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PubMed1987

Combined corneal transplantation, extracapsular cataract extraction, and artificial lens implantation (triple procedure).

The treatment of eyes with significant opacities of the cornea as well as cataract is a major challenge for the ophthalmic surgeon. Recent data indicate that these problems may be dealt with safely in a single combined operation which includes penetrating corneal transplantation, extracapsular cataract extraction, and implantation of an artificial lens (triple procedure). In the present report the author's initial experience with the triple procedure is presented. In four patients with a minimum of 6 months follow-up, clear media and marked visual improvement were achieved in all cases. The corneal pathology included two cases of Fuchs' dystrophy, and two cases of central scarring following interstitial keratitis. No complications occurred. The visual rehabilitation time was short, and comparable to ordinary phakic grafting. The triple procedure should be considered in selected cases where there are no specific contraindications to corneal grafting, cataract extraction, or lens implantation.

Cataract↗
PubMed2004

Long-term complications of extracapsular cataract extraction with posterior chamber intraocular lens implantation, in Nigeria.

AIM: To identify the long-term complications of extracapsular cataract extraction with posterior chamber intraocular lens implantation surgery, in the National Eye Centre, Kaduna, Nigeria. METHODS: The study is a retrospective review of patients that have had extracapsular cataract extraction with posterior chamber intraocular lens implantation, in the National Eye Centre, Kaduna, Nigeria from January 1996 to December 1999. The medical records of all patients that satisfy these criteria were retrieved. Information collected included age, sex, eye operated upon, intra-operative complications, pre-operative visual acuity and last follow-up, and long-term post-operative complications. RESULT: Medical records of only 66 patients (71 eyes) that maintained a minimum follow-up of at least one year were retrievable. No major intra-operative complications were recorded. Only one eye had posterior capsule rent. Ninety percent of the operated eyes had vision of 6/60 or better one year post-operative. The overall visual outcome (WHO criteria) was borderline. Of the corrected eyes, the consultants have a statistically significantly better outcome than residents. The following post-operative complications were recorded in 25 (35.2%) eyes: pseudophakic bullous keratopathy (11.3%); posterior capsular opacification (7.0%); persistent inflammation (7.0%); secondary glaucoma (2.8%); pupil distortion (5.6%); and ocular hypotony (1.4%). CONCLUSION: ECCE + PC-IOL microsurgery is associated with long-term complications like PBK (Pseudophakic bullous keratopathy) and PCO (Posterior capsular opacification). Their management creates new demands in our country. This study is limited by the small number of eyes eligible for review at least one year after surgery.

Adult↗
PubMed2006

Cataract extraction outcomes in patients with Fuchs' heterochromic cyclitis.

PURPOSE: To analyze the visual outcomes and complication rate after cataract extraction and posterior chamber intraocular lens (PC IOL) implantation in patients with Fuchs' heterochromic cyclitis. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This retrospective nonrandomized interventional study comprised 103 patients who were examined at the uvea clinic at L.V. Prasad Eye Institute between March 2000 and March 2004 and who were diagnosed with Fuchs' heterochromic cyclitis and cataract. They had extracapsular cataract extraction or phacoemulsification with IOL implantation. Outcomes measures were postoperative visual acuity, ocular inflammation, and complication rate. RESULTS: There were 57 men and 54 women in the study; the mean age was 31.36 years +/- 11.55 (SD) (range 10 to 60 years). Postoperative best corrected visual acuity (BCVA) at 5 weeks was 20/40 or greater in 91 patients (88.3%) (95% confidence interval [CI], 82.1-94.5). Eight patients (7.8%) had vitreous inflammation 5 weeks postoperatively. Five patients (4.9%) preoperatively and 3 patients (2.9%) postoperatively had elevated intraocular pressure. Clinically detected cystoid macular edema developed in 1 patient. The mean follow-up was 12.9 months in 53 patients. At the final follow-up, 49 of 53 patients (91.5%) (95% CI, 99.0-84.0) had a visual acuity of 20/40 or greater. Ten eyes (18.9%) had mild anterior chamber reaction. Decreased visual acuity (20/40 or worse) was the result of anterior chamber reaction in 4 patients, glaucoma in 3 patients, vitreous inflammation in 2 patients, and posterior capsule opacification, corneal edema, macular hole, and astigmatism in 1 patient each. CONCLUSIONS: Cataract surgery with PC IOL implantation in patients with Fuchs' heterochromic cyclitis resulted in good visual outcomes. Postoperative inflammation was mild and developed in few cases.

