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Purpose: To present a case involving a rarely seen prototype posterior chamber phakic IOL (PC-pIOL) in a highly myopic patient with bilateral cataract. Observations: A 64-year-old male presented to our clinic with poor vision in both eyes. Clinical examination revealed bilateral mature cataract, phacodonesis as well as a PC-pIOL implanted 35 years ago to address his high myopia. The visual acuity (VA) was 20/200 in the right eye and no light perception in the left eye. PC-pIOL extraction as well as 23G pars plana vitrectomy (PPV) and fragmentation surgery was scheduled for the right eye. The left eye was treated conservatively. Successful extraction of the PC-pIOL was performed while it was easy to remove. It was a bow-tie shaped lens with a collar-stud-like button in the middle which extended anteriorly into the anterior chamber through the pupil. PPV with lens fragmentation was successful and the patient was left aphakic in order to avoid the placement of a zero diopter IOL. Final best corrected VA was 20/25 one month post-surgery. Conclusions and importance: Removal of this rarely seen pIOL was performed without difficulty while excellent VA was achieved. Aphakia following complete vitrectomy represented a viable option in this case. Furthermore, we highlight the clinical manifestations associated with this IOL more than three decades after implantation.

PURPOSE: To study the clinical presentations, visual, and refractive profiles of children with congenital ectopia lentis in a large cohort of patients from a tertiary eye care network in India. MATERIALS AND METHODS: A retrospective review of electronic medical records from December 2012 to December 2020 was conducted. Two hundred and ninety‑seven consecutive children ≤18 years of age at presentation were identified and analyzed for demographic details, patient distribution, lens subluxation, visual, and refractive profiles before and after the interventions. RESULTS: Five hundred and ninety‑four eyes of 297 (male 56%; n = 166) patients were analyzed. The mean age at presentation was 8.74 ± 3.89. Best‑corrected visual acuity (BCVA) at presentation ranged from 0.3 logMAR to 3.5 logMAR; (Snellen: 6/9 – close to face [CF]) (mean 0.89 ± 0.68). High myopia (n = 201; 33.83%) and mild astigmatism (n = 340; 57.23%) were more frequent. Temporal (n = 108; 18.18%) subluxation was most common followed by superior. Lensectomy with limited vitrectomy was performed in 243 eyes of 127 patients (40.90%). Median preoperative BCVA was 1.0 (range: 0.3–3.5 logMAR; 20/40 ‑ CF). Median postoperative BCVA was 0.5 logMAR (6/18) in the pseudophakic group and 0.6 logMAR (6/24) in the aphakic group. Spherical equivalent in myopic children reduced from −12.06 ± 6.84D to −1.57D (−0.25D to − 5.5D) in the pseudophakic group and +9.3D (+5.5D to 15.5D) in the aphakic group. CONCLUSION: This study is a large cohort of children presenting with ectopia lentis. Following intervention, an improvement in the median BCVA and refractive correction was noted in the entire cohort. [ABSTRACT FROM AUTHOR]

PURPOSE: To study the clinical presentations, visual, and refractive profiles of children with congenital ectopia lentis in a large cohort of patients from a tertiary eye care network in India. MATERIALS AND METHODS: A retrospective review of electronic medical records from December 2012 to December 2020 was conducted. Two hundred and ninety-seven consecutive children ≤18 years of age at presentation were identified and analyzed for demographic details, patient distribution, lens subluxation, visual, and refractive profiles before and after the interventions. RESULTS: Five hundred and ninety-four eyes of 297 (male 56%; n = 166) patients were analyzed. The mean age at presentation was 8.74 ± 3.89. Best-corrected visual acuity (BCVA) at presentation ranged from 0.3 logMAR to 3.5 logMAR; (Snellen: 6/9 – close to face [CF]) (mean 0.89 ± 0.68). High myopia (n = 201; 33.83%) and mild astigmatism (n = 340; 57.23%) were more frequent. Temporal (n = 108; 18.18%) subluxation was most common followed by superior. Lensectomy with limited vitrectomy was performed in 243 eyes of 127 patients (40.90%). Median preoperative BCVA was 1.0 (range: 0.3–3.5 logMAR; 20/40 - CF). Median postoperative BCVA was 0.5 logMAR (6/18) in the pseudophakic group and 0.6 logMAR (6/24) in the aphakic group. Spherical equivalent in myopic children reduced from −12.06 ± 6.84D to −1.57D (−0.25D to − 5.5D) in the pseudophakic group and +9.3D (+5.5D to 15.5D) in the aphakic group. CONCLUSION: This study is a large cohort of children presenting with ectopia lentis. Following intervention, an improvement in the median BCVA and refractive correction was noted in the entire cohort.

Objective Procedure Results Conclusions The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure.Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy–ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months.Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy–ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy–ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months.Combined AVG and lensectomy–ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate surgical outcomes of eyes with severe anterior persistent fetal vasculature (PFV) and the role of associated anatomical anomalies on prognosis. Methods: This is a retrospective, comparative case series of 32 eyes of 31 patients who underwent vitreoretinal surgery for severe anterior PFV, defined as fibrovascular tissue totally covering the back of cataractous lens. Based on the degree of anterior retinal elongations, cases were classified as follows: group 1, eyes with well-developed pars plana and minor/no abnormalities (n = 11, 34%); group 2, eyes with partially developed pars plana and broad-based elongations (n = 9, 28%); and group 3, eyes with no visible pars plana and fibrovascular membrane having 360° continuity with peripheral retina (n = 12, 38%). Complications and functional and anatomical outcomes were investigated. Results: The median surgical age was 2 (1–12) months. The median follow-up was 26 (6–120) months. Seventy-three percent in group 1 achieved finger counting or better vision with a single surgery and without any pupillary/retinal complication. Groups 2 and 3 required 2.1 ± 0.9 and 2.6 ± 1.2 surgeries on average. Pupillary obliteration and RD occurred in 33% and 22% in group 2 and 58% and 67% in group 3. Retina remained attached after silicone oil removal in 89% of group 2 and 25% of group 3. Phthisis developed in 50% in group 3. Conclusion: Peripheral retinal anomalies are common in severe anterior PFV and have a major impact on prognosis. Prognosis is favorable in cases with mild-to-moderate anomalies with appropriate management of possible retinal tears. In eyes with 360° retinal elongations, severe fibrous proliferation and eventual eye loss are common. [ABSTRACT FROM AUTHOR]

