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intraocular lens selection in diabetic patients:How to increase the odds for success

World Journal of Diabetes 2024年第6期15卷 1199-1211页

作者： Arvind Kumar Morya Prateek Nishant Prasanna Venkatesh Ramesh Sony Sinha Aarti Heda Sarika Salodia Ripunjay Prasad Department of Ophthalmology All India Institute of Medical SciencesHyderabad 508126TelanganaIndia Department of Ophthalmology ESIC Medical CollegePatna 801113BiharIndia Department of Glaucoma and Research Mahathma Eye Hospital Private LimitedTrichy 620017Tamil NaduIndia Department of Ophthalmology-Vitreo-Retina Neuro-Ophthalmology and OculoplastyAll India Institute of Medical SciencesPatnaPatna 801507BiharIndia Department of Ophthalmology National Institute of OphthalmologyPune 411000MaharashtraIndia Department of Safety Global Medical SafetyLundbeckSingapore 307591Singapore Department of Ophthalmology RP Eye InstituteDelhi 110001India

The incidence of cataracts is significantly higher in diabetic individuals,particularly in younger age groups,with rates quadrupled in those under 65 and doubled in those over 65 compared to non-diabetics.Cataract surgery in diabetic patients poses many challenges:Poor epithelial healing,decreased corneal sensitivity,increased central corneal thickness,decreased endothelial cell count,variable topography,poor pupillary dilatation,anterior capsular phimosis,posterior capsular opacification(PCO),chances of progression of diabetic retinopathy(DR),zonular weakness,and vitreous prolapse and diabetic macular edema.Selection of an appropriate intraocular lens(IOL)is crucial for visual rehabilitation and monitoring DR.The choice of IOL in diabetic cataract patients is a challenging scenario.Square-edge IOLs are favored for their capacity to mitigate PCO,whereas hydrophilic counterparts may incur calcification in the setting of proliferative DR.The advisability of premium IOLs for achieving spectacle independence warrants judicious evaluation,particularly in the presence of advanced retinopathy.Optimal IOL placement within the capsular bag is advocated to minimize postoperative complications.Rigorous preoperative assessment and informed patient counseling regarding IOL options are indispensable for optimizing surgical outcomes.This review article covers various aspects regarding the choice of IOLs in different case scenarios and complications in the diabetic population.

关键词： Diabetics Cataract intraocular lens Diabetic retinopathy Diabetes mellitus

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Etiology, pathogenesis, and management of acute intraocular lens opacification: a systematic review

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International Journal of Ophthalmology(English edition) 2022年第7期15卷 1190-1197页

作者： Bita Momenaei Mohammad Reza Akbari Seyed Ali Tabatabaei Mohammad Soleimani Mahdi Soleymanzadeh Kaveh Fadakar Ahmed Alshaheeb Mahtab Malekpour Khazari Yasaman Vaseghi Kasra Cheraqpour Eye Research Center Farabi Eye HospitalTehran University of Medical SciencesTehran 33445432Iran School of Medicine Tehran University of Medical SciencesTehran ***Iran

Millions of cataract surgeries with intraocular lens(IOL) implantation are performed worldwide. Although cataract surgery brings many benefits to the patients, the risk of various complications is still a concern. One of the infrequent adverse events but potentially affecting on patients’ visual acuity and contrast sensitivity is losing the transparency of IOL. IOL opacification may lead to IOL removal or exchange, which is unpleasant to both the patient and the surgeon. Several reports of acute IOL clouding are available in the literature describing various etiologies of this phenomenon, however, the exact mechanism remained unclear in some cases. Herein, we aimed to review the causes and outcomes of intraoperative and early postoperative IOL opacification.

