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Purpose: To present a surgical technique for reopening the capsular bag in pediatric aphakia. Setting: Zhongshan Ophthalmic Center, Guangzhou, China. Design: Case series study. Methods: Consecutive pediatric patients with bilateral aphakia requiring secondary intraocular lens (IOL) implantation between July 2021 and June 2022 were included. The diameter of the capsular proliferative membranous ring (PMR) and position of IOL implantation were documented. Various parameters of capsular bag opening during primary cataract removal and secondary surgery were also analyzed. Results: 48 eyes were included with a mean follow-up of 8.1 ± 4.4 months. Using the surgical technique developed in this study, the capsular bag was successfully reopened with in-the-bag (ITB) implantation in 43 eyes (89.6%). ITB implantation was accomplished in all eyes with an outer diameter of PMR ≤5.5 mmand in 3 of 8 eyes (37.5%) with an outer diameter of PMR >5.5 mm. A positive correlation was observed between the primary and secondary anterior capsular opening diameters (ACODs) (r = 0.422, P = .007) and the primary and secondary posterior capsular opening diameters (PCODs) (r = 0.619, P < .001). The inner diameter of PMR was found to be positively correlated with secondary PCOD (r=0.728, P < .001) and the outer diameter with secondary ACOD (r = 0.669, P < .001). Conclusions: This was a safe and effective surgical technique for pediatric secondary IOL implantation with maximum preservation of the peripheral capsule. Aphakic eyes with an outer diameter of PMR ≤5.5 mm are preferred for secondary ITB implantation. [ABSTRACT FROM AUTHOR]

Purpose: To compare the predictive accuracy of the biometerembedded Barrett True-K TK and new total corneal power methods of intraocular lens (IOL) power calculation in eyes with prior laser vision correction (LVC) for myopia. Setting: Academic clinical practice. Design: Retrospective case series. Methods: IOL power formulas were assessed using measurements from a swept-source optical coherence biometer. Refractive prediction errors were calculated for the Barrett True-K TK, EVO 2.0, Pearl-DGS, and HofferQST, which use both anterior and posterior corneal curvature measurements. These were compared with the Shammas, Haigis-L, Barrett True-K No History (NH), optical coherence tomography, and 4-formula average (AVG-4) on the ASCRS postrefractive calculator, and to the Holladay 1 and 2 with non linear axial length regressions (H1- and H2-NLR). Results: The study comprised 85 eyes from 85 patients. Only the Barrett True-K TK and EVO 2.0 had mean numerical errors that were not significantly different from 0. The EVO 2.0, Barrett True-K TK, Pearl-DGS, AVG-4, H2-NLR, and Barrett True-K NH were selected for further pairwise analysis. The Barrett True-K TK and EVO 2.0 demonstrated smaller root-mean-square absolute error compared with the Pearl-DGS, and the Barrett True-K TK also had a smaller mean absolute error than the Pearl-DGS. Conclusions: The Barrett True-K TK and EVO 2.0 formulas had comparable performance to existing formulas in eyes with prior myopic LVC. [ABSTRACT FROM AUTHOR]

Purpose: To compare intraocular lens (IOL) decentration between patients in whom the continuous curvilinear capsulorhexis (CCC) completely covers the IOL optic and those in whom it incompletely covers the IOL optic and determine how an incompletely covered CCC affects the IOL position. Setting: Tertiary hospital in Japan. Design: Single-center retrospective study. Methods: 57 eyes of 57 patients (mean age 70.8 ± 6.2 years) that underwent phacoemulsification and IOL (SN60WF) implantation in the bag between April 2010 and April 2015 were included in this study. The patients were classified based on whether the CCC completely (CC group) or incompletely (NCC group) covered the IOL optic using an anterior eye segment analysis system(EAS-1000). The IOL decentration of the groups was analyzed using EAS-1000 at 1 week, 1 month, 3 months, and 6 months postoperatively and compared. The relationship between the NCC location and the IOL direction at 3 months postoperatively was analyzed. Results: The NCC group (25 eyes) had a significantly higher amount of IOL decentration than the CC group (32 eyes) at 1 week, 1 month, 3 months, and 6 months postoperatively (P < .05). There was a correlation between the direction of IOL decentration and the NCC location, and IOL decentration in the NCC group occurred in the opposite direction to the NCC area. Conclusions: An anterior capsule opening that completely covers the IOL optic is important to control IOL decentration. [ABSTRACT FROM AUTHOR]

Light microscopical analysis of 30-gauge thin-wall needles and 3-piece IOL haptics showed significant dimension variability, which is of relevance for the flanged intrascleral fixation technique to correct aphakia without capsule support. Purpose: To assess the diameter of different 30-gauge thin-wall needles and 3-piece intraocular lens (IOL) haptics readily used for the flanged-haptic intrascleral fixation technique. Setting: Hanusch Hospital, Vienna, Austria. Design: Laboratory investigation. Methods: 5 30-gauge thin-wall needles and 5 3-piece IOLs were assessed. An upright light microscopy was used for measurements. The inner and outer diameters of the needles and the end thickness of the haptics were analyzed and compared for haptic fitting into the needle. Results: Among the needles, the inner diameter of the T-lab needle was significantly wider compared with all the others (mean 209.3 ± 8.0 μm, P <.001), followed by TSK (194.8 ± 5.0 μm), MST (194.7 ± 5.8 μm), Sterimedix (187.5 ± 9.0 μm) and significantly narrower Meso-relle (mean 178.7 ± 7.0 μm, P <.05). The outer diameter of the T-lab needle was significantly larger of all (mean 316.0 ± 2.0 μm, P <.001). Concerning the IOLs, the AvanseePreset Kowa's haptic was significantly thinner (mean 127.2 ± 0.7 μm) than all the others, such as the TecnisZA900 Johnson & Johnson (143.5 ± 3.1 μm), the CTLucia202 Zeiss (143.8 ± 1.3 μm), and the AcrysofMA60AC Alcon (143.9 ± 1.4 μm). The only haptic that was thicker than all the others assessed was that of SensarAR40 Johnson & Johnson (170.7 ± 1.7 μm, P <.001). Conclusions: Most of the analyzed haptics would fit into most of the measured needles, with the exception of the Sensar AR40 in combination with the Meso-relle or Sterimedix needles. The combination of a larger needle lumen and a thinner haptic could result in more ease of insertion during surgery. If the dimensions of the needle and IOL haptics used are unknown, we recommend trying insertion before beginning surgery. [ABSTRACT FROM AUTHOR]

