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Purpose: To compare the rate of posterior synechiae of the iris (PSI) occurrence after phacovitrectomy between a group with lens-in-the-bag (LIB) implantation, that is, implantation in the capsular bag, and a group with bag-in-the-lens (BIL) implantation., Setting: CHU de Caen, Department of Ophthalmology, Caen, France., Design: Comparative retrospective study., Methods: One hundred consecutive cases of phacovitrectomies conducted between May 2013 and July 2016 were included. A retrospective analysis of the occurrence rate of PSI in the LIB group and in the BIL group was performed, using multivariate analysis including multiple risk factors such as preoperative synechiae, proliferative diabetic retinopathy, use of 20-gauge vitrectomy, use of gas or silicone tamponade, and use of endophotocoagulation., Results: One hundred eyes of 92 patients were included in this study (55 eyes in the LIB group and 45 in the BIL group). The occurrence of PSI was significantly lower in the BIL group with 1 case (2%) versus 22 cases (40%) in the LIB group (P < .001). Among the risk factors studied, preoperative synechiae and the use of retinal endophotocoagulation were almost significantly associated with the occurrence of PSI (P = .068 and P = .087, respectively). In the LIB group, these PSI led to 1 case of acute elevation of intraocular pressure by pupillary seclusion and the use of laser iridotomy in 8 cases., Conclusion: The use of BIL rather than LIB implantation in phacovitrectomy practically eliminates PSI., (Copyright © 2019 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To quantify the forces necessary to change the shape and optical power of human and monkey lenses., Methods: Cynomolgus monkey (n = 48; age: 3.8-11 years), rhesus monkey (n = 35; age: 0.7-17 years) and human (n = 20, age 8-70 years) eyes obtained postmortem, including the lens, capsule, zonules, ciliary body, and sclera were mounted in an optomechanical lens-stretching system. Starting at zero load, the lenses were symmetrically stretched in a stepwise fashion in 0.25- or 0.5-mm steps. The load, lens diameter, inner ciliary body diameter, and lens power were measured at each step and the diameter- and power-load responses were quantified., Results: The diameter- and power-load responses were found to be linear in the physiologically relevant range of stretching. The average change in cynomolgus, rhesus, and human lens diameter, respectively, was 0.094, 0.109, and 0.069 mm/g in young lenses, and 0.069, 0.067, and 0.036, mm/g in older lenses. For the same lenses, the average change in lens power was -3.73, -2.83, and -1.22 D/g in young lenses and -2.46, -2.16, and -0.49 D/g in older lenses., Conclusions: The force necessary to change the lens diameter and lens power increases with age in human and monkey lenses. The results agree with the Helmholtz theory of accommodation and with presbyopia theories that predict that the force required to disaccommodate the lens increases with age.

Introduction: Large traumatic zonular dialysis (larger than 140) induces significant surgical problems., Case Report: Two cases of large zonular dialysis with vitreous hernia in the anterior chamber, significant hypertonia, and cataract with subluxation of the lens are described. The surgical treatment consisted of ablation of the lens by phacoemulsification after anterior capsular rhexis and insertion of a conventional capsular tension ring. Then a Cionni ring was sutured to the sclera opposite the center of the zonular dialysis zone. The implant was inserted in the bag followed by an anterior vitrectomy. The IOL was centered in a stabilized bag in both patients. Postoperative visual acuity was excellent, with transitory hypertonia controlled with medical treatment., Discussion: The conventional capsular tension ring does not allow effective treatment of large zonular dialysis or recentration of the bag. However, the Cionni modified ring stabilizes and recenters the bag, allowing capsular preservation and implantation in the bag. The authors describe the insertion technique for this type of ring., Conclusion: The Cionni ring seems to provide an effective surgical solution to large traumatic zonular dialysis with subluxation of the lens. However, the insertion technique for the ring is difficult to perform.

Purpose: To assess the efficacy of various drugs in the prevention of posterior capsule opacification (PCO) in a closed capsular bag technique., Setting: Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA., Methods: Lens material was removed using phacoaspiration or phacoemulsification through a microcapsulorhexis according to the hardness of the crystalline lens correlated with the weight and age of the rabbits. A mixture of an ophthalmic viscosurgical device (sodium hyaluronate 1.4% [SHA]) and a drug was injected into the empty capsular bag, allowed to remain inside for 3 minutes, and removed. The capsular bag was rinsed with balanced salt solution (BSS) and refilled with SHA. In a group of rabbits, the capsulorhexis was sealed with a minicapsulorhexis valve (MCV). Rabbits were treated with 1 of the following: SHA (control), BSS, mitomycin-C (MMC, 0.2 mg/mL), ethylenediaminetetraacetic acid (EDTA) (10 mM and 15 mM), 5-fluorouracil (5-FU, 33 mg/mL), acetic acid (3%, 0.3%, and 0.003%), and distilled water., Results: Upon completion of the study, the control and treated eyes had PCO and new lens material (not residual). Anterior capsule proliferation was observed in eyes treated with 5-FU. The order of PCO appearance (earliest to latest) was as follows: 15 mM EDTA, SHA, MMC, acetic acid 0.3%, acetic acid 3%, BSS, distilled water (small animals; no MCV), acetic acid 0.003%, 5-FU, 10 mM EDTA, and distilled water (large animals; MCV). The earliest appearance was day 1 postoperatively and the latest, day 47., Conclusions: Distilled water and 10 mM EDTA treatments were the most efficient in retarding the appearance of PCO.