关键词： intraocular lens phacoemulsification acute discoloration acute opacification cataract

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Timely vitrectomy without intraocular lens removal for acute endophthalmitis after cataract surgery

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International Journal of Ophthalmology(English edition) 2022年第6期15卷 1011-1014页

作者： Hai-Xia Guo Ruo-Tian Xie Yun Wang Cai-Yun You Yuan-Yuan Liu Xiang-Da Meng Jin-Guo Yu Hua Yan Department of Ophthalmology Tianjin Medical University General HospitalTianjin 300052China Laboratory of Molecular Ophthalmology School of Basic Medical SciencesTianjin Medical UniversityTianjin 300070China Department of Ophthalmology the First People's Hospital of XiningXining 810099Qinghai ProvinceChina

AIM:To investigate the clinical features,causative organisms and effects of timely vitrectomy and silicone oil tamponade without intraocular lens(IOL)removal in the treatment of acute-onset endophthalmitis after cataract surgery(APCE).METHODS:We retrospectively analyzed the clinical features and microbiological factors in 10 eyes of 10 patients with APCE at Tianjin Medical University General Hospital from January 2010 to December 2018.Data on the clinical features,causative organisms,visual acuity,intraocular pressure(IOP)and complications were collected.The mean follow-up period was 25.5 mo.RESULTS:The mean age of the patients was 71.4 y.The mean time between cataract surgery and the onset of endophthalmitis was 2.0 d.Preoperative visual acuity ranged from no light perception to hand motion.After vitrectomy,the visual acuity increased in nine eyes(90%),and was unchanged in one eye(10%).A significant difference was observed between the mean preoperative(36.3±7.1 mm Hg)and postoperative IOP(14.9±4.3 mm Hg,P<0.05).Staphylococcus epidermidis was isolated in 5 eyes,S.aureus in 2 eyes,and Enterococcus in 1 eye.Postoperative complications mainly included fibrin exudates in the anterior chamber at the early stages in all eyes and temporary IOP elevation in one eye.No retinal detachment or ocular atrophy was observed during the follow-up period.CONCLUSION:Under systemic antibiotic treatment and timely diagnosis,vitrectomy and silicone oil tamponade without IOL removal is a safe and effective method for APCE.

关键词： vitrectomy silicone oil endophthalmitis cataract intraocular lens

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Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

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Advances in Ophthalmology Practice and Research 2023年第2期3卷 86-92页

作者： Maciej Gawecki Natalia Pradzynska Krzysztof Kicinski Agnieszka Ratajczak Izabella Karska-Basta Andrzej Grzybowski Department of Ophthalmology of Specialist Hospital in Chojnice LesnaChojnicePoland Dobry Wzrok Ophthalmological Clinic Zabi KrukGdanskPoland Department of Ophthalmology Faculty of MedicineClinic of Ophthalmology and Ocular OncologyJagiellonian University Medical CollegeSwietej AnnyKrakowPoland Department of Ophthalmology University of Warmia and MazuryOczapowskiegoOlsztynPoland Institute for Research in Ophthalmology Foundation for Ophthalmology DevelopmentMickiewiczaPoznanPoland

Background:Enhanced depth-of-focus intraocular lenses(EDOF IOL)have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses.The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision.Methods:The study included 15 patients(29 eyes as one was amblyopic)with bilateral implantation of LUXSMART EDOF IOL(Bausch&Lomb)with a targeted myopia(between-0.25 and-0.50D)in both eyes.Monocular corrected and uncorrected visual acuity for far,intermediate and near as well as refractive outcomes were evaluated at 1,3,6 and 12 months after the surgery.Additionally,binocular visual acuity,contrast sensitivity and defocus curve were measured at the final follow-up visit.At 12 months’visit patients completed a questionnaire evaluating patient satisfaction,spectacle independence and presence of dysphotopsias.Results:Binocular uncorrected visual acuities at 12 month’s visit were 0.13±0.16,0.06±0.08,0.07±0.09 and 0.15±0.09 logMAR for far distance,80 cm,66 cm and 40 cm respectively.Corrected binocular visual acuities at 12 months were 0.00±0.00,0.05±0.07,0.05±0.06,0.13±0.16 respectively for distance,80 cm,66 cm and 40 cm.Automated refraction spherical equivalent at 12 months’visit stood at-0.70±0.48D,which was 0.46D less than calculated biometric target,however spherical equivalent of subjective refraction at 12 months equaled–0.49±0.46D,which was closer to preoperative biometric target.Defocus curve had gentle shape without peaks typical for monofocal IOLs.Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78±0.16 logMAR without correction and 1.81±0.13 logMAR with correction.Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3%of patients.Burdensome dysphotopsias were not reported in any cas