The Barrett calculator with measured and predicted posterior astigmatism and the Abulafia-Koch formula show similar predictions. The Kane calculator shows a slightly higher median absolute error and ATR centroid error. Purpose: To compare the accuracy of the Barrett toric calculator with measured and predicted posterior corneal astigmatism (MPCA and PPCA, respectively), the Abulafia-Koch (AK) formula, and the toric Kane formula. Setting: Ein-Tal Eye Center, Tel-Aviv, Israel. Design: Retrospective cohort. Methods: Consecutive cases of patients who underwent uneventful cataract extraction surgery with implantation of a toric intraocular lens between March 2015 and July 2019 were retrospectively reviewed. 1 eligible eye from each patient was included. The predicted postoperative refractive astigmatism was calculated using each method and compared with the postoperative refractive astigmatism to give the prediction error. Results: 80 eyes of 80 patients were included in this study. The mean centroid and the mean and median absolute prediction errors using Kane (0.25 diopters [D] ± 0.54 @ 6 degrees, 0.50 D ± 0.31 and 0.45 D, respectively) were significantly different compared with MPCA (0.12 D ± 0.52 @ 16 degrees, P <.001,.44 D ± 0.28 and 0.36 D, P =.027, respectively), PPCA (0.09 D ± 0.49 @ 12 degrees, P <.001,.41 D ± 0.27 and 0.35 D, P <.001, respectively), and AK (0.11 D ± 0.49 @ 11 degrees, P <.001,.42 D ± 0.27 and 0.35 D, P =.004, respectively). No significant differences were found between the calculators in the predictability rates within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D. Conclusions: The measured posterior corneal curvature in the Barrett calculator yielded comparable outcomes to its prediction by the Barrett and AK formulas. The Kane calculator showed a slight against-the-rule prediction error compared with the other methods, resulting in a small higher median absolute error with marginal clinical importance. [ABSTRACT FROM AUTHOR]

A review describing various options of surgical management of aphakia. Advantages and disadvantages of each technique is described and a clinical decision tree is proposed. Despite the safety and efficacy of cataract surgery, intraoperative complications can hamper the ability to place an intraocular lens in the capsular bag. With vast numbers of cataract surgeries performed daily, complications occur often enough that every ophthalmologist should be equipped with techniques to manage aphakia. Medical management of aphakia used to be commonplace but these techniques have their disadvantages including thick bulky lenses, poor cosmesis, and aniseikonia. Surgical management of aphakia overcomes these disadvantages and offers patients the possibility of a spectacle and contact lens-free lifestyle. This article reviews the various options of surgical management of aphakia and their advantages and disadvantages. Comparison of outcomes between techniques and a protocol for deciding between techniques is presented. [ABSTRACT FROM AUTHOR]

Ray-tracing simulations show that anatomical differences between patients with and without negative dysphotopsia have a strong, up to 18%, effect on the severity of the complaint. Purpose: To assess the effect of ocular anatomy and intraocular lens (IOL) design on negative dysphotopsia (ND). Setting: Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. Design: Ray-tracing study based on clinical data. Methods: Ray-tracing simulations were performed to assess the effect of anatomical differences and differences in IOL design on the peripheral retinal illumination. To that end, eye models that incorporate clinically measured anatomical differences between eyes of patients with ND and eyes of pseudophakic controls were created. The anatomical differences included pupil size, pupil centration, and iris tilt. The simulations were performed with different IOL designs, including a simple biconvex IOL design and a more complex clinical IOL design with a convex–concave anterior surface. Both IOL designs were analyzed using a clear edge and a frosted edge. As ND is generally considered to be caused by a discontinuity in peripheral retinal illumination, this illumination profile was determined for each eye model and the severity of the discontinuity was compared between eye models. Results: The peripheral retinal illumination consistently showed a more severe discontinuity in illumination with ND-specific anatomy. This difference was the least pronounced, 8%, with the frosted edge clinical IOL and the most pronounced, 18%, with the clear edge biconvex IOL. Conclusions: These results show that small differences in the ocular anatomy or IOL design affect the peripheral retinal illumination. Therewith, they can increase the severity of ND by up to 18%. [ABSTRACT FROM AUTHOR]

This exploratory study of a new anterior shape-changing presbyopia-correcting intraocular lens demonstrated good outcomes for distance, intermediate, and near vision, low rates of dysphotopsia, and an acceptable safety profile. Purpose: To report the initial safety and effectiveness profile for an anterior shape-changing, modular IOL, Juvene IOL (JIOL), for the treatment of aphakia and presbyopia after removal of the natural crystalline lens due to cataract. Setting: 2 private practices in Monterrey and Tijuana, Mexico. Design: Exploratory prospective multicenter open-label noncomparative clinical trial. Methods: A convenience sample of patients aged 50 to 80 years with planned cataract surgery was recruited to undergo unilateral or bilateral implantation with the JIOL. Patients were required to complete an informed consent and be able to dilate to at least 6.0 mm pharmacologically, be in good overall health, and have no significant eye health history to qualify. Visual acuities, defocus curves, and contrast sensitivity were measured for all patients 12 months postoperatively. Results: 51 of 58 eyes completed the 12-month visit. Intraoperative complication rates were extremely low (n = 1; missed base lens tab). The most frequent adverse events (AEs) were prolonged inflammation (N = 6) and cystoid macular edema (N = 4); all AEs were resolved without sequelae by the 12-month visit. The mean monocular logMAR corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity were 0.01, 0.08, and 0.24, respectively. Defocus testing showed visual acuity > 20/40 from approximately +1.00 through −2.00 diopters. Binocular implantation (n = 16) provided superior performance over monocular implantation. Conclusions: The JIOL offers a new solution to treat presbyopia, providing clear functional vision performance across a range of distances with an acceptable initial safety profile. [ABSTRACT FROM AUTHOR]

A modified Yamane technique with a 26-gauge needle for aphakia correction is described. Single corneal or corneoscleral incision is set at 12 o'clock. The 26-gauge needles are used to make 2 angled incisions parallel to the limbus to fix the haptics of a 3-piece intraocular lens. The modifications provide an easier and safer way of haptic insertion into the needle tip and decreases the possibility of bending or breaking the haptic. [ABSTRACT FROM AUTHOR]

