Table of Content

25 May 2023, Volume 32 Issue 3

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Vitreous-related spaces and its clinical associations

Huang Houbin

2023, 32(3):  177-181.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.001

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Several spaces and structures are formed in vitreous interface with adjacent tissues, including Hannover's canal, Petit's canal, Cloquet's canal, Wieger's ligament, Berger's space, Erggelet's space, Martegiani's space and premacular bursa. It is of much importance to make clear these spaces for elucidating the pathogenesis and pathophysiological processes of some entities or lesions, such as lens dislocation following acute episode of glaucoma, maligment glaucoma, posterior vitreous detachment, formation of macular hole, etc. (Ophthalmol CHN, 2023, 32: 177-181)

Genotype and clinical characteristics of ocular albinism and oculocutaneous albinism in China

Li Nien, Zhong Junwei, You Bing, Xu Ke, Zhang Xiaohui, Yan Weiyu, Xie Yue, Zhang Xin, Li Yang

2023, 32(3):  182-191.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.002

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Objective To analyze the genetic and clinical characteristics of Chinese patients with albinism-related gene variants, and to compare the clinical manifestations between ocular albinism (OA1) and oculocutaneous albinism (OCA). Design Retrospective case series. Participants 32 patients (from 28 families) with pathogenic variants in albinism-related genes collected from Beijing Tongren Hospital. Methods All patients underwent detailed ophthalmic examinations, including best-corrected visual acuity (BCVA), anterior segment photography, color fundus photography and optical coherence tomography (OCT). The pigmentation of skin and hair was also recorded. Genomic DNA was extracted from peripheral venous blood samples of the proband, his immediate family members and affected family members. Sanger sequencing, targeted exome sequencing (TES) and real-time quantitative polymerase chain reaction (PCR) was used to identify pathogenic variants. Multiple bioinformatics analysis software was used to predict the pathogenicity of the variants and co-segregation verification was performed. Main Outcome Measures Pathogenic variants, BCVA, nystagmus, foveal hypoplasia (FH) grade, pigmentation of eye, skin and hair. Results A total of 33 pathogenic variants in 7 genes (GPR143, OCA2, TYR, LRMDA, HPS1, HPS6 and SLC45A2) were detected in 32 patients, of which 8 were novel variants. There were 18 OA1 patients with GPR143 gene variants and 14 OCA patients with the other 6 genes variants. These patients all had varying degrees of vision loss, fundus hypopigmentation and FH. All but two patients had congenital nystagmus. The iris color of OA1 patients was darker, the FH grade was mainly 1~2, and no skin or hair hypopigmentation was found. OCA patients had diverse iris and fundus pigmentation, and most of them had varying degrees of skin and hair hypopigmentation. Patients with syndromic OCA were also associated with blood or immune system abnormalities. The two patients without nystagmus had mild visual impairment and FH. There were significant differences in iris and fundus pigmentation between OA1 patients and OCA patients. Conclusion This study preliminarily described the pathogenic gene composition of Chinese patients with albinism and expanded the variant spectrum of each gene. It was found that the degree of iris hypopigmentation was mild in OA1 patients, while the ocular and systemic pigmentation was highly variable in OCA patients. No obvious genotype-phenotype relationship was found. Genetic testing is essential for definitive diagnosis of atypical patients. (Ophthalmol CHN, 2023, 32: 182-191)

Surgical choice of retinal retinal detachment below PVR C1 in intraocular lens eyes

