中川 卓

RATIONALE: The objective of this study was to apply secondary intraocular lens (IOL) intrascleral fixation with lens capsule preservation in a patient with IOL dislocation following mature cataract surgery with incomplete continuous curvilinear capsulorhexis (CCC). PATIENT CONCERNS: A 56-year-old Japanese woman experienced distorted vision 4 days after phacoemulsification and intracapsular IOL implantation for a mature cataract. DIAGNOSES: Slit-lamp examination revealed inferior-nasal dislocation of the intracapsular IOL through an anterior capsule defect (3-6 o'clock) caused by peripheral extension of the CCC during the primary surgery. INTERVENTIONS: IOL extraction followed by intrascleral fixation with lens capsule preservation was performed 1 week after the initial surgery. The secondary surgery involved inserting a 30 G needle between the lens capsule and iris, with IOL fixation to the sclera using a double-needle technique. The IOL optics were successfully captured through the incomplete anterior CCC of the preserved lens capsule. No intraoperative vitreous prolapse occurred, eliminating the need for a vitrectomy. OUTCOMES: The IOL remained well-fixed without IOL pupillary capture. Additionally, no significant complications such as retinal detachment or vitreous hemorrhage were observed. LESSONS: Preserving the capsule during secondary intrascleral fixation for IOL dislocation in patients with incomplete CCC offers several advantages, including reduced intraoperative vitreous prolapse, minimized surgical invasiveness, suppression of postoperative iris flutter, and prevention of IOL capture within the pupil. However, the long-term outcomes, including the potential risk of lens capsule drop, warrant further investigation with more cases.

Minimally invasive glaucoma surgery (MIGS) is believed to induce less surgically induced astigmatism (SIA) due to smaller incisions, yet few studies have evaluated SIA in MIGS patients. This retrospective cohort study compared SIA and refractive outcomes among three MIGS techniques: first-generation trabecular micro-bypass stent (iStent [IS], n = 36), second-generation iStent inject W (IW, n = 39), and microhook ab interno trabeculotomy (μLOT, n = 36). SIA, refractive prediction error (RPE), intraocular pressure (IOP), and glaucoma subtype were analyzed. SIA remained minimal, with no significant differences between groups (p = 0.95, linear mixed model). RPE significantly differed between IW and μLOT (p = 0.025) but remained mild in both. The μLOT group exhibited a slight myopic shift and greater IOP reduction. However, absolute prediction error did not significantly differ among groups (p = 0.062). Subgroup analysis confirmed the refractive neutrality of MIGS across primary open-angle glaucoma, pseudoexfoliative glaucoma, and chronic angle-closure glaucoma. These findings support the refractive stability of MIGS when combined with cataract surgery, suggesting IS, IW, and μLOT as equally viable options from a refractive standpoint.