Cases reported "Vision Disorders"

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1/18. 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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2/18. Postoperative deposition of calcium on the surfaces of a hydrogel intraocular lens.

    OBJECTIVE: To report clinical, pathological and histochemical features of 5 Hydroview intraocular lenses (IOLs) explanted from five patients who had visual disturbances caused by postoperative deposits on the lens surfaces. DESIGN: Noncomparative small case series with clinicopathologic and histochemical correlations. PARTICIPANTS: Five hydrophilic IOLs explanted from five different patients. All patients presented with decreased visual acuity and glare circa 12 months after uneventful phacoemulsification and IOL implantation, associated with a red-brown granularity on the optical surfaces of the IOLs. methods: The lenses were explanted, fixed in buffered formaldehyde and examined by gross and light microscopy. MAIN OUTCOME MEASURES: Staining of the IOLs with 1% alizarin red and with the von Kossa method (both stains for calcium). Two additional IOLs were also stained and included as controls. RESULTS: The optical surfaces of all five IOLs were covered by a layer of irregular granular deposits, composed of multiple fine, translucent spherical-ovoid granules. The deposits stained positive for calcium in all cases. No deposit or positive staining was observed on the IOLs haptics. Staining of the control IOLs was also negative. CONCLUSION: This is the first histopathological report of calcified deposits on the surfaces of this hydrogel IOL model. Further studies on other similar cases with this lens should be done to determine the incidence and possible mechanisms of this phenomenon.
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ranking = 1
keywords = phacoemulsification
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3/18. Anterior capsular phimosis in eyes with a capsular tension ring.

    A 64-year-old woman with zonular weakness in the left eye and a 79-year-old man with bilateral pseudoexfoliation and intraoperative zonular dehiscence had phacoemulsification with in-the-bag implantation of a single-piece poly(methyl methacrylate) intraocular lens (IOL) and a capsular tension ring. Ten to 12 weeks postoperatively, all 3 eyes developed significant visual loss secondary to capsule shrinkage and occlusion of the capsulorhexis opening. All eyes had a neodymium:YAG laser radial anterior capsulotomy, anterior capsulectomy, or both. visual acuity was restored in all eyes despite slight IOL decentration.
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ranking = 1
keywords = phacoemulsification
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4/18. Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation.

    A 69-year-old man with pseudoexfoliation syndrome and bilateral cataract had phacoemulsification with continuous curvilinear capsulorhexis and implantation of a morcher endocapsular ring and AcrySof acrylic intraocular lens (IOL) (Alcon). Two months later, the patient had vision loss in the left eye with a visual acuity of 20/500. He presented with anterior capsule fibrosis in both eyes, with complete occlusion of the capsule opening in the left eye and mild occlusion in the right eye. After a neodymium:YAG laser anterior capsulotomy in the left eye, visual acuity was 20/20. This case shows that endocapsular ring implantation does not prevent anterior capsule contraction syndrome but can prevent IOL decentration.
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ranking = 5
keywords = phacoemulsification
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5/18. Visual discomfort after acrylic intraocular lens implantation.

    A 64-year-old man had phacoemulsification in both eyes. In January 1998, an Allergan SI-30NB silicone intraocular lens (IOL) with a 6.0 mm optic was implanted in the right eye. In April, an Alcon AcrySof MA60BN acrylic IOL with a 6.0 mm optic was implanted in the left eye. The following October, the patient experienced visual discomfort in the left eye. Two superior radial minikeratotomies were performed. The patient continued to have visual discomfort and the next month, a topographic ablation was performed in the same eye. In January 2000, the left IOL was replaced with a 5.5 mm Allergan SI-55NB silicone IOL. Visual impairment resolved 1 day after surgery.
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ranking = 1
keywords = phacoemulsification
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6/18. Macular phototrauma after cataract extraction and multifocal lens implantation: case report.