Adolescent↗
PubMed1984

Clinical classification of after-cataract following planned extracapsular cataract extraction.

A total of 100 eyes underwent planned extracapsular cataract extraction and were followed more than three months with a mean follow-up period of 12 +/- 8 months. After-cataract was found in 72 eyes. The after-cataract was classified by slit-lamp microscopy into two types, the remnant type and the proliferative type. The former type was due to remains of the lens materials and was present immediately after the surgery: this type was divided into veil-like and Soemmering forms. The proliferative type developed after a period following surgery and was divided into fibrous form and Elschnig form. The fibrous form was thought to be due to fibrous proliferation of the lens epithelial cells, since it was seen at or to originate from the sites of adhesion of the anterior and posterior capsules. The Elschnig form consisted of Elschnig's pearls and was divided into progressive and localized subforms. The former subform was seen more frequently in young patients than the latter subform. The incidences of the above types and forms of the after-cataract were determined. Impairment of the visual acuity due to after-cataract was seen in the proliferative type and was found in 7 eyes. A fluorophotometric study to evaluate the function of the blood-aqueous barrier was carried out in 7 patients with the presence of after-cataract and in 11 patients with no or subtle after-cataract. No difference was found in the barrier function between the two groups.

Adolescent↗
PubMed2005

Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study.

PURPOSE: To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. METHODS: In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) > or =40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. RESULTS: In total, 10 patients (five male, five female), with a mean age+/-SD of 73.1+/-10.3 years were recruited. Mean duration of symptomatic attack was 128+/-232 h. After ALPI, the mean IOP was reduced from 56.1+/-12.5 to 45.3+/-14.5 mmHg at 15 min, 37.6+/-7.5 mmHg at 30 min, 34.2+/-9.7 mmHg at 60 min, 25.5+/-8.7 mmHg at 120 min, and 13.6+/-4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. CONCLUSION: Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.

Acute Disease↗
PubMed1997

The preliminary report of epikeratophakia in the treatment of pediatric aphakia after traumatic cataract extraction.

PURPOSE: To study the role of epikeratophakia in treating pediatric unilateral aphakia after traumatic cataract extraction. METHODS: We performed epikeratophakia in 43 children to treat aphakia after traumatic cataract extraction, using the corneal lenses made by ourselves. The rehabilitation of the the postoperative vision and the prevention of amblyopia were observed with a mean follow-up period of 20 months. RESULTS: All the lenses remained transparent. Postoperatively, 31 cases (72.1%) achieved uncorrected visual acuities (V.A) over 0.2, 32 cases (74.4%) achieved corrected V.A over 0.4. Most of the cases achieved the best preoperative corrected V.A with spectacles of less than 3 diopters. No severe complication occurred. CONCLUSION: Epikeratophakia is predictable with quality lens and correct surgical technique. The result suggests that the epikeratophakia is one of the best treatment for the pediatric aphakia especially for those who are not optimal for IOL implantation.

Adolescent↗
PubMed2000

The results of cataract extraction and intraocular lens implantation in patients with Behçet's disease.

