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Results for “Aphakia, Postcataract”

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PubMed1984

Long-term follow-up of Nd:YAG laser posterior capsulotomy.

A Nd:YAG laser developed for ophthalmic surgery was studied for safety and efficacy in secondary discission of the posterior capsule in aphakic and pseudophakic subjects. The study involves 6,800 subjects, 526 of whom had completed the six-month postoperative course by the time the data base was closed for analysis. Of the 526 subjects who were treated with the laser, 87.8% had improved vision, with 82.9% achieving a visual acuity of 20/40 or better. This result compares favorably with results for the surgically treated population in which only 68.4% experienced improved vision, with 80.2% achieving a visual acuity of 20/40 or better. Approximately four times more surgically treated subjects than laser-treated subjects experienced diminished vision (14.8%). Cumulative complication rates in the laser-treated population were very low (CME 2.3%, secondary glaucoma 3.6%, retinal detachment 0.4%, overall rate 4.8%). Persistent complications (present at the six-month postoperative period) were present at an overall incidence of 2.3%, comprised primarily of CME, 0.2%, retinal detachment, 0.2%, and secondary glaucoma, 0.8%. Only 5.7% of subjects experienced an intraocular pressure (IOP) rise to 30 mm Hg or greater. Return to the preoperative IOP level occurred in 89% of subjects in the first 24 hours to one week. Predictors of IOP rise to 30 mm Hg or greater were determined to be preoperative glaucoma and/or preoperative IOP of greater than 20 mm Hg.

Aged↗
PubMed2000

Bilateral intraocular lens implantation in the pediatric population.

PURPOSE: To evaluate bilateral intraocular lens (IOL) implantation in children. DESIGN: Retrospective, noncomparative case series PARTICIPANTS: Thirty pediatric patients with bilateral IOL implants at one institution with more than 6 months of followup. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Complications, visual acuity, axial length, and refractive changes were recorded. RESULTS: Thirty patients (60 eyes) had an average followup of 31 months (range, 7-69 months). Average age at implantation was 73 months (range, 12 days-13 years). At last followup, 91% of eyes had vision better than or equal to 20/40. Patients in the youngest age group (<2 years) demonstrated the most rapid refractive and axial length changes, and there were progressively smaller changes in older age groups. Only four patients had acuity differences between eyes of more than one line. CONCLUSIONS: Bilateral IOLs are safe and effective in pediatric aphakia.

Adolescent↗
PubMed2000

Cataract surgery in children with chronic uveitis.

OBJECTIVE: To evaluate the visual outcome of cataract surgery in children's eyes with chronic uveitis and the feasibility of intraocular lens (IOL) implantation in these cases. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seventeen children (20 eyes) with chronic uveitis, dense cataract, and a preoperative visual acuity of 6/120 or less with follow-up of 5 years after the initial cataract surgery. METHODS: In 10 eyes of 10 children (five with juvenile rheumatoid arthritis [JRA] and five with non-JRA-associated uveitis) with uniocular or markedly unequal binocular disease, surgery was carried out through the limbus and a posterior chamber IOL was implanted. In seven children (10 eyes), three with JRA and four with non-JRA-associated disease, a pars plana approach was used, and contact lenses or glasses (for the bilateral cases) were prescribed. RESULTS: The postoperative course and immediate restored visual acuities were similar whether an IOL was implanted or not. One month after the surgery, visual acuity improved in all operated eyes. After monocular surgery, in the younger children, contact lenses were poorly tolerated and their use discontinued. These aphakic eyes remained with low vision, developing strabismus on longer follow-up. Children with JRA-associated uveitis were younger, demonstrated an active intraocular inflammation for an extended period after surgery, and tended to have secondary membranes develop, necessitating a second surgical intervention. Five years after the initial surgery, only two of nine eyes (22%) in the JRA group (one aphakic of a bilaterally affected child and one pseudophakic in a child undergoing cataract surgery in one eye) retained a visual acuity of 6/9 and 6/6, respectively. In the other seven eyes, the visual acuity was 6/60 in one pseudophakic eye and 6/240 or less in six eyes (three aphakic and three pseudophakic). In children with non-JRA-associated uveitis, 6 (four aphakic in two patients bilaterally affected and two pseudophakic) of 11 eyes (54.5%) retained a vision of 6/12 or better. CONCLUSIONS: Cataract surgery in children's eyes with uveitis may be beneficial. IOL implantation seems preferable to correction with contact lenses in young children needing surgery in one eye. In children with JRA-associated uveitis, the final visual results remain guarded because of irreversible amblyopia and a more complicated postoperative course. For these cases, a modified management approach and a better surgical technique are needed.

