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PubMed2001

Cystoid macular edema after pediatric intraocular lens implantation: fluorescein angioscopy results and literature review.

PURPOSE: To evaluate the occurrence of cystoid macular edema (CME) after lens extraction, anterior vitrectomy, and intraocular lens implantation (IOL) in children using angioscopy after administration of oral fluorescein. SETTING: Centers in Tamil Nadu, India, and Hong Kong, China. METHODS: This study comprised 18 children (28 eyes) who had cataract extraction, posterior capsulorhexis, anterior vitrectomy, and in-the-bag IOL implantation. The presence of CME was evaluated 1 week and 4 to 6 weeks after surgery using fluorescein angioscopy. RESULTS: Anterior chamber fibrin occurred in 4 eyes (14.3%). Fluorescein angioscopy was performed 1 week after surgery in all eyes and after 1 month in 25 eyes (89.3%). No eye demonstrated the presence of CME on fluorescein angioscopy. CONCLUSIONS: Cystoid macular edema did not occur in the early period after pediatric cataract surgery using current surgical techniques. Longer follow-up is required to ascertain the incidence of CME in the late postoperative period.

Capsulorhexis↗

PubMed2001

Early postoperative capsular block syndrome.

PURPOSE: To report the results of early postoperative capsular block syndrome (CBS) after phacoemulsification and intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Dokuz Eylül University School of Medicine, Izmir, Turkey. METHODS: Thirteen eyes of 13 patients with CBS who had uneventful phacoemulsification were included in the study. Twelve patients had in-the-bag implantation of a foldable IOL, and 1 had implantation of a poly(methyl methacrylate) IOL in the ciliary sulcus. Continuous curvilinear capsulorhexis was performed in all eyes, and sodium hyaluronate 1.4% (Healon GV(R)) was used during all steps of surgery. The patients were closely followed without intervention during the first month after surgery. If resolution did not occur during follow-up, a neodymium:YAG (Nd:YAG) laser peripheral anterior capsulotomy was performed first, followed by posterior capsulotomy if the anterior capsulotomy was not successful. RESULTS: The CBS resolved without intervention in 2 eyes by 1 month postoperatively. A small Nd:YAG laser peripheral anterior capsulotomy was attempted in 10 cases after 1 month but could not be performed in 2 eyes because of inadequate pupil dilation. Peripheral anterior capsulotomy was successful in 5 of 8 eyes, with resolution of CBS in a few days. The Nd:YAG laser posterior capsulotomy was successful in 5 cases after the failure of the anterior capsulotomy. One patient chose to postpone treatment for 11 months, at which time posterior capsulotomy was performed successfully and the CBS resolved. CONCLUSIONS: Resolution of CBS occurred spontaneously in only a small percentage of cases during the first month after phacoemulsification with IOL implantation. Neodymium:YAG laser peripheral anterior capsulotomy and posterior capsulotomy were successful in treating CBS.

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PubMed2001

Massive anterior capsule shrinkage after plate-haptic silicone lens implantation in uveitis.

Two patients, both with bilateral uveitis, had synechiolysis, continuous curvilinear capsulorhexis (CCC), phacoemulsification, and in-the-bag implantation of a foldable single-piece plate-haptic silicone intraocular lens (IOL) in 1 eye. Several weeks postoperatively, massive anterior capsule shrinkage with obstruction of the visual axis occurred in both patients. Surgical revision was performed in both eyes. Both patients had CCC and phacoemulsification and confirmed in-the-bag acrylic IOL implantation in the second eye months after surgery in the first eye. Follow-up examinations showed no significant shrinkage of the anterior capsule opening in any eye. In patients with uveitis, intraoperative lens epithelial cell removal, creation of a large CCC, and careful selection of IOL style and material may prevent occlusion of the anterior capsule opening.

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PubMed2001

Necessity of vitrectomy when optic capture is performed in children older than 5 years.

