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PubMed1988

[Correction of unilateral aphakia in children, adolescents, and adults at an age when accommodation is still possible].

Twenty-one patients, aged 4-42 years, with unilateral aphakia after perforating injury, were corrected with a combination of spectacles and contact lenses. While taking stereopsis and aniseikonia into consideration, each patient was corrected with the combination of contact lens and spectacles to achieve the best stereoscopic vision. Two of the five children (aged 4 and 7) achieved positive results on stereoscopic acuity. 15 of 16 patients (10-42 years old) showed good results on the TNO table test. The influence of visual acuity and age as well as the influence of the principles of the stereoacuity test are discussed.

Accommodation, Ocular↗
PubMed1992

Superficial punctate keratopathy and bacterial growth in patients with unilateral aphakia using extended-wear soft contact lenses.

We prospectively examined corneal conditions and bacterial growth in 77 individuals with unilateral aphakia who were using extended-wear soft contact lenses. The ratios of positive bacterial growth (70.6-79.4%) from 34 patients with superficial punctate keratopathy were significantly higher than those (41.9-46.5%) from the 43 subjects with normal corneas. Bacterial growth was found frequently in patients with superficial punctate keratopathy who were older than 80 years and in those using soft contact lenses for more than 22 days. Several kinds of bacteria grew from the specimens. Among the most common were Staphylococcus epidermidis and Corynebacterium species. Pseudomonas aeruginosa grew from patients with superficial punctate keratopathy who were using extended-wear soft contact lenses.

Aged↗
PubMed1996

Corneal coloboma, aphakia and retinal neovascularization with anterior segment dysgenesis (Peters' anomaly).

An infant with bilateral Peters' Anomaly, with corneal opacification in the right eye and an opacification with an axial defect in the left also had an associated hydrocephalus and cardiac anomalies that proved fatal; histopathology of the right eye showed retinal neovascularization in addition to findings consistent with a diagnosis of Peters' Anomaly; in the left eye, pathologic findings were suggestive of a corneal coloboma associated with aphakia.

Abnormalities, Multiple↗
PubMedDate not supplied

Binocular vision regained after monocular traumatic aphakia by wearing contact lenses.

In this study 35 patients with monocular traumatic aphakia were enrolled to document the degree of binocular vision gained by optical correction with contact lenses. The most important factors in achieving binocular vision were the interval between formation of the traumatic cataract and surgery and between the operation and starting wearing contact lenses. There was a statistically significant correlation between these two intervals and the achievement of near stereopsis and normal visual acuity.

Adolescent↗
PubMed1987

Intracorneal correction of aphakia: paraxial approach at null incidence.

The technique of intracorneal implantation, recently proposed by de Laage de Meux and Cinquin [Implants, 2, 26 (1984)] for the correction of aphakia, is analyzed in terms of geometrical optics. The analysis is done by using matrix optics and by assuming a null incidence. The characteristics (diameter, radii of curvature, axial thickness) of the hard or soft lens to be implanted are determined and given. The aniseikonia of such lenses is shown to be nearly the same as that of contact lenses.

Aphakia↗
PubMed1981

Epikeratophakia: the surgical correction of aphakia. I. Lathing of corneal tissue.

Epikeratophakia is a newly developed form of refractive corneal surgery for the correction of hyperopia. In this procedure, a piece of donor corneal tissue is lathed to a specific dioptric power. The epithelial cells are removed from the recipient cornea, and the donor tissue is sutured to the front of the eye. The resulting change in corneal curvature provides the visual correction, as, for instance, in the correction of aphakia. We describe here the computational analysis used to lathe human donor corneal tissue for use as epikeratophakia grafts. With these equations, the precision of the observed thickness of the lathed lenticule was +/- 0.05 mm and the precision of the observed diameter was +/- 0.25 mm. We found that, in a graft of a given diameter, the smaller the optical zone, the greater the maximal dioptric power of the graft, limited only by the central thickness of the donor cornea and the mechanical limitations of the cryolathe. In our case, the highest theoretical correction obtainable was 37 diopters.

Aphakia, Postcataract↗
PubMedDate not supplied

Extended wear contact lenses in pediatric aphakia.

A 100% silicone polymer contact lens can be used successfully for extended wear in pediatric aphakia. Compared to a hydrogel extended wear contact lens, the silicone lens has several advantages. These include easier handling, a less traumatic fitting procedure for the child, fluorescein use for evaluation of the lens-cornea relationship and a lower loss rate. Bacterial and preservative contamination are minimized due to the lower water content. The silicone lens appears to be safe, having no permanent adverse effects on the cornea. It would be more advantageous if the lens could be obtained in higher plus powers; however, the available power (up to +32.00D) is appropriate in almost all cases.

Aphakia↗
PubMedDate not supplied

Unilateral traumatic aphakia in children: role of corneal contact lenses.

