Pub Date : 2023-08-29DOI: 10.1097/j.jcro.0000000000000102
Nour Bundogji, Achilleas Filios, V. Hawn, S. Crafoord, L. Werner
Introduction: A case of a calcified Carlevale intraocular lens (IOL), which was explanted or exchanged and underwent laboratory analyses, is reported. Patient and Clinical Findings: A 74-year-old pseudophakic man with a history of type 2 diabetes presented with progressive vision changes 2 years after undergoing vitrectomy and implantation of a Carlevale IOL in the right eye due to previous subluxation of a 3-piece lens. Slitlamp examination was significant for mild band keratopathy and a diffusely opacified Carlevale IOL. Diagnosis, Intervention, and Outcomes: The opacified IOL was explanted and exchanged for an Artisan IOL, with posterior enclavation. Grossly, the explanted IOL exhibited extensive and diffuse deposits/crusts throughout its surface, causing opacification. Scanning electron microscopy coupled with surface analysis confirmed that the deposits/crusts were composed of calcium/phosphate. Conclusions: To the authors' knowledge, this is the first reported case of an opacified Carlevale IOL that underwent laboratory analysis confirming calcification. Alteration in calcium homeostasis that may accompany the diabetic state may represent a contributing factor to the band keratopathy and IOL calcification in this case.
{"title":"Calcification of an intraocular lens designed for sutureless scleral fixation in a patient with band keratopathy","authors":"Nour Bundogji, Achilleas Filios, V. Hawn, S. Crafoord, L. Werner","doi":"10.1097/j.jcro.0000000000000102","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000102","url":null,"abstract":"Introduction: A case of a calcified Carlevale intraocular lens (IOL), which was explanted or exchanged and underwent laboratory analyses, is reported. Patient and Clinical Findings: A 74-year-old pseudophakic man with a history of type 2 diabetes presented with progressive vision changes 2 years after undergoing vitrectomy and implantation of a Carlevale IOL in the right eye due to previous subluxation of a 3-piece lens. Slitlamp examination was significant for mild band keratopathy and a diffusely opacified Carlevale IOL. Diagnosis, Intervention, and Outcomes: The opacified IOL was explanted and exchanged for an Artisan IOL, with posterior enclavation. Grossly, the explanted IOL exhibited extensive and diffuse deposits/crusts throughout its surface, causing opacification. Scanning electron microscopy coupled with surface analysis confirmed that the deposits/crusts were composed of calcium/phosphate. Conclusions: To the authors' knowledge, this is the first reported case of an opacified Carlevale IOL that underwent laboratory analysis confirming calcification. Alteration in calcium homeostasis that may accompany the diabetic state may represent a contributing factor to the band keratopathy and IOL calcification in this case.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00102"},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43496775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-18DOI: 10.1097/j.jcro.0000000000000101
Brandon L. Vander Zee, Tanner J. Ferguson, John P Berdahl, Brent A. Kramer
Introduction: The small-aperture intraocular lens (IOL) is a recently introduced IOL that can provide favorable central visual acuity in patients with irregular corneas. This case describes a patient with multiple prior penetrating keratoplasties secondary to ocular trauma that achieved a favorable outcome with the aforementioned IOL. Patient and Clinical Findings: A 66-year-old man presented with a penetrating corneal injury that was successfully repaired but was eventually complicated by fungal keratitis requiring a therapeutic penetrating keratoplasty (PKP). The patient had a prolonged postoperative course complicated by multiple graft failures and finally stabilized after a third PKP. Through the protracted course, the patient developed a brunescent cataract, and the multiple PKPs resulted in significant irregular astigmatism. Diagnosis, Intervention, and Outcomes: The patient underwent cataract surgery in the affected eye with implantation of a small-aperture IOL 18 months after his initial injury. The patient's uncorrected distance visual acuity was 20/20 at six months post-operatively and he reported excellent quality of vision. Conclusions: This case represents the first use of the small-aperture IOL in a patient with prior PKP since its U.S. Food and Drug Administration approval. The small-aperture IOL can overcome high levels of corneal irregularities and provide favorable visual acuity in complex eyes.
