Survival analysis for success of Molteno tube implants.
(9/105)
AIM: To apply survival analysis in assessing the long term outcome of Molteno tube implantation and to identify risk factors for failure. METHODS: A retrospective, 10 year, consecutive case series study of 119 eyes that underwent implantation of a Molteno tube. The main outcome measures considered were intraocular pressure (IOP), visual acuity, and complications. RESULTS: A 30% or greater reduction in IOP was achieved in 68.9% of cases. However, the overall, "complete success" rate (IOP <22 mm Hg with no medications) after a mean (SD) follow up period of 43 (33) months (range 6-120) was only 33.6% despite a fall in mean (SD) IOP from 38.2 (8.2) mm Hg to 20.1 (11.0) mm Hg. The "qualified success" rate (IOP <22 mm Hg with or without medications) was 60.5%. Failure was most common in the first postoperative year but could occur after several years, the survival curve having an exponential shape. The only statistically significant risk factor for failure identified was pseudophakia, although eyes with neovascular glaucoma tended to fare poorly. Postoperative IOP tended to be lower after double plate than after single plate implantation. There was no significant difference in outcome based on age, sex, race, previous penetrating keratoplasty, or previous conjunctival surgery. CONCLUSIONS: In eyes at high risk of trabeculectomy failure, implantation of an aqueous shunt device should be considered. Pseudophakia should be considered an additional risk factor for failure. Early failure appeared relatively more common but long term follow up of all cases is recommended to ensure adequate management of late failures. (+info)
Herpes simplex virus bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma: an unusual presentation.
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PURPOSE: To report an unusual case of herpetic bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma. RESULTS: A retrospective analysis of the case record of a 60-year-old man who had earlier undergone bilateral cataract surgery, was done. He presented with a complaint of decrease in vision in the right eye of 20 days duration. On examination, cornea showed epithelial bullae all over the surface with stromal and epithelial edema. Intraocular pressure was 30 mm of Hg in RE. He was treated with anti-glaucoma medications. Two dendritic lesions were seen in the cornea during a subsequent visit four days later. Virological investigations confirmed a diagnosis of Herpes simplex keratitis. He was treated with topical acyclovir. CONCLUSIONS: This case highlights the fact that herpes simplex keratitis can present initially as a more diffuse corneal stromal and epithelial edema with epithelial bullae mimicking bullous keratopathy. Herpetic bullous keratitis, although unusual, should be considered in the differential diagnosis under such circumstances. (+info)
Popped eye (blunt trauma leading to penetrating eye injury and lens displacement in the pseudophakic eye).
(11/105)
Blunt trauma to the eye of patients with an artificial intraocular lens may cause globe rupture with all the accompanying sequelae. It must be recognised promptly and dealt with appropriately before urgent referral to ophthalmology. (+info)
A comparative assessment of endothelium from pseudophakic and phakic donor corneas stored in organ culture.
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AIMS: To evaluate the endothelial quality of corneas obtained from pseudophakic donors and to compare the data with matched phakic controls. METHODS: Corneas from eyes with posterior chamber intraocular lenses (PCIOLs) and corneas from phakic eyes (controls) were stored for 1-2 weeks in organ culture and then examined after staining with Alizarin red S. The corneas were divided into two groups according to the duration of storage. Endothelial cell density, the percentage of hexagonal cells, and the coefficient of variation (CV) were determined. RESULTS: There was no statistically significant difference between the 14 PCIOL corneas and the 13 controls stored in organ culture for 7 days for any of the three parameters studied. The mean cell density was 2155 (SD 529) cells/mm(2) in the PCIOL corneas and 2118 (453) cells/mm(2) in the controls (p=0.85). The mean percentage of hexagonal cells was 52% (8%) and 58% (7%), respectively (p=0.06). The mean CV was 0.32 (0.18) in the pseudophakic corneas and 0.39 (0.18) in the controls (p=0.33). Moreover, there was no significant difference between the PCIOL corneas and the controls stored for up to 2 weeks. CONCLUSIONS: The corneal endothelium from eyes with PCIOLs appears to be similar to that of phakic eyes after 1-2 weeks in organ culture. This finding suggests that corneas from pseudophakic eyes should not routinely be disqualified for transplantation. The use of at least some pseudophakic corneas may substantially increase the potential donor pool. (+info)
Bipseudophakia. Clinicopathological findings of a pseudophakic human globe obtained postmortem implanted with an anterior chamber and a posterior chamber intraocular lens.
