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At least 343 records · Page 19Linked to original sources
PubMed2003

Fungal infection of sutureless self-sealing incision for cataract surgery.

PURPOSE: To report the clinical picture and outcome of fungal infection of self-sealing wounds in cataract surgery. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seven postoperative cataract patients. METHODS: Seven consecutive patients who underwent cataract surgery in different locations in India and developed microbiologically proven fungal infection of the surgical wound were included. All were managed at a tertiary eye care center in India between May 2001 and April 2002. MAIN OUTCOME MEASURES: The data reviewed included patient age, gender, onset of symptoms after surgery, examination findings at the time of onset of symptoms and referral, laboratory workup, treatment, and outcome. The cataract surgeons involved were contacted to determine their cataract practice and to determine any possible breach in the sterile technique. RESULTS: The median interval to onset of symptoms after cataract surgery was 5.0 days (mean, 5.8 days; range, 3-9 days). The initial diagnoses at the time of onset of symptoms were keratitis (n = 3), scleritis (n = 1), and excessive anterior chamber reaction (n = 3). The last 4 patients were treated with topical and/or systemic corticosteroid therapy before referral. All cases subsequently developed deep keratitis. Specimens for microbiology workup were obtained by scrapings (n = 6), corneoscleral biopsy (n = 4), and anterior chamber paracentesis (n = 4). Organisms identified were Aspergillus flavus (n = 2), Aspergillus terreus (n = 2), Aspergillus spp. (n = 2), and Candida albicans (n = 1). The infection resolved with medical therapy in 2 cases; the final visual acuity was 20/125 in one case and 20/20 in the other case. The infection progressed to endophthalmitis in 5 eyes, resulting in complete loss of vision. The source of infection could not be identified in any case. CONCLUSIONS: Infection of self-sealing tunnel incision for cataract surgery is a diagnostic and therapeutic challenge.

Aged↗
PubMed2000

Intraocular bacterial contamination during sutureless, small incision, single-port phacoemulsification.

PURPOSE: To evaluate the incidence of anterior chamber bacterial contamination during no-stitch, 1-handed, small incision phacoemulsification. SETTING: Little Company of Mary Hospital, Evergreen Park, Illinois, USA. METHODS: This study comprised 53 eyes of 46 patients. Topical gentamicin sulfate was administered 1 hour preoperatively. After povidone-iodine cleansing solution and povidone-iodine paint (5% and 10%) were applied, the eyes were draped in a sterile manner. Aqueous fluid was aspirated upon entering the anterior chamber and at the end of surgery; the specimens were cultured for up to 14 days. All eyes had no-stitch, 1-handed, small incision phacoemulsification with implantation of a foldable acrylic posterior chamber intraocular lens through a 3.5 mm scleral tunnel incision. RESULTS: Three specimens (5.7%) aspirated on entry into the anterior chamber were positive for microorganisms. Of the cultures obtained at the end of surgery, 4 (7.5%) were positive for microorganisms. All posterior lens capsules were intact. The following organisms were cultured at the end of phacoemulsification: alpha-streptococci, micrococci, saprophytic mold, alpha-viridans streptococci, coagulase-negative Staphylococcus species, and anaerobic positive cocci. No eye developed endophthalmitis. CONCLUSIONS: The incidence of anterior chamber bacterial contamination was low. Bacterial contamination of the anterior chamber occurred at the beginning and toward the end of phacoemulsification. Staphylococcus species was the most common organism in the beginning, while Streptococcus species was the most common at the end. Saprophytic mold was present only at the end. No eye developed endophthalmitis.

Aged↗
PubMed2001

Optimal incision sites to obtain an astigmatism-free cornea after cataract surgery with a 3.2 mm sutureless incision.

PURPOSE: To determine the optimal incision to eliminate astigmatism after cataract extraction. SETTING: Hara Eye Hospital, Utsunomiya, Japan. METHODS: Patients having cataract extraction through a 3.2 mm corneal limbal incision without limbal sutures were divided into 2 groups. Group 1 comprised 98 eyes of 80 patients without preoperative astigmatism and Group 2, 72 eyes of 62 patients with no astigmatism postoperatively. In Group 1, the incisions that caused postoperative corneal changes were retrospectively evaluated. In Group 2, the types of incisions that induced an astigmatism-free cornea postoperatively were retrospectively studied. Patients were examined preoperatively and 6 months postoperatively. RESULTS: In Group 1, 23 of 40 eyes (57.5%) with an incision between 9 and 12 o'clock (BENT incision) and 10 of 58 eyes (17.2%) with an incision at 12 o'clock remained astigmatism free postoperatively (P <.0001). One eye (2.5%) with a BENT incision and 17 (29.3%) with a 12 o'clock incision had astigmatism greater than 1.0 diopter (D) postoperatively (P <.001). In Group 2, 72 eyes had less than 1.2 D of preoperative astigmatism. No eye with more than 1.2 D of astigmatism was astigmatism free postoperatively, even when the incision was made at the steepest meridian. CONCLUSIONS: The results indicate that to reduce astigmatism in eyes with preoperative astigmatism of 0.5 D or more, a limbal 3.2 mm BENT incision should be placed at 10:30 o'clock. To prevent astigmatism postoperatively, the incision should be placed at the steepest meridian in eyes with preoperative astigmatism greater than 0.5 D; for preoperative astigmatism greater than 1.2 D, a 3.2 mm incision at the corneal limbus is insufficient and a wider incision or an additional incision is required.

Aged↗
PubMed2002

Minimal astigmatism after sutureless planned extracapsular cataract extraction.

PURPOSE: To evaluate astigmatism after mini-nuc extracapsular cataract extraction (ECCE) in which a chevron incision is enlarged to 6.0 to 7.0 mm for easier nucleus removal and to compare the results with those using a 5.0 mm incision. SETTING: Department of Ophthalmology, The Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Holon, Israel. METHODS: Thirty eyes of 29 patients were enrolled in this study. Keratometry was performed preoperatively and 3 to 9 months postoperatively. The incision length was 6.0 mm in 6 eyes, 6.5 mm in 10 eyes, and 7.0 mm in 14 eyes that had mature cataract. RESULTS: The mean induced astigmatism calculated by simple subtraction was 0.12 diopter (D) +/- 0.51 (SD), 0.16 +/- 0.98 D, and 0.67 +/- 0.91 D for the 6.0 mm, 6.5 mm, and 7.0 mm incision, respectively. By vector analysis, the mean induced astigmatism was 0.60 +/- 0.30 D, 0.75 +/- 0.67 D, and 1.36 +/- 0.77 D, respectively. Results by both methods showed no significant difference between the previously reported 5.0 mm incision and the 6.0 mm and 6.5 mm incisions. The 7.0 mm group had statistically significantly greater induced astigmatism than the 5.0 mm group (P =.01, simple subtraction; P =.002, vector analysis). CONCLUSIONS: Enlarging the size of the chevron incision up to 7.0 mm resulted in a small increase in induced astigmatism. The enlarged incision simplified the operative technique.

Adult↗
PubMed1996

Conjunctival wound closure by saline injection in sutureless, scleral tunnel incision phacoemulsification.

PURPOSE: To compare two methods of conjunctival closure in phacoemulsification. SETTING: Frimley Park Hospital NHS Trust, Surrey, England. METHODS: This prospective, randomized study comprised 40 patients (40 eyes) who had phacoemulsification via superior axis scleral tunnels and implantation of a poly(methyl methacrylate) intraocular lens with a 5.5 mm optic diameter. In 24 eyes, the conjunctival wound was closed manually with a Moorfields forceps (Group A). In 16, 0.5 ml of balanced salt solution was injected subconjunctivally to reappose the conjunctival wound (Group B). Conjunctival reapposition was assessed by measuring the maximum radial distance of bare sclera preoperatively and during outpatient clinic visits at 1, 7, and 28 days postoperatively. RESULTS: Follow-up was obtained on 38 eyes. One day after surgery, total wound closure was achieved in 15 of 16 eyes in Group B; however, closure was still incomplete in 13 of 22 Group A eyes. At 7 days postoperatively, the size of the conjunctival wound remained significantly smaller in Group B eyes (P < .01). CONCLUSION: The saline injection produced a faster rate of conjunctival wound closure than standard manual reapposition.

Aged↗
PubMed1997

Sutureless scleral fixation of intraocular lenses.

A technique is presented in which pars plana fixation of a posterior chamber intraocular lens (IOL) is achieved by the transscleral passage of the haptics. The IOL used has three equidistant supple loops, each attached to an armed suture, which serve as haptics. A specially designed needle driver is used to pass the sutures into and out of the eye through the pars plana and along the surface of the sclera, where they are severed by cautery. Stable fixation is achieved without contact with the inner tissues of the eye, and no additional sutures are necessary. Lens stability is maintained even in the presence of asymmetrical fibrosis of the capsular remnants.

Adolescent↗
PubMed2000

Manual sutureless cataract surgery using a claw vectis.

Two-handed sandwich methods of extracapsular cataract extraction using a self-sealing incision have proved difficult for many inexperienced surgeons. We developed a simpler 1-handed technique using a claw vectis-a vectis with a claw placed on its tip. When the nucleus is pulled through the scleral tunnel, it is fixed by the claw and is smoothly removed from a wound of a size comparable to that in the sandwich method. During nucleus removal, viscoelastic material is constantly injected through the irrigation vectis to maintain the anterior chamber depth, resulting in a low incidence of complications. We have performed 620 cases using the technique and found it safe and easy for both novice and experienced surgeons.

Adult↗
PubMed2001

Cataract surgery and transpupillary silicone oil removal through a single scleral tunnel incision under topical anesthesia; sutureless surgery.

The author evaluated the results of combined cataract extraction and transpupillary silicone oil removal through a single scleral tunnel incision, in eyes that had undergone pars plana vitrectomy with silicone oil tamponade. Twenty-four of the 46 eyes were operated on under topical anesthesia with Blumenthal mode mini-nucleus manual extracapsular cataract extraction technique (mini-nuc ECCE), and silicone oil was removed passively through planned posterior capsulorhexis via the scleral tunnel, followed by endocapsular intraocular lens (IOL) implantation. The operation was completed without any suturing. The remaining 22 eyes were similarly operated on with the same cataract extraction technique, but in these cases silicone oil was classically aspirated actively through pars plana sclerotomies. Results were evaluated by visual acuity measurement, duration of operation, and complications. The transpupillary silicone oil removal group had significantly less vitreous hemorrhage (0- 31.8%) and posterior capsule opacification (0-36.4%). Also, the mean duration of the operation was significantly shorter in this group. There was no significant difference between the two groups with regard to postoperative recurrence of retinal detachment (12.5-18.1%) and visual acuity outcome. The combination of mini-nuc ECCE with transpupillary silicone oil removal compares favorably with the combination of silicone oil aspiration through pars plana sclerotomies. This combined technique allows the surgeon to perform the operation under topical anesthesia and no sutures are required. The intervention period is shorter and no posterior capsule opacification or vitreous hemorrhage develops.

Adolescent↗
PubMed1989

The use of a biological adhesive to achieve sutureless epikeratophakia.

An adhesive made of concentrated human fibrinogen produced from samples of single donor blood by a simple cryoprecipitation method was tested for its ability to bond lamellar corneal buttons in vitro and found to have a bond strength of 140 gm/cm2. The adhesive was successfully used to attach experimental epikeratophakia grafts in a rabbit model. The results were similar to those reported from an earlier trial using a commercially available adhesive prepared from pooled multi-donor human plasma. This experimental trial of single-donor adhesive demonstrates the possibility of successful use of autologous fibrinogen adhesive in human epikeratophakia. Autologous adhesive would remove the possible threat of transmitted disease posed by multi-donor adhesive and avoid immune reactions to foreign proteins.

Animals↗