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PubMed1988

Effect of extracapsular cataract extraction on intraocular pressure.

Intraocular pressure (IOP) was measured in 27 normotensive patients scheduled to undergo uncomplicated extracapsular cataract extraction with insertion of a posterior chamber intraocular lens implant. The measurements were recorded the day before surgery, 3, 6 and 9 hours after surgery and the following morning. Fourteen of the patients had a substantial increase in IOP, to more than 30 mm Hg, on the evening of surgery. Most had normal IOP values the next morning. Ophthalmologists should be aware of this possible effect of extracapsular cataract extraction on IOP.

Cataract Extraction↗
PubMed1978

Depth of anterior chamber after cataract extraction.

A total of 80 patients with senile cataract had the anterior eye chamber depth measured optically by means of Haag-Streit's attachment II. The distance to the pupillary border was 2.59 +/- 0.05 mm (mean +/- SEM) preoperatively. It increased gradually after cataract extraction to 3.33 +/- 0.04 mm, measured 4 months after the operation. The increase of depth was the greatest in patients with a flat chamber and in elderly patients. The central chamber depth decreased gradually after the operation (from 2.82 +/- 0.05 mm preoperatively to 1.95 +/- 0.13 mm 4 months postoperatively). The number of vitreous prolapse cases rose from 68 to 87.5% in 4 months. These altered chamber depths were observed to bear no relation to postoperative corneal oedema (neither of parenchyma nor of epithelium), intraocular pressure, or bleeding into the chamber.

Aged↗
PubMed1989

Use of hyaluronate sodium v air in extracapsular cataract extraction.

A total of 17 patients underwent extracapsular cataract extraction with artificial lens implantation by one surgeon. Eight were given hyaluronate sodium (Healon) during the procedure, while nine received only air. Corneal thickness and endothelial cell counts were obtained one day prior to surgery and 90 days postoperatively. There were mean cell losses of 10.5% and 11.2% in the Healon and air groups, respectively. This is a mean difference of 0.7%, which is not significant statistically. Therefore, despite several studies that demonstrate the protective value of hyaluronate sodium on the corneal endothelium during anterior segment surgery, this study showed no such difference in the protective effects between the two.

Air↗
PubMed1998

[Progression of diabetic retinopathy after cataract extraction].

A prospective study of the effect of cataract extraction with intraocular lens implantation on the course of diabetic retinopathy (DR) in 44 patients (59 eyes) was carried out. It showed that in the 1-3 years following surgery, there was progression of DR (including development of newly formed retinopathy) in 35% of the patients (28.8% of eyes). Progression was more marked in patients with pre-operative bilateral DR compared to those without bilateral DR (77% and 16% respectively). Insulin dependence did not play a role in progression. Final visual acuity was better in patients without pre-operative DR, as well as in eyes without progressive retinopathy.

Aged↗
PubMed1987

The effect of intracameral carbachol on intraocular pressure after cataract extraction.

We randomly assigned 44 patients undergoing extracapsular cataract extraction and posterior chamber lens implantation to two equal groups. The treatment group received intracameral carbachol during the operative procedure, and the control group received only balanced salt solution. Intraocular pressures were measured preoperatively, and at three, six, nine, and 24 hours postoperatively. Preoperatively, the mean pressures in the two groups were not significantly different. Three hours postoperatively, the mean pressure in the control group was 3.9 mm Hg above the preoperative baseline, whereas in the treatment group the mean pressure was 3.1 mm Hg below the baseline. This difference was statistically significant (P = .002). Similar differences between the two groups persisted throughout the study period.

Aged↗
PubMed1995

Effect of cataract extraction on automated fields in chronic open-angle glaucoma.

OBJECTIVE: To evaluate the influence of cataract extraction on the results of visual field testing in chronic open-angle glaucoma. DESIGN: We performed automated perimetry within 6 months before and after phacoemulsification and combined trabeculectomy in 24 consecutive patients with chronic open-angle glaucoma. Eyes were pharmacologically dilated and were tested with their best corrected refraction for each visual field performed. RESULTS: After surgery, the average mean defect, pattern SD, and total decibel loss within any visual field cluster (as determined by the Glaucoma Hemifield Test, Humphrey Field Analyzer, Humphrey Instruments, San Leandro, Calif) did not change significantly (P > .05, paired t test). These findings did not vary on the basis of the amount of preoperative damage in the visual field. The power of this study to exclude a 4-dB change in the mean defect after surgery was 86.5%. CONCLUSION: This study suggests that cataract extraction in patients with chronic open-angle glaucoma has minimal effect on the visual field test results after surgery.

