PRÉCIS:The presence of anterior capsular laxity caused acute angle closure glaucoma, and posterior capsular laxity alone was associated with a chronic progressive course, revealing new insight into the pathogenesis of primary angle closure disease. PURPOSE:This study investigates the association between anterior or posterior capsular bag laxity during cataract surgery and clinical characteristics in patients with primary angle closure disease (PACD). METHODS:This retrospective study included 137 patients (200 eyes) diagnosed with PACD and undergoing phacoemulsification cataract surgery. Patients were categorized into 4 groups based on the condition of the capsular bag: loose anterior capsular bag (LACB), loose posterior capsular bag (LPCB), loose anterior and posterior capsular bag (LAPCB), and stable capsular bag (SCB). We analyzed the association of capsular bag laxity with clinical characteristics using ANOVA and χ 2 . RESULTS:Significant differences were observed among the groups in terms of sex, disease duration, anterior chamber depth (ACD), lens vault (LV), and lens Front R, while age, PACD classification, mean corneal power, axial length, and lens thickness showed no significant variation. The ACD was notably deeper in the LPCB and SCB groups. The LV was higher, and the lens Front R was smaller in the LACB and LAPCB groups. Lens Back R varied more in the LPCB group. Anterior capsular laxity, alone or combined with posterior capsular laxity, was more prevalent in cases of acute angle closure glaucoma (ACG) (56.0%) compared with chronic ACG (19.4%). Posterior capsule laxity alone was more common in chronic ACG (45.2%) than in acute ACG (10.7%). CONCLUSION:The presence of anterior capsular laxity, with or without posterior capsular laxity, is associated with the development of acute ACG, whereas posterior capsular laxity alone is typically linked to the development of chronic ACG.

To evaluate the peripheral vitreoretinal abnormality (PVA) and its correlation with the risk of malignant glaucoma (MG) in nanophthalmos with secondary angle closure glaucoma (NSACG). This prospective case series included 47 NSACG eyes with axial length (AL) < 21 mm from 25 patients. PVA was defined as a hyperreflective echo at the peripheral vitreoretinal region under ultrasound biomicroscopy (UBM). Eyes were categorised into two groups based on the presence (PVA group) or absence (NPVA group) of PVA. AL, lens thickness (LT), radius of corneal curvature (K1: flat, K2: steep), and corneal cylinder degree (CYL) were measured by IOL-Master. Anterior chamber depth (ACD), lens vault (LV), corneal limbus thickness (CLT), trabecular-ciliary processes distance (TCPD) and angle (TCPA), and peripheral iris thickness (PIT) were measured by UBM. MG incidence was recorded during a minimum 2-year follow-up. PVA was detected in 29 eyes(62

BACKGROUND:This study aims to investigate the morphologic features of the crystalline lens in Primary Angle Closure Disease (PACD) patients with zonular instability during cataract surgery using the swept-source CASIA 2 Anterior Segment-Optical Coherence Tomography (AS-OCT) system.METHODS:A total of 398 eyes (125 PACD eyes with zonular instability, 133 PACD eyes with zonular stability, and 140 cataract patient controls) of 398 patients who underwent cataract surgery combined or not glaucoma surgery between January 2021 and January 2023 were enrolled. The crystalline lens parameters were measured by CASIA2 AS-OCT. Then, logistic regression was performed to evaluate the risk factors associated with zonular instability.RESULTS:The results revealed that PACD eyes had a more anterior lens equator position, a steeper anterior curvature of lens, shorter Axial Length (AL), shallower Anterior Chamber Distance (ACD), higher Lens Vault (LV) and thicker Lens Thickness (LT), when compared to eyes in the cataract control group. Furthermore, PACD eyes in the zonular instability group had steeper front R, front Rs and Front Rf, flatter back Rf, thicker lens anterior part thickness, higher lens anterior-to-posterior part thickness ratios, shallower ACD, and greater LV, when compared to PACD eyes with zonular stability. The logistic regression analysis, which was adjusted for age and gender, revealed that zonular instability was positively correlated with anterior part thickness, lens anterior-to-posterior part thickness ratio, and LV, but was negatively correlated with lens anterior radius and ACD.CONCLUSION:Steeper anterior curvature, increased lens anterior part thickness, higher anterior-to-posterior part thickness ratio, shallower ACD, and greater LV are the anatomic features of PACD eyes associated with zonular instability.

