中川 卓

Background/Objectives: Brown-McLean syndrome (BMS) is a rare peripheral corneal edema that may arise years after cataract extraction or intraocular lens (IOLs) fixation. This article presents a case of IOL dislocation following scleral fixation in a patient with BMS, effectively managed by resuturing the existing IOL. Additionally, a literature review was conducted to summarize the clinical features, etiologies, and surgical outcomes of BMS. A PubMed search identified 30 reports encompassing 169 patients (244 eyes). Among these, corneal transplantation was performed in three eyes. Only four eyes underwent intraocular surgery after BMS onset, with no prior reports of IOL resuturing. Methods: A 73-year-old man with a history of left-eye trauma underwent vitrectomy and scleral fixation of a polymethyl methacrylate IOL 18 years prior. The patient presented with reduced vision in his left eye. Examination revealed BMS-related peripheral corneal edema and partial IOL dislocation. The dislocated haptic was resutured using an ab externo approach under a scleral flap. Results: Postoperative IOL fixation remained stable, with best-corrected visual acuity improving from 0.6 to 0.9. Edema persisted without central spread, and endothelial cell density decreased slightly (2496 to 2364 cells/mm2). One year postoperatively, no IOL tilt progression or suture-related complications were observed. Conclusions: Partial resuturing of a scleral-fixated IOL is effective for managing IOL dislocation in BMS when haptics remain stable. This approach minimizes incision size and potential endothelial trauma compared to explantation. However, aqueous dynamics correction may not reverse established BMS. Long-term endothelial monitoring is advised due to its chronic and progressive nature.

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.

PURPOSE: This retrospective study compares the surgical outcomes of ab interno trabeculotomy using the Kahook Dual Blade (KDB) and Tanito microhook (TMH) combined with cataract surgery. PATIENTS AND METHODS: Twenty-four eyes from 19 and 17 patients with glaucoma in the KDB and TMH groups, respectively, were included. Background factors were matched for medication score and disease type using propensity scores. RESULTS: Preoperative age, sex, intraocular pressure (IOP), medication scores, and disease type were comparable between the groups. The intraoperative incision range was lower in the KDB than TMH group. The postoperative medication scores and IOPs were 2.7±1.6 mmHg and 14.5 ± 2.8 mmHg in the KDB group, and 2.0±1.8 and 13.8 ± 3.4 mmHg in the TMH group, respectively. There were no significant differences between the groups regarding changes in medication scores, IOP reduction rate, or survival 6 months postoperatively. Postoperative IOP changes were significantly associated with preoperative IOP in both groups, and trabeculotomy range in the KDB group. There were no significant between-group differences regarding the incidence of postoperative complications, excluding a higher incidence of hyphema in the TMH group. CONCLUSION: Surgical outcomes for ab interno trabeculotomy using the KDB and TMH were not significantly different. There was no significant difference in the occurrence of postoperative complications, except hyphema, which may reflect the difference in the incision range of trabeculotomy between the hooks. Finally, in the KDB group, where narrow incisions range up to just over one quadrant, the trabeculotomy incision range correlated with IOP.