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An inadvertent filtering bleb is a complication of cataract extraction that typically occurs during the first few months of the postoperative period. These blebs may be leaking or nonleaking. The sequelae are discussed for both types, with the former being more threatening. Different aspects of cataract surgery may raise or lower their incidence, although newer techniques have reduced its risk. Two atypical cases are presented.
Four cases of unsuspected uveal melanoma diagnosed after cataract extraction were found in a review of the records of enucleation specimens processed at our centre between 1974 and 1988. Similarities among the four cases included disparity in loss of visual acuity, unilateral angle-closure glaucoma, asymmetric cataract formation, inability to view the fundus and rapid flattening of the anterior chamber, with difficult closure at the time of surgery. Uveal melanoma should be suspected in any cataract patient presenting with one or more of these atypical clinical findings, and complete investigation, including A-scan and B-scan ultrasonography, is indicated.
OBJECTIVE: To investigate the long-term visual results after cataract extraction in patients with uveitis, and to demonstrate the long-term viability of intraocular lenses. DESIGN: In all, 61 patients (72 eyes), with update clinical examination, were retrospectively evaluated. Comparison of preoperative, postoperative, and latest visual function including best-corrected Snellen visual acuity, progression of uveitis and its complications, need for postoperative medical or surgical interventions. RESULTS: After a minimum follow-up of 5 years (mean 7 years 7 months), 82% of eyes maintained a visual improvement of two Snellen lines, 74% maintained 6/9 or better, and 14% had 6/18 or worse. The mode acuity was better than 6/6. The prevalence of macular oedema or scarring was 24%, of posterior capsule opacification 96%, and of glaucoma drainage, 15%. CONCLUSIONS: We report the long-term follow-up of cataract extraction and intraocular lens (IOL) implantation performed by a single surgeon on patients with uveitis attending a regional tertiary referral uveitis clinic. Using stringent perioperative and postoperative control of inflammation, patients with uveitis usually maintain high visual acuity over long-term follow-up. The incidence of sight-threatening postoperative complications is low and no ongoing complication has been attributed to IOL implantation.
We present a technique for planned manual extracapsular cataract extraction (ECCE) incorporating a modification of mini-nuc ECCE in which the scleral tunnel is made wide enough to allow a nucleus of any size to settle in the tunnel. A 5.0 mm, inverted-V chevron incision is used in which the exposed part of the nucleus lodged in the scleral pocket can be manually picked and fragmented until it is small enough to be removed through the incision. The chevron incision is flexible enough to allow a medium-sized nucleus to be extracted without fragmentation and implantation of a rigid 6.0 mm poly(methyl methacrylate) lens. Vector analysis of preoperative and 3 month postoperative keratometric results in 30 patients showed that the surgically induced vector was 0.54 diopter (D) +/- 0.58 (SD). Mean reduction in astigmatism was 0.08 +/- 0.39 D. The sutureless technique is fast and safe, allows a nucleus of any size to be extracted through a constant size 5.0 mm incision, and results in minimal postoperative astigmatism.
We studied the effect of postoperative administration of subconjunctival 5-fluorouracil in maintaining postoperative filtration following combined trabeculectomy and extracapsular cataract extraction with posterior chamber lens implantation. Three months postoperatively, the mean intraocular pressure in 15 patients who had received 5-fluorouracil was 13.1 +/- 3.2 mm Hg; in 17 control patients, it was 13.0 +/- 3.0 mm Hg (P greater than .05). The mean number of postoperative medicines in the study patients was 0.7; in the control patients, 0.8 (P greater than .05). Bleb appearance and improvement in visual acuity were similar in the two groups. This study does not support the routine use of 5-fluorouracil in patients who have undergone combined trabeculectomy and extracapsular cataract extraction.
Two cases of dellen following cataract extraction with implant insertion are described. Etiology may be based upon deprivation of nervous and vascular supplies, and possibly related to large corneal sections. Conservative therapy was found to be sufficient in restoring the corneal integrity.
The advantage of a planned extracapsular cataract extraction is that the intact posterior capsule holds the vitreous face in a more physiologic position. The extracapsular method has been improved by newer techniques and a good result has been made more certain by the following: a large microscopically controlled capsulectomy with the irrigating cystotome, aspiration of the cortex while the wound is secured with sutures, and the use of the irrigating sand-blasted cannula when indicated. The indications for the extracapsular extraction have increased because there is a greater certainty of obtaining a clear pupil with less change of secondary inflamation. These indications and the newer technique are discussed in the body of the paper.
