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This paper presents the results of cataract extraction in 124 patients who had previously undergone glaucoma surgery. The results were best when cataract extraction was combined with iridoplasty. With this method we were able to improve the patients' vision and preserve the filtration bleb. The technique of the operation is described.
A retrospective investigation of aphakic retinal detachments following intracapsular cataract extraction during a 12-year period was performed. A total of 8350 eyes had intracapsular cataract extraction in the study period and 118 eyes developed aphakic retinal detachment. The occurrence of retinal detachment is related to age, sex, intraoperative complications, myopia, hyperopia, and pseudophakia. Age and myopia were significantly associated with aphakic retinal detachment. Previous aphakic retinal detachment in the one eye was a strong predictor for the other eye.
The author suggests a method for accurate positioning of the edges of the rigid pupil edge in radial iridosphyncterotomy in cataract extraction, this permitting a minimally traumatic intra- or extracapsular cataract extraction and, if necessary, IOL implantation to the lens sac or to the posterior chamber, after which the supramide suture previously made at the pupil edge is tied before radial iridosphyncterotomy. Eighteen sphyncteroiridoplastic surgeries of the rigid pupil were carried out after cataract extractions.
The authors examined prospectively the association between dietary fat intake and cataract extraction in adult women from the Nurses' Health Study. A total of 71,083 women were followed prospectively for up to 16 years between 1984 and 2000. Dietary fat was assessed by repeated food frequency questionnaires. Incident cases of cataract extraction were determined by a biennial questionnaire. The multivariate-adjusted relative risk for the highest compared with the lowest quintile of total fat intake was 1.10 (95% confidence interval (CI): 0.99, 1.22; p(trend) = 0.01). Women in the highest quintile of long-chain omega-3 fatty acid had a 12% lower risk of cataract extraction compared with those in the lowest quintile (relative risk = 0.88, 95% CI: 0.79, 0.98; p(trend) = 0.02). Total fish intake was inversely associated with cataract (for intake of > or = 3/week vs. <1/month: relative risk = 0.89, 95% CI: 0.81, 0.98; p(trend) = 0.01). The authors' findings suggest that higher intake of long-chain omega-3 fatty acid (eicosapentaenoic acid and docosahexaenoic acid) and consumption of fish may modestly reduce the risk of cataract.
The introduction of cataract extraction by Jacques Daviel, in 1752/53, appears to us as a revolutionary step in eye surgery. It should be realized, however, that this achievement was not only the result of intuition and bold decision in critical situations, but also of careful evaluation, over seven years, of extraction vs. the best modifications of the time-honored needle operation. This included anatomical examination of the effects of needling (couching of the lens) in isolated eyes.
Out of 58 eyes in which a cataract extraction followed a successful detachment operation, only 8, or 15.5%, developed a detachment of the retina after the cataract operation and, of these 8 eyes, 7 were cured with further retinal detachment operation. Thus, in 58 healed detachment eyes, only 1 (1.7%) lost useful vision because of incurable retinal detachment following cataract extraction. Therefore, one may conclude that, in a patient definitely handicapped by poor vision due to a cataract in an eye with a healed retinal detachment, extraction of this cataract is justified and carries a good prognosis.
Extracapsular cataract extraction with lens implant under local anaesthesia consisting of amethocaine drops followed by a simple subconjunctival injection in the upper part of the globe but without a retrobulbar injection was carried out in 175 eyes of 165 patients. The purpose of the study was to establish the feasibility of this type of anaesthesia in cataract surgery with the principal object of avoiding the possibility of retrobulbar haemorrhage and the other, rarer, complications of retrobulbar injection. The method, which is referred to as the NR method, proved to be satisfactory. No undue difficulties were encountered as a result of using the technique, the visual results were satisfactory and compared favourably with those under general anaesthesia, and the patients accepted the method well, possibly preferring it to conventional methods.
