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Results for “Aphakia, Postcataract”

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PubMed1983

Secondary intraocular lens implantation.

The visual, refractive, and surgical results with 190 consecutive secondary implantations of an anterior chamber intraocular lens were studied. Best-corrected postoperative visual acuity was either better than or within 1 Snellen line of best-corrected preoperative vision in 87% of the cases. Vision worsened by more than two Snellen lines in ten cases (5%), which included three cases of retinal detachment and one case of ischemic optic neuropathy; however, in only one case (0.5%) did we feel that the visual decrease was directly attributable to the secondary implantation procedure. We believe that secondary intraocular lens implantation can improve functional visual acuity in aphakic patients, especially those unable to tolerate aphakic correction with contact lenses or spectacles.

Adult↗

PubMed1983

Update on keratophakia.

Visual results are reported for 23 cases of keratophakia for the correction of surgical aphakia followed from 12 to 48 months. Seventeen of the 23 patients had final visual acuities of 20/40 or better. The average residual visual overrefraction was 1.87 +/- 1.79 diopters (mean +/- SE), with an increase of postoperative astigmatism of 1.70 +/- 1.33 diopters. Complications included interface deposits and peripheral epithelial deposits that did not interfere with vision. One patient had an anterior chamber penetration and subsequent penetrating keratoplasty, and two patients had lenticules removed because of corneal edema secondary to increased intraocular pressure. The major disadvantages of keratophakia are the complexity of the procedure and the time required (4 to 6 months) to achieve best-corrected spectacle visual acuity. However, because this procedure is extraocular, it is a better choice than secondary intraocular lens implantation for patients who are unilaterally aphakic and for the young patient.

Aphakia, Postcataract↗

PubMed1983

Results of penetrating keratoplasty in 123 eyes with pseudophakic or aphakic corneal edema.

The clinical records of 123 eyes that received a penetrating keratoplasty for aphakic or pseudophakic corneal edema with a mean follow-up time of 18 months were studied retrospectively. Thirty-five eyes from which an intraocular lens (IOL--85% iris fixated) was removed at the time of keratoplasty were compared with 88 eyes that never had an IOL. The mean interval between initial cataract surgery and penetrating keratoplasty was 28 months for the pseudophakic group from which the IOL was removed and 67 months for the aphakic group without IOL. In both groups, 97% had an anterior vitrectomy. Corneal grafts remained clear in 91% of the previously pseudophakic eyes and in 81% of the aphakic eyes (P less than or equal to 0.05). The final corrected visual acuity was worse in the pseudophakic eyes with IOL removed (16% saw 6/6 to 6/12 while 22% saw worse than 6/60) than in the aphakic eyes (34% saw 6/6 to 6/12 while 7% saw worse than 6/60). Postoperative maculopathy occurred in 43% of eyes from which IOLs were removed and in 22% of aphakic eyes.

Aged↗

PubMed1984

Trabeculectomy in aphakic eyes.

One hundred twenty-seven trabeculectomies performed on aphakic eyes at the Bascom Palmer Eye Institute (BPEI) between 1972 and 1982 were reviewed. Forty-five cases were excluded from data analysis: 28 in eyes with confounding conditions, such as neovascular glaucoma; ten with follow-up of less than six months; and seven that were the second or third trabeculectomy performed at the BPEI in six eyes. Of the remaining 82 trabeculectomies in 82 eyes: 32 (39%) were categorized as successes (eyes that achieved an intraocular pressure of less than or equal to 21 mmHg with medication or less than or equal to 25 mmHg without medication); eight (10%) were categorized as qualified failures (eyes that had an intraocular pressure of greater than 21 mmHg despite medication or greater than 25 mmHg without medication); and 42 (51%) were categorized as complete failures (eyes that underwent further glaucoma surgery, had further glaucoma surgery recommended, or lost light perception). In the 20 eyes of the patients younger than 50 years of age, only one (5%) was categorized as a success; while in the 62 eyes of the patients 50 years of age or older, 31 (50%) were categorized as successes.

Adolescent↗

PubMed1984

Alloplastic implants for the correction of refractive errors.