A modified Yamane technique with a 26-gauge needle for aphakia correction is described. Single corneal or corneoscleral incision is set at 12 o'clock. The 26-gauge needles are used to make 2 angled incisions parallel to the limbus to fix the haptics of a 3-piece intraocular lens. The modifications provide an easier and safer way of haptic insertion into the needle tip and decreases the possibility of bending or breaking the haptic. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the difference in anterior chamber depth (ACD) after uneventful cataract surgery between 2 hydrophobic acrylic 1-piece intraocular lenses (IOLs) with different material properties. Setting: Hanusch Hospital, Vienna, Austria. Design: Single-center, bilateral randomized paired-eye controlled study. Methods: Patients scheduled for bilateral cataract surgery were randomized to receive the Clareon IOL in 1 eye and the AcrySof IQ IOL (both Alcon Laboratories, Inc.) in the contralateral eye. Preoperatively, a slitlamp examination, optical biometry (IOLMaster 700, Carl Zeiss Meditec AG), refraction, and visual acuity measurements were performed. ACD was assessed 1 hour and 1 week postoperatively and with additional measurement of uncorrected (UDVA) and corrected distance visual acuity (CDVA) 6 months postoperatively. Results: 80 eyes of 40 patients were analyzed in this study. ACD at the 6-month follow-up was 3.94 +/- 0.30 mm for the Clareon IOL and 3.91 +/- 0.32 mm for the AcrySof IQ IOL (P =.08). Statistically significant differences in the ACD shift between both IOLs were detected between 1 week and 6 months (P =.04) and 1 hour and 6 months (P =.04). There were no statistically significant differences between both IOLs in UDVA (P =.78), CDVA (P =.59), and spherical equivalent (SE, P =.39) at the 6-month visit. The mean absolute error between the measured and the aimed SE was not significant (P =.97). Conclusions: There was no clinically relevant difference in ACD between the Clareon IOL and the AcrySof IQ IOL in patients after uneventful cataract surgery. Both IOLs yielded good refraction and visual acuity outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Prediction of refraction after cataract surgery in children is limited by the variance in rate of refractive growth (RRG3). This study compared RRG3 in aphakic and pseudophakic eyes with their fellow, normal eyes in the Infant Aphakia Treatment Study. Setting: Twelve clinical sites in the United States. Design: Randomized clinical trial. Methods: Infants randomized to unilateral cataract extraction had RRG3 calculated based on biometric data (axial length and keratometry) at cataract surgery and at 10 years of age, for both the normal and cataract eyes. Subjects were included if complete biometric data from both eyes were available both at surgery and at 10 years. Variance in RRG3 was compared between the groups with Pitman test for equality of variance between correlated samples. Results: Longitudinal biometric data were available for 103 of the 114 patients enrolled. RRG3 was -15.00 diopters (D) (3.00 D) for normal eyes (reported as mean [SD]), -17.70 D (6.20 D) for aphakic eyes, and -16.70 D (6.20 D) for pseudophakic eyes (P <.0001 for comparison of variances in RRG3 between normal and all operated eyes). Further analysis found differences in the variance in axial length growth (P <.0001) between operated and normal eyes; the variance in keratometry measurement change did not reach significance. Conclusions: The standard deviation in the RRG3 of normal eyes in our study was half of that found in eyes that underwent cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the optic plate and haptics of a specially designed sutureless intrascleral-fixated intraocular lens (IOL) using ultrasound biomicroscopy and anterior segment optical coherence tomography (AS-OCT). Setting: Department of Ophthalmology, San Marino Hospital, Republic of San Marino. Design: Retrospective observational case series. Methods: Eyes that underwent intrascleral fixation with IOL implantation (Carlevale) were included. Preoperative and postoperative refractive outcomes were reported. Optic plate tilt and haptics position were assessed with ultrasound biomicroscopy, whereas intrascleral plug depth and conformation were evaluated with AS-OCT. Results: The study comprised 10 aphakic eyes. Postoperative visual acuity improved in all patients. At postoperative month 3, 3 eyes (30%) had a vertical tilt of more than 100 [mu]m, whereas no horizontal tilt was observed in any patient. The mean vertical intraocular tilt was 0.19 +/- 0.22 mm. Of 20 haptics, 13 (65%) passed through the ciliary sulcus, 4 (20%) posterior to the ciliary body, and 3 (15%) through the ciliary body. AS-OCT scans showed a mean intrascleral plug depth of 247.20 +/- 62.82 [mu]m in the nasal sector and 265.50 +/- 30.11 [mu]m in the temporal sector, with adequate integration of the T-shaped plugs in the scleral tissue. Conclusions: This secondary IOL showed good intraocular stability and safe haptics fixation, making it suitable for the intrascleral fixation technique. The specific foldable design results in a low predisposition to optic plate tilt and haptic torsion. In long eyes, the sulcus-to-sulcus distance should be carefully evaluated preoperatively because the flexible structure of the IOL could be subjected to excessive stretching. [ABSTRACT FROM AUTHOR]

A 29-gauge model test fine needle is used to create a beveled intrascleral tunnel; with microforceps, a 6-0 polypropylene suture is placed in the bore of the needle, which is used as a guide to pass and externalize the monofilament through the sclera. This maneuver is repeated by passing the suture ends through the intraocular lens (IOL) eyelets. The folded IOL is inserted and centered, the sutures are cut, and the flanges are created by thermocautery and inserted into the scleral tunnel. This technique was performed on 7 patients and visual acuity was recorded. The 4-flanged technique for scleral fixation using a 4-eyelet IOL was an effective and a safe treatment in the setting of aphakia. [ABSTRACT FROM AUTHOR]

Purpose: To report outcomes of secondary intraocular lens (IOL) implantation in the Infant Aphakia Treatment Study (IATS). Setting: Multicenter clinical practice. Design: Secondary analysis of patients enrolled in a randomized clinical trial. Methods: Details regarding all secondary IOL surgeries conducted in children enrolled in the IATS were compiled. Visual outcomes, refractive outcomes, and adverse events at the age of 101/2 years were evaluated. Comparisons were made with eyes that remained aphakic and with eyes randomized to primary IOL placement. Results: The study included 114 infants, 57 in the aphakic group and 57 in the primary IOL group; 55 of 57 patients randomized to aphakia with contact lens correction were seen for the 101/2-year study visit; 24 (44%) of 55 eyes had secondary IOL surgery. Median age at IOL surgery was 5.4 years (range 1.7 to 10.3 years). Mean absolute prediction error was 1.00 +/- 0.70 diopters (D). At age 101/2 years, the median logarithm of the minimum angle of resolution visual acuity (VA) was 0.9 (range 0.2 to 1.7), similar to VA in the 31 eyes still aphakic (0.8, range 0.1 to 2.9); the number of eyes with stable or improved VA scores between the 41/2-year and 101/2-year study visits was also similar (78% secondary IOL eyes; 84% aphakic eyes). For eyes undergoing IOL implantation after the 41/2-year study visit (n = 22), the mean refraction at age 101/2 years was -3.20 +/- 2.70 D (range -9.90 to 1.10 D), compared with -5.50 +/- 6.60 D (n = 53, range -26.50 to 3.00 D) in eyes with primary IOL (P =.03). Conclusions: Delayed IOL implantation allows a more predictable refractive outcome at age 101/2 years, although the range of refractive error is still large. [ABSTRACT FROM AUTHOR]

Posttraumatic aphakia is a serious deterrent to visual rehabilitation that usually follows sensory exotropia, thereby mandating urgent surgical intervention. In addition, abnormal iris configuration and iris defects postocular trauma can lead to amblyopia and glare and require surgical correction. However, in individuals where such multiple posttraumatic extraocular and intraocular abnormalities coexist, confusion remains about whether to perform sequential or concomitant surgeries. In these situations, an unusual triple technique consisting of strabismus correction, glued scleral fixation of intraocular lens, and single-pass 4-throw pupilloplasty is a useful cost-effective method of single-stage visual and cosmetic rehabilitation. However, it requires collaboration of experienced surgeons form multiple ophthalmic subspecialties. [ABSTRACT FROM AUTHOR]