{"title":"Small-aperture intraocular lens implantation after multiple penetrating keratoplasties secondary to penetrating ocular trauma","authors":"Brandon L. Vander Zee, Tanner J. Ferguson, John P Berdahl, Brent A. Kramer","doi":"10.1097/j.jcro.0000000000000101","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000101","url":null,"abstract":"Introduction: The small-aperture intraocular lens (IOL) is a recently introduced IOL that can provide favorable central visual acuity in patients with irregular corneas. This case describes a patient with multiple prior penetrating keratoplasties secondary to ocular trauma that achieved a favorable outcome with the aforementioned IOL. Patient and Clinical Findings: A 66-year-old man presented with a penetrating corneal injury that was successfully repaired but was eventually complicated by fungal keratitis requiring a therapeutic penetrating keratoplasty (PKP). The patient had a prolonged postoperative course complicated by multiple graft failures and finally stabilized after a third PKP. Through the protracted course, the patient developed a brunescent cataract, and the multiple PKPs resulted in significant irregular astigmatism. Diagnosis, Intervention, and Outcomes: The patient underwent cataract surgery in the affected eye with implantation of a small-aperture IOL 18 months after his initial injury. The patient's uncorrected distance visual acuity was 20/20 at six months post-operatively and he reported excellent quality of vision. Conclusions: This case represents the first use of the small-aperture IOL in a patient with prior PKP since its U.S. Food and Drug Administration approval. The small-aperture IOL can overcome high levels of corneal irregularities and provide favorable visual acuity in complex eyes.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00101"},"PeriodicalIF":0.0,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42195268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-18DOI: 10.1097/j.jcro.0000000000000103
Ameeta Kumar, Diana-Maria Toia, Sharmina Khan
Introduction: Intraoperative instrument fractures pose a serious risk during cataract surgery through the retention of metallic foreign bodies and subsequent injury to intraocular structures. Patient and Clinical Findings: An 83-year-old woman underwent phacoemulsification and insertion of an intraocular lens, during which an intraoperative phacoemulsification tip fracture was encountered during quadrant removal. Diagnosis, Intervention, and Outcome: A thorough examination of the operative field revealed the broken tip fragment in the drape bag, with no intraocular fragments. The surgery was completed with a replacement phacoemulsification probe without issues, and the patient made an uneventful recovery. Conclusions: Early diagnosis and management after instrument breakage are necessary to prevent the retention of metallic foreign bodies.
{"title":"Intraoperative phacoemulsification tip fracture","authors":"Ameeta Kumar, Diana-Maria Toia, Sharmina Khan","doi":"10.1097/j.jcro.0000000000000103","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000103","url":null,"abstract":"Introduction: Intraoperative instrument fractures pose a serious risk during cataract surgery through the retention of metallic foreign bodies and subsequent injury to intraocular structures. Patient and Clinical Findings: An 83-year-old woman underwent phacoemulsification and insertion of an intraocular lens, during which an intraoperative phacoemulsification tip fracture was encountered during quadrant removal. Diagnosis, Intervention, and Outcome: A thorough examination of the operative field revealed the broken tip fragment in the drape bag, with no intraocular fragments. The surgery was completed with a replacement phacoemulsification probe without issues, and the patient made an uneventful recovery. Conclusions: Early diagnosis and management after instrument breakage are necessary to prevent the retention of metallic foreign bodies.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00103"},"PeriodicalIF":0.0,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47717438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-26DOI: 10.1097/j.jcro.0000000000000099
Evan Frigoletto, Annahita Amireskandari, T. Mauger
Introduction: To report a case of visually significant band keratopathy associated with ocular inflammation in the setting of epithelial ingrowth, both of which resolved after repeated antimetabolite treatments. Patient and Clinical Findings: A 74-year-old woman with a history of uveitis–glaucoma–hyphema syndrome after complicated cataract surgery presented with epithelial ingrowth in the right eye and diffuse central band keratopathy after posterior chamber intraocular lens (IOL) removal and pars plana vitrectomy and anterior chamber IOL placement. Diagnosis, Intervention, and Outcomes: After multiple intraocular injections of antimetabolites, the epithelial ingrowth and visually significant band keratopathy resolved. Conclusions: Treating the underlying source of inflammation, such as epithelial ingrowth with antimetabolites, was associated with clearance of the band keratopathy without further intervention.
