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Results for “Aphakia, Postcataract”

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PubMed1979

The lens and pars plana vitrectomy for diabetic retinopathy complications.

Major cataracts developed in 28 of 168 eyes during the six months after pars plana vitrectomy for complications of diabetic retinopathy. In only ten of these cases did the cataract influence the visual results. The visual acuities of the phakic and aphakic eyes six months after vitrectomy were almost identical. Rubeosis iridis occurred in 23% of the phakic eyes and 45% of the aphakic eyes, with the difference being related to the loss in the aphakic eyes of a protective barrier lens quality. However, this same barrier quality increased the incidence of postoperative opaque vitreous hemorrhage from 8% of the aphakic eyes to 21% of the phakic eyes. Corneal epithelial edema at surgery occurred in 55% of those eyes that had lens removal combined with vitrectomy, but in only 36% of those that retained their lenses, and the difference was caused by the increase in operative time and procedure.

Adult↗

PubMed1979

Drainage of microspheres and RBCs from the vitreous of aphakic and phakic eyes.

The movements of plastic microspheres (7 to 10 mu in diameter) and autologous RBCs labeled with sodium chromate Cr 51 from the vitreous to the anterior chamber were studied in 24 rabbit eyes. Rabbits were made aphakic in one eye by intracapsular lens extraction of lensectomy via the pars plana, the fellow eyes serving as phakic controls. In phakic eyes the intravitreally injected microspheres and RBCs were retained inside the vitreous space, not gaining access to the anterior chamber. In aphakic eyes microspheres and RBCs moved to the anterior chamber and were usually seen on the corneal endothelium and in the chamber angle within two to ten days, although most particles remained in the vitreous for long periods of time. Removal of the lens thus improved forward drainage of particles from the vitreous space, but the structure of the vitreous seemed to preclude rapid clearance.

Animals↗

PubMed1979

Epithelialization of the anterior chamber: clinical investigation with the specular microscope.

Four patients, each of whom had had an uncomplicated cataract extraction, were examined because of an apparent epithelialization of the anterior chamber. In each instance, the diagnosis was later verified histopathologically. The involved eye was photographed with the clinical specular microscope and the endothelial photomicrographs were analyzed. It was noted that considerable endothelial cell loss had occurred, as evidence by the larger size of the remaining cells. Endothelial cells were present but they were grossly abnormal well below the demarcation line visible with the slit-lamp biomicroscope. These in vivo observations support the thesis that damage to the corneal endothelium is a necessary factor for epithelial invasion of the anterior chamber.

Aged↗

PubMed1979

360 degrees prophylactic cryoretinopexy. A clinical and experimental study.

Complications occurred after 360 degrees prophylactic cryoretinopexy in three of six eyes in which fellow eyes had previously developed aphakic retinal detachment. Two of the six prophylactically treated eyes developed retinal detachment in advance of anticipated cataract surgery, and a third developed vitreitis and progressive preretinal membrane formation after uncomplicated cataract extraction. In an experiment study with rhesus monkeys, preretinal membrane formation was produced by administering heavy freezes with 360 degrees cryoretinopexy. Although the quantities of cold were considered excessive for clinical use, the cryoretinopexy used clinically in this series must also be considered excessive. The use of 360 degrees cryoretinopexy in the management of eyes at high risk for retinal detachment must be considered judiciously. Particular caution must be exercised in administering cryoretinopexy to nondetached retinas so as to avoid heavy freezes, which destroy the linear retinal layers.

Aged↗

PubMed1979

Argon laser photocoagulation of the ciliary processes in cases of aphakic glaucoma.

A new procedure for the treatment of uncontrolled aphakic glaucoma has been the subject of a carefully conducted prospective clinical trial in 14 patients. The study spanned more than five years. The transpupillary argon laser photocoagulation of the ciliary process procedure, done on an outpatient basis, shows promise as a convenient, low-risk, and useful alternative procedure in selected aphakic glaucoma cases that are poorly controlled by medical or surgical measures. This new approach may also be used as an adjunct in the medical and/or surgical management of aphakic ciliary block glaucoma. The magnitude of intraocular pressure reduction is directly related to the number of ciliary processes coagulated and the level of laser energy applied. The indications for this new procedure are generally similar to that of the cyclocryotherapy.

Adult↗

PubMed1980

Anterior ischemic optic neuropathy. IV. Occurrence after cataract extraction.

Findings are described from 13 eyes in which post-cataract-extraction anterior ischemic optic neuropathy (PCE-AION) developed immediately after an uncomplicated cataract extraction. During the early stages of the disease, the disc is edematous, with optic disc-related visual-field defects, but after about two months, the disc is pale. The almost invariable high rise of intraocular pressure during the immediate postoperative period plays a critical role in production of PCE-AION in eyes with vulnerable optic nerve head circulation. There is a high risk of development of PCE-AION in the second eye in patients with PCE-AION in the first eye, but this can be prevented by prophylactic measures. Post-cataract-extraction AION needs to be differentiated from ordinary AION seen in aphakic eyes months or years after the cataract extraction.