Adolescent↗
PubMed2002

Diode laser cyclophotocoagulation: role in the management of refractory pediatric glaucomas.

PURPOSE: To report the efficacy and complications of diode laser cyclophotocoagulation (cyclodiode) in the management of refractory pediatric glaucomas. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Pediatric patients with uncontrolled glaucoma. Seventy-seven eyes of 61 patients underwent cyclodiode. Mean age was 7.4 years (range, 0.4-17 years). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), visual acuity, complications. RESULTS: Diagnoses included aphakic glaucoma, congenital glaucoma, juvenile chronic arthritis, aniridia, anterior segment dysgenesis, and Sturge-Weber syndrome. Sixty percent of eyes were aphakic, and 64% had undergone at least one previous surgical procedure for glaucoma. Patients underwent a mean of 2.3 treatment sessions per eye (maximum, 8 sessions). Mean pretreatment IOP was 32.0 mmHg. After one treatment session, 62% had a clinically useful reduction in IOP (<22 mmHg or by 30%), but this had fallen to 37% by 12 months. With repeat cyclodiode, 72% had a clinically useful reduction in IOP for a year or more (mean, 8.4-month interval between treatments). Aphakic eyes had a more sustained IOP reduction (P < 0.01 log rank test). Of treatment failures, 13% had no useful IOP response, and three eyes developed subsequent retinal detachment and loss of vision. No other eyes lost vision because of cyclodiode-related complications. In 5.5% of the treatment sessions there was a significant posttreatment inflammatory episode. Cyclodiode treatment did not enable a reduction in the number of medications. CONCLUSIONS: With repeated treatment, cyclodiode can provide effective control of IOP. However, the success rate is lower than with adults, and younger eyes may recover from treatment more rapidly. Although response may be temporary, cyclodiode has a lower rate of severe adverse effects than surgical modalities and has roles as a temporizing measure, as an adjunct to surgery, or in managing selected patients in whom surgery is undesirable because of a high risk of surgical complications.

Adolescent↗
PubMed2002

Scleral fixation of secondary foldable multifocal intraocular lens implants in children and young adults.

OBJECTIVE: To assess the feasibility of transscleral fixation of a foldable, multifocal intraocular lens (IOL) as an alternative form of optical correction to monofocal IOL implantation in aphakic children and young adults intolerant of contact lenses in the absence of sufficient capsular support. STUDY DESIGN: Prospective, nonrandomized, comparative trial. PARTICIPANTS: Twenty-six eyes of 26 unilateral aphakic patients in the age group 6 to 29 years (mean, 13.2 years) at two university institutions with more than 6 months of follow-up. INTERVENTIONS: Anterior vitrectomy and secondary scleral-fixated foldable IOL implantation were performed in all cases. In 12 patients, a zonal-progressive optic multifocal IOL (Array SA40-N; Allergan, Irvine, CA) was implanted, whereas 14 patients received a monofocal IOL (SI40NB; Allergan). The follow-up ranged from 6 to 20 months (mean, 13.4 months). RESULTS: Preoperative patient demographics, mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity (BCDVA) were similar in the two groups. After surgery, BCDVA within one Snellen line of the preoperative BCDVA was achieved by 83% of the multifocal group and by 85% of the monofocal group. Patients with a multifocal IOL achieved a significantly better uncorrected near visual acuity than patients with monofocal IOL (019 versus 0.34; P = 0.02). With distance correction only, mean near visual acuity was 0.25 versus 0.44 (P = 0.01). Best-corrected near visual acuity was approximately 0.18 for both groups (P = 0.77), with +1.32 diopters (D) for the multifocal group and +2.54 D for the monofocal group (P = 0.001). Spectacle dependency differed significantly between the two groups, with 10 patients (71%) of the monofocal group commonly requiring an additional plus add for near tasks compared with two patients (16%) in the multifocal group (P = 0.001). The Lang test showed stereopsis to be superior in the multifocal group (P = 0.04). Complications encountered were: pressure increase in three eyes (11.5%), which was permanent in one case (3.8%); marked postoperative anterior chamber reaction in four eyes (15.4%); IOL decentration in five eyes (19.2%), one (3.8%) requiring surgical reintervention; and suture erosion through the conjunctiva in two eyes (7.4%). There was no statistically significant difference between the two groups. CONCLUSIONS: Secondary scleral-fixated multifocal IOL implantation was as successful as monofocal IOL implantation in achieving BCDVA comparable with preoperative BCDVA. Moreover, stereopsis, uncorrected and distance-corrected near visual acuities were better in the multifocal patients than in the monofocal eyes. Multifocal IOL seems a viable alternative to monofocal scleral fixation in children and young patients with contact lens-intolerant aphakia.