An innovative intraocular lens (IOL), the CM-T Flex IOL, was used to correct surgical aphakia without disturbing a functioning filtering bleb. A 66-year-old man presented with aphakia in the left eye. Cataract extraction and trabeculectomy was performed in the left eye 2 years previously elsewhere. Corrected distance visual acuity (CDVA) in the left eye was 6/18, and, on examination, it showed a filtering bleb that encroached on the limbus and superior cornea. The cornea was clear with a deep anterior chamber. Retinal examination was normal. Disc cupping was noted with a cup-to-disc ratio of 0.8. Refractive correction was performed by implanting the CM-T Flex IOL. This IOL has a unique design that eliminates the need for maneuvering the IOL haptics extraocularly. It entails a simple grasp, exteriorize, and release technique that anchors the IOL firmly to the scleral bed. At 6 months, CDVA in the left eye was 6/9 with a stable, centered IOL. [ABSTRACT FROM AUTHOR]

Purpose: To describe the technique and outcomes of modified adjustable flange intrascleral fixation using 6-0 polypropylene sutures in primary scleral fixation in a variety of intraocular lenses (IOLs) and capsular stabilizing devices. Setting: Center for Applied Eye Research, Meir Medical Center, Israel. Design: Case series. Methods: Laboratory studies were performed to test the feasibility of passing 6-0 polypropylene sutures through hydrophobic and hydrophilic IOLs. The durability of the IOL, suture, and created flange was tested. IOL implantation was performed first on porcine eyes with assessment of IOL position. Surgery was then performed using this adjustable flange technique using a variety of IOLs, including hydrophilic, hydrophobic, and poly(methyl methacrylate) aniridic IOLs and the capsular anchor (AssiAnchor) to stabilize the capsular lens in eyes with compromised zonular fibers. Results: Surgery was performed on 9 eyes. Both hydrophobic and hydrophilic IOLs together with the 6-0 polypropylene suture were sufficiently durable in laboratory tests. Intrascleral fixation of 3 hydrophobic IOLs and 1 hydrophilic IOL was successfully achieved in 4 aphakic eyes. Stable and secure capsular bag fixation using the AssiAnchor was achieved in 4 eyes. Fixation of an aniridia IOL was also performed with success in 1 eye. All cases had stable and securely fixated IOLs and good postoperative recovery at 3 months follow-up. There was improvement in uncorrected distance visual acuity postoperatively in all cases. Conclusions: The modified adjustable flange technique for scleral fixation using polypropylene 6-0 was effective, relatively quick, and technically simpler and safer than alternative methods in the management of aphakia and zonular instability. [ABSTRACT FROM AUTHOR]

To analyze the visual acuity and complications between primary intraocular lens (IOL) implantation and contact lens wearing, this literature search was performed with data on patients with congenital cataract younger than 2 years published in March 2019. Seven identified studies enrolling 675 eyes were selected for analysis. Patients with primary IOL implantation owned better visual acuity than those with aphakia who wore the contact lens (weighted mean difference = 0.161; 95% CI, 0.108-0.214). For visual axis opacification (VAO), primary IOL implantation increases the incidence of VAO compared with contact lens wearing (relative risk = 0.23; 95% CI, 0.13-0.42). No statistically significant difference was found between the 2 groups about the prevalence of glaucoma and strabismus. Primary IOL implantation achieved better visual outcomes after cataract extraction in patients younger than 2 years. In addition, no higher risk for complications among primary IOL implantation compared with contact lens wearing was noted. Therefore, implanting a primary IOL during congenital cataract surgery is a better therapy for children younger than 2 years than wearing a contact lens. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate posterior capsule opacification (PCO) with a new hydrophobic acrylic intraocular lens (IOL) featuring a new micropatterned membrane, in comparison with a commercially available 1-piece hydrophobic acrylic IOL. Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Study Design: Experimental study. Methods: Twelve New Zealand rabbits had bilateral phacoemulsification and implantation of a ClearSight unpatterned IOL (Group 1), a ClearSight Sharklet-patterned IOL (Group 2), or a control, commercially available IOL (Group 3) (8 IOLs in each group). Slit-lamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely, and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes underwent histopathology. Results: The mean postmortem central PCO was 1.87 +/- 1.35 in Group 1, 1.06 +/- 1.23 in Group 2, and 3.14 +/- 0.89 in Group 3. Peripheral PCO was 2.18 +/- 1.36 in Group 1, 1.5 +/- 1.03 in Group 2, and 3.57 +/- 0.53 in Group 3. When comparing central and peripheral PCO between Groups 1 and 3, the difference was not statistically significant, but it was statistically significant between Groups 2 and 3 (P =.003 and P =.0003, t test with Bonferroni correction). Conclusions: Unique discontinuous features comprising the micropattern allow for focal adhesions to be precisely guided and therefore controlling cell migration. The patterned membrane incorporated on the posterior surface of the IOL significantly reduced capsular bag opacification compared with a commercially available control IOL. [ABSTRACT FROM AUTHOR]

We describe a technique for performing phacoemulsification in eyes with zonular fiber dehiscence of less than 90 degrees using hard nuclear fragments as a scaffold. In conjunction with a capsular tension ring (CTR), hard nuclear fragments and the intraocular lens (IOL) are used as scaffolds during different steps of nuclear emulsification to prevent posterior capsule rupture and aggravation of zonulopathy. Devices such as capsular hooks, CTRs, and IOLs are used to support the capsular bag associated with zonulopathy. The mass of hard nuclear fragments provides support toward the anteroposterior and the horizontal planes, thereby providing 3-dimensional capsular bag support. [ABSTRACT FROM AUTHOR]

To compare intraocular lens (IOL) tilt and decentration after Nd:YAG laser posterior capsulotomy in eyes that had femtosecond laser–assisted capsulotomy versus manual capsulorhexis. Ekol Eye Hospital, Izmir, Turkey. Retrospective case series. Intraocular lens decentration and angle of tilt were measured using a Scheimpflug camera before and 1 month after Nd:YAG capsulotomy. Eighteen eyes had a femtosecond laser–assisted capsulotomy and 25 eyes a manual capsulorhexis. The mean age was 58.2 years ± 10.2 (SD) (range 44 to 69 years) and 60.6 ± 8.3 years (range 45 to 70 years), respectively. Before capsulotomy, the angle of tilt and decentration at both meridians did not differ significantly between the 2 groups (P >.05). After capsulotomy, the angle of tilt was significantly decreased in both groups (femtosecond: vertical 1.5 degrees and horizontal 1.2 degrees; manual: vertical 1.1 degrees and horizontal) and decentration was significantly increased (femtosecond: vertical 0.085 mm and horizontal 0.096 mm; manual: vertical 0.2 mm and horizontal 0.2 mm) at both meridians (P <.05). After capsulotomy, all tilt and decentration parameters were significantly different between the 2 groups (P <.05) except decentration on the horizontal meridian (P =.669). Nd:YAG posterior capsulotomy performed after femtosecond laser–assisted capsulotomy resulted in better mechanical stability of the IOL. This suggests that a femtosecond laser–created capsulotomy better maintains a proper IOL position. Although the differences were statistically significant, the tilt and decentration values were small and might not be clinically significant. [ABSTRACT FROM AUTHOR]

