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The aim of the study was to assess the spectrum of clinical presentation, intraoperative challenges and immediate surgical outcome of cataract patients with pseudoexfoliation syndrome (PXF) following manual small incision cataract surgery (MSICS). This prospective observational study which was conducted in a rural tertiary care hospital included adult patients with cataract and associated PXF. MSICS was performed for all after a complete ophthalmic and systemic examination. Clinical profile, intraoperative and post-operative complications were noted. Uncorrected visual acuity on first day post-surgery was used to assess the surgical outcome following MSICS. MSICS was performed in 80 eyes with varying grades of cataract and PXF. The mean age of the patients was 62.5 ± 8.9 years. PXF material on pupillary margin in 77(96%) patients was the most common finding noted. Majority of the patients had advanced cataract (72, 90%) and inadequate mydriasis (62, 77.5%). Posterior capsular rent (8, 10%) and zonular dehiscence (8, 10%) were the intraoperative difficulties faced. Uncorrected visual outcome on first post-operative day was moderate to good in 71 (88.8%) patients, limited by post-operative corneal oedema (21, 26.3%), iritis (31, 38.8%) and aphakia (9, 11.3%). Patients with pseudoexfoliation had poor pupillary dilatation, advanced cataracts and higher rate of posterior capsular rent. Our study showed good outcome of MSICS in PXF patients, even with advanced cataract suggesting that MSICS is a safe, effective and viable option for patients with PXF and cataract.

Purpose To evaluate anterior segment parameters in patients undergoing sutureless scleral fixation intraocular lens implantation with the modified Yamane technique (SSF-IOL-MY) by using Scheimpflug camera system. Methods Each group of 25 patients was included for aphakia undergoing SSF-IOL-MY and for senile cataract undergoing uneventful phacoemulsification and intraocular lens implantation (Phaco+IOL). Anterior chamber depth (ACD), iridocorneal angle (ICA), anterior chamber volume (ACV) and keratometric values were evaluated by Scheimpflug camera (Sirius, CSO, Italy) system. Results It was seen that the ACD, ICA and ACV display wider structures in patients with SSF-IOL-MY group compared to Phaco+IOL group. However, the ACD (p = 0.828) and ICA (p = 0.219) have not a statistically significant difference, while ACV (p = 0.007) has a statistically significant difference. In terms of keratometric values of the patients, there was no statistically difference in K1, K2 and Kmax values (p = 0.348, p = 0.106, p =0.269, respectively). Although there was no statistically significant difference between the groups in terms of anterior corneal astigmatism, posterior corneal astigmatism was statistically higher in the Phaco+IOL group (p = 0.192, p = 0.031, respectively). Conclusion SSF-IOL-MY surgery affects anterior segment parameters similar to the Phaco+IOL method, which is the gold standard in cataract surgery. In this surgery, it was approached to the gold standard method in terms of IOL position with the ACD, ACV and ICA values and the results of the corneal incision with the keratometric values.

Purpose To elucidate visual outcome of patients after combined Descemet stripping endothelial keratoplasty (DSEK) with scleral fixated intra ocular lens (SFIOL) implantation in patients of endothelial decompensation with coexistent aphakia or lens subluxation. Materials and Methods A prospective interventional study of combined DSEK with sutured SFIOL in the patients who have undergone surgery at our center over 6-month follow-up period. Preoperative visual acuity and slit lamp findings were documented. Postoperative follow-up was done at days 1, 3, and 7 subsequently, months 1 and 3, and thereafter monthly till the sixth month. Results Mean age of the patients was 60.47 years. Six patients had aphakic bullous keratopathy, while 11 patients had pseudophakic bullous keratopathy with subluxated posterior chamber IOL (PCIOL). Preoperative visual acuity ranged from hand movements close to face (LogMar 2.4) with accurate projection of rays to 1/60 (LogMar 2) due to existing corneal edema and aphakia. Postoperatively uncorrected visual acuity at 6 months improved up to 6/36 (LogMar 0.8) in all cases. There was gradual improvement in corneal clarity and compactness during the follow-up. A good donor tissue endothelial count and an adequate IOP control were vital prognostic factors for the successful outcome. Conclusion This novel surgical merger reduces the complications of lenticule dislocation into vitreous and repeated surgeries and shows results akin to when performed in a staged manner.

PURPOSE To evaluate the outcomes and safety of retropupillary iris-claw intraocular lens implantation and associated pars plana vitrectomy. METHODS Multicenter, national audit of 325 eyes (325 patients). Demographics, surgical details, and complications are described. Visual acuity, intraocular pressure, and central retinal thickness assessed by optical coherence tomography were collected at 1, 3, 6, and 12 months after surgery. Kaplan-Meier curves were created to assess the cumulative probability of postoperative visual acuity and intraocular pressure levels, macular edema development, and corneal decompensation. RESULTS The cumulative probability of the final visual acuity ≤0.3 logarithm of the minimum angle of resolution (≥20/40 Snellen) was 75.6% at 12-month follow-up. The probability of intraocular pressure >21, ≥25, and ≥30 mmHg was 48.1%, 33.1%, and 19.0%, and the probability of intraocular pressure-lowering drops was 50.9% at 12 months. Glaucoma surgery was required in 4.3% of the eyes (14/325). The cumulative probability of macular edema was 20.5% at 12 months and was greater in complicated cataract surgery than in intraocular lens-luxation eyes (26% vs. 16.7%, P = 0.04). Corneal transplantation was required in 2.8% of the eyes (9/325). CONCLUSION This study on 325 eyes with aphakia or intraocular lens dislocation managed with the retropupillary iris-claw intraocular lens technique provides clinical outcomes in a real-world scenario, reporting relevant data for patient counseling and preoperative discussions.

Summary Purpose Lacking a standard technique, the surgical management of aphakia without capsular support remains to be optimized. The goal of this study is to analyze results for the Carlevale FIL-SSF intraocular lens and propose surgical recommendations. Patients and methods The P1.5 Collective performed a retrospective analysis, with a minimum follow-up of 6 months, of the records of 72 implantations of the Carlevale FIL-SSF intraocular lens, specifically designed for sutureless scleral fixation in the ciliary sulcus. Results The most common indication was exchange of a posterior chamber intraocular lens (70.8%). The surgery lasted a mean of 53.4 minutes due to the creation of scleral flaps. The implant was damaged in 12.5% of cases. Visual acuity was improved in 83.3% of cases. The postoperative spherical equivalent was −0.3 diopters, with no change in corneal astigmatism. The implant was centered and stable in all cases. Two cases (2.8%) of cystoid macular edema were observed and resolved over six months. Discussion A number of advantages of the Carlevale FIL-SSF intraocular lens make it a safe and effective solution for correction of aphakia in the absence of capsular support. It requires a longer than usual surgical procedure, and the implant must be handled with care. From their experience, the authors propose 7 recommendations to accelerate the learning curve. Conclusion In light of the results of this study, we propose the Carlevale FIL-SSF intraocular lens as the new standard for the correction of aphakia without capsular support, but other studies are necessary to determine its exact place within the heirarchy of other available techniques.