In 1998, a total of 617 cataract operations were performed on 523 patients at five outreach sites in Jimma Zone; south-western Ethiopia. The first 500 consecutive operations performed on 423 patients were analysed for visual outcome two weeks following field surgery. Four hundred and seventy-seven eyes underwent standard intra capsular cataract extraction (ICCE) while 23 eyes underwent extra capsular cataract extraction (ECCE). Seventy-seven patients underwent bilateral cataract surgery while 346 patients had been operated on only one eye. Forty-two patients (10.1%) or eighty-one eyes were lost for follow up. Thirty-nine of the 77 patients (50.6%) who received bilateral surgery and only 3 of 346 patients (0.9%) who received unilateral surgery were lost for follow up. Seventy-seven eyes (18.4%) had final visual acuity (v/a) of > or = 6/18; 388 eyes (92.6%) had v/a of > or = 6/60 and 395 eyes (94.3%) had v/a > or = 3/60. Capsule rupture and vitreous loss were the most common intra operative complications, accounting for 7.4% and 6%, respectively. Both complications were encountered in 1.8% of the eyes. Twenty-four eyes (5.7%) were blind despite surgery. However, only three eyes were blind as a result of complications related to surgery. There is a need for improvement in the screening of patients for surgery. The overall visual outcome obtained was satisfactory. Possible factors affecting visual outcome are considered and recommendations to effect improvement discussed.
The authors conducted a case-control hospital-based study to assess the prevalence of systemic diseases and drugs in 161 cataract extraction patients and 196 surgical patients matched by age, sex, and race. The data were analyzed using matched multiple logistic regressions. A statistically significant increased risk of cataract extraction was found in patients with systemic hypertension (odds ratio [OR] = 1.49, 95% confidence interval [CI] = 1.06-2.09) and diabetes mellitus (OR = 1.79, 95% CI = 1.23-2.60). Estimation of the combined effect of systemic hypertension and diabetes mellitus resulted in an even higher risk for cataract extraction (OR = 2.66, 95% CI = 1.67-4.23). A positive association of cataract extraction and treatment of systemic hypertension with the diuretic furosemide was also found (OR = 1.95, 95% CI = 1.02-3.74).
Review was performed of extracapsular cataract extraction with posterior chamber lens implantation in 90 diabetic patients and 263 non-diabetic patients. There was a higher incidence of posterior capsular opacification as judged by the requirement for Nd:YAG posterior capsulotomy in patients with non-proliferative (12/35, 34%) or quiescent proliferative diabetic retinopathy (8/18, 44%) than in non-diabetic patients (48/263, 18%) (Mantel-Haenszel p = 0.04). Although subgroup analysis showed a higher incidence of posterior capsule opacification in diabetics with non-proliferative or quiescent proliferative retinopathy than in diabetics without retinopathy, this was not statistically significant (Mantel-Haenszel p = 0.19 and p = 0.07, respectively). Following cataract surgery in diabetics with retinopathy, frequent review and prompt management of posterior capsular opacification is recommended, to maintain adequate fundus visualisation at a time when deterioration of retinopathy is likely.
Extracapsular cataract extraction with posterior chamber lens implantation and trabeculectomy was performed on 15 cataractous eyes in 15 patients: 5 were affected with chronic closed angle glaucoma and 10 with primary open angle glaucoma. This procedure offers the intraocular pressure control expected after trabeculectomy and, at the same time, gives the patients all visual benefits that cataract extraction with intraocular lens implantation warrants, without the introduction of new complications.
One hundred cases of uncomplicated cataract with clear corneae had cataract extraction and were examined at 20 days and six weeks after operation. Keratometry was done preoperatively and keratometry and retinoscopy at each of the follow-up visits. The study was undertaken to evaluate the type (whether pre- or postplaced) and the number of sutures (one, three, or five) that produce the least postoperative astigmatism. We found that the type of suture was immaterial but that three sutures produced the least astigmatism.
A review of 1,107 cases of cataract extraction by phacoemulsification is presented. The incidence of retinal detachment in this group was found to be 1,7%. This incidence of retinal detachment following phacoemulsification appears to be favorable compared to that following conventional cataract extraction. It is hoped that this report will encourage others to study this important subject.