Yu Yajie, Zheng Pengfei, Zhang Ke, Zhou Haiying, Liu Wu

2023, 32(3):  192-196.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.003

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Objective To observe and compare the anatomical and functional outcome of scleral buckling (SB) and pars plana vitrectomy (PPV) to treat the rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C1 below in the intraocular lens (IOL) eyes. Design Retrospective case series. Participants 156 patients (156 eyes) with IOL diagnosed as RRD at the south district of Beijing Tongren Hospital were enrolled. Methods Review the patient records. According to the method of surgery, all patients included were divided into SB group (44 eyes) and PPV group (112 eyes). The general characteristics, left/right eyes, retinal detachment duration, number and shape of retinal holes, and the stage of PVR were recorded for both groups. The rate of retinal reattachment (after primary and final surgery), best corrected visual acuity (BCVA), and secondary surgery were observed and compared between the two groups at 6 months after surgery. We also analyzed the reasons for the second surgery. Main Outcome Measures The rate of retinal reattachment, BCVA, and secondary surgery at 6 months after primary surgery. Results There was no difference in gender, left/ right eyes, retinal detachment duration, number and shape of retinal holes, and the stage of (PVR) between SB group and PPV group (all P>0.05). The rate of retina reattachment after the initial surgery was 77.3% (34/44) in SB group, and 92.9% (104/112) in PPV group (χ2=7.52，P=0.006). The secondary PPV was underwent for the patients without retinal reattachment, and finally, all of them achieved anatomical success. In the cases with unattached retina after the primary surgery in SB group, except for one new retinal hole, the rest retinal holes were all located on the encircling ridge. The absence of retina reattachment was associated with the progression of PVR. In the PPV group, the unattached retina after the primary surgery was also associated with postoperative PVR. The BCVA (LogMAR) before and after surgery in the SB group were 1.1 (0.70, 1.80) and 0.75 (0.50, 1.00), respectively (P=0.003). And in PPV group, the BCVA (LogMAR) before and after surgery were 1.9 (1.53, 1.90) and 0.7 (0.50, 1.00), respectively (P<0.001). There was no statistically significant difference in postoperative BCVA between these two groups (P=0.35). Conclusion For RRD with PVR less severe than grade C1 in IOL eyes, postoperative PVR is an important factor that affects the success rate of surgery. Although SB can achieve good surgical efficiency, PPV is superior to SB surgery in terms of retinal reattachment rate. (Ophthalmol CHN, 2023, 32: 192-196)

Short-term efficacy comparison of intravitreal aflibercept and dexamethasone sustained-release implantin on macular edema secondary to central retinal vein occlusion

Liu Yuhui, Wang Bei, Liu Gang

2023, 32(3):  197-201. 

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Objective To compare and analyze the short-term clinical efficacy of intravitreal aflibercept and dexamethasone(DEX) sustained-releaseimplant on macular edema (ME) secondary to central retinal vein occlusion (CRVO). Design Retrospective case series. Participants Thirty-six patients diagnosed with CRVO-ME in Nanjing Lishui People's Hospital from October 2018 to June 2021. Methods According to different therapeutic drugs, two groups were divided: aflibercept group (intravitreal aflibercept 0.5 mg) 17 cases (17 eyes), and DEX group (intravitreal DEX sustained-releaseimplant 0.7 mg) 19 cases (19 eyes). Clinical data between the two groups before surgery and 1, 2, 3, and 6 months after surgery, including best corrected visual acuity (BCVA), serous retinal detachment height (SRDH), central retinal thickness (CRT), photoreceptor layer thickness (PLT), and intraocular pressure (IOP) were analyzed. Main Outcome Measures BCVA, SRDH, CRT, PLT, IOP. Results There was no statistically significant difference in preoperative BCVA, SRDH, CRT, PLT, and IOP between the two groups (all P>0.05). One month after surgery, the BCVA, SRDH, CRT, and PLT of the two groups were better than before surgery (all P<0.05), and there was no statistically significant difference between the two groups (all P>0.05). At 2 and 3 months after surgery, the SRDH in the DEX group was significantly lower than that of the aflibercept group (P=0.021, 0.017, respectively), however, there was no significant statistical difference in BCVA, CRT, and PLT between the two groups (all P>0.05). At 6 months after surgery, the CRT in the aflibercept group was lower than that of the DEX group, the PLT was significantly higher than that of the DEX group, and the BCVA was better than that of the DEX group (P=0.005, 0.029, 0.036, respectively). There was no statistically significant difference in SRDH between the two groups (P=0.054). Conclusion Intravitreal aflibercept and DEX were proven effective for the patients with CRVO-ME, which significantly improve SRDH and CRT, and achieve visual benefits. Intravitreal DEX has better short-term efficacy in reducing SRD, with longer treatment intervals, while intravitreal aflibercept can maintain better visual outcomes during the treatment period. (Ophthalmol CHN, 2023, 32: 197-201)

