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PubMedDate not supplied

[Fluorescent angiographic evaluation of the iris microcirculation in cataract extraction by Nd:YAG laser with wavelength of 1.44 mcm].

The purpose of the present study is to evaluate the iridial microcirculation by fluorescent iridial angiography after laser cataract extraction by using a new extraction device, i.e. "RAKOT", based on the Nd:YAG-laser with wave length of 1.44 mcm. 25 eyes (21 patients) aged 71 to 87 with mature senile cataract were examined. The method of laser cataract extraction was used in 14 cases. These eyes made up the main examination group. As for the controls (11 eyes), the manual technic of cataract extraction was used for them. The results in the main group show that the degree of the response of the iridial microvessels to surgery is insignificant and the microcirculation restores completely in 1.5-2 months after surgery provided there are no initial pathological changes in the iridial microcirculation (3 eyes). A short-time intensification of permeability of the iridial microcirculation is possible in eyes with a pronounced initial pathology in the iris (11 cases), however it restores to the original level during 3-3.5 months after surgery. The iridial microcirculation restores in the controls during 3 months after surgery. The described data demonstrate that the laser cataract extraction does not lead to pronounced iridial vascular disorders. A comparison with the controls is indicative of a lower trauma in case of laser method versus the manual technic of lens extraction.

Age Factors↗
PubMed1998

Contrast sensitivity after extracapsular and intracapsular cataract extraction.

Contrast sensitivity function after cataract extraction and intraocular lens implantation has been mainly correlated to the type or the material of the intraocular lens. Our purpose was to identify other possible factors, like posterior capsule, to contrast sensitivity alterations after cataract surgery, comparing patients operated for cataract by techniques that mainly differed on the posterior capsule's integrity. The intraocular lens implanted was either a posterior or an anterior chamber one, always monofocal and made of PMMA. We measured contrast sensitivity function at four spatial frequencies in two groups of operated individuals (group A and B) and in one group of healthy control individuals. Each group consisted of 42 eyes. Group A comprised eyes with intact, clear posterior capsule and posterior chamber monofocal intraocular lens. Group B comprised eyes with ruptured or removed posterior capsule and anterior chamber monofocal intraocular lens. Control group comprised healthy control eyes. A pair matched design was used to compare contrast sensitivity values among the individuals of the three groups. No statistically significant differences in contrast sensitivity values were found when group B patients were compared to healthy controls (p >0.05). Patients of group A exhibited contrast sensitivity function impairment at intermediate and high spatial frequencies when compared to patients of group B (p <0.05) and to controls (p <0.01). It seems that intact posterior capsule provides inferior visual function, in spite of relatively good visual acuity and apparently satisfactory results.

Aged↗
PubMed1996

Anterior intraocular lens dislocation after combined cataract extraction trabeculectomy.

PURPOSE: To evaluate the incidence, cause, and effect of intraocular lens (IOL) dislocation after combined cataract extraction and trabeculectomy. SETTING: An ophthalmic ambulatory surgery center in Lynwood, California. METHODS: This retrospective study comprised 150 patients with open-angle glaucoma who had either planned extracapsular cataract extraction (ECCE) (n = 96) or phacoemulsification (n = 54) combined with IOL implantation and trabeculectomy. I reviewed type of cataract extraction, preoperative glaucoma medications, axial length, and amount of filtration achieved postoperatively. RESULTS: The lens dislocated in 20 eyes (13.3%), with the highest incidence after planned ECCE (18.7%) and the lowest after phacoemulsification with capsulorhexis (3.7%). Eighteen of 30 eyes (60%) that had excessive filtration also had IOL dislocation. Mean induced postoperative myopia in eyes with lens dislocation was-2.25 diopters (D) +/- 0.55 (SD). CONCLUSIONS: Anterior IOL dislocation was related to increased postoperative filtration and was more common after planned ECCE. In all cases, it caused a distorted pupil, posterior synechias, and induced myopia of over -1.00 D.

Anterior Chamber↗
PubMedDate not supplied

Risk factors of massive suprachoroidal hemorrhage during extracapsular cataract extraction surgery.

PURPOSE: To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery. METHODS: The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test. RESULTS: The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction. CONCLUSIONS: Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.

Adult↗
PubMed1990

[4 mm incision for cataract extraction: a report of 728 eyes].

The author analyzed 728 cataract extractions performed through 4 mm incisions during January 1972 to January 1987. 230 of the operations were done by phaco-emulsification, 320 by lensectomy, and 178 by aspiration. 580 of the eyes were followed up 1-15 years, when 87.8% of the eyes had corrected vision of 0.06 or over, and 48.8% of 0.6 or over. The technical aspect of cataract extraction through a small incision was evaluated and corneal astigmatism thereof discussed.

