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IBM 9.7 test

Intraocular Lens Opacification Following Silicone Oil Endotamponade | 000-544 Braindumps and Dumps

Introduction

at present, intraocular lens (IOL) opacification is a infrequent but a well-recognized late-term complication of cataract surgery.1–12 despite the fact a couple of stories have proven late opacifications of polymethylmethacrylate,1,2 silicone,3,four hydrophilic acrylic,5–19 and hydrophilic acrylic lined with hydrophobic surface IOL designs,20,21 visually colossal opacification leading to IOL explantation is commonly stated in instances with hydrophilic acrylic IOLs.12–20

these days published case studies have tested opacified hydrophilic acrylic IOLs after ocular surgical procedures corresponding to corneal transplantation approaches involving diverse injections of intracameral gas or vitreoretinal interventions mixed with intravitreal SF6 or C3F8 gas injections.6–10,14–sixteen Gross and histochemical analysis of explanted hydrophilic acrylic IOLs published that calcium phosphate crystalline deposits on or in the optic fabric are the leading intent of opacification.20–23 because various factors may be the reason behind such calcification, which has been attributed to IOL cloth itself, presence of phosphate add-ons within the ophthalmic viscosurgical contraptions (OVDs) or calcium within the irrigating solutions used all over phacoemulsification surgical procedure, as neatly because the supersaturated content of aqueous humor, the accurate mechanism remains unknown.22–25 although, opacification following silicone oil (SO) injection is a less widely wide-spread phenomenon.18,19 Herein, they file a case collection of 32 eyes with IOL opacification following vitrectomy and SO injection.

sufferers and strategies

Thirty-two eyes of 31 patients with the prognosis of IOL opacification between September 2010 and can 2019 were evaluated retrospectively. All sufferers had been pointed out Dokuz Eylul school, department of Ophthalmology, with the prognosis of rhegmatogenous retinal detachment and had a historical past of outdated phacoemulsification with hydrophilic acrylic IOL implantation. In all eyes, because of the presence of huge, multiple and/or inferior tears with or with out proliferative vitreoretinopathy (PVR) immediate 23- or 25-gauge pars plana vitrectomy (PPV) become performed the usage of 1,300 centistoke (cs) SO endotamponade (Oxane; Bausch + Lomb, Rochester, big apple). Silicone oil removal (SOR) was performed with two-port 23- or 25-gauge vitrectomy, where SO was exchanged with balanced salt answer (BSS; Alcon Laboratories, fort worth, TX).

Demographics as smartly as the information concerning the ophthalmologic examinations, together with gold standard-corrected visible acuity (BCVA), intraocular pressure, slit-lamp and retina evaluation including B-scan ultrasonography scans of all analyze members, have been recorded. particulars about their old cataract surgeries have been collected from their old scientific facts. The prognosis of IOL opacification became based on slit-lamp biomicroscopy. All opacified IOLs were exchanged by using the equal surgeon (AY) after a written advised consent was provided and signed with the aid of the affected person. This look at changed into performed in line with the ethics standards of the institutional evaluation board and with the Helsinki assertion.

In IOL exchange surgery, following topical anesthesia, the anterior chamber (AC) and the capsular bag have been filled with a cohesive OVD (Healon GV; superior clinical Optics, Santa Ana, CA), and the anterior pill become cautiously separated from the opacified IOL floor. as a result, the IOL become subluxated into the AC, the place it become either folded with microforceps or divided into two halves with scissors and eliminated via a transparent three.5-mm corneal incision. a three-piece hydrophobic acrylic IOL (Acrysof MA60AC; Alcon, castle price, TX) became then implanted into the capsular bag or ciliary sulcus in keeping with the presence of each posterior capsular and zonular integrity. In two situations with colossal zonular weak spot, 13-mm Morcher Cionni-modified capsular anxiety rings class 2L had been inserted into the capsular bag and fixated to the sclera at 3-o'clock and 9-o'clock quadrants the use of 9-0 polypropylene looped-sutures with a long curved needle (workstation-9; Alcon Surgical, fortress value, TX).

The explanted IOLs have been kept in dry state and despatched to the Intermountain Ocular research middle (John A. Moran Eye middle, college of Utah) for extra evaluation, where unstained specimens had been evaluated and photographed under a light-weight microscope (Olympus Optical Co., Ltd., Tokyo, Japan). The specimens have been rinsed individually in distilled water, and immersed into 1% alizarin purple answer, which is a different stain for calcium, for 20 minutes. They have been additionally rinsed once more in distilled water earlier than the reexamination below the gentle microscope.

