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Toxic Anterior Segment Syndrome after Foldable Artiflex Iris-Fixated Phakic Intraocular Lens Implantation  [PDF]
Lucien A. M. van Philips
Journal of Ophthalmology , 2011, DOI: 10.1155/2011/982410
Abstract: Toxic anterior segment syndrome (TASS) developed in four cases after uneventful implantation of a foldable iris-fixated phakic intraocular lens (pIOL). Two cases occurred sequentially in one patient. The TASS subsided without complications in all cases after intensive topical steroid treatment. A multitude of possible causes is considered for the occurrence of these TASS cases. From the sterilization and cleaning of surgical instruments to the possibility of endotoxines in ophthalmic viscosurgical devices (OVD). These rare cases should alert the surgeon to the possibility of TASS after pIOL implantation.
Toxic Anterior Segment Syndrome after Foldable Artiflex Iris-Fixated Phakic Intraocular Lens Implantation  [PDF]
Lucien A. M. van Philips
Journal of Ophthalmology , 2011, DOI: 10.1155/2011/982410
Abstract: Toxic anterior segment syndrome (TASS) developed in four cases after uneventful implantation of a foldable iris-fixated phakic intraocular lens (pIOL). Two cases occurred sequentially in one patient. The TASS subsided without complications in all cases after intensive topical steroid treatment. A multitude of possible causes is considered for the occurrence of these TASS cases. From the sterilization and cleaning of surgical instruments to the possibility of endotoxines in ophthalmic viscosurgical devices (OVD). These rare cases should alert the surgeon to the possibility of TASS after pIOL implantation. 1. Introduction Toxic anterior segment syndrome (TASS) is an acute, sterile anterior segment inflammation following any anterior segment surgical procedure [1]. Usually the anterior segment inflammation starts within 12–48 hours after surgery. Clinically alarming symptoms include diminished visual acuity, increased intraocular pressure, corneal edema, inflammation of the anterior chamber, fibrin, hypopyon, and a fixed pupil [2–4]. TASS results from a noninfectious toxic agent within the anterior chamber [5, 6]. The offending substances include denatured ophthalmic viscosurgical devices (OVDs), preservatives, talc from surgical gloves, topical ophthalmic ointment, inappropriately reconstituted intraocular preparations, altered pH and osmolarity of intraocular fluids, heat stable endotoxins, and detergents [5, 6]. Mild to moderate cases respond well to corticosteroids [3, 4], while severe cases might lead to corneal decompensation, glaucoma, a permanently dilated pupil, and cystoid macular edema [2, 3, 7, 8]. TASS is most commonly reported after cataract surgery and rarely after phakic intraocular lens (pIOL) implantation [1, 9, 10]. In the literature, three TASS cases have been reported after pIOL implantation [11, 12]. This report presents three cases of TASS, two of which occurred sequentially in one patient after foldable Artiflex iris-fixated pIOL implantation. 2. Case Reports Case 1. A 45-year-old woman with high myopia consulted our clinic for a refractive surgical procedure. The patient was not contact lens intolerant. History revealed no allergy, uveitis, rheumatic disease, or herpetic keratitis. Corrected distance visual acuity (CDV) in the right and left eye was, respectively, 1.0 and 0.80 with a manifest refraction of, respectively, ?12.25 and ?15.0–0.50?×?135. Photopic (85 candelas/m2) low contrast (2.5%) visual acuity (LCVA) preoperatively was 0.40 and 0.32 in the right and left eye, respectively. Mesopic (0.7 candelas/m2) LCVA
Phakic intraocular lenses  [cached]
Sinha Rajesh,Kumar Chandrashekhar,Titiyal Jeewan
Indian Journal of Ophthalmology , 2009,
Abstract:
Acute endothelial failure after cosmetic iris implants (NewIris®)  [cached]
Garcia-Pous M,Udaondo P,Garcia-Delpech S,Salom D
Clinical Ophthalmology , 2011,
Abstract: Maria Garcia-Pous1, Patricia Udaondo2, Salvador Garcia-Delpech2, David Salom1, Manuel Díaz-Llopis21Faculty of Medicine, University of Valencia, Valencia, Spain; 2Ophthalmology Department, Hospital Universitario La Fe, Valencia, SpainAbstract: We report a case of an acute endothelial failure after the implantation of a new cosmetic, colored, artificial iris diaphragm implant called NewIris . A 21-year-old woman came to us complaining of progressive loss of vision and pain after NewIris lenses had been implanted. Decreased visual acuity, corneal edema, and increased intraocular pressure in both eyes appeared only 3 weeks after the surgery. The lenses were removed as soon as possible but had already severely affected the endothelial cell count. NewIris implants are an alternative to cosmetic contact lenses, but they are not as safe as other phakic anterior chamber intraocular lenses, nor are they a good option for the patient.Keywords: NewIris, endothelial failure, cosmetic iris implants
