To investigate complications in the posterior segment after transscleral suturing of the posterior chamber in intraocular lens (PC-IOL) implantation.Preoperative clinical characteristics and clinical course were analyzed in 13 eyes of 13 patients who underwent vitreous surgery for either suprachoroidal hemorrhage or rhegmatogenous retinal detachment after transscleral suturing in PC-IOL implantation.Preoperative low intraocular pressure (IOP) was found in 3 of 6 eyes with suprachoroidal hemorrhage (50%) and longer axial length in 3 eyes (50%). Retinal reattachment was achieved in 4 eyes (67%) and final vision was more than 0.1 in 3 eyes (50%). In 7 eyes of retinal detachment, retinal tear was undetected preoperatively in 3 eyes (43%), and retinal breaks were located in the superior quadrant in 5 eyes (71%), similar to the characteristics of aphakic retinal detachment. The retina was reattached in all eyes and vision improved to more than 2 Snellen lines in 6 eyes(86%).Low IOP caused by leakage from the scleral wound was a potential risk for developing suprachoroidal hemorrhage after transscleral suturing in PC-IOL implantation. A complete closure of the wounds may prevent suprachoroidal hemorrhage. Collapse and incarceration of the peripheral vitreous may cause retinal detachment and complete removal of the peripheral vitreous may prevent retinal detachment.
It is generally stated that opacities of the ocular media, including senile cataract, have little effect on the electrical responses of the retina. However, lower amplitudes and longer implicit times are sometimes observed in electroretinograms (ERGs) of patients with mature cataract.Single flash ERGs of mature cataractous eyes with decimal visual acuity less than 0.1 were compared with those of the fellow eyes with decimal visual acuity better than 0.5, in 105 senile cataract patients.The mean amplitudes and implicit times of ERG a-waves were, respectively, 323.6±95.8 μV and 14.7±3.5 ms in the cataractous eyes and 352.3±96.6 μV and 12.0±1.5 ms in the fellow eyes. The mean amplitudes and implicit times of ERG b-waves were, respectively, 390.1±108.7 μV and 63.4±27.9 ms in the cataractous eyes and 415.3±119.1 μV and 59.0±9.3 ms in the fellow eyes. The mean amplitudes of the a- and b-waves were significantly lower and the mean implicit times of the a- and b-wave were significantly longer in the cataractous eyes as compared to those of the fellow eyes. Postoperative visual acuity was similar in cataractous and fellow eyes.Even though single flash ERG was influenced due to mature cataract, eyes revealed good postoperative visual acuity. Single flash ERG does not always reflect the foveal function and the visual pathway; nevertheless, it remains a reliable guide to evaluate visual prognosis before cataract surgery.
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To develop a grading system that provides objective quantification of flow through the conventional aqueous humor outflow (AHO) system. The technique gives clinicians an additional assessment option in the evaluation of glaucoma treatment approaches. This was a retrospective observational study. This study evaluated the eyes of all primary open-angle glaucoma patients who underwent a Trabectome (NeoMedix Corp., Tustin, CA, USA) procedure with or without cataract surgery in the interval between April and September 2016 (n = 73). The nasal hemisphere was divided into three regions. Utilizing a four-level grading system designed for this study, an aqueous humor outflow grade (G0–G3) was assigned to each region using a video taken during examinations. The individual grade levels of the three regions were combined to get a composite AHO score. The correlation between the composite AHO score and intraocular pressure (IOP) was then analyzed. Additionally, the speed of red blood cell (RBC) clusters in the episcleral veins (ESV) was calculated when made possible by the existence of pulsatile flow. At 3 months following the Trabectome procedure, average IOP decreased from 26 to 15 mmHg. Assessment of the relationship between AHO grade and IOP demonstrated that a high composite AHO score was correlated with lowered IOP (Tukey-Kramer method p < 0.05). Additionally, it was found that if one of the three regions had an AHO grade of ≥ G2, an IOP of < 20 mmHg could be predicted. (Fischer's exact test p < 0.0001). Calculated speed was as follows: at G1, the speed was 0.68 ± 0.26 mm/s (n = 7), at G2, the speed was 1.8 ± 0.84 mm/s (n = 5), and at G3, the speed was 6.8 ± 3.3 mm/s (n = 6). There was a significant correlation between an increase in the composite AHO score and a decrease in IOP. Additionally, the speed of RBC clusters as they traveled through the ESVs remained consistent for each of the grades, and the span of the speeds from lower to higher grades represented a significant range. These findings suggest that the grading system is a reliable measure of AHO. UMIN 000031745.