PURPOSE: To determine whether anterior vitrectomy is necessary when optic capture is performed in children between 5 and 12 years old with congenital cataract. SETTING: Iladevi Cataract and IOL Research Center, Ahmedabad, India. METHODS: This prospective randomized controlled study comprised 41 eyes of 25 children whose mean age was 83.57 months (range 60 to 144 months). Intraocular lens (IOL) implantation with optic capture through a primary posterior continuous curvilinear capsulorhexis was performed in all the eyes. The IOL haptics were bag fixated. Patients were randomly assigned to 1 of 2 groups. Vitrectomy was performed in 1 group (n = 21 eyes) and not performed in the other group (n = 20 eyes). The mean follow-up was 21.04 months. A Student t test and chi-square test were used for statistical analysis. RESULTS: All eyes in the vitrectomy group and 30% in the no-vitrectomy group had a clear visual axis at the last follow-up (P <.001) The visual axis was obscured as a result of anterior vitreous fibrosis in 70% of eyes in the no-vitrectomy group. High-contrast visual acuity was not significantly different between groups (P =.28). Low-contrast sensitivity was significantly better in the vitrectomy group (P =.02). Eighteen eyes (85.7%) in the vitrectomy group and 16 eyes (80%) in the no-vitrectomy group developed deposits on the IOL (P =.62). The deposits were present at the last follow-up in 4 eyes (19.0%) in the vitrectomy group and in 6 eyes (30.0%) in the no-vitrectomy group (P =.85). Three eyes (14.3%) in the vitrectomy group and 8 eyes (40.0%) in the no-vitrectomy group developed synechias (P =.06). CONCLUSION: The results suggest that anterior vitrectomy is necessary with optic capture in children with congenital cataract who are between 5 and 12 years old.

Capsulorhexis↗

PubMed2001

Anterior capsular phimosis in eyes with a capsular tension ring.

A 64-year-old woman with zonular weakness in the left eye and a 79-year-old man with bilateral pseudoexfoliation and intraoperative zonular dehiscence had phacoemulsification with in-the-bag implantation of a single-piece poly(methyl methacrylate) intraocular lens (IOL) and a capsular tension ring. Ten to 12 weeks postoperatively, all 3 eyes developed significant visual loss secondary to capsule shrinkage and occlusion of the capsulorhexis opening. All eyes had a neodymium:YAG laser radial anterior capsulotomy, anterior capsulectomy, or both. Visual acuity was restored in all eyes despite slight IOL decentration.

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PubMed2001

Capsular bending ring to prevent posterior capsule opacification: 2 year follow-up.

PURPOSE: To evaluate the preventive effect of a capsular bending ring on anterior and posterior capsule (PCO) opacification in a 2 year clinical study. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: This study comprised 60 patients with senile cataract (35 women, 25 men) with a mean age of 69 years. An open poly(methyl methacrylate) capsular bending ring with a truncated edge profile designed to create a sharp bend in the equatorial capsule was implanted in 1 eye of patients with a hydroxyethyl methacrylate intraocular lens (IOL). The contralateral eye, which acted as a control, received an IOL but no ring. Patients were examined 6 months (n = 52), 1 year (n = 48), and 2 years (n = 42) postoperatively. Anterior capsule opacification was determined by slitlamp evaluation. Anterior capsule shrinkage (area within the capsulorhexis) and PCO were evaluated and scored using a computer software package for image analysis. Posterior capsule opacification was also measured by the rate of neodymium:YAG (Nd:YAG) capsulotomies. RESULTS: Anterior capsule opacification and shrinkage were significantly less in eyes with the ring. The mean PCO score was 0.235 +/- 0.215 (SD), 0.287 +/- 0.200, and 0.398 +/- 0.248 with the ring and 0.530 +/- 0.190, 0.670 +/- 0.225, and 1.111 +/- 0.298 without the ring at 6 months, 1 year, and 2 years, respectively (P <.01 at each follow-up). An Nd:YAG laser capsulotomy was performed in 4 eyes with and 17 eyes without the ring after 2 years (P <.01). CONCLUSIONS: The capsular bending ring significantly reduced anterior capsule fibrosis and shrinkage as well as PCO. The ring may be useful in patients who are at high risk of developing eye complications from capsule opacification that require Nd:YAG laser capsulotomy, in those expected to have vitreoretinal surgery and photocoagulation, and in cases of pediatric cataract.

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PubMed2001

Patient satisfaction after uneventful cataract surgery with implantation of a silicone or acrylic foldable intraocular lens. Comparative study.