Twenty-eight children below ten years of age with unilateral traumatic aphakia were fitted with hard corneal contact lenses. Visual acuity of 6/12 or better was achieved in 68% of the cases. Patients who were above seven years of age at the time of injury, and those fitted with contact lenses within eight months of trauma, were found to have better chances of recovering normal binocular functions.

Aphakia, Postcataract↗
PubMedDate not supplied

The correction of unilateral aphakia in children treated for orbital rhabdomyosarcoma.

The survival rate of children with localized orbital rhabdomyosarcoma is now greater than 90% 3 years after diagnosis as a result of advances in radiation and chemotherapy. Ninety percent of these children develop cataracts within 1 to 4 years after the completion of radiotherapy. The correction of aphakia in these children is complicated by the concurrent keratoconjunctivitis and dryness associated with radiotherapy. Three patients with a diagnosis of orbital rhabdomyosarcoma underwent treatment for uniocular cataract. Two of the patients were unable to use extended wear contact lenses. Both underwent epikeratophakia with poor results. One patient who had clinically significant ocular drying prior to cataract extraction underwent successful implantation of an intraocular lens as a primary procedure, with excellent visual results. Clinicians should be aware of the difficulties associated with contact lens wear and epikeratophakia tissue lenses in children who have had high doses of radiation for orbital rhabdomyosarcoma. Such patients are probably best served by primary intraocular lens implantation or by preservation of the posterior capsule at the time of cataract extraction to allow secondary lens implantation if contact lens wear is unsuccessful.

Aphakia, Postcataract↗
PubMedDate not supplied

Is the phakic eye normal in monocular pediatric aphakia?

This retrospective review of 97 pediatric patients who underwent monocular surgery for congenital or developmental cataracts studied the incidence of abnormalities in the contralateral phakic eye. Fifty-nine percent of patients had a normal phakic eye. However, 40 patients showed at least one abnormality in the phakic eye: reduced vision (21%), nystagmus (19%), cataract (15%), iris heterochromia (9%), myopia (6%), microphthalmos (6%), pupillary miosis (2%), congenital glaucoma (2%), optic nerve abnormality (2%), aniridia (1%), and corneal opacity (1%). Not all abnormalities were detected at the time of diagnosis of the contralateral cataract. The more significant findings of reduced vision and nystagmus in the phakic eye were usually detected postoperatively, often several months after the optimum time for treatment of pediatric cataracts. We suggest that monocular cataract surgery not be delayed. This will allow the best vision to be obtained for the aphakic eye, as the "sound eye" may not always be normal in monocular pediatric aphakia.

Aphakia, Postcataract↗
PubMed2002

Contact lenses in the correction of childhood aphakia.

PURPOSE: To evaluate the results of extended-wear silicone contact lenses (Silsoft, Bausch & Lomb, Rochester, NY, U.S.A) after congenital cataract extraction. METHOD: Case records of congenital cataract extraction performed between 1992-1999, in the Department of Ophthalmology, Dokuz Eylül University School of Medicine, were retrospectively reviewed. Convenient-power extended-wear silicone contact lenses (Silsoft) were prescribed for patients 5 to 12 days after surgery. Patients were scheduled for follow-up control visits once per month in the first year, bimonthly in the second year, and quarerly visits thereafter. Visual acuity, fixation, binocularity, and deviation were checked at each follow-up visit. Examination of the cornea and the contact lens surface was also performed at each visit. RESULTS: A total of 51 children (83 eyes) were included in the study. Mean age was 19.4 +/- 18 months. Mean duration of contact lens wear per lens was 26 +/- 11 weeks. Contact lens wear was discontinued for 11 eyes: 6 because of unstable lens, frequent loss, and financial problems, and 5 were discontinued because of recurrent irritation and corneal infiltration. Mean contact lens usage time per patient was 5.8 years, and mean contact lens loss was 0.98 per year. Visual acuity improved in 58 (69.8%) eyes and remained unaltered in the remaining 25 eyes. CONCLUSION: Extended-wear silicone contact lenses offer a safe, easy treatment option for childhood aphakia, providing prolonged wearing time and low rates of complications and drop out.

Aphakia, Postcataract↗
PubMed2002

Diagnosing glaucoma in pediatric aphakia.

BACKGROUND: Cataracts pose a serious threat to the visual system in infants and children, requiring prompt surgical intervention and rehabilitation to optimize visual development. Glaucoma is a serious complication following cataract surgery in infants and can lead to loss of vision. Early diagnosis of glaucoma, however, can be quite challenging in these patients. CASE REPORTS: Three cases are presented in which comeal edema was the initial presenting sign that led to the diagnosis of glaucoma during routine contact lens follow-up examinations for pediatric aphakia. CONCLUSION: The contact lens practitioner, during the course of management of aphakic infants and children, should always be suspicious of glaucoma as a complication of cataract surgery, and the presenting sign may be corneal edema.

Aphakia, Postcataract↗
PubMedDate not supplied

[Surgical treatment of bilateral retinal detachment in aphakia and the efficacy of prophylactic measures].

