SEARCH · PubMed Health

Results for “Phacoemulsification”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources

PubMed1996

Phacoemulsification versus endocapsular cataract extraction in a unique cohort of patients.

The visual recovery and refractive results of 33 consecutive patients (66 eyes) undergoing standard endocapsular cataract extraction in one eye and simultaneous phacoemulsification in the fellow eye are reported. One surgeon performed all the operations. Surgically induced astigmatism was evaluated for the two techniques in terms of: (1) the proportion of eyes with a refractive cylinder of 1.5 dioptres (D) or less; (2) the interocular difference in post-operative astigmatism. Eyes undergoing phacoemulsification had a significantly lower mean induced cylinder (paired Student's t-test: t = 3.729; p < 0.001) and were more likely to exhibit a cylinder of 1.5 D or less (chi-squared test with Yates' correction: chi 2 = 7.88; p < 0.01) than the nuclear expression group. For paired eyes less post-operative astigmatism (Wilcoxon's signed rank test: T = 92; p < 0.01) was seen in the phacoemulsification eye. At the time of the last post-operative assessment a significantly higher proportion of phacoemulsified eyes achieved a corrected Snellen visual acuity of 6/6 or better than their fellow eyes (McNemar's test: p < 0.01). The results of this unique cohort of patients confirm the beneficial effects of phacoemulsification on astigmatism and visual outcome in the early post-operative period.

Aged↗

PubMed1997

The maintenance of per-operative mydriasis in phacoemulsification with topical diclofenac sodium.

PURPOSE: To determine whether the use of topical diclofenac sodium (diclofenac) pre-operatively improves the maintenance of per-operative mydriasis, in conjunction with irrigating solutions containing adrenaline. METHODS: Sixty-four consecutive patients undergoing phacoemulsification were randomised to receive either diclofenac or no diclofenac in conjunction with cyclopentolate 1% and phenylephrine 10% pre-operatively. They subsequently underwent routine phacoemulsification by one consultant surgeon. Irrigating solutions of balanced salt solution contained adrenaline 1:10(6). Pupil diameters were measured pre-sclerostomy, post-phacoemulsification, post-irrigation/aspiration and on day 1 post-operatively. These were then compared by Student's t-test. RESULTS: The two groups were statistically similar in age and sex. The mean pre-sclerostomy pupillary diameters were 8.1 mm in both groups. The mean post-phacoemulsification diameters were 7.6 mm in those receiving diclofenac and 7.2 mm in those not (p = 0.03). The mean diameters after infusion/aspiration were 7.7 mm in those receiving diclofenac and 7.1 mm in those not (p = 0.008). The mean pupillary diameters on day 1 were 5.3 mm in those receiving diclofenac and 4.6 mm in those not (p = 0.003). CONCLUSION: Diclofenac improves the maintenance of per-operative mydriasis, in the presence of irrigating solutions containing adrenaline.

Aged↗

PubMed2006

Phacoemulsification in patients with previous trabeculectomy: role of 5-fluorouracil.

UNLABELLED: Cataract surgery in a patient with previous trabeculectomy is considered to have an adverse effect on the long-term survival of the filtering bleb. 5-Fluorouracil (5-FU) has been used in patients with a pre-existing bleb, undergoing cataract surgery, but there are no published reports for or against its use in such cases. This study was carried out to evaluate the protective role of subconjunctival 5-FU on the pre-existing bleb from trabeculectomy in patients undergoing phacoemulsification. METHODS: This retrospective study was carried out on patients with pre-existing filtering bleb from trabeculectomy for primary open-angle glaucoma who then underwent phacoemulsification at least 12 months after trabeculectomy. Data were collected for two groups of patients. Group 1 (22 patients) received 5-FU at the end of successful phacoemulsification, whereas group 2 (25 patients) did not receive it. The two groups were comparable with respect to age, gender, intraocular pressure (IOP), type of glaucoma, number of adverse risk factors present, and duration of follow-up. Any worsening of IOP control was analysed using mean IOP and mean change in the treatment for glaucoma. RESULTS: Mean IOP was comparable in the two groups, but there was a significant difference in mean change in glaucoma treatment between the two groups at 12 months postoperatively. Worsening of IOP control was seen in 13.6% of the patients in group 1 and in 36.4% in group 2 (P-value=0.03). CONCLUSION: Our study suggests that 5-FU has a protective effect on the functioning bleb and may be used routinely at the end of phacoemulsification in such cases.