AIM: To verify the feasibility and safety of staged lensectomy and vitrectomy in stage 5C retinopathy of prematurity (ROP) with corneal opacification. METHODS: This was a retrospective, interventional, consecutive case series. Twenty-two eyes of 18 stage 5C ROP patients with corneal opacification were included. Regular combined lensectomy and vitrectomy were not prescribed due to the invisible fundus. Staged lensectomy and posterior vitrectomy were performed. The anatomical and visual outcomes were reviewed at the final follow-up visit. RESULTS: The mean gestational age of ROP patients was 29.3±1.6wk (range: 27-32wk), comprising 8 males and 10 females. The average birth weight was 1363.0±300.0 g. All the eyes had corneal opacity and flat or disappeared anterior chambers pre-operatively. Two eyes had complicated cataract and 7 eyes had retrolental fibroplasia. Six eyes had posterior pupillary synechiae or membranes. Seven (31.8%) eyes had vascularly active retinas. The average interval between two procedures was 6.8±4.6mo (2.5-18.5mo). After surgeries, all the patients had normal anterior chambers. Fourteen eyes had clear corneas. The intraocular pressure of 3 eyes with glaucoma was controlled by medication. Two eyes had ocular phthisis. The retina was reattached in 3 eyes and partially attached in 11 eyes. Visual acuity ranged from no light perception to hand motion. CONCLUSION: Staged lensectomy and vitrectomy are procedures that can halt progression to further complications and preserve some useful eyesight in stage 5C ROP patients with corneal opacification. The earlier the lensectomy is performed, the better the prognosis is.

Objective Procedures Results Conclusions To describe a modified ab externo method of sulcus intraocular lens (IOL) fixation and report outcomes of eyes treated with this approach.Records of patients with lens instability or luxation that underwent a lensectomy and sulcus IOL implantation from January 2004 to December 2020 were reviewed.Nineteen eyes of 17 dogs had a sulcus IOL placed via a modified ab externo approach. The median follow‐up time was 546 days (range 29–3387 days). Eight eyes (42.1%) developed POH. A total of six eyes (31.6%) developed glaucoma and required medical management long term to control IOP. The IOL position was satisfactory in most cases. Nine eyes developed superficial corneal ulcers within 4 weeks following surgery, all of which healed without complication. At the time of the last follow‐up, 17 eyes were visual (89.5%).The technique described represents a potentially less technically challenging option for sulcus IOL implantation. The success rate and complications are similar to previously described approaches. [ABSTRACT FROM AUTHOR]

Introduction: Mechanical ocular trauma is a major cause of ocular morbidity and can lead to severe visual loss. One of the most complicated mechanical ocular trauma is iridodialysis. In this case, we report three surgical procedures to treat the effect of mechanical ocular trauma. Case Presentation: A 32-year-old man was referred to Gatot Soebroto National Army Hospital, Jakarta, with major complaints of pain and blurred vision in the left eye after sustaining blunt trauma while playing tennis two days ago. He was diagnosed with postoperative corneal laceration repair, subtotal iridodialysis, traumatic cataract, and vitreous hemorrhage on his left eye. He underwent iridodialysis repair with the McCannel suture technique and continued with a pars plana lensectomy to remove the lens and a pars plana vitrectomy to treat the vitreous hemorrhage. Postoperative examination showed a significant improvement of best-corrected visual acuity (BCVA) from hand movement to 0.15 and no sign of acquired infection. Conclusions: The effect of mechanical ocular trauma might be unpredictable and may include various conditions. Accurate management will prevent further complication and improves the patient's quality of life. A good approach and visual result will satisfy both patients and doctors. [ABSTRACT FROM AUTHOR]

A 13-year-old girl with a systemic diagnosis of homocystinuria (methylenetetrahydrofolate reductase deficiency type) associated with intellectual disability, skeletal abnormalities (genu varum, kyphoscoliosis, and arachnodactyly), and pancytopenia presented with bilateral ectopia lentis with anterior lens dislocation and secondary glaucoma in the left eye. Following medical management of glaucoma, the child underwent pars plana lensectomy with sutureless scleral fixation of the intraocular lens under general anesthesia. On follow-up, the intraocular pressure was controlled. The patient has also been started on systemic medications as per the pediatrician's advice.

Daniel Laroche,1,2 Melanie Scheive3 1Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, New York, NY, USA; 2Advanced Eyecare of New York, New York, NY, USA; 3Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence: Daniel Laroche, Department of Ophthalmology, New York Eye and Ear Infirmary and Advanced Eyecare of New York, 49 West 127th Street, New York, NY, 10027, USA, Tel +1 212663-0473, Email dlarochemd@aol.comAbstract: Glaucoma continues to be a leading cause of blindness worldwide for the same reasons as in the past several decades, including the lack of early detection, improper treatment, and non-adherence to therapy. Medical therapy continues to be the first-line therapy even as surgical techniques are improving in their safety and efficacy. To turn the tide in preventing blindness from glaucoma, attention must be focused on targeted patient education, screening, effective treatment, and addressing health disparities. To achieve this, early safer cataract surgery and microinvasive glaucoma surgery must be considered as a first-line therapy in addition to medical therapy to best lower both intraocular pressure and the medication burden.Keywords: glaucoma, prevention, cataract surgery, lensectomy, MIGS