PURPOSE: To compare patient satisfaction with vision 12 months after implantation of a silicone or acrylic foldable intraocular lens (IOL). SETTING: John A. Moran Eye Center, University of Utah Medical Center, Salt Lake City, Utah, USA. METHODS: Selection criteria included patients who had uneventful cataract extraction by phacoemulsification with a temporal clear corneal incision or superior scleral tunnel incision, a curvilinear capsulorhexis, and in-the-bag IOL placement. One hundred sixty-two patients surveyed had a mean follow-up of approximately 15 months (range 12 to 18 months). Patients were divided into 3 groups of 54 each based on IOL type: AMO SI-30/40, Alcon MA30BA, and Alcon MA60BA. All patients were surveyed over the telephone using a standardized questionnaire protocol. They were questioned about their perception of vision with best optical correction in relation to visual blurring symptoms, glare symptoms, night vision, near vision, and overall vision. RESULTS: There were no significant differences in patient satisfaction among the 3 IOL groups in visual blurring or night vision. Patients in the SI-30/40 and MA60BA groups reported significantly higher satisfaction with glare symptoms, near vision, and overall satisfaction than patients in the MA30BA group. CONCLUSION: The SI-30/SI-40 and the MA60BA IOLs received significantly higher patient satisfaction scores than the MA30BA IOL in glare symptoms, near vision, and overall satisfaction.

Acrylic Resins↗

PubMed2001

Pars plana vitreous tap for phacoemulsification in the crowded eye.

This technique facilitates phacoemulsification and foldable intraocular lens (IOL) implantation in eyes with extremely crowded anterior segments. An automated pars plana vitreous tap is used to expand the anterior segment when extremely shallow anterior chambers do not deepen sufficiently with viscoelastic injection alone. This technique permits successful completion of pupilloplasty, capsulorhexis, phacoemulsification, and foldable IOL implantation in these high-risk eyes.

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PubMed2002

Managing anterior capsule contraction by mechanical widening with vitrector-cut capsulotomy.

We present a technique, vitrectorhexis, in which a vitrector-cut capsulotomy is used to treat anterior capsule contraction syndrome. A vitrector handpiece is used to remove all fibrous capsule tissue and residual lens epithelial cells from the anterior chamber. Vitrectorhexis may be an alternative to neodymium:YAG laser capsulotomy as it decreases the risk of radial tear extension to the zonules and of secondary IOL decentration. The technique was used in a 77-year-old man with capsulorhexis contraction syndrome and extensive fibrosis after phacoemulsification with silicone piggyback intraocular lens implantation. One day postoperatively, visual acuity improved from 20/60 to 20/30 and the anterior chamber reaction was minimal. At 1 month, best corrected visual acuity was 20/20. The IOL was well centered at 6 months.

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PubMed2002

Implantation and capsular bag stability of single-piece, foldable EasAcryl 1 intraocular lenses.

PURPOSE: To assess the folding and implantation of the single-piece EasAcryl 1 intraocular lens (IOL) and the maintenance of the tunnel structure and capsular bag stability after implantation. SETTING: S. Orsola Hospital Department of Pathophysiologic Optics, University of Bologna, Bologna, Italy. METHODS: This study comprised 300 cases of EasAcryl 1 IOL implantation. First, a 3.2 mm corneal incision was made according to preoperative astigmatism followed by a 5.5 mm +/- 0.3 (SD) capsulorhexis. After sutureless phacoemulsification using a venturi pump, the 6.0 mm optic, 11.0 mm diameter IOL was implanted using a hexagonal cartridge. The IOLs were implanted using a 2-step maneuver when the superior haptic was grasped with the forceps (first case) or a 1-step maneuver when only the Microsert injector was used. The cartridge was never pushed beyond the tunnel. The preoperative and postoperative incision size and the corneal surgically induced astigmatism were recorded. The IOL rotation was measured 30 +/- 5 days and 8 +/- 1 months postoperatively. RESULTS: No intraoperative complications occurred after the learning curve. No alteration in astigmatism was observed. The mean IOL rotation was 1.04 +/- 0.5 degrees at 30 +/- 5 days and 1.02 +/- 0.2 degrees at 8 +/- 1 months. CONCLUSIONS: The EasAcryl 1 was easily implantation through a 3.2 mm tunnel without altering the natural architecture. The unfolding of the IOL was well controlled, and the IOL remained well centered. A short learning curve is required.

Acrylic Resins↗

PubMed2002

Floaterectomy: combined phacoemulsification and deep anterior vitrectomy.

We describe a 1-stage surgical technique to treat vitreous floaters. Phacoemulsification is combined with a deep anterior vitrectomy through a posterior curvilinear capsulorhexis followed by implantation of a posterior chamber intraocular lens. The technique was used in 10 eyes of 6 patients. Six months postoperatively, 8 eyes had a best corrected visual acuity (BCVA) of 6/6 with complete resolution of symptoms. Two eyes of 1 patient developed cystoid macular edema that reduced final BCVA to 6/18 bilaterally. In this case, the floaters may have been the result of previously undiagnosed intermediate uveitis.