The effect of cataract surgery in patients with glaucoma controlled by either topical medication or surgery was assessed in 64 patients. At one year there was a small significant fall in intraocular pressure (IOP) for eyes without previous surgery (preoperative IOP 18.9 +/- 4.7, range 12 to 35 mmHg; postoperative IOP 16.3 +/- 3.4, range 10 to 26 mmHg; P < 0.01) and also for those with previous surgery (preoperative IOP 15.0 +/- 4.3, range 3 to 22 mmHg; postoperative IOP 14.2 +/- 3.7, range 6 to 22 mmHg, P < 0.05). There was a significantly greater incidence of high rise in IOP to 30 mmHg or more immediately after operation in patients without (32%) than those with previous surgery (13%) (chi 2 = 3.9; P < 0.05). Complications were minimal in each group. Iridotomy to deliver the nucleus was necessary in nine eyes without and 21 with previous surgery. Cataract extraction usually causes only a small fall in IOP in glaucomatous patients. If a separate corneal section is used there is no loss of function of the filtering bleb in patients with previous glaucoma surgery.
PURPOSE: To determine whether there is a difference in intraocular pressure (IOP) control between extracapsular cataract extraction (ECCE) and phacoemulsification performed after successful trabeculectomy. SETTING: Eye Unit, St. Woolos Hospital, Newport, United Kingdom. METHODS: This retrospective study comprised 55 patients with glaucoma who had had trabeculectomy and subsequently had cataract surgery. Extracapsular cataract extraction was performed in 34 eyes and phacoemulsification in 21. The IOP before cataract surgery was used as a baseline for comparison with the IOP at 6 and 12 months and at the last follow-up visit (mean 44.26 months in the ECCE group and 15.09 months in the phacoemulsification group). At the 3 postoperative examinations, the IOP was recorded before and after institution of medical treatment. RESULTS: In the ECCE group, the IOP exceeded the target pressure in 7 eyes and required medical treatment; it remained uncontrolled in 1 eye at the final visit. In the phacoemulsification group, the IOP was less than 18 mm Hg without any medication and within the target pressure in all 21 eyes. The IOP increase after ECCE was statistically significant (mean IOP was 13.61 mm Hg before and 15.53 mm Hg after ECCE; P = .0297). After treatment was instituted, there was no statistically significant difference in the IOP compared with the preoperative value (P = .0796 at 6 months, .677 at 1 year, and .4419 at the final visit in the ECCE group and .0703, .2220, and .1035, respectively, in the phacoemulsification group). CONCLUSION: The findings indicated that IOP was better controlled by phacoemulsification than by ECCE in patients who had had filtration surgery.
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214 patients who underwent cataract-extraction in 1973 were examined for systemic diseases. The average age of patients with (70%) and without (30%) general diseases was 67 years. The frequency of cardio-vascular and respiratory diseases corresponded to that observed in the general population of the same age. In contrast, the rate of diabetes mellitus was four times higher than to be expected statistically. The importance of an adequate clinical management of diabetic cataract patients is discussed.
A modified irrigating lens loop applied externally to the eye may be used to express the nucleus in an extracapsular cataract extraction. No skill is required in subluxating the nucleus into the anterior chamber, as this maneuver is not necessary. The danger of posterior capsule rupture is diminished because no counter-pressure is applied and the lens loop is not placed in the eye. It is occasionally necessary to peak the pupil with forceps if it is not well dilated. We recommend this technique to simplify extracapsular cataract extraction and to markedly reduce the surgeon's risk of rupturing the posterior capsule.
It has been assumed that lens epithelial cells (LECs) existing at the capsulotomy edge have been traumatized through anterior capsulotomy in cataract extraction. In this study, the correlation between traumatized LECs remaining at the anterior capsulotomy edge and epidermal growth factor (EGF) found in the aqueous humor, a cell growth factor though to affect cell morphology, was determined. Anterior lens capsules with adhering LECs were obtained following anterior capsulotomy performed during cataract surgery to first confirm the presence of EGF receptors on LECs, which are needed for EGF to be biologically active. Besides, to identify any EGF receptors on traumatized LECs, I next intentionally traumatized the cells by pressing them with a forceps from the anterior capsular side. It has been found that the LECs containing EGF receptors were always those existing at the edge of the anterior capsular opening and LECs containing EGF receptors existed along the pressed region too. The present results indicate that traumatized LECs along the capsulotomy edge have undergone changes to manifest EGF receptors, thus allowing EGF from the aqueous humor to become more active. The physiological effect of EGF upon these LECs may therefore be one of the causative factors of fibrous opacification of the anterior capsulotomy edge after cataract extraction.
