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PubMed1989

[Implantation of posterior chamber IOL after traumatic cataract extraction].

Traumatic cataracts are often complicated with posterior capsule perforation and opacity to render implantation of posterior chamber IOL difficult. The authors operated on 62 cases using McIntyre's canula and Peyman's vitrophage with satisfactory results. The visual acuity was 0.5 or better in 66%, 0.7 or better in 45%, less than 0.1 in 3 patients because of vitreous opacity and corneal leucoma. In 2 cases associated with aniridia, the IOL was implanted into the capsule bag to obtain visual acuity of 1.2 and 1.0. In 4 patients with intraocular foreign body, the combined operation of foreign body and cataract extraction, vitrectomy, and posterior chamber IOL implantation was performed.

Adolescent↗
PubMed1989

Warfarin and cataract extraction.

Ten cataract extractions were performed on eight patients for whom warfarin was not discontinued prior to surgery. Three were complicated by hyphaema. No retrobulbar haemorrhages occurred in the four cases given a local anaesthetic. Cataract surgery can be performed successfully without discontinuing warfarin.

Aged↗
PubMedDate not supplied

[Anterior capsulectomy in extracapsular cataract extraction].

Extracapsular cataract extraction involves several stages, one of which is anterior capsulectomy. Up to present anterior capsulectomy was performed before removal of the lens sac contents in the majority of cases, this ruling out the use of the anterior capsule of the lens as a posterior corneal epithelium protector. The author has developed two types of scissors that permit resection of the anterior capsule of the lens before removal of the lens mass. The technique of the operation used in 43 surgeries is described, and the results of clinical follow-up presented.

Cataract Extraction↗
PubMed1981

Effects on the corneal endothelium of anterior chamber reconstituents instilled during intracapsular cataract extraction.

Intracapsular cataract extractions with a standardized technique were performed on a series of patients. The loss of corneal endothelial cells was found to vary predictably with the material instilled into the eye to reconstitute the anterior chamber. Reconstitution with Miochol was associated with minimal constant cell loss, while reconstitution with air resulted in greater cell loss in the early than in the late postoperative period. The additional instillation of phenylephrine enhanced the endothelial cell loss in both the early and late postoperative periods. In the ideal operation, attention should be paid not only to be amount of corneal manipulation but also to the material chosen to reconstitute the anterior chamber.

Acetylcholine↗
PubMed1993

Pseudoexfoliation syndrome and extracapsular cataract extraction.

Extracapsular cataract extraction (ECCE) in 139 eyes with pseudoexfoliation syndrome was compared to 762 eyes without pseudoexfoliation syndrome in a consecutive study. Preoperative findings, operative procedure and problems were registered, stored and analyzed in a computer program package. Of the patients with pseudoexfoliation syndrome 88.5% were 70 years or older, compared to 67.2% of the patients without pseudoexfoliation syndrome (p < 0.001). Glaucoma occurred in 48.9% of eyes with pseudoexfoliation syndrome and in 6.8% of eyes without pseudoexfoliation syndrome, respectively. Poorly dilated pupil was demonstrated in 46.8% and in 5.8% of eyes with and without pseudoexfoliation syndrome, respectively. Capsule/zonulae tears (without vitreous loss) occurred in 4.3% of the pseudoexfoliation syndrome eyes, compared to 1.3% in eyes without pseudoexfoliation syndrome (p < 0.05). The incidence of vitreous loss was similar in both groups. We found no correlation between the pupil size and capsule/zonulae tears or vitreous loss in either group. In conclusion, when appropriate care is undertaken, ECCE with posterior chamber IOL implantation is a safe procedure in pseudoexfoliation syndrome eyes.

Aged↗
PubMed1996

Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study.

AIMS: To estimate the risk of retinal detachment (RD) following cataract extraction in Denmark, and to compare the risk with that following cataract extraction in the USA, and with that in a sample of Danish patients who did not have ocular surgery. METHODS: A sample was created from the administrative Danish Hospital Register and included 19,252 patients who underwent first eye cataract surgery between 1985 and 1987, and who were 50 years of age or older. The patients were then followed for 4-6 years using the register data. The design and definition of events were identical to the US National Study of Cataract Outcomes. RESULTS: In Denmark a 4 year cumulative risk of hospitalisation for RD of 0.93% (95% confidence interval (CI) 0.71-1.16) was observed following an extracapsular cataract extraction with a lens implant. A similar cumulative risk of RD was reported from the US study. Thus, no difference in outcomes concerning risk of RD was shown between Denmark and the USA. In a multivariate analysis younger age, male sex, and intracapsular cataract extraction were all associated with higher risk of postoperative RD. A reference group of 7636 people not undergoing any ocular surgery was created and the incidence of RD in this group was calculated. During the sixth year following cataract surgery, the incidence of RD in the cataract group was still 7.5 (95% CI 1.6-22.0) times higher than that observed in the reference group.