Five-year endothelial cell loss after implantation with Artiflex myopia and Artiflex toric phakic intraocular lenses. We read with interest the article by Papa-Vettorazzi et al. on Artiflex phakic intraocular lens (pIOL) results.[1] The authors found that the mean corneal endothelial cell loss (ECL) at the final follow-up (10.7 ± 0.6 years) was 12.2% ± 12.5%. [Extracted from the article]

A surgical technique is described for reducing surgically induced astigmatism (SIA) during combined implantation of IOL and artificial iris. The CUSTOM FLEX ARTIFICIAL IRIS was implanted in 2 patients who suffered from aphakia and complete traumatic aniridia. Implantation of the prosthesis was accompanied by insertion of an IOL that was fixed at the iris implant. Although prosthesis and IOL can be implanted through small incisions individually, the combined package usually requires a larger incision causing greater SIA. The new technique minimizes the SIA because both components are fixed together but can be inserted separately. Final assembling of the iris-IOL package is performed after separate implantation. The technique to implant the artificial iris combined with a nontoric or a toric IOL is described. The slip-and-slide technique was a safe and an effective way to implant an iris-IOL package while keeping the SIA small and reducing the incision size. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the safety, refractive and visual results of an iris-claw intraocular lens for aphakia (Artisan) according to the technique used. Setting Ophthalmology Department, Valme University Hospital and Oftalvist Clinic, Seville, Spain. Design Retrospective case series. Methods This study evaluated the outcomes of iris-claw IOL implantations performed by the same surgeon between 2011 and 2017. The results were analyzed by the incision type (corneal versus scleral tunnel) and lens position (prepupillary versus retropupillary). Results Seventy-six eyes (75 patients) were included. The postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuities were significantly better than the preoperative acuities (P <.001). The UDVA was 20/40 or better in 41.7% of patients, and had the CDVA was 20/40 or better in 68.1% of patients. The mean UDVA was significantly better in the scleral tunnel incision group (0.29 logarithm of the minimum angle of resolution [logMAR] ± 0.41 [SD]) than in the corneal incision group (0.66 ± 0.45 logMAR) (P <.001). The mean surgically induced astigmatism in the scleral tunnel incision group (0.73 ± 0.62 diopter [D]) was significantly lower than in the corneal incision group (2.49 ± 1.36 D) (P <.001). Although endothelial cell loss was lower in the retropupillary position, the difference was not significant (P =.07.) Conclusion Implantation of the iris-claw IOL in the retropupillary position and through a scleral tunnel incision was an effective and safe alternative to aphakia without capsule support, providing better refractive results compared with other techniques. [ABSTRACT FROM AUTHOR]

Purpose To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). Setting Complejo Hospitalario Universitario de Santiago de Compostela, Spain. Design Retrospective case series. Methods Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. Results The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n = 24), lens luxation or subluxation (n = 17), trauma (n = 15), aphakia (n = 30), and other (n = 9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3 months and 8 months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. Conclusions Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME. [ABSTRACT FROM AUTHOR]

Purpose To assess the safety and efficacy of Morcher 67B black iris diaphragm intraocular lens (IOL) implantation for managing large iris defects and aphakia. Setting Stein Eye Institute, UCLA, Los Angeles, California, USA. Design Prospective case series. Methods The demographic, preoperative, and postoperative data on patients implanted with a black iris diaphragm IOL and followed to 1 year were reviewed. Safety measures included loss of corrected distance visual acuity (CDVA), perioperative complications, adverse events, and secondary surgical interventions. Efficacy measures included CDVA with glare, daytime and nighttime glare symptom scores, and subjective cosmesis scores. Results Thirty-one eyes of 31 patients were implanted. There was a 7-line improvement in median Snellen CDVA ( P < .001). Four eyes worsened more than 1 line. There was 1 minor intraoperative complication. Twenty-one eyes experienced postoperative complications, most of which were related to preexisting ocular comorbidities. Three adverse events included cystoid macular edema, corneal graft dehiscence, and uveitis with ocular hypertension. There were 12 secondary surgical interventions. The CDVA with glare improved 6 Snellen lines ( P < .0001). The mean subjective glare symptoms improved 4.94 points on a 0 to 10 scale during the day ( P < .0001) and 3.61 points at night ( P < .0001). The mean cosmesis score improved 2.23 points ( P < .0001) on the same scale. Conclusion Black iris diaphragm IOL implantation in aphakic eyes with large iris defects and significant ocular comorbidity was found to be relatively safe and very effective at improving CDVA and reducing light and glare sensitivity. [ABSTRACT FROM AUTHOR]

Purpose To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. Setting University Eye Hospital, Tübingen, Germany. Design Retrospective case series. Methods Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3 years were reviewed. Results Sixty-six eyes of 62 patients were included. The mean preoperative corrected distance visual acuity (CDVA) was 0.71 logarithm of the minimum angle of resolution (logMAR) ± 0.58 (SD). The mean CDVA was 0.67 ± 0.54 logMAR ( P = .257; n = 66) after 3 years, 0.73 ± 0.55 logMAR ( P = .399; n = 60) after 5 years, 0.8 ± 0.68 logMAR ( P = .348; n = 30) after 8 years, and 1.09 ± 0.76 logMAR ( P = .069; n = 13) after 10 years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5 years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10 years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P = .049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). Conclusions Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture. [ABSTRACT FROM AUTHOR]

Purpose To analyze the alterations in corneal topography and keratometry (K) after glued transscleral-fixated intraocular lens (IOL) implantation. Setting Dr. Agarwal's Eye Hospital, Chennai, India. Design Prospective case series. Methods Eyes having glued IOL implantation for aphakia or subluxated lens (>180 degrees) were included. Preoperative autorefractometer and corneal topography was performed. Intraoperative parameters, namely the type, position, and incision size, flap position, and number of sutures were noted. The mean corneal curvature in a steep meridian (maximum K), flat meridian (minimum K), simulated K, pachymetry, and surgically induced astigmatism (SIA) were analyzed. Results This study evaluated 16 eyes with aphakia and 15 eyes with a subluxated over a mean follow-up of 12 months ± 6 (SD). There was a significant reduction in mean simulated K ( P = .014) after surgery. The maximum K decreased significantly ( P = .002), from 44.85 ± 2.83 diopters (D) preoperatively to 44.47 ± 2.75 D at 6 months. The mean SIA was 1.0 ± 0.7 D (range 0.16 to 3.6 D) and the postoperative astigmatism analysis by the Alpins method was negative (−1.8), showing relative flattening after surgery. Multiple regression analysis found no association between postoperative vision and preoperative maximum K, postoperative simulated K, incision size, and number of sutures. There was no correlation between the postoperative simulated K and incision position ( P = .674), sutures ( P = .881), and scleral flap position ( P = .401). Conclusion Glued transscleral fixation resulted in a reduction in mean corneal curvature in the steep meridian and there was significant change in corneal astigmatism. [ABSTRACT FROM AUTHOR]