To systematically review the characteristics of patients experiencing acute angle closure (AAC) attacks during the COVID-19 outbreak in Beijing. Patients with AAC attacks during the COVID-19 epidemic and those in the same period the following year were recruited. Demographic characteristics, ocular biometry, ocular signs, sequential relationships, and the prognosis of operative management outcome were recorded and compared between the 2 groups. We included 60 eyes of 55 patients with AAC attacks in the COVID-19 group and 34 eyes of 33 patients in the control group. There was a significantly higher incidence of bilateral attacks during the COVID-19 outbreak compared to the control group (9 vs 1, P = .043). Additionally, a higher proportion of AAC attacks were observed in the COVID-19 group (P = .035). The COVID-19 group had a higher mean peak intraocular pressure (53.42 ± 8.87 mm Hg vs 47.86 ± 11.22 mm Hg; P = .007), larger pupil diameter (5.75 ± 1.04 mm vs 4.86 ± 1.26 mm; P < .001), more pigmented keratic precipitates (39 vs 8, P < .001), and segmental atrophy of the iris (32 vs 10, P = .019). Coronavirus infection was simultaneous with or slightly preceded the appearance of AAC attacks. Most patients had an ideal prognosis after comprehensive management. An increased incidence of AAC attacks, more bilateral cases and severe anterior segment inflammation were observed during the COVID-19 outbreak in Beijing. There may be a correlation between the onset of AAC attacks and coronavirus infection, but further research is needed to explore this link.

AIMS:To evaluate the association between contrast sensitivity function (CSF) and glaucomatous structural damage in primary open-angle glaucoma (POAG). METHODS:A cross-sectional study was performed with 103 patients (103 eyes) aged 25-50 years who had POAG without any other ocular disease. CSF measurements were obtained by the quick CSF method, a novel active learning algorithm that covers 19 spatial frequencies and 128 contrast levels. The peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell complex (mGCC), radial peripapillary capillary (RPC) and macular vasculature were measured by optical coherence tomography and angiography. Correlation and regression analyses were used to assess the association of area under log CSF (AULCSF), CSF acuity and contrast sensitivities at multiple spatial frequencies with structural parameters. RESULTS:AULCSF and CSF acuity were positively associated with pRNFL thickness, RPC density, mGCC thickness and superficial macular vessel density (p<0.05). Those parameters were also significantly associated with contrast sensitivity at 1, 1.5, 3, 6, 12, 18 cycles per degree spatial frequencies (p<0.05) and, the lower the spatial frequency, the higher the correlation coefficient. RPC density (p=0.035, p=0.023) and mGCC thickness (p=0.002, p=0.011) had significant predictive value for contrast sensitivity at 1 and 1.5 cycles per degree, with adjusted R 2 of 0.346 and 0.343, respectively. CONCLUSIONS:Full spatial frequency contrast sensitivity impairment, most notably at low spatial frequencies, is a characteristic change in POAG. Contrast sensitivity is a potential functional endpoint for the measurement of glaucoma severity.