Purpose. To assess one year results and stability of the implantation of a scleral anchored intraocular lens (IOL). Design. Interventional prospective case series. Methods. Sixty eyes of 60 patients affected by either aphakia or IOL dislocation were included in this study. Patients underwent vitrectomy, scleral fixation of the IOL, and, if present, dislocated IOL removal. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery by best-corrected distance visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, corneal specular microscopy, and optical coherence tomography (OCT) of both the macula and anterior segment. Results. At twelve months, mean BCVA significantly improved ( p < 0.0001 ), and none of the patients experienced a decrease of visual acuity. A 10% decrease of endothelial cell count occurred after surgery. Cystoid macular edema occurred in three patients (5%). A transient increase of intraocular pressure was noted in 7 cases (12%). At one month, horizontal and vertical IOL tilt was 1.04 ± 0.87 and 0.74 ± 0.71 degrees, respectively, and did not significantly change in the follow-up ( p > 0.05 ). None of the patients had decentration or dislocation of scleral-fixated IOL during the follow-up. Conclusion. Implantations of scleral plug fixated IOL provide good visual results, low complication rate, and excellent stability of the lens until one-year follow-up.

Purpose: To report two rare cases of Brown McLean syndrome after cataract surgery in a patient with aphakia.Case summary: (Case 1) A 54-year-old woman with Marfan’s syndrome who had aphakia and peripheral corneal edema after left eye cataract surgery 4 years ago. The patient had an elevated lesion in the peripheral cornea without involving the central cornea, and had symptoms of pain, irritation and tearing. Specular microscopy showed normal endothelial cell density and morphology in the edematous cornea. The peripheral corneal edema improved after use of antibiotics, autoserum eyedrops and 5% NaCl eyedrops. (Case 2) A 61-year-old woman with aphakia in her left eye after bilateral cataract surgery 11 years ago, underwent surgery for a macular hole in both eyes. The patient developed peripheral corneal erosions and edema in the left eye 2 months after the surgery. Specular microscopy showed normal endothelial cell density and morphology. The peripheral corneal edema was static over the years while using 5% NaCl eyedrops and artificial tears, and did not progress to involve the central cornea.Conclusions: Brown McLean syndrome is a rare disease but the possibility should be considered if a patient with aphakia after cataract surgery has peripheral corneal edema for several years.

Purpose: To analyze the surgical outcomes and complications of sutureless needle-guided intrascleral intraocular lens (IOL) implantation (Yamane technique) combined with pars plana vitrectomy. Methods: Retrospective study of 47 eyes of 46 patients that underwent scleral fixation of IOL by the Yamane technique combined with 3-port pars plana vitrectomy. Demographic data, primary indications for surgery, history of trauma, best corrected visual acuity (BCVA), intraocular pressure (IOP), duration of follow-up, and complications were analyzed. Results: Mean preoperative BCVA was 0.79 logMAR, which improved to 0.39 logMAR at mean 4.21 months (SD: 4.87 D) follow-up. Mean spherical equivalent pre and postoperative was + 7.64 D (SD: 7.74 D) and − 0.47 D (SD: 2.26 D), respectively. Early postoperative complications included hypotony with cyclodialysis cleft (n = 1; 2%), mild vitreous hemorrhage (n = 2; 4%), raised IOP (n = 2; 4%), and transient corneal edema (n = 2; 4%). Late complications included iris optic capture (n = 1; 2%), retinal detachment (n = 1; 2%), cystoid macular edema (CME; n = 2; 4%), IOL decentration (n = 1; 2%), and decentration and tilting of IOL (n = 1; 2%). Management of complications included laser treatment to cyclodialysis cleft, observation for vitreous hemorrhage, topical and oral IOP lowering agents for raised IOP. CME was managed with topical non-steroidal anti-inflammatory drugs. One eye was subjected IOL refixation. The mean number of surgeries per eye was 1.04. Conclusion: Combining needle-guided intrascleral IOL implantation with vitrectomy allows management of other posterior segment complications in the same sitting while obviating the need for the second surgery. It provides satisfactory outcomes that are comparable to published studies. However, a longer follow-up will allow a better understanding of the potential advantages of this approach.

To assess the safety of scleral fixation using the Akreos AO60 intraocular lens (IOL) and Gore-Tex suture. Prospective evaluation of 20 patients who underwent scleral fixation of an Akreos AO60 with Gore-Tex. Patients presenting with aphakia or dislocated IOL without capsular support were enrolled in the study. Main outcome measures included visual acuity, endothelial cell density, and postoperative complications over 6 months of follow-up. Mean ± standard deviation (SD) uncorrected logMAR visual acuity improved from 1.92 ± 0.23 (20/1600 Snellen equivalent) preoperatively to 0.80 ± 0.56 (20/125) at 6 months postoperatively (p p = 0.312). The mean ± SD endothelial cell density was 1740.50 ± 522.92 cells/mm2 and 1187.19 ± 493.00 cells/mm2 (p

Hyungil Kim,1 Sohee Jeon2 1Gyeongju St. Mary’s Eye Clinic, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea; 2Keye Eye Center, Seoul, Republic of KoreaCorrespondence: Sohee JeonKeye Eye Center, 326 Teheran-ro, Gangnam-gu, Seoul, KoreaTel +82-02-6207-1236Fax +82-02-6207-1246Email soheeeee@gmail.comPurpose: To evaluate refractive outcomes after retropupillary iris-claw intraocular lens (IOL) implantation and to compare postoperative astigmatism from (1) a conventional 5.5-mm sclerocorneal incision, (2) an L-shaped scleral tunnel incision, and (3) a frown scleral tunnel incision.Methods: This was a retrospective study of eyes undergoing dislocated IOL exchange for a retropupillary iris-claw IOL. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and postoperative complications were evaluated until postoperative months 24. The refractive outcomes and the surgically induced astigmatism (SIA) vector were compared between groups.Results: The medical records of 107 eyes from 107 patients with mean age of 65.31 ± 12.15 years were reviewed. Eyes with a frown incision showed the best UDVA, followed by those with L-shaped and conventional incisions (P = 0.003). Eyes with an L-shaped incision or frown incision had a lower SIA than that of the conventional incision group at postoperative 6 months (mean ± standard deviation [SD] SIA, 0.86 ± 0.85 D, 0.63 ± 0.37 D, and 1.70 ± 1.27 D for frown incision, L-shaped incision, and conventional incisions, respectively; P = 0.004).Conclusion: The frown incision and L-shaped incision induced a significantly smaller SIA than the conventional incisions, which was associated with better UDVA postoperatively.Keywords: aphakia, astigmatism, intraocular lens dislocation, retropupillary iris-claw intraocular lens, scleral tunnel incision, sclerocorneal incision

Purpose: We investigated the effect of the time of secondary intraocular lens (IOL) implantation on final visual acuity and other causes affecting visual prognosis in cases left aphakic after open globe injury.Methods: The study included 62 eyes of 62 patients left aphakic after the repair of open globe injury between 2012 and 2019. Demographic characteristics, trauma zone, ocular trauma score, type of injury, time of secondary IOL implantation, final best-corrected visual acuity (BCVA), and complications were recorded for each patient.Results: The mean follow-up time of 62 patients was 25.05 ± 12.59 months. The preoperative BCVA was found to be 2.40 ± 0.86 logarithm of the minimum angle of resolution (logMAR), while the postoperative final BCVA was found to be 0.53 ± 0.70 logMAR (p < 0.01). The mean interval timing of secondary sulcus foldable IOL implantation was determined to be 3.79 ± 4.04 months. No correlation was observed between secondary IOL implantation time and final BCVA (r = 0.140, p = 0.319). Furthermore, when only pediatric patients were taken, an excellent positive correlation was found between the secondary IOL implantation time and final BCVA logMAR (r = 0.895, p < 0.01). Multiple linear regression on final BCVA with age, revealed a significant model explaining 48.0% of the variability with younger age and better final BCVA with as significant coefficients (p = 0.007).Conclusions: Although time interval between primary repair and secondary IOL implantation to correct aphakia does not effect final BCVA in adult patients, earlier surgery should be considered for amblyopia management in pediatric patients.