Convex-shaped, hydrophilic lenticles of various water content were implanted into microkeratome-dissected corneal pockets in a baboon model. Freshly trephined, cryolathed, and factory-lathed hydrogels were evaluated for periods exceeding 15 months, documenting clinical response, corneal curvature shifts, and morphologic features. Previously implanted hydrogels were subsequently removed, documenting the reversibility of the procedure while allowing the corneas to return to their preoperative condition. Various alloplastic materials were then reimplanted into the same intrastromal pockets. Medium and high water content lenses produced good results without affecting the recipient cornea, whereas thick or low water content materials extruded or produced severe anterior segment inflammation. The use of medium and high water content, convex-shaped lenticles for the correction of aphakia is possible using current techniques.

Animals↗

PubMed1984

Epikeratophakia in children.

Epikeratophakia was performed in 61 children for the correction of aphakia after the removal of unilateral congenital or traumatic cataracts; 51 patients (54 grafts) have more than 6 months follow-up. In the first 27 grafts, 8 (30%) failed, but in the last 27 grafts, only 2 (7%) failed, largely due to improved surgical and tissue handling techniques. The average increase in corneal refractive power for the early patients was 12.68 +/- 4.63 D with an average overrefraction of +0.45 +/- 5.60 D. The last half of the patients showed an average increase of 14.83 +/- 4.83 D, with an average overrefraction of -0.00 +/- 5.20 D. Visual acuity results in patients with traumatic cataracts have been the most satisfactory, with the majority of patients obtaining useful vision. It also appears that in patients with congenital cataracts, the younger the patient at the time of surgery, the greater the chance for a good visual result. Some improvement in vision has been seen in all of the children with successful grafts, even those beyond the age when amblyopia therapy would be considered to have some potential for therapeutic effect. By attaching the correction permanently on the eye, epikeratophakia facilitates the vigorous occlusion therapy required after cataract extraction in these children.

Amblyopia↗

PubMed1984

Gram-negative corneal ulcers in elderly aphakic eyes with extended-wear lenses.

We report 13 cases of corneal ulcers caused by gram-negative bacteria. These cases occurred in aphakic eyes wearing hydrophilic contact lenses on an extended-wear basis. The risks for infection in the elderly aphakic eye with extended-wear hydrophilic lenses are increased by delay in removal of the lens. Caution in the use of these lenses is urged. The ability of either the patient or an attendant to remove the lens as soon as redness, diminished vision, or pain presents itself is essential in minimizing the risks for serious infection.

Aged↗

PubMed1985

Silsoft extended wear contact lenses in pediatric aphakia.

Fifty pediatric aphakic patients, ranging in age from 7 days to 11 years, were fitted with the Silsoft extended wear contact lens. Compared to other extended wear lenses, the Silsoft lens has several advantages. These include easier handling, a less traumatic fitting procedure for the child, the use of fluorescein for evaluation of the lens-cornea relationship and a low loss rate. This lens appears to be safe, with no permanent adverse effects on the cornea.

Aphakia, Postcataract↗

PubMed1985

Comparison of intracapsular and extracapsular cataract surgery. Histopathologic study of eyes obtained postmortem.

We examined 201 consecutive aphakic and pseudophakic eyes postmortem. Of these, 146 eyes had undergone intracapsular cataract extraction (ICCE) and 55 eyes had undergone extracapsular cataract extraction (ECCE), either with the posterior capsule preserved intact (ECCE-CI, 30 eyes) or having had a surgical discission performed (ECCE-D, 25 eyes). Wound-related complications were most numerous in the ICCE group, and this probably reflects the relatively recent development of microsurgical techniques. Posterior vitreous detachment was present in 84% of eyes following ICCE, in 76% of eyes following ECCE-D, and in 40% of eyes following ECCE-CI (P less than 0.001). Peripheral retinal holes were found in 8.2% of ICCE eyes, 8.0% after ECCE-D, and 3.3% of eyes after ECCE-CI. Five (3.4%) of ICCE eyes had associated retinal detachments, while no ECCE eyes had detachments. Macular edema, macular holes, and epiretinal membranes occurred in 2.1%, 1.4%, 12.3% of ICCE eyes; 4.0%, 0.0%, and 8.0% of ECCE-D eyes; and 0.0%, 6.7%, and 6.7% of ECCE-CI eyes, respectively.

Anterior Eye Segment↗

PubMed1985

Prevalence of cataracts in a population-based study of persons with diabetes mellitus.