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We report the clinicopathological findings of a human pseudophakic globe obtained postmortem, containing both anterior and posterior chamber intraocular lens, a condition we termed "bipseudophakia". (+info)
Pupillary block glaucoma following implantation of a posterior chamber pseudophakos in the anterior chamber.
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Pupillary block glaucoma is a common complication of cataract surgery, especially following anterior chamber intraocular lens implantation. We report a case of pupillary block glaucoma with a posterior chamber IOL that was implanted in the anterior chamber following a complicated extracapsular cataract extraction. The case was successfully managed by explantation of the posterior chamber lens, anterior vitrectomy, peripheral iridectomy and secondary anterior chamber intraocular lens implantation. The intraocular pressure was controlled with a single topical antiglaucoma medication. (+info)
Prospective randomised double-masked trial of bilateral multifocal, bifocal or monofocal intraocular lenses.
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AIMS: To evaluate the functional effect of bilateral implantation of two different multifocal intraocular lenses (IOL) compared with the standard monofocal IOL. METHODS: Sixty-nine patients were recruited into a prospective, double-masked, randomised, controlled trial at a single hospital in the United Kingdom. Sixty completed follow-up; 16 implanted with monofocal IOLs, 29 with AMO 'ARRAY' multifocal IOLs and 15 with Storz 'TRUEVISTA' bifocal IOLs. Phacoemulsification and IOL implantation was performed to a standardised technique in both eyes within a 2-month period. The main outcome measures were distance and near visual acuity, depth of field and validated assessment of subjective function (TyPE questionnaire). RESULTS: naided distance acuity was good, and equivalent across the three groups. Corrected distance acuity was significantly lower in the bifocal group. Patients with multifocal and bifocal IOLs could read smaller absolute print size than those in the monofocal group (P = 0.05), but at a closer reading distance such that mean unaided near acuity was equal in the three groups. Corrected near acuity was significantly higher in the monofocal control group (P < 0.05). Depth of field was increased in multifocal (P = 0.06) and bifocal (P = 0.004) groups. Overall visual satisfaction was equal in the three groups, while near visual satisfaction was higher in the multifocal group than the monofocal (P = 0.04). Spectacle independence was not seen in the monofocal group, but was achieved in 28% of multifocal IOL patients and 33% of bifocal patients (P < 0.001). Adverse symptoms such as glare and haloes were significantly more bothersome with multifocal (not bifocal) IOLs than monofocals (P = 0.01). CONCLUSIONS: Multifocal and bifocal IOLs improved unaided near vision performance, with around one in three patients becoming spectacle-independent. The main adverse effect was an increased incidence of subjective glare and haloes in the multifocal IOL group. (+info)
Apparent accommodation and corneal wavefront aberration in pseudophakic eyes.
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PURPOSE: To assess the relationship between apparent accommodation in pseudophakic eyes, multifocal corneal effects, and wavefront aberrations of the cornea. METHODS: In 102 eyes of 86 patients who had undergone phacoemulsification and posterior chamber intraocular lens implantation, the amount of apparent accommodation was measured with an accommodometer. The degree of corneal multifocality was determined on the corneal topography by measuring the maximum and minimum corneal refractive powers within the pupillary area. Wavefront aberrations of the cornea were calculated by expanding the height data of the corneal topography into Zernike polynomials for individual pupil size. The influence of higher-order aberration on the retinal image quality was simulated by computing the point-spread function (PSF) and modulation-transfer function (MTF) from the aberration function. RESULTS: There was a significant positive correlation between the amount of apparent accommodation and corneal multifocality (Pearson correlation coefficient, r = 0.451, P < 0.001). The coma-like aberration showed a significant positive correlation with the amount of apparent accommodation (r = 0.440, P < 0.001), but the spherical-like aberration did not (r = 0.001, P = 0.993). Among the coma-like aberrations, the component representing vertically asymmetrical distribution of corneal refractive power with greater refraction located in the lower part of the eye was most relevant to apparent accommodation. Computer simulation of PSF and MTF indicated that a focus shift of 0.5 D deteriorated the retinal image significantly more in eyes without higher-order aberrations than in eyes with a moderate amount of coma-like aberrations. CONCLUSIONS: Coma-like aberration of the cornea, along with corneal multifocality, contributes to apparent accommodation in pseudophakic eyes. (+info)