Adult↗

PubMed1981

Aphakic cystoid macular edema in children.

Twenty-five eyes of 18 pediatric patients (aged 7 1/2 months to 14 years 8 months) who had had cataract extractions were examined for evidence of cystoid macular edema (CME) with fluorescein angiography. No patient showed CME when studied from five weeks to four years after surgery. One patient with Peter's anomaly, glaucoma, and chronic iridocyclitis had intense fluorescence of the aqueous and vitreous that precluded evaluation of the macula. Even if this patient is assumed to have had CME, its incidence in our population of aphakic pediatric patients was no more than 4%.

Adolescent↗

PubMed1982

A new glare tester for clinical testing. Results comparing normal subjects and variously corrected aphakic patients.

A simple, inexpensive, readily available, easy-to-service clinical glare tester combines an audioviewer able-top projector with a series of specially made slides. Each slide supplies a constant glare source and a variable-contrast, central target. The device was evaluated on 161 normal subjects, 144 patients with cataracts, and 110 aphakic patients whose visual acuity was corrected with spectacles or intraocular lenses. Results showed that aphakic patients, irrespective of the mode of correction, were statistically more glare sensitive than normal phakic patients. Further results confirmed earlier studies that demonstrated that glare sensitivity also increased with age in normal eyes. Broad potential exists for using this method of glare testing in industry, transportation media, and medicolegal and and clinical ophthalmologic studies.

Aged↗

PubMed1982

Epidemiology of retinal detachment.

A survey of rhegmatogenous retinal detachment during 1976 was conducted on the population of Iowa. The annual incidences (per 100,000 populations) of four types of detachment were determined: nontraumatic phakic (6.1), traumatic phakic (1.0), nontraumatic aphakic (4.9), and traumatic aphakic (0.4). The incidences of nontraumatic phakic detachment for men and women were similar, although there was a preponderance of women that reflected their greater representation in the general population. The proportions of men were significantly higher in traumatic detachments compared with nontraumatic detachments. Men tended to be younger than women for all types of detachment; however, only in nontraumatic aphakic detachment was there a significant difference between mean ages. There was an insignificant preponderance of right eye involvement in all four detachment groups.

Adolescent↗

PubMed1982

Disposition of topical flurbiprofen in normal and aphakic rabbit eyes.

In a study of the ocular absorption and elimination of a topically applied non-steroidal anti-inflammatory drug (NSAID), flurbiprofen, the compound was well absorbed into rabbit ocular tissues and was highly concentrated in the rabbit cornea. In aphakic eyes, more drug penetrated to the vitreous and choroid-retina area than in normal rabbit eyes, although corneal concentrations were still high. No ocular metabolism of flurbiprofen could be detected, and the ocular route of application did not lead to any changes in blood elimination rates or metabolism when compared with intravenously injected drug. Currently, no NSAID is available for topical ocular use, and the development of such a drug is desirable for treatment of ocular inflammations, especially when long-term treatment is indicated.

Absorption↗

PubMed1982

Aphakic cystoid macular edema: occurrence in infants and children after transpupillary lensectomy and anterior vitrectomy.

Twenty-seven children and infants underwent surgery for bilateral infantile cataracts. In each infant, the lens in one eye was removed by discission and aspiration, and the other lens was removed by lensectomy and anterior vitrectomy. Ten of 27 eyes undergoing lensectomy and vitrectomy developed aphakic cystoid macular edema; in only one eye that underwent discission and aspiration did macular edema develop. Six of the eyes of the first group developed persistent cystoid macular edema, of which four seem to be visually important. Further long-term studies of the prevalence and functional importance of cystoid macular edema after lensectomy and anterior vitrectomy in children are needed. We do not presently advocate this technique except in the treatment of complicated infantile cataracts.

Aphakia, Postcataract↗

PubMed1982

Blood-retinal barrier in eyes with long-standing aphakia with apparently normal fundi.

Vitreous fluorophotometry was used to evaluate the integrity of the blood-retinal barrier in 130 eyes with long-standing aphakia and apparently normal fundi. All patients had undergone intracapsular lens extraction because of senile cataract and had been followed up for approximately one year (group 1) or three years (group 2). Thirty normal eyes served as controls. Thirty minutes or one hour after intravenous administration of fluorescein sodium, 50 of 130 aphakic eyes (32 of 70 group 1 eyes; 18 of 60 group 2 eyes) and three of 30 control eyes were judged abnormal in breakdown of the blood-retinal barrier. In aphakic eyes, the older the age at operation, the higher the incidence of barrier breakdown. These results indicate that the blood-retinal barrier remains disrupted for a longer postoperative period than was previously thought, and that the incidence of barrier breakdown relates to the age at operation. Although these findings reflect subclinical phenomena, they are biologically important.

Age Factors↗

PubMed1982

The ultrastructure of Descemet's membrane. II. Aphakic bullous keratopathy.