Aged↗
PubMed1990

Intraocular lens implantation following cataract extraction in Fuchs' heterochromic uveitis.

Nine patients with cataract secondary to heterochromic uveitis underwent intraocular lens implantation after extracapsular cataract extraction from the posterior chamber, and were followed up for a period ranging from 12 to 36 months (mean 23.3). Visual acuity was restored to 6/9 unaided or better in 5 cases and 6/12 unaided in 3 cases whose reduction of vision was due to massive pigmentation like keratic precipitates (KP) on the implant. A 6/18 unaided visual acuity in the ninth case was due to opacification of the posterior capsule. Postoperative complications included: mild uveitis (2 cases) and massive pigmentation like KP on the lens implant (3 cases). The rest of these patients had mild pigmentation. There were no cases that developed either intraocular pressure or inflammatory pupillary membranes. Additionally, disappearance of KP from the cornea was observed in 2 cases.

Adult↗
PubMed1992

The effect of diclofenac sodium ophthalmic solution on intraocular pressure following cataract extraction.

Ninety-two nonglaucomatous patients undergoing extracapsular cataract extraction with implantation of a posterior chamber intraocular lens by residents at a Veterans hospital were randomized in double-masked fashion to receive either a topical nonsteroidal antiinflammatory agent, diclofenac sodium 0.1%, or a placebo consisting of vehicle only. One drop of placebo or diclofenac sodium 0.1% was administered on an inpatient basis by trained staff every 6 hours for three doses, starting the afternoon prior to surgery. A further drop was given at 90, 60, 30, and 15 minutes before the operation. Starting 24 hours after surgery, all patients received diclofenac sodium 0.1%. All patients remained hospitalized for 72 hours postoperatively. Mean baseline intraocular pressure (IOP) was 14.0 and 14.1 mm Hg in the diclofenac and placebo groups, respectively. IOP rose 8.6 mm Hg in both groups at 6 hours after surgery. At 24 hours, the mean IOP elevation from baseline was 11.3 mm Hg in the diclofenac group and 9.6 mm Hg in the placebo group (P = .47). Within the first 24 hours, IOP spiked more than 10 mm Hg in 57% (26/46) of the diclofenac patients and in 54% (25/46) of the placebo patients. These results suggest that diclofenac sodium 0.1% drops affect neither the incidence nor the height of IOP elevation following cataract surgery.

Aged↗
PubMed1997

Cataract extraction rates in Olmsted County, Minnesota, 1980 through 1994.

OBJECTIVE: To analyze population-based trends in cataract extraction. DESIGN: Rochester Epidemiology Project databases; which capture virtually all health care services provided to residents of Olmsted County, Minnesota, were used to perform retrospective cohort analyses of rates of primary cataract extractions performed between 1980 and 1994. PARTICIPANTS: The population of Olmsted County, Minnesota. MAIN OUTCOME MEASURES: Incidence rates adjusted to the age and sex distribution of the 1990 US white population were analyzed using Poisson regression. RESULTS: The 4257 procedures performed on 3176 patients of all ages represented overall annual age-adjusted rates of 404 procedures per 100,000 females and 320 per 100,000 males. Annual age- and sex-adjusted rates for both sexes combined rose from 133 procedures per 100,000 in 1980 to a peak of 507 per 100,000 in 1992. The rates fell to 470 per 100,000 in 1994. Manual review of a random sample of records estimated case overascertainment at 0.9%. CONCLUSIONS: With the exception of 1988 and 1989, rates of cataract surgery in this geographically circumscribed population increased every year between 1980 and 1992. Data from 1993-1994 indicate that rates may have plateaued and possibly declined slightly. If sustained, these patterns could have major implications for future utilization of ophthalmologic resources.

Age Distribution↗
PubMed1992

Superior rectus muscle overaction after cataract extraction.

