[From the activity of the ophthalmological society in Vienna; contributions to the technic of cataract extraction].
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Cataract Extraction↗
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Primary cataract extraction and intraocular lens implantation in penetrating ocular trauma.
PURPOSE: To analyze the postoperative outcome and complication rate after cataract extraction or lensectomy with primary intraocular lens (IOL) implantation for penetrating traumatic cataract. DESIGN: Retrospective, nonconsecutive, noncomparative case series. METHODS: We retrospectively reviewed the files of 21 patients who were admitted to our departments because of traumatic cataract with corneal or scleral laceration caused by penetrating trauma with or without intraocular foreign body (IOFB) from 1992 through 1997. Lens aspiration or manual extracapsular cataract extraction with primary IOL implantation was performed in all patients. Removal of an IOFB was performed in eight patients. MAIN OUTCOME MEASURES: Final visual acuity and deviation of actual refraction from emmetropia and from expected postoperative refraction. RESULTS: The mean follow-up was 20.4 months. Fourteen eyes (67%) achieved final visual acuity of 20/40 or better, 95% obtained 20/60 or better final visual acuity, and all eyes achieved 20/100 or better final visual acuity. Major causes of limited visual acuity were central corneal scar and central retinal injury. Eleven eyes (57%) experienced secondary cataract and underwent neodymium:yytrium-aluminum-garnet capsulotomy. CONCLUSIONS: Primary implantation of posterior chamber lenses after penetrating ocular trauma is associated with favorable visual outcome and a low rate of postoperative complications.
Adolescent↗
The problems of biometry in combined silicone oil removal and cataract extraction: a clinical trial.
PURPOSE: To evaluate the problems and accuracy of biometry in eyes that have been operated on by silicone oil removal combined with cataract extraction with or without intraocular lens implantation. SUBJECTS AND METHODS: Twenty-nine consecutive cases that have been operated on for silicone oil removal and cataract, with or without intraocular lens implantation, were included in a prospective study. Axial length measurement was done in silicone oil-filled eyes after changing the sound speed in vitreous cavity to 987 m/sec. The SRKT formula was used for intraocular lens calculation. The cataract was removed by phacoemulsification through corneal section or phacofragmentation through the standard vitrectomy sclerotomy. Intraocular lens implantation was done either on the peripheral anterior capsule (single piece, PMMA) or in the bag (acrylic foldable three pieces). The final refraction after at least 3 months' follow-up was measured. The difference between the predicted and the actual refraction was evaluated. A control group of 30 consecutive cases (20 nonmyopic and 10 highly myopic) of cataract extraction and intraocular lens implantation in eyes not filled with silicone oil was included using the same evaluation methods. RESULTS: The mean deviation of the final from the predicted refraction was 1.87 +/- 2.11 diopters (range, +3.25 to -9 diopters). A total of 72.4% had a deviation of +/-2 diopters. The mean deviation in high myopia was 3.04 +/- 2.68 diopters (12 cases) (range, +/-1.75 to -9 diopters), while in nonmyopic patients, the mean deviation was 1.04 +/- 1.04 diopters (17 cases) (range, +3.25 to -3.25 diopters). The difference between highly myopic and nonmyopic eyes was statistically significant (P < 0.05). Most high errors occurred in highly myopic eyes. There was no statistical difference between the types of silicone oil (1000 versus 5000) or the mode of cataract extraction (phacoemulsification versus pars plana phacofragmentation). In the control group, the mean deviation in high myopia was 1.48 +/- 1.02 diopters (10 cases) (range, +/-0.5 to -3.5 diopters), while in nonmyopic patients, the mean deviation was 0.65 +/- 0.75 diopters (20 cases) (range, +2.75 to -1.75 diopters). The difference was statistically significant (P < 0.05). CONCLUSION: Intraocular lens calculation in silicone oil-filled eyes is accurate in eyes that are not highly myopic. Some highly myopic eyes with posterior staphyloma have great deviation. Unsuitable formula, artifacts, or large eyes beyond the machine range may be the cause of errors of deviation of refraction. Comparable results are obtained in eyes regardless of the type of silicone oil (1000 or 5000) and techniques of intraocular lens implantation (in the sulcus or in the bag).
Adult↗
Uveal melanoma presenting after cataract extraction with intraocular lens implantation.