Aged↗

PubMed2006

The -174G/C interleukin-6 promoter polymorphism influences the development of macular oedema following uncomplicated phacoemulsification surgery.

AIM: To determine whether the functional -174 G/C interleukin-6 gene polymorphism is a risk factor for the development of cystoid macular oedema (CMO) following routine uncomplicated phacoemulsification surgery in patients with no established risk factors. METHODS: A total of 40 patients who underwent routine phacoemulsification surgery as part of a randomised controlled trial comparing the use of postoperative steroid drops against a single sub-tenon injection of triamcinolone were genotyped for the IL-6 -174G/C polymorphism. All patients underwent fluorescein angiography at 30 days and anterior chamber flare measurements pre-operatively and at day 1, 7, and 30. RESULTS: Angiographic CMO developed in 14 patients of the 40 studied. 9 out of the 14 patients carried the GG genotype (Fisher's exact test P=0.05, Hazard ratio for GG genotype; 4.05 (1.02-16.00)). There was no difference in flare measurements between the GG and Non-GG (GC/CC) group. The two groups were otherwise well matched in terms of age, sex, phacoemulsification energy used intraoperatively, and proportion of patients receiving postoperative triamcinolone or steroid drops. CONCLUSION: The -174G/C interleukin-6 promoter gene variant appears to modulate the response to phacoemulsification surgery and to influence the development of postoperative CMO. These data suggest a genetic predisposition to this complication.

Aged↗

PubMed2000

Topical anaesthesia for phacoemulsification surgery.

AIM: To assess the discomfort experienced by patients undergoing phacoemulsification under topical anaesthesia. METHODS: Thirty patients had a collagen contact lens, soaked in 4% lignocaine, placed on the cornea 23-89 min preoperatively. Immediately preoperatively, additional ophthetic drops were inserted. The patients underwent phacoemulsification surgery with the insertion of a foldable intraocular lens. This group was compared with 30 age- and sex-matched controls who underwent phacoemulsification and the insertion of a non-foldable lens under peribulbar anaesthesia. (8 mL of an 80:20 mix of 0.5% bupivacaine, 4% lignocaine and hyaluronidase). The pain perceived by patients was assessed on a verbal analogue scale (0-10) at administration of anaesthesia, perioperatively and 3-6 h postoperatively. RESULTS: Topical anaesthesia was less painful than peribulbar anaesthetic at administration (difference in mean pain score 1.2, P < 0.05, Wilcoxon paired signed rank test). Patients experienced more pain during the operation under topical anaesthesia (difference in means 0.63, P < 0.05). There was no difference between the groups postoperatively. CONCLUSION: Topical anaesthesia does not carry the risk of injection into, or injury of, the many delicate structures of the orbit. Because it provides acceptable levels of anaesthesia for phacoemulsification, it could be used more frequently.

Aged↗

PubMed2001

Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation.

PURPOSE: To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities. METHODS: This retrospective study consisted of 113 eyes of 109 patients with various vitreoretinal abnormalities and visually significant cataract. Vitreoretinal surgery was combined with clear corneal phacoemulsification and intraocular mplantation. RESULTS: The combined surgery resulted in minimal complications, and postoperative visual acuity was improved in 83 eyes (71.6%). Visual acuity was improved by two or more lines in 26 eyes (66.6%) with proliferative diabetic retinopathy, 22 eyes (73%) with proliferative vitreoretinopathy, eight eyes (30.7%) with macular abnormalities, four eyes (55.5%) with trauma and two eyes (40%) with retinal vein occlusion. CONCLUSIONS: The combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation was safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Combined surgery is recommended for all patients having simultaneous vitreoretinal pathological changes and cataract. The addition of phacoemulsification does not prolong vitreoretinal operative time notably nor increase the risk of intraoperative and postoperative complications significantly

Adult↗

PubMed2000

[Blood-aqueous barrier after phacoemulsification with posterior chamber lens implantation; foldable acrylate lens vs PMMA lens-- a clinical study on 46 eyes].