Purpose. To present a clinical case of surgical treatment of post-traumatic aphakia by the method of corneoscleral IOL fixation using the combined method of Kanabrava and Kozhukhov. Material and methods. In March 2021, patient A., born in 1992, turned to the RSSPCEM. diagnosed with OS Condition after a penetrating injury to the eye. Corneal scar. Post-traumatic aphakia. Foreign body (non-metallic) driven into the retina. A decision was made on OS surgical treatment of aphakia by the method of transscleral IOL fixation as the most gentle method, taking into account the paracentral scar of the cornea. And do not remove the foreign body, but additionally restrict it with laser coagulates. Results. On the 14th day after the operation, visual acuity OS 0.7, IOP 18. The eye is calm, there is a scar on the cornea in the paraoptic zone, transparent in the rest of the zone, the anterior chamber is deep, the iris is subatrophic, the pupil is 3 mm, deformed, the IOL is in the posterior chamber, centered. The fundus of the eye: the optic disc is pale pink, the boundaries are clear, the reflex is blurred in the macular zone, the foreign body is limited by pigmented laser coagulates. The standard postoperative drop regimen is recommended. Conclusions. 1. Corneoscleral fixation of the IOL according to the combined method of Canabrava and Kojuhov in the aphakic eye in complicated cases allows to achieve good refractive results with the developed technique of execution. 2. Preliminary laser limitation of an encapsulated non-metallic foreign body gives confidence in the stability of the retina in the intra- and postoperative period. 3. Further clinical observations are required using the above-described surgical technique for correcting aphakia Key words: сorneoscleral fixation, aphakia, Canabrava, Kojuhov.

The purpose of this study is to conduct a comparative analysis of the correction of aphakia by various models of intraocular lenses using silicon oil tamponade (SO) of the vitreous cavity. Materials and methods. The studies were conducted on 16 eyes of patients aged from 56 to 75 years (65.5±12 years) with aphakia and pathology of the vitreal cavity. The duration of the silicone tamponade was 2-3 months. Depending on the use of the type of IOL, all patients were divided into 2 groups. Results. When using an anterior chamber intraocular lens (IOL), the presence of ophthalmic hypertension was revealed in 75% of cases, which is 2.02 times higher than when using transcleral IOL fixation. In 37.5% of cases, the SO output to the anterior chamber is determined, in contrast to the group where IOL hemming was used. A higher percentage of SO migration to the anterior chamber of the eye in group 2 patients is due to a violation of the anatomy of the anterior chamber barrier and the vitreal cavity. Conclusion. Thus, in patients who underwent transcleral IOL fixation, visual acuity is 2.1 times higher than in patients who were implanted with an anterior chamber IOL. Transcleral fixation of the IOL can form the necessary barrier between the anterior and posterior chambers of the eye, and is also the closest IOL position to the physiological one. Key words: intraocular lens, silicone oil, transcleral fixation.

In the present cases, the use of the Ophtec Arificial Iris model C1 is described in patients with traumatic or postoperative aniridia/aphakia. In one of the patients, it was combined with perforating keratoplasty because of corneal scarring. In both of the presented cases, improvement in visual acuity and a satisfactory aesthetic result without any serious complications can be shown. However, the short follow-up time must be emphasised.In den hier vorgestellten Kasuistiken wird die Versorgung mittels Ophtec Artificial Iris Modell C1 bei traumatischer bzw. postoperativer Aniride/Aphakie beschrieben. In einem Fall wird bei visuslimitierender Hornhautvernarbung zusätzlich die Kombination mit einer perforierenden Keratoplastik angewendet. Im Ergebnis zeigt sich in beiden Fällen ein Zugewinn von Visus und kosmetischer Zufriedenheit ohne schwerwiegende Komplikationen. Einschränkend muss aber auf den aktuell noch kurzen Nachbeobachtungszeitraum hingewiesen werden.

Objective To describe reoperations that occurred within 90 days of minimally invasive glaucoma surgery (MIGS) at a single institution over a 30-month period. Setting Tertiary care hospital. Design Retrospective case series. Methods Charts of adult patients who underwent trabecular microbypass stents, gel microstents, and goniotomy procedures (including gonioscopy-assisted transluminal trabeculotomy) from October 1, 2017, to March 15, 2020, at Wills Eye Hospital were examined. Outcome measures were unanticipated reoperations within the first 90 days after MIGS procedures and the complications that led to these reoperations. Results A total of 448 MIGS procedures were performed on 436 eyes of 348 patients over a 30-month period by 6 glaucoma surgeons. Of these, 206 (46.0%) were trabecular microbypass stents (198 iStent/iStent inject and 8 Hydrus), 152 (33.9%) were gel microstents, and 90 (20.1%) were goniotomy procedures. Combined phacoemulsification took place in 256 eyes (58.7%). Reoperation within 90 days took place in 23 (5.3%) of 436 eyes, including 16 (10.5%) of 152 eyes in the gel microstent group, 4 (2.0%) of 198 eyes in iStent/iStent inject group, and 3 (3.3%) of 90 eyes in the goniotomy group. Indications for reoperation were elevated intraocular pressure (IOP) in 16 (69.6%) of 23 eyes, gel microstent tip exposure with wound leakage in 3 (13.0%) of 23 eyes, and early gel microstent encapsulation without elevated IOP in 1 (4.3%) of 23 eyes. Two (8.7%) of 23 eyes required reoperation for intraocular lens complications, whereas 1 (4.3%) of 23 eyes had elevated IOP and aphakia requiring reoperation. Conclusions The rate of reoperation within the first 90 days after MIGS was low. Elevated IOP and complications associated with gel microstents were the main indications for reoperation.