Lentes fácicas de camara anterior Anterior chamber phakic lenses
Walton Nosé,Adriana dos Santos Forseto
Revista Brasileira de Oftalmologia , 2012, DOI: 10.1590/s0034-72802012000400012
Abstract: Os implantes em olhos fácicos apresentam-se como uma op o para a corre o de altas ametropias. De acordo com sua localiza o podem ser classificados como de camara anterior ou posterior, sendo que os primeiros subdividem-se em fixa o iriana ou de suporte angular. Além da corre o da miopia, as lentes de fixa o iriana apresentam modelos para hipermétropes e astigmatas. Várias modifica es no desenho das lentes foram propostas nas últimas décadas com a finalidade de reduzir complica es tardias, como a perda endotelial progressiva. Cuidados no intraoperatório devem ser tomados de forma a diminuir a perda endotelial aguda relacionada ao trauma. Avan os nos métodos de triagem pré-operatória também melhoraram a seguran a do procedimento. A estimativa do poder dióptrico é baseada nos cálculos de Van der Heijde, sendo dependente da profundidade de camara anterior, do equivalente esférico da refra o e da média ceratométrica. Resultados a longo prazo demonstram a eficácia, previsibilidade e seguran a do procedimento. Dependendo do modelo, além da possibilidade de perda endotelial, outras possíveis complica es incluem: irite, dispers o pigmentar, atrofia de íris, ovaliza o pupilar, rota o, descentra o ou deslocamento da lente, hipertens o ocular e bloqueio pupilar. Modelos dobráveis atualmente disponíveis vêm apresentado resultados bastante promissores com redu o da taxa de complica es. The phakic intraocular lenses (pIOLs) are a good option for the correction of high refractive errors. According to their anatomical position there are two types of pIOLs: anterior or posterior chamber. The anterior chamber pIOL may be iris-fixated or angle-supported. The iris-fixated pIOLs are available not only for myopia correction, but also for hyperopia and astigmatism. During the last decades many modifications on the pIOLs designs were proposed in order to reduce late complications, such as progressive endothelial cell loss. Acute endothelial cell trauma related to the surgical procedure may be minimized with proper intraoperative care. Advances in the preoperative screening methods have improved the safety of the procedure. Estimation of the pIOL power is based on the van der Heijde calculations and is dependent on the anterior chamber depth, the spherical equivalent and the mean keratometric values. Long-term results show the efficacy, predictability and safety of the procedure. According to the type of the pIOL, complications other than endothelial cell loss include iritis, pigment dispersion, iris atrophy, pupil ovalization, pIOL rotation, decentration or dislo
Acute endothelial failure after cosmetic iris implants (NewIris )
Garcia-Pous M, Udaondo P, Garcia-Delpech S, Salom D, Díaz-Llopis M
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S18569
Abstract: cute endothelial failure after cosmetic iris implants (NewIris ) Case report (3544) Total Article Views Authors: Garcia-Pous M, Udaondo P, Garcia-Delpech S, Salom D, Díaz-Llopis M Published Date May 2011 Volume 2011:5 Pages 721 - 723 DOI: http://dx.doi.org/10.2147/OPTH.S18569 Maria Garcia-Pous1, Patricia Udaondo2, Salvador Garcia-Delpech2, David Salom1, Manuel Díaz-Llopis2 1Faculty of Medicine, University of Valencia, Valencia, Spain; 2Ophthalmology Department, Hospital Universitario La Fe, Valencia, Spain Abstract: We report a case of an acute endothelial failure after the implantation of a new cosmetic, colored, artificial iris diaphragm implant called NewIris . A 21-year-old woman came to us complaining of progressive loss of vision and pain after NewIris lenses had been implanted. Decreased visual acuity, corneal edema, and increased intraocular pressure in both eyes appeared only 3 weeks after the surgery. The lenses were removed as soon as possible but had already severely affected the endothelial cell count. NewIris implants are an alternative to cosmetic contact lenses, but they are not as safe as other phakic anterior chamber intraocular lenses, nor are they a good option for the patient.