Persons with diabetes mellitus have been found to be at increased risk of developing cataracts when compared with nondiabetic persons. This report describes the study of characteristics which may be related to this problem in a population-based sample of diabetic persons. Prevalence of surgical aphakia and cataract increased with increasing age in both younger and older onset diabetic persons. Females had higher rates than males. In multivariate analyses, for younger onset persons, longer duration of diabetes, older age at examination, increased severity of retinopathy, diuretic usage and higher glycosylated hemoglobin levels were significantly associated with greater prevalence of cataract. In older onset persons, age at examination, increased severity of retinopathy, diuretic usage, lower intraocular pressure, smoking and lower diastolic blood pressure were significantly associated with greater prevalence of cataract. Longitudinal data concerning the relationship of some of these characteristics to subsequent development or progression of cataract are necessary before considering the possibility of preventive trials in this condition.

Adolescent↗

PubMed1985

Vitrectomy for chronic aphakic cystoid macular edema. Results of a national, collaborative, prospective, randomized investigation.

A five-year (1979-1984) prospective, randomized, controlled, collaborative study was performed by 27 experienced vitrectomy surgeons in 15 medical centers on 136 surgically aphakic eyes without lens implants but with vitreous adherent to the corneoscleral wound and with chronic aphakic cystoid macular edema (ACME). One hundred fifteen eyes completed the entire course of investigation. The purpose of the study was twofold: to determine the effectiveness of vitrectomy in eliminating established ACME and to determine the natural history of this condition. Following criteria contained within the study protocol, 68 eyes were randomized to surgery (RAN-S) or control (RAN-C), and 47 eyes were observed in the long-term observation group (LTO). Twenty-one eyes were eliminated from the investigation for reasons stated in the text. The RAN-S group proved to have a significantly better visual course than the RAN-C group (P = less than 0.01). An analysis of the LTO group revealed that if central vision did not decline to a level of 20/80 or worse, 27% of the eyes had a chance of spontaneously improving to a level of 20/50 or better. However, if central vision declines to or beyond this point, spontaneous visual improvement to 20/50 or better only occurred in 8% of eyes. Also reported are other important clinical findings such as the role of systemic diseases in ACME, the incidence of vitreous traction on the macula, prognostic value of pre-surgical medical therapy, a comparison of limbal versus pars plana surgical approach, the timing of surgery, and the effectiveness of fluorescein angiography as an objective monitor of visual function.

Aged↗

PubMed1985

Cyclocryotherapy in the treatment of advanced glaucoma.

Cyclocryotherapy in the treatment of aphakic open-angle glaucoma (AO), aphakic angle-closure glaucoma (ACL), and neovascular glaucoma (NVG) was evaluated in 96 eyes of 96 patients. All patients had follow-up of greater than 12 months, with a mean of 29.0 +/- 2.1 months (+/- SEM). Intraocular pressure (IOP) was lowered to less than 21 mmHg in 76% of eyes with AO, 68% of eyes with ACL, and 55% of eyes with NVG. Patients with NVG lost vision more frequently (70%) than patients with AO (41%) or ACL (41%). Patients with NVG had a higher incidence of loss of light perception and phthisis bulbi than patients with ACL (P less than 0.015). In patients having visual field examinations (76/96), glaucomatous field loss was arrested in 71% of patients with AO and 65% of patients with ACL, compared to 29% of patients with NVG (P less than 0.025). There was a significant correlation between postoperative IOP less than 21 mmHg and preservation of visual field. Patients receiving initial 360 degrees cryosurgical treatment required fewer repeat treatments than patients receiving initial 180 degrees treatment (P = 0.004); complications were slightly more common in the 360 degrees group.

Aged↗

PubMed1985

Pharmacologic therapy of aphakic and pseudophakic cystoid macular edema. 1985 update.

Major advances in the pharmacologic therapy of aphakic cystoid macular edema (ACME) have not occurred since 1982. Topical nonsteroidal anti-inflammatory agents are still not commercially available for ocular therapy. Topical indomethacin remains the one agent which has been proven to be of prophylactic value for angiographic aphakic cystoid macular edema although other non-steroidal agents may also work. The therapeutic value of these compounds for established ACME remains uncertain. No prospective randomized prophylactic or therapeutic trials of either topical or systemic corticosteroids have been performed.

