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Intraocular lens implantation has been developing over the past 15 years in Europe and is now becoming popular in the United States. Lens materials and designs as well as surgical techniques are still being evaluated. The overall results are excellent, with a small increase in complications being the price paid for a dramatic increase in visual rehabilitation.
40 cases of intraocular lens implants are reported. 33% had an optimal post-operative vision of greater than 1.0; 56% and larger than or equal to 0.9 and 84% 0.5 or better. After a postoperative follow-up of 1 month to 32 months, mean 15.1 months, the patients were all satisfied with the pseudophakic eye, and no endothelial corneal dystrophy, chronic uveitis or glaucoma was detected. Several minor post-operative complications were seen, most without consequence. One case had recurrent iridial haemorrhages.
Seven patients had bilateral intraocular lens implantation performed with a short interval between procedures, using intraocular lenses of unproven design or deficient quality control All seven patients suffered severe visual impairment, some to the level of legal blindness in both eyes. Lenses with unproven design characteristics should never be implanted in both eyes of a patients. The interval between the first and second procedure, even when using lenses of proven design and quality, should be long enough to insure the long-term successful outcome of the first procedure.
Cases of sterile hypopyon following intraocular lens implantation, accumulated over a 4 1/2-year period, were subjected to critical clinical review and analysis. In approximately two-thirds of the cases, the anterior chamber cleared within three to four weeks without significant sequelae. The remaining cases followed a chronic or recurrent course. Recurrent anterior segment reaction appears to be a definite indication for early implant removal. The final visual results in this group of cases were less than satisfactory, suggesting that the appearance of sterile hypopyon after implant surgery is an ominous clinical sign which may prelude secondary membrane formation, chronic cystoid maculopathy, or even phthisis. The etiology of sterile hypopyon remains vague.
Two cases with special indications for intraocular lens implants are presented. The first case was of a 60-year-old monocular patient with congenital absence of the external nose and multiple limb deformities. The second case was of a young Bedouin girl with bilateral developmental cataracts who had poor living conditions and social objections to wearing spectacles. Intraocular lenses restored good vision.
A restrospective analysis was conducted of 27 cases of penetrating keratoplasty associated with intraocular lens implantation. Although not statistically significant, the results indicated an 80% success rate when penetrating keratoplasty, cataract extraction and intraocular lens implantation were combined in a single operation. Secondary implantation of intraocular lenses in cases of previous keratoplasty were unsuccessful in all three cases.
Positive vitreous pressure during intraocular lens implantation is treated by early recognition and instillation of an air bubble to deepen the anterior chamber, and subsequently to prevent contact between the intraocular lens and the corneal endothelium. A technique is presented which has proven successful in 20 cases.
A retrospective study of the first 225 intraocular lens implants (IOL) performed by a single surgeon was conducted for this report. In complication rate and visual acuity assessed 4.5 months postoperatively, these patients (pseudophakes) compared very closely with 2 populations of aphakic patients who had had phacoemulsification surgery without lens implantation by the same surgeon. The majority of pseudophakes were left with moderate to low refractive errors. Patient satisfaction was found to be high. It appears that implantation of iris and capsular fixated intraocular lenses is a comparatively safe and in many cases advantageous procedure.
Higher degrees of astigmatism are found after intraocular lens implantation than after routine cataract surgery. The cause is optical and is associated with the effectivity of lenses. The same amount of corneal astigmatism requires, in the spectacle correction, a cylinder that is smaller than, equal to, or larger than the corneal astigmatism, depending on whether the spherical equivalent of the refraction is a plus, zero, or minus sphere.
Six patients had hypotony from inadvertent cyclodialysis after intraocular lens implantation. Factors that may have contributed to the formation or persistence of the cyclodialysis are scleral cataract incision, prolonged postoperative course of corticosteroid treatment, intraocular lens weight, iridectomy, and maneuvers related to insertion and fixation of the intraocular lens. Closure of these cyclodialysis clefts may be a lengthy process involving various treatment modalities. Fortunately, cyclodialysis with hypotony, although increased in incidence with intraocular lens surgery over routine extraction, occurs rarely.
In summary, corneal surgery with or without simultaneous cataract extraction and intraocular lens implantation, or in the presence of an intraocular lens, is justified in view of possible good, clear grafts (80% of our cases) and vision better than 20/50 (60% of our cases).
A controlled series of intraocular lens implantations on paired cat eyes was performed to determine if a polymacon sheet (Bausch & Lomb plano-T soft contact lens) could protect the corneal endothelium from damage caused by contact with a methyl methacrylate intraocular lens. A new surgical technique has been developed that reduces the endothelial cell loss from 51% (standard implantation technique) to 9% (new polymacon-shield technique).