Purpose This study aims to investigate the effect of lensectomy with anterior vitrectomy plus goniosynechialysis followed by a secondary iris-claw intraocular-lens implantation on intraocular pressure (IOP) and visual acuity in pediatric patients with microspherophakia-associated angle-closure glaucoma. Patients and methods A prospective randomized interventional case-series surgical study included 24 eyes of 12 patients aged from 6 to16 years with angle-closure glaucoma. Patients initially underwent lensectomy plus anterior vitrectomy and goniosynechialysis in a primary session followed later by secondary iris-claw implantation. The main outcome measure was IOP control and stability and the secondary outcome measure was visual acuity. Results IOP decreased from 25±2.59 mmHg preoperatively to 13.21±1.77, 14.71±2.33, 16.17±3.25, 16.13±3.55, 15.63±1.17, 15.67±1.17, 15.67±1.17, 15.71±1.23, 15.71±1.23, 5.71±1.23, 15.71±1.23, and 15.71±1.23 at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. IOP was controlled with complete success in 62.5% of cases and qualified success in 29.2%, while 8.3% became controlled with further glaucoma surgery. Anterior-chamber depth increased from 1.56±0.7 preoperatively to 3.33±0.20 postoperatively and remained stable over the next 5 years (P˂0.001). Visual acuity significantly improved from 0.79±0.1 to 0.88±0.8 (P˂0.001). Refractive error significantly decreased from −16 D preoperatively to −0.5 D postoperatively (P˂0.01). Antiglaucoma treatment decreased significantly as 62.55% of patients stopped receiving antiglaucoma treatment postoperatively (P˂0.001). Conclusion Lensectomy with anterior vitrectomy and goniosynechialysis followed by secondary iris-claw intraocular-lens implantation is effective in the control of angle-closure glaucoma secondary to microspherophakia and results in significant improvement in visual acuity.

PurposeTo report a modified technique of dry-lensectomy assisted lensectomy in the management of end-stage familial exudative vitreoretinopathy (FEVR) complicated with capsule-endothelial, iris-endothelial adhesion and secondary glaucoma.Methods24 eyes of 16 patients with severe complications of advanced pediatric total retinal detachment caused by FEVR who received limbus-based dry-lensectomy were studied retrospectively. Preoperative and postoperative clinical information was collected and reviewed.ResultsAmong the 24 eyes, three eyes (12.50%) underwent lensectomy combined with vitrectomy and membrane peeling simultaneously. 21 (87.50%) eyes underwent lensectomy without membrane peeling due to severe corneal opacity or retinal vascular activity, of which eight underwent another vitrectomy combined with membrane peeling. At the last visit (mean:13.86 ± 5.24 months of follow-up), all eyes had a reconstructed anterior chamber with normal depth. Among 21 eyes having preoperative corneal opacity, 15 (71.43%) had a clearer cornea with reduced opacity, 5 (23.81%) showed similar corneal opacification without deterioration. Among 11 eyes undergone retrolental fibroplasia peeling, seven (63.64%) eyes showed partial retinal reattachment in open-funnel type.ConclusionDry-lensectomy offered a simple way to lower the intraocular pressure and simplified the surgery, which helped to solve the severe anterior segment complications and offer a chance for following retrolental fibroplasia peeling and potential visual gain for selected end-stage FEVR patients.

Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (

Purpose: To present a case involving a rarely seen prototype posterior chamber phakic IOL (PC-pIOL) in a highly myopic patient with bilateral cataract., Observations: A 64-year-old male presented to our clinic with poor vision in both eyes. Clinical examination revealed bilateral mature cataract, phacodonesis as well as a PC-pIOL implanted 35 years ago to address his high myopia. The visual acuity (VA) was 20/200 in the right eye and no light perception in the left eye. PC-pIOL extraction as well as 23G pars plana vitrectomy (PPV) and fragmentation surgery was scheduled for the right eye. The left eye was treated conservatively. Successful extraction of the PC-pIOL was performed while it was easy to remove. It was a bow-tie shaped lens with a collar-stud-like button in the middle which extended anteriorly into the anterior chamber through the pupil. PPV with lens fragmentation was successful and the patient was left aphakic in order to avoid the placement of a zero diopter IOL. Final best corrected VA was 20/25 one month post-surgery., Conclusions and Importance: Removal of this rarely seen pIOL was performed without difficulty while excellent VA was achieved. Aphakia following complete vitrectomy represented a viable option in this case. Furthermore, we highlight the clinical manifestations associated with this IOL more than three decades after implantation., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors have no conflict of interest., (© 2024 The Authors. Published by Elsevier Inc.)

Purpose This study aims to investigate the effect of lensectomy with anterior vitrectomy plus goniosynechialysis followed by a secondary iris-claw intraocular-lens implantation on intraocular pressure (IOP) and visual acuity in pediatric patients with microspherophakia-associated angle-closure glaucoma. Patients and methods A prospective randomized interventional case-series surgical study included 24 eyes of 12 patients aged from 6 to16 years with angle-closure glaucoma. Patients initially underwent lensectomy plus anterior vitrectomy and goniosynechialysis in a primary session followed later by secondary iris-claw implantation. The main outcome measure was IOP control and stability and the secondary outcome measure was visual acuity. Results IOP decreased from 25±2.59 mmHg preoperatively to 13.21±1.77, 14.71±2.33, 16.17±3.25, 16.13±3.55, 15.63±1.17, 15.67±1.17, 15.67±1.17, 15.71±1.23, 15.71±1.23, 5.71±1.23, 15.71±1.23, and 15.71±1.23 at 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. IOP was controlled with complete success in 62.5% of cases and qualified success in 29.2%, while 8.3% became controlled with further glaucoma surgery. Anterior-chamber depth increased from 1.56±0.7 preoperatively to 3.33±0.20 postoperatively and remained stable over the next 5 years (P˂0.001). Visual acuity significantly improved from 0.79±0.1 to 0.88±0.8 (P˂0.001). Refractive error significantly decreased from −16 D preoperatively to −0.5 D postoperatively (P˂0.01). Antiglaucoma treatment decreased significantly as 62.55% of patients stopped receiving antiglaucoma treatment postoperatively (P˂0.001). Conclusion Lensectomy with anterior vitrectomy and goniosynechialysis followed by secondary iris-claw intraocular-lens implantation is effective in the control of angle-closure glaucoma secondary to microspherophakia and results in significant improvement in visual acuity. [ABSTRACT FROM AUTHOR]