Objective:To compare the efficacy and safety of trabeculotome tunnelling trabeculoplasty and gonioscopy-assisted transluminal trabeculotomy (GATT) in the treatment of open-angle glaucoma.Methods:A prospective randomized controlled study. The patients with open-angle glaucoma diagnosed in the ophthalmology center of Beijing Tongren Hospital affiliated to Capital Medical University from January to July 2022 were collected and divided into GATT group (undergoing GATT) and 3T group (undergoing 3T operation) using a random number table. Intraocular pressure (IOP) was recorded for both groups at 1 day, 1 week, 1 month, and 3 months after the operation, and the types and quantities of anti-glaucoma drugs used, postoperative complications, and surgical success rate were compared. Normal distribution measurement data were analyzed using independent sample t-tests, non-normal distribution measurement data were analyzed using non-parametric tests, and counting data were analyzed using chi-square tests. Results:This study included 35 patients (43 eyes), consisting of 27 males and 8 females, with an average age of (43.0±14.3) years. There were 21 patients (23 eyes) in the GATT group and 19 patients (20 eyes) in the 3T group. The maximum IOP without anti-glaucoma drugs before surgery, the highest IOP with the maximum number of anti-glaucoma drugs, and the IOP at 3 months after surgery in the GATT group were (33.5±9.1), (22.2±6.1), and (16.0±3.1) mmHg (1 mmHg=0.133 kPa), respectively. The corresponding values for the 3T group were (35.2±7.8), (21.5±6.8), and (16.1±2.0) mmHg. After surgery, the IOP in both groups was lower than before surgery, with a statistically significant difference ( P<0.05) and no significant difference between the two groups ( P>0.05). In the 3 months following surgery, 13 eyes in the GATT group and 11 eyes in the 3T group received more than two types of anti-glaucoma drugs, with no significant difference between the two groups ( P>0.05). Three months after surgery, the complete and conditional success rates of the GATT group were 14/18 and 16/18, respectively, and those of the 3T group were 12/15 and 13/15, respectively, with no significant difference between the two groups ( P>0.05). The incidence of hyphema, ciliary detachment, and shallow anterior chamber 1 day after surgery was 91%(21/23), 35%(8/23), and 30%(7/23), respectively, in the GATT group and 55%(11/20), 5%(1/20), and 0 in the 3T group, with a statistically significant difference between the two groups ( P<0.05). Conclusion:3T and GATT have similar success rates in the treatment of open-angle glaucoma. However, compared with GATT, 3T has fewer complications and is considered to be safer. (This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on February 28, 2023)

AIM To assess the predictive value of baseline parameters of ultrasound biomicroscopy (UBM) for angle widening after prophylactic laser peripheral iridotomy (LPI) in patients with primary angle-closure suspect (PACS). METHODS Angle-opening distance (AOD), trabecular iris angle (TIA), iris thickness, trabecular-ciliary process angle, and trabecular-ciliary process distance were measured using UBM performed before and two weeks after LPI. Iris convexity (IC), iris insertion, angulation, and ciliary body (CB) size and position were graded. Uni- and multivariate regression analyses were used to determine factors predicting the change in AOD (ΔAOD500, calculated as an angle width change before and after LPI) in all quadrants and in subgroup quadrants based on IC. RESULTS In 94 eyes of 94 patients with PACS, LPI led to angle widening with increases in AOD500 and TIA (P<0.01). Multivariable regression analysis showed that IC (P<0.001), CB position (P=0.007) and iris insertion (P=0.049) were significantly predictive for ΔAOD500. All quadrants were categorized into extreme IC (27.8%), moderate IC (62.3%), and absent IC (9.9%) subgroups. The AOD500 increased by 220% and no other predictive factor was found in the extreme IC quadrants. The AOD500 increased by 55%, and baseline iris angulation was predictive for smaller changes in ΔAOD500 in the moderate IC quadrants. CONCLUSION In PACS patients, quadrants with greater iris bowing predict substantial angle widening after LPI. Quadrants with a flatter iris, anteriorly positioned CB, and basal iris insertion are associated with less angle widening after LPI. Quadrants with iris angulation as well as a flatter iris configuration predict a smaller angle change after LPI.

目的 探讨原发性闭角型青光眼(primary angle closure glaucoma,PACG)白内障手术中发现晶状体悬韧带异常患者的生物学测量参数特征.设计回顾性比较性病例系列.研究对象2019年5月至2020年12月北京同仁医院连续的PACG术前未明确悬韧带异常、白内障术中发现悬韧带异常者(术中悬韧带异常组)45例(45眼),PACG悬韧带无异常者95例(95眼),术前即诊断为晶状体不全脱位继发闭角型青光眼者41例(41眼),共181例181眼.方法 回顾三组患者的病例资料.比较三组患者的IOLmaster和UBM的生物学测量参数.主要指标前房深度、晶状体拱高、晶状体厚度、眼轴长.结果 术中悬韧带异常组和悬韧带无异常组的前房深度[(1.61±0.31)mm、(1.74±0.35)mm,P=0.074]和眼轴长[(22.07±0.78)mm、(22.20±0.75)mm,P=0.650]无统计学差异.晶状体拱高在术中悬韧带异常组、悬韧带无异常组和晶状体不全脱位组分别为[(1.41±0.35)、(1.04±0.21)、(1.73±0.45)mm,P=0.000];两两比较中差异均有统计学意义.术中悬韧带异常眼的晶状体拱高[(1.42±0.25)mm]、高于对侧健眼[(1.24±0.27)mm](P=0.049).晶状体厚度在术中悬韧带异常组和晶状体不全脱位组[(5.14±0.26)、(5.18±0.29)mm,P=0.808]中无统计学差异,但较悬韧带无异常组[(4.89±0.31)mm,P=0.001]增厚.术中悬韧带异常组患者80％晶状体拱高＞1.2 mm,晶状体厚度＞4.9 mm.结论 PACG患者白内障手术前晶状体拱高超过1.2 mm同时晶状体厚度超过4.9 mm时应警惕晶状体悬韧带异常的可能.