Adolescent↗
PubMed2003

Contact lenses for the treatment of pediatric cataracts.

OBJECTIVE: To evaluate the experiences, attitudes, and perceptions of the caregivers of children with cataracts who were visually rehabilitated with contact lenses. PARTICIPANTS: One hundred twenty-three caregivers of children <8.1 years old treated for unilateral and bilateral cataracts at one pediatric hospital. DESIGN: Survey by questionnaire. INTERVENTION: Primary caregivers were asked to complete an anonymous questionnaire. MAIN OUTCOME MEASURES: Caregiver responses to questions assessing background and demographic and clinical information, as well as perceptions, attitudes, levels of compliance, and anxiety with respect to treatment, were reviewed. Caregivers were also asked to choose between aphakic rehabilitation with contact lenses, aphakic glasses, or intraocular lenses, given various hypothetical scenarios differing in regard to their final visual prognosis, risks of treatment complications, and cost. RESULTS: The response rate was 82.9%. Absolute average stress levels for contact lens use were 1.36 +/- 1.79 and 0.79 +/- 1.48 (scale, 0-5) for insertion and removal, respectively, compared with 4.03 +/- 1.64 and 2.40 +/- 1.92 for cataract surgery and patching therapy, respectively. Although average paired initial resistance to treatment (RT) levels for contact lens insertion and removal on a scale of 0 to 3 were high (2.09 +/- 1.15) and moderate (1.63 +/- 1.20), respectively, final RT levels were significantly lower (1.09 +/- 1.14 and 0.66 +/- 1.07, respectively; P < 0.0001). The vast majority of caregivers chose contact lens use in hypothetical scenarios that depicted realistic expectations for other forms of aphakic rehabilitation. CONCLUSIONS: In our study, contact lenses seemed to be well tolerated by most patients, as assessed by caregivers. Although initial resistance to contact lens use is high, this decreases with time. Relative to other events in the treatment of pediatric cataracts, contact lens use is not a major stressor for most caregivers and patients. This study supports the notion that contact lenses should continue to receive serious consideration as a treatment option for pediatric cataracts.

Aphakia, Postcataract↗
PubMed2003

Prediction of visual outcome after penetrating keratoplasty for pseudophakic corneal edema.