Purpose: To present a previously unreported cause of bacterial endophthalmitis manifesting as delayed post-traumatic endophthalmitis ultimately responsive to total capsulectomy. Case Report: A patient presented with chronic endophthalmitis that occurred after ocular trauma with organic material and Oerskovia turbata was eventually isolated. After a prolonged treatment course, including two pars plana vitrectomies and total capsulectomy, the patient achieved 20/80 visual acuity at 1-year follow-up. Conclusion: This is the first reported patient with endophthalmitis due to O. turbata, a Gram-positive bacillus found in soil that rarely causes human infection. The infection had a delayed presentation despite early prophylactic antibiotics and was ultimately eliminated with total capsulectomy. Removal of lens and lens capsule may be necessary in the management of post-traumatic endophthalmitis unresponsive to more conservative therapy, particularly in cases involving atypical organisms and lens capsule violation.

Introduction Radical anterior vitreous base dissection and lensectomy in combination with inferior 180° retinectomy will improve the anatomic success of complex proliferative diabetic vitreoretinopathies (PVR)-related retinal detachment. Our study aims to describe the anatomical and functional results of pars plana vitrectomy with retinotomies and relaxing retinectomies in patients with tractional retinal detachment in advanced PVR. Patients and methods A case series study was conducted on 28 eyes of patients with tractional retinal detachment with severe PVR. Preoperative and postoperative complications and final visual outcomes were recorded. The follow-up period was 12 months. Results Full reattachment rate was reached intraoperatively in 26 (92.9%) eyes, with final complete reattachment success rate in 22 (78.5%) eyes at least 6 months of follow-up. A total of 17 (60.7%) eyes had their best-corrected visual acuity (BCVA) improved at 6 months postoperatively, and reaching a final BCVA of more than or equal to 2/60 at 6 months. The BCVA remained stable in six (21.4%) eyes and declined in five (17.9%) eyes. The complications postoperatively included secondary glaucoma (three eyes), retinal redetachment (four eyes), and hypotony (two eyes). Conclusion Pars plana vitrectomy with relaxing retinotomies and retinectomies is an effective treatment method for complex PVR-related retinal detachment. Improved preoperative visual acuity, lower PVR extension, and silicone oil tamponade use during the early recovery period are essential factors for good anatomical and visual outcomes and a lower rate of complications. [ABSTRACT FROM AUTHOR]

We present the clinical case of an 8-years-old male patient with a genetic diagnosis of Stickler syndrome type 1 and the management of associated vitreoretinal complications. The patient had an antecedent of no light perception in his left eye secondary to retinal detachment treated in another health centre. He consulted with a history of blunt trauma in his head with an unremarkable anterior segment and fundus exam. Scleral indentation showed no lesions to be treated in the right eye. We recommended follow-up every six months. The patient did not come to controls. He was consulted three years later because of visual loss in his right eye. Fundus showed a total retinal detachment secondary to a giant retinal tear of 320° with macular involvement and choroidal detachments. Therefore, scleral buckling, lensectomy, pars plana vitrectomy, inferior retinectomy, endovenous laser treatment (endolaser), and silicone oil tamponade were performed. After six weeks of follow-up, the patient presented an inferior re-detachment with grade C3 vitreoretinal proliferation. A new procedure of silicone oil removal, epiretinal membrane removal, enlargement of inferior retinectomy, endolaser, and silicone oil tamponade was indicated. After 6-months of follow-up, no new retinal detachment was presented, and the best-corrected visual acuity was 20/100. [ABSTRACT FROM AUTHOR]

BACKGROUND: The purpose of this paper was to report a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport's syndrome. CASE PRESENTATION: A 12-years-old child was referred to our hospital for cataract extraction secondary to decreased visual acuity in the right eye two years after lensectomy and posterior chamber intraocular lens implant in the left eye secondary to assumed traumatic cataract. Slit-lamp examination showed a ruptured anterior capsule in the right eye with lens matter in the anterior chamber. Clinically the patient was anemic and deaf; he was referred for pediatric evaluation and was diagnosed with Alport's syndrome and end-stage renal disease. Once the patient's hypertension was controlled, a lensectomy and posterior chamber intraocular lens implant was performed. RESULTS: Lensectomy and posterior chamber intraocular lens implant removed the cataract and allowed the restoration of visual acuity. CONCLUSIONS: Ophthalmologists may be the first to consider the diagnosis of Alport's syndrome based on lens changes. Uncontrolled Blood pressure can delay surgery, during which time intraocular pressure (IOP) should be monitored closely. RESULTS: of lensectomies with foldable IOL implantation are successful. To our knowledge, this is the second report of a case of bilateral lens capsule rupture in a patient with previously undiagnosed Alport's syndrome. [ABSTRACT FROM AUTHOR]

