To assess the long-term stability of cataract wounds of various lengths. SETTING: Private practice. METHODS: This retrospective study comprised 5 groups of consecutive cataract surgery cases and 1 control group with similar mean ages and wound lengths of 10.0, 6.0, 4.0, 2.0, and 0 (control) mm. Except for the 4.0 mm cases, follow-up was 5 years, with few patients lost during that time. Cases within each group had the same wound position, configuration, and suturing. Refractive data, controlled by keratometry, were collected and analyzed preoperatively and 1 day, 1 and 6 weeks, 3 and 6 months, and 1, 2, 3, 4, and 5 years postoperatively. No sutures were cut. RESULTS: With long-term follow-up, there was a progressive against-the-rule shift in astigmatism. Smaller wounds showed less immediate induced astigmatism. However, except for the unsutured 2.0 mm iridectomy wounds and the control group, all shifted similarly. Data were not available for the 4.0 mm wounds beyond 1 year. CONCLUSION: Wounds were not necessarily "stable" at 6 months. Larger wounds continued to shift years after surgery. Smaller wounds have significant postoperative advantages, but absolute long-term refractive stability may not be one.

Aged↗

PubMed1999

Suspected ciliary block associated with Viscoat use.

Ciliary block or malignant glaucoma is thought to be caused by the misdirection of aqueous into the vitreous. It is refractory to medical treatment and often requires vitreous aspiration. We present a case of ciliary block glaucoma caused by sodium chondroitin sulfate-sodium hyaluronate (Viscoat) gaining access to the vitreous through an unsuspected, small zonular dialysis. Vitrectomy performed through a peripheral iridectomy resolved this severe condition.

Adult↗

PubMed1999

Ab externo 4-point scleral fixation of posterior chamber intraocular lenses.

PURPOSE: To evaluate the results of ab externo 4-point scleral fixation of posterior chamber intraocular lenses (PC IOLs) as a primary or secondary procedure. SETTING: Aravind Eye Hospital, Madurai, India. METHODS: This retrospective study comprised 25 patients: 17 aphakic and 8 with traumatic subluxated lenses. The subluxated cataracts were removed intracapsularly. All patients had ab externo 4-point flapless scleral fixation of a PC IOL. Preoperative status, intraoperative details, and postoperative outcome were analyzed. RESULTS: Mean follow-up was 8.02 months (range 6 to 26 months). The preoperative findings included sector iridectomy (n = 6), peripheral anterior synechias (n = 5), corneal scar (n = 2), vitreous hemorrhage (n = 2), traumatic angle recession (n = 1), retinitis pigmentosa (n = 1), primary open-angle glaucoma (n = 1), and macular pigmentary mottling (n = 1). There were no intraoperative problems related to scleral fixation. Postoperative complications and findings included cystoid macular edema (CME) (n = 2), uveitis (n = 1), and a healed macular choroidal tear (n = 1). No patient had suture exposure, IOL tilt/decentration, or infection. Twenty-two patients (88.0%) had a visual acuity of 6/12 or better at final follow-up. The cause of poor visual recovery in 3 patients included pre-existing macular degeneration, healed macular choroidal tear, and CME in 1 patient each. CONCLUSION: Four-point scleral fixation is a simple technique that in this series of 25 patients was not associated with major intraoperative or postoperative complications and gave satisfactory visual results.

Adult↗