Extracapsular cataract extraction with implantation of an intraocular lens (IOL) is a routine operation in Norway today. With the conventional monofocal IOL, most people require spectacles post-operatively to attain optimal vision. A new principle is the bifocal IOL, which is designed to minimize the patient's need for additional post-operative near vision correction. In this article we present the first results using this bifocal lens. Ten out of 17 patients (18 eyes) had no need of post-operative spectacles. We believe that this lens represents a promising new optical principle, and is an advance in IOL implant technology.
This retrospective study reviews the time interval between extracapsular cataract extraction with posterior chamber intraocular lens placement and neodymium (Nd):YAG laser posterior capsulotomy relative to the age of the patient at the time of cataract surgery. Two hundred thirteen consecutive laser procedures involving eyes that had had extracapsular cataract extraction within 6 years were reviewed. We found that there was an upper limit on the time interval from extracapsular cataract extraction to Nd:YAG posterior capsulotomy for all patients eventually requiring a Nd:YAG capsulotomy. This time limit appeared to be directly proportional to the age of the patient at the time of his or her cataract surgery: the older the patient at the time of surgery, the longer the period the patient was at risk for requiring a capsulotomy. Beyond this time limit, the likelihood that an Nd:YAG capsulotomy would be required was less than 2.5%. The prolonged period of risk for elderly patients may be related to an age-related decline in lenticular hyperplasia.
An extracapsular cataract extraction (ECCE) with posterior-chamber-IOL was performed in 21 eyes of 20 patients with primary angle closure glaucoma (PACG; 2 suspects, 5 acute PACG, 14 chronic PACG). The ECCE was performed to improve the IOP. In 14 cases the ECCE was done in lieu of a filtering procedure. After the ECCE the anterior chamber deepened. The mean IOP was reduced from 31 mmHg preoperative to 16 mmHg postoperative. Only 5 eyes needed additional medication after the ECCE. The IOP was reduced even if extensive peripheral anterior synechiae were diagnosed or after failed filtering procedures. The only temporary complication was the IOP-peak in the immediate postoperative period. It is concluded that an ECCE with PC-IOL should be seriously considered as the procedure of choice in PACG instead of a filtering procedure (or instead of a combined procedure).
One hundred eyes undergoing intracapsular cataract extraction and 100 undergoing extracapsular extraction were examined prospectively within one week postoperatively and again at 6-10 weeks postoperatively. Indirect ophthalmoscopy showed vitreous haemorrhage in 36% of the intracapsular group and 13% of the extracapsular group. Vitreous haemorrhage was significantly related to the occurrence of operative hyphaema (p less than 0.01) but not to iridectomy (p greater than 0.05). In the intracapsular group the use of chymotrypsin significantly reduced the incidence of vitreous haemorrhage (p less than 0.01). Three different types of vitreous haemorrhage were identified--streaks, diffuse haze, and beads in the vitreous base. Wound haemorrhage and operative hyphaema account for most cases, but it is suggested that zonular traction may be responsible for the bead haemorrhages and also for the retinal haemorrhages reported by other authors. Although no difference in visual result or incidence of cystoid macular oedema was observed in this study, a relationship to the vitreoretinal pathology of aphakia is suggested.
A prospective study of the effect of cataract extraction and intraocular lens implantation on insulin-dependent diabetics is presented. Cataract extraction was performed on 138 patients with diabetic retinopathy. The patients were randomly selected for intracapsular or extracapsular extraction and for the administration of topical indomethacin or placebo. In a second group, 103 diabetic patients received intraocular lens implants, which were anterior-chamber-angle fixated, iris supported, iridociliary sulcus supported, or placed in the capsular bag. Random selection determined who among the extracapsular cases would have on-the-table capsulotomy or six-month-postoperative capsulotomy. The study indicated that a greater progression of diabetic changes occurred in both the posterior and the anterior segment of the eye after intracapsular extraction than after extracapsular extraction, especially if the capsulotomy was performed six months postoperatively. Furthermore, the study indicated that in-the-bag implantation without on-the-table capsulotomy was a safe procedure; anterior-chamber-angle-fixated lenses exhibited a higher incidence of diabetic changes in the anterior and posterior segments than the other lenses.