A slight modification to the Yamane transconjunctival double-needle flanged-haptic technique of intrascleral fixation of an intraocular lens (IOL) shows the technique's usefulness when combined with Descemet-stripping endothelial keratoplasty (DSEK). The modification uses bipolar cautery to create flanges at the tip of the IOL haptics and delays tucking the haptics into the scleral tunnels until DSEK has been completed. Bipolar cautery enables the technique to be used in situations in which disposable low- or high-temperature cautery, as originally described, might not be possible. Delaying the haptic tuck until after the complete air fill of DSEK means the surgeon can be confident of the IOL position at all times. This combined technique can be a viable option for patients with aphakia and endothelial cell dysfunction. [ABSTRACT FROM AUTHOR]

Purpose To describe secondary pigment dispersion syndrome (PDS) and pigmentary glaucoma after secondary sulcus transscleral fixation of 1-piece hydrophobic acrylic foldable posterior chamber intraocular lenses (PC IOLs) in aphakic patients in a Chinese population. Setting Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao, China. Design Retrospective case series. Methods This chart review included eyes that had secondary sulcus transscleral fixation of a 1-piece hydrophobic acrylic foldable PC IOL (Tecnis ZCB00) between March 2011 and March 2014. The patients’ demographic data, clinical data, postoperative complications, intervals between initial surgery and the onset of PDS, pigmentary glaucoma occurrences, and findings on slitlamp biomicroscopy, gonioscopy, and ultrasound biomicroscopy (UBM) were recorded. Results The study comprised 23 consecutive eyes of 21 patients. Seventeen eyes of 16 patients were diagnosed with PDS, and 7 eyes of 6 patients were diagnosed with pigmentary glaucoma. The slitlamp examination and UBM showed that the location between the IOL optic and the posterior surface of the iris was very close. Slitlamp examination of the anterior chamber angle using a gonioscope showed dense pigment deposition on the IOL surfaces. A reverse pupillary block was found in 10 eyes of 9 patients. Other postoperative complications included intraocular hemorrhage, pupillary capture of the IOL optic, IOL tilt, IOL decentration, IOL dislocation, and suture erosion. Conclusion The 1-piece hydrophobic acrylic foldable PC IOL was not suitable for sulcus transscleral fixation because of a high incidence of PDS and pigmentary glaucoma after surgery in a Chinese population. [ABSTRACT FROM AUTHOR]

Purpose To compare the rate of refractive growth (RRG) between aphakic eyes and pseudophakic eyes in the Infant Aphakia Treatment Study (IATS). Setting Twelve clinical sites across the United States. Design Randomized clinical trial. Methods Patients randomized to unilateral cataract extraction with contact lens correction versus intraocular lens (IOL) implantation in the IATS had their rate of refractive growth (RRG3) calculated based on the change in refraction from the 1-month postoperative examination to age 5 years. The RRG3 is a logarithmic formula designed to calculate the RRG in children. Two-group t tests were used to compare the mean refractive growth between the contact lens group and IOL group and outcomes based on age at surgery and visual acuity. Results Longitudinal refractive data were studied for 108 of 114 patients enrolled in the IATS (contact lens group, n = 54; IOL group, n = 54). The mean RRG3 was similar in the contact lens group (−18.0 diopter [D] ± 11.0 [SD]) and the IOL group (−19.0 ± 9.0 D) ( P = .49). The RRG3 value was not correlated with age at cataract surgery, glaucoma status, or visual outcome in the IOL group. In the aphakia group, only visual outcome was correlated with refractive growth ( P = .01). Conclusions Infants’ eyes had a similar rate of refractive growth after unilateral cataract surgery whether or not an IOL was implanted. A worse visual outcome was associated with a higher RRG in aphakic, but not pseudophakic, eyes. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

The surgical treatment of patients with combined advanced ectasia and cataract present is challenging. The most common approach is a corneal graft followed by cataract surgery at a later date. A second option is simultaneous corneal grafts with cataract extraction and intraocular lens implantation. This triple procedure has several benefits, which include a shorter period of visual disability and less cost to the patient than the 2-stage technique. There have been attempts to combine phacoemulsification and deep anterior lamellar keratoplasty (DALK) to maximize the advantages of both procedures in a single sitting. Some authors suggest a triple procedure in which the big-bubble DALK technique is performed before phacoemulsification; however, they recommend that phacoemulsification be performed with extreme caution to prevent Descemet membrane rupture. We describe a variant of the triple procedure in which phacoemulsification is followed by a corneal graft using the big-bubble DALK technique. [ABSTRACT FROM AUTHOR]

Purpose To assess whether iris-claw intraocular lenses (IOLs) undergo gravitation-dependent changes in position and refraction. Setting Tertiary referral center, Bern, Switzerland. Design Observational case study. Methods Patients with a history of pars plana vitrectomy and IOL exchange with implantation of an aphakic iris-claw IOL (Artisan) were included in this study. Objective refraction was obtained with a handheld autorefractometer, and the IOL position was measured by ultrasound biomicroscopy with the patient prone, sitting, and supine. Results Twenty-one eyes of 19 patients with retropupilary IOLs (13) or prepupillary IOLs (8) were included. The mean spherical equivalent (SE) in the sitting position was −0.81 diopter (D) ± 0.95 (SD), and the mean distance from the endothelium to the anterior edge of the IOL was 3.35 ± 0.72 mm. The mean SE in the supine position was −0.61 ± 1.28 D, whereas the mean SE in the prone position was −1.34 ± 1.17 D ( P = .0030). The IOL position changed from 3.50 mm in the supine position to 3.06 mm in the prone position ( P < .0001). Conclusions The aphakic iris-claw IOL was subject to significant movement related to gravity. The change in the refractive effect suggests that there is a degree of pseudoaccommodation caused by the forward shift of the aphakic IOL in the face-down position. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