关键词： Enhanced depth of focus intraocular lens Uncorrected visual acuity Cataract surgery

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Out-of-the-bag intraocular lens dislocation： outcomes of posterior chamber intraocular lens exchange, risk factors, and prevention

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Chinese Medical Journal 2010年第18期123卷 2562-2567页

作者： ZHENG Dan-ying CHEN Li-na SUN Yi SHAO Ying-feng LIANG Jing-li LIU Yi-zhi Cataract Division Department of Visual Electrophysiology Guangzhou Guangdong 510060 China Guangzhou Guangdong 510060 China Zhongshan Ophthalmic Center Affiliated to Sun Yat-sen University Guangzhou Guangdong 510060 China Department of Cataract Tianjin Medical University Eye Center Tianjin 300070 China

Background Dislocation of posterior chamber intraocular lens is one of the most common complications of intraocular lens implantation. lens exchange is an effective solution to this unsatisfactory status. This study was conducted to analyze the possible predisposing factors for out-of-the-bag posterior chamber intraocular lens dislocation and to study the outcomes of lens exchange surgery. Methods Thirty-six consecutive patients （36 eyes） with out-of-the-bag intraocular lens dislocation who underwent posterior chamber intraocular lens exchange in Zhongshan Ophthalmic Center of Sun Yat-sen University （Guangdong, China） from January 2003 to October 2009 were included. A 6-month follow-up was completed. The causes for out-of-the-bag intraocular lens dislocation and visual outcomes of posterior chamber intraocular lens exchange were analyzed. The out-of-the-bag intraocular lens dislocation was diagnosed on the basis of the findings from slit-lamp microscope and B-ultrasound. The dislocated intraocular lens was explanted. Reimplantation of a new posterior chamber intraocular lens was performed in each case using standardized surgical procedures. Results In this study, a total of thirty-six consecutive patients （36 eyes） with out-of-the-bag intraocular lens dislocation underwent posterior chamber intraocular lens exchange surgery. Causes for out-of-the-bag intraocular lens dislocation included posterior capsule rupture during the initial cataract extraction procedure （23 eyes, 63.8%）, trauma （5 eyes, 13.9%）, neodymium-doped yttrium aluminium garnet （Nd：YAG） laser-induced dislocation （2 eyes, 5.6%）, the status after vitrectomy （2 eyes, 5.6%） and unidentifiable etiology （4 eyes, 11.1%）. Symptoms of these patients mainly included decrease in visual acuity （17 cases, 47.2%）, blurred vision （16 cases, 44.4%）, glare （1 case, 2.8%）, diplopia （1 case, 2.8%）, and halo （1 case, 2.8%）. intraocular lens dislocation into the posterior vitreous cavity （29 eyes, 80.5%）, anterior chamber （1 eye, 2.8%） and anterior vitreous cavity （6 e

关键词： intraocular lens dislocation exchange

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Biosafety of a 3D-printed intraocular lens made of a poly (acrylamide-co-sodium acrylate) hydrogel in vitro and in vivo

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International Journal of Ophthalmology(English edition) 2020年第10期13卷 1521-1530页

作者： Jia-Wen Li Yi-Jian Li Xi-Su Hu Yu Gong Ben-Bin Xu Hai-Wei Xu Zheng-Qin Yin Southwest Hospital/Southwest Eye Hospital Third Military Medical University(Army Medical University)Chongqing 400038China Key Lab of Visual Damage and Regeneration&Restoration of Chongqing Chongqing 400038China Smart Materials and Surfaces Lab Faculty of Engineering and EnvironmentNorthumbria UniversityNewcastle upon Tyne NE18STUK