BACKGROUND: Cataract surgery leads to a more or less pronounced postoperative inflammation due to breakdown of the blood-aqueous barrier. This alteration of the blood-aqueous barrier can be reduced by minimally invasive surgery. The purpose of this study was to quantify the early course of the postoperative alteration of the blood-aqueous barrier following phacoemulsification with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. PATIENTS AND METHODS: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous intraocular surgeries were divided into two groups: group 1 (24 patients): phacoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneoscleral tunnel incision); group 2 (22 patients): phacoemulsification with foldable acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardized. Alteration of the blood-aqueous barrier was quantified by the laser flare-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. RESULTS: Preoperative aqueous flare values (photon counts/ms) were comparable in both groups (6.7 +/- 2.7 versus 5.6 +/- 2.7 respectively, p = 0.1). On day 1, aqueous flare in group 1 (9.7 +/- 2.9) was not statistically significantly higher than in group 2 (9.2 +/- 2.2, p = 0.2) and remained relatively constant on day 2 after surgery (9.3 +/- 3.3), whereas the aqueous flare values in group 2 decreased statistically significant (6.7 +/- 2.3, p = 0.01). Postoperatively, there was no statistically significant difference of aqueous flare values between eyes with corneoscleral tunnel incision and eyes with clear corneal incision (p = 0.7) in group 2. CONCLUSIONS: Our study shows that phacoemulsification with foldable IOL implantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especially with preexisting alteration of the blood-aqueous-barrier.

Acrylates↗

PubMedDate not supplied

Phacoemulsification and thermal wound injury.

The technique of lens nucleus phacoemulsification has revolutionized cataract surgery. However, the production of ultrasound energy is associated with heat generation that can result in damage to ocular tissue, in particular the corneoscleral wound site. Thermal damage to the corneoscleral wound site may result in difficulty with wound closure and consequent risk of wound leakage, as well as damage to the adjacent corneal stroma and endothelium, fistula formation, and the induction of high degrees of post-operative astigmatism. The loss of adequate flow of irrigation fluid around the phacoemulsification tip is the key factor in the development of phacoemulsification-induced thermal injury. Use of excessive ultrasound power and production of excessive frictional forces generated by contact of the vibrating phacoemulsification needle with the irrigation sleeve are also factors involved. In the event of a "phacoburn," a specialized "gape suture" may help minimize surgically-induced astigmatism. The degree of induced astigmatism tends to wane over time; astigmatic keratotomy is an option in the setting of high degrees of residual astigmatism.

Cornea↗

PubMed2000

Prospective evaluation of deep topical fornix nerve block versus peribulbar nerve block in patients undergoing cataract surgery using phacoemulsification.

We compared the efficacy of deep topical fornix nerve block anaesthesia (DTFNBA) versus peribulbar nerve block in patients undergoing cataract surgery using phacoemulsification. We studied 120 patients, allocated randomly to two groups. Group 1 (n = 60) received peribulbar block with 5 ml of a 1:1 mixture of 0.5% plain bupivacaine and 2% lidocaine supplemented with hyaluronidase 300 i.u. ml-1. Group 2 received DTFNBA with placement of a sponge soaked with 0.5% bupivacaine deep into the conjunctival fornices for 15 min. No sedation was given to either group. Analgesia was assessed by the reaction to insertion of the superior rectus suture and by questioning during the procedure. A three-point scoring system was used (no pain = 0, discomfort = 1, pain = 2). Scoring was repeated at keratotomy, hydrodissection and hydrodelineation, phacoemulsification, irrigation and aspiration, and at intraocular lens insertion. If the patient's pain score was 0 or 1, no further action was taken. If the pain score at any stage of the operation was 2, intracameral injection of 1% preservative-free lidocaine was given. One patient in Group 2 needed intracameral lidocaine at the stage of phacoemulsification (P > 0.05) and four experienced discomfort at irrigation and aspiration (P = 0.043). We conclude that DTFNBA may be a useful needle-free anaesthetic technique in patients undergoing cataract surgery using phacoemulsification.

Administration, Topical↗

PubMed2002

Phacoemulsification with intraocular lens implantation after trabeculectomy.