目的 探讨根据爆破音调节经巩膜二极管激光睫状体光凝能量方案治疗难治性青光眼的疗效.设计 回顾性比较性病例系列.研究对象 难治性青光眼患者62例(62眼).方法 将患者随机分为爆破音调节能量组(调节组)30例(30眼),爆破音固定能量组(固定组)32例(32眼).调节组在经巩膜二极管激光睫状体光凝术术中根据爆破音出现的频率不断调节能量.固定组以首次出现爆破音的能量完成手术.术后随访3个月.主要指标 激光总平均能量、爆破音数量、眼压、视力、用药数量、术后并发症.结果 术前及术后3个月调节组平均眼压分别为(46.1±10.7)mmHg和(15.8±6.9)mmHg;固定组分别为(44.9±12.3)mmHg和(16.7％8.2)mmHg.不使用降眼压药物眼压控制在21 mmHg以下者,调节组占80.0％,固定组占65.6％(x2=5.643,P=0.018).爆破音数量与眼压下降幅度呈中度正相关(调节组r=0.517,P=0.001;固定组r=0.572,P=0.001).调节组术后1例视力下降;固定组术后2例视力下降,1例持续性低眼压.结论 爆破音调节能量的经巩膜睫状体光凝方案较爆破音固定能量方案对难治性青光眼的的疗效更好.

目的 中脑星形胶质细胞源性神经营养因子(MANF)可能对视网膜光感受器细胞和视网膜神经节细胞具有保护性作用.但是其作用机制还不清楚.本研究探索MANF在视网膜上的作用通路,为其在眼科的应用奠定基础.方法 选用Sprague-Dawley雄性大鼠25只,体重0.2～0.25 kg.采用数字表法,随机将大鼠分为未处理组和处理组.其中,未处理组5只,处理组左眼注射重组人MANF10μg(3μl),右眼注射磷酸盐缓冲液(PBS)3μl,分别于注射后0.5 h、1 h、2 h及4 h四个时间点取材视网膜,每个时间点5只大鼠.新生大鼠视网膜分离培养原代Müller细胞,100ng/ml MANF处理细胞后,在不同时间点收集细胞Western blot检测磷酸化p44/42丝裂原活化蛋白激酶(MAPK)的表达水平,冰冻切片免疫组化检测MANF诱导活化的磷酸化p44/42MAPK在视网膜上的定位.以Image J图像分析软件分析图像,Western blot条带密度比值和免疫荧光强度为计量资料以(-x±s)表示;各时间点与未处理组组间,采用独立样本t检验的方法进行比较.结果 SD大鼠玻璃体腔注射MANF后,磷酸化p44/42MAPK的表达在0.5 h就开始明显升高,1 h达到高峰,较对照玻璃体腔注射PBS组和未处理组差异均具有统计学意义(t=21.18,4.41;P<0.05),然后逐渐下降,4 h降至未处理组水平.冰冻切片免疫组化检查结果显示磷酸化p44/42MAPK阳性的细胞位于视网膜内核层的Müller细胞,其荧光强度显著高于阴性未处理组,差异有统计学意义(t=11.41,P<0.05).原代培养的Müller细胞经MANF处理后,磷酸化p44/42MAPK在5 min时较未处理组就有显著升高,差异有统计学意义(t=4.48,6.43;P<0.05),15 min达到高峰,差异有统计学意义(t=19.57,9.18;P<0.05),到30 min降至正常水平.结论 p44/42MAPK信号通路参与了MANF的神经保护作用机制.MANF直接作用于视网膜Müller细胞,可能通过与Müller细胞的相互作用起到细胞保护性作用.

