Poster 69: Anterior Capsular Contraction Syndrome Following Cataract Extraction
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tients treated with Intacs have a steep central cornea, but a flat midperipheral cornea. This topography presents a chal- lenge for post-surgical rigid gas-permeable (RGP) contact lenses. Here we present a keratoconic patient with Intacs, who achieved maximum vision and comfort from a silicone hydrogel piggyback contact lens system. Case Report: A 41-year-old man with advanced keratoco- nus came to the clinic 1 week after Intacs surgery. The patient was without visual correction and reported de- creased visual acuity and monocular polyopia OU. The patient was initially fit with a high minus Purevision SCL while waiting for the corneas to stabilize following surgery. Methods: RGP fitting was initiated 3 months after surgery. The patient was corrected to 20/30 in both eyes with RGP contact lenses; however, the patient was not able to tolerate the lenses for more than 2 hours O.S. and 8 hours O.D. The patient was then fit with Purevision soft contact lenses under the RGP contact lenses in a piggyback contact lens system. The patient was able to wear the piggyback contact lenses all waking hours and was corrected to 20/20 O.D. and 20/30 O.S. Conclusion: Keratoconic patients treated with Intacs present a challenge to manage postoperatively. RGP contact lenses may be required for the best visual outcome, but the fitting of the RGP lenses is difficult due to topographical irregu- larity from the corneal ectasia and the intrastromal corneal ring implants. Piggyback contact lenses ease the RGP con- tact lens fitting process by creating a more regular topog- raphy and increasing patient comfort. Oxygen availability is important to consider for post-surgical corneas. A piggy- back system that includes silicone hydrogel soft contact lenses coupled with a high dK RGP contact lens provides excellent oxygen availability to the cornea and excellent visual acuity to the patient. Poster 69 Anterior Capsular Contraction Syndrome Following Cataract Extraction Jessica Potter, O.D., VA Medical Center, 718 Smyth Road, c/o Eye Clinic, Manchester, New Hampshire 03104 Background: Anterior capsular contraction syndrome, also known as anterior capsular phimosis, is a potential compli- cation of cataract extraction that occurs 1 to 5 months following surgery. It most commonly occurs in patients with conditions that compromise zonular strength. Anterior capsular contraction syndrome occurs when residual lens epithelial cells, located within the capsular bag following cataract extraction, proliferate into myofibroblasts. These myofibroblasts opacify the anterior capsule and produce contractile forces. Patients with weakened lens zonules are unable to counteract these contractile forces, causing the opacified anterior capsule to cinch down and eventually obscure the visual axis. Case Reports: Case 1—A 77-year-old man underwent phacoemulsification with posterior chamber lens implanta- tion by clear corneal incision O.S. During the surgery, it was noted that he had weak lens zonules. Four weeks after the cataract surgery, he was diagnosed with a Descemet’s mem- brane detachment, which was treated with an anterior cham- ber gas injection. Once the detachment was healed, the patient’s vision was still reduced to 20/400, consistent with dense fibrosis and contraction of the anterior capsule. He was treated with neodynium:YAG anterior capsulotomy and vision was restored to 20/40. Case 2—A 70-year-old man underwent phacoemulsification with posterior chamber lens implantation by clear corneal incision O.S. His ocular his- tory was remarkable for pseudoexfoliation OU. Two months following cataract surgery, his vision was reduced to 20/40 O.S., secondary to anterior capsular fibrosis and contraction. He was treated with neodynium:YAG anterior capsulotomy and vision was restored to 20/20. Conclusion: Anterior capsular contraction syndrome is a complication of cataract extraction that is easily treated to restore vision. These case reports support successful treat- ment of anterior capsular contraction syndrome with neody- mium:YAG anterior capsulotomy. Poster 70 Deep Lamellar Endothelial Keratoplasty (DLEK) in Fuch’s Corneal Dystrophy Katarzyna Ciesek, O.D., Ivan Garcia, M.D., and Edward Wasloski, O.D., Omni Eye Specialists Balimore, 9401 White Cedar Drive, Owings Mills, Maryland 21117 Background: Fuch’s dystrophy is a common corneal disease accounting for about 10% of all corneal transplants. Tradi- tionally, patients affected by this genetic disorder needing surgical intervention had to resort to penetrating kerato- plasty. Methods: Recently, a new technique in corneal transplan- tation was introduced in the United States, namely DLEK. It replaces the sick endothelium without violating the surface of the cornea with incision or sutures, allowing the original topography to be preserved. Case Report: A 41-year-old woman was referred for a corneal dystropy evaluation. She had significant guttata, stromal edema OU, as well as epithelial bullae, and band keratopathy O.S. O.D. A dilated fundus examination revealed nuclear sclerotic changes O.S. O.D. A DLEK with phaco/IOL procedure was performed on the O.S. Results: She was able to achieve a 20/70 acuity on the second postoperative day. Conclusion: This new technology offers better alternative to patients who require a corneal transplant. It preserves the healthy tissue, resulting in a greater integrity of the cornea, accelerates the healing time, and obtains better end-point acuity. 293 Poster Presentations
