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PubMed1988

Clinical experience with the single-plate Molteno implant in complicated glaucomas.

Ninety patients with medically uncontrollable glaucomas and poor surgical prognoses received single-plate Molteno implants (Optomat Supplies, Dunedin, New Zealand) without postoperative adjunctive systemic antifibrosis therapy. Eleven patients had insufficient follow-up for assessment of intraocular pressure (IOP) or visual acuity outcome. The initial Molteno implant procedures in the remaining 79 patients were successful (IOP less than or equal to 21 mmHg with at least 6 months' follow-up) in 26 (63%) of the 41 patients older than 12 years of age with non-neovascular glaucomas in aphakia/pseudophakia; 7 (70%) of the 10 patients older than 12 years of age with non-neovascular glaucomas in phakic eyes after failed filtering surgery; 7 (47%) of the 15 patients with neovascular glaucomas; and 7 (54%) of the 13 patients younger than 13 years of age with non-neovascular glaucomas. The visual acuities remained within one line of their preoperative levels or improved in 31 (76%) of the 41 aphakic or pseudophakic eyes with non-neovascular glaucomas; 3 (30%) of the 10 phakic eyes with non-neovascular glaucomas after failed filtering surgery; 10 (67%) of the 15 eyes with neovascular glaucomas; and 9 (100%) of the 9 eyes with non-neovascular glaucomas in patients younger than 13 years of age on whom Snellen acuity was available.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Extended-wear contact lenses for the treatment of pediatric aphakia.

The practicality of extended-wear contact lenses in the refractive correction of pediatric aphakia was assessed with 240 eyes in 184 patients. Patient ages at the time of contact lens fitting ranged from 18 days to 9.8 years. One hundred forty-one eyes were fit from 1 day to 55 months postoperatively and then followed for 6 months to 5.7 years (average, 29 months). Only five patients lost more than five lenses. The overall loss rate was less than one lens per year of follow-up. No patient had contact lens-related complications with permanent visual sequelae. Only 14% of patients had contact lens problems or factors related to parental inability to care for the lens which resulted in discontinuation of contact lens therapy. The authors were unable to identify any subset of patients who should be considered for primary surgical optical correction of their aphakia.

Aphakia, Postcataract↗

PubMed1988

The correction of aphakia in infants with hydrogel extended-wear contact lenses. Corneal studies.

Although hydrogel extended-wear contact lenses (EWCLs) have been used extensively in the correction of aphakia in neonates, little is known about the effects of these lenses on infant corneas. Recent studies have demonstrated that long-term contact lenses can induce endothelial morphometric changes, including an increased coefficient of variation (CV) of mean endothelial cell area. Using wide-field specular microscopy, the authors studied 11 eyes of 10 patients, 1 to 3 years of age who, after lensectomy for congenital cataracts, wore EWCLs for the correction of aphakia. Except for two corneas in which increased pachometric readings and CV developed after repeated episodes of lens loss and inflammation, the EWCL were well tolerated and associated with few complications in this study.

Aphakia, Postcataract↗

PubMed1988

Binocular function in unilateral aphakia. Correlation with aniseikonia and stereoacuity.

Aniseikonia and stereoacuity were measured in patients with unilateral aphakia, most of whom were postoperative senile cataract cases. The New Aniseikonia test was used to evaluate aniseikonia and the Titmus Stereotest to measure stereoacuity. Ninety cases were studied, 57 (63.3%) of which had intraocular lens (IOL) implants; 27 (30%) had extended-wear soft contact lenses; and six (6.7%) had spectacle lenses. In the IOL group, aniseikonia averaged 2.8%, and 39 patients (68.4%) had good stereoacuity. In the contact lens group, aniseikonia averaged 4.6%, and 11 (40.7%) had good stereoacuity. In the spectacle lens group, aniseikonia averaged 17.8%; none of the patients had good stereoacuity. The authors concluded that in cases with unilateral aphakia, correction with an IOL implant is superior to the other alternatives in achieving good binocular function.