PURPOSE: To evaluate the results of extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in patients with Behçet's disease. METHODS: Retrospective study was based on 19 uveitic eyes of 12 patients with Behçet's disease who underwent classic ECCE with IOL implantation in 5 eyes and phacoemulsification with IOL implantation in 14 eyes between 1993-1999. RESULTS: In eyes with Behçet's uveitis 0.5 or better postoperative visual acuity was found in 21% at the end of mean 34.2-4.6 (range 5 to 66) months follow-up. The most frequent postoperative complications were posterior capsule opacification in 9 (47%), posterior synechiae in 5 (26%), anterior synechiae in 3 (16%). Anterior and posterior synechiae in the phacoemulsification group were less than those in the ECCE group (respectively p<0.05 and p<0.01). CONCLUSIONS: In eyes with chronic Behçet's uveitis, cataract extraction and IOL implantation by phacoemulsification had fewer postoperative complication than ECCE, but most of the patients had low visual acuity due to preoperatively existing optic atrophy and/or inflammatory degeneration or edema of macula.

Adult↗
PubMed1997

Risk factors, complications, and results in extracapsular cataract extraction.

PURPOSE: To examine a large series of extracapsular cataract extractions (ECCEs) to determine the risk factors for posterior capsule rupture with vitreous loss (PCR + VL) and the complications and results of this cataract surgery technique. SETTING: North Riding infirmary, Middlesbrough, United Kingdom. METHODS: In this retrospective study, the records of 1552 patients who had ECCE performed by two surgeons were examined. Follow-up was 4 months to 4 years. The main outcome measures were the incidence of risk factors, PCR + VL, major and minor postoperative complications, and the visual outcome. RESULTS: Three hundred twenty-two cases were considered high risk for PCR + VL. In this group, the PCR + VL rate was 5.3%; it was 3.7% in the low-risk group and 4.0% overall. Visual acuity of 6/9 or better was achieved by 76% of all eyes. Postoperative complications were 3 cases of endophthalmitis, 4 of retinal detachment, and 1 of pseudophakic bullous keratopathy. In 323 eyes, loose or broken sutures were removed and in 175, a neodymium: YAG capsulotomy was performed because of posterior capsule opacification. CONCLUSIONS: The incidence of perioperative and postoperative complications was comparable with those reported in other series. Factors that increased the risk of PCR + VL included pseudoexfoliation, diabetes mellitus, and a traumatic etiology. Previous glaucoma surgery and axial myopia of greater than 26.0 mm did not increase the PCR + VL risk. Loose or broken corneal sutures was a common finding that could be reduced substantially by planned suture removal.

Cataract Extraction↗
PubMed1991

Intercapsular cataract extraction with implantation of the Galand disc lens: a retrospective analysis in patients with and without glaucoma.

We studied the results of intercapsular cataract extraction and implantation of the rigid Galand disc intraocular lens (IOL) in 164 cataract patients with and without glaucoma. Eighty-eight percent of the glaucomatous eyes and 98% of the eyes without glaucoma had a postoperative visual acuity of 20/40 or better after best-case analysis. Intercapsular bag placement appeared satisfactory in all but two cases, in which the IOL was slightly tilted. Cataract extraction favorably affected glaucoma control, especially in patients with angle-closure glaucoma (7.3 mm Hg intraocular pressure [IOP] reduction) and in those with primary open-angle glaucoma (2.6 mm Hg IOP reduction). The complications encountered, cystoid macular edema and hyphema, occurred in 1% and 0.5% respectively, and were not more frequent in the glaucoma subgroup. Posterior capsular opacification (30%) and inflammatory complications such as posterior synechiae (7.6%) and prepupillary fibrin (6%) were more often noted in the glaucomatous eyes. Pupillary capture or significant IOL decentration did not occur. We conclude that a circular type of IOL is the best currently available lens for use in glaucoma patients.

Aged↗
PubMedDate not supplied

Keratoplasty and cataract extraction.

Fifty eyes were evaluated following penetrating keratoplasty and cataract extraction. Twenty five of them had intracapsular lens extraction while the remaining 25 had intercapsular method of extracapsular lens extraction. Both operative and post operative complications were more in group I. Visual outcome and graft clarity were also better in eyes of group II. Combined keratoplasty and intercapsular method of extracapsular lens extraction was recommended in eyes having both corneal and lenticular pathology.

