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      Secondary in-the-Bag Implantation of Intraocular Lenses in Aphakic Eyes after Vitreoretinal Surgeries

      research-article
      ,
      Ophthalmologica
      S. Karger AG
      Aphakia, Intraocular lens, Phacoemulsification, Retinal detachment, Scleral buckling, Vitrectomy

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          Abstract

          Background/Aims: To report the accuracy of intraocular lens (IOL) power calculations and refractive outcomes in aphakic eyes after secondary in-the-bag IOL implantation. Method: We retrospectively reviewed a consecutive case series of secondary in-the-bag IOL implantations in aphakic patients with intact capsular bag without severe capsular fibrosis between October 2006 and October 2010. Single-piece foldable lenses were secondarily implanted in 21 eyes of 20 patients. Postoperative best-corrected visual acuity (BCVA) and refraction were measured approximately 1 month after surgery. The accuracy of IOL power prediction was evaluated using the mean error (ME) and mean absolute error (MAE). Results: Successful in-the-bag IOL implantation without capsular tear or defect was achieved in all eyes. The mean interval between phacoemulsification and IOL implantation was 5.4 months (range, 1.5–19 months). The ME was +0.06 dpt and the MAE was +0.24 dpt. The BCVA significantly improved from 0.66 logMAR at the pre-IOL implantation examination to 0.38 logMAR at the postoperative examination (p < 0.0001). Conclusions: The postoperative refractive results are comparable with those of routine cataract surgery. Among the selected aphakic patients who underwent simultaneous phacoemulsification and vitreoretinal surgery, successful in-the-bag IOL implantation and satisfactory refraction were achieved after secondary IOL implantation.

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          Most cited references11

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          Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology.

          To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. Retrospective, consecutive, interventional case series. Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between March 1995 and May 2000 were reviewed. In all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89 years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. In 105 patients vision improved, in 7 there was no change, and in 10 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL. Combined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems. Copyright 2003 by Elsevier Science Inc.
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            Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases.

            To describe the results of combined phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL), and pars plana vitrectomy for patients with retinal disorders resulting from diabetic retinopathy. Retrospective, consecutive, noncomparative, interventional case series. Two hundred twenty-three patients with vitreoretinal disorders secondary to diabetic retinopathy. A case series of 223 consecutive patients with retinal disorders resulting from diabetic retinopathy who underwent combined phacoemulsification, insertion of PCIOL, and pars plana vitrectomy. Vision, number of secondary procedures, and complications. Two hundred twenty-three patients (153 with vitreous hemorrhage, 58 with traction retinal detachment, and 12 with macular traction) underwent combined surgery. The average increase in vision was 4.3 Snellen lines. The average follow-up was 10 months. Retinal detachment occurred in 5% of patients who underwent surgery. Diabetic macular edema was found in 12% after combined surgery. Cystoid macular edema was found in 3%. Vitreous hemorrhage requiring another procedure occurred in 11%. Twenty-two patients (10%) required a repeat vitrectomy (12 for vitreous hemorrhage and 10 for retinal detachment). Combined phacoemulsification, insertion of PCIOL, posterior capsulectomy, and pars plana vitrectomy can be used to treat patients with complications resulting from proliferative diabetic retinopathy. Combined surgery may prevent a second operation for postvitrectomy cataract, allowing earlier visual rehabilitation.
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              • Article: not found

              IOLMaster biometry: refractive results of 100 consecutive cases.

              To study the refractive outcome of cataract surgery employing IOLMaster biometry data and to compare it with that of applanation ultrasonography in a prospective study of 100 eyes that underwent phacoemulsification with intraocular lens implantation. The Holladay formula using IOLMaster data was employed for the prediction of implanted intraocular lenses (IOLs). One month after cataract surgery the refractive outcome was determined. Preoperative applanation ultrasonography data were used retrospectively to calculate the IOL prediction error. The two different biometry methods are compared. 100 patients, 75.42 (SD 7.58) years of age, underwent phacoemulsification with IOL implantation. The optical axial length obtained by the IOLMaster was significantly longer (p<0.001, Student's t test) than the axial length by applanation ultrasound, 23.36 (SD 0.85) mm v 22.89 (0.83) mm. The mean postoperative spherical equivalent was 0.00 (0.40) D and the mean prediction error -0.15 (0.38) D. The mean absolute prediction error was 0.29 (0.27) D. 96% of the eyes were within 1 D from the intended refraction and 93% achieved unaided visual acuity of 6/9 or better. The Holladay formula performed better than the SRK/T, SRK II, and Hoffer Q formulas. Applanation ultrasonography after optimisation of the surgeon factor yielded a greater absolute prediction error than the optimised IOLMaster biometry, 0.41 (0.38) D v 0.25 (0.27) D, with 93% of the eyes within 1 D from the predicted refraction. IOLMaster optical biometry improves the refractive results of selected cataract surgery patients and is more accurate than applanation ultrasound biometry.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2012
                January 2012
                22 November 2011
                : 227
                : 2
                : 80-84
                Affiliations
                Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
                Author notes
                *Dr. Yung-Jen Chen, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Niao Sung District, Kaohsiung City 833, Taiwan (ROC), Tel. +886 7 731 7123, ext. 2801, E-Mail f75622@adm.cgmh.org.tw
                Article
                333823 Ophthalmologica 2012;227:80–84
                10.1159/000333823
                22116033
                881bb854-8b62-4243-9ffa-1971aecc6eff
                © 2011 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 15 April 2011
                : 19 September 2011
                Page count
                Tables: 2, Pages: 5
                Categories
                EURETINA – Original Paper

                Vision sciences,Ophthalmology & Optometry,Pathology
                Aphakia,Intraocular lens,Vitrectomy,Phacoemulsification,Retinal detachment,Scleral buckling

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