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Purpose: To investigate the inflammatory reaction in eyes with late in‐the‐bag intraocular lens (IOL) dislocation. Methods: This prospective clinical study with fellow‐eye comparison consists of 76 of the patients (76 eyes) with late in‐the‐bag IOL dislocation enrolled in the LION trial. The main outcome measure was anterior chamber flare before surgery measured with a laser flare meter in photon counts per millisecond (pc/ms). The dislocation was graded as 1 (small: optic still covering the visual axis), 2 (optic equator close to the visual axis) or 3 (optic decentred beyond the visual axis, but the IOL–capsule complex partly visible in the pupillary area). The secondary aim was to compare intraocular pressure (IOP) before surgery. Results: Flare levels before surgery were significantly higher in the dislocation eyes than in the fellow eyes with a median flare of 21.5 (range 5.4–135.7) pc/ms versus 14.1 (2.0–42.9) pc/ms, respectively (p ˂ 0.001). A regression analysis of log‐transformed flare values showed that the dislocation eyes had a non‐significant tendency towards higher flare in dislocation grade 1 with a median flare of 24.6 (5.4–135.7) pc/ms compared to grade 2; 19.6 (6.5–41.5) pc/ms (p = 0.06), and no significant difference compared to grade 3; 19.4 (10.2–53.5) pc/ms (p = 0.47). The IOP was significantly higher in the dislocation eyes than in the fellow eyes (p ˂ 0.001). Conclusions: Eyes with late in‐the‐bag IOL dislocation had increased flare levels compared to their fellow eyes. This suggests that inflammation is part of the clinical picture of late in‐the‐bag IOL dislocation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the intra‐ and postoperative complications, especially the risk of visual axis opacification (VAO), following the implantation of the bag‐in‐the‐lens (BIL) intraocular lens (IOL) in infants with congenital cataract operated on before 12 weeks of age. Methods: Infants operated on before 12 weeks of age between June 2020 and June 2021 with a follow‐up longer than 1 year were included in the present retrospective study. This was a first‐experience cohort of an experienced paediatric cataract surgeon with this type of lens. Results: Nine infants (13 eyes) with a median age at surgery of 28 days (range, 21–49 days) were included. The median follow‐up time was 21.6 months (range, 12.2–23.4 months). The lens was correctly implanted with the anterior and posterior capsulorhexis edges placed into the interhaptic groove of the BIL IOL in seven of 13 eyes; none of these eyes developed VAO. In the remaining six eyes, the IOL was only fixated to the anterior capsulorhexis edge, and in these cases, an anatomical anomaly of the posterior capsule and/or anterior vitreolenticular interface dysgenesis were observed. These six eyes developed VAO. One eye had a partial iris capture in the early postoperative phase. Otherwise, the IOL remained well centred and stable in all eyes. Anterior vitrectomy was necessary in seven eyes due to vitreous prolapse. One patient with unilateral cataract was diagnosed with bilateral primary congenital glaucoma at 4 months of age. Conclusion: Implantation of the BIL IOL is safe even in the youngest age group less than 12 weeks of age. Although being a first‐experience cohort, the BIL technique is shown to reduce the risk of VAO and the number of surgical procedures. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to report visual outcome and safety after cataract surgery with primary intraocular lens implantation before 12 weeks of age. Methods: Infants with visually significant unilateral congenital cataract having primary IOL implantation in the capsular bag before 12 weeks of age in 2007–2016 were enrolled for a prospective study examination in 2017. The medical records were also reviewed. Results: In total, 23 patients with a median age at cataract surgery of 32 days (range, 12–75 days) were included. Seventeen (74%) eyes had persistent foetal vasculature (PFV). After a median follow‐up of 6.3 years (range, 1.4–10.9 years), the corrected distance visual acuity was 0.8 logMAR (range, 3.0–0.1 logMAR). All, except one eye, required surgery for visual axis opacification (VAO), with a median of two (range 0–5) additional surgical procedures. Four (17%) eyes developed secondary glaucoma. Conclusion: Cataract surgery with primary IOL implantation before 12 weeks of age resulted in a high number of VAO operations, and the visual outcome varied considerably, showing the range in outcome for this challenging patient group. Co‐existent PFV in these young patients was common. The incidence of secondary glaucoma was similar to other studies, despite the young age at surgery, high percentage of PFV and number of surgical procedures for VAO. [ABSTRACT FROM AUTHOR]