Four patients underwent cataract extraction with implantation of intraocular lenses. Preoperative ultrasonography did not include a comprehensive diagnostic B-scan analysis. Postoperative examination revealed uveal melanomas. The clinical presentations as well as the histopathologic findings of the two enucleated eyes are discussed. These cases emphasize the necessity for B-scan ultrasonography prior to cataract surgery when media opacity prevents adequate visualization of the fundus.
Aged↗
[Combined trephining with scleral flap (Elliot-Fronimopoulos) and intracapsular cataract extraction (author's transl)].
68 eyes of 51 non-selected patients on which a combined cataract extraction and Elliot's trephining with scleral flap (Fronimopoulos) had been performed between 1972 and september 1976, were re-examined between 6 and 48 months following operation. Postoperative complications were rare: there was one persistent shallow anterior chamber following excessive filtration, one increase of tension floowing a block of the trephine canal by vitreous, and one increase of tension following too tight suturing of the scleral flap which necessitated re-operation. Tension was compensated without therapy in 42 eyes (61,7%) and with local therapy in 24 eyes (35,3%). Only in 2 eyes (3%) normal intra-ocular pressure was not achieved. Altogether 97% of the eyes were compensated, some with additional local therapy. The combined cataract extraction and Elliot's trephining with scleral flap (Fronimopoulos) is an effective and low risk technique that is recommended in cases of cataract with raised intraocular pressure not controlled by medical treatment.
Adult↗
Nutrient intake and cataract extraction in women: a prospective study.
OBJECTIVE: To examine prospectively the association between dietary intake of vitamins C and E, carotene, and riboflavin and cataract extraction in women. DESIGN: Prospective cohort study beginning in 1980 with eight years of follow up. SETTING: 11 states of the United States. PARTICIPANTS: Female registered nurses who were 45 to 67 years of age. 50,828 women were included in 1980 and others were added as they became 45 years of age. MAIN OUTCOME MEASURE: Incidence of extraction of senile cataracts. RESULTS: 493 cataracts were extracted during 470,302 person years of follow up. Intake of carotene and vitamin A was inversely associated with cataract: in multivariate analyses, women in the highest fifth of total vitamin A intake (excluding supplements) had a 39% lower risk of cataract relative to women in the lowest fifth (relative risk 0.61; 95% confidence interval 0.45 to 0.81). Neither riboflavin nor dietary vitamins E or C were associated with cataract in a multivariate analysis. Among specific food items spinach (rather than carrots, the greatest source of beta carotene) was most consistently associated with a lower relative risk. The risk of cataract was 45% lower among women who used vitamin C supplements for 10 or more years(relative risk 0.55 (0.32 to 0.96)), but no association was noted for multivitamin intake. CONCLUSION: Dietary carotenoids, although not necessarily beta carotene, and long term vitamin C supplementation may decrease the risk of cataracts severe enough to require extraction.
Aged↗
Bacterial contamination of intraocular and extraocular fluids during extracapsular cataract extraction.
Fluid aspirated from the anterior chamber and fluid drained from the conjunctival sac during 101 extracapsular cataract operations was examined for bacterial contamination. Bacteria were grown by enrichment culture from the conjunctival sac of 90 eyes and from the anterior chamber aspirate of 29 eyes. Conjunctival fluid, stained with fluorescein, was demonstrated to flow into the anterior chamber during the aspiration stage of extracapsular cataract extraction and during intraocular lens implantation. It is suggested that this fluid from the conjunctival sac, contaminated with bacteria, routinely enters the anterior chamber during extracapsular cataract extraction and is the likely source of some cases of post-operative endophthalmitis.
Anterior Chamber↗
The incidence of retinal detachment following extracapsular cataract extraction. A ten-year study.
A long-term prospective study was conducted to evaluate the incidence of specific complications following extracapsular cataract extraction. Eight hundred forty-two consecutive extracapsular cataract extractions were performed over a ten-year period with a minimum follow-up time of one year. The mean follow up period for this series was 32.2 months. The incidence of retinal detachment in the entire population was 1.4%. In those eyes with a cataract as the only ocular abnormality and with no surgical complications, the frequency was 1.0%. The incidence in eyes following uncomplicated procedures, with no other ocular pathology and with an intact posterior capsule was 0.8%. The incidence of opacification of the posterior capsule requiring capsulotomy was 16.7%. The mean time interval for a secondary capsulotomy was 24.3 months. A positive correlation between this time interval and patient age was established.
