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PubMed2005

Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation--report no. 1.

PURPOSE: To compare the anatomic and visual results and complications of conventional scleral buckling versus primary vitrectomy for management of pseudophakic and aphakic retinal detachment. DESIGN: Prospective, randomized, multicenter clinical trial. PARTICIPANTS: Two hundred twenty-five eyes of 225 patients with pseudophakic or aphakic retinal detachment. INTERVENTION: Eligible eyes were assigned randomly either to conventional scleral buckling or primary vitrectomy without any buckle. MAIN OUTCOME MEASURES: Visual results, retinal reattachment rate, proliferative vitreoretinopathy, macular pucker, cystoid macular edema, choroidal detachment, intraocular pressure, extraocular muscle dysfunction, and anisometropia. RESULTS: There were no statistically significant differences between the 2 treatment groups regarding the single-operation retinal reattachment rate at the 1-, 2-, 4-, and 6-month follow-up examinations. Patients in the buckle group had 28% greater likelihood of anatomic success compared with those in the vitrectomy group (odds ratio, 1.28; 95% confidence interval, 0.73-2.24), indicating no statistically significant difference. Proliferative vitreoretinopathy was the main cause of anatomic failure in both groups and occurred independent of the surgical technique used. Best-corrected visual acuity at the 1-, 2-, 4-, and 6-month postoperative follow-up examinations showed no statistically significant difference between the 2 groups. Six months after surgery, 12.8% of eyes in the buckle group and 11.3% of eyes in the vitrectomy group achieved visual acuity of 20/40 or better. The difference between the 2 groups was not statistically significant. Corresponding figures were 66.3% and 64.5% for visual acuity of 20/200 or better in the buckle and vitrectomy groups, respectively, again with no statistically significant difference. There were no statistically significant differences in rates of complications. CONCLUSIONS: Scleral buckling and primary vitrectomy without an encircling band have comparable results in pseudophakic and aphakic retinal detachment. The choice of surgical technique depends on various factors, including patient compliance, cost of surgery, experience and capability of surgeons, and availability of appropriate instrumentation.

Aphakia, Postcataract↗
PubMed2003

The association between myopic shift and visual acuity outcome in pediatric aphakia.

PURPOSE: The advent of intraocular lens implantation after pediatric cataract surgery necessitates an increased understanding of refractive development. The significant variation in rate and amount of refractive change among eyes, both aphakic and pseudophakic, is well recognized, although the causes of such variation remain unclear. The purpose of this study was to determine if a correlation exists between the rate of refractive growth (RRG) and visual acuity outcome in pediatric aphakia. METHODS: Multicenter, retrospective observational case series. One hundred and twenty-five eyes of 85 patients with cataract surgery before 1 year of age and a minimum of 3 years of follow-up were analyzed. RRG was calculated for each eye using the logarithmic model of ocular growth and compared with final logMAR acuity using linear regression. RESULTS: The correlation of RRG with final logMAR acuity was statistically significant (r(2) = 0.10; P <.01), ie, 10% of variance in RRG is related to acuity outcome. The correlation was higher in unilaterally aphakic patients (n = 44; r(2) = 0.19; P <.01) than in bilaterally aphakic patients (n = 81; r(2) = 0.08; P <.01). Eyes with visual acuity of 20/60 or better had a significantly lower RRG than those with poorer acuity (4.1 v 5.4 diopters (D); P <.01). CONCLUSIONS: RRG in aphakia is correlated with visual acuity outcome. Eyes with poorer acuity have a greater RRG.

Aphakia, Postcataract↗
PubMed2002

Results of surgery for bilateral cataract associated with sensory nystagmus in children.

