History of cataract surgery.
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Cataract Extraction↗
Biomedical subjects
N S Jaffe
Publications and source records attributed to N S Jaffe.
The effect of ketorolac tromethamine in reducing postoperative inflammation: double-mask parallel comparison with dexamethasone.
Anterior chamber fluorophotometry was done after the oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion before and after surgery. The administration of ketorolac solution 0.5% eye drops before and after surgery decreased the breakdown of the blood-aqueous barrier as much as did dexamethasone sodium phosphate solution 0.1% (dexamethasone solution) eye drops at each postoperative time period as measured by fluorophotometry. Slit-lamp observations of postoperative anterior ocular inflammation were not different between treatment groups. Both ketorolac and dexamethasone solutions were well tolerated by patients. No additional corticosteroids were given to any patients during the study. Therefore, ketorolac solution was as effective as dexamethasone solution in suppressing postoperative inflammation after cataract surgery as measured by fluorophotometry and as observed by slit-lamp examinations. This study confirms prior studies that suggest ketorolac ophthalmic solution 0.5% may be effective and safe as a nonsteroidal antiinflammatory agent for topical use after cataract surgery and intraocular lens implantation and as a substitute for topically applied corticosteroids.
Adult↗
Cataract and lens implant surgery. The way it was and the way it is.
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Cataract Extraction↗
Spontaneous enlargement of neodymium:YAG posterior capsulotomy in aphakic and pseudophakic patients.
Two cases of spontaneous enlargement of a neodymium:YAG posterior capsulotomy, involving an aphakic and a pseudophakic patient, are presented. Consequences and possible causality are discussed.
Aged↗
Sulcus versus bag fixation of intraocular lenses.
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Ciliary Body↗
New designs of intraocular lenses.
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Endophthalmitis↗
Endophthalmitis: septic and aseptic.
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Aged↗
Lens techniques of capsular bag fixation.
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Cataract Extraction↗
Chronic postoperative endophthalmitis associated with Propionibacterium acnes.
We present two cases of Propionibacterium acnes endophthalmitis that confirm the association of this organism with a delayed onset and chronic and indolent intraocular inflammation following extracapsular cataract extraction with posterior chamber intraocular lens implantation. The clinical, microbiologic, and histopathologic features of these cases suggest that the organism can be sequestered in the capsular bag, which may make this entity difficult to diagnose. We conclude that complete capsulectomy may be required if inflammation persists after conventional treatment for endophthalmitis, which may include pars plana vitrectomy, partial capsulectomy, and antibiotic therapy. Sterile postoperative uveitis is a diagnosis of exclusion. We stress the importance of appropriate microbiologic investigation in all cases of postsurgical inflammation, even if the onset is delayed until several months after surgery.
Aged↗
Cataract extraction in eyes with congenital colobomata.
Cataract surgery was performed in six eyes of four patients with typical colobomata of the iris, choroid, and retina. Contrary to previous reports of poor surgical results in these eyes, we saw no surgical or postoperative complications. Final visual acuity was excellent in four eyes. The other two had preexisting amblyopia. Most previous reports describe outmoded extracapsular techniques or contemporary intracapsular cataract extraction, all without an intraocular lens. Five of the six eyes in this study had modern cataract surgery--phacoemulsification with a posterior chamber lens placed in the capsular bag.
Aged↗
The outlook for intraocular lenses through 1990.
Extracapsular cataract extraction with posterior chamber intraocular lens implantation has become the most successful intraocular procedure ever practiced. The number of cataract extractions and intraocular lenses implanted have increased enormously over the past decade. One might ask if a saturation point is near. The progress of cataract extraction and intraocular lens implantation is reviewed from 1973 to 1983 and an attempt to predict their volume to 1990 is made. Significant research and development factors and their impact on the domestic and foreign markets are presented. Because of these and demographic factors, it is concluded that we are not nearing the saturation point in cataract surgery or the intraocular lens industry.
Cataract Extraction↗
Glare and contrast: indications for cataract surgery.
The present method of using Snellen visual acuity to evaluate the vision of cataract patients is inadequate because it may grossly overestimate the nature of their visual world. Many of these patients have poor visual functioning as a result of glare disability and loss of contrast. The loss of visual contrast on the retina may be quantified using devices currently available and applicable to a clinical setting in the office. These are described. A study of glare disability in pseudophakic eyes following phacoemulsification or planned extracapsular cataract extraction with intact capsules is made and compared with a previous report of eyes with a primary posterior capsulotomy. It is recommended that glare disability be measured in eyes of cataract patients and be used as an indication for cataract surgery.
Adolescent↗
Current concepts in posterior chamber lens technology.
