Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7–0 polypropylene flange

BackgroundTo report a novel surgical technique for recurrent pupillary optic capture after flanged intraocular lens (IOL) fixation.MethodsIn this retrospective case series, we detail our use of two parallel 7–0 polypropylene sutures passed between the iris plane and the optic of scleral-fixated IOL to address pupillary optic capture. Flanges were created using ophthalmic cautery to secure it to the sclera without suture.ResultsTwo eyes with pupillary optic capture underwent a sutureless surgical technique using 7–0 polypropylene flanges. No recurrences of pupillary optic capture were observed during the 1-year follow-up.ConclusionOur sutureless surgical technique using a 7–0 polypropylene flange was an effective, efficient, and less invasive approach for treating recurrent pupillary optic capture

Vitreous hyper-reflective dots in optical coherence tomography and cystoid macular edema after uneventful phacoemulsification surgery.

PURPOSE: To report the observation of hyper-reflective dots in the vitreous cavity using spectral domain optical coherence tomography (SD-OCT) after uneventful phacoemulsification cataract surgery and to investigate their association with cystoid macular edema (CME). MATERIALS AND METHODS: Medical records of consecutive Asian patients who had no preoperative retinopathy and underwent uneventful phacoemulsification cataract surgery from March 2012 through February 2013 were reviewed. SD-OCTs were performed before, 1 week, and 1 month after surgery. The number of vitreous hyper-reflective dots (VHDs) was counted in 5 OCT images of high-definition 5-line raster scans. The development of CME was assessed using postoperative 1-month OCT. RESULTS: In 74 eyes of 74 patients, all of three SD-OCTs with a signal to noise ratio of 0.6 or more were available and were analyzed in this study. In preoperative OCT, the VHD was observed in 2 (2.7%) of 74 eyes; one eye had 1 VHD and the other eye had 2 VHDs. In 72 eyes with no preoperative VHD, VHDs were observed in 40 (55.6%) eyes at 1 week after the surgery. In the multivariate analysis, the number of VHDs measured at 1 week after the surgery was significantly associated with CME development at 1 month after the surgery (odds ratio = 1.93, 95% confidence interval = 1.15 to 3.24, P = 0.012). CONCLUSIONS: VHDs were frequently observed in OCT after uneventful phacoemulsification cataract surgery. VHDs observed at 1 week after the surgery may be a risk factor for the development of pseudophakic CME. Further studies are needed to identify the source of the VHDs

Serial OCT images of an eye with cystoid macular edema at 1 month after uneventful phacoemulsification cataract surgery.

<p>VHDs (arrows) are observed at 1 week and 1 month after the surgery in OCT and intraretinal cystoid spaces are observed in OCT at 1 month after the surgery.</p

Characteristics of groups with or without CME in OCT 1 month after surgery.

<p>CME = cystoid macular edema; OCT = optical coherence tomography; BCVA = best-corrected visual acuity; logMAR = the logarithm of the minimum angle of resolution; D = diopters; CRT = central subfield retinal thickness; VHD = vitreous hyper-reflective dot.</p><p>Results are expressed a mean ± standard deviation.</p><p>*Incidence of CME in total cases of each condition.</p><p><i>P</i> values were calculated with the Fisher exact test for categorical variables and the Mann-Whitney U test for continuous variables.</p

Characteristics of eyes with or without VHDs at 1

<p>VHD = vitreous hyper-reflective dot; BCVA = best-corrected visual acuity; logMAR = the logarithm of the minimum angle of resolution; D = diopters; CRT = central subfield retinal thickness.</p><p>Results are expressed a mean ± standard deviation.</p><p>*Incidence of VHDs in total cases of stated condition.</p><p><i>P</i> values were calculated with the chi-square analysis or Fisher exact test^† for categorical variables and t-test for continuous variables.</p

Multivariate logistic regression results for predicting CME development.

<p>CME = cystoid macular edema; OR = odds ratio, CI = confidence interval; BCVA = best-corrected visual acuity; logMAR = the logarithm of the minimum angle of resolution; D = diopters; CRT = central subfield retinal thickness; VHD = vitreous hyper-reflective dot.</p

OCT images of an eye 1 month after uneventful phacoemulsification cataract surgery.

<p>In the vitreous cavity, hyper-reflective dots (arrows) are observed on OCT images of a high-definition 5-line raster scan images.</p

Video_1_Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7–0 polypropylene flange.MP4

BackgroundTo report a novel surgical technique for recurrent pupillary optic capture after flanged intraocular lens (IOL) fixation.MethodsIn this retrospective case series, we detail our use of two parallel 7–0 polypropylene sutures passed between the iris plane and the optic of scleral-fixated IOL to address pupillary optic capture. Flanges were created using ophthalmic cautery to secure it to the sclera without suture.ResultsTwo eyes with pupillary optic capture underwent a sutureless surgical technique using 7–0 polypropylene flanges. No recurrences of pupillary optic capture were observed during the 1-year follow-up.ConclusionOur sutureless surgical technique using a 7–0 polypropylene flange was an effective, efficient, and less invasive approach for treating recurrent pupillary optic capture.</p

Table_1_Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7–0 polypropylene flange.DOCX

BackgroundTo report a novel surgical technique for recurrent pupillary optic capture after flanged intraocular lens (IOL) fixation.MethodsIn this retrospective case series, we detail our use of two parallel 7–0 polypropylene sutures passed between the iris plane and the optic of scleral-fixated IOL to address pupillary optic capture. Flanges were created using ophthalmic cautery to secure it to the sclera without suture.ResultsTwo eyes with pupillary optic capture underwent a sutureless surgical technique using 7–0 polypropylene flanges. No recurrences of pupillary optic capture were observed during the 1-year follow-up.ConclusionOur sutureless surgical technique using a 7–0 polypropylene flange was an effective, efficient, and less invasive approach for treating recurrent pupillary optic capture.</p