Adolescent↗
PubMed2004

A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trial.

BACKGROUND: Extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PC IOL) is the preferred method of cataract surgery in developed countries. However, intracapsular cataract extraction (ICCE) with an anterior chamber lens (AC IOL) may be appropriate in rural Africa. A randomised controlled trial was carried out to compare these surgical strategies. METHODS: Participants over 50 years requiring bilateral cataract surgery were recruited from outreach clinics in rural north and east Uganda. One eye was randomly allocated to AC IOL or PC IOL, the other eye being allocated to the second strategy. The main outcome measure was WHO distance visual acuity (VA) category after a minimum of 1 year. Secondary outcomes were numbers and causes of complications and refractive corrections. RESULTS: Of the 110 participants recruited, 98 (89%) were assessed at least 1 year after the operation (median follow up 17.5 months). Nine eyes randomised to PC IOL were converted to AC IOL; one eye randomised to AC IOL inadvertently received PC IOL. There was no difference in VA between 95 pairs of eyes for which data for both eyes were available (uncorrected VA, p = 0.26; corrected VA, p = 0.59). 80 (82%, 95% CI 73 to 89) and 82 (84%, 95% CI 75 to 90) eyes randomised to AC IOL and PC IOL respectively had corrected VA of 6/18 or better. 16 (16%, 95% CI 10 to 25) and eight (8%, 95% CI 4 to 15) eyes respectively had secondary procedures or other complications. CONCLUSIONS: Where both strategies are available, ECCE with PC IOL should be first choice because of fewer complications. Where ECCE with PC IOL is not immediately feasible, ICCE with AC IOL is an acceptable interim technique.

Aged↗
PubMed2000

An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation.

PURPOSE: The benefits of sutureless cataract surgery have not been available to the majority of developing world patients. This report describes a surgical technique developed to gain the benefits of self-sealing sutureless techniques, without the need for costly, complex instrumentation, expensive consumables, or difficult nucleus fragmentation manoeuvres in the anterior chamber. METHOD: A detailed description of a sutureless technique that uses only standard manual extracapsular cataract extraction instrumentation is presented. The clinical records of 362 consecutive completed sutureless surgeries were reviewed, and preliminary indicative data of visual outcome for those having follow up between postoperative weeks 3 and 8 are also presented. RESULTS: Hospital and eye camp experience confirms this operation offers speed, routinely 5 min or less with mature cataracts, reduced cost because no suture, viscoelastic or anterior chamber maintainer is needed, wound security and stability, and rapid effective visual rehabilitation. Uncorrected distance visual acuity during the third to eighth postoperative week was available for 266 of the 362 patients (73%): 10, 145, 101, and 10 had acuities of better than 6/9, 6/9-6/18, 6/24-6/60, and worse than 6/60, respectively. Ninety-seven, 165, 12, and two of the 276 (76%) patients with recorded corrected distance acuity were in the same groups. Comparing postoperative with preoperative corneal astigmatism for each patient with postoperative information available (208), without regard to axis, the amplitude of astigmatism worsened by a mean of 0.94 dioptres (+/- 0.17, 95% confidence; +/- 1.23 standard deviation; 7.5D maximum worsening; 2.5D maximum improvement). No attempt has been made to analyse complication type or frequency in this preliminary report. CONCLUSION: The authors believe this sutureless cataract extraction technique to be an innovation with widespread application in the developing world. Further and more exhaustive critical appraisal is warranted.

Cataract Extraction↗
PubMed1989

[Early ocular hypertension after cataract extraction].

The intraocular pressure (IOP) course during the first postoperative month was measured with Goldmann applanation tonometry in 93 eyes. The patients include 30 eyes of intracapsular cataract extraction (ICCE), 32 eyes of extracapsular cataract extraction (ECCE) and 31 eyes of ECCE combined with posterior chamber intraocular lens (PC-IOL) implantation. The preoperative average IOP was 13.30 +/- 3.24 mmHg in 93 eyes. The first day after cataract extraction was 25.33 +/- 8.18 mmHg and 59 eyes (63.44%) had an IOP higher than 23 mmHg. On the second day it was 16.03 +/- 7.54 mmHg. On the third day it was 14.69 +/- 5.45 mmHg. On the seventh day it was 13.32 +/- 3.44 mmHg and only 2 eyes (2.14%) IOP was higher than 23 mmHg. The first postoperative month average IOP was 12.93 +/- 1.31 mmHg and it was above 23 mmHg in only one eye. When compared with preoperation a significant increase in IOP was found postoperatively. But on the seventh day and after the first month there was no significant difference (P greater than 0.05). The IOP rise among ICCE group, ECCE group and PC-IOL group did not differ significantly.