Corrección de la alta miopía con lentes de contacto fijación en iris: Resultados visuales y refractivos Iris-Claw phakic intraocular lens for high myopia correction: Visual and refractive results  [cached]
A Arntz,M Arango,JA Durán
Archivos de la Sociedad Espa?ola de Oftalmología , 2003,
Abstract: Objetivo: Evaluar la precisión, eficacia, complicaciones y satisfacción subjetiva en pacientes con miopía elevada del implante de lentes intraoculares fáquicas (Artisan ). Método: Estudio retrospectivo de 65 ojos (36 pacientes), con equivalente esférico (EE) preoperatorio entre -9,75 y -25,0 dioptrías (D), operados por el mismo cirujano (JAD) en el período comprendido entre enero de 1999 y agosto de 2001. Se evaluó la agudeza visual no corregida (AVNC) y la agudeza visual mejor corregida (AVMC), refracción, complicaciones y respuesta subjetiva. Resultados: La AVNC, evaluada 3 meses tras la cirugía, fue 0,47; y la AVMC fue 0,62, con un incremento en promedio de 2,3 líneas de visión respecto a la AVMC preoperatoria. La refracción evaluada a los 3 meses era de ±0,50 D de la emetropía en un 49,23%, y en un 78,46% dentro de ±1,0 D de la emetropía. La diferencia entre el EE esperado (EE preop - dioptría LIO) y el EE obtenido arrojó una subcorrección promedio de 0,55 D. Se observó un incremento de la presión intraocular (PIO) sobre 30 mmHg en el postoperatorio inmediato en un 10% de los ojos. La percepción nocturna de halos fue evaluada de moderada en un 20% de los casos, y el grado de satisfacción con el procedimiento fue positivo en un 90,77% de los casos. Conclusiones: El implante de LIO fáquicas Artisan en pacientes altos miopes es un procedimiento seguro que aumenta la AVMC. Se observa una tendencia hacia la subcorrección del EE esperado. Purpose: To determine predictability, efficacy, complications and patient’s satisfaction to phakic intraocular lens (Artisan ) in highly myopic patients. Method: Retrospective study of 65 eyes (36 patients), with preoperative spherical equivalent (SE) between -9,75 and -25,0 diopters (D) operated on by a single surgeon (JAD) between January 1999 and August 2001. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, postoperative complications, and patient’s subjective response were evaluated. Results: UCVA evaluated 3 months postoperatively was 0.47 and BSCVA was 0.62. An average gain of 2.3 lines was observed with respect to the preoperative BSCVA. Refraction between ±0.50 D from emmetropia ocurred in 49.23% of the eyes, and between ± 1.0 D in 78.46% of the eyes. The difference between intended SE (preoperative SE minus IOL diopter) and achieved postoperative SE, showed a 0.55 D mean undercorrection. An intraocular pressure (IOP) over 30 mmHg was seen in 10% of the eyes in the immediate postoperative period. Night halos/glare perception was mild in 20% of the eyes, and in 90.7
Fulminant Panuveitis following Iris Suture Fixation of Posterior Chamber Intraocular Lens  [PDF]
Ahmad M. Mansour,Shady T. Awwad
Case Reports in Ophthalmological Medicine , 2013, DOI: 10.1155/2013/910342
Abstract: We present a case of fulminant panuveitis following iris suture fixation of a posterior chamber intraocular lens. We hypothesize that the zonular dehiscence allowed the inflammatory cells in the anterior compartment to gain access to the posterior segment mimicking endophthalmitis or toxic anterior segment syndrome. Also certain bulky lens designs, like the current Rayner hydrophilic acrylic lens, are difficult to manipulate and hold in the optic capture position, and hence the iris fixation of these lenses can be traumatic and lengthy. It is advised to exchange such lenses with 3-piece intraocular lenses that are easy to fixate. 