[Show abstract][Hide abstract] ABSTRACT: Purpose:
To study the possible mechanism and treatment for pigment dispersion glaucoma (PDG) caused by single-piece acrylic (SPA) intraocular lens (IOL) ciliary sulcus fixation in Asian eyes.
Materials and methods:
Patients referred for PDG caused by SPA IOL ciliary sulcus fixation to our hospital from April 2005 to June 2011 were included. The patients' general information, IOL type, interval between initial surgery and PDG occurrence, examination findings, antiglaucoma medicine regimen and surgical interventions were recorded.
In total, six eyes from five Chinese patients were included in this study. The intraocular pressure (IOP) increased 19-30 days after cataract surgery and was not satisfactorily controlled with antiglaucoma medication. Dense pigmentation was deposited on the IOLs and on the anterior chamber angle. IOL haptic chafing was noted on the rear iris surface. IOL repositioning in the capsular bag was performed in three eyes and was combined with trabeculectomy in two eyes with progressive glaucoma. An IOL exchange with three-piece IOL ciliary sulcus fixation was performed in the other three eyes. Scanning electron microscopy of the explanted IOLs demonstrated a rough edge on the IOL haptics.
SPA IOLs were not suitable for ciliary sulcus fixation. The chafing effect of the IOL haptics on the posterior iris pigment epithelium could induce PDG in Asian eyes. IOLs should be positioned in the capsular bag or a three-piece IOL should be used instead.
No preview · Article · Nov 2012 · Current eye research
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification cataract surgery or lens exchange in corneal endothelial dysfunction eyes with lens disorders.
Retrospective case series. Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulsification and intraocular lens (IOL) insertion. Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up.
The irritation was disappeared in all of patients. All of the corneas became transparent. The preoperative and postoperative mean CCT of the recipient beds was 859 µm and 553 µm respectively. T value was 5.303 (t = 5.303, P < 0.01). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm(2). The ECD was 1803 cells/mm(2) in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection. These complications occurred in anterior chamber IOL eyes.
DSAEK combined with phacoemulsification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.
No preview · Article · Jan 2011 · [Zhonghua yan ke za zhi] Chinese journal of ophthalmology
[Show abstract][Hide abstract] ABSTRACT: To study the change of corneal birefringence at different pressures in vitro to determine whether corneal birefringence changes along with pressure.
The pattern of corneal birefringence was recorded at different intraocular pressures. The pressure differences were 0.10, 0.50 and 1.00 mm Hg, respectively. To compare the pattern sequence at two pressure values, a nonpaired t test was performed.
Statistical analysis indicates that the difference of the corneal birefringence is significant when the pressure difference was more than 0.50 mm Hg in polarized light.
The results of corneal photoelasticity in vitro demonstrate that the change in pressure on the cornea leads to a change in corneal birefringence.
No preview · Article · Feb 2010 · Ophthalmic Research
[Show abstract][Hide abstract] ABSTRACT: To investigate the clinical efficacy, prevention and management complications and choice of indication with Descemet membrane stripping with automated endothelium keratoplasty (DSAEK).
Clinical case series. Nine patients (9 eyes) with bullous keratopathy underwent DSAEK procedure from Peking University Eye Center, Peking University Third Hospital during September to December in 2007. Visual acuity, cornea transparency, graft position, corneal thickness, curvature, astigmatism and endothelial cells density (ECD) were observed over 3-7 month follow-up period.
One patient with iris cornea endothelium syndrome was fail to insert graft into anterior chamber and changed procedure to penetrating keratoplasty. Eight patient successfully performed procedure. One graft dislocation in was managed in first day after surgery. All 8 grafts remained transparent and improved visual acuity. After surgery, mean corneal thickness was (775 +/- 30)microm. Mean corneal curvature was (44.19 +/- 2.28) D. Mean corneal astigmatism was (2.20 +/- 0.83) D. Mean endothelial cells density was (1439 +/- 296) cells/mm(2).
DSAEK is a less damage, faster recovery vision, safer procedure. It is expected to be the important procedure to treat bullous keratopathy.
No preview · Article · Jan 2010 · [Zhonghua yan ke za zhi] Chinese journal of ophthalmology
[Show abstract][Hide abstract] ABSTRACT: To explore the feasibility of reattaching the dislocated graft with viscoelastic in abnormally structured eyes after Descemet-stripping automated endothelial keratoplasty (DSAEK).
Retrospective case series.
Five pseudophakic bullous keratopathy cases (5 eyes) with a history of vitrectomy and/or iris-lens diaphragm injury.
After DSAEK, graft dislocation occurred in each of the 5 cases (5 eyes). We attempted to fill the anterior chamber (AC) with an air bubble to push up the dislocated graft, but this was not successful. We then injected balanced salt solution into the vitreous body to obtain normal intraocular pressure (IOP) and injected a small amount of viscoelastic (Healon GV) to support the AC. Next, we injected an air bubble into the AC.
The position of the grafts was checked with a slit lamp and anterior segment optical coherence tomography (AS-OCT). The IOP was observed with Goldmann tonometer. The best visual acuity was checked.
As observed through the slit lamp and AS-OCT, the grafts reattached well in all patients. The IOP was normal in all patients except one, who had high IOP 1 month postoperatively. After receiving drug treatment, the patient's IOP returned to normal. The grafts had slight edema on postoperative day 1, but became transparent between days 5 and 8.
Viscoelastic aided in the reattachment of the dislocated graft in eyes with a history of vitrectomy and/or iris-lens diaphragm injury. The presence of viscoelastic in the AC in the early period of post-DSAEK was well tolerated in this small series.
[Show abstract][Hide abstract] ABSTRACT: To observe the pathological changes of the lens and anterior lens capsule of the patients with familial congenital aniridia, and discuss the histopathological etiology of the fragility of the anterior capsule and the significance of surgical project.
Anterior lens capsules and lens specimens were obtained from aniridic patients during cataract surgery. The intraoperative behavior of each capsule was noted, after which the specimens were submitted for histopathologic evaluation and electron microscope examination.
The anterior lens capsule was extremely fragile and remarkably thin. Degenerative changes(degeneration, necrosis, loss) of the lens epithelium and discontinuity of the lens epithelium were found in some specimens. Proliferation and double layer of the epithelial cells in some area of the specimens can be seen also. Ply structure of the anterior capsule became thin or disappeared.
Degenerative or proliferative changes of the lens epithelial cells were associated with the thinness and extreme intraperative fragility of the anterior lens capsules in familial aniridia with cataract. Greater awareness of anterior capsule fragility in some aniridic patients with cataract may reduce the risk of capsule complications and lead to safer surgical outcomes.
No preview · Article · Nov 2005 · Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences