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PubMed1982

Cataract extraction in an eye with filtering bleb.

Seventy-two ophthalmologists with a major interest in glaucoma (glaucoma surgeons) responded to a questionnaire as to how they would remove a cataract from a hypothetical 60-year-old patient with a functioning filtering bleb in the superior nasal quadrant. The majority recommended an intracapsular cataract extraction through a lateral or inferolateral limbal incision or a superior corneal incision anterior to the bleb. Most of the glaucoma surgeons preferred to close the wound with five to nine interrupted 10-0 nylon sutures. Estimates of the percentage of blebs failing after cataract extraction ranged from zero to more than 50%, with a median of 30%. The majority of the glaucoma surgeons stated that they would never, or only under exceptional circumstances, implant an intraocular lens in an eye with a filtering bleb. Twelve ophthalmologists with a major interest in intraocular lens implantation (implant surgeons) responded to the same questionnaire. They were more likely than the glaucoma surgeons to recommend extracapsular cataract extraction and to implant an intraocular lens in an eye with a filtering bleb.

Cataract↗
PubMed1987

A prospective study of intraocular pressure four months after extracapsular cataract extraction with implantation of posterior chamber lenses.

Sixty-six consecutive cases of extracapsular cataract extraction (ECCE) and sulcus implantation of a posterior chamber lens had intraocular pressure (IOP) measurements recorded four months postoperatively. These results were compared to the fellow unoperated eyes, as well as to a group of 64 patients, whom we reported previously, who had intracapsular cataract extraction (ICCE) and implantation of an anterior chamber lens. The ECCE and posterior chamber lens group demonstrated a significant reduction in the IOP of the operated eye after four months (P less than 0.001), with none of the patients having an IOP greater than 20 mm Hg. No significant IOP change could be demonstrated in the fellow eye (0.1 less than P less than 0.2). We found a significant difference between the ECCE and ICCE groups in the IOP of the operated eye (P less than 0.001).

Aged↗
PubMed2001

Improvements in measures of vision and self-reported visual function after cataract extraction in patients with late-stage age-related maculopathy.

PURPOSE: A recent study indicated that patients with cataracts and early age-related maculopathy may benefit from cataract extraction. To ascertain whether cataract extraction in the presence of concurrent advanced age-related maculopathy was also associated with a clear benefit, we studied visual function and self-reported visual functioning in a cohort of 12 patients pre- and post-phakoemulsification. METHODS. All 12 patients had a diagnosis of advanced age-related maculopathy in the eye scheduled for cataract surgery. Preoperative assessment included refraction and recording of best corrected distance and near acuity and contrast sensitivity in both eyes. The Daily Living Tasks Dependent on Vision questionnaire was administered. After phakoemulsification and intraocular lens implantation, all patients were reviewed and assessed. RESULTS: After surgery, improvement in acuity was recorded in nine operated eyes, whereas acuity remained unchanged in three eyes. Improvement in contrast sensitivity in the operated eye occurred in 10 patients, but in two patients contrast was reduced postoperatively. In terms of self-reported visual functioning, improvement in the ability to undertake many daily living tasks dependent on vision was recorded after cataract surgery. CONCLUSIONS: Significant improvements in specific areas of self-reported visual functioning and measures of vision were recorded after cataract surgery. During the follow-up period, none of the operated eyes suffered a fall in visual acuity. There was also no evidence of worsening of the pre-existing macular lesion as judged by clinical examination and fundus photography.

Aged↗
PubMed1997

Control of ocular inflammation after cataract extraction with rimexolone 1% ophthalmic suspension.

PURPOSE: To assess the efficacy and safety of rimexolone 1% ophthalmic suspension in controlling intraocular inflammation after cataract extraction. SETTING: Twelve independent investigational centers in the United States METHODS: This study comprised 197 patients who had cataract extraction. Postoperatively, patients were randomized to a 2 week regimen of rimexolone 1% ophthalmic suspension or a placebo. Efficacy was analyzed by monitoring total anterior chamber cells and flare, other parameters of inflammation, and treatment failures. Safety was evaluated by monitoring treatment-related adverse events and intraocular pressure (IOP). RESULTS: Rimexolone 1% was clinically and statistically more effective in suppressing cell and flare than the placebo (P < .02). The overall discontinuation rate for treatment-related adverse events was 5.3% in the rimexolone group and 22.2% in the placebo group. There were no between-group differences in IOP. CONCLUSION: Rimexolone 1% ophthalmic suspension was safe and significantly more effective than a placebo in controlling intraocular inflammation after cataract extraction when used four times daily and continued for 2 weeks.

Administration, Topical↗
PubMed1985

Intracapsular cataract extraction with and without implantation of an anterior chamber lens. A comparative study.

Intracapsular cataract extraction with anterior lens implantation was performed in 60 eyes and matched to a control group of 55 eyes, which were operated without implantation. Per- and immediately postoperatively 8 eyes in each group had minor complications without consequences for the final visual outcome. 76.7% of the implanted eyes obtained a final visual acuity of 0.5 or better versus 70.9% in the non-implanted eyes. In both groups senile maculopathy was the main cause of permanent visual reduction. At the time of follow-up (between 12 and 29 months after surgery) maculopathy was seen in 12 eyes of the implanted group versus 14 eyes of the non-implanted group. 91% of the eyes in the implanted group gave a subjectively satisfactory result to the patient, in the non-implanted group 63% gave a satisfactory result. It is concluded that anterior chamber lens implantation in this material has been a safe procedure with no more short term complications than cataract extraction alone, and that the patients obtain a high degree of visual comfort.

Aged↗
PubMed1985

Regional specular microscopy of endothelial cell loss after intracapsular cataract extraction: a preliminary report.

In a group of 10 patients (12 eyes) undergoing intracapsular cataract extraction, corneal endothelial cell loss was serially investigated by means of regional specular microscopy. Prevoperatively there were no significant regional differences in the endothelial cell density. Two weeks after surgery, the superior endothelium alone showed a significant cell loss (15.6%). Whereas, a definite endothelial cell loss occurred in each region of the cornea one month after surgery. The cell loss was greater in the superior (22.8%) and lower in the inferior (4.7%), respectively, when compared to that seen in the central cornea (9.6%). In each region, cell loss continued 3 months postsoperatively, but no significant cell loss occurred thereafter. These results suggest that the entire endothelial cell population may participate in the healing of the damage associated with intracapsular cataract extraction and that regional specular microscopy can be of help for detailed evaluation of such a damage.

Aged↗
PubMed2004

Recurrent scleral abscess after uncomplicated cataract extraction.

PURPOSE: To report the unusual occurrence of a recurrent scleral abscess after uncomplicated cataract extraction. METHODS: Case report of a 77-year-old healthy woman. RESULTS: Multiple cultures and antibiotic treatments failed to resolve presenting symptoms. Gram stain, Gomori methenamine silver (GMS) stain, and all cultures were negative. After drainage of the abscess, the patient's symptoms cleared briefly, then returned 6 months later showing a positive GMS stain consistent with Candida. The patient was treated with amphotericin, natamycin, and fluconazole at this time, and a return in visual acuity occurred along with a resolution of symptoms. No re-occurrence has been noted with 2.5 years of follow-up. CONCLUSIONS: Cataract extraction, although generally a safe procedure, can still result in unusual complications such as scleral abscesses. Excellent outcomes are possible once the infections are identified and treated.

Abscess↗
PubMed1992

Cystoid macular oedema following cataract extraction in patients with diabetes.

The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.

Adult↗
PubMed1987

Defects of Descemet's membrane as a complication in cataract extraction with lens implantation.

As a complication of cataract extraction with lens implantation, a detachment of the Descemet's membrane can occur. In 1,163 eyes that were cataract operated during 1 year (1,060 extracapsularly--973 of them got a Kratz elliptical posterior chamber lens and 39 a Mark Choyce IX anterior chamber lens implantation--and 103 intracapsularly) 69 showed Descemet's detachments of a width of 0.5-2 mm, mostly located between 10 and 1 h. As a rule a reattachment is possible by air, Healon injection and rinsing with Ringer's solution. Normally, the peripheric clouded stroma and the edema of the epithelium regenerate postoperatively. Extensive Descemet's detachments lead to corneal dystrophy. The detachment of the Descemet's membrane is caused by intrusion of the instruments into the anterior chamber or by implantation of the lens.

Aged↗
PubMed1997

Cataract extraction as a means of treating postfiltration hypotony maculopathy.

Hypotony maculopathy may arise after glaucoma filtering surgery. This can be treated by inducing inflammation and scarring within the filter, with the aim of increasing intraocular pressure (IOP) and promoting resolution of maculopathy. Cataract extraction can promote such inflammation. Phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation was performed in two consecutive patients with postfiltration hypotony maculopathy and preexisting cataracts. After cataract extraction, improvement of IOP, visual acuity, maculopathy, and metamorphopsia occurred in both patients. Cataract extraction can be beneficial in the management of postfiltration hypotony maculopathy.

Cataract Extraction↗
PubMed1989

Effects of carbachol and acetylcholine on intraocular pressure after cataract extraction.

We compared the effect of carbachol and acetylcholine on intraocular pressure 24 hours after extracapsular cataract extraction. All agents were administered intracamerally at the time of surgery. Sixty patients scheduled for routine extracapsular cataract extraction and intraocular lens implantation were randomly assigned into one of three treatment groups: (1) carbachol, (2) acetylcholine, or (3) 0.5% balanced salt solution (placebo). Baseline intraocular pressures were determined the day before surgery, and postoperative pressures were measured approximately 24 hours after surgery. The group intraocular pressures averaged over preoperative and postoperative values were 21.06 mm Hg in the acetylcholine group, 19.36 mm Hg in the control group, and 17.30 mm Hg in the carbachol group. The average difference between preoperative and postoperative intraocular pressure measurements for the three groups were 7.33 mm Hg for the acetylcholine group, 8.73 mm Hg for the control group, and 2.20 mm Hg for the carbachol group. Only carbachol was significantly different from placebo on statistical subsequent testing. Carbachol is suggested as the agent of choice both for achieving intrasurgical miosis and prophylaxis of increasing intraocular pressure after cataract surgery.

Acetylcholine↗