PURPOSE: To report the outcome of cataract surgery in children with bilateral cataract and preoperative sensory nystagmus. DESIGN: Interventional case series. METHODS: Retrospective review of 95 children who underwent surgery for bilateral cataract associated with sensory nystagmus. All patients lacked other structural ocular defects or neurologic abnormalities and were old enough at last follow-up to cooperate with recognition visual acuity testing. Outcome parameters studied were best-corrected postoperative visual acuity of the better eye and postoperative reduction or elimination of nystagmus. RESULTS: Mean age at surgery +/- SD was 2.0 +/- 2.6 years (range, 1 month to 13 years). Mean follow-up was 6.1 +/- 3.4 years (range, 2 months to 15 years). Best-corrected postoperative visual acuity of the better eye ranged from 20/25 to counting fingers and was 20/60 or better in 44 (46%), between 20/60 and 20/200 in 37 (39%), and 20/200 or worse in 14 (15%). Preoperative recognition visual acuity data were available for 16 of the older patients, and 5 or more lines of visual acuity improvement occurred in 5 (31%) including children as old as 9 years at the time of surgery. Nystagmus was reduced or eliminated postoperatively in 38 (40%). Mild, as opposed to severe, preoperative nystagmus was predictive of both a better visual acuity outcome (P =.004) and reduced or eliminated nystagmus postoperatively (P =.02). CONCLUSIONS: Good or even excellent visual acuity can be achieved after cataract surgery in some children with bilateral cataract and sensory nystagmus, and the nystagmus sometimes improves postoperatively.

Aphakia, Postcataract↗
PubMed2003

Reduced oscillatory potentials of the full-field electroretinogram of eyes with aphakic or pseudophakic cystoid macular edema.

PURPOSE: To report reduced oscillatory potentials (OPs) in the full-field electroretinogram (ERG) of eyes with aphakic or pseudophakic cystoid macular edema (CME). DESIGN: Observational case series. METHODS: Bright white flash full-field ERGs were recorded from 19 eyes of 19 patients (ages, 53-84 years) with aphakic or pseudophakic CME. Seven of the cases had uncomplicated phacoemulsification (PE) with implantation of a posterior chamber intraocular lens (PC-IOL) and 6 had posterior capsular rupture during phacoemulsification and aspiration with implantation of a PC-IOL. Four additional patients had uncomplicated intracapsular cataract extraction (ICCE), and 2 had secondary anterior chamber intraocular lens after ICCE. Their fellow eyes without CME served as controls. Cystoid macular edema was diagnosed as clinically significant by slit-lamp examination and by fluorescein angiography. The grading for severity of CME was based on the fluorescein angiography. The visual acuity ranged from 20/200 to 20/16. RESULTS: There were no significant differences in the mean amplitudes and implicit times of the a-waves and b-waves between the affected eyes and the fellow eyes. The mean summed amplitude of the OPs was significantly reduced in the affected eyes (P =.0003, Wilcoxon signed rank test). This decrease was strongly correlated with visual acuity (r =.779, P <.0001). The mean implicit time of the first OP was significantly delayed in the affected eyes (P =.0089, Wilcoxon signed rank test). CONCLUSIONS: Because the peripheral retina contributes more significantly to full-field ERGs than the macula, the reduced OP amplitudes of the full-field ERGs in eyes with aphakic or pseudophakic CME suggest a functional impairment not only in the macula but also throughout the retina.

Aged↗
PubMed1996

Results following secondary intraocular lens implantation in children.

BACKGROUND: Placement of a secondary intraocular lens (IOL) in a child may be considered in children with congenital monocular cataracts who have had complete opacities removed early in life and who later become contact lens intolerant, in eyes that have received trauma which precluded placement of a primary IOL, and in young adults who have bilateral aphakia who become resistant to use of contact lenses or spectacles. METHODS: Clinical records of all children in our practice who received a secondary IOL between January 1988 and December 1994 were reviewed. Indications, biometry, type of procedures, preoperative and postoperative acuity, refractive error, binocular status, and complications were studied. RESULTS: During the 7-year period, 242 cataract operations were performed. Fifty-nine eyes received a lens implant, and 28 of these were secondary implants. There was a mean interval between the initial cataract operation and the procedure for the secondary implant of 77 months. The mean follow-up was 35 months (range, 3 to 71) for the 28 eyes that received a secondary implant. Two received anterior chamber implants. Eight eyes had insufficient capsular support for an IOL. Six implants were placed in the posterior chamber and required suture fixation to the sclera. Twenty of 28 eyes had a measurable improvement in visual acuity. Only 1 eye had a decrease in visual acuity of 2 lines. Fifteen patients (54%) had a final refraction within 1.50 diopters of the fellow eye, and 75% were within 3.00 diopters. During the follow-up period, 2 eyes developed glaucoma. One had a transient pressure elevation, and the second has required 2 filtration procedures. Three patients required a Nd: YAG capsulotomy. Six patients demonstrated Worth fusion at distance and near, but only 3 patients demonstrated 200 seconds of arc or better stereo acuity. CONCLUSION: Placement of contemporary-style, secondary intraocular lenses in children and young adults appears to provide a safe and effective alternative for correction of aphakia in children who become contact lens or spectacle-intolerant.