We describe a surgical technique for scleral fixation of a posterior chamber intraocular lens (PC IOL) using a 24-gauge injectable polypropylene suture delivery system. A 3-piece PC IOL is inserted into the anterior chamber of the eye. Two sclerotomies are made 1.5 mm posterior to the limbus using a microvitreoretinal blade. The 24-gauge injector delivers a preformed suture loop into the eye with the double-armed needles still external to the eye. Each polypropylene IOL haptic is directed through the loop using microforceps. The suture loop is tightened around the haptic, and the attached needles are used to fixate the IOL to the sclera and close the sclerotomies simultaneously. This technique has been used in an ex vivo porcine eye and in an aphakic patient. In the latter, the IOL was quickly fixated to the sclera and maintained a stable position postoperatively. Financial Disclosure Dr. Olson has a patent pending for the device described in this article. No other author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

A new intrascleral fixation technique for a standard 3-piece posterior chamber intraocular lens (PC IOL) using a simple guide is described. To secure the haptics, 27-gauge scleral tunnels are created. Both haptics are secured extraocularly. The leading haptic of the PC IOL placed in the cartridge is released partly and introduced into the lumen of the guide. The PC IOL is inserted into the eye, and the leading haptic is externalized by pulling the guide gently through the 27-gauge sclerotomy site. The trailing haptic is externalized using the same procedure. This technique facilitates achieving minimally invasive sutureless intrascleral PC IOL fixation. [ABSTRACT FROM AUTHOR]

We describe a technique for sutureless intrascleral fixation of a 3-piece intraocular lens (IOL) and custom silicone iris prosthesis complex to address the optical and functional issues of aphakia and aniridia, as well as to restore excellent cosmesis. The 3-piece IOL is anchored to the iris prosthesis using the belt-loop technique. We believe the intrascleral haptic fixation is overall a more robust fixation method in patients with aphakia and aniridia, who are often younger and require a long-lasting anterior segment reconstruction. Financial Disclosure Dr. Ahmed is a consultant to Alcon Laboratories, Inc., and Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

We present a technique for posterior chamber intraocular lens (IOL) scleral suturing for the management of aphakia, which includes the use of a needleless Gore-Tex CV-8 suture to create a girth hitch around both IOL fixation eyelets using microinstruments. This technique avoids intraocular needle manipulation, provides long-term IOL stability, avoids both passive and torque-induced IOL tilt, and enables fine tuning of the intraoperative IOL centration using the Purkinje reflexes. Financial Disclosure Dr. Snyder is a consultant to Alcon Laboratories, Inc., Microsurgical Technology, Haag-Streit AG, and Humanoptics AG. Dr. Perez has no financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To determine the outcomes of sutured scleral fixation of posterior chamber intraocular lenses (PC IOLs) after trauma in an African population. Setting: State hospital and affiliated district hospital, Cape Town, South Africa. Design: Case series. Methods: A retrospective review was performed of the medical records of patients in whom a sutured PC IOL had been implanted for traumatic aphakia in the preceding 5 years. Results: Eighty-five percent of the 59 patients had a significant improvement in uncorrected distance visual acuity (UDVA) at the final visit. Two-thirds of patients achieved an UDVA of 6/18 or better. Those not improving had severe preexisting macular or corneal pathology. A significant number of patients (28%) with angle recession developed ocular hypertension during the postoperative period. Conclusion: After careful preoperative selection, sutured PC IOLs were effective in the visual rehabilitation of eyes with traumatic subluxated cataract in which the capsular bag could not be retained. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

We describe a modified technique of black diaphragm intraocular lens (IOL) implantation in eyes with traumatic aniridia, aphakia, and previous vitrectomy. During black diaphragm IOL implantation, a double-armed 10-0 polypropylene suture is used to fixate the IOL in the ciliary sulcus. Two 10-0 polypropylene sutures are subsequently placed in front of the IOL to block its forward displacement and thus prevent its contact with the anterior chamber angle and corneal endothelium. This modified implantation technique reduces long-term complications following black diaphragm IOL implantation in patients with traumatic aniridia. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