PURPOSE:The purpose of this study was to investigate the role of HtrA serine peptidase 1 (HTRA1) in the proliferation and migration of cells of the human retinal pigment epithelial cell line ARPE-19, and the possible mechanisms involved.METHODS:ARPE-19 cells were transduced by a recombinant lentiviral vector carrying HTRA1-shRNA to knockdown HTRA1 expression. Subsequent HTRA1 gene and HTRA1 protein levels in these cells and control cells were detected by quantitative real-time PCR and Western blot, respectively. Changes in cell proliferation and migration associated with the inhibition of HTRA1 expression were assessed, as well as changes in the mRNA levels of transforming growth factor beta 1 (TGFB1), bone morphogenetic protein 4 (BMP4), and bone morphogenetic protein 2 (BMP2).RESULTS:The recombinant lentivirus carrying HTRA1-shRNA was successfully generated, as evidenced by reduced levels of HTRA1 mRNA and HTRA1 protein in ARPE-19 cells. The knockdown of HTRA1 in ARPE-19 cells was associated with reduced cellular proliferation and migration, and increased mRNA levels of TGF-β1, BMP4, and BMP2.CONCLUSIONS:Silence of the HTRA1 gene was associated with significantly higher levels of TGF-β1, BMP4, and BMP2 mRNA and reduction in the proliferation and migration of ARPE-19 cells.

Pediatric glaucoma is a broad term referring to a variety of glaucomas comprising a heterogeneous group of ocular diseases and may occur among individuals from birth to 18 years of age.The paediatric glaucoma presents some of the greatest clinical challenges and can be potentially blinding.At present,medications for adult glaucoma are available to treat pediatric glaucoma,but the risk profiles in children might be more severe than in adults.Surgical results with current techniques are less than outstanding,and are associated with a significant number of complications,re-operations,and late failure.This review summarizes current concepts regarding terminology,classification,epidemiology,medical and surgical treatment,and recent advances with an emphasis on the primary congenital glaucoma,glaucoma following congenital cataract surgery,and glaucoma associated with Sturge-weber syndrome.

患儿男性,9岁,因出生后3个月双眼不能上转于2011年4月2日来首都医科大学附属北京同仁医院北京同仁眼科中心就诊.患儿足月顺产,否认家族病史.体检未见异常.眼部检查:视力双眼均为0.4.阿托品散瞳验光:右眼-0.75DS()+2.00DC ×90°矫正视力不提高,左眼-1.00DS()+1.75 DC×95 °矫正视力0.5.眼位:双眼下斜15°注视.眼球运动:双眼上转完全受限,双眼下转无亢进,内转、外转基本到位(图1),Bell征阳性(图2),无上睑下垂.

患者男性,50岁.主因双眼反复红、磨痛半年余于2012年6月28日来我院就诊.近半年来双眼反复红肿、磨痛,伴畏光、流泪、睁不开眼,视力轻度下降,无头痛、眼胀、眼前黑影、视物变形等.既往中耳炎病史30年,无糖尿病、高血压、冠心病等系统性疾病,无家族遗传性疾病史.眼科检查:视力:右眼0.9,左眼0.9,双眼睑痉挛,轻度水肿,双眼结膜混合性充血、水肿,结膜囊分泌物多,右眼角膜鼻上方边缘区溃疡,进行缘呈潜掘状,深达后弹力层,表面不平,被覆新生血管和瘢痕组织,左眼角膜颞下方边缘区浅层溃疡,新生血管长入,双眼KP(-),前房浮游细胞(-),双眼前房深,瞳孔圆,晶状体清,眼底视盘边界清,色正,C/D0.3.诊断:双眼蚕蚀性角膜溃疡.

