Cases reported "Lens Subluxation"

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1/16. Managing a dropped nucleus during the phacoemulsification learning curve.

    Three patients had a pars plana vitrectomy to remove retained nuclei within 72 hours after phacoemulsification performed by a surgeon making the transition from extra-capsular cataract extraction to phacoemulsification. After vitrectomy, the nuclei were brought to the midvitreous cavity from the retinal surface with a posterior segment phacofragmenter, emulsified, and completely removed. Then, a posterior chamber intraocular lens was implanted in the sulcus through the previous cataract surgery incision and remained well centered postoperatively. postoperative complications included cystoid macular edema in 1 patient and choroidal detachment in another. No other complications were detected. Final visual acuity ranged from 20/60 to 20/30.
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2/16. Complications of endocapsular tension ring implantation in a child with Marfan's syndrome.

    A 4-year-old boy with Marfan's syndrome had severe visual impairment after subluxation of the crystalline lens with bisection of the pupil. In the first eye, a capsular tension ring and an intraocular lens (IOL) were uneventfully placed in the capsular bag after phacoemulsification. During implantation of the endocapsular tension ring in the second eye, an inadvertent tear of the anterior capsule occurred, and the posterior chamber IOL was placed in the sulcus. In both eyes, severe lens epithelial proliferation with secondary IOL decentration developed postoperatively. Several surgical revisions were necessary to keep the IOL within the optical axis. In the eye with the sulcus-implanted IOL, the endocapsular tension ring was markedly decentered.
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keywords = phacoemulsification
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3/16. Scheimpflug imaging of bilateral foldable in-the-bag intraocular lens implantation assisted by a scleral-sutured capsular tension ring in Marfan's syndrome.

    A 35-year-old white man with bilateral high myopia, astigmatism, subluxated crystalline lenses, and incipient cataract had phacoemulsification and implantation of a hydrophobic acrylic intraocular lens (IOL) (Alcon MA60BM) in both eyes. The subluxated capsular bag was stabilized and recentered using a scleral-fixated capsular tension ring (CTR) (type 1L, Morcher). Measured with Scheimpflug photography, the capsular bag and IOL were in a stable intraocular position during the 18-month follow-up. There were no major changes in refraction. Despite the sharp-edged IOL design, both eyes had posterior capsule opacification (PCO) 18 months after surgery that in 1 eye caused a decrease in visual acuity of more than 2 lines. High myopia and subluxated lenses may be treatable long-term with a scleral-fixated CTR and foldable IOL implantation; further evaluation of PCO is necessary.
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keywords = phacoemulsification
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4/16. Modified capsular tension ring for patients with congenital loss of zonular support.

    PURPOSE: To evaluate the results of implantation of a modified capsular tension ring (MCTR) and a posterior chamber intraocular lens (PC IOL) in patients with congenitally subluxated crystalline lenses. SETTING: Cincinnati eye Institute, Cincinnati, ohio, USA. methods: Ninety eyes of 57 patients with congenital loss of zonular support (weill-marchesani syndrome, idiopathic ectopia lentis, and Marfan's syndrome) had phacoemulsification with PC IOL and MCTR implantation. The preoperative examination included best corrected visual acuity (BCVA) and the presence or absence of phacodonesis, lens decentration, and vitreous prolapse. The postoperative evaluation included BCVA and the presence or absence of pseudophacodonesis, PC IOL centration, and posterior capsule opacification (PCO). RESULTS: At the last postoperative examination, the BCVA was 20/40 or better in 80 eyes (88.9%); 1 eye (1.1%) lost 1 line of acuity. Preoperatively, 18 eyes (20%) had phacodonesis; 1 eye had postoperative pseudophacodonesis. Decentration before surgery was present in 86 eyes (95.6%); 6 eyes (6.7%) developed late symptomatic PC IOL decentration a median of 17.84 months /- 10.73 (SD) after surgery. Other complications were increased intraocular pressure (2.2%), persistent iritis (3.3%), broken suture (10.0%), retinal detachment (1.1%), and PCO (20.0%). CONCLUSIONS: Use of the MCTR resulted in centration of the capsular bag and PC IOL in 90 eyes with congenitally subluxated crystalline lenses. Fixation of a 9-0 polypropylene suture is recommended to decrease the risk for late suture breakage.
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keywords = phacoemulsification
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5/16. Surgical management of crystalline lens dislocation into the anterior chamber with corneal touch and secondary glaucoma.