Cataract Extraction↗
Intraocular lenses: one hundred consecutive cases of intracapsular cataract extraction with Copeland iris plane lens implantation.
A series of one hundred consecutive cases of intracapsular cataract extractions with insertion of the Copeland iris plane intraocular lens implant are presented. The preoperative management, surgical technique, and postoperative management are discussed in detail. Complications that may arise during surgery, early postoperative phase (first week), convalescent period (one to six weeks), and early long-term phase (1.5 through eight months) are presented and discussed. Short-term results to data have been most gratifying. The incidence of surgical complications closely parallels any consecutive series of one hundred intracapsular cataract extractions without lens implantation. The usual problems associated with adjustment to aphakia (particularly unilateral) are eliminated to the relief of patient and surgeon. The level of patient satisfaction is extremely high in comparison with standard cataract surgery. Elderly patients experience a sense of social rejuvenation that is phenomenal.
Adult↗
[Cataract extraction combined intraocular lens implantation through corneal incision].
OBJECTIVE: We reported the clinical results of the extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation through a corneal incision. METHODS: The ECCE with IOL implantation was performed through a stepped corneal incision within limbus 1.0-1.5 mm. The changes of intraocular pressure (IOP), endothelia and astigmatism were observed. RESULTS: The IOP has no significant changes, and the rate of endothelial cells loss (12.55%) also has no significant differences compared with routine cataract extraction. The corneal astigmatism became 0.96 DC with the rule after operation. CONCLUSION: For complicated cataract after trabeculectomy, uveitis with pupillary block, and serious diabetic cataract, the intraocular surgery through a corneal incision is effective and safe.
Adolescent↗
[Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation].
OBJECTIVE: To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. METHODS: 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and binocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. RESULTS: BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. CONCLUSIONS: Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.
Adolescent↗
[The choice of intraocular lens before cataract extraction for cases with high myopia].
OBJECTIVE: To study the choice of diopter and size of optical portion of intraocular lens (IOL) before cataract extraction for cases with high myopia. METHODS: Extracapsular cataract extraction (ECCE) or phacoemulsification with IOL implantation was performed on 60 cases (94 eyes) with high myopia (axial length > 26mm). The posterior chamber IOL selected and inserted was the one with the diopter and size of the optical portion suitable for the recipient to have a postoperative low myopia and easy to be examined with an ophthalmoscope. RESULTS: The postoperative eyes were of low myopia, -2.07 +/- 1.95 D. The larger size of optical portion was more suitable for ocular fundus examination. Great care was taken for phacoemulsification for cataractous nucleus below III grade. CONCLUSIONS: For patients with axial myopia, the IOL implanted should create low myopia postoperatively. Larger optic size is better for fundus examination. Phacoemulsification can produce less astigmatism and damage, but the indication must be controlled strictly.
Adolescent↗
Extracapsular cataract extraction with posterior chamber lens implantation in capsular glaucoma.
PURPOSE: To evaluate intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in patients with capsular glaucoma (CG) and coexisting cataract. METHODS: This prospective study included 20 patients (20 eyes) having CG and cataract whose IOPs were under 22 mm Hg and controlled with antiglaucoma medication. All patients had ECCE with PCIOL implantation and the follow-up period was at least 18 months. IOP was measured postoperatively at 3, 6, 9, 12 and 18 months and compared with preoperative IOP. RESULTS: Following the cataract extraction, PCIOL implantation produced a statistically significant reduction in IOP at all time points compared with the preoperative IOP during the study period (p < 0. 001). The mean preoperative IOP was 18.25 +/- 1.83 mm Hg; postoperatively at 1 month, it was 13.45 +/- 2.06 mm Hg; at 3 months 14.80 +/- 2.50 mm Hg; at 6 months 15.35 +/- 1.27 mm Hg, at 12 months 14.85 +/- 1.87 mm Hg and at 18 months 15.15 +/- 1.42 mm Hg (p < 0. 0008). The mean reduction in IOP was 16.98% from baseline at 18 months postoperatively. The mean number of antiglaucoma medication was reduced from 1.35/eye preoperatively to 0.60/eye postoperatively at 18 months (p < 0.0007). CONCLUSION: The result of our study revealed that ECCE with PCIOL implantation may be a reliable choice in controlling IOP in patients with CG.
