In this report we describe the surgical details involved in refilling the lenses of 13 rabbit and 3 primate eyes using an inflatable endocapsular balloon to restore accommodation. The procedure involves endocapsular phacoemulsification through a small "buttonhole" or "dumbbell" anterior capsulotomy or minicircular capsulotomy and the simultaneous preservation of capsular integrity, including the zonules and ciliary muscles. An inflatable balloon made of thin silicone membrane is then inserted into the empty capsular bag. A liquid silicone polymer is injected into the balloon through a delivery tube, and the empty capsular bag is refilled by the inflated balloon. The procedure was found to be reproducible, and an accommodation of 6 D was confirmed in one primate eye. Capsular opacification occurred, but the proliferation and migration of residual lens epithelial cells could be hindered by abundant refilling. This lens-refilling technique may provide restoration of accommodation in future cataract surgery.
Objective: To confirm the effect of a square-edged, closed endocapsular equator ring (E-ring) for preventing posterior capsular opacification (PCO) after cataract extraction. Methods: Fifty-one eyes underwent cataract surgery associated with E-ring implantation between October 2002 and March 2008. Group 1 included 14 patients (14 eyes) who received an E-ring and intraocular lens (IOL) in 1 eye before March 2006. Their fellow eyes received only an IOL as controls. Group 2 included 23 patients (37 eyes) who received an E-ring and IOL in 1 or both eyes after March 2006 and another 37 age-matched control eyes with only IOL implants. After cataract removal, the E-ring (1.0 mm wide and thick and 9.0 or 9.5 mm long) was implanted in the capsule and an IOL was fixed in the ring. In the control eyes, only an IOL was implanted. The follow-up periods were 2 to 7 years. The PCO value was determined using the Hayashi method. Results: Two years postoperatively in group 1, the PCO value in the central area of the eyes with an E-ring was significantly lower than in the controls (4.4 vs 11.4, respectively; P=.005). No eyes with an E-ring required Nd:YAG laser posterior capsulotomy postoperatively compared with 23 of 51 control eyes (45%). The posterior capsule in the eyes with an E-ring remained transparent without touching the IOL optic. The 9.5-mm ring fit all eyes. Conclusion: The 9.5-mm E-ring, which fit all eyes, prevented PCO in human eyes 2 to 7 years postoperatively.
To report the outcomes in eyes in which a Sinskey-type conventional posterior chamber intraocular lens (PC-IOL) was fixed in the anterior chamber and followed up for an average of 10 years. Methods: Twenty-one eyes were included in the study. The IOLs were conventional hard PC-IOLs, 13.0 mm in overall length with 6.0-mm polymethylmethacrylate optic and polyvinylidene fluoride loops that tilted 10°anteriorly. Results: At implantation the corneal endothelial cell density in 13 of 21 eyes was 382 to 1580 cells/mm 2 owing to the previous implantation of iris-clip or iridocapsular IOLs. The overall postoperative corneal endothelial cell loss was 30.9%. Six of 14 eyes with a preoperative corneal endothelial cell density less than 2000 cells/mm 2 developed bullous keratopathy. Although serious complications did not occur in 7 eyes with a cell density exceeding 2000 cells/mm 2 , an average corneal endothelial cell loss of 26.5% still occurred. Except for 2 eyes, all loops were fixed at the scleral spur and a slight pupillary transformation occurred in only 1 eye. Conclusion: Although this procedure is easy to perform and pupillary transformation does not occur, it is not recommended for aphakic eyes owing to the high corneal endothelial cell loss after an average 10-year follow-up.
Objective: Toreporttheresultsofaspeciallydesignedclosed ringwithasquareedge(endocapsularequatorring)inayoung patient to prevent posterior capsular opacification. Methods: One eye of a 22-year-old atopic patient underwent endocapsular equator ring implantation with a 1-piece polymethylmethacrylate intraocular lens immediately after phacoemulsification at Hara Eye Hospital on January 10, 2003. The solid flexible silicone ring has an outer diameter of 9.0 mm, is 1.0 mm wide and 1.0 mm thick, and has a square edge. The loops of the intraocular lens are fixed in the inner groove of the ring. The contralateral control eye underwent phacoemulsification and implantation with a conventional intraocular lens im-plantation. The Hayashi method was used to determine the posterior capsular opacification score. Results: The ring retained the transparency of the entire posterior capsule. Two years postoperatively, the posterior capsular opacification score in the central area was 3.75 in the ring eye and 15.25 in the control eye, which underwent Nd:YAG laser capsulotomy 2.5 years postoperatively. Conclusion: An endocapsular equator ring effectively prevents posterior capsular opacification in a young patient with atopic cataracts.
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