1/21. Refractive error in cataract surgery after previous refractive surgery.Bilateral cataract extraction with posterior chamber intraocular lens (IOL) implantation was performed in a patient after previous photorefractive keratectomy, radial keratotomy (RK) combined with astigmatic keratotomy, and retreatment of RK. Significant hyperopic error was observed after cataract surgery, and the IOLs were eventually exchanged in both eyes. A review of this case found that the refractive error was smaller when a refraction-derived keratometric value was selected for IOL power calculation. Nevertheless, hyperopic error still occurred.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/21. Contact lens fitting difficulties following refractive surgery for high myopia.PURPOSE: To describe the clinical and optical problems encountered in contact lens fitting following refractive surgery for high myopia. methods: Following refractive surgery for high myopia (greater than -10.00 D) we corrected residual refractive errors with contact lenses in the four eyes of two patients. The first patient had undergone bilateral laser in situ keratomileusis (LASIK),with two subsequent LASIK retreatments in the left eye. Ten months later she was fit with rigid gas permeable (RGP) lenses in both eyes. The second patient had undergone a clear lens extraction in the right eye and radial keratotomy followed by photorefractive keratectomy(PRK) in the left eye. She was fit with toric soft lenses six years postoperatively. RESULTS: Final visual acuity obtained with contact lenses was 20/25-20/20 in all eyes. The first patient required significant minus lens power compensation. Furthermore, the RGP lens in the left eye was slightly decentered due to corneal irregularity induced by LASIK. The second patient had regular corneal surfaces and was successfully fit with daily wear toric soft lenses despite the 2.75 D of residual astigmatism in the left eye. CONCLUSIONS: Following refractive surgery for high myopia a proportion of patients will remain undercorrected. In these patients the alterations in corneal architecture that ensue make contact lens fitting more challenging. patients with regular astigmatism may be fitted successfully with toric soft lenses. patients with corneal irregularities should be fit with RGP lenses.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/21. Clear lens extraction and intraocular lens implantation in Marfan's syndrome.Intracapsular clear crystalline lens extraction and intraocular lens (IOL) implantation were performed in 4 highly myopic eyes of 2 patients with Marfan's syndrome. One eye of each patient received an anterior chamber IOL and the other, a scleral-fixated posterior chamber IOL. The preoperative spherical equivalent ranged between -14.50 and -28.00 diopters (D) and axial length range, between 25.32 and 36.02 mm. The SRK II formula was used. Mean uncorrected visual acuity improved from counting fingers to 20/80. Postoperative spherical equivalent correction ranged from -0.75 to 2.75 D. One eye had vitreous loss that was managed by anterior vitrectomy. Modern surgery for cataract and management of its complications suggest that clear crystalline lens extraction and IOL implantation can be attempted in selected cases with Marfan's syndrome.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |
4/21. Piggyback silicone intraocular lenses of opposite power.A patient with high myopia and astigmatism had cataract extraction with implantation of 2 silicone intraocular lenses (IOLs) of opposite power (ie, 1 plus and 1 minus). A Staar AA4203TL toric IOL ( 9.50 diopters [D]/3.50 D) and a Staar AQ5010V additive lens (-3.00 D) were used to correct both the astigmatism and the high myopia. The use of the 2 lenses was necessary because the toric IOL was not available in low dioptric powers. A crystalline interpseudophakos deposit developed after 1 week and resolved after 4 weeks. Three months postoperatively, the patient had an uncorrected visual acuity of 20/25.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/21. vitreous hemorrhage following phakic anterior chamber intraocular lens implantation in severe myopia.PURPOSE: To describe two cases of vitreous hemorrhage following phakic anterior chamber lens (AC-IOL) implantation in high myopia. CASE REPORT: In case 1, hemorrhage developed one month after surgery, without retinal involvement, and visual acuity (VA) resulted 20/200 after pars-plana vitrectomy (PPV). In Case 2, vitreous hemorrhage was complicated by retinal detachment (RD). PPV and silicone oil injection were performed, with AC-IOL removal and cristalline lens extraction. After 2 years the retina was attached and VA was 20/80. DISCUSSION: Only few cases of RD, posterior uveitis and endophthalmitis are reported following phakic AC-IOL implant. vitreous hemorrhage could represent an additional posterior segment complication. Intraoperative manoeuvres, hypotony-induced posterior vitreous detachment and/or peripheral retina traction could play a role in engendering this complication in highly myopic eyes.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/21. Surgical identification of posterior lenticonus.A 79-year-old patient was referred for cataract and high myopia. His optometrist noted difficult refraction. biometry predicted an emmetropic intraocular lens power of 22.0 diopters. During cataract extraction, the typical features of posterior lenticonus were noted. A careful look for posterior lenticonus is suggested in cases in which there is a discrepancy between the biometry and refraction and no significant nuclear sclerosis to account for the high myopia. Surgeons should be aware of dehiscence or thinning of the posterior capsule while doing cataract extraction in these patients.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
7/21. Surgery for 4 refractive errors in 1 patient.We report a case of cataract extraction with implantation of a multifocal intraocular lens (IOL) after photorefractive keratectomy for myopia and astigmatism and subsequent laser thermal keratoplasty for surgically induced hyperopia. Good refractive results were obtained using standard biometry techniques for calculation of the IOL power.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/21. Clear lens extraction for the treatment of persistent accommodative spasm after head trauma.We report the case of a 28-year-old man with decreased visual acuity after closed head trauma sustained in a motor vehicle accident 16 weeks earlier. Several structures thought to be associated with the control of accommodation were injured. The patient had a persistent accommodative spasm causing up to 7.0 diopters of pseudomyopia. We present the patient's progress through the clinic, including manifest and cycloplegic refractions and results of a trial with atropine drops, and successful transition to bilateral pseudophakia 2 years and 9 months after the accident.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
9/21. Secondary artisan phakic intraocular lens for correction of progressive high myopia in a pseudophakic child.An 8-week-old infant underwent unilateral cataract extraction and posterior chamber intraocular lens implantation for total cataract in the left eye. After surgery, a residual progressive myopic error was observed, ranging from -4.5 diopters (D) 6 months after the operation to -14.0 D at the age of 3 years. Because of parental noncompliance for contact lens and spectacles use, secondary implantation of Artisan phakic IOL of -14.0 D power was performed. No intra- or postoperative complications were observed. Nine months after this second operation, myopia diminished to -3.25 D.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
10/21. Genetic spontaneous late subluxation of the lens. A study of two families.patients with genetic spontaneous late subluxation of the lens may present signs and symptoms other than lens displacement due to secondary anatomic alteration of the anterior segment. Two families are described, one of them with affected individuals in five successive generations. The vast majority of the patients sought consultation because of progressive myopia or intermittent acute intraocular hypertensive crisis which obscured the basic condition. Upon recognition of the disease, the affected patients underwent an uneventful intracapsular extraction. Histopathologic examination of the removed lenses suggested a dysplastic development of lens zonules.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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