Purpose: To present a series of 4 patients from the Ohio Amish or Mennonite populations with isolated ectopia lentis. Methods: A case series was evaluated. Results: Four cases with bilateral lens subluxations were diagnosed with a homozygous c.767_786del pathogenic variant in ADAMTSL4 . Their ages ranged from 2 to 22 years. Three cases were symptomatic and were managed surgically with lensectomy, vitrectomy, and endolaser photocoagulation with or without secondary intraocular lens (IOL) implantation. One asymptomatic patient was observed. The postoperative visual acuity ranged from 20/20 to 20/60 in nonamblyopic eyes. Conclusions: The pathogenic homozygous c.767_786del variant in ADAMTSL4 may be a cause of bilateral isolated ectopia lentis in the Ohio Amish and Mennonite populations, likely as a result of a founder effect. Vitrectomy and lens extraction with or without secondary IOL implantation may lead to good visual outcomes. There were no cases of retinal detachment., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: To present surgical outcomes following intraocular lens (IOL) implantation in combination with lensectomy and vitrectomy for the treatment of persistent fetal vasculature (PFV). Methods: This interventional case series included 19 eyes from 19 patients with unilateral combined PFV. Limbal lensectomy, capsulotomy, anterior vitrectomy, dissection of the retrolental membrane and stalk, and in-the-bag or in-the-sulcus IOL implantation were performed for the treatment of visually significant lenticular opacity with the presence of a retrolental fibrovascular membrane and stalk, in an eye with sufficient capsular support. Postoperative anatomical and visual outcomes were evaluated. Results: After 22 to 50 months of follow-up, IOLs were well positioned in 18 (95%) of 19 eyes. Retinal dragging was reversed in all 8 eyes with preexisting peripapillary tractional retinopathy. Major complications occurred in 2 eyes (11%): one eye (5.5%) of vitreous hemorrhage and posterior capsular opacity and one eye (5.5%) of IOL dislocation. Nine (47%) of 19 eyes achieved best-corrected visual acuity (BCVA) above 20/200. Myopic shift after IOL implantation ranged from 0.75 to 4.17 D. Compared with eyes with poorer BCVA, eyes with BCVA above 20/200 had a better preoperative BCVA (mean 20/400 vs. 20/4000, P = 0.004) and were less likely to have preexisting peripapillary tractional retinopathies (11% vs. 70%, P = 0.002). Conclusion: Primary IOL implantation in combination with lensectomy and vitrectomy is an alternative to treat eyes with combined PFV. Prospects for rehabilitation may be limited by poor preoperative visual function and the presence of tractional retinopathies preoperatively. Postoperative refractive status requires long-term monitoring. [ABSTRACT FROM AUTHOR]

Background. Refractive laser surgery has absolute and relative contraindications. Among the relative ones is amblyopia and a history of strabismus. Caution should also be exercised when there is trauma, scar, or leukoma in the ablation site. Purpose. To report a case with regression of strabismic amblyopia after refractive surgery. Material and Methods. It was a pre-existing strabismus, which initially went unnoticed because it was a microtropia on left eye; the fixing right eye suffered a traumatic injury that produced a high ametropia and changed fixation. Results. The left eye developed excellent vision, but after the operation, somehow, momentarily the right eye became the fixator again, and the left eye saw very poorly. That situation was corrected quickly with right eye occlusion and lenses. That has happened because the eye had corrected its amblyopia for the years that the right eye was penalized. Once a good result was achieved, there was no change in fixation or visual loss. Conclusion. The change in ocular dominance and visual readjustment at the neuronal level that occurs in the postoperative period of refractive surgery stands out. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. ROP screening and interventions (e.g., laser ablation and anti-vascular endothelial growth factor [VEGF] therapy) at the right time can reduce disease activity and prevent retinal detachment. However, sometimes, ROP is refractory to treatment, leading to tractional retinal detachment (TRD), requiring surgical intervention, such as vitrectomy. Vitrectomy for Stage 5 ROP (total retinal detachment) is beneficial in preventing total blindness in some patients. However, it has poor anatomical and functional results. Vitrectomy (lens-sparing vitrectomy, if possible) should be performed at Stage 4A ROP (partial TRD not involving the macula) because the anatomical and functional results are much better.

Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis.Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013-June 2015) were compared with those without surgical PI (July 2015-December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA).Results: The mean age at surgery was 8.8 years (range: 3.5-15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture -6; rise in IOP -4; IOL subluxation -4; repeat surgery -5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ≈ 20/200) and post BCVA was 0.40 (±0.50) (Snellen ≈ 20/50). The mean preoperative refraction was - 9 D (±8D) (range: -5 D to -23D) and postoperative was -1 (±1.15) D. The mean follow-up was 25.4 months.Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications. [ABSTRACT FROM AUTHOR]

Importance: To determine visual and surgical results in children with Marfan syndrome. Background: Marfan syndrome involves ocular complications which can lead to visual disturbance and amblyopia. Data about the visual and surgical results in children with Marfan syndrome is vital for the clinical management of these patients. Design: Retrospective data analysis. Participants: Eighty‐two eyes of 41 patients with a genetically proved diagnosis of Marfan syndrome. Methods: Medical records of patients with Marfan syndrome were reviewed between 2007 and 2017. Ocular complications, visual acuity (VA) of patients with/without lensectomy and surgical method were evaluated. Main Outcome Measures: VA outcomes of patients with Marfan syndrome with/without surgical repair of ectopia lentis. Results: In 27 (66%) of the 41 patients a bilateral subluxation of the lens was visible and 14 (52%) patients received lensectomy. The mean age at initial presentation was 12.3 ± 9 years and mean follow‐up was 3 years (range 1‐7). VA varied from 1.2 to −0.1 logMAR at first examination. At initial presentation, mean VA was 0.1 ± 0.7 logMAR in patients with a normal lens status (n = 14) and 0.3 ± 0.5 logMAR in patients with subluxation of the lens (n = 27) (P <.01). VA improved from 0.2 ± 0.5 logMAR to 0.1 ± 0.5 logMAR (P =.06) in children with subluxation of the lens who did not need a lensectomy (n = 12) and from 0.5 ± 0.5 logMAR to 0.2 ± 0.5 logMAR (P =.02) in patients who were referred to lensectomy with/without secondary lens implantation. Conclusions and Relevance: In Marfan syndrome subluxation of the lens was found in the majority of children. Improvement of VA resulted in children with subluxation of the lens and following lensectomy. [ABSTRACT FROM AUTHOR]