{"title":"Transient band keratopathy associated with epithelial ingrowth treated with antimetabolites","authors":"Evan Frigoletto, Annahita Amireskandari, T. Mauger","doi":"10.1097/j.jcro.0000000000000099","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000099","url":null,"abstract":"Introduction: To report a case of visually significant band keratopathy associated with ocular inflammation in the setting of epithelial ingrowth, both of which resolved after repeated antimetabolite treatments. Patient and Clinical Findings: A 74-year-old woman with a history of uveitis–glaucoma–hyphema syndrome after complicated cataract surgery presented with epithelial ingrowth in the right eye and diffuse central band keratopathy after posterior chamber intraocular lens (IOL) removal and pars plana vitrectomy and anterior chamber IOL placement. Diagnosis, Intervention, and Outcomes: After multiple intraocular injections of antimetabolites, the epithelial ingrowth and visually significant band keratopathy resolved. Conclusions: Treating the underlying source of inflammation, such as epithelial ingrowth with antimetabolites, was associated with clearance of the band keratopathy without further intervention.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00099"},"PeriodicalIF":0.0,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42319701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-21DOI: 10.1097/j.jcro.0000000000000100
V. Hawn, Nour Bundogji, Ruth Sahler, M. Mifflin, B. Monson, N. Mamalis, L. Werner
Introduction: A case in which a light-adjustable lens (LAL) underwent explantation and extensive laboratory analyses is reported. Patient and Clinical Findings: A 61-year-old man underwent uneventful cataract surgery with in-the-bag implantation of a first-generation LAL in the right eye. Examination on the second postoperative day revealed limbus-to-limbus corneal edema, moderate anterior chamber cells, and a mid-dilated, minimally responsive pupil, suggesting toxic anterior segment syndrome (TASS). Diagnosis, Intervention, and Outcomes: Endothelial keratoplasty was performed 2 months after LAL implantation. The patient reported noncompliance with required UV-protective eyewear, and an attempted light adjustment confirmed macromer reserve depletion, likely secondary to ambient UV contamination. Gross and microscopic examinations of the explanted LAL showed a decentered round elevation on the optic. The light transmittance (%T) curve was normal, with 95.9%T on average in the visible spectrum. Optical coherence tomography revealed irregular curvatures of the anterior and posterior optic surfaces. Wavefront analysis displayed aberrations and large power variations, which corresponded to decreased focus and contrast through the optic. Conclusions: To the authors' knowledge, this is the first reported case of LAL implantation complicated by TASS, leading to a prolonged clinical course and nonadherence to proprietary UV-protective spectacles. Extensive laboratory analyses of the explanted LAL demonstrated findings that can be expected with uncontrolled polymerization of the LAL.
{"title":"Explantation of a light-adjustable intraocular lens: case report with laboratorial analyses","authors":"V. Hawn, Nour Bundogji, Ruth Sahler, M. Mifflin, B. Monson, N. Mamalis, L. Werner","doi":"10.1097/j.jcro.0000000000000100","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000100","url":null,"abstract":"Introduction: A case in which a light-adjustable lens (LAL) underwent explantation and extensive laboratory analyses is reported. Patient and Clinical Findings: A 61-year-old man underwent uneventful cataract surgery with in-the-bag implantation of a first-generation LAL in the right eye. Examination on the second postoperative day revealed limbus-to-limbus corneal edema, moderate anterior chamber cells, and a mid-dilated, minimally responsive pupil, suggesting toxic anterior segment syndrome (TASS). Diagnosis, Intervention, and Outcomes: Endothelial keratoplasty was performed 2 months after LAL implantation. The patient reported noncompliance with required UV-protective eyewear, and an attempted light adjustment confirmed macromer reserve depletion, likely secondary to ambient UV contamination. Gross and microscopic examinations of the explanted LAL showed a decentered round elevation on the optic. The light transmittance (%T) curve was normal, with 95.9%T on average in the visible spectrum. Optical coherence tomography revealed irregular curvatures of the anterior and posterior optic surfaces. Wavefront analysis displayed aberrations and large power variations, which corresponded to decreased focus and contrast through the optic. Conclusions: To the authors' knowledge, this is the first reported case of LAL implantation complicated by TASS, leading to a prolonged clinical course and nonadherence to proprietary UV-protective spectacles. Extensive laboratory analyses of the explanted LAL demonstrated findings that can be expected with uncontrolled polymerization of the LAL.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00100"},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43286003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1097/j.jcro.0000000000000098
Harshul Tak
The author describes a novel technique of using autologous blood as a sealant to seal clear corneal phacoemulsification incisions, which leak even after stromal hydration at the end of phacoemulsification surgery. Using a 26-gauge, half-inch straight needle, mounted on an empty 2-mL syringe, limbal blood vessels near the leaking incisions are nicked so that mild blood oozes out. Once some blood is collected, this blood is spread over the incision by the property of surface tension using the 26-gauge needle tip and kept there for 20 to 40 seconds. By capillary action, it also seals the microleaks in the incision tunnel and forms a clot at the incision entry.