Age Factors↗
PubMed2006

[Oblique nuclear chopping and nuclear extraction by binding procedure for cataract extraction].

OBJECTIVE: To investigate the effects of oblique nuclear chopping and nuclear extraction by binding procedure (ONCNEB) in cataract extraction. METHODS: Extracapsular cataract extraction by ONCNEB with foldable IOL implantation was performed in 86 senile cataract cases (97 eyes) by using a line-shaped cataract nuclear chopping apparatus developed by the authors. RESULTS: In 97 eyes treated with ONCNEB, there was posterior capsular rupture in 1 eye; anterior chamber hemorrhage in 2 eyes; elevated intraocular pressure in 6 eyes; mild corneal edema in 8 eyes which subsided within 5 days. Corrected visual acuity > or = 0.5 was obtained in 78 eyes (80.41%) one week and 91 eyes (93.81%) three months after the operation. Corrected visual acuity was > or = 1.0 in 66 eyes (68.04%) three months after the operation. Mean astigmatism one week and three months postoperatively showed not significant difference as compared with preoperative astigmatism. CONCLUSION: The ONCNEB can solve the problem of implanting foldable IOL through a small incision. This procedure is relatively simple and safe.

Aged↗
PubMed1997

Risk of endophthalmitis after cataract extraction: results from the International Cataract Surgery Outcomes study.

AIM: To estimate risk of infectious endophthalmitis after cataract extraction in Denmark and to compare results with the risk of this complication in the USA. METHODS: In the national Danish administrative hospital register, 19,426 patients were identified who underwent first eye cataract surgery from 1985 to 1987 and who were 50 years of age or older. Of these, 61 patients had postoperative endophthalmitis. RESULTS: A 12 month cumulative risk of rehospitalisation for endophthalmitis was estimated at 0.18% (95% CI 0.09-0.26) after extracapsular cataract extraction with lens implant. Advanced age, male sex, intracapsular cataract extraction, and anterior vitrectomy were all associated independently with an increased risk of postoperative endophthalmitis. When restricting the sample to patients aged 65 years or older, in order to allow comparisons to be made with the US National Study of Cataract Outcomes, a 12 month risk of 0.17% (95% CI 0.08-0.25) was estimated. The previously reported US risk of 0.12% is included in the confidence interval of the risk estimated in the Danish sample. CONCLUSION: Despite considerable differences in the healthcare systems, no statistically significant difference in outcome of surgery as measured by risk of endophthalmitis was shown between Denmark and the USA.

Aged↗
PubMed1994

Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To better define the effectiveness and risks of modern cataract surgery. DESIGN: Meta-analysis (formal systematic identification, selection, review, and synthesis) of published literature. PATIENTS: Patients described in 90 studies published between 1979 and 1991 that addressed visual acuity (n = 17,390 eyes) or complications (n = 68,316 eyes) following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phaco-emulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: The proportion of eyes with postoperative Snellen visual acuity of 20/40 or better and the proportion of eyes with each of 18 complications. RESULTS: The pooled percentage of eyes (weighted by sample size) with postoperative visual acuity of 20/40 or better was 95.5% (95% confidence interval [CI], 95.1% to 95.9%) among eyes without preexisting ocular comorbidity and 89.7% (95% CI, 89.3% to 90.2%) for all eyes. The pooled percentage of eyes experiencing complications (weighted by sample size and, when pertinent, by quality score of the individual studies but not adjusted for variation in duration of follow-up) ranged from 0.13% for endophthalmitis to 19.7% for posterior capsule opacification. Pooled proportions of eyes with other complications were as follows: bullous keratopathy, 0.3%; intraocular lens malposition/dislocation, 1.1%; clinically apparent cystoid macular edema, 1.5%; and retinal detachment, 0.7%. Pooled results for postoperative Snellen visual acuity and most complications were similar for surgery performed via phacoemulsification vs standard extracapsular cataract extraction, although comparisons of the outcomes between these procedures should be interpreted with caution. CONCLUSIONS: The published literature indicates that modern cataract surgery yields excellent visual acuity and, although not free of complications, is a very safe procedure regardless of the extraction technique used.

Aged↗
PubMed1989

Endocapsular cataract extraction.

Endocapsular (intercapsular) cataract surgery has recently gained popularity, particularly in Europe. We describe our technique of endocapsular cataract extraction and insertion of an intraocular lens and prospectively compare 93 eyes which underwent endocapsular cataract extraction with 83 which underwent a standard extracapsular procedure. There was no apparent difference between the two groups in visual outcome. Preoperative and post-operative complications were more common in the endocapsular group: posterior synechiae formation in the latter occurred in 19%. In 90% of the endocapsular cataract extractions, the lens was placed 'in the bag' at the time of surgery but at three months only 53% remained 'in the bag'. Displacement of one haptic from the capsular bag was associated with symptomatic lens decentration requiring repositioning in four eyes in the endocapsular group and two eyes in the extracapsular group.