Norihiko Yoshida,1 Takashi Kojima,1,2 Kazuo Ichikawa3 1Department of Ophthalmology, Japanese Red Cross Gifu Hospital, Gifu, Japan; 2Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 3Chukyo Eye Clinic, Nagoya, JapanCorrespondence: Takashi KojimaDepartment of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, JapanTel +81-3-5363-2012Fax +81-3-5363-3087Email tkojkoj@mac.comPurpose: In this study, we aimed to report on the early results of intrascleral intraocular lens (IOL) fixation using a hook-shaped haptic IOL (hsh-IOL).Patients and Methods: We enrolled 27 consecutive eyes of 27 patients (mean age, 74± 11.4 years) who underwent intrascleral IOL fixation with an hsh-IOL and were followed-up for 3 months postoperatively. The reasons for surgery included insufficient capsular support, including IOL dislocation, aphakia, or dislocated crystalline lens. The haptic of the hsh-IOL was externalized from the eye using forceps, and the hook was buried in the scleral tunnel. We investigated the preoperative and 3-month postoperative corrected visual acuity (VA), intraocular pressure (IOP), corneal endothelial cell density, refractive prediction error, postoperative intraocular astigmatism, surgically induced astigmatism, and intraoperative and postoperative complications.Results: The mean postoperative corrected VA (logMAR, 0.083± 0.18) was significantly better than the mean preoperative value (0.42± 0.60, p=0.0007). The 3-month postoperative mean absolute prediction error was 1.00± 0.96 D. The mean IOL-induced astigmatism was 0.95± 0.70 D. Further, the mean postoperative corneal endothelial cell count (2036± 644 cells/mm2) was significantly lower than the preoperative value (2316± 527 cells/mm2) (p=0.009). No patient had a 1-month postoperative IOP < 5 mmHg or > 25 mmHg. There were no intraoperative or vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, due to postoperative haptics misalignment.Conclusion: Intrascleral IOL fixation using hsh-IOL is an effective option for eyes with insufficient capsular support.Keywords: intrascleral IOL fixation, efficacy, safety, hook-shaped haptics, visual acuity, intraocular lens

To evaluate post operative visual outcomes and complications of retro-pupillary iris fixated Intracoular lens (IOL) in aphakia. This is a prospective interventional case study conducted at our tertiary eye care centre from March 2018 to February 2019. All monocular aphakias secondary to any cause with no capsular support, good iris diaphragm support and BCVA of better than 6/60 were included. Patients who required combined procedures like trabeculectomy and retinal procedure were excluded. Patients with poor endothelial count/ corneal decompensation, any posterior segment pathologies, pre existing glaucoma and any form of uveitis were also excluded from the study. Pre operative visual acuity, slit lamp examination and fundus examination were carried out. Anterior vitrectomy and retropupillary fixation of iris claw lens were done. The primary outcome was to assess the post operative visual acuity and secondary outcome was to analyse post operative complications at various intervals up to 6 months after surgery. Our study comprised of thirty eyes of 30 aphakic patients. Retropupillary Iris fixated IOL was inserted as primary intraocular lens in 18 patients (60%) and secondary intraocular lens in 12 patients (40%). Baseline best corrected visual acuity was 0.831±0.66 logMAR. Four patients had light perception at baseline. The mean best corrected visual acuity was 0.77±0.35 logMAR at month 1, 0.64±0.36logMAR at month 3 and 0.53±0.33logMAR at month 6. Mean intraocular pressure at baseline was 16mmHg. Mean intraocular pressure at month 1, 3 and 6 were 17mmHg, 16mmHg, and 16mmHg respectively. Among the complications, twelve eyes (40%) had significant ovalisation of pupil at post operative month 1 which persisted at month 6, two eyes(6.66%) had transient ocular hypertension (OHT), and none of the eyes progressed to glaucoma. Choroidal detachment was noted in 2 eyes (6.66%), CME in 3 eyes (9.99%), 1 eye (3.33%) had retinal detachment and 2 eyes (6.66%) had one haptic disenclavation. Among the complications, ovalisation of pupil was the most common observed one. Retro-pupillary Iris fixated IOL is an effective, safe and simple procedure for management of aphakia in eyes with no posterior capsular support.

Background: A potential complication of cataract surgery is posterior capsular rent, where PCIOL can’t be implanted. Primary Iris claw implantation means that the IC-IOL is implanted in the same setting after cataract removal. While secondary Iris claw lens implant is done in an aphakic eye without capsular support and post cataract surgeries when the eye is left aphakic. Aim: To compare the visual outcome in cases of primary and secondary iris claw lens implantation after cataract surgery. This was a hospital-based Prospective Interventional Longitudinal study,conducted on patients in a tertiary care centre, in Western Maharashtra from September 2018 to August 2020. 31 eyes underwent primary iris claw implant and 19 underwent secondary iris claw implant. Results: Highly significant difference in visual acuity preoperatively due aphakia among subjects who underwent secondary iris claw implantation (p=0.000) was seen. Highly significant difference in visual acuity post operatively till 15 days was also seen due to less corneal oedema& inflammation in patients who underwent secondary iris claw implantation. No significant difference in visual acuity was seen on day 40 as lens was put in both the groups and the signs of inflammation had reduced (p=0.759). Conclusion: Overall visual outcome after 40 days is comparable in primary and secondary cases. It is better to do a primary retro fixated iris claw implantation, as in case of a secondary implant the patient will have undue anxiety, to undergo a second surgery along with increased financial burden and patient can develop complications due to aphakia. Keywords: Primary and Secondary Iris claw lens, Visual acuity, Endothelial cell count,Intra ocular pressure.

Purpose. To systematically review the results of comparative studies of modern cataract surgery in pediatric uveitis with or without intraocular lens (IOL) implantation and to perform comparative meta-analyses to compare visual acuity outcomes and complication rates. Methods. On 12 November 2020, we systematically searched the Cochrane Central, PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, and all affiliated databases of the Web of Science. Two authors independently reviewed studies and extracted data. Studies were reviewed qualitatively in text and quantitatively with meta-analyses. Outcome measures were preoperative and postoperative best-corrected visual acuity (BCVA), inflammation control, and rates of postoperative complications. Results. Ten studies of 288 eyes were eligible for review of which the majority were eyes with juvenile idiopathic arthritis-associated uveitis. Summary estimates revealed that the BCVA was better in pseudophakic eyes vs. aphakic eyes (1-year postoperative: −0.23 logMAR, 95% CI: −0.43 to −0.03 logMAR, P = 0.027 ; 5-year postoperative: −0.35 logMAR, 95% CI: −0.51 to −0.18 logMAR, P = 0.000036 ). Pseudophakic eyes had more visual axis opacification (OR 6.76, 95% CI: 2.73 to 16.8, P = 0.000036 ) and less hypotony (OR 0.19, 95% CI: 0.04 to 0.95, P = 0.044 ). Conclusions. In modern era cataract surgery on eyes with pediatric uveitis with IOL implantation leads to satisfactory and superior visual outcomes and no differences in complication rates apart from an increased prevalence of visual axis opacification and a decreased prevalence of hypotony when compared to aphakia. However, limitations of the retrospective design and the presence of selection bias necessitate a careful interpretation.

