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PubMed1986

Extracapsular cataract extraction and primary posterior chamber lens implantation.

We reviewed the charts of 420 consecutive extracapsular cataract extraction cases in which the surgeon's primary intention was to implant a posterior chamber lens. Posterior chamber lens implantation was precluded in eight cases (1.9%) because of vitreous loss or capsule dehiscence. A visual acuity of 20/40 or better was achieved by 83.8% of patients. When nonoperative causes of poor vision were eliminated, this result was achieved by 96.7% of patients. The percentage of patients achieving 20/40 or better acuity decreased with increasing age but remained constant despite varying follow-up periods. The most common complication was opacification of the posterior capsule, occurring in 25.7%; 83.8% of the complications occurred during the first two postoperative years. We conclude that extracapsular cataract extraction with primary posterior chamber lens implantation is an efficient way to restore good vision after cataract formation and that the results appear to remain stable over time.

Adult↗
PubMed2000

Characteristics after cataract extraction or secondary lens implantation among patients screened for the Endophthalmitis Vitrectomy Study.

PURPOSE: This report describes the presenting clinical ophthalmic features and historical findings in patients with a clinical diagnosis of endophthalmitis after cataract extraction or secondary lens implant surgery screened for enrollment in the Endophthalmitis Vitrectomy Study (EVS). DESIGN: Clinic-based, cross-sectional study. PARTICIPANTS: Eight hundred fifty-four patients suspected to have endophthalmitis after cataract extraction or secondary lens implantation. METHODS: As part of the screening process for the study, an eye examination, a medical history, and demographic data were recorded in standardized form for all patients with endophthalmitis after cataract extraction or secondary lens implant surgery referred to the clinical centers, regardless of whether the patient met entry criteria. MAIN OUTCOME MEASURES: Demographics, presenting signs, and symptoms. RESULTS: The median age of individuals presenting with suspected bacterial endophthalmitis was 75 years (range, 9-100 years). Most of those screened (57.7%) were women. Seventy-nine percent of patients sought treatment within 6 weeks of surgery. Blurred vision, conjunctival injection, pain, and lid swelling were the predominant presenting symptoms in order of prevalence. Ocular pain and hypopyon, widely regarded as diagnostic of endophthalmitis, were each absent in 25% of patients. The median hypopyon height, when present, was 1.5 mm. CONCLUSIONS: The classic presentation of postoperative endophthalmitis includes reduced vision, conjunctival hyperemia, pain, hypopyon, and lid swelling within days after cataract surgery or secondary lens implantation. These were the prominent clinical findings in the EVS as well. Because pain and hypopyon, although common, were not always present, clinicians must be vigilant in postsurgical monitoring of patients.

Adolescent↗
PubMed1987

Alteration of trabecular aqueous flow after cataract extraction.

Two human eyes that had undergone intracapsular cataract extraction were perfused with cationized ferritin. In both eyes segmental areas of trabecular meshwork collapse were demonstrated superiorly, adjacent to the cataract incision. Electron-microscopic study of these regions disclosed no labeling of the trabecular beams and trabecular spaces, suggesting impermeability to aqueous flow. In other regions, a diffuse labeling with cationized ferritin was demonstrated throughout the trabecular spaces, indicating aqueous flowthrough. Use of corneoscleral sutures may cause trabecular collapse and impermeability. When the collapse is extensive, subsequent increase in intraocular pressure may follow.

Aged↗
PubMed1994

Vision related daily life problems in patients waiting for a cataract extraction.

Problems in daily life activities caused by bad vision were studied in 150 patients with cataract before and 6 months after a cataract extraction. A relation was found between binocular visual acuity before surgery and the number of problems experienced (p < 0.001). After cataract extraction a reduction in problems was closely associated with an increase in visual acuity (p < 0.001) and also, in the patients' opinion, a better life situation (p < 0.001). Six questions to be answered when considering surgery are given.

Activities of Daily Living↗
PubMed1987

Limited choroidal hemorrhage associated with extracapsular cataract extraction.

Limited choroidal hemorrhage was observed in eight (2.2%) of 368 eyes subjected to extracapsular cataract extraction, compared with a rate of 3.07% in our previous study, in which the technique employed was intracapsular extraction. The difference was found to be significant only for eyes with high myopia. Myopia was found to be the main risk factor for the development of limited choroidal hemorrhage, especially when general anesthesia was used. The presence of glaucoma or the combination of extracapsular cataract extraction and trabeculectomy may increase the susceptibility to this complication. The occurrence of limited choroidal hemorrhage did not affect the final visual function.

Adult↗
PubMed2003

Erbium:YAG laser in cataract extraction.

Erbium:yttrium-aluminum-garnet (Er:YAG) cataract extraction has shown considerable promise as a new technique for lens nucleus removal prior to intraocular lens (IOL) implantation for the treatment of cataracts. Recent studies suggest that the laser energy is dissipated much more locally and heats surrounding intraocular tissues less than traditional ultrasonic phacoemulsification does. Clinical studies demonstrate the safety of the procedure in human cataract patients, and a randomized study found little difference in outcomes when compared to conventional cataract surgery. Further advances in fiber optic delivery systems and handpiece development may make this approach even more attractive in the future.

