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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.

Importance To determine visual and surgical results in children with Marfan syndrome. Background Marfan syndrome involves ocular complications which can lead to visual disturbance and amblyopia. Data about the visual and surgical results in children with Marfan syndrome is vital for the clinical management of these patients. Design Retrospective data analysis. Participants Eighty‐two eyes of 41 patients with a genetically proved diagnosis of Marfan syndrome. Methods Medical records of patients with Marfan syndrome were reviewed between 2007 and 2017. Ocular complications, visual acuity (VA) of patients with/without lensectomy and surgical method were evaluated. Main Outcome Measures VA outcomes of patients with Marfan syndrome with/without surgical repair of ectopia lentis. Results In 27 (66%) of the 41 patients a bilateral subluxation of the lens was visible and 14 (52%) patients received lensectomy. The mean age at initial presentation was 12.3 ± 9 years and mean follow‐up was 3 years (range 1‐7). VA varied from 1.2 to −0.1 logMAR at first examination. At initial presentation, mean VA was 0.1 ± 0.7 logMAR in patients with a normal lens status (n = 14) and 0.3 ± 0.5 logMAR in patients with subluxation of the lens (n = 27) (P

Advances in cataract surgery and intraocular lens implantation techniques continue to allow improved safety for the cornea. Complications can include mechanical or toxic injury of the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infectious keratitis, or epithelial ingrowth. Most of the recent work has addressed endothelial cell survival after cataract extraction and lens implantation or in cases following secondary lens implantation. A great deal of controversy has been raised over the past year as to whether flexible open-loop anterior chamber lenses, iris-fixated posterior chamber lenses, or transsclerally sutured posterior chamber lenses are safest for the cornea. Even with additional data accumulating, it still is not clear which type of implant provides the best degree of safety in cases requiring secondary implantation. Certainly, both flexible open-loop anterior chamber lenses and bag-fixated posterior chamber lenses placed at the time of cataract surgery have a good record of safety for the cornea. Patients with keratoconjunctivitis sicca require extra lubrication to prevent epithelial toxicity at the time of surgery and also postoperatively. Methylcellulose-containing lubricants appear to be most protective of the corneal epithelium. Overall, cataract surgery and intraocular lens implantation is extremely safe with modern techniques.

In a prospective study ten commercially available anterior chamber lenses with S-shaped haptics and multipoint support were implanted into the posterior chamber in cases of secondary lens implantation after intracapsular cataract operation. The lenses were trans-sclerally fixed by two sutures through the ciliary sulcus. They showed more immediate stability than ten C-loop posterior chamber lenses of a control group and remained firmly fixed without complications during a follow-up of up to 54 months. To overcome the disadvantages of suture fixation a sutureless sulcus self-fixation PCL was developed and implanted into six eyes with special indications. After more than one year of follow-up no late adverse reaction was noted.

BACKGROUND: There are several advantages to implanting a posterior chamber intraocular lens (IOL) in the ciliary sulcus when the lens capsule is absent. I have developed a simple method of fixating an IOL into the ciliary sulcus which does not require different needles, multiple needle passes, scleral dissection, or awkward surgical maneuvers. METHODS: Thirty eyes were enrolled in this study. All eyes were either aphakic, requiring a secondary lens implantation, or required IOL exchange. The patients were followed for 30 months. Using a single 10-0 double-armed, polypropylene suture, a through-and-through infracuiary scleral pass secured each haptic without tying. The lens was then positioned into the ciliary sulcus and the knots tied outside the eye under direct visualization. RESULTS: This procedure has been used in 30 eyes without erosion of sutures, dislocation or tilting of the IOL, or induced astigmatism. Twenty-one eyes (70%) had spectacle-corrected visual acuity of 20/40 or better. CONCLUSION: The results of this study demonstrate that posterior chamber transscleral fixated IOLs give improved postoperative visual results. [J Refract Corneal Surg. 1994;10:647-651.]