Iris‐claw lenses have gained increasing popularity over the last years and are by many surgeons regarded as viable options in eyes with insufficient capsular or zonular support. The iris‐claw lens has two haptics with fine fissures for folding (enclavating) the mid‐peripheral part of the iris stroma and can either be placed in front of or posterior to the iris. In particular, the retropupillary implantation has been increasingly chosen probably due to having an anatomical position similar to that of the crystalline lens. The present review is based on a literature review and also on the authors' clinical experience with this lens, and it focuses on surgical techniques and outcomes especially related to the characteristics of this lens, having haptics with claws that fixate the lens to the posterior iris. Implanting retropupillary iris‐claw lenses has a relatively short learning curve, and there are only few complications reported during surgery. Retropupillary iris‐claw lenses have demonstrated generally favourable efficiency and safety. However, the outcomes are probably more influenced by the reason for surgery and eye comorbidity than the lens itself. Albeit seldom reported, the postoperative complications have mostly been related to atrophy of the iris at the site of the haptics, or IOL decentration or disenclavation of one of the haptics. To date, however, there are few randomized clinical trials comparing this lens to other lens alternatives in eyes exhibiting insufficient capsular or zonular support for placing the lens in the ciliary sulcus. In the future, prospective studies with large samples should be performed to gain insights into the long‐term safety of retropupillary placed iris‐claw lenses, and for comparisons with the various other techniques of lens fixation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long-term efficacy and safety after intraocular lens (IOL) repositioning by scleral suturing of 1-piece IOL compared with other IOL designs in the treatment of late in-the-bag IOL dislocation. Setting: Patients referred to Oslo University Hospital Oslo, Norway. Design: Prospective cohort study. Methods: The study comprised 54 patients (54 eyes) with late in-the-bag IOL dislocation treated with IOL repositioning by scleral sutures (10-0 polypropylene). All operations were performed with an anterior approach and by 1 surgeon. The following IOL designs were repositioned: 1-piece foldable (n = 17), 3-piece foldable (n = 28), plate-haptic (n = 8), and 1-piece rigid (n = 1) IOLs. Patients were evaluated comprehensively preoperatively and at 6 months (80%), 1 year (67%), and 2 years (61%) postoperatively. The main outcome measures were efficacy regarding corrected distance visual acuity (CDVA) and spherical equivalent (SE) and safety regarding complications. Results: Postoperative visual acuity was similar for different IOL designs. The mean SE change to final observation was -0.08 (95% CI, -0.93 to 0.77) in the 1-piece IOL group (n = 11) and -0.98 (-1.73 to -0.23) in the 3-piece IOL group (n = 18) (P =.11). Regarding safety, no patients had uveitis-glaucoma-hyphema syndrome, retinal detachment, or endophthalmitis. The 3-piece IOL group had 1 case of redislocation and 1 case of iritis. No patients had symptoms related to clinical IOL decentration. Long-term intraocular pressure remained within normal limits with overlapping 95% CIs for different IOLs. Conclusions: Repositioning surgery of 1-piece IOLs seems as efficient and safe as that for other IOL designs in the treatment of late in-the-bag IOL dislocation. [ABSTRACT FROM AUTHOR]

Aim: To investigate the long-term risk of suture breakage after implantation of a modified capsular tension ring (MCTR) fixated to the sclera with polypropylene 10– 0 suture. Methods: Retrospective case series of operations for subluxated phakic lenses in 2007– 2015 with implantation of an MCTR secured with a 10– 0 polypropylene suture as part of an intraocular lens (IOL)-capsular bag complex. Results: We identified 132 eyes (92 patients) operated on with an MCTR. Of these eyes, 26 (20%) had suture breakage requiring re-operation, while another eight eyes (6%) had suture breakage that did not require surgery. The re-operations occurred after a mean 4.8± 3.3 years. Suture breakage occurred in patients with a mean age of 34.0± 23.3, as compared to 43.2± 26.0 years for patients who did not experience this complication (p=0.36). In patients aged 40 years or younger at the time of surgery, 47% experienced suture breakage in one or both eyes, as compared to 19% in the age group 41– 69 years and 13% in the age group 70 years and older (p=0.004). Of the 132 eyes that were operated on, we registered one case (0.8%) of possible suture-related late endophthalmitis. Conclusion: The long-term risk of suture breakage was quite high after scleral fixation of the MCTR in this patient cohort, and it seems as the risk is increased with young age. [ABSTRACT FROM AUTHOR]