Clinical and imaging characteristics analysis of toxoplasmic retinochoroiditis

Mao Yu, Cao Xusheng, Mo Bin, Peng Xiaoyan

2023, 32(3):  202-207.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.005

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Objective To investigate the clinical and imaging features of toxoplasmic retinochoroiditis. Design Retrospective case series. Participants Six cases (6 eyes) with toxoplasmic retinochoroiditis patients in Beijing Tongren Hospital from Aug. 2017 to Sep. 2022. Methods Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, indirect ophthalmoscopy, fundus fluorescein angiography (FFA), indocyanine green fundus angiography (ICGA) and optical coherence tomography (OCT) were undergone. Goldmann-witmer coefficient and PCR assay in the ocular fluid were also recorded. All patients were treated with systemic antibiotics and corticosteroids for 4~6 weeks and followed up for 2~24 months. Main Outcome Measures Features of the fundus, FFA, ICGA and OCT. Results All patients had unilateral onset. The fundus showed a single and active focus with yellow-white focal retinochoroiditis, accompanied by vitritis. Two of the 6 cases had retinal vascular white sheath and 1 had an old lesion. Lesions in 4 cases were located in the posterior pole, while 2 were in the nasal mid-periphery. Three of the 6 cases had inflammation in anterior chamber. Lesion sizes ranged from (0.5×0.5) PD to (3.0×4.0) PD. The BCVA of the affected eye ranged from counting fingers to 0.5. The lesion appears as hypofluorescent or slightly hyperfluorescent in the early phase and showed varying degrees of fluorescence leakage in the late phase on FFA. Five cases had retinal vascular leakage and 4 had hyperfluorescence leakage of the optic disc in late stage. The lesions were consistently hypofluorescent on ICGA. OCT showed that lesions in 4 cases involved the entire layer of the retina, which were thickened and hyperreflective. Meanwhiles, choroid was thickened and single hyporeflective choroidal nodule could be found. The remaining 2 cases showed localized retinal thinning, and the inner retinal layer was collapsed with cavities. All 6 patients had macular epiretinal membrane or epiretinal membrane, including 1 case with vitreomacular traction. All 6 patients showed reduced activity of lesions after treatment, and no recurrence was observed during the follow-up period. Conclusion The typical presentation of toxoplasmic retinochoroiditis is a unilateral, focal yellow-white lesion in posterior pole with vitritis. OCT shows involved the entire layer of the retina with the possibility of choroidal nodules. Clinical and imaging examinations can effectively diagnose the typical cases. (Ophthalmol CHN, 2023, 32: 202-207)

Orbital solitary fibrous tumors: a single-institution study of 38 cases

Zhao Hongshu, Shi Jitong

2023, 32(3):  208-214.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.006

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Objective To analyze the clinical manifestations, surgical options and prognosis of primary solitary fibrous tumors (SFTs) of orbit. Design Retrospective cases series. Participants 38 cases of primary orbital SFTs confirmed by pathology from 2017 to 2022 in Beijing Tongren Hospital. Methods The course of the disease, symptoms, signs, imaging and histopathology, as well as follow-up and survival data were analyzed. And recurrence free survival (RFS) and overall survival (OS) were analyzed by Kaplan-Meier curve. Main Outcome Measures Visual acuity, clinical symptoms and signs, pathological features, recurrence, and survival. Results The median age of initial cases and recurrent cases was 37 years (5~65 years) and 64.5 years (41~81 years), respectively (P=0.000). The sensitivity of preoperative imaging examination for SFTs was 22.58%, and the misdiagnosis rate was 41.93%. Pathological examination showed that 97.37% of all SFTs tumors were CD34 positive, and all tumors were STAT6 positive (100%). The mean course of disease of 37 patients with follow-up data was 8.6±7.6 years (1.9~31.0 years), and the mean course of disease of 16 patients with recurrence was 15.1±7.8 years (3.9~31.0 years). The mean interval between the first operation and the last operation was 12.7±7.9 years (1.3~29.7 years). The 36 patients with survival data (excluding biopsy and one case of lost follow-up) had 91.67% OS and RFS after surgery (first operation for primary cases, last operation for recurrent cases), and the mean follow-up time was 2.3±1.4 years (0.1~5.8 years) and 2.4±1.9 years (0.0~5.8 years), respectively. Of the 10 cases of malignant SFTs, 4 cases received postoperative radiotherapy and no recurrence was reported. 6 cases did not receive radiotherapy, of which 1 case relapsed and died, and 5 cases had no relapse at present. 3 cases recurred, of which 1 was malignant and 2 benign. Three cases died, of which two were tumor-related. Conclusion Most primary cases of orbital SFTs occur in young adults. Both benign and malignant orbital SFTs can recurs and spread to the intracranial easily. Extensive intracranial spread of benign SFTs can also lead to death. Imaging examination may misdiagnose SFTs as other tumors. (Ophthalmol CHN, 2023, 32: 208-214)