Adult↗
PubMed1997

Glaucoma after cataract extraction and posterior chamber lens implantation in children.

PURPOSE: To evaluate the incidence of postoperative glaucoma in children who have cataract extraction and posterior chamber intraocular lens (IOL) implantation. SETTING: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. METHODS: The incidence of glaucoma of all etiologies was evaluated in 45 eyes of 37 selected consecutive patients aged 1 to 18 years who had cataract extraction and posterior chamber IOL implantation from 1991 to 1994. Mean follow-up was 23 months (range 6 to 38 months). Nineteen patients had traumatic and 18 had developmental cataract. Exclusion criteria were microcornea smaller than 9.0 mm in diameter, preoperative glaucoma, or poor pupil dilation. The surgical technique comprised a continuous curvilinear anterior capsulorhexis in most cases, extracapsular aspiration by Ocutome or phacoemulsification, and retention of the posterior capsule. A peripheral iridectomy was done in 7 eyes (16%). Postoperative medications included topical atropine combined with topical, subconjunctival, and systemic corticosteroids and antibiotics. RESULTS: Three patients with traumatic cataract developed postoperative glaucoma during the follow-up. One developed pseudophakic pupillary block; however, a peripheral iridectomy prevented glaucoma. Two other patients developed late-onset glaucoma: one secondary to angle recession and the other to peripheral anterior synechias. No patient with developmental cataract developed glaucoma. CONCLUSION: Careful patient selection, atraumatic surgical technique, continuous curvilinear capsulorhexis, in-the-bag IOL placement, postoperative atropine, and topical and systemic corticosteroids significantly lower the incidence of pseudophakic pupillary block and glaucoma. Although no patient developed glaucoma, lifelong follow-up is mandatory to detect chronic open-angle and traumatic angle-recession glaucoma.

Adolescent↗
PubMed2002

[Refraction changes after cataract extraction with IOL implantation in the eyes with previous performed vitrectomy].

PURPOSE: To determine differences between the predicted and postoperative refraction after cataract extraction with intraocular lens implantation in the eyes, which previous underwent vitrectomy. MATERIAL AND METHODS: Fifty three eyes of 52 patients underwent the analysis: twenty five in group I, nineteen in group II and nine eyes with previous scleral buckling in group III. All the eyes had ECCE and IOL with PMMA implantation after vitrectomy. In groups II and. III silicone oil tamponade was used and removed before cataract extraction. Thirty eyes of the control group K underwent cataract surgery and IOL implantation alone. The IOL power calculation was performed with SRK II formula. The predicted and postoperative refractions were compared. The follow-up was minimum 4 months (on average 15 +/- 12.71 months). RESULTS: The postoperative refractions were significantly shifted toward myopia than it was predicted--1.41 +/- 1.21 D in group I, -0.81 +/- 2.11 D in group II and -3.03 +/- 1.49 D in group III. In the control group K the difference was--0.07 +/- 0.91. CONCLUSIONS: Myopic shift of postoperative refraction after cataract surgery should be considered, when calculating the IOL power in the eye after vitreoretinal procedures.

Adult↗
PubMed1990

On the practicalities of eye camp cataract extraction and intraocular lens implantation in Nepal.

Based on our experience in Nepal, we discuss the practicalities of performing extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in the context of the third-world eye camp. At slightly less than 30 minutes per case, while not as quick as an intracapsular cataract extraction (ICCE) with a Graefe section, the trade-off between vision result and operation time, according to patients, is very much in favor of the ECCE/IOL technique. Also, although IOLs remain expensive, by using donated lenses, the overall costs of providing ECCE/IOL surgery need not exceed those of providing ICCE.