The facts had been stored on a computerized database and analyzed using SPSS edition 22.0 statistical utility (IBM, Armonk, new york). After normality became tested with Shapiro-Wilk examine, paired samples t-check turned into used for the statistical evaluation of the visual acuity alteration in eyes underwent IOL change surgery, and a P price of below .05 become considered as significant.

effects

The suggest age of the patients changed into fifty seven.0 ± 13.5 years (range: 26–seventy nine years) within the preliminary prognosis of IOL opacification; 12 (38.7%) have been feminine and 19 (61.3%) had been male. they had no concomitant systemic disorder other than hypertension in three cases (9.7%). five eyes (15.6%) had a previous history of excessive myopia (≥ 7.0 diopters), which changed into the most effective ocular abnormality within the complete study inhabitants. All situations had gone through phacoemulsification with hydrophilic acrylic IOL implantation between October 2003 and September 2014. Sixteen eyes (50%) had a posterior capsular defect as a result of posterior capsular rupture throughout surgery in nine eyes (28.1%) and postoperative YAG capsulotomy in seven eyes (21.9%).

The mean duration between phacoemulsification and retinal detachment became 23.9 ± 21.2 months (range: 1–ninety three months) (table 1). In specified slit-lamp examination, earlier than detachment surgery there changed into no proof of opacification and the mean preoperative BCVA was 20/400 (latitude: 20/2000-20/forty). all over the comply with-up after vitrectomy, three eyes (9.4%) underwent reoperation with inferior retinectomy and SO exchange because of superior inferior PVR under SO. together with those reoperated eyes, the suggest length of SO endotamponade changed into four.6 ± 2.0 months (latitude: three–7 months).

Demographics and Ophthalmologic Findings (32 Eyes of 31 Cases)

table 1:

Demographics and Ophthalmologic Findings (32 Eyes of 31 instances)

apart from two eyes, all IOL opacification become detected right through the follow-up duration following SOR (determine 1). In these two eyes, opacification turned into detected beneath SO 14 weeks and 18 weeks after the first surgical procedure. that they had both required reoperation with inferior retinectomy and SO alternate. one of them changed into a hydrophilic acrylic IOL coated with hydrophobic floor. imply interval between SOR and IOL opacification changed into 22.0 ± 18.6 months (latitude: 3–88 months). surgical procedure for IOL alternate become carried out in 12 eyes (37.5%) having enormous visual impairment. among them, the imply BCVA become 20/50 (latitude: 20/200–20/32) just after SOR whereas 20/seven-hundred (range: 20/2000–20/200) following opacification; and became 20/sixty three (range: 20/400–20/25) after the IOL change surgical procedure (P = .096 and P = .001, respectively). Demographics and medical facets of the study population have been proven in desk 1. In eyes that IOL alternate become not required, all through the long-term follow-up (imply: forty seven.3 ± 22.1 months), IOL opacification remained sturdy in size and placement.

Opacified intraocular lens (IOL) was diagnosed on slit-lamp biomicroscopy. Bulky deposits could be easily seen (A); however, more fine and diffuse deposits located on the surface of the IOL optic required more elaborate examinations with slit-lamp (B).

figure 1.

Opacified intraocular lens (IOL) was diagnosed on slit-lamp biomicroscopy. bulky deposits could be readily considered (A); youngsters, more satisfactory and diffuse deposits determined on the floor of the IOL optic required greater problematic examinations with slit-lamp (B).

Gross contrast of the explanted IOLs published an glaring whitish colour alternate on the optic floor with incredibly clear haptics. gentle microscopy showed the presence of distinctive best granular deposits covering the optical surfaces of the opacified IOLs in a circular trial located in the enviornment of haze or such whitish discoloration. however first-rate granules had been present on each optical surfaces, they have been greater well-liked on the anterior optic surface of the explanted IOLs. The haptics were found to be freed from such deposits in all evaluated specimens. Histochemical evaluation with alizarin crimson printed massive calcification in the main on the floor of all lens optics; although, two had pigmentary dispersion on the floor of the loops (figure 2).

Light microscopy of the explanted intraocular lenses revealed severe calcification (A–F). Calcified deposits could be seen mostly on the surface/subsurface of the lens optics. Such light photomicrographs exhibit pigmentary dispersion, which could be seen on the surface of the loops, and other deposits including surface contaminants such as fibers, dust-like deposits, as well as crystals probably corresponding to dried viscoelastic or balanced salt solutions used in the explantation surgery (A–F).

determine 2.

light microscopy of the explanted intraocular lenses revealed extreme calcification (A–F). Calcified deposits may be seen generally on the surface/subsurface of the lens optics. Such easy photomicrographs demonstrate pigmentary dispersion, which may well be considered on the floor of the loops, and other deposits together with floor contaminants equivalent to fibers, grime-like deposits, as well as crystals probably corresponding to dried viscoelastic or balanced salt solutions used in the explantation surgery (A–F).