    We present a 53-year-old man with a crystalline lens that spontaneously dislocated anteriorly with corneal touch and secondary glaucoma. A dry anterior vitrectomy and partial intercapsular lensectomy were performed using a limbal approach to control intraocular pressure (IOP) and decrease the lens volume. The lens capsule was gently separated from the corneal endothelium with viscoelastic material, after which a bimanual lensectomy was performed with a vitrectomy probe and a phacoemulsification microflow tip. The risk for expulsive choroidal hemorrhage, which can occur during large-incision, open-chamber surgery; a sudden IOP decrease; and significant damage to the corneal endothelium were avoided with this technique. After secondary intraocular lens scleral fixation, the final visual acuity was 20/25.
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keywords = phacoemulsification
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6/16. Retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification.

    PURPOSE: To report a method of retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification. DESIGN: Interventional case report. methods: A 65-year-old man presented with a totally luxated crystalline lens in the vitreous cavity of the left eye. After total vitrectomy was performed, a viscoadaptive viscoelastic agent was applied over the retina and optic disk. Then the luxated lens was removed by intravitreal phacoemulsification. The lens dropped several times during the surgery but the thick viscoadaptive viscoelastic agent protected the posterior retina. RESULTS: In two cases treated this way, no complications occurred at six months after surgery. CONCLUSION: This method may be useful for protecting the retina from damage by a luxated crystalline lens and is less costly than perfluorocarbon liquid.
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keywords = phacoemulsification
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7/16. Chopstick technique for nucleus removal in an impending dropped nucleus.

    We describe a bimanual chopstick technique for nucleus removal after a posterior capsule tear and an impending dropped nucleus during phacoemulsification. The technique stabilizes the nucleus and nuclear fragments by providing posterior support with a Sinskey hook introduced from the pars plana. Once supported, the nucleus is gripped between 2 instruments, brought out of the capsular bag into the anterior chamber, and then taken out of the enlarged wound. This bimanual removal technique causes minimal disturbance to the vitreous, iris, and cornea.
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keywords = phacoemulsification
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8/16. Identification of retained nucleus fragment in the posterior chamber using ultrasound biomicroscopy.

    PURPOSE: To describe the use of ultrasound biomicroscopy (UBM) to image retained nuclear fragments posterior to the iris plane after uncomplicated phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation in two patients. DESIGN: Interventional case report. methods: Two patients presented with an iris elevation after uncomplicated phacoemulsification and lens implantation. RESULTS: visual acuity was 20/20 in the first patient and 20/30 in the second. There was no anterior chamber inflammation in either eye. UBM revealed a small, retained nuclear fragment between the iris pigment epithelium and the anterior lens capsule, causing localized anterior iris displacement in both patients. The PCIOL was within the capsular bag, and the iris root and ciliary body were normal in both patients. CONCLUSION: UBM can demonstrate retained lens fragments within the posterior chamber.
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keywords = phacoemulsification
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9/16. phacoemulsification using iris-hooks for capsular support in high myopic patient with subluxated lens and secondary angle closure glaucoma.

    We report an unusual case of angle closure glaucoma in a 78-year-old highly myopic female patient. The patient did not show any preoperative signs of subluxation of lens. However, the capsular bag was noted to be unstable during surgery. The patient was managed with phacoemulsification of lens using a novel method of iris hooks for stabilization of capsular bag during surgery.
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keywords = phacoemulsification
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10/16. Endocapsular ring approach to the subluxed cataractous lens.

    The surgical management of the cataract associated with extensive zonular dialysis presents a challenge for the anterior segment surgeon. In 1993, a poly(methyl methacrylate) endocapsular ring was introduced to stabilize the capsular bag. We describe the use of this endocapsular ring in phacoemulsification and intraocular lens (IOL) implantation in the capsular bag in four patients with extensive traumatic or congenital zonular dialysis. The endocapsular ring allows expansion and stabilization of the capsular bag to facilitate cortical aspiration and uncomplicated IOL implantation. With follow-up of 4 to 10 months, all IOLs have remained well centered and the patients have had excellent vision free of complications.
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ranking = 0.16666666666667
keywords = phacoemulsification
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