PURPOSE: To determine the effect of phacoemulsification with intraocular lens (IOL) implantation, using a superior clear-corneal incision, on the long-term intraocular pressure (IOP) control in patients who have undergone previous trabeculectomy. METHODS: Twenty-eight consecutive patients who underwent phacoemulsification with IOL implantation (phaco group) at least 3 months after trabeculectomy were identified and matched to 28 patients who underwent trabeculectomy only (trabeculectomy-only group) with respect to age, gender, IOP, and duration of follow-up. The mean IOP was compared 1 and 2 years after phacoemulsification, and the surgical success rate in each group was determined by Kaplan-Meier survival analysis. RESULTS: The mean IOP 1 year after cataract surgery was significantly higher ( = 0.025) in the phaco group (15.6 +/- 3.5 mm Hg) than in the trabeculectomy-only group (13.4 +/- 2.5 mm Hg), but at 2 years the difference was not statistically significant (15.3 +/- 3.1 mm Hg in the phaco group compared with 14.3 +/- 3.2 mm Hg in the trabeculectomy-only group; = 0.35). Two years after surgery, 5 of 28 patients in the phaco group and 1 of 28 patients in the trabeculectomy-only group had commenced or were using additional topical medication ( = 0.089). If the introduction of glaucoma medication was considered a "failure," then the IOP control was significantly better in the trabeculectomy-only group using two different criteria for surgical failure. CONCLUSION: Although phacoemulsification and IOL implantation through a superior clear-corneal incision have little effect on mean IOP in a group of patients who have undergone previous trabeculectomy, this procedure may jeopardize the long-term IOP control in individual patients.

Aged↗

PubMed2006

Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients.

PURPOSE: This study evaluates the change in intraocular pressure (IOP) and glaucoma medication requirements after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients at 3 years and last follow-up (mean 5 y). PATIENTS AND METHODS: This study represents a retrospective analysis of patients who had clear corneal phacoemulsification and at least 3 years of follow-up. The patients were classified into 3 groups: glaucoma (G), glaucoma suspects (GS), and no glaucoma (NG). No patient had a history of previous intraocular surgery. Single factor analysis of variance, Fisher exact tests, 2-tailed paired Student t tests and Kaplan-Meier analysis were applied. RESULTS: Forty-eight patients (55 eyes) in the glaucoma group, 41 patients (44 eyes) in the GS group, and 59 patients (59 eyes) in the NG group met the above criteria. At 3 years follow-up IOP was significantly decreased in all groups; (G) group decreased 1.4+/-3.3 mm Hg (P = 0.0025), GS 1.4+/-4.2 mm Hg (P = 0.004), and NG 1.7+/-3.1 mm Hg (P = 0.0005). At the final follow-up visit (mean near 5 y for all groups) the IOP was significantly decreased in all groups, (G) group 1.8+/-3.5 mm Hg (P = 0.005), GS 1.3+/-3.7 mm Hg (P = 0.025), and NG 1.5+/-2.5 mm Hg (P < 0.0001). The number of preoperative and postoperative glaucoma medications in the (G) group did not show any significant change at 3 and 5 years (P = 0.36, P = 0.87). Kaplan-Meier analysis shows that at 3 years, 85% of the (G) group, 81% of GS, and 90% of the NG had IOPs less than or equal to their preoperative IOP, with the same number of glaucoma medications or less. At 5 years the percentages were 76%, 79%, and 85%, respectively. CONCLUSIONS: This study demonstrates that cataract removal by clear cornea phacoemulsification in glaucoma patients, glaucoma suspects, and normal patients results in a small but significant decrease in IOP that is sustained at 3 years and a mean of 5 years in all groups. This study does not imply that cataract removal by phacoemulsification is a substitute for a combined procedure but may be an appropriate procedure for certain patients based on medication requirements and extent of optic nerve damage.

Aged↗

PubMed1997

Phacoemulsification trabeculectomy compared to other methods of combined cataract and glaucoma surgery.