Adolescent↗
PubMed1997

Traumatic cataract in children: correction of aphakia by contact lens or intraocular lens.

PURPOSE: To compare the postoperative complications, visual outcome, and incidence of strabismus in children suffering from traumatic cataract corrected with contact lens or intraocular lens and to follow up the refractive changes in these eyes for an extended period of time. METHODS: Forty children, 2 to 13 years old at time of surgery for unilateral traumatic cataract, were followed up for 1.5 to 11 years. Seventeen children were corrected with contact lenses and 23 with intraocular lenses. Thirty-two underwent a primary posterior capsulectomy and anterior vitrectomy. RESULTS: The mean follow-up after surgery was 7.4 years for the children with contact lenses and 6.2 years for those with intraocular lenses. The incidence of secondary surgical interventions was higher among the children corrected with contact lenses. The eight children (five with contact lenses, three with intraocular lenses) who did not undergo primary posterior capsulectomy had Nd:YAG capsulectomy within 1 year after surgery. Fifteen of the 23 children with intraocular lenses (65.2%) achieved a best-corrected visual acuity of 20/40, and 17 children (73.9%) had a final visual acuity of 20/50, but only five of 17 children with contact lenses (35.3%) achieved this level of visual acuity. CONCLUSIONS: Correction of unilateral aphakia by intraocular lens in children after traumatic cataracts results in better final visual acuities and binocularity with a smaller incidence of strabismus than when correction is carried out by contact lens. Intraocular lens implantation should be considered the primary aphakic correction in children with traumatic cataract.

Adolescent↗
PubMed1995

Pars plana Baerveldt tube insertion with vitrectomy in glaucomas associated with pseudophakia and aphakia.

PURPOSE: We reviewed the course of intraocular pressure, visual acuity, and complications in patients with shallow anterior chambers or vitreous prolapse who underwent insertion of glaucoma drainage tubes through the pars plana (after a complete posterior vitrectomy). METHODS: Thirteen patients (13 eyes) with uncontrolled glaucoma associated with shallow anterior chamber or vitreous prolapse and aphakia or pseudophakia underwent pars plana Baerveldt tube insertion after vitrectomy. RESULTS: In 11 eyes the intraocular pressure was less than or equal to 15 mm Hg at a minimum follow-up of one year; the other two eyes underwent additional glaucoma surgery. Two of the 11 eyes with controlled intraocular pressure had limitation of ocular motility postoperatively. No retinal complications had occurred in any of the 13 eyes. CONCLUSION: This technique of combined pars plana vitrectomy and pars plana insertion of a Baerveldt tube provides intraocular pressure control in eyes with shallow anterior chamber or vitreous prolapse and glaucoma associated with pseudophakia or aphakia.

Adolescent↗
PubMed1991

Delayed-onset pseudophakic endophthalmitis.

We reviewed 19 cases of delayed-onset pseudophakic endophthalmitis in which diagnostic cultures were performed at one month or more after cataract extraction with posterior chamber intraocular lens implantation. We isolated four different organisms in these 19 cases: 12 Propionibacterium species (63%), three Candida parapsilosis (16%), three Staphylococcus epidermidis (16%), and one Corynebacterium species (5%). Because of the unusual delayed-onset features of these cases and the retrospective nature of this study, a variety of treatment regimens were used. Twelve patients had recurrence of marked inflammation despite an apparent initial cure, and ten of these patients had positive culture results on repeat examination of intraocular fluids. Nine patients continued to be treated with topical corticosteroids postoperatively to suppress low-grade inflammation. Of the 19 patients, 16 had final visual acuity of 20/400 or better. Delayed-onset pseudophakic endophthalmitis had a more favorable visual prognosis, compared to acute-onset endophthalmitis.