Purpose To evaluate repeat Descemet membrane endothelial keratoplasty (re-DMEK) success rates and to identify risk factors for re-DMEK failure. Design Retrospective case series. Methods Settings: Institutional. Patients and interventions: A chart review was performed, including all eyes with primary DMEK failure that underwent re-DMEK between 2013 and 2019 at the Toronto Western Hospital and the Kensington Eye Institute (Toronto, Ontario, Canada) and had at least 6 months of follow-up. Main outcome measure: Predicting factors for re-DMEK outcome. Results Of 590 consecutive DMEK surgeries, 40 eyes (6.7%) were identified for having a secondary DMEK surgery after primary DMEK failure. Etiologies for primary DMEK were Fuchs endothelial corneal dystrophy (32.5%), pseudophakic bullous keratopathy (35%), previous failed graft (27.5%), and other indications (5%). Fifty-five percent of the cohort were categorized as having a complicated anterior segment including 11 eyes with previous glaucoma surgery, 7 eyes post–penetrating keratoplasty, 4 eyes post–Descemet stripping automated endothelial keratoplasty, 3 eyes peripheral anterior synechia, 3 eyes previous pars plana vitrectomy, 2 eyes aphakia, and 1 eye each with aniridia, anterior chamber intraocular lens, and iris-fixated intraocular lens. Re-DMEK failure was documented in 12 eyes (30%) of the entire cohort. The risk factor for re-DMEK failure was the presence of a complicated anterior segment (P = .01, odds ratio = 17.0 [95% confidence interval: 1.92-150.85]), with 50% re-DMEK failure rate in this subgroup. Conclusion Re-DMEK is a viable option for cases of primary DMEK failure, especially for eyes with Fuchs endothelial corneal dystrophy as the indication for primary DMEK without other ocular morbidities; however, eyes categorized with a complicated anterior segment had high re-DMEK failure rates.

We are reporting a case of a 22-year-old lady with bilateral microphthalmia and microcornea, in which a modified technique for sutureless scleral fixated intraocular lens implantation provided a successful aphakic rehabilitation alternative with a good visual outcome and significant improvement in quality of life. Management of aphakia in microphthalmic eyes is challenging due to the anatomical abnormalities and limited literature on managing such cases. Visual rehabilitation for aphakia using contact lenses is limited by intolerance and poor lens fitting. Significant optical aberrations may limit aphakic spectacle use, further exacerbated in patients with nystagmus. Thus, secondary IOL implantation seems to be a reasonable rehabilitation alternative; however, it is surgically challenging in microphthalmic eyes.

Purpose: To evaluate usefulness and safety of removal of silicone oil from the vitreous cavity via the anterior chamber. Methods: The procedures were performed between 2012 and 2020 in 31 patients who required endotamponade with the use of light silicone oils. In most of the patients, the procedure was combined with cataract removal, secondary lens implantation or transscleral fixation of an artificial lens. A passive bimanual technique was used to replace silicone oil with fluid. Results: The procedure to remove silicon oil via the anterior chamber proceeded without serious intra- and postoperative complications. There were no hypotony observed in first postoperative day. Conclusion: Patients eligible for the procedure are those who have preoperative indications for silicone oil removal and whose removal path via the anterior chamber is not associated with a special need to remove the lens from the eye.

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 to their fellow, normal eyes in the Infant Aphakia Treatment Study (IATS). SETTING: 12 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 was available both at surgery and at 10 years. Variance in RRG3 was compared between the groups with Pitman’s test for equality of variance between correlated samples. RESULTS: Longitudinal biometric data was available for 103 of the 114 patients enrolled. RRG3 for normal eyes was −15.0 (3.0) D (reported as mean (standard deviation)), for aphakic eyes −17.7 (6.2) D, and for pseudophakic eyes −16.7 (6.2) D (P < 0.0001 for comparison of variances in RRG3 between normal and all operated eyes). Further analysis found differences in the variance in axial length growth (P < 0.0001) between operated and normal eyes; the variance in keratometry measurement change did not reach significance. CONCLUSIONS: The standard deviation in the rate of refractive growth of normal eyes in our study is half of that found in eyes that underwent cataract surgery.

The aim of this study was to evaluate the clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized eyes. A multi-surgeon, retrospective case series of previously vitrectomized eyes that underwent DMEK between 2013 and 2018 at Moorfields Eye Hospital. Patients’ demographics, preoperative, intraoperative and postoperative data were collected. In total, 14 eyes of 13 patients, aged 63 ± 14.6 years were included. Three eyes had intraoperative posterior dislocation of the DMEK graft into the vitreous cavity, two of these were aphakic and one had an unstable PCIOL. Postoperatively, one graft had a total detachment and required repeat keratoplasty for primary failure, two grafts had visually significant partial detachment and needed rebubbling. Three patients developed high intraocular pressure (IOP) and one required an urgent glaucoma drainage device 1-month post-DMEK. The mean corrected distance visual acuity was 0.81 ± 0.42 logMAR preoperatively, and postoperatively was 0.6 ± 0.51 at 3 months (p = 0.414); 0.69 ± 0.81 at 6 months (p = 0.684); and 0.7 ± 0.8 at 12 months (p = 0.658). DMEK in vitrectomized eyes has unique challenges that necessitate careful preoperative planning. We observed a significant proportion of dislocated grafts in vitrectomized eyes with either unstable IOL or aphakic. Moreover, vitrectomized eyes with secondary glaucoma may be particularly vulnerable to uncontrolled IOP postoperatively and close monitoring is essential to prevent worsening of visual acuity. We recommend that DMEK may not be a feasible option in eyes that are prone to collapse, in particular aphakic vitrectomized eyes, as opposed to DSAEK or penetrating keratoplasty.

Purpose. To determine the specificity of functional and tonographic parameters of the eyeball in children with cataract, aphakia and pseudophakia. Material and methods. A comparative analysis of eye hydrodynamics indices was made according to a simplified procedure, using the Friedenwald nomogram, on 75 children aged 2 to 17 years with cataract (24 eyes), aphakia (21 eyes), pseudophakia (15 eyes), and IOL dislocation (15 eyes), as well as 12 healthy children.Results. In pseudophakia, true IOP was found to fall to 10.00 ± 0.01 mm Hg due to a decrease in aqueous humor production (to 0.10±0.01 mm3 / min) and increase of its outflow (to 0.75 ± 0.02 mm3/min / mm). IOL dislocation led to an increase in true IOP (24.40±1.0 mm Hg) due to an increase in aqueous humor production (4.09±0.05 mm3/min) and a decrease in its outflow (0.010 ± 0.002 mm3/min/mm). In these eyes, clinical manifestations of secondary pseudophakic glaucoma were noted, which are explained by factors obstructing aqueous humor outflow (vitreous prolapse and partial vitreous block) and considered an indication for re-operation.Conclusion. Statistically significant changes of hydrodynamic eye parameters in children with pseudophakia have been detected: increased true IOP in IOL dislocation, and, conversely, reduced true IOP in case of the normal IOL location. The authors believe that eye “hypotension” in case of pseudophakia requires further study.

We report herein a case of fitting with a photochromic silicone hydrogel contact lens under a rigid gas-permeable lens (piggyback system) for photophobia and low vision correction after traumatic aniridia and aphakia. A 40-year-old woman was referred to our practice for contact lens fitting in her right eye, which was left aphakic after an open globe injury. She also presented traumatic aniridia in the right eye, and her left eye had been previously eviscerated. A successful fitting was obtained with a photochromic silicone hydrogel (senofilcon A) contact lens, with a Dk/t of 121 × 10-9, under an aspheric design, +13.00 D rigid gas-permeable lens. The patient displayed visual acuity and contrast sensitivity improvement and reported decreased photophobia.