Aged↗
[Vitrectomy in the treatment of vitreous body prolapse after cataract extraction].
Vitreous prolapse into the anterior chamber after cataract extraction is a severe complication in cases in which there is a contact between the vitreous and the cornea. The present paper discusses the result of treatment by vitrectomy in 15 patients with this complication. Anatomical and functional improvement was attained in 12 cases (89 p.c.) and in 5 among them--full visual acuity was obtained.
Aged↗
Manual tunnel incision extracapsular cataract extraction using the sandwich technique.
Small incision extracapsular cataract extraction (ECCE) using the sandwich technique is described. After capsulorhexis, hydrodissection, and hydrodelineation, the endonucleus is moved into the anterior chamber and extracted by sandwiching it between the irrigating vectis and iris spatula. In a series of 37 eyes, most achieved a best corrected visual acuity of 5/10 or better postoperatively. Complications were posterior capsule rupture, vitreous loss, and transient corneal edema. Small incision ECCE using the sandwich technique is safe, easy, and does not require expensive instrumentation.
Adult↗
Smoking cessation and risk of cataract extraction among US women and men.
Although the observational evidence linking cigarette smoking with risk of senile cataract is well-established, it is unclear whether any benefit is obtained from quitting smoking. Therefore, in this study, the authors examined the association between time since quitting smoking and incidence of cataract extraction in women and men enrolled in the Nurses' Health Study and the Health Professionals Follow-up Study, respectively. There were 4,281 incident physician-confirmed cases of cataract and 1,038,493 accumulated person-years of follow-up. Compared with current smokers, former smokers who had quit smoking 25 or more years previously had a 20% lower risk of cataract extraction after adjustment for age, average number of cigarettes smoked per day, and other potential risk factors (relative risk (RR) = 0.80, 95% confidence interval (CI): 0.71, 0.91). However, risk among past smokers did not decrease to the level seen among never smokers (for never smokers, RR = 0.64, 95% CI: 0.52, 0.79). The observed relation was similar when data were examined by cataract subtype (>25 years since quitting vs. current smoking: primarily nuclear cataract, RR = 0.82, 95% CI: 0.68, 0.97; primarily posterior subcapsular cataract, RR = 0.90, 95% CI: 0.71, 1.13). These findings suggest that any healing from damage due to cigarette smoking occurs at a very modest pace, and they emphasize the importance of never starting to smoke or quitting early in life.
Aged↗
[Early and late complications in cataract extraction in diabetic patients].
Between 1982 and 1985, cataract extraction was performed on 144 eyes of 122 diabetics, and the early and late complications of the operation were recorded. There was seldom any intraoperative hemorrhaging or any postoperative anterior chamber hemorrhaging. On the first day after the operation, increased IOP was measured more frequently in diabetic patients than in those without diabetes. Diabetic retinopathy deteriorated in 12 eyes, while hemorrhaging glaucomas occurred in 5 eyes.
Cataract Extraction↗
Exfoliation syndrome and cataract extraction.
In a prospective study of 351 consecutive cataract operations performed on Finnish patients, the prevalence of exfoliation syndrome was 31% (108 of 351 eyes), increasing from 0% (zero of 54 eyes) in patients younger than 60 years to 15% (12 of 78 eyes) in patients aged 60 to 69 years, 42% (57 of 137 eyes) in patients aged 70 to 79 years, and 48% (39 of 82 eyes) in those aged 80 years or more, than has previously been reported in general populations of the same age in Finland. Exfoliation syndrome was more common in patients aged 70 years or more. Glaucoma was found in 41 of 108 eyes with exfoliation syndrome (38%). Exfoliation syndrome increased the risk of intraoperative complications in extracapsular cataract extraction either directly (rupture of the zonules) or through poor dilation of the pupil (rupture of the posterior lens capsule). The occurrence of vitreous loss was fourfold, and the need to use an anterior chamber intraocular lens instead of a posterior chamber lens because of loss of capsular support was tenfold in eyes with exfoliation as compared to those without exfoliation.
Adult↗