Cases reported "Hyperopia"

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1/6. Piggyback posterior chamber multifocal intraocular lenses in anisometropia.

    A 63-year-old white man with anisometropic hyperopia presented with cataract in both eyes. He had uneventful temporal limbal phacoemulsification with intracapsular placement of a multifocal 3-piece silicone intraocular lens (IOL) in his right eye (model SA-40N, Allergan, Inc.). One week later, 2 intracapsular 3-piece silicone IOLs (1 monofocal backward, Allergan model SI-40NB; 1 multifocal in front, Allergan model SA-40N) were implanted in his left eye. At 8 days postoperatively, uncorrected visual acuity was 20/20 for distance and J1 for near vision in the right eye and 20/30 and J2, respectively, in the left. These values remained constant until the patient was seen 7 months postoperatively. Power calculation and insertion order of the piggyback IOLs were considered.
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ranking = 1
keywords = phacoemulsification
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2/6. Piggyback implantation using the AMO array multifocal intraocular lens.

    Piggyback intraocular lens (IOL) implantation allows refractive correction in cases in which the IOL power requirement exceeds that of the available lenses. By combining a piggyback technique with the use of a multifocal IOL, one can obtain the optical advantages of both, achieving high-quality visual acuity for distance and near vision and reducing the optical aberrations of extremely high-powered single IOLs. We report 5 hyperopic patients (6 eyes) who had phacoemulsification and in-the-bag implantation of 2 foldable IOLs in the bag, a silicone multifocal IOL placed in front of a silicone monofocal IOL. Good results were obtained in near and distance uncorrected visual acuities, and patient satisfaction was excellent in all cases. However, in 2 cases, the anteriorly placed IOL was exchanged because of incorrect power calculation. Piggyback IOL implantation with a multifocal lens appears to be a safe, efficient procedure and a good refractive solution.
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ranking = 1
keywords = phacoemulsification
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3/6. corneal perforation during laser in situ keratomileusis after hyperopic electrothermal keratoplasty.

    PURPOSE: To report a corneal perforation during laser in situ keratomileusis (LASIK) after previous electrothermokeratoplasty. DESIGN: Interventional case report. methods: A 49-year-old man presented with primary hyperopia in the right eye and residual hyperopia after electrothermokeratoplasty in the left eye. His refraction was 4.00 in the right eye and 7.00 -3.00 x 135 degrees in the left eye, with a central pachymetry of 535 microm and 549 microm, respectively. phacoemulsification with intraocular lens (IOL) insertion in the right eye and a two-step keratophacorefractive procedure with a piggyback IOL insertion and LASIK in the left eye were proposed. RESULTS: Postoperative refraction was -0.50 -0.50 x 150 degrees 20/20 in the right eye. Postphacoemulsification refraction was -4.75 -4.25 x 135 degrees in the left eye. Laser in situ keratomileusis was performed in the left eye, 4 months later, with uneventful astigmatic laser ablation. During the myopic ablation, a sudden outcome of aqueous humor in one of the temporal corneal scars was observed. CONCLUSIONS: Unpredictably thin areas after electrothermokeratoplasty may lead to unexpected corneal perforation during LASIK. The available pachymetry systems may be unreliable after electrothermal keratoplasty.
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ranking = 1
keywords = phacoemulsification
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4/6. Cataractous changes due to posterior chamber flattening with a posterior chamber phakic intraocular lens secondary to the administration of pilocarpine.

    OBJECTIVE: To present the first reported case of cataract formation as a consequence of instillation of pilocarpine in an eye with a posterior chamber phakic intraocular lens (IOL). DESIGN: Interventional case report. INTERVENTION: A 46-year-old man received a hyperopic implantable collamer lens (ICL) bilaterally. MAIN OUTCOME MEASURES: Determination of best-corrected visual acuity (BCVA); contrast sensitivity testing with and without glare; and intraocular pressure (IOP), specular endothelial cell, and slit-lamp examinations were performed serially. In addition, the distance between the ICL and crystalline lens was measured with optical coherence tomography. RESULTS: Both eyes underwent uneventful ICL implantation for the correction of a manifest spherical equivalent of 7 diopters (D) in the right eye and 7.1 D in the left eye. The left eye was followed for 2 years without developing complications. The right eye, however, showed on the first postoperative day a fleckenlike opacification on the anterior pole of the crystalline lens after instillation on the operative day of 2% pilocarpine in an attempt to accelerate recovery from unwanted pupil dilation causing patient complaints of glare disability after surgery. Optical coherence tomography demonstrated complete contact of the ICL with the natural lens 24 hours postoperatively. Serial IOP measurements were always within the normal limits. The instillation of 1% cyclopentolate resulted in an increase in the ICL vault that measured 132 mum 24 hours later. Three days after the completion of a 3-day course of topical 1% cyclopentolate, the opacification was less dense and demarcated, and a 124-mum vault was measured. Three months postoperatively, the cataract was associated with a 3-line loss of BCVA and considerable degradation of the contrast sensitivity, especially at higher spatial frequencies and with a glare source, and corneal endothelial cell changes were within normal limits. One year after ICL implantation, the right eye had to undergo phacoemulsification and IOL implantation, which were uneventful. CONCLUSIONS: Posterior chamber flattening with resulting crystalline lens opacification can occur immediately after the instillation of pilocarpine in an eye with a hyperopic ICL. Therefore, caution should be taken with the administration of cholinergic agonists such as pilocarpine in patients with phakic IOLs, at least if they are hyperopic ICLs.
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ranking = 1
keywords = phacoemulsification
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5/6. Intraocular lens pupillary capture after neodymium:YAG laser treatment of interlenticular opacification of posterior chamber piggyback intraocular lenses.

    A hyperopic 73-year-old woman had bilateral phacoemulsification with primary implantation of piggyback AcrySof intraocular lenses (IOLs) (Alcon) in the capsular bag. Interlenticular opacification (ILO) developed after 6 months in the left eye and after 2 years in the right eye. Treatment of the ILO in the left eye with a neodymium:YAG (Nd:YAG) laser resulted in pupillary capture of the optic of the anterior IOL. This case shows that despite using low energy levels, pupillary capture of the anterior IOL can occur after Nd:YAG laser treatment for ILO in piggyback IOLs.
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ranking = 1
keywords = phacoemulsification
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6/6. Relaxing the fibrosed capsulorhexis rim to correct induced hyperopia after phacoemulsification.

    I present two cases in which hyperopia occurred after phacoemulsification through a capsulorhexis. In both eyes, the anterior capsule rim had become fibrosed and contracted. The patients were successfully treated with YAG laser relaxing incisions.
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ranking = 5
keywords = phacoemulsification
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