Purpose: To report the surgical outcomes of penetrating keratoplasty (PKP) and sutureless scleral fixation (SSF) using Carlevale Lens (Soleko) combined procedure to solve corneal failure and aphakia in vitrectomized eyes and discuss eventual advantages of this new approach. Methods: Two patients underwent primary wound repair and pars plana vitrectomy after a penetrating ocular trauma and were referred to the author’s clinic. The PKP and SSF-Carlevale lens implantation were performed under retrobulbar anesthesia. Intraoperative and postoperative complications were recorded, intraocular lens positioning was evaluated using anterior segment optical coherence tomography (AS-OCT) and endothelial cell density was determined using an endothelial microscope. Both patients completed 12 months follow-up. Results: The surgery was performed without intraoperative complications. After 1 month, the lens was fixed well, and the graft showed no sign of rejection. At the last visit after 12 months, the corneal graft remained transparent with good endothelial cell density in both cases; conjunctival scarring or inflammation and plugs externalization did not occur during follow-ups. Best-corrected visual acuity was 4/10 Snellen in the first case, while in the second case, we witnessed a limited visual recovery of 1/20 Snellen due to retinal issues. Conclusion: We report the feasibility of secondary IOL implantation using Carlevale with penetrating keratoplasty. The relative of ease of Carlevale lens implantation through the transscleral plugs reduces the open globe length resulting in a safer procedure, especially for vitrectomized eyes.

To evaluate outcomes of bilateral cataract surgery in children aged 7 to 24 months and compare rates of adverse events (AEs) with other Toddler Aphakia and Pseudophakia Study (TAPS) registry outcomes.Retrospective clinical study at 10 Infant Aphakia Treatment Study (IATS) sites. Statistical analyses comparing this cohort with previously reported TAPS registry cohorts.Children enrolled in the TAPS registry between 2004 and 2010.Children underwent bilateral cataract surgery with or without intraocular lens (IOL) placement at age 7 to 24 months with 5 years of postsurgical follow-up.Visual acuity (VA), occurrence of strabismus, AEs, and reoperations.A total of 40 children (76 eyes) who underwent bilateral cataract surgery with primary posterior capsulectomy were identified with a median age at cataract surgery of 11 months (7-23); 68% received a primary IOL. Recurrent visual axis opacification (VAO) occurred in 7.5% and was associated only with the use of an IOL (odds ratio, 6.10; P = 0.005). Glaucoma suspect (GS) was diagnosed in 2.5%, but no child developed glaucoma. In this bilateral cohort, AEs (8/40, 20%), including glaucoma or GS and VAO, and reoperations occurred in a similar proportion to that of the published unilateral TAPS cohort. When analyzed with children aged 1 to 7 months at bilateral surgery, the incidence of AEs and glaucoma or GS correlated strongly with age at surgery (P = 0.011/0.004) and glaucoma correlated with microcornea (P = 0.040) but not with IOL insertion (P = 0.15).Follow-up to age 5 years after bilateral cataract surgery in children aged 7 to 24 months reveals a low rate of VAO and very rare glaucoma or GS diagnosis compared with infants with cataracts operated at7 months of age despite primary IOL implantation in most children in the group aged 7 to 24 months. The use of an IOL increases the risk of VAO irrespective of age at surgery.

To evaluate the frequency and outcomes of acute-onset endophthalmitis following combined pars plana vitrectomy and scleral fixation of intraocular lens. We evaluated patients undergoing a sutureless, glueless, flapless technique of scleral fixation of intraocular lenses (SFIOL) implantation for various causes of aphakia and documented the clinico-demographic data, microbiological profile and final outcome after acute endophthalmitis in this cohort of eyes. The frequency of suspected acute endophthalmitis diagnosed post-surgery was 0.112% (4/3541 eyes), with culture-positive endophthalmitis frequency being 0.028% (1 eye), showing growth of Pseudomonas aeruginosa. Mean age of patients with endophthalmitis was 51.75 ± 9.28 years, and mean interval between surgery and acute endophthalmitis presentation was 10.25 ± 9.6 days. Patients were managed with intravitreal antibiotics with or without core vitrectomy. Visual acuity of patients increased from baseline 1.43 ± 0.32 logMAR (Snellen equivalent = 6/150) to 0.79 ± 0.16 logMAR (Snellen equivalent = 6/36) after an average follow-up of 11 ± 2 weeks. Endophthalmitis is a rare complication following SFIOL surgery, and all ophthalmic surgeons must be aware of this inadvertent possibility, since SFIOLs are gaining wider acceptability recently. Moreover, these cases of endophthalmitis may show a different pattern of microorganisms than post-cataract surgery endophthalmitis; however, with prompt diagnosis and effective timely management, favorable outcomes can be achieved.

PURPOSE We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. DESIGN Systematic review. METHODS We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. RESULTS Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. CONCLUSIONS Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.

Introduction: Iris-claw Intraocular Lens (IOL) is one of the alternatives to correct aphakia without sufficient capsular support. This technique is preferred because it has a simple procedure. Iris-claw IOL was originally designed to be fixated on the anterior chamber. The use of retropupillary fixation is increasing because the location is more physiologic and it shows less risk to corneal endothelial damage. Purpose: To describe safety and efficacy of iris-claw Artisan IOL in correcting aphakia without sufficient capsular support. Methods: This is a descriptive retrospective study of patients with aphakic iris-claw Artisan IOL implantation in National Eye Center Cicendo Eye Hospital, Indonesia from July 2017-July 2019. Patients were divided into prepupillary and retropupillary group. The Uncorrected Visual Acuity (UCVA), Best-Corrected Visual Acuity (BCVA), Safety Index (SI), Efficacy Index (EI), and complications were recorded. The procedure is safe if SI value ≥ 1.0 and effective if EI value ≥ 1.0. Results: There were 54 eyes in the retropupilary group and 17 eyes in the prepupillary group. In the prepupillary group, there were 94.11% eyes with SI ≥ 1.0, the mean SI was 1.79 ± 1.02, 50% of eyes with EI ≥ 1.0, and the mean EI was 0.77 ± 0.20. In the retropupillary group, there were 96.29% eyes with SI ≥ 1.0, the mean SI was 2.49 ± 2.23, 74.07% of eyes with EI ≥ 1.0, and the mean EI was 1.75 ± 1.64. Postoperative UCVA and BCVA were improved significantly compared to preoperative visual acuity in both groups (p < 0.05) Conclusion: Prepupillary and retropupillary iris-claw IOL implantation are safe. Retropupillary fixation technique is more effective in improving visual acuity.