Cataract↗
PubMed1979

Exacerbation of senile macular degeneration following cataract extraction.

Six eyes in four patients had hemorrhagic detachment of the retinal pigment epithelium following cataract extraction. All eyes had evidence of nonexudative senile macular degeneration preoperatively as manifested by drusen or alterations in the retinal pigment epithelium, or both. Postoperatively, all eyes had evidence of a subretinal neovascular membrane manifested by the presence of subretinal hemorrhage or by evidence on fluorescein anglography. We believe cataract extraction may cause changes in the choroidal hemodynamics that allow pre-existing new blood vessels to leak or bleed, or induces the formation of choroidal neovascularization in a predisposed eye.

Aged↗
PubMed2002

A prospective study of the relationship between body mass index and cataract extraction among US women and men.

BACKGROUND: Obesity may influence several physiologic processes involved in cataract formation such as oxidative stress, glycosylation and osmotic stress. OBJECTIVE: To examine the association between increased body mass index (BMI) and the incidence of cataract extraction. DESIGN AND SETTING: The Nurses' Health Study and the Health Professionals Follow-up Study, both prospective cohort studies of US women and men. SUBJECTS: A total of 87 682 women and 45 549 men aged 45 y and older who did not have diagnosed cataract or cancer at baseline (1980 for women, 1986 for men). MEASUREMENTS: Cataract extractions occurring between baseline and 1996, confirmed by medical records. RESULTS: During 16 y of follow-up in the women, and 10 y in the men, (1 097 997 person-y), 4430 incident cases were documented. Compared to participants with BMI less than 23 kg/m(2), those with BMI greater than or equal to 30 kg/m(2) had 36% higher risk of any type of cataract (pooled multivariate relative risk (RR), 1.36; 95% CI, 1.23-1.49) after adjusting for smoking, age and lutein/zeaxanthin intake. The association was strongest for posterior subcapsular (PSC) cataract (pooled multivariate RR, 1.99; 95% CI, 1.55-2.55). With adjustment for diabetes, the RR of obesity associated with posterior subcapsular cataract was 1.68 (95% CI, 1.30-2.17). Obesity was not significantly associated with nuclear cataract. CONCLUSION: Obesity increases the risk of developing cataract overall, and of PSC cataract in particular; the etiology of PSC cataract may be mediated at least in part by glucose intolerance and insulin resistance, even in the absence of clinical diabetes.

Aged↗
PubMed1978

Vitreous loss during intracapsular cataract extraction.

Among 448 patients operated upon for bilateral cataracts (896 eyes), vitreous was lost in 96 eyes, an incidence of 10.7%. The most striking difference between the whole group of eyes without vitreous loss (800 eyes) and those with vitreous loss is in the percentage of eyes able to perform a very good visual acuity postoperatively. An analysis of 50 cases losing vitreous unilaterally shows the following: (a) more than 80% of eyes with vitreous loss achieved a vision comparable to their fellow eyes; (b) 12% of eyes with vitreous loss achieved a poorer vision than their fellow eyes; and (c) fewer eyes with vitreous loss achieved a very good visual acuity as compared to their fellow eyes (8.7% to 11.1% in eyes with vitreous loss as compared to 21.5% to 22.2% of fellow eyes). The combination of vitreous loss with an accidental extracapsular cataract extraction had a worsening effect on the expected postoperative visual performance.

Cataract Extraction↗
PubMed1998

[The effect of corneal incision method on astigmatism after cataract extraction].

PURPOSE: To assess the effect of the type of corneal incision and its closure on astigmatism after cataract extraction. MATERIAL AND METHODS: Induced astigmatism was evaluated in 94 eyes after cataract extraction with IOL implantation 7 days, 1 month, 3 months, 6 months and 12 months after operation. 3 groups: were compared I--after extracapsular extraction with corneo-scleral incision (10 h-2 h) and continuous cross-like suture, II--after phacoemulsifications with scleral tunnel incision (3.3 mm) without suture. RESULTS: The highest induced astigmatism was observed 7 days after surgery in patients with the longest corneo-scleral incision with suture (group I). Induced astigmatism gradually decreased in time. In group after phacoemulsification especially with no suture low astigmatism with prompt stabilization was observed. CONCLUSIONS: The length and type of closure of the incision have an essential effect on induced astigmatism. Small incision, especially without suture induces minimal early postoperative astigmatism which remains stabile.

Adult↗
PubMed1992

Secondary cataract in infants after extracapsular cataract extraction and anterior vitrectomy.

Two infants developed secondary cataract after undergoing extracapsular cataract extraction (ECCE), posterior chamber intraocular lens (IOL) implantation, posterior capsulectomy, and anterior vitrectomy. A similar complication developed in a third child, who had undergone ECCE and posterior capsulotomy. The secondary cataracts developed in these patients from 3 to 12 weeks after the primary operation. In infants, unlike adults, posterior capsulectomy and anterior vitrectomy after ECCE do not seem always to prevent secondary cataracts. In infants, the complication may be related to IOL implantation.