Adult↗
PubMedDate not supplied

[Endothelial damage after planned extracapsular cataract extraction and phacoemulsification of hard cataracts].

PURPOSE: To evaluate and compare the endothelial damage after planned extracapsular cataract extraction (ECCE) and phacoemulsification of very hard cataracts. METHODS: In this prospective, randomized study, 41 patients with age-related and very hard cataract were divided into two groups: in group 1 (21 patients) an extracapsular cataract extraction was performed and in group 2 (20 patients), phacoemulsification. In both groups, intraocular lenses were implanted in the capsular bag. Preoperatively and 1, 3 and 6 months postoperatively, a complete ophthalmological examination, endothelial specular microscopy, and ultrasonic pachymetry were done. Endothelial cell loss, pleomorphism, polymegathism and corneal thickness were studied. RESULTS: Both groups presented an endothelial cell loss in the postoperative time, as compared with the preoperative values, but there were no significant differences among the postoperative values (1, 3 and 6 months). Six months after surgery, mean cell loss was 28.50% in group 1 and 34.77% in group 2. There were no differences among the indexes of pachymetry, polymegathism and pleomorphism between the two groups. CONCLUSIONS: Endothelial response was not statistically different between the two studied groups.

Aged↗
PubMed1994

Rigor of research methods in studies of the effectiveness and safety of cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team.

OBJECTIVE: To assess the rigor of research methods reported in studies of the safety or effectiveness of contemporary cataract surgery. DESIGN: Formal systematic identification of pertinent studies and critical appraisal of each study's research methods. SUBJECTS: From 6113 unique, potentially relevant citations that we identified, 90 original studies published between 1979 and 1991 that addressed visual acuity or complications following standard extracapsular cataract extraction with posterior chamber intraocular lens implantation, phacoemulsification with posterior chamber intraocular lens implantation, or intracapsular cataract extraction with flexible anterior chamber intraocular lens implantation. MAIN OUTCOME MEASURES: Strength of study design, performance, and reporting in 11 methodologic areas assessed with a standardized abstraction form by two reviewers masked to authors, their institutions, and the journal of publication. Results of reviews were tallied to produce an overall quality score (measure of rigor in research methods) for each study. RESULTS: The mean (+/- SD) quality score was 43.1 +/- 20.1 out of a maximum possible score of 100. Studies received intermediate scores on description of baseline ocular disease and low scores on descriptions of other characteristics of enrolled patients, standardization of outcome assessment and follow-up duration, and handling of patient attrition. Eighty-three studies (92%) lacked a comparison group. The rigor of research methods in studies varied by the journal of publication, did not improve over time, and was no greater for studies with larger vs smaller sample sizes. CONCLUSIONS: The rigor of research methods in studies of cataract surgery can be improved if more attention is paid to fundamental principles of study design, data analysis, and reporting.

Cataract Extraction↗
PubMed1987

Cataract extraction after vitrectomy.

Cataract extractions were performed in 25 patients who had previously undergone pars plana vitrectomy. Posterior chamber IOLs were implanted in 20 of 26 eyes. Modification of the usual surgical technique was often necessary because the zonules and/or posterior capsule were unusually mobile. Lens opacities were nuclear sclerotic in 17 eyes (65%) and posterior subcapsular in nine eyes (35%). Visual acuity improved an average of five lines, and final visual acuity was 20/50 or better in 13 eyes (50%). Visual acuity after cataract extraction closely paralleled the best visual acuity after vitreous surgery in all patients. Complications were tears in the posterior capsule in two eyes and postoperative vitreous hemorrhage in one eye. These complications did not limit final vision.

Adolescent↗
PubMed1996

Cataract extraction in Behçet's disease.

Cataract is one of the most common complications of ocular inflammation due to Behçet's disease. A retrospective clinical trial was performed to review the management and discuss the outcome of cataract extraction in patients with Behçet's disease in order to find the best method of treatment. Fifty-five eyes of 40 patients were included into the study group. The surgical methods used were intracapsular cataract extraction (ICCE), extracapsular cataract extraction (ECCE), extracapsular cataract extraction+intraocular lens (ECCE+IOL), and extracapsular cataract extraction+trabeculectomy (ECCE+T). The postoperative visual prognosis was not satisfactory with any of the surgical methods because of the severe posterior segment complications of ocular Behçet's disease, particularly optic atrophy.

Adolescent↗