To investigate the clinical manifestations and surgical prognoses after direct cyclopexy in patients with traumatic cyclodialysis according to the cleft extent as determined by ultrasound biomicroscopy (UBM).Methods: A detailed ophthalmologic examination, which included gonioscopy and UBM, was performed before and after direct cyclopexy in 32 eyes of 31 patients with traumatic cyclodialysis clefts.Results: Cyclodialysis clefts were accurately diagnosed and delineated in all 32 eyes using UBM. Cyclodialysis resulted in hypotony with a mean intraocular pressure of 3.2 mm Hg irrespective of cleft size. On A-scan ultrasonography, mean (SD) preoperative and postoperative lens thicknesses were 4.4 (0.4) mm (range, 3.71-4.92 mm) and 4.1 (0.4) mm (range, 3.42-4.57 mm), respectively, and mean (SD) preoperative and postoperative axial lengths were 23.2 (0.7) mm (range, 21.91-24.57 mm) and 23.6 (0.7) mm (range, 22.47-24.56 mm), respectively. The larger a cleft was, the longer it took for a postoperatively elevated intraocular pressure to normalize after direct cyclopexy. Postoperative visual acuities were significantly better than preoperative values, even when direct cyclopexy was performed 54 months after trauma.Conclusions: Even small clefts usually resulted in hypotony and visual prognosis was better after cyclopexy, even in cases with a protracted history. Larger clefts need longer postoperative follow-up to check for intraocular pressure normalization after direct cyclopexy.
Purpose:
To evaluate the changes in iridocorneal angle structure and trabecular pigmentation after implantation with the STAAR Implantable Collamer Lens (ICL), as potential risk factors of secondary glaucoma.
Methods:
An ICL was implanted in 48 eyes of 29 patients with high myopia. Angle opening distance (distance between trabecular meshwork and iris) measured at 500 µm from the scleral spur and trabecular-iris angle were assessed preoperatively and at 1, 6, 12, and 24 months postoperatively by ultrasound biomicroscopy, and trabecular pigmentation was evaluated preoperatively and at 1, 12, and 24 months postoperatively by standardized gonioscopic photography.
Results:
Mean follow-up was 33.2±7.3 months. One-month postoperative trabecular-iris angle and angle opening distance values were significantly smaller than preoperative values by 41.5% and 31.8%, respectively (
P
<.001), but no significant progressive changes were observed thereafter. The mean trabecular pigmentation of four quadrants did not change significantly during the first month after ICL implantation (
P
=.317), but significantly decreased at 1 and 2 years postoperatively compared with the preoperative value (
P
=.039 and .047, respectively). Intraocular pressure (IOP) remained stable in all eyes throughout follow-up except in one eye, which showed elevated IOP and significantly increased trabecular pigmentation requiring antiglaucoma medications.
Conclusions:
No ongoing narrowing of iridocorneal angle was noted after approximately 40% narrowing at 1 month postoperatively. There was no general increase in trabecular pigmentation or IOP over a mean follow-up of 33.2 months. Considering significant initial angle crowding and one eye with increased trabecular pigmentation and IOP, careful monitoring of iridocorneal angle and IOP is required during the early postoperative period, especially for 1 month. [
J Refract Surg
. 2009;25:251–258.]
Implantation of the STAAR TICL appears to be an effective and safe method for correction of myopic astigmatism. No clinically significant rotation or footplate displacement of the TICLs was detected postoperatively during mean follow-up of 7.6 months.
Although DALK is a safe alternative in cases of keratoconus, the DALK group evidenced significantly higher myopia than did the PKP group, which was related to steeper central corneal power and deeper ACD.
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