Purpose: To compare the cost‐effectiveness of two operation methods for late in‐the‐bag intraocular lens (IOL) dislocation. Methods: In this randomized clinical trial, 104 patients were randomly assigned to IOL repositioning by scleral suturing (n = 54) or IOL exchange with a retropupillary iris‐claw lens (n = 50). A cost‐effectiveness analysis (CEA) was performed in conjunction with previously published 6‐month efficacy and safety results. An incremental cost‐effectiveness ratio was calculated as the cost difference between the operation groups relative to their difference in postoperative corrected distance visual acuity (CDVA) (mean and 95% confidence interval: minimum and maximum), reported as the cost difference in United States Dollars ($) per logMAR difference. Results: Exchange surgery was $281.20 ± 17.66 more expensive than repositioning, mainly explained by the new IOL and the frequent use of anterior vitrectomy. A previous trial publication revealed no significant difference in the 6‐month postoperative CDVA between the groups. In the CEA, the mean group difference yielded an incremental cost‐effectiveness ratio of −$281.20 per −0.11 logMAR (‐$1108/QALY) in favour of repositioning, ranging from −$281.20 per −0.29 logMAR (‐$406/QALY) in favour of repositioning to +$281.20 per −0.08 logMAR (+$1522/QALY) in favour of exchange. The CEA did not include the mean 9.5 min shorter operation time for exchange. Conclusion: Repositioning tended to be more cost‐effective than exchange; however, this is modified if also considering the operation time. Overall, it seems the cost‐effectiveness is not alone sufficiently different to recommend one of the operation methods over the other for late in‐the‐bag IOL dislocation. [ABSTRACT FROM AUTHOR]

. Purpose: To assess long-term positioning of posterior chamber intraocular lenses within the capsular bag in eyes with pseudoexfoliation syndrome. Methods: The study includes 44 patients with pseudoexfoliation syndrome and 85 age-matched controls, who underwent cataract surgery in 2001 and 2002 at the Eye Department, Oslo University Hospital. In 2008, all patients were re-examined. A comparison of the extent of possible decentration in eyes with and without pseudoexfoliation syndrome was made by evaluating Scheimpflug images (Pentacam) of the anterior segment. Results: It was found that, 6-7 years following cataract surgery, posterior chamber intraocular lenses were positioned lower in eyes with pseudoexfoliation syndrome than in control eyes. The difference was statistically significant (p = 0.01). Downward shift was associated with presence of glaucoma only in eyes with pseudoexfoliation syndrome (p = 0.01). No patients had visual disturbances related to displacement of the intraocular lens. Three of the patients with pseudoexfoliation syndrome (6.8%) had observable pseudophacodonesis by slit-lamp examination, compared to one in the control group (1.2%). The study demonstrated that Pentacam is an appropriate instrument to measure decentration of intraocular lenses. Conclusion: The study suggests that, 6-7 years after cataract surgery, the intraocular lenses within the capsular bag are more prone to decentration in pseudoexfoliation syndrome eyes, compared to controls. [ABSTRACT FROM AUTHOR]

. Purpose: To assess preoperative features, frequency, surgical approaches and outcomes of late in-the-bag dislocation of posterior chamber intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome. Methods: Seventy-seven patients (81 eyes) were enrolled. Inclusion criteria were patients with pre-existing pseudoexfoliation syndrome who underwent surgery for late in-the-bag IOL dislocation between March 2004 and April 2010. Medical records were reviewed. Data from before and after secondary surgery were analysed. Results: Mean time between cataract extraction and secondary surgery for late in-the-bag dislocation of posterior chamber IOLs was 8.5 years. The increase in frequency within the reviewed period was statistically significant, ranging from six patients in the first year to 25 patients in the final year (p = 0.004). When surgical correction was performed within 1 month of referral, deterioration of the dislocation occurred in only one of 23 patients (4.3%). Complications, especially vitreous loss, occurred significantly more frequently during exchange surgery ( n = 23) when compared with scleral suturing ( n = 50) (p < 0.0001). After surgery, however, no differences in complications (p = 0.98) or best-corrected visual acuity (p = 0.74) was found. In general, following secondary surgery, there was a statistically significant improvement in best-corrected visual acuity (p < 0.0001). Conclusion: The frequency of late in-the-bag dislocation of posterior chamber IOLs in eyes with pseudoexfoliation syndrome increased during the observation period. Our study suggests that surgical repair should not be delayed beyond 1 month and that scleral suturing is preferable to exchange surgery, because of less intraoperative complications. [ABSTRACT FROM AUTHOR]