{"title":"Sealing of clear corneal incisions with autologous blood","authors":"Harshul Tak","doi":"10.1097/j.jcro.0000000000000098","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000098","url":null,"abstract":"The author describes a novel technique of using autologous blood as a sealant to seal clear corneal phacoemulsification incisions, which leak even after stromal hydration at the end of phacoemulsification surgery. Using a 26-gauge, half-inch straight needle, mounted on an empty 2-mL syringe, limbal blood vessels near the leaking incisions are nicked so that mild blood oozes out. Once some blood is collected, this blood is spread over the incision by the property of surface tension using the 26-gauge needle tip and kept there for 20 to 40 seconds. By capillary action, it also seals the microleaks in the incision tunnel and forms a clot at the incision entry.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00098"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43981611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-23DOI: 10.1097/j.jcro.0000000000000096
Sanjay Chaudhary, Hema Mehra, Shanu Kumar Mittal, A. Pandey
Introduction: With ever-increasing cases of myopia worldwide, there has been a quantum jump in the number of refractive procedures. 3 cases who had an uncomplicated implantable collamer lens (ICL) surgery in both eyes, but had a new complication, are presented here. This is not yet described in the literature to the authors' knowledge. Patient and Clinical Findings: 2 weeks after uneventful bilateral ICL surgery, the patients presented with slight blurring of vision in 1 eye only. On examination, there was excessive pigment dispersion in the anterior chamber both in front of and behind the ICL. They also had raised intraocular pressure (IOP) a few days later, possibly due to blockage of the trabecular meshwork by iris pigments. Diagnosis, Intervention, and Outcomes: All the patients were managed conservatively on anti-inflammatory and IOP-lowering eyedrops. The dispersed pigments decreased with normalization of IOP after 2 to 4 weeks of conservative management with no blurring of vision. However, the pupil remained slightly dilated and irregular in all these cases. Conclusions: The excessive pigment dispersion seen after ICL surgery is not commonly encountered after ICL surgery and can be managed conservatively.