AIM:To assess the biosafety of a poly(acrylamide-cosodium acrylate)hydrogel(PAH)as a 3D-printed intraocular lens(IOL)material.METHODS:The biosafety of PAH was first evaluated in vitro using human lens epithelial cells(LECs)and the ARPE19 cell line,and a cell counting kit-8(CCK-8)assay was performed to investigate alterations in cell proliferation.A thin film of PAH and a conventional IOL were intraocularly implanted into the eyes of New Zealand white rabbits respectively,and a sham surgery served as control group.The anterior segment photographs,intraocular pressure(IOP),blood parameters and electroretinograms(ERG)were recorded.Inflammatory cytokines in the aqueous humor,such as TNFαand IL-8,were examined by ELISA.Cell apoptosis of the retina was investigated by TUNEL assay,and macro PAHge activation was detected by immunostaining.RESULTS:PAH did not slow cell proliferation when cocultured with human LECs or ARPE19 cells.The implantation of a thin film of a 3 D-printed IOL composed of PAH did not affect the IOP,blood parameters,ERG or optical structure in any of the three experimental groups(n=3 for each).Both TNFαand IL-8 in the aqueous humor of PAH group were transiently elevated 1 wk post-operation and recovered to normal levels at 1 and 3 mo post-operation.Iba1+macroPAHges in the anterior chamber angle in PAH group were increased markedly compared to those of the control group;however,there was no significant difference compared to those in the IOL group.CONCLUSION:PAH is a safe material for 3D printing of personal IOLs that hold great potential for future clinical applications.

关键词： cataract biosafety lens epithelial cells ARPE19 cells intraocular lens 3D printing poly hydrogel rabbit

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High order aberration and straylight evaluation after cataract surgery with implantation of an aspheric,aberration correcting monofocal intraocular lens

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International Journal of Ophthalmology(English edition) 2015年第4期8卷 736-741页

作者： Florian T A Kretz Tamer Tandogan Ramin Khoramnia Gerd U Auffarth International Vision Correction Research Centre & David J Apple International Laboratory for Ocular Pathology of the Department of Ophthalmology University Hospital Heidelberg International Vision Correction Research Network (***) Augenklinik Ahaus-Raesfeld-Rheine Gerl Group

·AIM: To evaluate the quality of vision in respect to high order aberrations and straylight perception after implantation of an aspheric, aberration correcting,monofocal intraocular lens(IOL).·METHODS: Twenty-one patients(34 eyes) aged 50 to83 y underwent cataract surgery with implantation of an aspheric, aberration correcting IOL(Tecnis ZCB00,Abbott Medical Optics). Three months after surgery they were examined for uncorrected(UDVA) and corrected distance visual acuity(CDVA), contrast sensitivity(CS)under photopic and mesopic conditions with and without glare source, ocular high order aberrations(HOA, Zywave II) and retinal straylight(C-Quant).· RESULTS: Postoperatively, patients achieved a postoperative CDVA of 0.0 log MAR or better in 97.1% of eyes. Mean values of high order abberations were +0.02±0.27(primary coma components) and-0.04 ±0.16(spherical aberration term). Straylight values of the C-Quant were 1.35±0.44 log which is within normal range of age matched phakic patients. The CS measurements under mesopic and photopic conditions in combination with and without glare did not show any statistical significance in the patient group observed(P ≥0.28).· CONCLUSION: The implantation of an aspherical aberration correcting monofocal IOL after cataractsurgery resulted in very low residual higher order aberration(HOA) and normal straylight.

关键词： cataract aberrations intraocular lens

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Posterior chamber phakic intraocular lens implantation for high myopia

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Chinese Medical Journal 2003年第10期116卷 1523-1526页

作者：沈晔杜持新顾扬顺王竞 Department of Ophthalmology the First Affiliated HospitalCollege of Medicine Zhejiang University

Objective To evaluate the efficacy,safety and stability of posterior chamber phakic intraocular lens (PIOLs) implantation for the correction of high myopia.Methods Thirty-nine eyes of twenty patients with high myopia (between-11.75 and-25.75 diopters) had a posterior chamber PIOL (Staar ICL) implanted. During 6-48 months’ follow-up,visual acuity,refraction,intraocular pressure (IOP),corneal reaction and space between crystal lens and intraocular lens (IOLs) were tested.Results Successful implantation was achieved in all patients. Visual acuity without correction greater than 0.5 was found in 34 eyes at 1 day and 3 months postoperatively. Thirty-five eyes maintained a low negative power of refraction (-1.42±1.32 doipters),which did not prevent the patients from most of their daily activities. During 3-48 months’ follow-up,refraction was stable and no cornea edema and glaucoma was found. Two eyes of one patient had corticosteroid glaucoma and another eye showed cataractogenesis under anterior capsular membrane.Conclusion Posterior chamber PIOL implantation is predictable,safe,and effective in the correction of high myopia,and its indications should be carefully selected.