Prognosis of large avascular PED

Mo Bin, Ji Haixia, Zhou Haiying, Liu Wu

2023, 32(3):  217-221.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.007

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Objective To observe and analyze the changes and prognostic characteristics of large avascular retinal pigment detachment (aPED) associated with dry age-related macular degeneration (AMD). Design Retrospective case series. Participants 17 eyes of 15 cases diagnosed with large (the maximum horizontal diameter of PED is greater than 1500 μm, the height is greater than 165 μm) aPED in dry AMD at Beijing Tongren Eye Center from January 2013 to January 2023. Methods We retrospectively analyzed the patients’ medical records, and the average follow-up time was （19.76±17.39） months. The characteristics of OCT, including choroid thickness, PED height, PED width, RPE collapse, hyperplasia of RPE, inner retinal capsules, hyperreflective foci, subretinal fluid, RPE laceration, geograghic atrophy (GA), neovascularization, and the changes of best corrected visual acuity (BCVA) were evaluated. Main Outcome Measures The BCVA, the choroidal thickness and the height and width of PED measured by OCT. Results At baseline, LogMAR BCVA was 0.55±0.31, the mean choroidal thickness of the macular center was (237.29±77.39) μm, the mean height of PED was (476.67±313.83) μm, and the mean width of PED was (3268.17±1482.28) μm. At the last follow-up, LogMAR BCVA was 0.70±0.34, which was significant worse than that at baseline (t=-2.842, P=0.012). In 5 eyes with PED collapse at baseline, 4 eyes had GA, another 1 eye had the RPE proliferation aggravated and RPE collapse, and had inner retinal capsules during the follow-up. One eye with retinal inner capsule at baseline appeared GA during the follow-up. There were 6 eyes (35.29%) with increased height and width of PED, of which 5 eyes had increased proliferation of RPE and 1 eye had no significant change; there were 4 eyes (23.53%) with the width of PED bottom diameter increasing and the height decreasing, all of which had the collapse of PED; RPE laceration occurred in one eye (5.89%); There was no obvious change in 2 eyes (11.76%), and no neovascularization was seen. At the last follow-up, the mean choroidal thickness of the macular center was (223.12±67.53) μm, which was no significant difference with the baseline. There were 12 cases with PED at the last follow-up which the mean height of PED was (370.08±242.25) μm, and the mean width of PED was (3545.17±1313.10) μm.There was no significant difference with the baseline (t=1.409、-2.105, P=0.186、0.059). Conclusion For large aPED associated with dry AMD, its natural prognosis is mostly transformed into GA, which seriously affects the vision of patients. The collapse of RPE and the appearance of retinal inner capsule can be used as biomarkers for the progress of the disease. Clinicians should pay enough attention to the mand increase the number of follow-up visits so as to detect the changes of the disease as soon as possible. (Ophthalmol CHN, 2023, 32: 217-221)

Experimental study on efficacy of electrothermal capsulorhexis rings assisted anterior capsule membrane circular capsulorhexis of isolated porcine lenses

Lu Mingfeng, Pei Yajing, Zhu Jianbo, Guo Tonglin, Ma Ke

2023, 32(3):  222-227.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.008

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Objective To explore the efficacy of Nichrome electrothermal capsulorhexis rings assisted anterior capsule membrane circular capsulorhexis of isolated porcine lenses. Design Experimental studies. Participants Fifty solated porcine eyeballs. Methods Solated porcine eyeballs was divided into two groups randomly with 25 cases in each group: continuous curvilinear capsulorhexis group (traditional group) and electrothermal assisted capsulorhexis group (electrothermal group). The surgical procedure will be performed after corneal removal and the whole procedure was videotaped. Anterior capsule holes and corneoscleral limbus were photographed after the operation. PotPlayer, Digimizer and MATLAB were used to perform marker analysis and mathematical calculation of the edge of anterior capsule holes and corneoscleral limbus in the video and image, and then the main indicators were obtained. Main Outcome Measures Circularity (△Z), bias(B), diameter(D), error of diameter(△D), capsulorhexis-time (T). Results There was no radial tearing of the anterior capsule during the experimental process. The average values of the parameters for the traditonal group were: △Z=(17.57±6.10)px, B=(36.99±17.59)px, D=(5.51±0.95)mm, △D=(0.59±0.49)mm, T=(26.12±8.82)s. Those values of the electrothermal group were: △Z=(16.95±7.08)px, B=(25.54±15.78)px, D=(5.29±0.50)mm, △D=(0.21±0.23)mm, T=(43.48±12.31)s. There was no statistically significant difference between the two groups in terms of △Z (Z=-0.534, P=0.594) or D (t=1.055, P=0.298). The B value of the traditional group was significantly greater than that of the electrothermal group (t=2.423, P=0.019). The T value was significantly shorter in the traditional group than in the electrothermal group (t=-5.731, P＜0.001). The △D in the traditional group was significantly greater than that in the electrothermal group (Z=-3.218, P=0.001). Conclusion The electrothermal assisted capsulorhexis is feasible and can achieve similar results to continuous curvilinear capsulorhexis in roundness, while achieving better centering, more controllable and ideal diameter of anterior capsule holes. However, it still increasing the surgical steps to extend the time of capsulorhexis. (Ophthalmol CHN, 2023, 32: 222-227)