{"title":"Early pigment dispersion and raised intraocular pressure after uneventful central-hole implantable collamer lens surgery","authors":"Sanjay Chaudhary, Hema Mehra, Shanu Kumar Mittal, A. Pandey","doi":"10.1097/j.jcro.0000000000000096","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000096","url":null,"abstract":"Introduction: With ever-increasing cases of myopia worldwide, there has been a quantum jump in the number of refractive procedures. 3 cases who had an uncomplicated implantable collamer lens (ICL) surgery in both eyes, but had a new complication, are presented here. This is not yet described in the literature to the authors' knowledge. Patient and Clinical Findings: 2 weeks after uneventful bilateral ICL surgery, the patients presented with slight blurring of vision in 1 eye only. On examination, there was excessive pigment dispersion in the anterior chamber both in front of and behind the ICL. They also had raised intraocular pressure (IOP) a few days later, possibly due to blockage of the trabecular meshwork by iris pigments. Diagnosis, Intervention, and Outcomes: All the patients were managed conservatively on anti-inflammatory and IOP-lowering eyedrops. The dispersed pigments decreased with normalization of IOP after 2 to 4 weeks of conservative management with no blurring of vision. However, the pupil remained slightly dilated and irregular in all these cases. Conclusions: The excessive pigment dispersion seen after ICL surgery is not commonly encountered after ICL surgery and can be managed conservatively.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00096 - 4"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45489384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-20DOI: 10.1097/j.jcro.0000000000000097
Cooper D. Rodgers, Ankit Shah, C. R. Blake
Introduction: To the authors' knowledge, this is the first reported case of netarsudil-associated reticular corneal edema noted shortly after phacoemulsification with intraocular lens (IOL) implantation. Patient and Clinical Findings: A 68-year-old woman with a history of chronic angle-closure glaucoma with a long-term history of tolerance to netarsudil presented with “honeycomb” epitheliopathy shortly after phacoemulsification with IOL implantation. Diagnosis, Intervention, and Outcomes: Netarsudil was discontinued, and the patient's reticular corneal edema resolved shortly thereafter. Conclusions: Reticular corneal epitheliopathy can be seen in patients being treated with netarsudil after phacoemulsification with IOL implantation. Fortunately, this condition resolves shortly after the drug is discontinued.
{"title":"Netarsudil-associated reticular epithelial corneal edema after phacoemulsification","authors":"Cooper D. Rodgers, Ankit Shah, C. R. Blake","doi":"10.1097/j.jcro.0000000000000097","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000097","url":null,"abstract":"Introduction: To the authors' knowledge, this is the first reported case of netarsudil-associated reticular corneal edema noted shortly after phacoemulsification with intraocular lens (IOL) implantation. Patient and Clinical Findings: A 68-year-old woman with a history of chronic angle-closure glaucoma with a long-term history of tolerance to netarsudil presented with “honeycomb” epitheliopathy shortly after phacoemulsification with IOL implantation. Diagnosis, Intervention, and Outcomes: Netarsudil was discontinued, and the patient's reticular corneal edema resolved shortly thereafter. Conclusions: Reticular corneal epitheliopathy can be seen in patients being treated with netarsudil after phacoemulsification with IOL implantation. Fortunately, this condition resolves shortly after the drug is discontinued.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00097"},"PeriodicalIF":0.0,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44456539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.1097/j.jcro.0000000000000093
Andrew C. Thomson, Kathryn E McAnnis, B. Ambati
Introduction: High myopic astigmatism often presents a challenge for cataract surgeons. Procedures such as limbal relaxation incisions may also be impossible in the setting of an extensive refractive surgical history. Patient and Clinical Findings: A 61-year-old woman for cataract surgery with a history of automated lamellar keratoplasty, 4-incision radial keratotomy, and arcuate incisions in the left eye. Astigmatism was 8.00 diopters (D) by manifest refraction, and on optical biometry, corneal topography, and auto keratometry, astigmatism was 9.01 D, 7.52 D, and 8.25 D, respectively. Diagnosis, Intervention, and Outcomes: A primary in-the-bag toric intraocular lens (IOL) and piggyback toric IOL with reverse optic capture were used. A surgically induced astigmatism of 6.59 D, magnitude of error of −1.41 D, angle of error 5.6 degrees, and correction index of 0.82 were achieved. Owing to limited potential improvement with IOL rotation, additional enhancement with photorefractive keratectomy (PRK) of −0.61 −1.78 × 69 degrees was performed to achieve desired results and high patient satisfaction. Preoperative corrected distance visual acuity was 20/50, and the uncorrected visual acuity achieved after cataract surgery and PRK enhancement was 20/25. Conclusions: The use of double toric IOLs for treating high astigmatism in patients with prior keratorefractive surgery is reported.