Although extracapsular cataract extraction and posterior chamber lens technology is of unrivaled safety and efficacy, the following aspects command considerable attention: chronic postoperative inflammation, inhibition of posterior capsular opacification, facilitation of YAG-laser posterior capsulectomy, prevention of ultraviolet radiation exposure, and sulcus versus capsular-bag fixation of posterior chamber lenses. The differential diagnosis of lens-induced and intraocular-lens-induced inflammation is presented, along with recommendations for the treatment and management of the second eye. Use of the complete laser-ridge lens to create a barrier for migrating cells capable of causing posterior capsular opacification is discussed. Using it to create a space between the posterior surface of the optic and the posterior capsule to facilitate YAG-laser posterior capsulectomy is also described. The status of ultraviolet blockers in intraocular lenses is discussed. The transition to capsular-bag fixation is recommended based on the following problems with sulcus-fixated lenses: mechanical disruption of the blood-aqueous barrier with release of inflammatory mediators, hemorrhage from or obstruction in the major arterial circle, the danger of polypropylene in metabolically active tissue, and the posterior iris chafing syndromes.
Cataract Extraction↗
Ptosis and cataract surgery. A multivariant computer analysis of a prospective study.
A prospective study investigated the effect of local anesthesia, eyelid edema and superior rectus muscle injury on postoperative ptosis. Patients were randomized into four groups to study these effects. Group A received a Van Lint eyelid block and a superior rectus bridle suture. Group B received a Van Lint block and an episcleral retraction suture. Group C received a Nadbath retroauricular facial nerve block and a superior rectus bridle suture. Group D received a Nadbath block and an episcleral retraction suture. Results of the study indicate that postoperative ptosis can be significantly reduced by varying our operative techniques. Postoperative ptosis was significantly increased in group A and reduced in group D. It appears that trauma to the superior rectus muscle complex is the most critical factor in postoperative ptosis. Fifty five and one-half percent of the population entered the study with preoperative ptosis. Preoperative ptosis had no effect on postoperative ptosis. Lid crease, superior sulcus fullness and lash rotation are poor anatomical landmarks of levator insertion in the elderly population, both preoperatively and postoperatively.
Adolescent↗
Current and future concepts of the design of the intraocular lens.
Anterior chamber lenses are currently much less popular than posterior chamber lenses. They are mainly used in conjunction with intracapsular cataract extraction, as a secondary lens implant, and as a back up lens in case of intraoperative complications of extracapsular cataract extraction. A major disadvantage of anterior chamber lenses is improper sizing. Rigid lenses cause the greatest ocular tenderness and present serious problems with errors in sizing but they are the easiest to explant. Semiflexible and flexible lenses show a greater tendency to develop peripheral anterior synechiae. This makes explanation a very difficult procedure. Posterior chamber lenses are the most popular today. There is a trend toward all-PMMA lenses because of concern over the biocompatibility of polypropylene. The use of a laser ridge may inhibit posterior capsule opacification and facilitate YAG laser posterior capsulectomy. Ultraviolet blockers are being incorporated as a copolymer of a mechanical additive. There is a major trend towards capsular bag fixation of posterior chamber lenses as a result of complications associated with sulcus-fixated lenses. These include: disruption of the blood-aqueous barrier due to loop penetration of the ciliary body; chafing of the posterior surface of the iris leading to transillumination defects, microhyphaemas, and pigment dispersion glaucoma. It is predicted that the number of cataract extractions and the percentage of intraocular lens implantations will continue to increase due to demographic factors. Budgetary allocations for research and development will increase because of the involvement of some of the giants of medical industry. This will lead to new implant materials and new surgical techniques.
Aged↗
Glare disability in eyes with intraocular lenses.
For 32 eyes tested for glare disability after undergoing extracapsular cataract extraction with implantation of posterior chamber intraocular lenses, the mean contrast threshold in the presence of the glare source was 23% for undilated pupils and 31% with dilation. A regression analysis of glare scores as a function of the amount of posterior capsule opacification showed a significant (P less than .00001) association between the two.
Aged↗
Retinal detachment in myopic eyes after intracapsular and extracapsular cataract extraction.
We analyzed two consecutive series of cataract extractions in patients with moderate to severe myopia for the incidence of postoperative retinal detachment. One series consisted of 122 intracapsular cataract extractions without surgical loss of vitreous and the other series consisted of 151 extracapsular (phacoemulsification and planned extracapsular) cataract extractions without loss of vitreous and with intact posterior capsules. All patients were 40 years of age or older and all were followed up for one to four years. We defined moderate to severe myopia as an aphakic refraction of +7.00 diopters spherical equivalent or less. The rate of postoperative retinal detachment was greater in the intracapsular series (seven of 122 cases; 5.74%) than in the extracapsular series (one of 151 cases; 0.66%).
Adult↗