Cataract Extraction↗
PubMed1993

Changes in corneal shape after suture cutting using the argon laser for postoperative astigmatism following cataract extraction.

We studied the changes in corneal shape after suture cutting with an argon laser to reduce corneal astigmatism following cataract extraction. Sixty-two patients who exhibited high with-the-rule astigmatism (> 3 diopters [D]) following extracapsular lens extraction had argon laser suture cutting. The patients were classified into three groups: Group A comprised 30 patients whose sutures were cut two to three months after planned extracapsular cataract extraction (p-ECCE); Group B consisted of eight patients who had the same treatment five to nine months after p-ECCE; Group C comprised 24 patients who had the treatment one to two months after phacoemulsification (PE). The dioptric reduction of corneal astigmatism (the percent reduction of astigmatism) was 1.83 +/- 0.98 D (37.4 +/- 18.3%) in Group A, 3.20 +/- 2.35 D (55.6 +/- 34.4%) in Group B, and 2.08 +/- 1.20 D (41.4 +/- 20.4%) in Group C. There was no statistical significance in the dioptric reduction and the percent reduction among Groups A, B, and C. This suggests that the wound size and time of cutting are not directly correlated to the effect of argon laser suture cutting. To examine the relationship between the effect and changes in corneal shape from suture cutting, we divided the patients into two subgroups; one was Subgroup (+) in which the percent reduction of astigmatism was above 25%; the other was Subgroup (-) in which the percent reduction was below 25%.(ABSTRACT TRUNCATED AT 250 WORDS)

Astigmatism↗
PubMed2000

Postoperative Mycobacterium chelonae endophthalmitis after extracapsular cataract extraction and posterior chamber intraocular lens implantation.

OBJECTIVE: To describe a case of postoperative endophthalmitis caused by Mycobacterium chelonae after extracapsular cataract extraction with posterior chamber intraocular lens implantation. DESIGN: Interventional case report. METHODS: The history and clinical presentation of a 66-year-old female patient, in whom a low-grade delayed-onset endophthalmitis and keratitis developed after extracapsular cataract extraction with posterior chamber intraocular lens implantation, is described. Microbiologic investigations of the scrapings of corneal infiltrate at the cataract incision site, aqueous humor and eviscerated material, and histopathologic study of eviscerated material and an enlarged cervical lymph node were performed. MAIN OUTCOME MEASURES: The clinical, histopathologic, and microbiologic findings in a case of low-grade delayed-onset endophthalmitis. RESULTS: Analysis of the direct smear of both the corneal infiltrate as well as the eviscerated material revealed acid-fast bacilli. M. chelonae was isolated from these specimens. Direct smear and culture of the aqueous humor were negative for bacteria (including mycobacteria) and fungus. Histopathologic examination of the eviscerated material showed a dense infiltration of polymorphonuclear leukocytes in the uveal tissue, extensive necrosis and hemorrhage, and exudates with hemorrhage in the vitreous cavity. Histopathologic examination of the lymph node revealed granulomatous inflammation with caseation necrosis, but did not reveal acid-fast bacilli. CONCLUSIONS: M. chelonae, although infrequent, should be considered an etiologic agent of delayed-onset, postoperative endophthalmitis and early bacterial diagnosis should help in institution of appropriate therapy.

Abscess↗
PubMed1979

The triple procedure; combined penetrating keratoplasty, cataract extraction and lens implantation.

Results of combined keratoplasty, extracapsular cataract extraction and lens implantation (triple procedure) are reported for 67 eyes having at least 12 months follow-up. The average age of the patients was 73; the majority were female with a pre-op diagnosis of Fuchs's dystrophy. Post-op visual acuities were 20/40 or better in 72% of the eyes. No implants were removed and only one eye required regrafting. The discission rate was 32%; discissions were usually performed a year post-op. We feel the favorable results are due to uniform use of microsurgical extracapsular catarat extraction at the time of surgery with good capsular fixation of the lens implant.

Aged↗