    PURPOSE: To report a patient who developed photic injury after cataract surgery and multifocal MF4 lens implantation methods: A 41-year-old caucasian woman without antecedents of interest was subjected to left catarct surgery involving phacoemulsification with capsular sac implantation of a new type of multifocal lens. A coaxial light microscope was used for surgery. The operation was filmed and anterior pole photographs were obtained. RESULTS: Two days after the operation, the patient noted a paracentral scotoma and hand movement visual acuity in the left eye. Indirect ophthalmoscopy revealed an oval, hyperpigmented macular lesion compatible with phototoxic maculopathy. CONCLUSIONS: Phototoxic injury to the macula may occur after cataract extraction. Implantation of an intraocular lens is an important factor in the producion of maculopathy, on account of its light-focusing effect on the retina. This effect was probably increased in our patient by the use of a new autofocus multifocal lens.
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ranking = 1
keywords = phacoemulsification
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7/18. Single-piece hydrophobic acrylic intraocular lens explanted within the capsular bag: case report with clinicopathological correlation.

    A 74-year-old woman had uneventful phacoemulsification with implantation of a single-piece hydrophobic acrylic intraocular lens (IOL) (SA30AL) in her left eye. Two weeks after the surgery, the patient presented for ophthalmological consultation reporting pseudophakic dysphotopsia, which she had subjectively noted since surgery. Explantation/exchange of the IOL was performed 3 months after the surgery. The IOL was strongly attached to the capsule, which was fibrotic and contracted; explantation of the capsular bag complex in toto was done. To our knowledge, this is the first case of explantation of this IOL design with clinicopathological correlation.
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ranking = 1
keywords = phacoemulsification
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8/18. Eccentric capsulorhexis and postoperative dysphotopsia following phacoemulsification.

    We report a case of troublesome visual symptoms or dysphotopsia in a 68-year-old patient after right phacoemulsification and implantation of a 3-piece AcrySof(R) MA60BM acrylic intraocular lens (IOL) (Alcon) in the capsular bag. The patient described multiple horizontal streaks in dim lighting conditions with light sources in the right temporal visual field. The anterior capsulorhexis was eccentric, leaving the nasal optic edge and site of polypropylene haptic insertion uncovered by the semi-opaque anterior capsule and the probable source of the flare images. Miotic therapy was poorly tolerated and IOL exchange declined. The case illustrates the importance of creating a central capsulorhexis smaller than the IOL optic to reduce the risk photic phenomena and edge effect with square-edged IOLs.
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ranking = 5
keywords = phacoemulsification
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9/18. Evaluation of calcification of a hydrogel intraocular lens by optical coherence tomography.

    We describe 2 cases of calcification of hydrogel intraocular lenses (IOLs) evaluated by optical coherence tomography. Dense or slight surface opacities of hydrogel IOLs were detected initially by slitlamp biomicroscopy in a 55-year-old woman and a 77-year-old woman. The opacities resulted in complaints of hazy vision after uneventful phacoemulsification and IOL implantation. Optical coherence tomography was used to further assess the opacities and showed calcification by high reflectivity on the anterior and posterior IOL surfaces in the first patient and on the anterior surface in the second patient. No abnormal reflectivity was seen on the surface of a hydrophobic acrylic IOL in the second patient's fellow eye. Optical coherence tomography may be useful to detect calcification of a hydrogel IOL.
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ranking = 1
keywords = phacoemulsification
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10/18. Total iris expulsion through a sutureless cataract incision due to vomiting.

    PURPOSE: To present a case of isolated total iris expulsion through a self-sealing cataract incision 2 weeks postoperatively due to vomiting. methods: Ophthalmological examination included visual acuity assessment, tonometry, slit-lamp examination, fundus ophthalmoscopy and ultrasound examination. RESULTS: A 65-year-old woman experienced sudden visual loss during an episode of vigorous vomiting 2 weeks after uncomplicated phacoemulsification cataract surgery with a sutureless corneal incision. Clinical examination showed a dense anterior chamber haemorrhage. When the blood had cleared, isolated total aniridia was seen. CONCLUSIONS: This is the first reported case of aniridia after cataract surgery due to vomiting.
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ranking = 1
keywords = phacoemulsification
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