Purpose To describe a new surgical technique for sutureless intrascleral intraocular lens (IOL) fixation with an adapted retinal scraper used as an instrument “the Catcher Pole” to retrieve the IOL haptic through a scleral tunnel. Setting Public Eye Hospital, Roma, Italy. Design Retrospective case series. Methods Twenty-one eyes from 19 patients who underwent sutureless intrascleral IOL fixation were studied. A standard three-piece posterior chamber IOL (PCIOL) was implanted in aphakia or rescued and fixated in cases of dislocated PCIOL. A 23 to 25 G retinal loop scraper (the “Catcher Pole“) was inserted through a 1.5 mm long tunneled sclerotomy performed on the horizontal meridian, to capture, hold and externalize the tip of the haptic of the IOL. A flange created with an handheld cautery on the externalized haptic tip prevents IOL slippage. The best-corrected visual acuity (BCVA), central corneal pachymetry (CCP), IOL tilt and complications were assessed. Results In twenty-one eyes of 19 patients, the mean preoperative BCVA was 0.61 logMAR units ±0.05 SD, and the mean postoperative BCVA improved significantly to 0.18 logMAR units at three months ±0.05 SD (P=0.002). The mean preoperative CCP was 610 µ ±17 SD and the mean postoperative CCP 623 µ ±16 SD, (P=0.73). In the subgroup that underwent IOL tilt evaluation, mean IOL tilt was 3.19±2.01. The postoperative complications included iris capture of the IOL in one eye (4,7%) and transient ocular hypertension in two eyes (9,4%). Conclusions The “Catcher Pole” sutureless intrascleral IOL fixation technique is easy to perform with reduced anterior chamber manipulations and achieves both anatomical and optical stability., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/jwiK7MtrVsU

Purpose To evaluate outcomes of anterior chamber intraocular lens (ACIOL) implantation with vitrectomy in eyes with surgical or traumatic aphakia, and subluxated or dislocated lens. Methods In this retrospective study, we evaluated patients who underwent pars plans vitrectomy with ACIOL implantation from April 2016 to March 2019. Patients with minimum follow-up period of 1 year and operated by single surgeon were included. Ophthalmic history, indication for surgery, BCVA, IOP, slit-lamp examination, and fundus assessment findings were noted. Postoperatively best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications if any were noted. Results Ninety eyes of 88 patients were included in the study. The mean age of the patients was 60.2 ± 10.2 yrs. Majority (75.6%) were males and 24.4% were females. Indications for pars-plana vitrectomy (PPV) with ACIOL implantation were nucleus drop in 16.6%, IOL drop in 25.5%, large posterior capsular rupture (PCR) with vitreous disturbance or zonular dehiscence (ZD) during cataract surgery in 33.3%, more than 180° subluxation of lens in 10% and traumatic lens or intraocular lens (IOL) drop in 14.4% cases. Preoperative and postoperative mean Log MAR visual acuity was 1.59 ± 0.44 and 0.36 ± 0.33 respectively, with few complications like cystoid macular edema (CME) in 8.8%, persistently raised IOP in 4.4%, persistent uveitis in 2.2%, retinal detachment (RD) in 2.2%, and tilted IOL in 1.1% cases. Conclusion Out of different options available for secondary IOL implantation in patients with poor capsular support ACIOL has the advantages of cost-effectiveness, small learning curve, faster surgical time with a lesser rate of complications like IOL tilt, vitreous hemorrhage, and suture erosion as compared to scleral-fixated IOL (SF-IOL). Comparable visual outcome can be obtained by proper patient selection in these cases.

Background: The modern cataract surgery involves implantation of posterior chamber intraocular lens (PCIOL) when the posterior capsule is intact. However, in case of weak or no capsular support, PCIOL implantation is not possible. In such situations, implantation of secondary Iris claw lens (ICIOL) or Scleral fixated IOL(SFIOL) remains as treatment options. The aim of this study was to compare the efficacy of ICIOL and SFIOL in terms of visual outcomes and complications in aphakic patients. Methods: This prospective randomized study was done from January 2019 to December 2019. Forty aphakic patients fulfilling inclusion criteria, who attended the ophthalmology outpatient department of VVPF’s Medical college and hospital, Ahmednagar were included in this study. These patients were randomly divided into two groups such as Group 1 included 20 patients who underwent ICIOL implantation and Group 2 included 20 patients who underwent SFIOL implantation. The preoperative and postoperative evaluation was done with visual acuity, slit-lamp examination, IOP, fundus examination for the follow up period of 6 months. Results were analysed with Chi square test and t-test using SPSS software. Results: 85% ICIOL and 80% of SFIOL patients had final Best Corrected Visual Acuity (BCVA) of 6/18-6/6. Surgical time in ICIOL was significantly less than SFIOL group (p=0.00). Suture related complications were significantly more in SFIOL group. However, oval pupil and pigment dispersion were seen more in ICIOL group but were harmless. One patient in SFIOL group developed Cystoid Macular Edema (CME) which persisted till final follow up and 1 haptic of ICIOL was disenclavated which was re-enclavated. Conclusion: Comparable final visual outcome was found between ICIOL group and SFIOL group. However, Implantation of ICIOL required less surgical time with fewer complications and hence is a better alternative to SFIOL implantation in correction of aphakia.

Purpose: To analyze and determine the postoperative visual acuity and complications after intraocular implantation of an iris-claw lens in aphakic patients. Setting: Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Design: Retrospective study. Materials and Methods: Medical records of cataract and aphakic patients who underwent posterior fixation of iris claw lens over a five-year period were reviewed for collection and analysis of data. Results: The study comprised 138 eyes of 57.25% female and 42.75% male with mean age of 62.84 ± 8.649 years. The follow up period was 6 to 24 months. The mean preoperative CDVA was 0.44 + 0.23 logMAR. After 1 year of follow up period the mean postoperative CDVA was 0.3+ 0.15 logMAR which was statistically significant (p Conclusions: This study showed the merits of retrofixated iris claw lens over AC IOL and SF IOL in terms of simple technique, short learning curve, satisfying overall visual outcome, less risk of complications and good safety profile. Keywords: Aphakia, Enclavation, Iris claw, Retrofixation.

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.

Purpose. To evaluate the clinical and functional results of the technique of transcleral fixation of the artificial iridochrustalic diaphragm during its decentration in a patient with aniridia and aphakia. Material and methods. Under observation was a 32-year-old patient K. with a diagnosis on the right eye: iridochrustalic diaphragm decentralization, posttraumatic aniridia, posttraumatic aphakia, who underwent a method of transcleral fixation of a displaced artificial iridochrustalic diaphragm developed at the Academician S. N. Fedorov Eye Microsurgery of the Moscow Ministry of Health of the Russian Federation. Results. Patient K. is subjectively satisfied with the visual functions obtained in the right eye. Conclusion. Thus, this clinical case demonstrates a very successful implementation of the fixation of the iridochrustalic diaphragm with its displacement to obtain satisfactory visual functions in the patient. Key words: aniridia, iridochrustalic diaphragm, transcleral fixation.

To report clinical outcomes of retropupillary iris-suture-fixated rigid intraocular lens (IFIOL) Tertiary care ophthalmic hospital Retrospective study This study included all eyes undergoing IFIOL with a minimum follow-up of 6 months between April 2017 and January 2019. Patients with preexisting anterior or posterior segment pathologies causing defective vision, uveitis or history of previous intraocular surgeries with exception of cataract surgery were excluded from the study. Data were retrieved from electronic medical records, and we documented demographics, history, position of cataractous lens or IOL, primary/secondary surgery and its complications. Postoperative visual acuity, pupillary response, diplopia, centration of IOL, inflammation were also recorded at the baseline visit and at 1 month, 3 months and 6 months postoperatively. One hundred and ten eyes of 110 patients that underwent IFIOL were evaluated. Twenty-two patients (20%) underwent primary IFIOL, whereas 67 (60.9%) patients had secondary IFIOL. In 18 patients (16.36%), IFIOL was done to reposition decentered/dislocated IOLs. At the final follow-up, there was a significant improvement in corrected distance visual acuity (CDVA) with 87 patients (79.09%) achieving CDVA of 6/12 or better. IFIOL was stable and centered in 101 eyes (91.81%). Two patients (1.81%) had intraoperative complications. Postoperative iritis was seen in 7 patients (6.36%), and 4 patients (3.63%) had rise in IOP. This is a safe, reliable, reproducible technique for aphakia rehabilitation and decentered IOL stabilization with good clinical outcome, especially in a limited resource setting.