Adrenal Cortex Hormones↗
PubMed1995

Vancomycin levels in the vitreous cavity after intravenous administration.

PURPOSE: We studied the effects of inflammation, repeated antibiotic doses, and the surgical status of the eye on penetration of vancomycin hydrochloride into the rabbit vitreous cavity after intravenous administration. METHODS: We studied three anatomic states (phakic, aphakic, and aphakic, vitrectomy-treated eyes) subdividing each into inflamed and noninflamed groups. Intravenous vancomycin hydrochloride (15 mg/kg of body weight) was administered every 12 hours for 48 hours. Eyes were harvested for the assay of vitreous cavity antibiotic levels at various intervals from one to 49 hours. We determined concentrations and calculated mean values and S.E.M. RESULTS: Therapeutic levels were not established in the vitreous cavity at any time period in the two phakic groups. At 25 hours, the inflamed aphakic eyes had concentrations of 5.05 +/- 1.9 micrograms/ml and the control noninflamed aphakic eyes 4.5 +/- 1.23 micrograms/ml; slight increases were found by 49 hours. Concentrations tested in the aphakic, vitrectomy-treated eyes at two, 13, 25, and 49 hours demonstrated progressive increases both in the inflamed eyes (5.4 +/- 2.4 micrograms/ml, 9.64 +/- 4.25 micrograms/ml, 9.2 +/- 3.96 micrograms/ml, 10.34 +/- 4.49 micrograms/ml) and noninflamed eyes (3.52 +/- 2.1 micrograms/ml, 5.4 +/- 1.96 micrograms/ml, 6.8 +/- 2.53 micrograms/ml, 8.7 +/- 5.44 micrograms/ml). CONCLUSIONS: Vitreous vancomycin concentrations in aphakic and aphakic, vitrectomy-treated eyes after intravenous administration exceed the minimal inhibitory concentrations for the usual gram-positive pathogens that create endophthalmitis, suggesting a role for intravenous vancomycin in the treatment of bacterial endophthalmitis.

Animals↗
PubMed1987

Effectiveness of ketorolac tromethamine 0.5% ophthalmic solution for chronic aphakic and pseudophakic cystoid macular edema.

The effect of ketorolac tromethamine 0.5% ophthalmic solution (a new nonsteroidal anti-inflammatory agent) treatment was compared to placebo treatment in patients with chronic, angiographically proven aphakic or pseudophakic cystoid macular edema (visual acuity less than or equal to 20/40 for six months) during a three- to four-month double-masked, randomized study. Twenty-six patients completed this study without significant ocular or systemic toxicity. The improved distance visual acuity observed in the ketorolac treatment group (8/13 patients) was statistically different from the improved vision observed in the placebo treated group (1/13 patients) (P = .005). No patient on a regimen of ketorolac therapy had a significant decrease in Snellen distance visual acuity while on treatment, but two patients in the placebo group demonstrated a decrease in visual acuity of two lines or more. Fluorescein angiography was consistent with changes in visual acuity.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1980

Extended-wear Hydrocurve and Sauflon contact lenses.

Fifty-six of 70 eyes selected for extended-wear lenses were successfully fitted with moderately hydrophilic (Hydrocurve II and Hydrocurve II-55) and highly hydrophilic (Sauflon) contact lenses. Thirty-two of 34 myopic eyes and 24 of 36 aphakic eyes were successfully fitted. The myopic eyes were followed up for two to 20 months and the aphakic eyes for two to 17 months. Ninety-one percent of all eyes achieved visual acuity better than or equal to 6.9 (20/30). Approximately 2.8 lenses per eye per year were required for success. The major complication was corneal edema (anoxic overwear); some of these cases responded to the fitting of looser, more hydrophilic lenses, frequent use of artificial tears, and increased blinking. There was no difference in the incidence of lens deposits between the moderately and highly hydrophilic lenses, and in only six eyes did lens deposits necessitate a lens change. There were no corneal ulcers in this study.

Adolescent↗