The ultrastructure of Descemet's membrane was studied by transmission electron microscopy in nine corneal buttons from aphakic eyes with bullous keratopathy. All nine corneas had abnormal collagenous material in the posterior portion of Descemet's membrane. Five of the buttons had abnormalities in layers of Descemet's membrane secreted at an early age. These abnormalities are evidence of endothelial dysfunction long before cataract extraction. In the remaining four corneas, the Descemet's membrane secreted prior to cataract extraction remained relatively normal, despite corneal endothelial decompensation for up to five years. Thus, the layers of Descemet's membrane remain relatively unchanged after their formation and serve as a historic record of one aspect of endothelial function.

Aged↗

PubMed1983

Extended-wear soft contact lenses for aphakic correction.

Evaluation of an extended-wear perfilcon A soft contact lens (Permalens) in 299 eyes of 244 patients showed that 266 eyes (89%) were successfully fitted and wore the lenses without important complications (mean follow-up, 23 months; range, four to 48 months). Use of the lens in 33 eyes was discontinued because of transient lens-related problems. "Overcorrected" acuity of 6/12 (20/40) or better (with spectacles plus the contact lens) was achieved in all patients who were without vitreous, retinal, or optic nerve disease. Seventy-six percent of patients could wear the lens for longer than one-month intervals, and 30% removed the lens at four- to six-month intervals. There were no cases of infectious corneal ulcers or scarring or permanent visual loss. Our more limited experience with lidofilcon B lenses (Sauflon PW) (24 eyes) and the silicone lenses (Silsoft) (25 eyes) also showed beneficial results.

Aged↗

PubMed1983

Penetration of topical indomethacin into phakic and aphakic rabbit eyes.

The penetration of indomethacin labeled with radioactive carbon (14C) into all ocular tissues and fluids was determined at various intervals in both phakic and aphakic rabbit eyes after either single or multiple (every 12 hours for three days) topical application (50 microL) regimens. More indomethacin was found in the vitreous of aphakic eyes compared with phakic eyes after single- or multiple-drop administration. Retinal and choroidal indomethacin concentrations were equal in both phakic and aphakic eyes after either drug regimen and are much greater than those of the vitreous. A pathway other than diffusion through the vitreous exists for the drug to reach these tissues. The concentration of indomethacin reaching the retina and choroid is not sufficient to inhibit prostaglandin formation locally. The concentrations of indomethacin are high enough to inhibit the biotransformation of prostaglandin precursor only in the anterior segment.

Administration, Topical↗

PubMed1983

Spectral sensitivity of the pseudophakic eye.

Spectrophotometric measurements indicated that polymethyl methacrylate intraocular lenses do not mimic the crystalline lens in absorption of shortwave visible light and near-UV light. These wavelengths are particularly effective in producing photochemical damage to the retina. Scotopic spectral sensitivity functions directly confirmed that patients with intraocular lens implants are much more sensitive than normal to these wavelengths (by as much as a factor of 46 at 380 nm).

Aged↗

PubMed1983

Corneal edema accompanying aphakic extended lens wear.

Corneal swelling was monitored for nine hours in 14 unilateral aphakic patients who wore +13.25-diopter extended-wear lenses. After closed-eye wear, the corneal swelling was 6.9% and 11.4% for aphakic and phakic eyes, respectively. To determine if aphakic corneal swelling could be predicted from either corneal epithelial oxygen uptake or hypoxic corneal swelling, we measured epithelial oxygen uptake and corneal swelling from hypoxia. These were 3.67 mm Hg/s and 3.96 mm Hg/s and 8.0% and 12.1% for the aphakic and phakic eyes, respectively. Differences in these measurements between aphakic and phakic eyes were significant, but correlations of oxygen uptake rate and hypoxic swelling response to extended-wear edema were modest. A high intrasubject correlation between the edema accompanying extended-wear was found indicating that postsurgical extended-wear corneal edema may be predicted by measuring presurgical extended-wear corneal edema.

Adult↗

PubMed1983

Extended-wear aphakic soft contact lenses after penetrating keratoplasty.

Seven patients undergoing aphakic keratoplasty or combined keratoplasty and cataract extraction were fitted with a single type of high-water-content, extended-wear, aphakic soft contact lens (Permalens). Six patients were fitted early after keratoplasty, ie, before the removal of the sutures and while they were still receiving corticosteroid drops (1% prednisolone acetate). The patients were followed up at close intervals with high-magnification serial corneal photography. Complications of extended wear included superficial neovascularization, punctate epithelial keratitis, and variable visual acuity. Our results suggest that although extended-wear aphakic soft contact lenses may be an acceptance form of visual rehabilitation in selected patients who undergo transplantation, they are frequently problematic. In addition, fitting of these lenses should be withheld until after the removal of the sutures, and patients should be followed up at closer intervals than the patients with extended-wear aphakic soft contact lenses who have not undergone keratoplasty.

Adult↗