1. Introduction The concept of iris suture fixation for posterior chamber intraocular lenses dates back to 1976, when Malcolm McCannel, M.D., described his trans-corneal suture technique to stabilize subluxated posterior intraocular lenses. Since then, iris suture fixation has become a well-established effective means for stabilizing posterior chamber lenses in the lack of adequate capsular support [1–8]. The technique consisted of a McCannel 10-0 polypropylene suture which was used to fixate the haptics to the iris using the Siepser sliding knot [5]. In a series of 46 patients [6], the main complications of iris suture fixation included transient low-grade uveitis in 3 (6.5%), transient pigment dispersion in 3 (6.5%), and intraocular lens dislocation in 2 (4.3%). Additionally in a second series of 17 eyes of 9 children [7], other complications of iris suture fixation included hyphema in 1 case and sterile endophthalmitis in another case. A case of severe uveitis and severe visual loss after iris suture fixation is described. 2. Case Report This 46-year-old Iraqi lady had prior anterior chamber intraocular lens implantation for familial lens subluxation and previous pars plana vitrectomy for retinal detachment ending with poor vision in the right eye. The left eye underwent scleral buckle for rhegmatogenous retinal detachment with findings of severe scleral thinning. Subsequently she had phacoemulsification with hydrophilic acrylic intraocular lens (Superflex, Rayner Intraocular Lenses Ltd, East Sussex, UK; 6.25?mm optic and 12.5?mm overall length) implantation in the bag with zonular dehiscence. Visual acuity was 6/9 in the left eye with mild decentration (Figure 1). The patient was referred for scleral fixation of the lens. Because of scleral thinning and history of retinal detachment, we proceeded with iris suture fixation. Two surgeons were working simultaneously through several keratome incisions, and it was necessary to
Iris claw type intraocular lenses  [cached]
Singh Daljit
Indian Journal of Ophthalmology , 1982,
Abstract:
Intraocular lens iris fixation. Clinical and macular OCT outcomes
Leonardo Garcia-Rojas, Juan Paulin-Huerta, Eduardo Chavez-Mondragon, Arturo Ramirez-Miranda
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-560
Abstract: The final CDVA was 20/40 or better in 8 eyes (62%), 20/60 or better in 12 eyes (92%), and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT.We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.Cataract surgery is the most common intraocular surgery; about 10 million cataract surgeries are performed worldwide each year [1]. Despite the low rates of surgical complications, aphakia and malpositioned intraocular lenses (IOLs) in the absence of capsular support represent a clinical problem and a surgical challenge. Anterior chamber (AC) IOLs, posterior chamber (PC) trans-scleral sutured IOLs, and PC iris-fixated IOLs are commonly used surgical approaches to treat aphakia and malpositioned IOLs. A review by the American Academy of Ophthalmology concluded that there was insufficient evidence to demonstrate superiority of one type or fixation site over another [2]. Although modern AC IOLs designs have significantly improved, concerns about corneal decompensation, trabecular meshwork damage, and chronic inflammation still exist [3,4]. Scleral fixation PC IOLs avoids some of these problems. However, disadvantages such as IOL tilting, vitreous entrapment, retinal detachment, intraocular hemorrhage, and a technically challenging surgery, appears as a questionable alternative [5-10]. Iris suture fixation of an
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