A 56-year-old man complaining of decreased visual acuity in his left eye visited the emergency room 1 hour after blunt trauma. Slitlamp examination showed no visible iris tissue. The corneal wound at 5 o’clock was sharp, and Seidel was negative. In the right eye, there was a main clear corneal incision (CCI) at 11 o’clock and an opposite CCI (OCCI) to correct corneal astigmatism at 5 o’clock in the left eye. Anterior chamber inflammation and hyphema resolved 4 weeks after the trauma. The intraocular lens and capsular bag were intact, and the corrected distance visual acuity returned to 20/25. To our knowledge, this is the first report of traumatic iris expulsion through a 3.0 mm OCCI. An OCCI may seal better than a main CCI, which is used in cataract surgery, because the OCCI is not used during the cataract procedure. However, surgeons should be aware of the risk for postoperative wound dehiscence associated with the OCCI. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To select a normal post-cataract-surgery cohort, determine visual quality parameters, and compare these parameters with self-reported satisfaction and visual function. Setting: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Design: Retrospective cohort study. Methods: A cohort of pseudophakic patients was selected based on uneventful surgery, good corrected visual acuity (no worse than logMAR 0.02), and lack of ocular complaints or pathology including dry-eye syndrome or posterior capsule opacification. A single-piece high-refractive-index acrylic intraocular lens, age 50 or older, and at least 1 year out from surgery were other inclusion criteria. Testing included logMAR corrected distance visual acuity (CDVA), mesopic 10% contrast logMAR CDVA with and without glare, straylight determination, Rasch-modified National Eye Institute Visual Function questionnaire 11R (NEI VF-11R), custom pseudophakic dysphotopsia survey, and overall satisfaction question. Correlations were determined between these parameters. Results: Of the 2953 patients considered, 70 patients met all criteria, provided consent, and enrolled. Only pseudophakic dysphotopsia (r = −0.60; P<.0001) and the NEI VF-11R (r = −0.44; P<.0001) correlated with overall satisfaction. In addition, pseudophakic dysphotopsia correlated with the NEI VF-11R (r = 0.58; P<.0001). Conclusions: When evaluating a highly controlled population with expected high satisfaction after cataract surgery, pseudophakic dysphotopsia was clearly the only significant dissatisfier. Furthermore, dysphotopsia highly correlated with the NEI VF-11R questionnaire; thus, symptoms of dysphotopsia are also seen to have functional significance. A shortened NEI VFQ survey and satisfaction correlated strongly with the full survey. Financial Disclosure: Dr. Olson has been a consultant to Abbott Medical Optics, Inc., Becton, Dickinson and Co., and Allergan, Inc. He has received grant support from Abbott Medical Optics, Inc., and Allergan, Inc. No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To report uncorrected distance and near visual acuity in pediatric eyes treated with primary monofocal intraocular lens (IOL) implantation. Setting: Boston Children''s Hospital, Boston, Massachusetts, USA. Design: Retrospective chart review. Methods: Records of children older than 5 years who had uneventful monofocal IOL implantation targeted for emmetropia within ±1.00 diopter (D) spherical equivalent were reviewed. Eyes with secondary IOL placement and sulcus-fixated IOLs were excluded. Vision was tested using the Mentor BVAT or M&S system for distance and the standard Jaeger near card for near visual acuity. Keratometry, axial length, type of IOL, and preoperative and postoperative refractions were recorded. The main outcome measure was uncorrected visual acuity at distance and near. Good visual acuity was defined as 20/40 or better. Results: Forty-one eyes of 25 children had uncorrected distance and near visual acuity recorded in the early postoperative period. The mean age was 11.2 years ± 3.6 (SD). Twenty eyes (49%) had good visual acuity at distance and near, 11 had good visual acuity at distance only, 6 had good visual acuity at near only, and 4 had worse than 20/40 at distance and near. Thirty eyes (70%) had with-the-rule astigmatism. All but 2 eyes (95%) had 20/70 or better uncorrected acuity at distance and near. In children with bilateral pseudophakia, 12 (75%) of 16 had 20/40 or better uncorrected acuity at distance and near. Conclusion: Monofocal IOL placement resulted in good uncorrected distance and near visual acuity in almost 50% of pediatric eyes and in 75% of patients when targeted within ±1.00 D of emmetropia. Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose: To report the results and safety of sutureless intrascleral haptic fixation in traumatized eyes and to compare this procedure with retropupillary iris-claw intraocular lens (IOL) fixation. Setting: University Hospital of Strasbourg, Strasbourg, France. Design: Interventional case series. Methods: Patients with traumatic cataract and severely damaged capsular bags were divided into 2 groups (Group 1: intrascleral IOLs [Acrysof MN60 AC]; Group 2: retropupillary iris-claw IOLs [Verisyse]). The main outcome was the final visual acuity. The surgically induced astigmatism (SIA) was calculated by the vectorial method. Results: Twenty-six eyes of 23 patients were studied, 8 eyes in Group 1 and 18 eyes in Group 2. The mean follow-up was 14 months. There was no difference in corrected distance visual acuity (CDVA) at the time of the surgery (P>.05). The mean CDVA (logMAR) was 1.68 ± 1.15 (SD) preoperatively and 0.55 ± 0.9 postoperatively in Group 1 (P = .03) and 1.11 ± 1.13 and 0.32 ± 0.47, respectively, in Group 2 (P = .003). The final CDVA was not different between groups (P>.05). The mean SIA was 1.91 ± 1.66 diopters (D) in Group 1 and 2.74 ± 1.92 D in Group 2 (P>.05). No intraoperative complications occurred in Group 2; a haptic broke in Group 1. Macular edema occurred in both groups. Conclusions: Sutureless intrascleral IOLs corrected posttraumatic aphakia. The SIA was comparable between groups. This procedure should be considered after trauma when other implantation techniques are not possible. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the indications, visual outcomes, and complication rate after implantation of a posterior chamber iris-claw aphakic intraocular lens (IOL). Setting: Department of Ophthalmology, University Medicine Charité Berlin, Berlin, Germany. Design: Retrospective case series. Methods: Eyes without adequate capsule support had posterior chamber iris-claw aphakic IOL implantation (Verisyse/Artisan) between 2005 and 2010. Results: The study comprised 137 eyes (126 patients). The mean follow-up was 5 months (range 1 to 48 months). The IOLs were inserted during primary lens surgery in 10 eyes (7.3%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 95 eyes (69.4%), and as a secondary procedure in 32 aphakic eyes (23.3%). The final mean corrected distance visual acuity (CDVA) (0.38 ± 0.31 [SD] logMAR) was significantly better than preoperatively (0.65 ± 0.58 logMAR) (P < .05). In 128 eyes (93.4%), postoperative refractive errors were within ±2.00 diopters (D) of emmetropia. Complications included slight temporary pupil ovalization in 34 eyes (24.8%), cystoid macular edema in 12 eyes (8.7%), hyphema in 3 eyes (2.1%), early postoperative hypotony in 7 eyes (5.1%) and elevated intraocular pressure in 6 eyes (4.3%), chronic uveitis in 1 eye (0.7%), toxic anterior segment syndrome in 1 eye (0.7%), and endophthalmitis in 1 eye (0.7%). Iris-claw IOL disenclavation occurred in 12 eyes (8.7%); all IOLs could be easily repositioned. Conclusion: The retropupillary iris-claw IOL provided good visual outcomes with a favorable complication rate and can be used for a wide range of indications in eyes without adequate capsule support. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

An 83-year-old pseudophakic woman fell and sustained an open-globe injury to her left eye with traumatic aniridia, aphakia, and a total retinal detachment. Visual acuity was light perception. After primary repair of the ruptured globe, the retina was reattached using silicone oil tamponade with placement of silicone oil retention sutures to prevent the oil from touching the corneal endothelium. Three months later, the oil was removed and with glare, aphakic correction improved the patient’s visual acuity to 20/80−1. A scleral-fixated artificial iris–intraocular lens (IOL) was subsequently implanted. During placement of the IOL through a temporal corneoscleral beveled incision into the anterior chamber, the silicone oil retention sutures supported the optic as it was scleral fixated. The retention sutures aided in the placement of the IOL and prevented it from subluxating and/or dislocating during surgery. Postoperatively, the corrected visual acuity was 20/50−2. Financial Disclosure: Dr. Rosenthal is a consultant to and clinical investigator for Ophtec USA, Inc. No other author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy, predictability, stability, safety, and complications of secondary anterior iris fixation of the Artisan iris-fixated intraocular lens (IOL) to correct aphakia in eyes without sufficient capsule support. Setting: Department of Ophthalmology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China. Design: Cohort study. Methods: Eyes having implantation of aphakic iris-fixated IOLs for aphakia correction were followed for 3 years. Results: The study evaluated 72 eyes (72 patients). After 3 years, the uncorrected distance visual acuity improved in all eyes (P<.05); 53 eyes (73.6%) reached 20/40 or better. Two eyes had a postoperative corrected distance visual acuity (CDVA) worse than the preoperative CDVA due to postoperative ischemic optic neuropathy and retinal detachment, respectively. The mean spherical equivalent (SE) decreased from 11.65 diopters (D) ± 1.21 (SD) to −0.58 ± 0.56 D (P<.05); the SE at the last follow-up was within ±1.00 D of the target refraction in 63 eyes (87.5%). The mean endothelial cell loss 3 years postoperatively was 9.78%. There was no significant postoperative intraocular pressure increase throughout the follow-up. Twelve patients (16.7%) reported glare and halos during night driving. Iris pigment precipitates on the IOLs occurred in 4 eyes (5.6%) 3 years postoperatively. No other serious complications occurred. Conclusions: Three-year results indicate that secondary implantation of aphakic IOLs is effective, predictable, and safe for the correction of aphakia in eyes without capsule support. However, longer follow-up with a larger cohort is necessary to confirm these conclusions. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

We report the case of a highly myopic patient who developed severe bilateral endothelial cell loss following implantation of 2 angle-supported anterior chamber pIOL models, the Acrysof Cachet and the GBR (currently off the market). Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]