Effect of abnormal vertical fixation disparity on stereoacuity in intermittent exotropia

Hong Jie, Fu Jing, Ma Nan, Meng Zhaojun, Zhao Bowen, Li Lei

2023, 32(3):  228-232.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.009

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Objective To analyze the abnormal vertical fixation disparity which coexists with intermittent exotropia (IXT) and its influence on stereoacuity. Design Case control study. Participants 104 newly diagnosed IXT patients and 128 controls in Beijing Tongren Hospital from Jul 2016 to Feb 2017 were involved. Methods Perceptual eye position (PEP) test was performed on normal controls to get normal range (<x+1.64 s). The IXT patients were divided into two groups according to whether their vertical PEP exceeded normal range abnormal vertical PEP (group and normal vertical PEP group). Stereoacuity was measured for both near and medium distances. The differences of stereoacuity were compared between the two groups. Main Outcome Measures PEP test, stereoacuity measured for both near and medium distances. Results The near and medium distance stereopsis were better in normal vertical PEP group (2.21±0.34, 2.09±0.23) than abnormal vertical PEP group (2.40±0.44；2.25±0.31) (t=-2.43， P=0.02；t=-2.97， P<0.01, respectively). However, no statistic differences were found between the two groups in age (P=0.19), interocular difference in spherical equivalent (P=0.12), near and far horizontal deviation (P=0.53, 0.38), break point of fusional divergence (P=0.70) and fusional vergences (P=0.94), fusion range (P=0.70). Conclusion Abnormal vertical fixation disparity coexisting with IXT may aggravates the damage of stereoacuity. (Ophthalmol CHN, 2023, 32: 228-232)

Associations between retinal vessel diameters and optic disk morphology in a rural Chinese population: the Handan Eye Study

Zhang Qing, Zhang Ye, Xin Chen, Mao Yingyan, Wang Ningli

2023, 32(3):  233-239.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.010

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Objective To study the associations between the retinal vessel diameters (RVD) and optic disc parameters (ODP) in adults aged 30 years and older in rural northern China. Design Population-based cross-sectional study. Participants Adults aged 30 years and older in rural Northern China. Eligible 4137 subjects (60.6%)，include 4097 non-glaucoma and 40 subjects with primary open-angle glaucoma (POAG) were included from the baseline population of 6830 participants in the Handan Eye Study. Methods RVD parameters, including central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were measured by the IVAN software and ODP, including cup area (CA), disc rim area (RA), and maximum cup depth (MCD) were measured by Heidelberg retinal tomography (HRTII). Univariate and multivariate analysis were used to analyze the relationship between RVD and ODP. Main Outcome Measures CRAE, CRVE, CA, RA, and MCD. Results Univariable analysis showed narrower RVD were significantly associated with larger CA (P<0.001), smaller RA (P<0.001), deeper MCD (P<0.001). Multivariable linear regression analysis showed CRAE were significantly associated with CRVE (P<0.001, β=0.50), MCD (P=0.001, β=-3.7) , the presence of diabetes (P=0.043, β=-2.0), the presence of hypertension (P<0.001, β=-6.5); CRVE was significantly associated with female (P<0.001, β=3.9), CRAE (P<0.001, β=1.1), axial length (P<0.001, β=-4.7), RA (P<0.001, β=4.7), the presence of hypertension (P<0.001, β=6.0). In the final model, a unit increase in MCD was associated with an average reduction of 3.7 μm in CRAE, while a unit decrease in RA was associated with a reduction of 4.7 μm in CRVE. Conclusion The association between RVD and ODP reminds that smaller disk rim area is related to the thinner retinal vein, and the deeper optic cup is related to the thinner retinal artery. This may provide an epidemialogical basis for the ischemic mechanism of glaucoma. (Ophthalmol CHN, 2023, 32: 233-239)