Objective: This study was aimed to construct lentivirus-mediated shRNA expression vector targeting HTRA1 and identify the RNA interference effect in a RPE cell line. Design: Experimental study. Participants: HTRA1 shRNA lentivirus vector and RPE cells. Method: One pair of oligonucleotide sequences targeted at human HTRA1 mRNA was designed and synthesized. The annealed oligonucleotide fragments were subcloned into plasmid vector. Virus particles were collected and enveloped into HEK-293T cells. The RPE cells were infected with recombinant lentivirus. Real-time PCR and Western Blot were used respectively to detect the expression of HTRA1 after lentivirus infection. Main Outcome Measures: The mRNA and protein expression of HTRA1. Results: DNA sequencing demonstrated that the lentivirus shRNA vector of HTRA1 was constructed successfully and the virus was packaged in 293 T cells. The titer of virus was 8 × 108 TU/ml. The RPE cell line was successfully infected. The mRNA and protein levels of HTRA1 were reduced significantly in RPE cells after lentivirus infection, compared with blank control and negative control. Conclusion: It is concluded that the lentiviral shRNA vector of HTRA1 is constructed, and successfully reduced HTRA1 expression in a RPE cell line. (Ophthalmol CHN, 2013, 22: 195-200). Copyright © 2013 by the Editorial Board of OPHTHALMOLOGY IN CHINA.

Background Ultraviolet radiation is one of factors of the formation of age-related cataract.Indole-3-carbinol(I3C) is a plant chemical material with inhibitory effect on oxidative-induced cell damage and formation of amyloid fibrils,and the oxidative damage and amyloid fibrils are associated with cataract.However,the relationship between I3C and α-crystallin is in study. Objective This study was to evaluate the effects of ultraviolet-B laser irradiation on the secondary structure of α-crystallin and to explore the protection of I3C to chaperone activity of α-crystallin. Methods The fresh eyeballs were obtained from 1-year-old cattle to prepare the purified lens α-crystallin by gel chromatography.α-Crystallin was isolated from cattle lenses using gel chromatography.The purified α-crystallin was collected using fast protein liquid chromatography ( FPLC ) and exposed to 1:308 nmultraviolet-B at different irradiation intensities ( 23.75,118.75,475.00,1187.50,2375.00,4750.00,11 875.00,23 750.00 mJ/cm2 ) and then to ultraviolet-B 2:308 nm with irradiation intensities of 28 535.00,6730.00,3435.00,1910.00,1040.00 mJ/cm2.Ultraviolet-absorbance spectra,tryptophan fluorescence and N-formylkynurenine (N-FK)fluorescence spectra of both irradiated and non-irradiated α-crystallin were measured.I3C at the concentrations of 50 μmol/L and 100 μmoL/L were added to the α-crystallin solution to perform a catalase (CAT) thermal aggregation to confirm the chaperone activity of the α-crystallin,and the α-crystallin solution without any I3C was used as control.The ratios of A360 between various intervene groups with control group were calculated using spectrophotometry.Results The A280 values of the α-crystallin declined to 10％ at the ultraviolet-B irradiation intensity of 1187.5 mJ/cm2 and that at the intensity of 23.75 J/cm2 lowed to 2％.A negative correlation was seen between the ultraviolet-B irradiation intensity and the A280 value of the α-crystallin (R2=0.925 ) and a positive correlation was found between ultraviolet-B with N-FK ( R2 =0.949 ).Ultraviolet-B irradiation intensity showed a negative correlation with Trp fluorescence intensity (R2 =0.996 ).CAT hot condensed experiment revealed that after addition of different concentrations of indole-3-carbinol,the relative A360 values at various ultraviolet-B irradiation group were significantly higher than those of the control group (P =0.000),and the decreasing degree of chaperone activity of α-crystallin was lower than that of the control group ( P =0.000 ). Conclusions The study suggests that I3C can protect the chaperone activity of α-crystallin from photooxidation,and the ultraviolet-B laser may be a good exposure source compared with ultraviolet lamp.The ultraviolet-B laser irradiation causes the alteration of structure and chaperone activity of α-crystallin.