Administration, Topical↗

PubMed1986

Extended wear hydrogel and daily wear hard contact lenses for aphakia. Success and complications compared in a longitudinal study.

The success and complications of extended wear hydrogel (EWSCL) and daily wear hard contact lens (DWHCL) correction for aphakia were evaluated retrospectively in two comparable groups of unilaterally aphakic patients (64 with EWSCL, 86 with DWHCL). At the end of the follow-up period, 55% of patients in each group were still using contact lenses. Suppurative keratitis occurred in two (3%) patients using EWSCL and none with DWHCL. The relative risk to all patients of a complication developing severe enough to result in a loss of wearing time was 9.8 times higher for the EWSCL users compared with the DWHCL group; this risk increased to 11.4 times for the patients still using lenses at the end of the follow-up period. The EWSCL patients had 1.9 times more visits for routine care and 5 times more unplanned visits to deal with complications than the DWHCL patients.

Aged↗

PubMed1986

The inadvertent injection of gas beneath the retina in a pseudophakic eye.

Gas injected through the pupil to tamponade a detached retina in a pseudophakic eye inadvertently made its way beneath the retina and augmented the detachment. A transparent membrane posterior to an iris-supported lens prevented the gas from entering the vitreous and diverted it laterally behind the iris, to the ciliary body, where is dissected between layers of ciliary epithelium and entered the subretinal space.

Aged↗

PubMed1987

Pseudophakic and aphakic retinal detachment mimicking cystoid macular edema.

Seventeen eyes of patients who were being followed by their ophthalmologists for aphakic (8 eyes) or pseudophakic (9 eyes) cystoid macular edema (CME) were examined on referral. All eyes showed retinal detachment (RD), and eight eyes had CME with RD. Most RDs were inferior and shallow. Proliferative vitreoretinopathy (PVR) was noted in 15 eyes (88.2%). There was history of vitreous loss during the last intraocular surgery in 88.2% eyes. Visual acuity ranged from 20/40 to hand movements. Fundus view was hazy in most eyes, and indirect ophthalmoscopy was most useful in detecting RD. Retinal reattachment with scleral buckling and/or vitrectomy was achieved in 16 eyes (94.1%). Postoperative visual recovery was jeopardized due to longstanding macular detachment of greater than 1 month in 11 eyes (64.7%). Eight eyes (47%) achieved 20/50 vision whereas 25% did not improve to better than 20/400. Factors leading to failure in making the correct diagnosis and their prevention are discussed.

Aged↗

PubMed1987

Glaucoma associated with penetrating keratoplasty.

The occurrence of chronic postoperative glaucoma in 502 consecutive penetrating keratoplasty cases performed in 421 patients during 1978 through 1986 was 18% (91 cases). Immediate postoperative glaucoma occurred in 9% (44 cases) and progressive angle closure occurred in 2% (13 cases) of keratoplasties. Statistically significant risk factors for development of glaucoma were preexisting glaucoma and aphakia. The type of cataract extraction, use of an intraocular lens, or performance of vitrectomy did not pose significant risk of glaucoma. Surgical therapy of glaucoma was required in 24% of those with glaucoma and was most effective as cyclodestructive surgery especially in patients with progressive angle-closure glaucoma.

Aphakia, Postcataract↗

PubMed1988

Surgical therapy of chronic glaucoma in aphakia and pseudophakia.

Most glaucoma surgical procedures are less successful in aphakic or pseudophakic eyes. The authors reviewed 91 consecutive initial glaucoma procedures in aphakic patients from 1979 to 1986 to determine successful outcomes and complications. Success was defined as an intraocular pressure (IOP) of at least 30% below the preoperative value and less than 21 mmHg, less than 2 lines of Snellen acuity loss, and no further surgical intervention. At 9 months, success rates were: trabeculectomy, 4 of 15 patients; cyclodialysis, 3 of 20 patients; neodymium:YAG (Nd:YAG) cyclophotocoagulation, 1 of 8 patients; cyclocryotherapy, 9 of 22 patients; anterior chamber tube shunt (Schocket procedure), 3 of 6 patients; and argon laser trabeculoplasty, 2 of 20 patients. Severe complications included phthisis bulbi in 11% of cyclocryotherapy and severe visual loss in 20% with cyclodialysis and 14% with cyclocryotherapy. Results confirm the difficulty of surgical therapy in these patients.

Aged↗