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PubMed2002

Effect of a capsular tension ring on intraocular lens decentration and tilting after cataract surgery.

PURPOSE: To evaluate the effect of a capsular tension ring (CTR) on the tilting and decentration of intraocular lenses (IOLs) after cataract surgery. SETTING: Department of Ophthalmology, Ilsan Paik Hospital, Inje University, Kyunggyi-do, Korea. METHODS: Cataract surgery was performed in both eyes of 20 patients ranging in age from 57 to 75 years. The 40 eyes were divided into 2 groups based on whether a CTR (Lucid Korea) was implanted. Each patient received a CTR in 1 eye only. All IOLs (AcrySof MA60BM, Alcon) were implanted in the capsular bag after a continuous curvilinear capsulorhexis smaller than the IOL optic was created and phacoemulsification performed. The extent of IOL tilting and decentration was measured with the EAS-1000 anterior eye segment analysis system 7, 30, and 60 days after surgery. RESULTS: The extent of IOL decentration was statistically significantly less in eyes with both an IOL and CTR than in those with an IOL only. The mean decentration in the CTR-IOL group was 0.38 mm +/- 0.16 (SD) at 7 days, 0.43 +/- 0.15 mm at 30 days, and 0.42 +/- 0.17 mm at 60 days. The mean values in the IOL-only group were 0.49 +/- 0.11 mm, 0.53 +/- 0.14 mm, and 0.57 +/- 0.16 mm, respectively. The amount of IOL tilting was also significantly less in the CTR-IOL group. The mean tilting in the CTR-IOL group was 2.22 +/- 0.46 degrees at 7 days, 2.36 +/- 0.50 degrees at 30 days, and 2.47 +/- 0.40 degrees at 60 days. The mean values in the IOL-only group were 3.14 +/- 0.65 degrees, 2.91 +/- 0.67 degrees, and 3.06 +/- 0.56 degrees, respectively. CONCLUSION: These results indicate that the CTR reduces undesirable postsurgical IOL movement for at least 60 days.

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PubMed2002

Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag.

We report 4 cases of complete posterior dislocation of an intraocular lens (IOL) in the capsular bag occurring a mean of 5.5 years after uneventful cataract surgery. In all 4 cases, posterior chamber IOLs were fixated within the capsulorhexis. The patients experienced sudden loss of vision without an episode of trauma or ocular disease. Using a 3-port pars plana vitrectomy, the IOLs were explanted through a limbal incision and a new IOL was sutured to the ciliary sulcus. Histological examination indicated that zonular fibers were severed at the site of insertion in the capsule.

Capsulorhexis↗

PubMed2002

Combined lidocaine 1% and hydroxypropyl methylcellulose 2.25% as a single anesthetic/ viscoelastic agent in phacoemulsification.

PURPOSE: To evaluate the use of a mixture of hydroxypropyl methylcellulose 2.25% (HPMC) and lidocaine 1% (final concentrations) as a single viscoelastic/anesthetic agent to achieve proper anesthesia and viscoelastic properties during phacoemulsification. SETTINGS: Department of Ophthalmology, Cairo University, Cairo, Egypt. METHODS: This prospective randomized study comprised 70 eyes having routine phacoemulsification. Patients had the HPMC-lidocaine mixture (n = 35) or pure HPMC 2.25% (n = 35) injected before capsulorhexis and again before intraocular lens implantation. The results were evaluated by a pain/discomfort score postoperatively. RESULTS: The difference in medians of the overall intraoperative pain/discomfort scores between the 2 groups was not statistically significant. However, mild pain/discomfort was reported by 60.0% in the pure HPMC group and by 31.4% in the HPMC-lidocaine mixture group. Moderate pain/discomfort was reported by 28.6% and 5.7%, respectively. The difference between the 2 groups was statistically significant (P =.001). CONCLUSION: The use of a mixture of HPMC 2.25% and lidocaine 1% rather than a regular viscoelastic agent resulted in clinically and statistically significantly reduced pain/discomfort during phacoemulsification.

Adult↗

PubMed2002

Lensectomy in the management of glaucoma in spherophakia.