Objective To discuss the clinical characteristics of intraocular lens(IOL) dislocation.Design Retrospective cases series.Participants 49 eyes(49 cases) of intraocular lens dislocation in Beijing Tongren Hospital from 2004 to 2011.Methods Clinical data of intraocular lens dislocation were reviewed retrospectively.Main Outcome Measures Age,original disease,history of disease,position and type of intraocular lens,cause,surgical method,and complication.Results Majority of 49 cases of intraocular lens dislocation were cases with surgery of age-related cataract(46.9%) and traumatic cataract(28.6%).6 cases with dislocation of intraocular lens with ciliary sulcus fixation happened 1 year after surgery.Majority of intraocular lenses dislocated located in vitreous body(53.1%) and C loop(89.8%).75.5% of causes were original disease and surgery.Ciliary sulcus fixation or re-fixation of intraocular lens(47 eyes,95.9%) could achieve good centration and stability of the intraocular lens.Naked vision of 0.1 or more accounted for 59.6% at 2 weeks after fixation or re-fixation.Conclusion Intraocular lens dislocation is related with original disease and surgery.Ciliary sulcus fixation of intraocular lens is an effective strategy to treat intraocular lens dislocation.But intraocular lens with ciliary sulcus fixation still happens to dislocate.

As we know, intraocular lens (IOL) opacification is a rare and significant complication of IOL implantation surgery, and in most cases, these IOLs have to be explanted. IOL opacification can develop with many kinds of IOLs.1Mamalis N. Complications of foldable intraocular lenses requiring explantation or secondary intervention–2001 survey update.J Cataract Refract Surg. 2002; 28: 2193-2201Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar The mean interval between IOL implantation of the Hydroview lens (Bausch & Lomb, Rochester, NY) and the diagnosis of opacification was 19.8±11.9 months (range, 5.0–48.0 months), and for the MemoryLens (CIBA Vision, Duluth, GA), the interval was a little longer (25.8±11.9 months).2Neuhann I.M. Werner L. Izak A.M. et al.Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants.Ophthalmology. 2004; 111: 2094-2101Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar We report the case of a Chinese patient with posterior surface opacification of a hydrophilic acrylic IOL implanted 7 years ago. This patient was 70-year-old man. He had uneventful phacoemulsification with posterior chamber foldable single-piece hydrophilic acrylic IOL (Isotechnics, MDR Medical Corp., Clearwater, FL) implantation of his right eye in May 2002. He had pathological myopia, and scleral buckling was performed for rhegmatogenous retinal detachment in December 1985. Before cataract surgery, his best corrected visual acuity (BCVA) was 6/60 in the right eye. Postoperative BCVA was 2/6. He had a quiet eye for at least 5 years. The patient was seen again complaining of blurred vision of 1 year duration in February 2009. BCVA was 5/60 in the right eye. A uniformly granular white opacification was observed on the posterior surface of the IOL. An IOL exchange with an acrylic hydrophobic IOL (Figure 1, available at http://aaojournal.org) was performed in May 2009. Currently, BCVA remains 2/6 in the right eye. The posterior surface deposits of his explanted IOL were analyzed using energy dispersive X-ray spectroscopy (EDS) coupled with scanning electron microscopy and transmission electron microscopy. The deposits appear on the posterior surface of optic and 2 loops. The anterior surface, extending over the edges onto the peripheral posterior surface, was in general, free of any deposits. Scanning electron microscope photographs demonstrated the diameter of the deposit to be about 10 μm. The deposits have the tendency to be confluent, forming a dense crust with cerebriform structures toward the outside. Transmission electron microscope photographs showed crystal-like substance around a core in the internal deposit (Figure 2, available at http://aaojournal.org). The EDS performed precisely on the deposits located with scanning electron microscopic examination revealed the presence of higher calcium and phosphate peaks and lower carbon and oxygen peaks. Our case displayed similar morphological features to the surface deposits seen with the MemoryLens hydrophilic acrylic IOL opacification implanted before 1999.2Neuhann I.M. Werner L. Izak A.M. et al.Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: a clinicopathological analysis of 106 explants.Ophthalmology. 2004; 111: 2094-2101Abstract Full Text Full Text PDF PubMed Scopus (126) Google Scholar Components of the deposits in our case included calcium, phosphorus, carbon, and oxygen, which was similar to other reports. The quantity of elemental calcium and phosphorus accounted for the main component. We believe calcification of the hydrophilic acrylic lens lead to the IOL opacification in our case. In our patient, IOL opacification developed at least 5 years after the cataract surgery according to the clinical history and eye examination, and the interval between cataract surgery and IOL explantation was 7 years. To the best our knowledge, this is the longest interval between the IOL implantation and the diagnosis of opacification. It is possible that the process of IOL opacification in this case started before the patient's vision decreased. However, the process of calcification in this case may take longer than that with other hydrophilic IOLs. We hypothesize that the residual lens epithelial cells on the posterior capsule might slowly secrete crystalline. It then took a long time for the deposition of calcium and phosphorus on the protein film, which covers the posterior surface of IOL.3Werner L. Calcification of hydrophilic acrylic intraocular lenses.Am J Ophthalmol. 2008; 146: 341-343Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Several studies have demonstrated that the eventual reaction to an IOL implanted into the eye significantly depends on protein adsorption, especially in the presence of microdefects on the polymer surfaces.4Amon M. Biocompatibility of intraocular lenses.J Cataract Refract Surg. 2001; 27: 178-179Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar After absorption, the formation of tightly bound complexes of protein and calcium could be promoted by long-chain fatty acids. The adsorption of such macromolecules could provoke the formation of a calcification nucleus.5Linnola R.J. Werner L. Pandey S.K. et al.Adhesion of fibronectin, vitronectin, laminin, and collagen type IV to intraocular lens materials in pseudophakic human autopsy eyes Part 2: explanted intraocular lenses.J Cataract Refract Surg. 2000; 26: 1807-1818Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar The actual mechanism of IOL calcification remains unclear and would benefit from further study. Figure 2Scanning electron photomicrograph (A) and transmission electron photomicrograph (B) of the posterior surface of the opacified intraocular lens showing the confluent deposits and a crystal-like cone.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Late postoperative opacification of a hydrophilic acrylic (hydrogel) intraocular lens: A clinicopathological analysis of 106 explantsOphthalmologyVol. 111Issue 11PreviewTo report clinical, pathologic, histochemical, ultrastructural, and spectroscopic analyses of MemoryLens intraocular lenses (IOLs) explanted from patients who had visual disturbances caused by postoperative opacification of the lens optic. Full-Text PDF Lens Implant OpacificationOphthalmologyVol. 118Issue 10PreviewWe read with interest the letter Xue-Ting Pei and Yong-Zhen Bao on lens implant opacification describing a case of late onset opacification of a lens first noted 5 years after implantation.1 However, far from being a unique case, we think this highlights an underestimated problem. Other research has shown that Hydroview lenses (Bausch & Lomb, Rochester, NY) implanted prior to 2001 are still presenting with opacification.2–4 Our paper gave data on 50 opacified hydroview lenses with a mean time from implantation to assessment of 7.04 years (range, 6.43–7.49). Full-Text PDF