PURPOSE: To compare three methods of combined cataract extraction and glaucoma surgery. METHODS: Retrospective review of 35 eyes of patients who had extracapsular cataract extraction and trabeculectomy using a corneoscleral incision (SAME), 54 eyes undergoing extracapsular cataract extraction and trabeculectomy using a separated corneal incision for cataract extraction and 43 eyes undergoing phacoemulsification and trabeculectomy. RESULTS: Ninety-one percent of the eyes in the SAME group, 85% of the SEPARATE group and 97% of the phacoemulsification and trabeculectomy group had an IOP < 22 mmHg at 6 months with or without medication (NS). Postoperative visual acuity and astigmatism were not significantly different between the groups. The number of eyes requiring YAG laser capsulotomy was significantly greater in the extracapsular cataract extraction and trabeculectomy (same and separated incision) as compared to the phacoemulsification and trabeculectomy group (P < 0.001). CONCLUSION: Phacoemulsification and trabeculectomy was not significantly more successful than the other methods of combined surgery. Although complication rates were similar, visual rehabilitation was faster and there was a reduced incidence of early posterior capsule opacification.

Aged↗

PubMed2006

Validation of two scoring systems for the prediction of posterior capsule rupture during phacoemulsification surgery.

AIM: To attempt to validate two scoring systems for the prediction of intraoperative complication during phacoemulsification surgery. METHODS: The study population was patients attending Sunderland Eye Infirmary who underwent phacoemulsification surgery between 1 January 2001 and 31 December 2003. The authors applied each scoring system to a control group of 300 patients from this study population and extrapolated the results to give an estimate of the spread of scores for the entire population. They then applied the same scoring systems to all complicated cases from the same study population. Using these results they were able to calculate the risk of a complication for a particular score on each scoring system. CONCLUSION: The application of these systems in clinical practice would allow appropriate selection of phacoemulsification cases for trainee surgeons, more accurate consent from patients for their phacoemulsification surgery, and the unbiased comparison of surgical outcomes from surgeons with differing case mix difficulties.

Aged↗

PubMed1997

Relation between postoperative blood-aqueous barrier damage and LOCS III cataract gradings following routine phacoemulsification surgery.

AIM: To examine the relation between cataract density, the phacoemulsification energy required for its removal, and blood-aqueous barrier (BAB) damage on the first day after surgery. METHODS: A prospective study recruiting patients with normal eyes apart from senile cataract. Preoperatively, visual acuity, anterior chamber laser flare, and cell values were measured using the Kowa laser flare meter, and the LOCS III grading of the cataract defined. The patients all underwent standardised phacoemulsification surgery through a superior scleral tunnel incision, with confirmed in the bag placement of a one piece PMMA IOL; all surgical complications were excluded. The phaco power delivered was recorded as the cumulative delivered energy, CDE. On day 1 visual acuity and laser flare and cell readings were taken. RESULTS: 101 patients were recruited and all completed the protocol. Older patients had a higher preoperative flare value (p = 0.003); preoperative cell values were significantly related to nuclear opacity (p = 0.021) and colour (p = 0.011). Postoperative flare was related to preoperative flare (p = 0.001) and nuclear colour (p = 0.038). CDE was related to nuclear colour (p = 0.031) and opacity (p = 0.022), but not to aqueous flare. CONCLUSIONS: Damage to BAB after routine phacoemulsification surgery is predicted by the preoperative flare values and the density of the cataract nucleus. The amount of phacoemulsification energy required to remove a cataractous lens is related to the density of the cataract but affects postoperative flare to a minimal degree. Other factors such as surgical technique are probably more important. Laser photometry is a useful tool for objectively assessing surgical technique.

Blood-Aqueous Barrier↗

PubMed2002

Immediately sequential phacoemulsification performed under topical anaesthesia as day case procedures.

