Aim-To determine the long term visual and refractive results, and stability and complications of primary polypseudophakia using poly(methylmethacrylate) (PMMA) intraocular lenses (IOLs) for cataract surgery in hypermetropic eyes. (Br J Ophthalmol 2001;85:1198-1202 Polypseudophakia, also known as piggyback intraocular lens (IOL) implantation, was first described by Gayton in 1993, in a case of extreme hypermetropia in a nanophthalmic eye undergoing cataract surgery. As a +46 dioptres (D) IOL was not available, two IOLs were used with the first plano-convex lens implanted within the capsular bag (plano side facing anteriorly) and the second implanted in the ciliary sulcus (plano side facing posteriorly). Methods-Prospective Conclusion-Peripheral 1Many surgeons have since used this technique for less extreme cases of hypermetropia, where a single high power IOL was out of the range or near the upper limit of power inventories. Implanting two IOLs in cases of high hypermetropia is preferable, because such systems provide better optical quality with less spherical aberration than a single high power IOL. 3-5 Primary polypseudophakia (primary implantation of two or more intraocular lenses at the time of cataract removal) has been used not only in short hypermetropic eyes after cataract surgery 1 3 6-9 but also after refractive lensectomy, 10 in myopic keratoconic eyes with cataract, 11 and for the correction of paediatric aphakia.12 Secondary polypseudophakia 13 (implantation of a second intraocular lens at a later stage) has been used for the correction of refractive errors after cataract surgery, [13][14][15][16] penetrating keratoplasty, 14 17 and refractive surgery in order to avoid the risks associated with intraocular lens exchange. 14 Materials and methodsWe carried out a prospective study of consecutive hypermetropic patients who underwent cataract surgery and primary implantation of two poly(methylmethacrylate) (PMMA) IOLs from January 1997 to October 1999. The purpose of our study was to determine the refractive results, the long term stability of the implants, and the complications of primary polypseudophakia. The inclusion criteria for the study were axial length (AL) of less than 21 mm, or the requirement of an IOL of greater or equal to +30 D to achieve emmetropia. The AL was measured by applanation ultrasonography (Storz, CompuScan LT) with an ultrasound velocity of 1550 m/s. The IOL power was calculated using the SRK II formula in five eyes and the SRK/T formula in the other 10 eyes. The hospital was in transition to adopting the SRK-T formula as the standard formula, and two of the cases were treated in a private hospital. The intended postoperative refraction was emmetropic in all but two eyes where a slightly myopic refraction was required to avoid anisometropia.All of the patients had nucleofractis phacoemulsification, with continuous curvilinear capsulorrhexis slightly smaller than the size of
Patient selection is important for the effective use of the modified tarsorrhaphy technique and should be reserved for those with 2 mm or less of inferior scleral show. Two principal factors to be considered before this eyelid surgery and the use of a box suture in reformation of the lateral canthal angle are discussed. Although a number of surgical procedures are available to manage eyelid malposition secondary to thyroid eye disease, they vary in complexity and severity of complications. The modified tarsorrhaphy technique was effective in the treatment of a specific group of patients who had undergone previous orbital and eyelid surgery for thyroid eye disease.
A novel phenotype in a 3-generation family with early-onset aponeurotic ptosis and corneal limbal vascularization is described. Karyotype analysis was normal in the proband, and autosomal dominant transmission is demonstrated.
SUMMARYA woman in her late 70s with chronic bilateral epiphora under ophthalmology review was referred to our department for dacryocystorhinostomy after punctoplasty and detection of nasolacrimal duct obstruction. A CT scan of the paranasal sinuses for preoperative planning revealed complete opacification of the right maxillary, anterior ethmoid, frontal and sphenoid sinuses, left septal deviation and an incidental finding of foreign bodies in the right anterior nasal airspace. She proceeded with functional endoscopic sinus surgery (FESS) and removal of foreign bodies. To our surprise, a partially eroded 20 pence and 1 penny coin were found and removed from her right nasal airway. There was no history given about foreign bodies in her nose. Her symptoms improved postoperatively. BACKGROUND
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