Four patients with an ipsilateral hypertropia after cataract extraction consistent with superior rectus muscle overaction were identified between March 1990 and April 1992. Operative trauma was the most likely causative factor, as other likely conditions were excluded. The proposed pathogenesis for all cases is similar to that of botulinum type-A toxin therapy: a transient postoperative weakness of the ipsilateral inferior rectur muscle leads to a contracture or strengthening of the ipsilateral antagonist (the superior rectus muscle). Possible mechanisms of injury that would result in a transient inferior rectus muscle palsy would include anesthetic myotoxicity or direct trauma to the muscle and related structures from the retrobulbar injection (or subconjunctival injection). Surgical intervention consisting of an ipsilateral superior rectus muscle recession and posterior fixation sutures (when the vertical incomitance was large) yielded excellent results in restoring single binocular vision. Possible preventive measures would include using a minimal volume of anesthetic along with careful needle placement.

Adult↗
PubMed1992

Progression of nonproliferative diabetic retinopathy and visual outcome after extracapsular cataract extraction and intraocular lens implantation.

Twenty-one patients with symmetric nonproliferative retinopathy who underwent extracapsular cataract extraction and intraocular lens implantation were followed up postoperatively for an average (+/- standard deviation) of 18 +/- 7 months to determine the incidence of progression of diabetic retinopathy, the final visual acuity, and factors predictive of progression of retinopathy and final visual acuity. Progression of retinopathy, defined as the development of clinically significant macular edema, an increase in intraretinal hemorrhages or hard exudate, or the development of proliferative diabetic retinopathy, was assessed in both eyes of 19 patients; in two remaining patients, dense preoperative cataract in the fellow eye precluded comparison of retinopathy progression in the operated-on eye to progression in the fellow eye. Overall, retinopathy progressed in 14 of 19 operated-on eyes (74%). Cataract extraction was highly associated with asymmetric progression of nonproliferative retinopathy; it progressed only in the operated-on eye in seven of 19 patients (37%), but in no patients did progression occur in the fellow eye alone (P = .0078). Women had a significantly increased risk of progression of retinopathy in the operated-on eye compared to men (P = .005). Visual acuity improved in 19 of 21 operated-on eyes (86%); however, only 11 eyes (52%) achieved a visual acuity of 20/50 or better and only six eyes (14%) achieved a visual acuity of 20/25 or better. In only five eyes was the final visual acuity in the operated-on eye more than two lines better than the final visual acuity in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

National five-year mortality after inpatient cataract extraction.

We assessed the five-year mortality in all United States Medicare beneficiaries aged 65 to 79 years who underwent inpatient cataract extraction in 1984. The risk of dying within five years after cataract extraction was compared to the five-year mortality risk of the same aged persons in the United States population. Patients with cataracts who were younger than 75 years had significantly higher age-specific rates of mortality than would be predicted from United States life tables (P less than .001). For example, at the age of 65 years, patients with cataracts had 1.34 times the risk of the United States population (95% confidence interval = 1.29 to 1.41). This risk progressively declined until the age of 75 years, at which age there is little difference between the patients with cataracts and the United States population, except for the oldest women with cataracts (at the age of 79 years, relative risk = .90; 95% confidence interval = .82 to .99). Although selection factors may account for the excess mortality observed among these individuals, these data do support previous analyses that suggest an association between senile cataract and increased risk of mortality.

Aged↗
PubMed1995

Simultaneous bilateral cataract extraction in the UK.

AIMS/BACKGROUND: Simultaneous bilateral extracapsular cataract extraction (SBCE) is not routinely performed in the developed world. This study investigated the safety and efficacy of this procedure as performed in the UK. METHODS: A review of 319 consecutive patients (638 eyes) who underwent SBCE with posterior chamber intraocular lens implantation is presented. RESULTS: The incidence of intraoperative complications was 7.7%. These included posterior capsule rupture (0.8%) and vitreous loss (0.3%). Postoperative complications were seen in 8.7% of operated eyes and included iris prolapse (0.3%) and raised intraocular pressure (3.0%). Endophthalmitis occurred in one eye (0.15%). There were no major bilateral complications, and, in particular, no cases of bilateral endophthalmitis. Final visual acuities compared favourably with reports for unilateral surgery. Eighty two per cent achieved a final visual acuity of 6/12 or better, and 41% tested 6/6 or better. CONCLUSION: This study illustrates that SBCE is not associated with an increased incidence of complications and that the visual results are good. Where indicated, and under strict surgical protocol, this procedure is safe.