Application of a new type crystal adjuster on viscoelastics free implantable collamer lens implantation

Chu Huiying, Tong Fengfeng, Yuan Bin

2023, 32(3):  240-244.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.011

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Objective To observe the clinical efficacy of viscoelastic free implantable collamer lens (ICL) implantation assisted with a new type crystal adjuster. Design Retrospective case series. Participants 142 eyes of eighty-one patients who have done ICL V4C lens implanted surgery in Huzhou Aier Eye Hospital. Methods 142 eyes were divided into two groups: group of applied with viscoelastic (viscoelastic group, 72 eyes), and group of applied without viscoelastic (viscoelastic free group, 70 eyes). Intraocular pressure was measured before operation, and 2, 4, 6 hours, 1 day, 1 week, 1 , 3 , 6 months after operation; corneal endothelial cell count, corneal endothelial hexagonal cell ratio, vault height, and uncorrected visual acuity (UCVA) were measured before operation, and 1 week, 1, 3, 6 months after operation. The operation time were recorded during the operation. The differences of the above indicators during and after the operation were compared between the two groups. Main Outcome Measures Operation time, corneal endothelial cell count, corneal endothelial cell hexagonal cell ratio, vault height, UCVA, and intraocular pressure. Results The operation time of the viscoelastic free group and the viscoelastic group was 9.91±1.75 minutes and 18.90±8.93 minutes, respectively (t=-7.658, P<0.01). There was no significant difference in postoperative UCVA and postoperative vault height between the two groups. At 2, 4 hours after operation, the intraocular pressures of the viscoelastic free group and the viscoelastic group was (15.61±3.24) mmHg, (14.41±3.38) mmHg and (20.68±5.33) mmHg, (18.26±4.71) mmHg, respectively (All P<0.001); at 6 hours after operation, the intraocular pressures of the viscoelastic free group and the viscoelastic group was (14.48±3.54) mmHg and (16.59±4.05) mmHg, respectively (P=0.003). There was no significant difference in corneal endothelial cell counts between the two groups postoperatively. Conclusion The ICL implantation without viscoelastic agent assisted by the new lens positioner is safe and effective. It simplifies the process of surgery and reduces the high intraocular pressure caused by viscoelastics. (Ophthalmol CHN, 2023, 32: 240-244)

Causes and management of reoperation after implantable collamer lens implantation

Mu Yanxiao, Qiao Mingchao, Li Yan, Wang Kaifang, Wang Xiaoming

2023, 32(3):  245-250.  doi:10.13281/j.cnki.issn.1004-4469.2023.03.012

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Objective To observe the causes leading to reoperation after the implantation of phakic posterior chamber implantable collamer lens (PPC-ICL), also known as implantable collamer lens(ICL), and to explore the potential treatment options and preventive measures. Design Retrospective case series. Participants 8 patients (11 eyes) required reoperation due to a variety of reasons, whom out of 342 patients (669 eyes) who underwent PPC-ICL implantation at Jinan Mingshui Eye Hospital from July 2019 to April 2022. Methods The medical records were reviewed, and the examining general conditions and ocular data including refractive error, anterior chamber depth, corneal diameter, ciliary sulcus diameter, ICL data, vault hight, and reasons for reoperation were recorded. The time, management, and prognosis of these reoperations were also assessed. The reasons for reoperation, potential treatment options and preventive measures were discussed. Main Outcome Measures The reasons for reoperation, the time of reoperation, treatment methods, and prognosis. Results In the 11 reoperated eyes, five were implanted of regular ICLs and six were implanted of Toric ICLs (TICLs), which were all implanted horizontally. The reasons for the reoperation were the ICL rotation and the abnormal vault hight. Three TICLs experienced rotation and had to be repositioned. The mean vault hight measured before the reoperation was (1.28±0.14) mm, which subsequently decreased to (0.73±0.12) mm post-reoperation (P<0.05). In one particular case, a lower vault was executed and a larger size ICL was chosen in the reoperation. However, there was not a significant change in the vault after the operation. Conclusion The common reasons prompting reoperation after PPC-ICL implantation includes abnormal postoperative vault height and ICL rotation, for which alignment or replacement surgery proves effective. Preoperative accurate examination and measurement, combining multiple examination results, improving the predictability of vault height, selecting the appropriate ICL size, and avoiding accidental injury may be the possible countermeasures to prevent the reoperation. (Ophthalmol CHN, 2023, 32: 245-250)