PURPOSE: To assess and compare the morphologic changes in the anterior segment in eyes with nuclear or cortical age-related cataract using Scheimpflug imaging.SETTING: Peking University People's Hospital, Beijing, China.DESIGN: Case-control study.METHODS: Patients with nuclear or cortical age-related cataract were recruited. The grade of nuclear opalescence or cortical opacity was assessed using the Lens Opacities Classification System III (LOCS III). A group of elderly subjects with a clear lens and normal vision served as the control group. Anterior chamber depth (ACD), anterior chamber volume (ACV), and lens thickness were evaluated using Scheimpflug imaging (Pentacam).RESULTS: Two hundred sixty-nine patients (330 eyes) were recruited. Thirty eyes were enrolled for each nuclear opalescence and cortical grade. The control group comprised 30 eyes (19 subjects). In eyes with age-related cataract, lens thickness increased with an increase in cortical opacity, whereas the ACD and ACV values decreased. The ACD was inversely correlated with LOCS Ill grades for nuclear opalescence (r = -0.197, P = .004), nuclear color (r = -0.195, P = .005), and cortical opacity (r = -0.508, P<.005). There were significant differences in lens thickness, ACD, and ACV between nuclear color, nuclear opalescence, and cortical opacity for LOCS Ill grades 3, 4, and 5, respectively.CONCLUSIONS: There were significant differences in lens thickness, ACD, and ACV between nuclear and cortical age-related cataracts. The ACD decreased more in eyes with cortical cataract, suggesting that the risk for angle-closure glaucoma may be greater in cases of cortical opacity in which lens expansion is greater.