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Transcript of Poster 69: Anterior Capsular Contraction Syndrome Following Cataract Extraction
tients treated with Intacs have a steep central cornea, but aflat midperipheral cornea. This topography presents a chal-lenge for post-surgical rigid gas-permeable (RGP) contactlenses. Here we present a keratoconic patient with Intacs,who achieved maximum vision and comfort from a siliconehydrogel piggyback contact lens system.Case Report: A 41-year-old man with advanced keratoco-nus came to the clinic 1 week after Intacs surgery. Thepatient was without visual correction and reported de-creased visual acuity and monocular polyopia OU. Thepatient was initially fit with a high minus Purevision SCLwhile waiting for the corneas to stabilize following surgery.Methods: RGP fitting was initiated 3 months after surgery.The patient was corrected to 20/30 in both eyes with RGPcontact lenses; however, the patient was not able to toleratethe lenses for more than 2 hours O.S. and 8 hours O.D. Thepatient was then fit with Purevision soft contact lenses underthe RGP contact lenses in a piggyback contact lens system.The patient was able to wear the piggyback contact lensesall waking hours and was corrected to 20/20 O.D. and 20/30O.S.Conclusion: Keratoconic patients treated with Intacs presenta challenge to manage postoperatively. RGP contact lensesmay be required for the best visual outcome, but the fittingof the RGP lenses is difficult due to topographical irregu-larity from the corneal ectasia and the intrastromal cornealring implants. Piggyback contact lenses ease the RGP con-tact lens fitting process by creating a more regular topog-raphy and increasing patient comfort. Oxygen availability isimportant to consider for post-surgical corneas. A piggy-back system that includes silicone hydrogel soft contactlenses coupled with a high dK RGP contact lens providesexcellent oxygen availability to the cornea and excellentvisual acuity to the patient.
Poster 69
Anterior Capsular Contraction Syndrome FollowingCataract ExtractionJessica Potter, O.D., VA Medical Center, 718 SmythRoad, c/o Eye Clinic, Manchester, New Hampshire 03104
Background: Anterior capsular contraction syndrome, alsoknown as anterior capsular phimosis, is a potential compli-cation of cataract extraction that occurs 1 to 5 monthsfollowing surgery. It most commonly occurs in patientswith conditions that compromise zonular strength. Anteriorcapsular contraction syndrome occurs when residual lensepithelial cells, located within the capsular bag followingcataract extraction, proliferate into myofibroblasts. Thesemyofibroblasts opacify the anterior capsule and producecontractile forces. Patients with weakened lens zonules areunable to counteract these contractile forces, causing theopacified anterior capsule to cinch down and eventuallyobscure the visual axis.
Case Reports: Case 1—A 77-year-old man underwentphacoemulsification with posterior chamber lens implanta-tion by clear corneal incision O.S. During the surgery, it wasnoted that he had weak lens zonules. Four weeks after thecataract surgery, he was diagnosed with a Descemet’s mem-brane detachment, which was treated with an anterior cham-ber gas injection. Once the detachment was healed, thepatient’s vision was still reduced to 20/400, consistent withdense fibrosis and contraction of the anterior capsule. Hewas treated with neodynium:YAG anterior capsulotomy andvision was restored to 20/40. Case 2—A 70-year-old manunderwent phacoemulsification with posterior chamber lensimplantation by clear corneal incision O.S. His ocular his-tory was remarkable for pseudoexfoliation OU. Twomonths following cataract surgery, his vision was reducedto 20/40 O.S., secondary to anterior capsular fibrosis andcontraction. He was treated with neodynium:YAG anteriorcapsulotomy and vision was restored to 20/20.Conclusion: Anterior capsular contraction syndrome is acomplication of cataract extraction that is easily treated torestore vision. These case reports support successful treat-ment of anterior capsular contraction syndrome with neody-mium:YAG anterior capsulotomy.
Poster 70
Deep Lamellar Endothelial Keratoplasty (DLEK) inFuch’s Corneal DystrophyKatarzyna Ciesek, O.D., Ivan Garcia, M.D., andEdward Wasloski, O.D., Omni Eye Specialists Balimore,9401 White Cedar Drive, Owings Mills, Maryland 21117
Background: Fuch’s dystrophy is a common corneal diseaseaccounting for about 10% of all corneal transplants. Tradi-tionally, patients affected by this genetic disorder needingsurgical intervention had to resort to penetrating kerato-plasty.Methods: Recently, a new technique in corneal transplan-tation was introduced in the United States, namely DLEK. Itreplaces the sick endothelium without violating the surfaceof the cornea with incision or sutures, allowing the originaltopography to be preserved.Case Report: A 41-year-old woman was referred for acorneal dystropy evaluation. She had significant guttata,stromal edema OU, as well as epithelial bullae, and bandkeratopathy O.S. � O.D. A dilated fundus examinationrevealed nuclear sclerotic changes O.S. � O.D. A DLEKwith phaco/IOL procedure was performed on the O.S.Results: She was able to achieve a 20/70 acuity on thesecond postoperative day.Conclusion: This new technology offers better alternative topatients who require a corneal transplant. It preserves thehealthy tissue, resulting in a greater integrity of the cornea,accelerates the healing time, and obtains better end-pointacuity.
293Poster Presentations