espanolObjetivos: Comparacion de dos tecnicas quirurgicas para la implantacion de lentes intracorneales. Incidencia de complicaciones corneales y lenticulares en 2 grupos de conejos intervenidos con las tecnicas descritas. Metodo: Estudio experimental en 2 grupos de conejos. Grupo 1 (siete conejos): se practica una queratectomia con microqueratomo, se implanta la lente y se sutura la cornea con dos puntos. Grupo 2 (siete conejos): se talla un bolsillo estromal segun tecnica manual, se implanta la lente y se sutura la zona de la incision con 2 puntos. En ambos grupos se realizo un seguimiento por 2 meses. Resultados: La incidencia de edemas corneales en el primer mes fue superior (71,43%) en el grupo 1 y menor en el 2 (14,28%) (p: 0,0155), asi como en el segundo mes (42,86% vs 28,57%) (p: 0,2927). Se observaron adhesiones incompletas y retracciones de la queratectomia (4/7) en el grupo 1, complicaciones no observadas en el grupo 2. La incidencia de descentramientos de la lente fue del 28,57% en el grupo 1 y del 0% en el grupo 2. La perdida de lente intracorneal se produjo en cinco de los siete casos (71,43%) del grupo 1 y en solo 1 de 7 (14,28%) del grupo 2 (P: 0,0155). Conclusiones: Los ojos intervenidos por medio de la tecnica manual denominada de bolsillo, fueron los que presentaron mas seguridad en cuanto a estabilidad de la lente intracorneal (descentramientos y perdida de lenticulo) y menor incidencia de complicaciones postoperatorias corneales. EnglishObjective: To compare two different surgical techniques of intracorneal lens implantation. To determine the incidence of corneal and lens complications in two groups of rabbits subjected to such surgery. Method: The first group (7 rabbits) initially had a keratectomy performed with the microkeratome following which the corneal flap was sutured to the stromal layer. In the second group (7 rabbits), a pocket-shaped stromal dissection was performed manually. Both groups of rabbits had a secondary lens implantation in the corneal inlay. The follow up period was of 2 months duration. Results: The incidence of corneal edema in the first month was higher in group 1 (71.4%) than in group 2 (14.3%) (p= 0.0155); during the second month, the incidence was 42.9% in group 1 and 28.6% in group 2 (p= 0.2927). Flap dislocation and retraction of the flap was seen in 4 of the 7 rabbits in group 1, whereas no complication of this type was observed in the manual pocket group (group 2). The incidence of lens subluxation was 28.6% in group 1 and 0% in group 2. Finally, there was a 71.4% (5/7) loss of the intracorneal lens in the rabbits treated with the microkeratome (group 1) while only 1 of 7 rabbits (14.3%) lost the lens in group 2 (P= 0.0155). Discussion: Eyes in which the corneal pocket shape was made by manual stromal dissection had a higher stability of the lens and less post-operative corneal complications.

Purpose: To describe and evaluate alternate techniques for implanting intraocular lenses in children in the absence of adequate capsular support for traditional lens implantation. Methods: Postoperative results of 18 eyes with posterior chamber intraocular lenses (PCIOLs) sutured to the ciliary sulcus and 10 eyes implanted with anterior chamber intraocular lenses (ACIOLs) were reviewed. Visual outcomes were divided into 2 groups: onset of aphakia during the critical period of visual development (≤9 years) and onset after the critical period (>9 years). Visual outcomes and complications were recorded. Results: Average follow-up was 10.3 months in the PCIOL group and 49.2 months in the ACIOL group. Eyes that became aphakic after the critical period of visual development achieved better overall final visual acuity than the eyes that became aphakic during the critical period; indeed, the eyes that became aphakic during the critical period did not achieve significantly improved vision. There were no complications in the PCIOL group. Complications in the ACIOL group included corectopia, haptic migration through the operative wound requiring removal, and pigment deposits on the lens. Conclusions: PCIOLs sutured to the ciliary sulcus offer a superior option to ACIOLs for correction of childhood aphakia in children lacking capsular support. ACIOLs had a high rate of serious complications (10%) in this small series. Secondary implantation with transsclerally sutured PCIOLs should be considered in complicated cases when more conservative options have been exhausted. (J AAPOS 2001;5:301-6)

In a retrospective study of 75 consecutive eyes having transscleral suturing of a posterior chamber intraocular lens (IOL) (mean follow-up five months), 57% had improved best corrected visual acuity; 67% of those obtained a visual acuity of 20/40 or better. Thirty-seven eyes had an IOL exchange without penetrating keratoplasty (PKP) at the time of implantation, 15 had simultaneous PKP, and 23 had secondary lens implantation without IOL exchange or a corneal transplant. Transscleral fixation is an effective means of implanting a posterior chamber lens in eyes without capsular support. It allows secure two-point lens fixation with minimal risk of IOL tilting or suture erosion through the conjunctiva or sclera.

A retrospective review of 65 patients who had secondary lens implantation is given, showing the risks and benefits associated with the procedure. Visual outcome, astigmatism and patient satisfaction are parameters which are considered.

