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Self retaining contact lens system for vitreous surgery  [cached]
Chalam Kakarla,Shah Vinay
Indian Journal of Ophthalmology , 2004,
Abstract: We describe the principle and design of a new self-retaining contact lens system for vitreous surgery. The system has three lenses: the plano-concave, prism and magnifying lens. This system is based on the principle of a direct imaging contact lens, designed for a 150-200mm focal length operating microscope. The contact lenses are designed to have an inferior concave surface [radius of curvature (ROC) 7.7mm], modified by the addition of four footplates to provide stability and centration during vitreous surgery. The lenses are used with a drop of viscoelastic material placed between the concave surface of the contact lens and cornea. This induces negative suction and helps retain the lens in position during surgery. These specially designed lenses provide a stable, well-centered, high-resolution, magnified view of the fundus. This system eliminates the need for a skilled assistant or for suturing the lens to the sclera during vitreous surgery.
Pupillary-iris-lens membrane with goniodysgenesis: A case report  [cached]
Deshpande Nitin,Shetty Shashikant,Krishnadas S
Indian Journal of Ophthalmology , 2006,
Abstract: We describe a rare case of pupillary-iris-lens membrane with goniodysgenesis, a unilateral neurocristopathy. The membrane represents ectopic iris on the lens with abnormal iris stroma and anterior chamber angle from aberrant induction, migration or regression of neural crest cells. The membrane can be progressive. Catastrophic vision loss from angle closure can occur and may be controlled with surgery. This subject needed treatment for amblyopia.
Flexible Iris Retractors for Management of Zonular Dialysis during Planned Phacoemulsification  [PDF]
Chen-Hsin Tsai,Ching-Hsi Hsiao,Wan-Chin Ku
Chang Gung Medical Journal , 2006,
Abstract: Background: The aim of this study was to determine the use of flexible iris retractors infour patients with zonular dialysis occurring during cataract surgery.Methods: We describe the use of flexible iris retractors to stretch and fixate the capsulorhexisover the zonular dehiscence sector for patients with traumatic zonulardisruption occurring during phacoemulsification, which stabilizes thecapsular bag and facilitates cataract extraction without complications.Results: Each of the four eyes was implanted with posterior chamber intraocular lens(PCIOL) successfully. The intraocular lenses (IOLs) remained well centeredduring the 12-month follow-up period and the patients enjoyed improvedvision without complications.Conclusion: Flexible iris retractor is a simple, convenient and useful instrument for managingzonular dehiscence that occurred during cataract extraction. It facilitatesthe removal of the residual lens material and IOL implantation withoutmajor complications.
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
Phacoemulsification using iris-hooks for capsular support in high myopic patient with subluxated lens and secondary angle closure glaucoma  [cached]
Morris Brid,Cheema Rizwan
Indian Journal of Ophthalmology , 2006,
Abstract: We report an unusual case of angle closure glaucoma in a 78-year-old highly myopic female patient. The patient did not show any preoperative signs of subluxation of lens. However, the capsular bag was noted to be unstable during surgery. The patient was managed with phacoemulsification of lens using a novel method of iris hooks for stabilization of capsular bag during surgery.
Y-Shaped Intra-Scleral Fixated Lens versus Retro-Pupillary Iris Claw Lens in the Treatment of Aphakia  [PDF]
Ahmed Mohamed Morshed, Mahmoud Nasr Aldeeb, Adel Kamal Abdeen, Salah Mohamed Almosalamy
Open Journal of Ophthalmology (OJOph) , 2019, DOI: 10.4236/ojoph.2019.92012
Abstract: Background: Many reasons can lead to an aphakia without adequate capsular support for implantation of a posterior chamber intraocular lens (IOL), such as intraoperative unintentional rupture of posterior capsule during phacoemulsification, planned intracapsular cataract extraction, ocular trauma and lens dislocation due to congenital and acquired causes. Purpose: To compare Y-shaped intra-scleral fixation of a posterior chamber IOL with retro pupillary fixation of an iris-claw intraocular lens (IOL) for Aphakic eyes without sufficient capsular support as respects safety, visual recovery and complications of both methods. Patients and Methods: One hundred Aphakic eyes were arbitrarily distributed between two groups. Group A included 50 eyes treated with retropupillary fixation of iris claw lens and group B included 50 eyes treated with Y-shaped intra-scleral fixation technique. Preoperative, intraoperative and postoperative data were analysed including best corrected visual acuity (BCVA), intraocular pressure (IOP), surgical time, intraoperative problems, IOL malposition and postoperative complications. Following up on patients was carried out for at least six months. Results: The mean duration of surgery was 21 ± 5.3 min in group A and was 53.4 ± 6.9 min in group B (p-value < 0.001). After 6 months, the mean BCVA was 0.34 ± 0.15 in group A and was 0.31 ± 0.16 in group B (p > 0.05). IOL tilt was found in 0 (0%) eyes in group A and in 5 (10%) eyes in group B (p < 0.05). IOL decentration was observed in 1 (2%) eye in group A and 7 (14%) eyes in group B, with statistically significant difference (p value = 0.03). Cystoid macular edema was found in 2 (4%) eyes in group A and in 5 (10%) eyes in group B (p > 0.05). Conclusion: The results of our study indicated that both methods are satisfactory in correcting aphakia without sufficient capsular support as regards postoperative best corrected visual acuity (BCVA); however the surgical technique of retropupillary iris claw lens is easier, shorter, with low intra- and postoperative complications and safer than those used for intra-scleral fixation of IOL. But for eyes which lack both iris and capsular support, a scleral fixation of a posterior chamber IOL remains the only option.
Dhaliwal′s modified iris retractor  [cached]
Dhaliwal Ranjith
Indian Journal of Ophthalmology , 1990,
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
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
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