{"title":"Use of primary and piggyback toric intraocular lenses for treatment of high myopic astigmatism","authors":"Andrew C. Thomson, Kathryn E McAnnis, B. Ambati","doi":"10.1097/j.jcro.0000000000000093","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000093","url":null,"abstract":"Introduction: High myopic astigmatism often presents a challenge for cataract surgeons. Procedures such as limbal relaxation incisions may also be impossible in the setting of an extensive refractive surgical history. Patient and Clinical Findings: A 61-year-old woman for cataract surgery with a history of automated lamellar keratoplasty, 4-incision radial keratotomy, and arcuate incisions in the left eye. Astigmatism was 8.00 diopters (D) by manifest refraction, and on optical biometry, corneal topography, and auto keratometry, astigmatism was 9.01 D, 7.52 D, and 8.25 D, respectively. Diagnosis, Intervention, and Outcomes: A primary in-the-bag toric intraocular lens (IOL) and piggyback toric IOL with reverse optic capture were used. A surgically induced astigmatism of 6.59 D, magnitude of error of −1.41 D, angle of error 5.6 degrees, and correction index of 0.82 were achieved. Owing to limited potential improvement with IOL rotation, additional enhancement with photorefractive keratectomy (PRK) of −0.61 −1.78 × 69 degrees was performed to achieve desired results and high patient satisfaction. Preoperative corrected distance visual acuity was 20/50, and the uncorrected visual acuity achieved after cataract surgery and PRK enhancement was 20/25. Conclusions: The use of double toric IOLs for treating high astigmatism in patients with prior keratorefractive surgery is reported.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00093"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46211176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-16DOI: 10.1097/j.jcro.0000000000000094
Nour Bundogji, V. Hawn, J. Micheletti, Ruth Sahler, L. Werner
Introduction: A case of discoloration of a multifocal hydrophobic acrylic intraocular lens (IOL), which was explanted and exchanged as well as underwent laboratory analysis, is reported. Patient and Clinical Findings: The patient presented with a corrected distance visual acuity of 20/50 and glare in the right eye 8 years after implantation. Slitlamp examination revealed a nasally decentered IOL with a whitish-brownish haze throughout. Diagnosis, Intervention, and Outcomes: The discolored IOL (ZMB00) was explanted and exchanged for a 3-piece IOL (sulcus fixation). Grossly, the explanted IOL showed a whitish discoloration of the optic only after hydration, corresponding to a yellowish-brownish discoloration observed under light microscopy. Back light scattering revealed bulk scatter throughout the optic. Light transmittance (%T) showed a slight progressive decrease starting at 500 nm when compared with %T in the directions for use (DFUs). Although modulation transfer function analysis demonstrated similar values to the control lens, the contrast of U.S. Air Force targets appeared slightly decreased. Conclusions: To the authors' knowledge, this is the first reported case of a discolored ZMB00 IOL that underwent explantation and laboratory assessment. Although current analyses did not reveal the etiology of the discoloration, surgeons should be aware of this possible occurrence with this lens design and carefully assess signs and symptoms before explantation.
{"title":"Postoperative discoloration of a multifocal hydrophobic acrylic lens: case report with laboratory analyses","authors":"Nour Bundogji, V. Hawn, J. Micheletti, Ruth Sahler, L. Werner","doi":"10.1097/j.jcro.0000000000000094","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000094","url":null,"abstract":"Introduction: A case of discoloration of a multifocal hydrophobic acrylic intraocular lens (IOL), which was explanted and exchanged as well as underwent laboratory analysis, is reported. Patient and Clinical Findings: The patient presented with a corrected distance visual acuity of 20/50 and glare in the right eye 8 years after implantation. Slitlamp examination revealed a nasally decentered IOL with a whitish-brownish haze throughout. Diagnosis, Intervention, and Outcomes: The discolored IOL (ZMB00) was explanted and exchanged for a 3-piece IOL (sulcus fixation). Grossly, the explanted IOL showed a whitish discoloration of the optic only after hydration, corresponding to a yellowish-brownish discoloration observed under light microscopy. Back light scattering revealed bulk scatter throughout the optic. Light transmittance (%T) showed a slight progressive decrease starting at 500 nm when compared with %T in the directions for use (DFUs). Although modulation transfer function analysis demonstrated similar values to the control lens, the contrast of U.S. Air Force targets appeared slightly decreased. Conclusions: To the authors' knowledge, this is the first reported case of a discolored ZMB00 IOL that underwent explantation and laboratory assessment. Although current analyses did not reveal the etiology of the discoloration, surgeons should be aware of this possible occurrence with this lens design and carefully assess signs and symptoms before explantation.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00094"},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45869510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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