discussion

IOL opacification is rare additionally but one of the most annoying late-term issues of cataract surgical procedure and often results in explantation of opacified IOL as a result of visible impairment.9–28 despite the fact a couple of authors have published about late opacification with different IOL substances and designs, it has been commonly stated in hydrophilic acrylic IOLs in the literature.1–21 Calcification is proven because the major explanation for opacification in hydrophilic acrylic IOLs.13–17,20–23 according to the literature opacification may well be a first-rate calcification that's connected with the IOL itself or the metabolic changes in the aqueous humor secondary to breakdown in blood-aqueous barrier (BAB) can also set off the calcification method.20–23 youngsters, any affected person linked factors haven't been confirmed yet; concomitant systemic conditions such as diabetes, persistent kidney ailment, gout, and hyperparathyroidism, as well as ocular problems together with diabetic retinopathy, pseudoexfoliation, glaucoma, uveitis, asteroid hyalosis, or extreme postoperative inflammation, are alleged to trigger such calcification method by means of predisposing to provide crystalline deposits within aqueous humor, or increase the irritation that facilities BAB breakdown.2,11–17,20–24

From the standpoint of IOL opacification, the interaction of hydrophilic IOLs with SO is not smartly documented. Lee et al.29 stated a case of calcium deposits on the floor of an explanted C-flex 570C hydrophilic lens (Rayner international, Worthin, uk), which developed 6 months after SOR in a 24-year-historical myopic feminine who had oil within the eye for 3 months after retinal detachment repair. shut commentary below slit-lamp examination published neatly-demarcated uniform focal granular protrusions, which differed from inflammatory particles or iris pigments on the IOL floor. They claimed that such opacification isn't attributable to fundamental calcification led to by using the IOL material or the manufacturing or packaging method, however somewhat to a secondary calcification process brought on by means of environmental components.

Gregori et al.18 reported Akreos hydrophilic acrylic IOL (Akreos AO60; Bausch + Lomb, Rochester, new york) opacification under SO 5 months postoperatively. They outlined that opacity didn't magnify after SOR and remained strong in look. Rubin and Baker19 mentioned a further case of Akreos opacification associated with 5,000 cs SO (Bausch + Lomb, Rochester, big apple) tamponade. during the deliberate SOR, attempts to scrub the surfaces of the Akreos IOL were now not successful.

it's all the time complicated to determine the real onset of opacification, on the grounds that visual deterioration may additionally no longer be huge at the beginning in lots of instances. however, literature exhibits that situations required IOL explantation all through their second or third 12 months after the implantation.12,20,22,30 The imply interval between phacoemusification surgery and IOL opacification turned into 27.four ± 18.3 months, and the historical past of SO endotamponade turned into the regular finding in their examine population. They additionally had two eyes with IOL opacification below SO endotamponade. prolonged publicity to SO might also have an further affect on opacification in prone IOLs by means of facilitating the precipitation of calcium on the surface of IOL.

Localized anterior optical surface calcification turned into stated according to vitreous tamponade with gasoline or SO within the literature, and migration of such endotamponade agents into anterior chamber (AC) through zonular fiber defects become attributed because the feasible cause in circumstances underwent vitrectomy surgical procedure.9,10,25,29 nonetheless, there had been a lack of records about SO migration into the AC by way of ruptured posterior capsule or zonular defects in such circumstances. Any accumulation of emulsified SO droplets were now not Tested in the AC of any examine patients.

In a analyze of the structural qualities of hydrophilic acrylic IOLs, Gartaganis et al.31 recommended that the surface hydroxyl groups on the polyacrylic materials facilitate precipitation of hydroxyapatite. Such precipitation happens much more drastically when the aqueous humor is supersaturated with calcium. besides the fact that children the presence of an intact posterior lens capsule and the lack of direct physical contact of the SO bubble with the IOL surface all the way through surgical procedure or later on of their two instances with opacified IOL after PPV and SO injection, Gartaganis et al.21 accused the accelerated intraocular irritation involving combined surgery for the opacification. regardless of a lack of extended intraocular inflammation, a short-term disruption of the BAB changed into thought to be a leading trigger for increased intraocular calcium attention and related IOL opacification of their situations. In their examine, all eyes had a historical past of SO endotamponade and opacifications have been in a similar fashion located on the anterior facet of the explanted IOLs. They hypothesized that surgery raises each irritation and calcium awareness within the AC and SO might also have an further affect on the AC calcium to attain height degrees so that it regularly accumulates on the anterior side of the IOL. This manner continues slowly even after SOR except all calcium crystals in AC precipitates on IOL surface and then opacification is still solid.

