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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Capsular Waves: A Warning Indicator for Potentially Malpositioned Intraocular Lenses.

J Morgan Micheletti1, Kendrick M Wang1,2, Khanh Ton1

  • 1Berkeley Eye Center, Houston, TX, USA.

Clinical Ophthalmology (Auckland, N.Z.)
|September 9, 2024
PubMed
Summary

Capsular waves on slit lamp exam can indicate malpositioned intraocular lenses (IOLs). This finding, seen in cataract surgery patients, suggests the IOL may be anterior to the capsule, requiring further inspection before Nd:YAG capsulotomy.

Keywords:
IOLglaucomahyphemairis atrophymalpositioned IOLsulcustransepithelial defectuveitis

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Area of Science:

  • Ophthalmology
  • Cataract Surgery
  • Intraocular Lens Implantation

Background:

  • Posterior capsular opacification (PCO) is a common complication after cataract surgery.
  • Nd:YAG laser capsulotomy is often performed to treat visually significant PCO.

Purpose of the Study:

  • To identify examination findings of the lens capsule that may indicate malpositioned intraocular lenses (IOLs).
  • To highlight the significance of capsular waves as a potential indicator of IOL malposition.

Main Methods:

  • Observational case series reviewing pre-operative images of five malpositioned single-piece IOLs.
  • Cases involved patients referred for evaluation of PCO and potential Nd:YAG capsulotomy.

Main Results:

  • Five eyes with PCO exhibited capsular waves, a striated pattern resulting from anterior and posterior capsule fusion.
  • Capsular waves were the primary indicator of IOL malposition in some cases, especially with small pupils.
  • All identified cases had single-piece IOLs with at least one haptic in the ciliary sulcus, requiring repositioning or exchange.

Conclusions:

  • Capsular waves observed during slit lamp examination warrant a thorough inspection of IOL placement.
  • This finding can suggest an IOL positioned anterior to the anterior capsule.
  • Consideration of capsular waves is crucial before proceeding with Nd:YAG capsulotomy.