中川 卓

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.

BACKGROUND: This study aimed to report and recall a simple method to remove the lens capsule ab externo when performing intrascleral fixation of an intracapsular intraocular lens (IOL) dislocation with reuse of the IOL. CASE PRESENTATION: A 43-year-old Japanese male patient underwent pars plana vitrectomy, phacoemulsification, and IOL fixation for rhegmatogenous retinal detachment in the right eye 10 years prior. A 3-piece IOL was intraocularly fixed during the initial procedure. In December 2023, the patient presented with intracapsular IOL dislocation in his right eye, causing the IOL to descend into the vitreous cavity enveloped by its entire capsule. During surgery, an intravitreal dislocated IOL was placed over the iris with the entire capsule. The haptics on 1 side of the IOL were placed outside the eye through the corneoscleral wound. Subsequently, the lens capsule and Soemmerring's ring surrounding the haptics were removed. After the haptics were placed back over the iris, the same extraction procedure was performed for the remaining haptics. The IOL was intrasclerally fixed using a flange technique through the intrascleral tunnel at the 4 and 10 o'clock positions. One week postsurgery, the best-corrected visual acuity of the right eye was 20/16, and the corneal endothelial cell density was recorded as 2923 cells/mm2 (preoperative: 1650 cells/mm2). DISCUSSION AND CONCLUSIONS: In cases of 3-piece IOL dislocation, employing the ab externo technique for lens capsule extraction has been proven to be a straightforward and efficient method. This approach facilitates the removal of the lens capsule around the IOL. If subsequent damage to the IOL is identified, it allows for easy conversion to replacement.