Cases reported "Prosthesis Failure"

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1/11. 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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ranking = 1
keywords = phacoemulsification
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2/11. Positive and negative dysphotopsia in patients with acrylic intraocular lenses.

    PURPOSE: To report the incidence, management, and prevention of patient reports of glare and streaks around a point source of light or a dark shadow in the temporal field of vision after acrylic intraocular lens (IOL) implantation. SETTING: A private practice. methods: Cases in which patients complained vigorously of dysphotopsia were catalogued prospectively during the implantation experience in 6668 consecutive eyes having surgery between January 1995 and June 1999. The techniques of topical-intracameral anesthesia, temporal clear corneal incisions, and phacoemulsification were used in all cases. Alternate IOL styles were selected for use from July 1999 to April 2000. RESULTS: Fourteen cases (0.2%) were identified. The complaints resolved in 1, were diminished in 1, and were tolerated without change in 7. Five eyes of 4 patients required IOL exchange with capsular bag placement of a poly(methyl methacrylate) (PMMA) or silicone lens for resolution of symptoms. Selecting alternate IOL styles reduced the incidence of dysphotopsia. CONCLUSIONS: glare and streaks from a point source of light represent positive photic expressions of dysphotopsia, and temporal dark shadows represent similar negative photic expressions. Both appear to be associated with shiny square-edge optics made of high-refractive-index acrylic polymer. Intraocular lenses of PMMA and silicone with rounded edges, along with square-edge acrylic IOLs with nonreflective edges, appear less likely to cause clinically significant pseudophakic dysphotopsia.
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ranking = 1
keywords = phacoemulsification
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3/11. Posterior dislocation of a plate-haptic silicone intraocular lens with large fixation holes.

    We present a patient who had uneventful phacoemulsification with in-the- bag implantation of a silicone plate-haptic posterior chamber intraocula r lens (IOL) with 1.15 mm fixation holes. Six months after a neodymium: YAG laser capsulotomy, the IOL spontaneously dislocated posteriorly. A pars plana vitrectomy was performed, the IOL was explanted, and a 3-piece loop-haptic IOL was implanted in the ciliary sulcus. Eight weeks after surgery, best corrected visual acuity was 20/20.
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ranking = 1
keywords = phacoemulsification
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4/11. Spontaneous luxation of encapsulated intraocular lens onto the retina after a triple procedure of vitrectomy, phacoemulsification, and intraocular lens implantation.

    PURPOSE: To report the clinical and histological findings of a luxated intraocular lens (IOL) in the capsular bag. methods: review of a case. RESULTS: Twenty-three months after a triple procedure of vitrectomy, phacoemulsification, and IOL implantation for diabetic vitreous hemorrhage and cataract, the encapsulated IOL spontaneously luxated. Scanning electron microscopy showed sparsely distributed anterior and equatorial zonules, with only a few posterior zonules on the surface of the removed capusular bag. CONCLUSION: The absence of the anterior hyaloid membrane and posterior zonules and contraction of the lens capsule may cause dialysis of the zonules. Therefore, the anterior hyaloid membrane should be left in place in patients at low risk for the development of postoperative proliferation to maintain the long-term stability of the IOL.
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ranking = 5
keywords = phacoemulsification
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5/11. Spontaneous disinsertion of a haptic from a 3-piece acrylic foldable intraocular lens after surgery.

    A 49-year-old man with cataracts had uneventful phacoemulsification, continuous curvilinear capsulorhexis, and implantation of an MA30BA acrylic foldable intraocular lens (IOL) in the bag. One week later, 1 haptic spontaneously dropped off and the optic dislocated into the anterior chamber. The IOL was surgically removed and replaced with a new acrylic foldable IOL. Examination of the explanted IOL revealed that the loop hole was not created in the middle of the side face, leading to in vivo detachment of the haptic postoperatively.
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ranking = 1
keywords = phacoemulsification
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6/11. Hydrophilic acrylic intraocular lens optic and haptics opacification in a diabetic patient: bilateral case report and clinicopathologic correlation.