AIMS: To evaluate the visual outcome, safety, and economic benefits of immediately sequential phacoemulsification performed under topical anaesthesia as a day case procedure. METHODS: Immediately sequential phacoemulsification under topical anaesthesia was performed as a day case procedure on 218 eyes of 109 patients over 21 months by a single senior surgeon using intracameral antibiotics. Case notes were retrospectively analysed. RESULTS: The final best corrected visual acuity (BCVA) was 6/9 or better in 86% of eyes with 47% achieving 6/6 or better. The incidence of intraoperative complications was 0.45%. Postoperative complications occurred in 13.8% of eyes and included refractive error >1.00D from refractive aim (6.9%). Bilateral complications occurred in 5.5% of the patients. There were no cases of endophthalmitis. The mean time from surgery to discharge was 24 days. CONCLUSION: Immediately sequential phacoemulsification under topical anaesthesia performed as a day case procedure is not associated with an increased number of complications when compared to unilateral phacoemulsification. Under strict surgical protocol with the use of intracameral antibiotics and performed by an experienced surgeon with a good track record this procedure is safe.

Aged↗

PubMed2003

Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts.

AIM: To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS: 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS: Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS: A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.

Aged↗

PubMedDate not supplied

Management of retained intravitreal lens fragments after phacoemulsification surgery.

PURPOSE: To evaluate the clinical features of eyes with retained intravitreal lens fragments after phacoemulsification surgery and to assess the guidelines of management and the visual outcome after vitrectomy. METHODS: Twenty-five consecutive patients referred to our institute for retained intravitreal lens fragments after phacoemulsification cataract surgery were evaluated retrospectively over a 7-year period. RESULTS: The clinical features of retained lens fragments included deceased visual acuity of 6/60 or worse (68%), uveitis (60%), glaucoma (48%), corneal edema (44%) and retinal detachment in 2 patients (8%). There were 24 patients who underwent pars plana vitrectomy; 1 patient was managed with medical therapy. After vitrectomy, 17 eyes (71%) showed visual improvement, and final visual acuity was 6/12 or better in 13 eyes (54%). The causes of poor final visual outcome of 6/60 or worse included retinal detachment and cystoid macular edema. The time interval between vitrectomy and phacoemulsification was within 4 weeks in 17 patients (71%), ranging from on the same day to 97 days. There was only a trend of better visual outcome in early vitrectomy patients (within 1 week). There was no statistical difference between the initial intraocular lens status and final visual acuity. CONCLUSION: Vitectomy with removal of retained intravitreal lens fragments is beneficial for patients with persistent uveitis and glaucoma after phacoemulsification. In the majority of patients, visual improvement was achieved after vitrectomy. However, poor visual outcome may occur secondary to retinal detachment and cystoid macular edema.

Aged↗

PubMed2003

Ultrasound activates the TM ELAM-1/IL-1/NF-kappaB response: a potential mechanism for intraocular pressure reduction after phacoemulsification.

PURPOSE: Elevated intraocular pressure (IOP), the major causal risk factor for glaucoma, often decreases after cataract removal by phacoemulsification ultrasound. In this study, the hypothesis that ultrasound energy propagated through a fluid medium induces a stress response with the potential to lower IOP was investigated. METHODS: Normal and glaucomatous trabecular meshwork (TM) cell culture lines were initiated from tissue isolated from human cadaveric eyes or trabeculectomy specimens. Cultured cells were treated for 60 seconds with a phacoemulsification ultrasound probe set to a power of 70%. Activation of the TM cell-specific stress response was assayed by enzyme-linked immunosorbent assay (ELISA) and immunolocalization. RESULTS: Normal TM cell cultures did not release detectable levels of the stress response protein, IL-1alpha, into their culture medium. In contrast, IL-1alpha was easily detected after treatment with ultrasound energy. Consistent with earlier findings, glaucomatous TM cells produced IL-1alpha constitutively, and the level of expression was increased after treatment with phacoemulsification ultrasound. As was previously demonstrated, the stress-regulated transcription factor NF-kappaB was present in the cytoplasm of normal cells, but in the nucleus of glaucomatous cells. After treatment with ultrasound energy, NF-kappaB translocated to the nucleus in the normal cells. Endothelial leukocyte-adhesion molecule (ELAM)-1 was not detected in normal TM cells, but was constitutively present on glaucomatous TM cells, consistent with findings in previous work. ELAM-1 expression was induced in normal cells by ultrasound treatment. CONCLUSIONS: A potentially IOP-lowering stress response is induced in TM cells by ultrasound. The findings suggest that this response may be induced clinically during cataract removal by phacoemulsification, and may be one mechanism responsible for the reduction in IOP that often follows this procedure.

Cells, Cultured↗