Adolescent↗

PubMed1988

Results of anterior segment reconstruction for aphakic and pseudophakic corneal edema.

The authors studied prospectively 59 eyes with corneal edema after cataract surgery that required reconstructive surgery; penetrating keratoplasty in 59 (100%), anterior vitrectomy in 42 (71%), intraocular lens removal or exchange in 33 (56%), gonioplasty in 32 (54%), and iridoplasty in 30 (51%). With an average follow-up of 9.9 months, the corneal transplant was clear in 56 eyes (95%). The corrected visual acuity was improved in 49 eyes (83%) and was the same in seven eyes (12%). Intraocular pressure was less than or equal to 21 mmHg in 47 eyes (80%) and 22 to 29 mmHg in nine eyes (15%). The peripheral anterior synechiae score was the same or improved in 56 eyes (95%). Cystoid macular edema was absent to mild in 52 eyes (88%). Anterior segment reconstruction improved both anatomic integrity and visual acuity of most eyes without increasing complications.

Aged↗

PubMed1990

Prophylaxis of aphakic cystoid macular edema without corticosteroids. A paired-comparison, placebo-controlled double-masked study.

Prior investigations have reported that topical nonsteroidal anti-inflammatory drug (NSAID) therapy prevents the development of postoperative angiographic signs of angiographic cystoid macular edema (CME). However, these studies include concurrent use of corticosteroids. The current study reports therapeutic efficacy for ketorolac ophthalmic solution (an NSAID) in the prophylaxis of angiographic aphakic CME (ACME) after cataract surgery without concurrent corticosteroids for the first time. Fifty patients with bilateral cataracts were enrolled in this placebo-controlled, paired-comparison, double-masked study. Eleven patients had evidence of angiographic ACME on postoperative day 40. Two of these patients demonstrated bilateral ACME, one patient had ACME in the NSAID-treated eye, and eight patients demonstrated ACME in the placebo-treated eye. This is a statistically significant difference favoring drug treatment. The signs of anterior ocular inflammation were greater in the eyes with ACME. This study suggests prophylactic treatment of ACME may be possible without the risks of concurrent corticosteroid toxicity. In addition, a higher incidence of ACME in black patients (22%) is observed in this study than has been recognized previously.

Adult↗

PubMed1990

A prospective study on the implantation of anterior chamber intraocular lenses during keratoplasty for pseudophakic and aphakic bullous keratopathy.

Between April 1986 and April 1989, the authors conducted a prospective study of the use of open-loop anterior chamber intraocular lenses (AC IOLs) in patients undergoing penetrating keratoplasty for pseudophakic bullous keratopathy or monocular aphakic bullous keratopathy. All patients underwent the same operation--a penetrating keratoplasty combined with insertion of an open-loop AC IOL. Pseudophakic patients had an IOL exchange at the time of surgery. Thirty-six patients have been followed an average of 15 months. Thirty-two (89%) of the grafts are clear. Preoperatively, 100% of eyes had visual acuity less than 20/200. Postoperatively, 11 eyes (31%) have visual acuity better than 20/40 and 23 eyes (64%) have visual acuity better than 20/100. The most common causes for visual acuity less than 20/200 were cystoid macular edema, glaucoma, and immunologic graft failure. Using open-loop AC IOLs in patients with pseudophakic or aphakic bullous keratopathy can give good postoperative results and functional vision.

Aged↗

PubMed1991

Visual results after early surgical treatment of unilateral congenital cataracts.

The authors reviewed the records of 25 consecutive patients who had been operated on for unilateral congenital cataracts at 1 year of age or younger and who had been followed for a period of 5 years or longer. Excluded were patients who demonstrated retinal and optic nerve anomalies. Five eyes achieved 20/40 or better Snellen visual acuity, 5 eyes achieved 20/50 to 20/100 visual acuity, and 15 eyes had 20/200 or less visual acuity. All patients with visual acuity of 20/40 or better had cataract surgery performed before 17 weeks of age, the critical period, and surgery was scattered within this time frame. For surgery performed between 17 weeks and 1 year of age, the best achieved visual acuity in children with surgically significant unilateral congenital cataracts was between 20/50 and 20/100. There was no correlation between the age at the time of surgery and the attainment of these visual levels in this patient subset.