Summary Of 78 patients eligible for prolonged wear contact lenses, 50 (65%) were successfully fitted and followed for four months to four years. The most serious complication was peripheral corneal ulceration, occurring in 5 (10%) patients. None of these patients suffered permanent visual loss. The fitting of prolonged wear lenses required six or seven office visits during the first year and at least one lens per eye during the first year, for uncomplicated cases. In difficult cases the number of office visits and the number of replacement lenses increased significantly. In terms of the number of office visits and replacement lenses, the soft contact lens compares unfavorably with the intraocular lens. It is our feeling that the prolonged wear soft contact lens should be used when a lens implant is contraindicated or as an alternative to secondary lens implantation.

A small group of aphakic patients having secondary lens implantation had keratometry performed before and at four months after surgery. A temporally oriented scleral pocket incision and closure technique was used to place the incision in fresh tissue and in the steepest corneal meridian. The results demonstrated an overall reduction of corneal cylinder from modest flattening of the surgical axis. Placement of the scleral pocket incision in fresh temporal tissue for secondary lens implantation affords a watertight stable wound with astigmatic control.

We reviewed 224 cases that had undergone secondary lens implantation. Cystoid macular edema occurred in 16 (7.1%) cases; edema was transient in 14 (6.3%) cases and permanent in two (0.8%) cases. Three factors seem to affect the incidence of CME: time lapse between cataract extraction and lens implantation; a positive preoperative fluorescein angiogram; and vitreous loss during lens implantation--if implantation is performed within a year of cataract extraction. Two eyes with pre-existing CME and a functional vision of 20/100 or better deteriorated to 20/200 or less after secondary lens implantation due to permanent macula edema. However, the incidence of postoperative CME can be as low as 1.3% if the macula is clear on the preoperative fluorescein angiogram and if surgery is performed no sooner than one year after cataract extraction.

Summary We reviewed 70 cases that had undergone secondary lens implantation. The lenses used included 34 Medallion and 36 Choyce Mark VIII lenses. A 20/40 or better vision was present in 74.3% of the cases before implantation, and could be achieved postoperatively in 95.7% of the cases. Corneal changes, i.e. endothelial corneal dystrophy and induced astigmatism, were not noted in cases where Choyce Mark VIII lenses were used. Cystoid macular edema occurred in three cases where surgery followed an intracapsular cataract extraction (5.3%).

We reviewed 23 consecutive cases of intraocular lens implant exchange. Lens dislocation (26%) and chronic intraocular inflammation (26%) were the most frequent indications for lens exchange. Post-exchange vision was best in those eyes treated for inappropriate implant power (100% less than or equal to 20/40), intermediate in dislocation cases (83% less than or equal to 20/40), and poorest in eyes with chronic intraocular inflammation (50% less than or equal to 20/40), even though the inflammation usually improved. Eighty-three percent of the total cases remained within one line of the pre-exchange visual acuity.

One hundred and sixty-nine aphakic eyes underwent secondary implantation of anterior chamber lenses. The postoperative visual acuity decreased by one or more lines in five eyes (3%), remained the same in 71 eyes (42%), and improved by one or more lines in 93 eyes (55%). The presence of macular degeneration, background diabetic retinopathy, and open-angle glaucoma with a cup-to-disc ratio of 0.6 or less did not contribute to any visual deterioration.

“Secondary lens implantation” means the implantation of an artificial lens in an eye from which the lens had been removed in a previous surgical session.

To the Editor. —would like to comment on the recent article by Waring and colleagues. 1 There are several difficulties in placing an intraocular lens at the same time a corneal transplant is performed, especially at the same time an offending implant is removed. The new cornea must heal sitting on an eye that is inflamed from the extra manipulation of removing and/or replacing an intraocular lens. I think it is much wiser to perform this procedure in three separate operations. The first removes the intraocular lens, and the eye is allowed to "quiet down" completely before an atraumatic corneal transplant is performed. After the transplant is completely healed, a secondary lens implantation is performed. I will soon be reporting on a series of such cases. The most overwhelming argument for my proposal is the fact that it is extremely difficult, if not impossible, to estimate the postoperative curvature

In 12 aphakic patients iris-supported lenses were implanted as a secondary procedure over a period of approximately 1 1/2 years, in one patient bilaterally. In 9 patients the implantation was combined with anterior vitrectomy. In one case retinal detachment occurred postoperatively, and in another a subluxation. Both of these complications were successfully remedied.