Purpose: To evaluate the clinical consequences of complications from neodymium:YAG (Nd:YAG) laser capsulotomy for posterior capsule opacification (PCO) over the lives of cataract patients., Setting: CHU de Caen, Caen, France., Methods: A model was constructed to estimate the lifetime clinical consequences of postoperative PCO treated by Nd:YAG laser capsulotomy. The probability of death was modeled from French mortality tables as a polynomial function of sex and age. The probability of becoming blind was modeled as a function of age from data in the literature. The incidence of Nd:YAG complications came from the literature. The rate of Nd:YAG capsulotomy over time was modeled as a survival curve using data from a cohort of 3335 patients., Results: Over 9 years in a 70-year-old population, switching from an IOL with a 20% Nd:YAG capsulotomy rate at 3 years to an IOL with a 5% rate would avoid 1 chronic intraocular pressure increase requiring medical follow-up in every 54 surgeries, 1 case of glaucoma in every 237 surgeries, 1 case of cystoid macular edema in every 265 surgeries, and 1 retinal detachment in every 265 surgeries. A 3-year clinical study would only capture one-third to one-half of long-term adverse events of Nd:YAG capsulotomy., Conclusion: Reducing PCO and the associated use Nd:YAG laser capsulotomy may contribute to preserving visual acuity in patients over their lifetimes.

We report a case of traumatic subluxation of a circular poly(methyl methacrylate) intraocular lens (IOL) 5 years after surgery. Slitlamp examination revealed the lack of epithelial cells or fibrosis in the intact capsule bag. Trauma was minor, and no other complication was found in the eye and orbit. The subluxated IOL was easily relocated in the bag with a hook, revealing the poor capsule sealing. Among the factors ensuring the fixation of IOLs placed in the bag after continuous curvilinear capsulotomy are sealing of the anterior and posterior capsules and proliferation of epithelial cells from the equator of the bag.

To document the ultrastructural distribution of lens capsule proteoglycans, rabbit lens capsules were fixed and stained overnight in 50 mM sodium acetate, pH 5.6, containing 2.5% glutaraldehyde, 0.2% Cuprolinic Blue and 0.2 M MgCl2. They were rinsed, stained with 1% aqueous sodium tungstate, embedded in Epon, sectioned (60 nm), and examined with an electron microscope at 60 kV. Proteoglycan-Cuprolinic Blue complexes mainly appeared as networks of small electron-dense filaments throughout the posterior and anterior capsules. The posterior capsule was a single layer with a network of small proteoglycan filaments gradually decreasing in size from the humoral side (90 x 10 nm) to the lenticular side (30 x 8 nm). The humoral side of the anterior capsule had a thin lamina (400 nm) containing large (180 x 40 nm), very electron-dense proteoglycan-Cuprolinic Blue complexes plus small proteoglycans. Below this lamina, the complexes were only seen as filaments slightly smaller than those in the corresponding area of the posterior capsule. Cuprolinic Blue binding of the anterior and posterior lens capsules revealed differences in the size and distribution of their sulphated proteoglycans which do not correspond to the patterns of their immunoreactivity with anti-heparan sulphate proteoglycan. The humoral lamina in the anterior capsules, with large proteoglycan structures, might be a distinct structural and functional compartment.

Aim of the Study: We performed a prospective study to compare two techniques of local anesthesia: topical and subtenon anesthesia. Twenty-five patients underwent cataract surgery on both eyes by phakoemulsification and insertion of foldable lenses in the capsular bag. The second eye was operated 24 hours after the first one. We evaluated patient confort, surgeon confort, surgical complications and pupillary diameter evolution during the procedure., Results: 64% of patients preferred subtenon anesthesia procedure. Surgeon confort was better with subtenon anesthesia. No surgical complications occurred in either group. The pupillar diameter evolution was different, decreasing for about 25% for topical anesthesia and 15% for subtenon anesthesia., Conclusion: Subtenon anesthesia is more comfortable for the patient: deeper anesthesia, reliable, longer lasting; light tolerance is better. It is also more comfortable for the surgeon: better pupillar dilatation during the procedure. Topical anesthesia has inconstant efficiency.

In chick spinal cord the presence of low affinity (KD = 2.2 microM) receptors for prostaglandin E2 (PGE2) raises the question whether spinal cord possesses a PGE2 biosynthetic capacity able to activate these receptors. The production of PGE2 in spinal cord and meninges was investigated by enzyme immunoassay. Spinal cord exhibited a 30- to 100-fold lower PGE2 biosynthetic capacity compared to meninges, but can generate PGE2 resulting in micromolar concentrations, sufficient to activate the low affinity PGE2 receptors. It is suggested that in physiological conditions, PGE2 synthesized within the spinal cord might locally activate the low affinity PGE2 receptors, whereas in pathological situations, after disruption of the blood-spinal cord barrier, PGE2 produced by the meninges might be accessible to spinal cord PGE2 receptors, and thus largely contribute to their saturation.

The levels of immunoglobulin E (IgE) in aqueous humor (AH) and serum were determined in 74 uveitis patients and 13 control patients with senile cataract. Uveitis patients' levels ranged from less than 0.06 to 460 IU/ml according to the paper radioimmunosorbent test (PRIST; limit of sensitivity, 0.06 IU/ml). Only one control patient had an AH level higher than the sensitivity limit (0.08 IU/ml). Of the five patients with the highest levels in the AH, four had toxocaral retinitis. The ratio of AH/serum to IgE normalized to the albumin concentration was calculated in 25 uveitis patients and was greater than 0.60 in 13 cases, indicating a possible intraocular IgE synthesis.

The authors have compared intraocular pressure in during induction and intubation mode. All measures were made with an aplanation tonometer (Schiotz), before induction, after induction, and immediately after intubation. Both NNLA and propofol induced an important decrease of the IOP, more with propofol (45.6%) than with NLA (28.1%). It increased again during intubation, but less with propofol (-26.8%) than with NLA (+9%).