Aged↗
PubMed1998

Vitreous loss during conversion from conventional extracapsular cataract extraction to phacoemulsification.

PURPOSE: To study the outcome of vitreous loss among senior surgeons converting from conventional extracapsular cataract extraction (ECCE) to phacoemulsification. SETTING: A university teaching hospital in the United Kingdom. METHODS: A retrospective analysis of 87 planned cataract extractions performed from January 1992 to December 1996 and complicated by vitreous loss was done. Outcome measures included postoperative complication rates and visual acuity. RESULTS: During the study, vitreous loss occurred in 39 patients having ECCE and in 48 having phacoemulsification; the latter group included 8 patients with dropped nucleus. Postoperative complications included cystoid macular edema (18.7% of phaco patients, 30.8% of ECCE patients), retinal detachment (2.1% of phaco patients, 5.1% of ECCE patients), and expulsive hemorrhage (5.1% of ECCE patients). Phaco patients had higher rates of postoperative corneal edema (27.1%) than ECCE patients (12.8%) and transient intraocular pressure elevation (33.3%) versus 20.5%) but were more likely to receive posterior chamber intraocular lenses (70.8% versus 35.9%; P = .0024, chi-square test). After excluding pre-existing diseases, 83.3% of phaco patients and 67.6% of ECCE patients achieved a visual acuity of 6/12 or better. CONCLUSIONS: With careful patient selection, experienced extracapsular surgeons converting to phacoemulsification can achieve favorable results even in the presence of complications such as vitreous loss or dropped nucleus.

Aged↗
PubMed1992

Postoperative inflammation following cataract extraction caused by bacterial contamination of the cleaning bath detergent.

Five of 16 patients who had uncomplicated cataract extraction with intraocular lens (IOL) implantation within a 2.5 day period experienced increased anterior segment inflammation on their first postoperative day. Four of these five patients had phacoemulsification and one a planned extracapsular cataract extraction. All had posterior chamber IOL implantation in the capsular bag. In all patients, this anterior segment inflammation cleared with topical steroids over two to three weeks with no evident residual ocular effects. A careful search for the possible cause of the inflammation showed that the ultrasonic cleaning bath and Weck liquid detergent used to clean the instruments contained Klebsiella pneumoniae bacteria. Further investigation demonstrated the presence of a heat-stable endotoxin produced by the bacteria. We postulate that endotoxin remaining on the instruments after cleaning and sterilization caused this postoperative anterior segment inflammation. To the best of our knowledge, these are the first reported cases caused by contaminated liquid detergent.

Aged↗
PubMed1999

Long-term follow-up of anterior uveitis after cataract extraction and intraocular lens implantation.

PURPOSE: To assess whether cataract surgery and intraocular lens (IOL) implantation in patients with anterior uveitis interfere with the natural course of the ocular disease. SETTING: Tertiary care center at the University of Rome "La Sapienza", Rome, Italy. METHODS: Cataract extraction and IOL implantation were performed in 24 patients with uveitis-related cataract: 12 with Fuchs' heterochromic iridocyclitis (Group 1) and 12 with other types of anterior uveitis (Group 2). The mean follow-up in the 2 groups was 33.6 months and 24.8 months, respectively. The number and severity (inflammatory score) of uveitis relapses in all patients over the same period were recorded. RESULTS: After surgery, the mean number and severity of uveitis relapses decreased: Group 1, from 1.83 +/- 1.90 (SD) to 1.00 +/- 1.21 and from 1.08 +/- 0.90 to 0.92 +/- 0.67, respectively; Group 2, from 2.74 +/- 3.44 to 1.25 +/- 1.71 and from 1.83 +/- 1.10 to 1.25 +/- 0.75, respectively (P = .046). There were no statistically significant between-group differences. In Group 2, a trend toward worse visual rehabilitation was seen; this was significantly different from the result in Group 1 (P = .018) because of preoperative optic nerve damage, macula disease, or both. CONCLUSION: Cataract surgery and IOL implantation did not negatively influence the natural course of uveitis in patients with Fuchs' heterochromic iridocyclitis. Correct surgical timing, selection of cases, and adequate anti-inflammatory therapy may promote similar results in patients with other types of anterior uveitis.

Adolescent↗