OBJECTIVE: To evaluate the ability to predict visual outcome after penetrating keratoplasty (PKP) in patients with pseudophakic corneal edema (PCE) or aphakic corneal edema (ACE) based on preoperative parameters available from the patient history and ocular examination. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Forty-eight patients who underwent 59 PKP procedures for PCE between 1997 and 2000 by two cornea specialists. METHODS: Medical records were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. Variables included age, gender, presence of diabetes or cardiovascular disease, method of intraocular lens (IOL) implantation during cataract surgery, vitreous loss during cataract surgery, time between cataract and PKP surgery, and maximal visual acuity reached after cataract surgery. The predictive value of each preoperative variable on post-PKP visual outcome was assessed using both univariate and multiple regression analyses. MAIN OUTCOME MEASURES: Statistical significance for the predictive value of each preoperative variable on post-PKP visual outcome. RESULTS: Best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 13 patients (27%). The strongest predictor of this outcome was implantation of a bag-fixated or sulcus-fixated IOL at the time of cataract surgery (P = 0.007; odds ratio, 15.8; 95% confidence interval, 1.2-208). Less significant variables included BCVA after cataract surgery, time between cataract surgery and PKP, and gender. CONCLUSIONS: In planning and advising patients with pseudophakic or aphakic corneal edema who are candidates for PKP, the method of IOL implantation during the cataract surgery is the single most significant predictor of visual acuity after corneal transplantation. Bag-fixated or sulcus-fixated posterior chamber IOL was associated with a better visual outcome than anterior chamber IOL, scleral-fixated posterior chamber IOL, or aphakia.

Aged↗
PubMed2003

Intraocular lens implantation in the absence of capsular support: a report by the American Academy of Ophthalmology.

OBJECTIVE: This review was conducted to determine the safety and efficacy of open-loop anterior chamber, scleral-sutured posterior chamber, and iris-sutured posterior chamber intraocular lenses (IOLs) in eyes with inadequate capsular support for posterior chamber implantation in the capsular bag or ciliary sulcus. It also attempted to determine whether there is a preferred IOL or fixation site of choice in eyes with inadequate capsular support. METHODS: A literature search conducted for the years 1980 to 2001 yielded 189 citations related to IOL implantation in the absence of capsular support. An update search, conducted in March 2002, yielded an additional 28 articles. The Anterior Segment Panel members reviewed these abstracts and selected 148 articles of possible clinical relevance for review. Of these, 89 were considered sufficiently clinically relevant for the panel methodologist to review and rate according to the strength of evidence. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating was assigned to well-designed cohort and case-control studies; and a level III rating was assigned to case series. Articles comparing the safety and efficacy of the IOL type and fixation site were further evaluated for the quality of the statistical methods used in the study. Studies with a rating of A or B were considered acceptable, C was borderline, and D and F were considered unacceptable as medical evidence. RESULTS: Forty-three articles with data concerning outcome of IOL insertion in eyes with inadequate capsular support had an evidence rating of level III or higher and were used in the final review of the safety and efficacy of one or more lens types and/or fixation sites. Seven articles had data about more than one lens type. Six had a statistical method rating of C or higher and were used to evaluate differences in visual outcomes and complication rates between lens types and fixation sites. CONCLUSIONS: The literature supports the safe and effective use of open-loop anterior chamber, scleral-sutured posterior chamber, and iris-sutured posterior chamber IOLs for the correction of aphakia in eyes without adequate capsular support for placement of a posterior chamber lens in the capsular bag or ciliary sulcus. At this time, there is insufficient evidence to demonstrate the superiority of one lens type or fixation site. Precise determination of small differences in visual outcome or complication rates will require a large prospective, randomized clinical trial.

Anterior Chamber↗
PubMed2003

Long-term outcomes of combined penetrating keratoplasty with iris-sutured intraocular lens implantation.

PURPOSE: To evaluate the long-term outcomes of combined penetrating keratoplasty with iris-sutured posterior chamber intraocular lens implantation. PARTICIPANTS: Patients (264 eyes) with aphakic and pseudophakic bullous keratopathy. DESIGN: Retrospective case series. INTERVENTION: Penetrating keratoplasty combined with implantation of an iris-sutured posterior chamber intraocular lens performed by a single surgeon. METHODS: Data were gathered from the institutional database during a period of 10 years (1989-1999) and analyzed using customized software. MAIN OUTCOME MEASURES: Graft survival rate, visual acuity, and intraoperative and postoperative complications. RESULTS: Two-hundred fifty-two consecutive patients (264 eyes) were operated. Graft survival rates were 95% at 1 year, 89% at 2 years, and 81% at 5 years and were comparable to the results of previous corneal transplant studies. Among 180 patients (191 eyes) with a follow-up of at least 2 years (range, 2-11 years; mean, 5 years), the visual acuity at final follow-up visit, compared with preoperative visual acuity was improved in 72% of eyes (mean preoperative visual acuity, 20/250; mean postoperative visual acuity, 20/60). No intraoperative complications were encountered. CONCLUSIONS: Combined penetrating keratoplasty with iris-sutured posterior chamber intraocular lens implantation offers significant vision benefits in this patient group.