Anterior Eye Segment↗
PubMed1998

[Peripheral corneal edema after cataract extraction].

OBJECTIVE: To report a rare type of corneal edema, i.e. peripheral corneal edema after cataract extraction---Brown-Mclean syndrome. METHODS: Clinical charts of 8 affected eyes in 5 patients were reviewed. Ultrasound pachymetry was used to determine central corneal thickness. Cell densities were measured by specular microscopy. The clinical characteristics and pathogenesis were discussed. RESULTS: The average time from operation to initial diagnosis was 10.5 years. The typical edema started inferiorly and progressed circumferentially, but central portion of the cornea was clear. The corneal thickness at edematous area was increased. The cell counts of endothelium was decreased in our patients. Additionally, the edema was associated with a punctate orange-brown pigmentation on the endothelium. CONCLUSIONS: So far this new syndrome of corneal edema has not been reported in china. Its clinical characteristics are not similar to that of conventional edema after intracapsular cataract extraction. The pathogenesis of this curious condition is still unknown. It may be associated with an aphakic eye, chronic uveitis and hereditary factors.

Adult↗
PubMed1982

Reduction in endothelial cell density following cataract extraction and intraocular lens implantation.

Comparison of endothelial cell density by specular photomicroscopy of the right and left eyes after single eye surgery shows a similar reduction in endothelial cell density to that recorded between pre- and postoperative photographs in the operated eye. A review of 43 single-eye cataract extractions, with and without placement of a prepupillary intraocular lens, confirms that the major cause of endothelial cell loss is operative trauma to the endothelium. In our experience a cataract extraction with lens implantation but without endothelial contact produces no greater reduction in cell density than the cataract extraction alone.

Cataract Extraction↗
PubMed1991

Intracapsular lens delivery during attempted extracapsular cataract extraction. Association with capsulorrhexis.

Continuous circular tear capsulotomy, or capsulorrhexis, has become a popular technique in cataract extraction, especially in phacoemulsification. The authors report on six cases from five different surgeons at three institutions, in which the entire lens was inadvertently delivered on attempted expression of the nucleus after circular capsulorrhexis. In one case, scanning electron microscopy suggests that the smooth edge of a small, closed, capsular tear is not capable of controlled extension to allow nuclear egress. Therefore, superior radial anterior capsular relaxing incision is recommended when circular capsulorrhexis is used in extracapsular cataract extraction.

Aged↗
PubMed1993

Enlarging the pupil for cataract extraction using flexible nylon iris retractors.

A technique using flexible iris retractors to manage small pupils during cataract extraction reduces iris trauma, allows adjustment of pupil size, and reduces intraoperative difficulty more than previously described techniques. This method is appropriate for extracapsular cataract extraction and phacoemulsification, as well as the posterior segment procedures for which it was originally described.

Cataract Extraction↗
PubMedDate not supplied

Long-term surgical results of combined trabeculotomy ab externo and cataract extraction.

Trabeculotomy ab externo has been demonstrated to be effective in controlling intraocular pressure (IOP) in adult patients with either primary open-angle glaucoma or pseudoexfoliation syndrome. We evaluated the surgical outcome of 60 eyes with either primary open-angle glaucoma or pseudoexfoliation syndrome that underwent combined trabeculotomy ab externo and cataract extraction. All patients were at least 40 years old, and were followed for at least 1 year. At the final examination, IOP was well controlled (21 mm Hg or less) in 54 (90%) of the 60 eyes, with or without medication. Also, "overall success" (ie, stabilization of IOP, visual field, and optic nerve status) was achieved in 49 (81.7%). Complications included fibrin exudation (22%), transient IOP elevation (17%), early perforation of the probe into the anterior chamber (10%), and detachment of Descemet's membrane (5%). We recommend combined trabeculotomy ab externo and cataract extraction in selected cases of glaucoma with coexisting cataract. For cases in which the target IOP level is in the low teens, or for patients who may not tolerate postoperative fluctuations in IOP, we do not recommend trabeculotomy ab externo. Also, in eyes that have normal-tension glaucoma, or that have already sustained severe damage to the optic nerve, visual dysfunction caused by glaucomatous changes may progress even after successful combined trabeculotomy ab externo and cataract extraction.

Aged↗
PubMedDate not supplied

Acquired anterior ocular melanocytosis following cataract extraction.

The right eye of a 59-year-old man was the subject of extracapsular cataract extraction and posterior chamber lens implantation. He gradually developed superior sectoral scleral and diffuse iris hyperpigmentation within 7 years postoperatively. The iris was also uniformly thickened. He sustained 20/20 visual acuity in the pseudophakic eye. Despite marked pigmentation of the angle, his right intraocular pressure remained within normal limits. We use the term acquired anterior ocular melanocytosis because the pigmentary changes were confined to the anterior segment and the choroid was not involved. We conclude that surgical injury in the form of cataract extraction can induce episcleral/scleral hyperpigmentation and iris hyperchromia.

Anterior Eye Segment↗