关键词： myopia intraocular lens implantation

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Clinical evaluation of two multifocal intraocular lens implantation patterns

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International Journal of Ophthalmology(English edition) 2012年第1期5卷 76-83页

作者： Hao-Tian Lin Wei-Rong Chen Zhao-Feng Ding Wan Chen and Chang-Rui Wu State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat-sen University Guangzhou 510060 Guangdong Province China

AIM: To evaluate the visual outcomes and patient satisfaction of two multifocal intraocular lens implantation patterns, with the decision between the two patterns being guided by the patients' choice of visual zones that best suited their lifestyle, or lifestyle zones. METHODS: This is a prospective non-randomized comparative study. The lifestyle zones. of 32 consecutive age-related cataract patients (64 eyes) were investigated individually to guide the surgical decision between two multifocal intraocular lens implantation patterns. The first group (MIX) received a combined implantation of a ReZoom NXG1 lens in the dominant eye and a Tecnis ZM900 lens in the other eye. The second group (MATCH) received bilateral ReZoom NXG1 lenses. One year postoperatively, the patients were assessed for binocular uncorrected visual acuity, reading visual acuity, reading speed and depth of focus under different luminance and were surveyed for visual disturbances, satisfaction and complete spectacle independence. ' RESULTS: According to the determination of lifestyle zones, 18 and 14 patients were included in the MIX and MATCH groups, respectively. One year postoperatively, each of the patients exhibited positive visual outcomes and lifestyle satisfaction, although there were still some differences between the two groups. Generally, patients in the MATCH group had better distance visual acuity than those in the MIX group. In contrast, patients in the MD( group had better near visual acuity, better reading acuity and better reading speed than those in the MATCH group. Between the two groups, there was no clear difference in intermediate visual acuity, and the depths of focus between the two groups were approximately equal. The results of the mean NEI-RQL-42 questionnaire score, overall satisfaction, and complete spectacle independence did not differ between the two groups. CONCLUSION: Different multifocal intraocular lenses implantation patterns can have differing advantages and disadvantages; however, the best results with respect

关键词： intraocular lens visual outcomes patient satisfaction

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Refractive accuracy after intraocular lens implantation in pediatric cataract

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International Journal of Ophthalmology(English edition) 2012年第4期5卷 473-477页

作者： Tan Long, Li-Xin Xie Department of Ophthalmology People's Hospital of Wuhan University Wuhan 430060 Hubei Province China Shandong Eye Institute Qingdao 266071 Shandong Province China

AIM: To analyze the factors that influence the prediction error (PE). after intraocular lens (IOL) implantation in pediatric cataract. METHODS: The medical records of cataract patients of no more than 14 years old who had primary IOL implantation were reviewed from 2006 to 2010. The PE, absolute value of PE (APE), and predictability between in different axial length, mean corneal curvature, corneal astigmatism, and age at the surgery were analyzed. RESULTS: Seventy-five children (119 eyes) were included, with a mean age of (5.09 +/- 2.54) years. At the follow-up of (1.19 +/- 0.69) months, the mean postoperative PE was (-0.22 +/- 1.12) D, and APE was (0.87 +/- 0.73)D. The PE in eyes with an axial length > 20mm but <= 22mm were significantly under-corrected than that in eyes with longer axis, and the APE in eyes with an axial length <= 20mm was more obvious compared with the others. The correlations between PE and axial length, as well as corneal astigmatism, and between APE and axial length were significant. The predictability was significantly poorer in the eyes with an axial length <= 20mm than the others. CONCLUSION: The axial length is closely related with the PE after IOL implantation in pediatric cataract patients, especially when it is <= 20mm, PE is more significant. The formula that is more suitable to very short axial length should be explored.

关键词： cataract children refraction intraocular lens

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