Pseudoexfoliation syndrome is a risk factor in cataract surgery because of the increased weakness of zonular apparatus and reduced pupillary dilatation. The surgical outcome of using phacoemulsification in the central zone, inducing minimal stress on the zonules, inserting a capsular tension ring in selected cases, and stretching the pupil mechanically in eyes with miotic pupils, may turn out to be uneventful in most cases. Postoperative fibrosis with subsequent shrinkage of the capsule is increased in these eyes, and these centripetal forces will further loosen the zonular fibres. Late in-the-bag intraocular lens dislocation is therefore anticipated to become a growing problem in the future. Despite the dysfunctioning of the blood–aqueous barrier in eyes with pseudoexfoliation syndrome, the frequency of postoperative inflammatory reaction is low due to the improvements made in surgical technique and equipment in recent years. Glaucoma frequently occurs in eyes with pseudoexfoliation syndrome. Compared with primary open-angle glaucoma, optic damage is more pronounced in these eyes at the time of diagnosis and response to medical therapy is poorer. Although responses to argon laser therapy and filtering surgery are roughly similar between the two types of glaucoma, there are indications that primary laser trabeculoplasty has a higher success rate in pseudoexfoliation glaucoma than in primary open-angle glaucoma. [ABSTRACT FROM AUTHOR]

Abstract. Purpose: To evaluate the incidence of posterior capsule opacification after implantation of two different intraocular lenses (IOLs), AcrySof® and Stabibag® , by comparing the neodymium:YAG (Nd:YAG) laser capsulotomy rates. Methods: The medical records of 596 patients (705 eyes) who underwent phacoemulsification and posterior chamber IOL implantation using either AcrySof (n = 335) or Stabibag (n = 370) IOLs during a 1-year (1999) period were reviewed. Eyes with secondary cataract, combined procedures or operative complications, such as capsule tears, were excluded from the study. The subjects' age, sex, surgeon (two surgeons), and time for Nd:YAG laser capsulotomy were recorded. Results: The mean follow-up was 23 months in both IOL groups. There were no statistically significant differences within the two IOL groups regarding sex distribution or surgeon. The mean age in the AcrySof group was 77.0 years compared to 79.2 years in the Stabibag group (p = 0.001). Nd:YAG laser capsulotomy was performed in 7.6% of patients in the Stabibag group compared to 2.7% in the AcrySof group (i.e. at a significantly higher rate) (p = 0.004). Survival analyses demonstrated that age and type of IOL were the only independent predictors of the incidence of capsulotomy. Conclusions: This study shows that the frequency of eyes with posterior capsule opacification needing capsulotomy was significantly higher in eyes with Stabibag IOLs compared to eyes with AcrySof IOLs. [ABSTRACT FROM AUTHOR]

: PurposeTo evaluate the long-term results of secondary implantation of modern flexible, open-loop, anterior chamber intraocular lenses (IOLs).: SettingDepartment of Ophthalmology, National University Hospital, Oslo, Norway.: MethodsThis prospective study comprised 18 patients (20 aphakic eyes) who had secondary IOL implantation from January 1990 to May 1992. In an earlier report, these patients were followed for 4 months. The patients were reexamined in October 1998. The mean follow-up was 93.8 months ± 6.0 (SD). Two patients had died. No others were lost to follow-up. The intraocular pressure (IOP) in the remaining 16 patients (18 eyes) was compared to that 4 months postoperatively. Visual acuity was compared to the preoperative measurements. A complete slitlamp examination was performed, and complications were noted.: ResultsThere was no statistical decrease in visual acuity during the follow-up. The mean IOP was 16.6 ± 5.7 mm Hg (range 8 to 27 mm Hg) in 1998 and 13.4 ± 3.4 mm Hg (range 7 to 19 mm Hg) 4 months postoperatively. The difference was statistically significant (P = .037). Corneal pathology was seen in 3 eyes, 1 of which had developed corneal decompensation. One patient had surgery for retinal detachment 4 years postoperatively. The pupil was deformed in 5 eyes.: ConclusionsThis long-term study demonstrates that secondary implantation of flexible, open-loop, anterior chamber IOLs is safe in selected eyes. Anterior chamber IOLs should not be used in eyes with corneal problems and should be used with caution in eyes with glaucoma. These patients require close, continued observation to look for late complications such as IOP elevation. [Copyright &y& Elsevier]