AIM: To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous (PHPV). METHODS: This retrospective study included patients with cataract and PHPV treated with various strategies. Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization, posterior capsulotomy, anterior vitrectomy, and intraocular lens (IOL) implantation. Posterior PHPV was treated with lensectomy, posterior vitrectomy, retinal photocoagulation, and IOL implantation or silicone oil tamponade. Visual acuity (VA), pattern visual evoked potential (P-VEP), anatomic recovery, postoperative complications, and amblyopia outcome were examined. Subjects were followed-up for 3-48mo after surgery. RESULTS: Of the 30 patients (33 eyes) with congenital cataract and PHPV included (average age, 39.30±35.47mo), 9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage (6 eyes) and two-stage (3 eyes) implantation. Postoperative complications included retinal detachment (1 eye) and recurrent anterior chamber hemorrhage (1 eye). In eyes with posterior PHPV, 6 and 11 eyes received IOLs in one- and two-stage procedures, respectively. Silicone oil was retained in 2 eyes, and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48mo of amblyopia treatment. P-VEP P100 was improved following surgery in both PHPV types. CONCLUSION: Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.

AIM: To observe the visual recovery and complications in patients with proliferative diabetic retinopathy(PDR)after vitrectomy combined with phacoemulsification. METHODS: According to different surgical methods, 95 cases(95 eyes)with PDR were divided into the observation group(50 cases)and the control group(45 cases). The observation group was treated with vitrectomy and phacoemulsification, while the control group was treated with vitrectomy and lensectomy. The visual recovery, changes of intraocular pressure before and after surgery and the complications were compared between the two groups. RESULTS: The visual acuity of the two groups was significantly improved after surgery(PPPP>0.05). The incidence of iris neovascularization and capsule opacification in the observation group(2%, 6%)were significantly lower than those in the control group(18%, 27%; PCONCLUSION: Vitrectomy combined with phacoemulsification can obviously improve the visual acuity of patients with PDR, and the incidence of complications is low. Although it will lead to an increase in intraocular pressure, it can be improved after symptomatic treatment.

Background: Non-traumatic ectopia lentis is a rare ocular disorder usually associated with syndromes like Marfans's syndrome, Weil-Marchesani and Homocystinuria. Ectopia lentis can lead to profound visual loss from refractive errors, glaucoma as well as retinal detachment if left unattended., Aim: The aim of this study was to describe the clinical profile of patients with non-traumatic ectopia lentis in a paediatric ophthalmology clinic in Ibadan, Nigeria., Methods: The clinical records of children ≤16 years diagnosed with non- traumatic ectopia lentis at the Paediatric Ophthalmology Clinic, University College Hospital Ibadan, from May 1, 2015 to Dec 31, 2019 were retrospectively reviewed. Information on demography, family history, visual acuity (VA), mean refractive error (spherical equivalent), and management was retrieved., Results: Clinical records of 25 patients were reviewed. The mean age was 8.9 (±3.41) years with a range of 2-15 years. Sixteen (64%) patients were males. All the patients had bilateral involvement. A positive family history of ectopia lentis was elicited in 6 (24%) patients. Thirteen (52%) patients had a Marfanoid habitus and superior displacement of the lens was observed in 26 (52%) eyes. The presenting visual acuity was <6/60 in 22 (44%) eyes. The spherical equivalent of the refractive errors ranged from -20.00DS to +13.25DS. Twenty (40%) eyes underwent surgery within the period of the study and the best corrected postoperative visual acuity improved by 2 or more lines in 12 (60%) of operated eyes., Conclusion: Severe visual morbidity was common in this cohort of patients with ectopia lentis in our practice. Treatment provided some improvement in vision which highlights the need to encourage early presentation for care. Detailed family history is important as a few of the patients were diagnosed following acceptance of our invitation to siblings for ophthalmic evaluation., Competing Interests: None to declare., (© Journal Name, Year.)

Purpose: To present a previously unreported cause of bacterial endophthalmitis manifesting as delayed post-traumatic endophthalmitis ultimately responsive to total capsulectomy. Case Report: A patient presented with chronic endophthalmitis that occurred after ocular trauma with organic material and Oerskovia turbata was eventually isolated. After a prolonged treatment course, including two pars plana vitrectomies and total capsulectomy, the patient achieved 20/80 visual acuity at 1-year follow-up. Conclusion: This is the first reported patient with endophthalmitis due to O. turbata, a Gram-positive bacillus found in soil that rarely causes human infection. The infection had a delayed presentation despite early prophylactic antibiotics and was ultimately eliminated with total capsulectomy. Removal of lens and lens capsule may be necessary in the management of post-traumatic endophthalmitis unresponsive to more conservative therapy, particularly in cases involving atypical organisms and lens capsule violation. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of iridectomy, capsulotomy and anterior vitrectomy through the anterior chamber to treat misdirection syndrome in pseudophakic nanophthalmic eyes.Methods: This was a non-comparative study of seven nanophthalmic eyes from four consecutive patients. All eyes developed misdirection syndrome after successful cataract surgery. Treatment for misdirection syndrome involved capsulotomy and anterior vitrectomy through a peripheral iridectomy from the anterior chamber using a 25-gauge vitreous cutter. The best-corrected visual acuity, intraocular pressure and anterior and posterior segment findings were recorded before and after surgery.Results: Resolution of the aqueous misdirection was achieved in all but one eye. The single case of recurrence was observed after a mean follow-up of 45.6 ± 21.5 months and was caused by closure of the capsule hole by Elschnig's pearls. This eye was successfully treated by enlargement of the lens capsule hole with a vitreous cutter. The mean intraocular pressure before surgery was 28.7 ± 4.4 mmHg, and this was significantly reduced to 13.7 ± 1.3 mmHg at the final visit. All but one patient, who had uveal effusion, maintained their best-corrected visual acuity.Conclusion: In this study, we investigated an alternative option for the treatment of misdirection syndrome in nanophthalmic eyes. We undertook a lens capsulotomy and anterior vitrectomy through a peripheral iridectomy from the anterior chamber using a 25-gauge vitreous cutter, which was able to create a communication hole between the anterior and posterior chambers. [ABSTRACT FROM AUTHOR]