Adult↗
PubMed1988

Treatment of phacolytic glaucoma with extracapsular cataract extraction.

The treatment of choice for phacolytic glaucoma has been intracapsular cataract extraction (ICCE). The current study was undertaken to determine the efficacy of extracapsular cataract extraction (ECCE) as a definitive treatment for phacolytic glaucoma. Five cases of phacolytic glaucoma that occurred between 1984 and 1986 were studied after a retrospective chart review; ECCE (with placement of a posterior chamber intraocular lens [PC IOL]) was performed without complication and was curative in all five eyes. All patients (100%) maintained intraocular pressures (IOPs) of less than 20 mmHg, without medical therapy. The best-corrected visual acuity for all cases was 20/50 or better (80%, greater than or equal to 20/40) with 5 months to 3 years follow-up. These results suggest that ECCE is an effective alternative for the treatment of phacolytic glaucoma and allows surgeons the freedom to choose the procedure with which they are most comfortable. Additionally, implantation of a PC IOL is a safe and efficacious procedure in restoring visual function in these patients.

Aged↗
PubMed1995

Indications and efficacy of combined trabeculectomy and extracapsular cataract extraction with intraocular lens implantation in cataract patients with coexisting open angle glaucoma.

In an observational study 19 eyes with cataract and coexisting primary open angle glaucoma were scheduled to undergo combined procedure with ECCE-IOL and trabeculectomy. The aim of the present study was to investigate the results and the efficacy of combined surgery, when we extended the indication for surgery. Thus the surgical decision making was not based solely upon IOP readings, but also involved social/psychological factors. Median decrease in IOP (IOPpost-IOPpre) was significant through a 12-month observation period, p < 0.001. The number of medications dropped from 1.74 to 0.21, p < 0.01. Complication rate during operation and in the postoperative follow-up period was low. We conclude that it seems justified to extend the indication for combined surgery in cataract patients with coexisting open angle glaucoma in case of uncontrolled IOP, poor compliance, inability of sufficient medical care, or unacceptable medication. We recommend careful monitoring of the early postoperative IOP, even if hypotensive agents are given prophylactically.

Aged↗
PubMed1991

Uncontrolled primary angle closure glaucoma: results of early intercapsular cataract extraction and posterior chamber lens implantation.

In this study we retrospectively evaluated the effect of intercapsular or extracapsular cataract extraction and posterior chamber lens implantation in 67 eyes of 57 patients with different types of primary angle closure glaucoma (PACG) in combination with cataract. We subdivided this patient population into three groups, based on the preoperative methods of intraocular pressure (IOP) control. The best results were obtained in patients with acute PACG (55% IOP reduction) and in patients with uncontrolled PACG (44% IOP reduction). In the other PACG groups an IOP reduction of between 20 and 33% was achieved. A long-term postoperative IOP of less than 21 mmHg was established in 63 eyes or 94%. In 91% the glaucoma medication was reduced, 65% of all eyes needed no glaucoma medication postoperatively. We conclude that an intercapsular cataract extraction with PC-IOL implantation should be considered in both controlled and uncontrolled PACG in patients with cataract, instead of filtering surgery or combined procedures. Even in eyes with relatively good visual acuity, cataract extraction might be considered as a means of achieving glaucoma control.

Acute Disease↗
PubMed2001

Upper eyelid ptosis repair after cataract extraction and the importance of Hering's test.

Blepharoptosis is a well-documented complication of cataract extraction and other ocular procedures. Few authors have described the surgical findings and outcomes of postcataract blepharoptosis repair. The authors present a review of the causes of postcataract blepharoptosis with emphasis on both clinical findings and recommendations for treatment on the basis of their experience with 13 eyelids in eight patients over the past 10 years. They found that all patients had either partial or total disinsertion of the levator muscle from the tarsal plate. Of the eight patients in this series, five had bilateral blepharoptosis after bilateral cataract extraction. Although a multifactorial cause for postcataract blepharoptosis is commonly assumed, the authors propose that the mechanical forces of intraoperative traction on the levator aponeurosis during cataract surgery are the primary cause. This is further supported by their operative findings in the five patients who developed bilateral ptosis after bilateral cataract extraction. All eyelids in this series were repaired by levator muscle advancement and attachment to the tarsal plate with favorable outcomes and no recurrences during a 1-year follow-up. The importance of Hering's phenomenon of equal innervation is also discussed as it applies to bilateral and to apparent unilateral blepharoptosis. The authors propose "Hering's test" as an important indicative study in the preoperative evaluation of all patients with eyelid ptosis.

Aged↗