Sampei Miyake

New classification of capsular block syndrome

Purpose: To propose a new classification of capsular block syndrome (CBS) to improve understanding of the etiology and provide effective treatment. Setting: Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, and Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan. Methods: Three groups of eyes with CBS were reviewed: eyes originally reported and diagnosed as having CBS; eyes experiencing CBS after hydrodissection and luxation of the lens nucleus; and eyes with CBS accompanying liquefied aftercataract or capsulorhexis‐related lacteocrumenasia. Results: In all 3 groups, the CBS occurred in eyes with a ‐continuous curvilinear capsulorhexis (CCC). It was characterized by accumulation of a liquefied substance within a closed chamber inside the capsular bag, formed because the lens nucleus or the posterior chamber intraocular lens (IOL) optic occluded the anterior capsular opening created by the CCC. Depending on the time of onset, CBS can be classified as intraoperative (CBS seen at the time of lens luxation following hydrodissection), early postoperative (original CBS), and late postoperative (CBS with liquefied aftercataract or lacteocrumenasia). The etiology of the accumulated substance and the method of treatment are different in each type. Conclusion: Capsular block syndrome is a complication of cataract/10L surgery that can occur during and after surgery. Correctly identifying the type of CBS is crucial to understanding the nature and effective treatment of this disorder.

Correlation between intraocular lens hydrophilicity and anterior capsule opacification and aqueous flare

Purpose: To study the correlation between a basic parameter of intraocular lens biocompatibility, hydrophilicity, and two clinical parameters, postoperative inflammation and anterior capsule opacification. Setting: Miyake Eye Hospital, Nagoya, Japan. Methods: Three combinations of IOLs that were identical in shape but had distinct contact angles of water were used in this prospective double‐masked study: (1) experimental comparison of collagen type IV and poly(methyl methacrylate) (PMMA) IOLs in rabbit eyes; (2) clinical comparison of heparin‐surface‐modified and PMMA IOLs; (3) clinical comparison of three foldable IOLs, silicone, acrylic, and memory. One of the two IOLs being compared in each situation was randomly assigned to both eyes of each animal or patient. At 1 and 3 months postoperatively, the degree of anterior capsule opacification and the amount of flare in the anterior chamber were determined. Results: In all three comparative situations, greater postoperative inflammation and more rapid anterior capsule opacification was seen in the eyes with hydrophobic IOLs. Conclusion: There was a correlation between the hydrophilicity of an IOL and the severity of postoperative inflammation and the speed of anterior capsule opacification.

Liquefied aftercataract: a complication of continuous curvilinear capsulorhexis and intraocular lens implantation in the lens capsule.

PURPOSE To describe a new type of aftercataract that contains a liquefied, milky white substance between the lens optic and the posterior lens capsule. METHOD We reviewed the medical records of 41 patients identified as having this type of aftercataract. RESULTS All 41 eyes (41 patients) underwent uneventful phacoemulsification after continuous curvilinear capsulorhexis and implantation of a posterior chamber intraocular lens made from polymethylmethacrylate. Two months to 6 years after surgery (average+/-SD, 3.8+/-1.7 years), fibrosis was noted evenly along the entire circumference and between the anterior surface of the intraocular lens optic and the edge of the capsular opening created by continuous curvilinear capsulorhexis. This led to formation of a closed chamber between the intraocular lens and the posterior lens capsule, which then accumulated a liquefied, milky white substance. Twenty-three of the 41 eyes showed liquefied aftercataract in conjunction with other types of aftercataract: in 12 eyes with fibrosis, in 11 eyes with Elschnig pearls, and in one eye with a Soemmering ring. None of the eyes had any signs of inflammation; six of the 41 eyes had reduced visual acuity caused exclusively by the liquefied aftercataract. Before cataract surgery, 14 eyes were diagnosed with diabetic retinopathy, four with glaucoma, and two with uveitis. CONCLUSION We report a new type of aftercataract characterized by a liquefied, milky white substance that accumulates between the lens optic and the posterior lens capsule when the anterior capsular opening, originally created by continuous curvilinear capsulorhexis, becomes occluded with the lens optic.

ESCRS Binkhorst Lecture 2002: Pseudophakic preservative maculopathy

&NA; Many antiglaucoma eyedrops are reported to cause cystoid macular edema (CME) in aphakia and pseudophakia. We review 4 clinical and laboratory studies that compare the incidence of CME in early postoperative pseudophakia in eyes that received preserved latanoprost and timolol, nonpreserved timolol, and the preserved and nonpreserved vehicle for these drugs and looked at the morphological damage to cells and the changes in the indicators of cytokine and prostaglandin (PG) synthesis caused by latanoprost and timolol and the preservative benzalkonium chloride. Based on the findings of these studies, which indicate that the preservative causes increased synthesis of PGs and other substances and intensified postoperative inflammation, the term pseudophakic preservative maculopathy is proposed for CME caused by antiglaucoma eyedrops.