Age Factors↗

PubMed1992

Vision in the "good" eye of children treated for unilateral congenital cataract.

PURPOSE: The authors examined linear acuity and contrast sensitivity in the "good" (fellow) eye of children treated for unilateral congenital cataract to determine (1) whether there were subtle deficits like those described for the good eye of patients with strabismic amblyopia and (2) whether any deficits were related to the degree to which the good eye had been patched. METHODS: The authors tested patients treated for unilateral congenital cataract who had a well-documented history of patching. The good eye was physically normal with minimal refractive error. The measures were linear acuity at far (n = 15) and contrast sensitivity (n = 9). RESULTS: Compared with age-matched control subjects, the good eyes of patients had subtle deficits in linear acuity and in contrast sensitivity at high spatial frequencies. These deficits occurred even in eyes that had received minimal patching, and their severity was not related systematically to the duration of patching, which varied widely across the group. CONCLUSION: The visual sensitivity of the good eye of children treated for unilateral congenital cataract is, on average, slightly reduced, even in cases of minimal patching. Consequently, any deficits discovered after aggressive patching may not have been caused by occlusion amblyopia.

Adolescent↗

PubMed1992

Physiologic analysis of corneal healing after epikeratophakia.

The evaluation of epithelial permeability, stromal transparency, and endothelial cell density is essential to determine the resumption of normal function in each corneal physiologic unit after refractive surgical procedures. The authors report the results of a prospective study conducted in 55 consecutive patients undergoing epikeratophakia using prelathed, lyophilized tissue lenses. Epithelial permeability was evaluated by means of fluorophotometry preoperatively and 1, 2, 4, 8, 12, 24, and 52 weeks after epikeratophakia. With few exceptions, Scheimpflug photography also was performed at the same examination times to assess stromal optical density. Endothelial cell counts were performed in each patient preoperatively and between 6 and 12 months postoperatively. The epithelial barrier function resumed normal values within 8 weeks after epikeratophakia. The optical density of both donor lenticule and recipient corneas was initially increased but returned to values comparable with those of unoperated corneas by 12 weeks postoperatively. Endothelial cell density was not affected by epikeratophakia. These results confirm the authors' preliminary observation that epikeratophakia allows a relatively quick recovery of normal corneal functions and should prompt investigators to demonstrate the safety of other refractive surgical procedures in a similar way.

Aged↗

PubMed1993

Long-term visual results and complications in children with aphakia. A function of cataract type.

PURPOSE: Previous studies of outcome in children with aphakia have approached the data by grouping patients according to features such as age at surgery, type of procedure, or some other common attribute. The purpose of this study is to identify factors predictive for visual outcome and complications in pediatric patients with cataracts. METHOD: One hundred seventy-four eyes in 118 patients underwent lensectomy and anterior vitrectomy for congenital or juvenile cataracts. All received early optical correction, occlusion therapy when necessary, and follow-up for at least 6 months. Visual outcome and complications were analyzed statistically to determine predictive factors. Features analyzed included cataract type, laterality, age at onset, follow-up, and corneal size. RESULTS: Statistical analysis showed that the most important predictor of long-term visual outcome and complications is cataract type. Visual outcome differed significantly by cataract type, with best results in the lamellar and posterior lentiglobus groups. Unilateral cases had a mean acuity lower than bilateral cases. Other factors, such as age at surgery and corneal size, were less predictive but closely linked to cataract type. Complications, such as aphakic glaucoma, also were more closely linked to the type of cataract than to other variables. CONCLUSION: The results indicate that an important determinant of long-term outcome and complications in aphakic children is cataract type. Other features were found to be closely correlated to cataract type and were not independently significant.

Age Factors↗

PubMed1994

Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment.