Analysis of the immediate and late results of surgery for bilateral detachment of the retina in aphakia performed on 58 eyes of 44 patients has shown that the retina stays adhered to the pigmented epithelium after surgery in 63.79% of patients but later is again detached in half the patients, and the share of good late results is but 37.95%. The authors consider the efficacy of prophylactic measures, cryoretinopexy and silicon band circlage, carried out in three groups of patients. Group 1 (320 eyes) consisted of patients in whom cryopexy was performed on myopic eyes before cataract extraction; 1.9% of patients developed detachment of retina, this being 3.5 times less than in the reference group (6.7%). Group 2 (61 eyes) patients were subjected to cryopexy on the second eye if the retina was detached on the first eye; 5.56% of patients developed detachment of retina. Prophylactic circlage was carried out in Group 3 (17 eyes); none of the patients developed detachment of the retina over the follow-up period of 5 years. In the reference group, consisting of similar patients, 16 (21.05%) of the 76 patients developed detachment of retina on the second eye in periods of 2 months to 5 years after surgery. These results demonstrate the usefulness of prophylactic measures in cases with the risk factors.

Aphakia, Postcataract↗
PubMed1991

Combined relaxing incisions and epikeratophakia for the correction of aphakia and high postkeratoplasty degree astigmatism.

A combined surgical procedure consisting of corneal relaxing incisions and epikeratophakia was used to correct high-degree postkeratoplasty astigmatism and aphakia in two patients. Both patients achieved their final refractive result as soon as 1 month after suture removal (2 and 3 months after surgery, respectively). Keratometric readings showed a reduction of approximately 20.00 diopters in one case and 10.00 D in the other, while the spherical equivalent changed from +10.00 D to +0.50 D in one eye and from +7.50 D to +1.75 D in the other. Spectacle correction was prescribed for both patients. At the last follow-up visit, about 2 years after surgery, these values were unchanged. The main advantage of the combined technique over two separate procedures was that postoperative visual rehabilitation was faster. Equally important was the stability of the refractive result over a long period of time after surgery, as well as the absence of negative effects on the preexisting corneal graft. In spite of the technical complexity of a combined surgical procedure, this approach probably represents the best choice in rare cases such as the ones reported here.

Aphakia↗
PubMed1991

[Complications of epikeratophakia in correction of aphakia, myopia, hyperopia and keratoconus].

Epikeratophakia for the correction of aphakia, myopia, hyperopia and keratoconus has overcome many of the objections to earlier lamellar refractive procedures (keratophakia and keratomileusis), such as the lamellar dissection of the recipients' healthy cornea over the visual axis and the need for expensive surgical equipment. It is reasonably reversible and repeatable. The complications observed in a series of 119 operations performed at the 2nd Department of Ophthalmology, University of Vienna, are discussed and compared with those reported in the literature. Serious complications, both intraoperatively and in the early and late postoperative period, that permanently threaten the patients vision are rare. Predictability and loss of effect in a significant percentage of myopic cases, caused by lack of precision during manufacturing of the lenticules and individual wound healing, makes careful patient selection mandatory.

Adult↗
PubMed1991

[A report of epikeratophakia for the correction of aphakia].

Epikeratophakia is a new refractive corneal surgery since 1980. The authors treated 30 cases of unilateral aphakia with corneal lenses prepared by a self-made cryolathe. After a mean postoperative follow-up of 161 days, all patients obtained visual improvement. 19 eyes (63.3%) achieved uncorrected visual acuity over 0.5, and 5 eyes (16.7%) were 1.0 or over. 8 eyes (26.7%) were corrected to within 1 diopter by the surgery, and the mean postoperative corneal astigmatism was 2.53 diopters. The complications included over or under correction of the refractive error, interlamellar epithelial ingrowth and opacity. The safety, efficacy and re-operability of epikeratophakia make it a promising technique.

Adolescent↗
PubMed1990

[Improving the function of the visual system in children with aphakia].

Systematic reeducation by pleoptic-orthoptic exercises was performed in children with posttraumatic and congenital aphakia for the improvement of the visual acuity, normal retinal fixation and binocular vision. The treatment comprised 244 children aged 1-16 years who were formerly given a correcting contact lens on the aphakic eye. In the result of rehabilitation a visual acuity of over 5/16 was attained in 79.5 per cent of cases, a normal retinal fixation in 73.77 per cent and the binocular vision in 46.31 p.c. Better results were obtained after treatment of a posttraumatic cataract, poorer results after extraction of a congenital cataract.

Adolescent↗
PubMedDate not supplied

[Glaucoma secondary to aphakia. Its surgical resolution].

The paper reports on the functional results in the surgery of the glaucoma-aphakia pathologic relation, in a group of 30 patients: several very good, others moderate with uncertain visual prognosis, as a function of the precocity of the operation, blockage site and stage of the disease evolution. The good results obtained in the surgeries of the cases without the presence of the vitreous body in AC are evidenced.

Aphakia, Postcataract↗