A new micro blunt irrigating hook is introduced for utilization in intraocular lens implant surgery. It is simple, inexpensive, and requires no previous experience. It allows for adequate reposition of the superior loop of any type of lens along with the recovery of the proximal loop of a McCannel suture. Finally, it allows the most inexperienced operator to center a lens ideally in a totally deep chamber, avoiding the vicissitudes of either perforation of the posterior capsule, anterior hyloid, or damage to the delicate endothelium.
PURPOSE: To identify risk factors associated with the development of high myopia following congenital cataract surgery and to establish a robust predictive model. DESIGN: Retrospective clinical cohort study. SUBJECTS: This retrospective study included 106 pediatric patients who underwent congenital cataract surgery with primary IOL implantation (mean follow-up 8.19 years). The model was externally validated in an independent cohort of 72 patients with a mean follow-up of 7.83 years. METHODS: Preoperative and postoperative ocular biometric parameters were collected. Risk factors for postoperative high myopia were analyzed using Cox proportional hazards regression, which served as the basis for model construction. The predictive performance of the model was rigorously evaluated for discrimination and calibration. Discriminative ability was quantified using Harrell's C-index and the area under the receiver operating characteristic curve (AUC). Model calibration was assessed via calibration plots by comparing predicted probabilities with actual observed outcomes. Internal validation was performed using a bootstrapping method (500 iterations) to ensure model stability and adjust for potential overfitting. RESULTS: An initial postoperative refraction of <+0.75D, and a higher IOL Power to Axial length Ratio (IOL/AL ratio) were identified as significant risk factors for the development of postoperative high myopia. Shorter preoperative axial length was associated with a greater magnitude of postoperative myopic shift. The predictive model demonstrated robust performance, achieving a C-index of 0.711 (internal validation C-index: 0.713). The area under the receiver operating characteristic curve (AUC) values for predicting high myopia at 5 and 10 years were 0.858 and 0.745, respectively. Furthermore, calibration curves demonstrated excellent agreement between the predicted and observed outcomes throughout the follow-up period. In external validation, the model achieved a C-index of 0.825, 5-year AUC of 0.833, and 10-year AUC of 0.713. CONCLUSIONS: Our analysis established that initial postoperative refraction <+0.75D, and an elevated IOL/AL ratio are key determinants of high myopia risk following surgery. Shorter preoperative axial length was associated with a greater magnitude of postoperative myopic shift. This predictive framework provides clinicians with a practical tool to optimize preoperative IOL selection and identify high-risk infants who require vigilant myopia prevention and balanced amblyopia management.
Endophthalmitis developed in a 61-year-pld man after an intraocular lens implantation. A whitish opacity developed, visual acuity decreased to light perception, and we enucleated the eye. Paecilomyces lilacinus (Thom) Samson, a saphrophyte that has contaminated laboratory solutions, was cultured.
We analyzed pre- and postoperative corneal endothelial photographs of 33 intraocular lens patients and found an average endothelial cell density loss of 14%. Twenty-six cataract patients, similarly examined, showed a 13% mean endothelial cell loss. In 14 of the intraocular lens patients, a second postoperative evaluation of the central endothelium, at a later date, revealed a trend toward continuing cell loss. Our results indicate fewer endothelial cells were lost after intraocular lens implantation than has been previously reported. This may be accounted for by our considering only patients with normal corneas for lens implantation, and by our constant maintenance of the anterior chamber with an air bubble during lens implant surgery.
I compared an early series of 162 consecutive Copeland intraocular lens implants with a later series of 650 consecutive Binkhorst implants. Of the eyes with Copeland implants, 76.5% achieved 6/12 (20/40) or better visual acuity compared to 89.8% in the Binkhorst series. There was a striking difference in the incidence of clinically significant cystoid macular edema (less than 6/12 [20/40], visual acuity); 7.4% in the Copeland series and 1.4% in the Binkhorst series. I studied the Binkhorst series for visual acuity, causes of less than 6/12 (20/40) visual acuity, operative vitreous problems, additional surgery, secondary membranes, dislocations, and retinal detachment. A fluorescein angiographic study of 190 Binkhorst implants and 113 aphakic controls was done. There was a comparable incidence of cystoid macular edema in both groups at four, eight, and 16 to 24 months postoperatively. Extracapsular Binkhorst implants showed a lower incidence than intracapsular Binkhorst implants.
A microsurgical modification of Binkhorst's "open sky" technique of extracapsular cataract extraction was developed for intraocular lens implantation. Clear visualization of both anterior and posterior capsule is stressed and risky aspiration is minimized. Thirteen cases operated upon in the first year are described. Synechiae to the haptics occurred when mydriasis was not prompt. All but one obtained useful naked acuity. Binocularity depended chiefly upon the acuity of the opposite eye. Pre-calculation of lens power reduced the spread of postoperative refractive errors although deviation was greater than expected and myopia overaccentuated. High astigmatic errors occurred in three patients.