PURPOSE: This study was designed to elucidate various aspects of the natural history of posterior vitreous detachment (PVD), in particular the relation between symptomatology and prognosis as it relates to management of patients with the earliest symptoms of PVD. METHODS: A prospective study of 350 consecutive patients with PVD was performed, excluding all patients referred from an ophthalmologist, those with symptoms of more than 3 months in duration, and those with a history of ocular trauma, except for cataract surgery. Aphakia was present in 21 eyes, and 50 patients were bilaterally involved. RESULTS: Of 163 patients who had one to two floaters as their presenting symptom, with or without light flashes, a retinal tear developed in 12 (7.3%). Of 31 phakic eyes with secondary retinal tears on initial examination, 9 (29%) had one to two floaters and light flashes as the only symptoms. Of eight phakic eyes that initially, or eventually, had a retinal detachment, three (37%) had an interval of 2 1/2 to 3 weeks before visual field loss, during which they noticed only one to three visual floaters plus light flashes as their only symptoms. This early stage in which symptoms are detectable is crucial in terms of providing an opportunity for early treatment that might prevent retinal detachments. CONCLUSIONS: The prompt and conscientious vitreoretinal examination of each patient older than 45 years of age who experiences vitreous floaters, even though limited to one or two, should be undertaken without delay. This practice, combined with expeditious treatment of any secondary retinal tears, provides the most effective known means of preventing rhegmatogenous retinal detachment, and currently it appears to be neglected. A national public educational effort should be pursued to publicize the importance of these symptoms.

Adult↗

PubMed1995

Endophthalmitis after secondary intraocular lens implantation. A case-report study.

PURPOSE: To investigate whether endophthalmitis is more common after secondary intraocular lens (IOL) implantation than after other intraocular surgeries. Risk factors, causative organisms, and visual acuity outcomes of endophthalmitis after secondary IOL implantation were investigated. METHODS: The ten cases consisted of all patients treated at the Bascom Palmer Eye Institute between January 1, 1984, and December 31, 1994, for endophthalmitis after secondary IOL implantation. The 34 control patients consisted of all patients who underwent secondary IOL implantation within 3 years of the case patients (6-year span) by the same surgeons but who did not develop endophthalmitis. Demographic and clinical data were abstracted from patients' medical records. RESULTS: Fifty percent (5 of 10) of case patients had a history of diabetes mellitus, compared with 5.9% (2 of 34) of control patients. All three posterior chamber IOLs among case patients had transscleral suture fixation, whereas all four posterior chamber IOLs among control patients were in the sulcus without scleral sutures. Case patients were more likely than control patients to have IOLs with polypropylene haptics (30.0% and 5.9%, respectively) and to have had their IOLs placed through a superior rather than a temporal incision (70.0% and 17.9%, respectively). Eighty percent of case patients and 14.7% of control patients had either eyelid abnormalities (marked blepharitis, ectropion) or postoperative wound defects. Staphylococcus epidermidis was isolated in 50% of case patients. After treatment, 90.0% of case patients achieved a visual acuity of greater than or equal to 20/100. CONCLUSION: Endophthalmitis after secondary IOL implantation was associated with diabetes, transscleral suture fixation of posterior chamber IOLs, polypropylene haptics, preoperative eyelid abnormalities, re-entry of eye through a previous wound, and postoperative wound defects. Most cases were caused by Staphylococcus epidermidis, and the post-treatment visual outcomes were generally good.

Aged↗

PubMed1995

Extracapsular cataract surgery with and without intraocular lens implantation in Fuchs heterochromic cyclitis.