A 42-year-old woman presented with uncontrolled glaucoma despite patent peripheral iridotomies after a previous episode of acute angle-closure glaucoma. Spherophakia was diagnosed by anterior segment findings, refraction, A-scan biometry, and ultrasound biomicroscopy. Continuous curvilinear capsulorhexis, phacoemulsification, and infusion/aspiration were performed in the right eye. Attempted intraocular lens (IOL) implantation failed, and the eye was left aphakic. Six months later, the intraocular pressure (IOP) was normal without glaucoma therapy and visual acuity was 6/6 with a contact lens. The patient then had phacoemulsification in the left eye, removal of the capsular bag, anterior vitrectomy, and insertion of an anterior chamber IOL. Four months after surgery, the uncorrected visual acuity was 6/9 and the IOP was normal without glaucoma therapy.

Adult↗

PubMed2002

Complete anterior capsule contraction after phacoemulsification with acrylic intraocular lens and endocapsular ring implantation.

A 69-year-old man with pseudoexfoliation syndrome and bilateral cataract had phacoemulsification with continuous curvilinear capsulorhexis and implantation of a morcher endocapsular ring and AcrySof acrylic intraocular lens (IOL) (Alcon). Two months later, the patient had vision loss in the left eye with a visual acuity of 20/500. He presented with anterior capsule fibrosis in both eyes, with complete occlusion of the capsule opening in the left eye and mild occlusion in the right eye. After a neodymium:YAG laser anterior capsulotomy in the left eye, visual acuity was 20/20. This case shows that endocapsular ring implantation does not prevent anterior capsule contraction syndrome but can prevent IOL decentration.

Acrylic Resins↗

PubMed2002

Performance of a truncated-edged silicone foldable intraocular lens in Indian eyes.

PURPOSE: To study the role of truncated-edged silicone foldable intraocular lenses (IOLs) in preventing posterior capsule opacification (PCO) in Indian eyes. SETTING: Cornea and Anterior Segment Service, L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This prospective study evaluated 39 Indian patients (39 eyes) with a mean age of 55.4 years who had uneventful implantation of the CeeOn Edge 911A IOL (Pharmacia). All IOLs were placed in the bag. Except in 4 patients, the capsulorhexis margin overlapped 360 degrees on the IOL optic periphery. The mean follow-up was 10.9 months (range 6.5 to 13.0 months); 32 patients were followed for 1 year. RESULTS: Intraoperatively, posterior capsule fibrosis was noted in 7 patients. Diffuse haze was noted in the IOL optic in 1 patient. Clinically significant PCO did not occur in any case. One patient had clinically nonsignificant (grade 1) PCO at the 6- and 12-month follow-up visits. Although epithelial pearl accumulation (Soemmering's ring) was seen beyond the edge of the IOL in the 32 patients followed for 1 year, the epithelial pearls were central only in the patient with grade 1 PCO. Significant cell deposits were noted in 1 patient who had fibrinous uveitis at the 1-week postoperative visit; both resolved by 1 month. All eyes achieved a best corrected visual acuity of 20/30 or better. CONCLUSIONS: The CeeOn Edge 911A IOL was well tolerated in Indian eyes, and the posterior capsule remained clear. Larger patient groups with a longer follow-up will provide more useful information.

Adult↗

PubMed2002

Use of bipolar diathermy to prevent posterior capsule opacification(1).

PURPOSE: To determine the feasibility of using directed bipolar diathermy to eliminate or reduce the formation of new cortical lens material following phacoemulsification in a rabbit model. SETTING: Department of Research & Development, Bausch & Lomb Surgical, and Department of Ophthalmology, St. Louis University, St. Louis, Missouri, USA. METHODS: A rabbit model for posterior capsule opacification (PCO) was used. A continuous curvilinear capsulorhexis was performed followed by phacoemulsification to remove cortical lens material. In 2 experimental groups, modified bipolar instruments were used to apply diathermy to residual lens epithelial cells using an intracapsular or extracapsular method of application. Postoperative clinical examinations were at 1, 3, and 7 days and then weekly up to 60 days. Selected animals were followed for a longer period. Capsule integrity was evaluated by measuring the pressure required to rupture the capsule in similarly treated porcine eyes. RESULTS: Diathermy prevented PCO in 4 of 4 eyes in the intracapsular treatment group and 4 of 5 in the extracapsular group. Eyes remained free of new lens cortex for the life of the animal, which was as long as 18 months. New cortical material was detected after 35 days in 1 animal in the extracapsular group. Mean time for the formation of observable cortical material was 29 days +/- 5 (SD) in the control animals. Physical measurements did not detect a reduction in capsule integrity with diathermy treatment. The extracapsular treatment method resulted in fewer iris complications. CONCLUSIONS: Directed diathermy has the potential to eliminate secondary cataract formation with minimal damage to collateral tissues.

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