Dislocation of the Lens Nucleus Into the Vitreous Cavity After Standard Hydrodissection

PURPOSE Having encountered dislocation of the lens nucleus into the vitreous cavity immediately after continuous tear capsulorhexis and hydrodissection of the nucleus, we examined common features of eyes with this complication. METHODS We reviewed consecutive cases of cataract extraction. RESULTS The complication occurred in four of 10,126 eyes. All four eyes were in elderly patients and except for the patient whose contralateral eye had pseudoexfoliation syndrome, all eyes had an increased axial length. CONCLUSION In elderly patients with eyes that have a long axial length or pseudoexfoliation, we recommend performing hydrodissection with extreme care and only when necessary.

Blood-retinal barrier and autofluorescence of the posterior polar retina in long-standing pseudophakia.

PURPOSE To study the physiological state of the retina in long-standing pseudophakic eyes using blood-retinal barrier (BRB) disruption and autofluorescence as parameters. SETTING Miyake Eye Hospital, Nagoya, Japan. METHOD This retrospective, case-controlled study sought to determine whether ultraviolet (UV)-light-filtering and blue-light-filtering intraocular lenses (IOLs) had different outcomes in severity of BRB disruption and autofluorescence of the posterior polar retina than clear (untreated) IOLs. RESULTS Mean sodium fluorescein transmittance in eyes with untreated IOLs was 3.7 ng/mL +/- 2.2 (SD) 3 years after surgery (n = 40) and 3.5 +/- 1.8 ng/mL 8 years after surgery (n = 18). In eyes with a UV-filtering IOL, the values were 2.4 +/- 1.5 ng/mL (n = 39) and 2.6 +/- 2.0 ng/mL (n = 14), respectively. Eyes with a UV-filtering IOL had significantly lower transmittance (P < .01-< .05). Mean transmittance 5 years after surgery was 4.2 +/- 1.9 ng/mL in eyes with an untreated IOL (n = 31), 3.2 +/- 2.1 ng/mL in eyes with a UV-filtering IOL (n = 30), 2.8 +/- 1.9 ng/mL in eyes with a Menicon blue-light-filtering IOL (n = 20), and 2.6 +/- 1.8 ng/mL in eyes with a Hoya blue-light-filtering IOL (n = 21). The eyes with a UV-filtering and the blue-light-filtering IOLs had significantly lower transmittance than those with an untreated IOL (P < .01-< .05); the eyes with a Hoya IOL had a statistically lower mean than those with the UV-filtering IOL (P < .05). Mean autofluorescence was 44.9 +/- 6.8 (n = 14), 49.5 +/- 6.1 (n = 6), 53.0 +/- 11.9 (n = 15), and 64.5 +/- 13.2 (n = 7) at 1, 4, 9, and 14 years after surgery, respectively; there was a significant difference between 1 and 9 years and between 1 and 14 years (P < .05). CONCLUSION Eyes with a UV-filtering or blue-light-filtering IOL had a lower incidence of BRB disruption than eyes with an untreated IOL. Autofluorescence increased with age, even in eyes with UV-filtering IOLs.

Capsular block syndrome with external blockage of the capsular opening by a ciliary sulcus fixated posterior chamber lens

PURPOSE To report capsular block syndrome with external blockage of the capsular opening by a posterior chamber lens fixated in the ciliary sulcus. METHOD Case report. RESULTS In an 89-year-old man who had undergone cataract surgery, a posterior chamber lens was accidentally fixated in the ciliary sulcus after continuous curvilinear capsulohhexis and phacoemulsification/aspiration. The next day, capsular block syndrome was noted along the posterior chamber lens optic, which was blocking the capsular opening from the outside. CONCLUSION In all previously reported eyes with capsular block syndrome, the posterior chamber lens had been placed inside the lens capsule to block the continuous curvilinear capsulorhexis opening from the inside.

Form vision deprivation amblyopia: Further observations

Nine cases of esotropia occurring in deprivation amblyopia, where exotropia rather than esotropia is usually found, showed a refractive error of hypermetropia. This fact suggested that an accommodative factor is largely responsible for the development of esotropia. A- or V-pattern strabismus was encountered in a higher incidence in deprivation amblyopia than in ordinary strabismus. Pattern-reversal VEP showed more prominent abnormality than flash VEP did. Studies of the sensitive period of the visual system revealed that the sensitivity is likely to be low for a month or two after birth and increases with a peak around the 18th month of age, decreasing thereafter with a waning slope to the end of the 8th year of life.

aniseikonia in patients with a unilateral artificial lens, measured with Aulhorn's phase difference haploscope

Aniseikonia was measured in unilaterally pseudophakic patients using Aulhorns phase difference haploscope. Mean values of aniseikonia were 1.5% horizontally and 2.0% vertically without correction, and 2.1% horizontally and 2.3% vertically with correction. With spectacle correction, the greater the dioptric difference between two eyes, the greater the amount of aniseikonia. In either case, patients tolerated these amounts of aniseikonia according to our criteria of aniseikonia tolerance.

Localized liquefied after-cataract

We report 2 cases with a new type of after-cataract. In both, a milky white substance accumulated in a semicircular, closed chamber formed by the intraocular lens optic and the posterior lens capsule. Unlike in previous reports, the closed chamber did not cover the entire capsule but was based on residual lens remnants in the equatorial region of the lens capsule.