Introduction: To present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome.Case Report: A woman with Marfan syndrome presented with a subluxed crystalline lens in her right eye, which progressively subluxed over the following 2 years. A lensectomy was performed with placement of an anterior chamber intraocular lens (IOL); however, the patient experienced blurred vision and photopsias and preferred IOL explantation. The IOL was removed and a scleral-fixated posterior chamber IOL was placed. Vision improved with an uncomplicated postoperative course. Five months later, the patient experienced sudden onset redness and sharp pain in this eye. A 3-mm cystic lesion with tan material was found over a prior scleral incision site. Intraocular pressure was normal and no aqueous leaked from the lesion. Owing to concerns of an infected inadvertent bleb, treatment with topical and oral antibiotics was started, but the lesion did not change in appearance and the patient experienced persistent pain. The lesion was surgically excised and histopathology revealed a conjunctival epithelial inclusion cyst with intralesional keratin. A month later, another conjunctival inclusion cyst developed and was excised per patient preference.Conclusion: Marfan syndrome is characterized by defects in the FBN1 gene and may theoretically lead to an abnormal sclera, increasing the risk of bleb formation after scleral incision. Distinguishing between a filtering bleb and an epithelial inclusion cyst is critical in patient care. Although retained keratin from a cyst may mimic a bleb with purulence, intraocular pressure, aqueous leakage, and response to topical antibiotics may help distinguish between the two. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risks and benefits of simultaneous bilateral intraocular surgery (SBIS) in pediatric patients at a university hospital in the Kingdom of Saudi Arabia, who are placed under general anesthesia for the procedure. Methods: This retrospective, noncomparative case study comprised 15 children, who underwent bilateral cataract surgery and/or primary or secondary intraocular lens (IOL) implantation in one sitting between November 2008 and July 2014. Seven patients had bilateral lensectomy primary posterior capsulotomy and anterior vitrectomy, and the remaining eight patients had bilateral IOL implantation at the capsular bag either primarily IOL implantation (two cases) at the time of cataract extraction or secondary IOL implantation at the capsular bag (six cases). Bilateral surgeries were performed sequentially by the same surgeon, with strict aseptic separation of the two surgeries, while the patient was under general anesthesia. Results: The age of the patients at the time of the surgery ranged from 7 months to 9 years (mean age 2.13 years). The patients were followed up approximately for 4 months postsurgery. There were no catastrophic complications from the anesthesia (death, asphyxia, cardiac or respiratory arrest, or seizures) nor were there any intraoperative complications that necessitated cancelation of surgery in the second eye. Postoperatively, one patient was noted to have reproliferation of lens material in one eye. However, no serious postoperative complications such as endophthalmitis, aphakic glaucoma, and hyphema were noted. Conclusion: SBIS conducted during the same operative procedure is an alternative to sequential surgery in selected pediatric patients if operative guidelines and surgical asepsis are strictly followed.

Lensectomy with vitrectomy is often performed for crystalline lenticular subluxation. We report a new technique and a practical approach that involves the placement of a spatula beneath the iris tissue that facilitates retroiridial removal of subluxated lens and acts as a scaffold by protecting the iris tissue from being accidentally trapped into the vitrectomy cutter port. Our technique facilitates management of the lens and vitreous without any trauma to the iris and secondarily obviates the need to perform an iris repair procedure that may arise due to iatrogenic reasons.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. ROP screening and interventions (e.g., laser ablation and anti-vascular endothelial growth factor [VEGF] therapy) at the right time can reduce disease activity and prevent retinal detachment. However, sometimes, ROP is refractory to treatment, leading to tractional retinal detachment (TRD), requiring surgical intervention, such as vitrectomy. Vitrectomy for Stage 5 ROP (total retinal detachment) is beneficial in preventing total blindness in some patients. However, it has poor anatomical and functional results. Vitrectomy (lens-sparing vitrectomy, if possible) should be performed at Stage 4A ROP (partial TRD not involving the macula) because the anatomical and functional results are much better. [ABSTRACT FROM AUTHOR]

Purpose To describe the demographic data, evaluate the long-term refractive and anatomical outcomes, and report the incidence of complications of anterior iris (prepupillary) and posterior iris (retropupillary) fixation of the Artisan aphakia iris-claw intraocular lens (IOL). Setting Complejo Hospitalario Universitario de Santiago de Compostela, Spain. Design Retrospective case series. Methods Patients who had iris-claw IOL implantation were divided into 2 groups: Group 1 (prepupillary) and Group 2 (retropupillary). The corrected distance visual acuity (CDVA), anatomical changes, endothelial cell count (ECC), presence of cystoid macular edema (CME), and operative and postoperative complications were determined. Results The study comprised 95 eyes of 95 patients. Fifty-seven patients had prepupillary implantation and 38 patients had retropupillary implantation. Indications for surgery were IOL luxation or subluxation (n = 24), lens luxation or subluxation (n = 17), trauma (n = 15), aphakia (n = 30), and other (n = 9). The CDVA improved significantly in both groups and there were no differences between them. A significant ECC reduction was observed in both groups, with no differences between them. The incidence of CME was 16.1% (21.8% in the prepupillary group and 7.9% in the retropupillary group at 3 months and 8 months, respectively), although the difference was not statistically significant. Other postoperative complications were rare and no differences were found between groups. Conclusions Irrespective of location, the iris-claw IOL provided good visual outcomes with few complications. However, prepupillary IOL implantation seemed to contribute to greater endothelial cell loss and earlier onset of CME. [ABSTRACT FROM AUTHOR]