PURPOSE: To compare the surgical and postoperative complications and visual outcome of extracapsular cataract extraction (ECCE) with and without intraocular lens (IOL) implant in Fuchs heterochromic cyclitis. METHODS: The records of 77 patients with Fuchs heterochromic cyclitis who had undergone ECCE were reviewed. Of a total of 77 eyes, a posterior chamber IOL (PC IOL) was implanted in 43 eyes, whereas 34 eyes did not receive an implant. RESULTS: In the pseudophakic group, 40 (93%) eyes achieved 20/40 or better. This level also was achieved in 29 (85%) eyes not receiving an implant. Intraoperative anterior chamber hemorrhage was documented in 18 eyes but there was no correlation with preoperative gonioscopic findings. A temporary or permanent elevation of intraocular pressure was noted in five of eight eyes that had marked anterior chamber hemorrhage. Severe postoperative uveitis occurred in ten eyes and was more common in patients with glaucoma who had PC IOL implantation, but this did not adversely affect the visual outcome. Of 40 eyes with PC IOL implant, severe postoperative uveitis developed in 7. In six of these seven eyes, the implant was a three-piece lens with polypropylene haptics. Severe postoperative uveitis developed in 6 of 16 eyes with preoperative glaucoma. Five of these six eyes had a PC IOL implant. Of the 34 aphakic patients, 10 (29%) were intolerant of contact lens correction. There was no difference in the incidence of postoperative uveitis, cystoid macular edema, and development of glaucoma between the two groups. CONCLUSION: Implantation of PC IOLs in ECCE in patients with Fuchs heterochromic cyclitis appears to a safe procedure, but careful postoperative follow-up of intraocular pressure, particularly in patients with intraoperative hemorrhage or postoperative uveitis, is indicated.

Adolescent↗

PubMed1995

Extracapsular cataract extraction with or without posterior chamber intraocular lenses in eyes with cataract and high myopia.

PURPOSE: To compare the results of insertion of low-power or zero-power posterior chamber intraocular lenses (PC IOLs) after cataract extraction in eyes with high myopia with leaving the eye aphakic. METHODS: The outcome of extracapsular cataract extraction (ECCE) with low-power or zero-power PC IOLs in 184 consecutive highly myopic (axial length = 26.0 mm or longer) eyes was compared with 184 consecutive highly myopic eyes receiving ECCE without PC IOLs. Axial length, preoperative visual acuity, age, sex, and follow-up were similar between both groups. RESULTS: In the pseudophakic eyes, there was a statistically significantly better visual outcome (P = 0.006), decreased incidence of posterior capsule opacification (13.6% versus 33.2%, P < 0.01), and decreased requirement for YAG capsulotomy (6.5% versus 17.9%, P < 0.01). There were two retinal detachments in the pseudophakic eyes compared with four in the aphakic eyes. There were no sight-threatening complications in 12 pseudophakic eyes after YAG capsulotomy. There were four sight-threatening complications (2 retinal detachments, 2 cases of uveitis with secondary glaucoma) in 33 aphakic eyes after YAG capsulotomy. CONCLUSIONS: The use of PC IOLs may result in a lower complication rate and better visual outcome after ECCE in eyes with cataract and high myopia.

Adult↗

PubMed1995

A prospective study of ocular hypertension and glaucoma after pediatric cataract surgery.

BACKGROUND: Late-onset glaucoma can occur after pediatric cataract surgery. However, no large prospective study of the prevalence of ocular hypertension and glaucoma after pediatric cataract surgery has been performed. METHODS: A prospective glaucoma evaluation was offered to all eligible subjects at least 5 years after automated lensectomy and vitrectomy for pediatric cataracts. RESULTS: Sixty-two (58%) of 107 eligible subjects received a glaucoma evaluation. One (4.5%) of 22 patients with bilateral cataracts had glaucoma, and a much higher percentage (45%) had ocular hypertension. Five (12.5%) of 40 patients with unilateral cataracts had glaucoma, and an additional 32.5% had ocular hypertension. For patients with monocular cataracts, the age and corneal diameter at the time of cataract surgery were related to the subsequent development of ocular hypertension or glaucoma. The majority of subjects were able to cooperate with a comprehensive glaucoma examination that included cycloplegic refraction, determination of intraocular pressure, examination of the optic nerve, and fundus photography, without requiring sedation. CONCLUSIONS: There is a high prevalence of ocular hypertension after pediatric cataract surgery. Children who are 5 years of age and older usually are able to cooperate with a glaucoma evaluation. The natural history of ocular hypertension after pediatric cataract surgery will be determined with longitudinal studies in the future.