Posterior capsular defect become present in 50% of their complete study community. even though it become current in five out of 12 eyes that underwent IOL explantation surgical procedure (forty one.7%), having such defect did not display any extra abnormalities on each gross macroscopic and light-weight microscopic findings when compared to the ultimate seven eyes with intact posterior tablet. hence, it is thought that presence of a posterior capsular defect does not have a major influence on IOL opacification.

To the better of their knowledge, here is the first report of a comparatively colossal case series in hydrophilic acrylic IOL opacification after vitreoretinal surgery with SO tamponade. Vitreoretinal surgeons should still be aware about that some hydrophilic IOLs may have the expertise of opacification following SO endotamponade and want to be followed-up for longer durations even after SOR.

References
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  • Łabuz G, Yildirim TM, van den Berg TJTP, Khoramnia R, Auffarth GU. assessment of straylight and the modulation transfer characteristic of intraocular lenses with centrally localized opacification linked to the intraocular injection of gas. J Cataract Refract Surg. 2018;forty four(5):615–622. doi:10.1016/j.jcrs.2018.01.033 [CrossRef] PMID:29891155
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  • Oner HE, Durak I, Saatci OA. Late postoperative opacification of hydrophilic acrylic intraocular lenses. Ophthalmic Surg Lasers. 2002;33(four):304–308. PMID:12134990
  • Werner L, Michelson J, Ollerton A, Leishman L, Bodnar Z. Anterior section optical coherence tomography in the assessment of postoperative intraocular lens optic alterations. J Cataract Refract Surg. 2012;38(6):1077–1085. doi:10.1016/j.jcrs.2012.01.027 [CrossRef] PMID:22624909
  • Lee SJ, Choi JH, sun HJ, Choi KS, Jung GY. surface calcification of hydrophilic acrylic intraocular lens related to inflammatory membrane formation after combined vitrectomy and cataract surgery. J Cataract Refract Surg. 2010;36(four):676–681. doi:10.1016/j.jcrs.2009.08.045 [CrossRef] PMID:20362864
  • Barra D, Werner L, Costa JLP, et al. mild scattering and light transmittance in a collection of calcified single-piece hydrophilic acrylic intraocular lenses of the equal design. J Cataract Refract Surg. 2014;40(1):121–128. doi:10.1016/j.jcrs.2013.10.015 [CrossRef] PMID:24269137
  • Gartaganis SP, Kanellopoulou DG, Mela EK, Panteli VS, Koutsoukos PG. Opacification of hydrophilic acrylic intraocular lens because of calcification: investigation on mechanism. Am J Ophthalmol. 2008;146(3):395–403. doi:10.1016/j.ajo.2008.04.032 [CrossRef] PMID:18602078
  • table 1

    Demographics and Ophthalmologic Findings (32 Eyes of 31 situations)

    Age (Years)57.0 ± 13.5GenderFemale (n; %)12; 38.7Male (n; %)19; 61.3Posterior capsuleIntact (n; %)16; 50.0Ruptured (n; %)9; 28.1YAG-laser capsulotomy (n; %)7; 21.9Period between IOL implantation and RD surgical procedure (months)23.9 ± 21.2Period between YAG-laser capsulotomy and RD surgery (months) (n=7)3.7 ± 2.9Recurrence of RD (n; %)three; 9.4Total duration for thus tamponade (months)four.6 ± 2.0Period between IOL implantation and the analysis of IOLo (months)51.2 ± 27.4Period between RD surgery and the diagnosis of IOLo (months)27.four ± 18.3Period between SOR and the analysis of IOLo (months) (n=30)22.0 ± 18.6Mean BCVA on the postoperative first month visit of SOR (ETDRS)20/61 ± 20/87Mean BCVA on the time of IOLo diagnosis (ETDRS)20/161 ± 20/125Follow-up length after the diagnosis of IOLo (months)forty seven.3 ± 22.1Total follow-up (months)67.0 ± 23.5Patients underwent IOL change (n; %)12; 37.5Period between IOL implantation and exchange surgical procedures (months)65.8 ± 18.6Period between the analysis of IOLo and change surgical procedure (months)12.eight ± 10.5Explanted IOLs (n; %)  Hydrophilic acrylic cloth  Hydrophilic acrylic fabric covered with hydrophobic surface11; ninety one.seventy one; eight.3Implanted IOL type in trade surgery  positioned inner the capsular bag (n; %)  positioned in the ciliary sulcus (n; %)Acrysof MA60AC6; 50.06; 50.0Follow-up period after IOL trade surgery (months)30.8 ± 16.2Mean BCVA on the postoperative first month talk over with of SOR (ETDRS)20/50 ± 20/124Mean BCVA on the time of IOLo diagnosis (ETDRS)20/seven hundred ± 20/529Mean BCVA at the final comply with-up discuss with (ETDRS)20/sixty three ± 20/88

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