    OBJECTIVE: To report clinicopathologic and ultrastructural features of two opacified single-piece hydrophilic acrylic intraocular lenses (IOLs) explanted from a diabetic patient. DESIGN: Interventional case report with clinicopathologic correlation. SETTING: A 64-year-old white female underwent phacoemulsification and implantation of a single-piece hydrophilic acrylic lens (SC60B-OUV; Medical Developmental research, Inc., Clear water, FL) in October 1998 in the left eye and in July 1999 in the right eye. The best-corrected visual acuity after surgery was 20/60 in the left eye and 20/50 in the right eye. The patient had a marked decrease in visual acuity in June 2000 as a result of a milky, white opalescence of both lenses. Intraocular lens explantation and exchange was performed in both eyes and the explanted IOLs were submitted to our center for detailed pathologic, histochemical, and ultrastructural evaluation. They were stained with alizarin red and the von Kossa method for calcium, and also underwent scanning electron microscopy and energy dispersive radiograph spectroscopy to ascertain the nature of the deposits leading to opacification. MAIN OUTCOME MEASURES: documentation of calcium deposits confirmed by histochemical stains and surface analyses. RESULTS: Opacification of the IOL was found to be the cause of decreased visual acuity. The opacification involved both the IOL optic and the haptics in the left eye and was confined to the IOL optic in the right eye. Histochemical and ultrastructural analyses revealed that the opacity was caused by deposition of calcium and phosphate within the lens optic and haptics. CONCLUSIONS: There are two features that distinguish this case from those reported earlier. This is the first clinicopathologic report of lens opacification that has involved completely the lens optic and the haptics. Second, these two explanted IOLs document the first bilateral case. This process of intraoptic and haptic opacification represents dystrophic calcification of unknown cause. Diabetic patients appear to be more severely and more often affected by lens opacification. Long-term follow-up of diabetic patients implanted with this IOL design should be maintained by surgeons and manufacturers.
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ranking = 1
keywords = phacoemulsification
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7/11. Opacification of a silicone intraocular lens caused by calcium deposits on the optic.

    We describe opacification of a plate-haptic silicone intraocular lens (IOL) caused by calcification in a diabetic patient with asteroid hyalosis. The IOL was explanted 48 months after uneventful phacoemulsification because opacification of the posterior surface was causing significant visual disturbance. light and scanning electron microscopy and x-ray spectrometry of the explanted IOL showed the opacification consisted mainly of calcium and phosphate, presumably hydroxyapatite, in the form of precipitations on the posterior surface of the optic.
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ranking = 1
keywords = phacoemulsification
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8/11. Early opacification of SI-40NB silicone intraocular lenses.

    We report 4 cases of silicone intraocular lens (IOL) opacification (SI-40NB, Allergan Inc.) in patients who had phacoemulsification between April and June 2003. The opacification was observed on the first postoperative day in all cases. The appearance of the silicone IOLs ranged from milky gray to a yellow hue and affected the entire optical component homogeneously. The patients did not complain about their vision, and visual acuity was only slightly affected; 3 of the 4 patients had a best corrected visual acuity of 20/30, and no anterior chamber reaction was observed. contrast sensitivity was reduced in all cases. Careful scrutiny of medical histories failed to reveal factors that might have predisposed the patients to IOL opacification.
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ranking = 1
keywords = phacoemulsification
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9/11. Late opacification of a silicone intraocular lens caused by ophthalmic ointment.

    A 55-year-old man had uneventful phacoemulsification with implantation of a 3-piece silicone intraocular lens (IOL). Postoperative medications included antibiotic-steroid drops and ointments. Eight months postoperatively, the patient started having recurrent episodes of anterior chamber inflammatory reaction. Suspicion that lens instability was causing the reactions led to a lens repositioning procedure 11 months after the initial surgical implantation and again at 13 months. Eighteen months postoperatively, the IOL had a "greasy" film. Despite antiinflammatory and antibiotic treatment, the clinical outcome did not improve. Twenty-seven months after implantation, the lens was exchanged with a hydrophilic acrylic IOL. The course after the exchange was uneventful. The explanted lens was examined by gross and microscopic evaluations, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and gas chromatography-mass spectrometry (GC-MS) using electronic ionization. Gross and microscopic evaluations confirmed the presence of a thin, oily film covering the IOL optic surface. Surface analyses at the level of the oily substance showed unspecific peaks of sodium, chloride, and potassium. The GC-MS analysis showed the presence of compounds characteristic of hydrocarbons, including docosane, tricosane, and tetracosane, which are commonly found in the vehicle of ophthalmic ointments. The GC-MS analysis of 1 ointment used postoperatively found matching peaks, suggesting deposition of those compounds on the IOL.
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ranking = 1
keywords = phacoemulsification
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10/11. Probable edge defect in Acrysof single-piece intraocular lens.

    The purpose of this article is to report an edge defect in single-piece hydrophobic acrylic intraocular lens (IOL) observed during a routine phacoemulsification procedure. The chip was successfully removed intraoperatively with a McPherson's forceps. However, six months postoperatively patient complained of a disturbing glare due to posterior capsular folds originating from the site of IOL defect. Patient was advised, however refused to undergo Nd:Yag laser capsulotomy to relieve the symptoms. This case highlights the necessity to check each foldable IOL under the microscope before loading it into the cartridge, for possible edge defects.
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ranking = 1
keywords = phacoemulsification
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