Abstract: Importance: Quality of vision after multifocal intraocular lens (IOLs) implantation in relation to patient satisfaction. It is important to include the evaluation of visual quality and patient satisfaction in clinical practice. Background: To evaluate and compare quality of life and patient satisfaction after implantation of three types of diffractive–refractive and apodized‐diffractive bifocal and trifocal multifocal IOLs. Design: Comparative, prospective, case series and randomized. Participants: Hundred and four eyes of 52 patients. Methods: Three multifocal IOLs: AT LISA 809 M (Carl Zeiss Meditec) (AT LISA group, 38 eyes), AT LISAtri 839MP (Carl Zeiss Meditec) (AT LISAtri group, 32 eyes), and ReSTOR SN6AD1 (Alcon) (ReSTOR group, 34 eyes) were implanted after cataract surgery. Main Outcome Measures: Contrast sensitivity, photopic phenomena, patient satisfaction and quality of life criteria were evaluated. Results: Patient of ≥ 88% were satisfied with near and intermediate visual outcomes. Better distance‐corrected intermediate visual acuity at 90 cm was detected for AT LISA tri group (P < 0.04). No statistically significant differences were found among groups in postoperative contrast sensitivity (P ≥ 0.053). There were no significant differences in spectacle dependence scores among the groups (P ≥ 0.180). The addition of an intermediate focus did not statistically affect halo and glare size and intensity (P ≥ 0.256) or subjective impact (P ≥ 0.077). Patient satisfaction was consistently high for all groups ( P ≥ 0.154). Conclusions and Relevance: Contrast sensitivity outcomes and patient satisfaction remained high in the trifocal group when compared to the bifocal IOL groups. [ABSTRACT FROM AUTHOR]

Purpose To report the incidence of, and factors related to, glaucoma after lens-sparing vitrectomy (LSV) surgery in advanced retinopathy of prematurity (ROP). Design Retrospective case series at a single tertiary referral pediatric vitreoretinal practice. Participants Four hundred and one eyes from 270 patients were included. Methods The medical records of patients who underwent LSV for stage 4A, 4B, and 5 ROP were retrospectively reviewed. Data were collected from patient charts including gender, gestational age at birth, birthweight, stage of ROP at presentation, prior treatment (laser or cryotherapy), subsequent retinal surgeries, presence of glaucoma, time to glaucoma (interval between LSV and the onset of glaucoma), date of lensectomy (if performed), and retinal attachment status at last visit. Lensectomy was considered as a time-dependent covariate in the analysis. Main Outcome Measures Incidence of glaucoma and potential risk factors for time to glaucoma. Results Among 401 eyes with advanced ROP, 40 eyes (10.0%) had glaucoma during a mean of 3.06±4.11 years of follow-up. The incidence of glaucoma was 6.9% (17/247) in stage 4A, 12.0% (16/133) in stage 4B, and 33.3% (7/21) in stage 5 ROP. Twenty-one percent of eyes (87/401) required lensectomy at a mean of 1.23±2.19 years after LSV. In univariate analysis, having stage 5 ROP (vs. stage 4 ROP) and presence of lensectomy were found to be significantly associated with time to glaucoma (hazard ratio = 6.76, 95% confidence interval = 2.19–20.88, P = 0.001; hazard ratio = 3.06, 95% confidence interval = 1.56–6.0, P = 0.001, respectively). In multivariate analysis, lensectomy was the only significant independent factor associated with time to glaucoma (hazard ratio = 2.76, 95% confidence interval = 1.371–5.581, P = 0.004). Conclusions Patients with more severe ROP had a higher incidence of glaucoma after lens-sparing vitrectomy. If a patient required lensectomy owing to progression of ROP and/or presence of lens opacity, then the hazard of having glaucoma significantly increased compared with those without lensectomy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the functional and anatomical outcomes following surgical management of persistent fetal vasculature (PFV).Methods: Single-center, retrospective, interventional consecutive case series of 41 patients (44 eyes) who underwent vitrectomy with or without lensectomy through a limbal or pars plana/plicata approach with diagnosis of anterior, posterior, or combined anterior and posterior segment PFV were included.Results: The median age at the time of surgery was 3 months (range, 1–36 months), and the mean follow-up period was 37.2 ± 38.1 months (range, 12–164 months). Of the 44 eyes, 5 (11%) had clinical and ultrasonographic findings of anterior PFV, 5 (11%) had posterior PFV, and 34 (78%) had components of both anterior and posterior disease. At the last visit, 38 eyes (87%) were aphakic, 5 eyes (11%) were phakic, and 1 eye (2%) was pseudophakic. The mean Snellen equivalent VA at the final visit for the 14 (32%) eyes with measurable VA was 20/283. Nine (20%) eyes had final VA of only light perception or no light perception. The remaining 21 (48%) eyes behaved consistently with form vision, but the patients were not able to report VA.Conclusions: Most of the eyes achieved at least form vision, with acceptable postoperative complication rates. Functional and anatomical outcomes are not strictly dependent on axial length, and microphthalmic eyes with mild posterior segment involvement have the potential for good visual results. Outcomes after surgery for posterior PFV associated with tractional retinal detachment are limited. Anatomical success does not always equate to functional improvement. [ABSTRACT FROM AUTHOR]