Adolescent↗
PubMed1978

Juvenile rhegmatogenous retinal detachment.

Between Jan 1, 1966, and June 30, 1974, 179 children, birth through 16 years of age with rhegmatogenous retinal detachments, underwent scleralbuckling procedures at Wills Eye Hospital. The detachments were associated most frequently with trauma (44%), myopia (15%), aphakia (10%), and retinopathy of prematurity (8%). Successful reattachment was achieved in 80% of the cases. Vision of 20/100 or better was present in 22% preoperatively and 58% postoperatively.

Adolescent↗
PubMed1978

Survey on the use of intraocular lenses.

A birth of interest in lens implantation occurred especially in the United states in 1974. This coincides with the beginning of four major American lens manufacturers. This interest expoded in 1975 and 1976 and seems to be continuing to grow. Only a few surgeons have stopped implants, most of them after having done ten or less. Half of the surgeons now doing implants have done 25 or less, while 40% have performed a series of 25 to 200. Intracapsular lens styles were the most often used, and the Worst Medallion lens was by far the most popular. Medical Workshop was the leading supplier of lens implants. Accounting for 25%, and European lenses were more often used (61%). The majority of surgeons beginning lens implants after 1974 used either American lenses exclusively or both sources. The majority of lenses used were designed by Binkhorst and Worst. Only 4% of lenses implanted were done secondarily, but one third of the surgeons have performed this procedure; more do them as their experience grows. An overall visual acuity of 20/40 or better postoperatively was found in 83.8% of cases. Significant lens power errors were rare but increased with increasing experience. One third of the surgeons have reported removing a lens implant at a rate of 0.8%, but only 3% of the surgeons have reported removing an eye with a lens implant at a rate of 0.05%.

Aphakia, Postcataract↗
PubMed1978

Intraocular lenses: secondary membranes; cystoid macular edema.

In 650 consecutive Binkhorst lens implants, secondary membrane surgery was required more than eight times as frequently after an extracapsular than after an intracapsular cataract extraction. The visual acuity results after discussion were uniformly good. Transpars plana vitrectomy was reserved for more severe cases. The pupils were cleared, but the visual acuity results were mixed. A fluorescein angiographic study revealed little difference in the incidence of cystoid macular edema in implant and nonimplant cases. There was a lower incidence after extracapsular than intracapsular extractions in implant cases.

Aged↗
PubMed1978

Prolonged-wear contact lenses in aphakia.

While prolonged wear of contact lenses is possible for the aphakic patient, careful consideration must be given to patient selection and to the potential complications of such use. Currently available lenses are far from ideal and, if used at all, must be carefully monitored. The newer lenses, specifically designed for extended wear, more closely fit our needs. Several manufacturers are testing their devices under strict FDA supervision. FDA guidelines dictate a minimum of two years follow-up before a determination will be made as to which lenses are safe and effective enough for prolonged wear in aphakic eyes.

Adult↗
PubMed1978

Intraocular lenses--current status.

An attempt is made to depolarize current positions regarding intraocular implant lens surgery by presenting a reasonable list of advantages and disadvantages of the procedure. A current position on this controversial subject is presented and is based on currently available knowledge. Although this is a personal view, it is hoped that a middle ground can be created which would be acceptable to advocates and opponents of lens implant surgery.

Aged↗
PubMed1978

Spectacle correction of alphakia: how aspheric do they have to be?

A comparison of spheric and aspheric cataract lenses was carried out on 28 patients with uncomplicated surgery. Lenses were evaluated with respect to eccentric acuity, visual field, ring scotoma, magnification, distortion, and subjective preferences. The results suggest that design differences can be applied to specific visual tasks, thus improving clinical lens prescribing.

Adult↗