Late spontaneous in-the-bag intraocular lens (IOL) dislocation is a complication presenting 6 months or later after cataract surgery. We aimed to characterize the cells in the lens capsules (LCs) of 18 patients with spontaneous late in-the-bag IOL dislocation. Patients' average age was 82.6 ± 1.5 years (range 72–98), and most of them had pseudoexfoliation syndrome (PEX). Cells from the LCs were positive for myofibroblast (αSMA), proliferation (Ki-67, PCNA), early lens development/lens progenitor (SOX2, PAX6), chemokine receptor (CXCR4), and transmembrane (N-cadherin) markers, while negative for epithelial (E-cadherin) marker. Moreover, the cells produced abundant fibronectin, type I and type V collagen in the nearby extracellular matrix (ECM). During ex vivo cultivation of dislocated IOL-LCs in toto, the cells proliferated and likely migrated onto the IOL's anterior side. EdU proliferation assay confirmed the proliferation potential of the myofibroblasts (MFBs) in dislocated IOL-LCs. Primary cultured lens epithelial cells/MFBs isolated from the LC of dislocated IOLs could induce collagen matrix contraction and continuously proliferated, migrated, and induced ECM remodeling. Taken together, this indicates that long-lived MFBs of dislocated IOLs might contribute to the pathogenic mechanisms in late in-the-bag IOL dislocation. [ABSTRACT FROM AUTHOR]

This retrospective study of repositioning surgery by scleral suturing with polypropylene 10-0 for treating late in-the-bag intraocular lens dislocation showed a low rate of suture breakage in the long-term follow-up. Purpose: To investigate the long-term risk of suture breakage after scleral fixation with a polypropylene 10-0 suture in eyes with late in-the-bag intraocular lens (IOL) dislocation. Setting: Oslo University Hospital, Oslo, Norway. Design: Retrospective case series. Methods: Patients operated with scleral suturing of late in-the-bag IOL dislocation from 2007 to 2016. 192 eyes (176 patients) operated with scleral suture (polypropylene 10-0 suture) fixation of a dislocated IOL-capsule complex were identified; 91 patients (47%) were men. Results: The mean follow-up after the operation was 6.2 (95% CI, 5.7-6.7) years, and 98 patients (56%) deceased during the study. 11 eyes (6%) (11 patients) had suture breakage that required reoperation with a mean time of 5.5 (3.4-7.6) years after IOL repositioning surgery. These patients had a mean age of 73.5 (67.9-79.2) years at the time of the operation for late in-the-bag IOL dislocation vs 81.3 (79.8-82.9) years for patients who did not experience this complication (P =.004). No cases of late endophthalmitis were registered. Conclusions: The long-term risk of suture breakage was quite low after scleral fixation of late in-the-bag IOL dislocation, particularly in the oldest patients. Hence, the polypropylene 10-0 suture seems to be a safe option for scleral fixation in this patient group. [ABSTRACT FROM AUTHOR]

Purpose To compare the efficacy and safety of 2 operation methods for late in-the-bag intraocular lens (IOL) dislocation. Design Prospective, randomized, parallel-group surgical trial. Participants Patients referred to Oslo University Hospital (tertiary referral center). Methods We randomly assigned 104 patients (104 eyes) either to IOL repositioning by scleral suturing (n = 54) or to IOL exchange with retropupillary fixation of an iris-claw IOL (n = 50). One surgeon performed all operations. Patients were evaluated comprehensively before surgery, and most patients (82%) attended an examination 6 months after surgery. Main Outcome Measures Best-corrected visual acuity (BCVA) 6 months after surgery. Results The mean postoperative BCVA was 0.24±0.29 logarithm of the minimum angle of resolution (logMAR) units (range, −0.18 to 1.16 logMAR) in the repositioning group and 0.35±0.54 logMAR (range, −0.20 to 3.0 logMAR) in the exchange group ( P = 0.23). A BCVA of 20/40 or better (Snellen) was reached by 61% and 62% of the patients, respectively ( P = 0.99). The mean postoperative corneal cylinder was 1.2±1.0 and 1.2±0.8 diopters, respectively ( P = 0.84), and the postoperative endothelial cell density changes were −3±10% ( P = 0.07) and −10±14% ( P = 0.001), respectively (group difference, P = 0.04). Repositioning had a longer mean surgical time than exchange ( P < 0.001). There were 2 (4%) and 0 cases of perioperative fluid misdirection syndrome, respectively. Postoperative complications were intraocular pressure (IOP) increase (n = 12), cystoid macular edema (CME; n = 3), and nonarteritic anterior ischemic optic neuropathy (n = 1) in the repositioning group, and IOP increase (n = 9), pupillary block (n = 1), choroidal effusion (n = 2), CME (n = 4), and redislocation (n = 1) in the exchange group. Conclusions We found satisfactory and not significantly different outcomes for BCVA 6 months after surgery in the 2 groups. Both operation methods seemed safe, with low frequencies of serious perioperative and postoperative complications. However, some of the observed differences in complications should be taken into consideration when selecting the most suitable method in clinical practice. [ABSTRACT FROM AUTHOR]