Aphakia, Postcataract↗

PubMed1998

Medical prophylaxis and treatment of cystoid macular edema after cataract surgery. The results of a meta-analysis.

OBJECTIVE: The study aimed to determine the effectiveness of prophylactic medical intervention in reducing the incidence of cystoid macular edema (CME) and the effectiveness of medical treatment for chronic CME after cataract surgery. DESIGN: The study design was a systematic review and meta-analysis of published reports of randomized clinical trials (RCTs). PARTICIPANTS: Sixteen RCTs involving 2898 eyes examining the effectiveness of medical prophylaxis of CME and 4 RCTs involving 187 eyes testing the effectiveness of medical treatment of chronic CME were used in the study. INTERVENTIONS: Medical prophylaxis of treatment (cyclo-oxygenase inhibitors or corticosteroids) versus control (placebo or active treatment) was performed. MAIN OUTCOME MEASURES: Incidence of angiographically diagnosed CME, incidence of clinically significant CME, and vision were measured. RESULTS: Thirty-six articles reported testing a prophylactic medical intervention for CME after cataract surgery. The incidence of CME varied extensively across studies and was related to the study design used. Summary odds ratios (OR) indicated that prophylactic intervention was effective in reducing the incidence of both angiographic CME (OR = 0.36; 95% confidence interval [CI] = 0.28-0.45) and clinically relevant CME (OR = 0.49; 95% CI = 0.33-0.73). There also was a statistically significant positive effect on improving vision (OR = 1.97; 95% CI = 1.14-3.41). A combination of the results of the four RCTs testing medical therapy for chronic CME indicated a treatment benefit in terms of improving final visual acuity by two or more Snellen lines (OR = 2.67; 95% CI = 1.35-5.30). Assessment of the quality of the 20 RCTs included in the meta-analyses indicated problems in the design, execution, and reporting of a number of trials. CONCLUSION: A combination of the results from RCTs indicates that medical prophylaxis for aphakic and pseudophakic CME and medical treatment for chronic CME are beneficial. Because most of the RCTs performed to date have problems related to quality, a well-designed RCT is needed to confirm this result, using clinical CME and vision as outcomes.

Aphakia, Postcataract↗

PubMed2000

A comparison of the rate of refractive growth in pediatric aphakic and pseudophakic eyes.

OBJECTIVE: To compare the rate of refractive growth in pseudophakic children's eyes to that of aphakic eyes. DESIGN: Multicenter, retrospective observational case series. PARTICIPANTS: 83 patients with pseudophakic eyes (100 eyes) and 74 patients with aphakic eyes (106 eyes), with an age of surgery between 3 months and 10 years and a minimum follow-up time of 3 years or more, depending on the age at surgery. METHODS: A logarithmic model was used to analyze the rate of refractive growth for each eye. MAIN OUTCOME MEASURES: Age at surgery, intraocular lens power, intraocular lens A-constant, initial postoperative refraction, final refraction, and final age. RESULTS: Overall, pseudophakic eyes showed a lesser rate of refractive growth than aphakic eyes (-4.6 diopter vs. -5.7 diopter, P = 0.03). This trend was also present but less significant when the eyes were grouped into those less than 6 months of age at surgery (-3.3 diopter vs. -4.6 diopter, P = 0.09) and older patients (-5.0 diopter vs. -6.1 diopter, P = 0.07). However, the mean quantity of myopic shift was greater in pseudophakic eyes than in aphakic eyes (-5.26 diopter vs. -4.54 diopter), despite shorter follow-up times in the pseudophakic eyes. This is due to the optical effects of a constant intraocular lens power in a growing eye. CONCLUSIONS: Pediatric pseudophakic eyes have a slightly lesser rate of refractive growth than aphakic eyes. The new rate values should be used for predicting future refractions in these eyes.

Aphakia, Postcataract↗