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.

Purpose To report the clinical and refractive outcomes of a modified Yamane technique for scleral fixation of the CT Lucia 602 lens. Design Retrospective case series. Patients One hundred twenty-one eyes with dislocated posterior chamber lens implants, surgical aphakia, subluxed crystalline lenses, capsular tear, anterior chamber, or iris sutured posterior chamber lens intolerance were included. Methods Secondary implantation of the Zeiss CT Lucia 602 lens was performed by a single surgeon using a modified Yamane technique employing a single needle, rather than the double-needle approach. One hundred twelve eyes underwent simultaneous 3 port pars plana vitrectomy and 9 eyes had previously undergone posterior vitrectomy surgery. Exclusion criteria were age

To evaluate a new method of measuring the intraocular pressure (IOP) in the vitreous cavity. IOPs in the anterior chamber and vitreous cavities of 24 porcine eyes (12 eyes with lenses and 12 eyes without lenses) were measured directly, continuously, and simultaneously. We used a needle as a part of the pressure sensor to measure the anterior chamber IOP and a disk-shaped sensor to measure the vitreous cavity IOP. A significant group-by-condition interaction on the vitreous cavity IOP between the two groups (phakia and aphakia) and four conditions of anterior chamber IOP were observed (F[3,258] = 5.8564, p

Purpose To explore the clinical characteristics and profiles of newly diagnosed glaucoma subtypes in urban Korea. Methods All newly diagnosed glaucoma patients enrolled in the participating ophthalmology outpatient clinics were included. A review of medical history including family history of glaucoma was conducted. The patients underwent complete ophthalmologic examinations including visual field test. The diagnosis of glaucoma was based on the International Society of Geographical and Epidemiological Ophthalmology criteria developed by glaucoma specialists. Results A total of 198,671 patients visited the participating ophthalmology outpatient clinics during the study period (from January 1, 2001 to June 30, 2016), of which 5,530 (2.8%) were diagnosed with glaucoma. The mean age of the newly diagnosed glaucoma patients was 52.0 ± 17.3 years (range, 6 to 89) and 2,830 patients were male (51.2%). The mean untreated intraocular pressure and vertical cup-to-disc ratio of the optic nerve head of newly diagnosed glaucoma eyes were 22.1 ± 10.6 mmHg and 0.66 ± 0.22, respectively. The most frequently observed subtypes of glaucoma were: normal tension glaucoma (33.0%) primary open-angle glaucoma (28.4%), ocular hypertension (11.1%), chronic angle-closure glaucoma (6.8%), neovascular glaucoma (5.2%), glaucoma associated with inflammation (3.8%), acute angle-closure glaucoma (3.3%), and glaucoma associated with aphakia or pseudophakia (2.2%). Conclusions Normal tension glaucoma was the most frequently observed glaucoma subtype in urban ophthalmology outpatient clinics in Korea.

To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL).Retrospective interventional case series.A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3 mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt.Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt.This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.

Purpose. Experimental and clinical study of hydrophobic intraocular lenses (IOL) enVista and enVista Toric for the correction of aphakia and corneal astigmatism. Material and methods. In the experimental part, enVista and enVista Toric IOLs (manufactured by Baush&Lomb, USA) were studied by electron scanning microscopy. The clinical part of the study included the results of implantation of 100 IOL enVista in patients with cataract and corneal astigmatism up to 1.25 diopters and 20 IOL enVista Toric in patients with cataract and corneal astigmatism 1.25 diopters or higher. Results. According to the results of electron microscopy, no «defects» were found on the surface and optical edge of the lenses. The optical edge of the lens has a rectangular shape throughout 360°. The deviation of the shape of the optical edge of the IOL from the ideal square edge area was 71.53–164.48 um² and 99.05–338.61 um², respectively, at radii of 40 um and 60 um. High uveal biocompatibility was confirmed by the absence of cellular deposits on the surface of all 120 IOLs. The lens material was not biodegraded, and there was no glistening effect in all cases. The percentage of opacity of the posterior lens capsule due to migration of epithelial cells of the lens was 5.0% in the three-six millimeter zone without indications for laser capsulotomy. After implantation of the envista Toric IOL, the average value of astigmatism decreased from 1.77±0.38 to 0.42±0.11 diopters (p

Purpose To describe the efficiency and visual results of a new method of transconjunctival intrascleral fixation of single-piece foldable IOL using double-flanged 6/0 prolene suture. Materials and methods Seventeen aphakic eyes of 17 patients without adequate capsular support were involved in this study. Lens was prepared by passing the 6/0 prolene suture in a track in the haptic of single-piece foldable IOL created by 31 g needle. The 6/0 prolene suture was retrieved through a 30 g needle transconjunctivally to outside the globe; then, IOL was implanted and a terminal bulb was created at the outer end of the prolene suture. Results All cases were aphakic after complicated phacoemulsification. In 10 cases hydrophilic IOLs were used and in 7 cases hydrophobic IOLs were used. There is clear statistically significant difference between pre-UCVA and post- UCVA. Complications included suture slippage in 2 cases and prolene bulb exposure in one case. There was no significant difference in endothelial cell count and IOP before and after 3 months. Conclusion Transconjunctival intrascleral fixation of foldable single-piece IOLs is a safe efficient method for correcting aphakia.

To describe clinical outcomes of secondary intraocular lens (IOL) implantation using sutureless trans-scleral techniques in surgically complex eyes. Retrospective surgical case series of 45 eyes that underwent secondary IOL implantation using a sutureless haptic flange technique. Demographic data of age, sex, primary diagnosis, best-corrected visual acuity (BCVA), refractive error, intraocular pressure, full ophthalmic exam findings, surgical approach, and any intraoperative complications were noted. The most common indication for secondary IOL implantation was aphakia, most commonly after ocular trauma. The primary outcome measures were pre-operative and post-operative BCVA, which revealed recovery of pre-operative vision levels by post-operative week 1 and improved vision by post-operative month 1 (p = 0.03). Secondary outcome measures of target refraction pre-operatively and post-operatively revealed significant reduction in post-operative spherical equivalent to achieve BCVA (p < 0.001). Targeting of the secondary IOLs using Barrett Universal II, Holladay 1, Holladay 2, and SRK/T all exhibited a hyperopic shift post-operatively in post-traumatic aphakic eyes and a myopic shift in the post complicated cataract extraction eyes. No intraoperative adverse events were noted. The most common post-operative complication was transient IOP elevation, with most patients completing 6 months of follow-up. There is rapid visual rehabilitation and reduction of spherical equivalent correction to attain BCVA in eyes with a history of ocular trauma that undergo secondary IOL implantation using a trans-scleral flange technique. Moreover, this study highlights that a specific IOL power formula can be more predictive of the desired refractive outcome depending on the indication for secondary IOL implantation.