A combined operation a) keratoplasty; b) cataract extraction; c) iridocapsular implant must be advised when a corneal opacity and a cataract require both a surgical treatment. Six months after surgery, functional results are good in 4 cases/5.
We reviewed thirteen operated eyes (twelve diabetic patients) with rubeosis iridis who underwent extracapsular cataract extraction and intraocular lens implantation. Prior to surgery five had active proliferative retinopathy (APR), and eight had non-proliferative retinopathy (NPR), either quiescent proliferative retinopathy (QPR) or background retinopathy (BR). No case with APR was visually improved by surgery. Three cases with NPR achieved a visual acuity of 6/12. After surgery, vitreous haemorrhage or progression of proliferative retinopathy occurred in three cases with APR. Early postoperative fibrinous uveitis was severe in eyes with APR, resulting in permanent fibrin membrane formation in four. We suggest a significant prognostic indicator in diabetic cataract extraction with rubeosis iridis is the status of the underlying retinopathy. With NPR, postoperative visual acuity may be good and early postoperative complications less severe. In the presence of APR the visual outcome is poor, progression of retinopathy likely and early postoperative fibrinous uveitis may be severe enough to prevent postoperative panretinal photocoagulation. Maximum preoperative panretinal ablation is essential in these cases.
PURPOSE: To study the reason and management of posterior capsular bresks during cataract extraction and lens implantation. METHODS: The authors analyse the reasons of posterior capsular brseaks during cataract extraction and lens implantation on 55 eyes and discuss the management according to the different situations. RESULTS: The posterior capsular disruption occurred most frequently during cortical cleanup on 21 eyes (38.2%) and lens implantation on 21 eyes (38.2%). The diameter of the tears was about 3 mm on 39 eyes (70.9%), about 5 mm on 13 eyes (23.6%) and larger than 6 mm on 3 eyes (5.5%). The tears with central defined borders were on 12 eyes (21.8%), with peripheral defined border in one side on 39 eyes (71%), with pooly defined borders on 3 eyes (5.5%). Final visual acuity of 0.5 or better was achieved on 35 eyes (63.6%). CONCLUSIONS: When the complication occurs during the operation, we should use the suitable management according to the different situations in order to reduce the loss of the complication.
BACKGROUND AND OBJECTIVES: As the number of older Americans increases, more patients will need cataract extraction surgery. Outcome studies will be necessary to assess and improve the quality of care. This study documents the outcomes of extracapsular cataract extraction (ECCE) performed at Oak Forest County Hospital (OFH) and phacoemulsification (PE) performed at the University of Chicago Hospitals (UCH) by residents who were training at the University of Chicago. PATIENTS AND METHODS: Residents train using ECCE during their second year at OFH, and learn PE at the UCH during their third year. The authors performed a chart review of all patients who had undergone ECCE at OFH (N = 52) and all patients who had undergone PE at the UCH (N = 343) from 1995 through 1997. Complete preoperative, intraoperative, and postoperative clinical data were recorded on the American Society of Cataract and Refractive Surgery database. RESULTS: There were no intraoperative complications at OFH, and 23 of 52 (44%) of the eyes had a final best-corrected visual acuity (BCVA) of 20/40 or better. At the UCH, vitreous loss occurred in 16 of 343 (5%) of the PE patients. A final BCVA of 20/40 or better was achieved in 300 of 343 (87%) of the PE eyes. CONCLUSIONS: The visual outcomes of patients who undergo ECCE at a county hospital are poor, but the surgical complications are minimal. The visual outcomes of patients who undergo PE at a university hospital are good, but the complication rates are slightly higher.
PURPOSE: To compare the efficacy, safety and patient comfort of two topical steroids (prednisolone 1% and rimexolone 1%) and a topical non-steroidal anti-inflammatory agent (ketorolac tromethamine 0.5%) after extracapsular cataract extraction. METHODS: Forty-five patients were enrolled in this prospective, randomized, double-blind study. They were assigned to receive topical treatment with either prednisolone, rimexolone or ketorolac tromethamine ophthalmic solution after phacoemulsification for cataract extraction. On postoperative days 1, 3, 5, 14 and 28 best-corrected visual acuity, intraocular pressure (IOP), slit-lamp examination of the anterior segment and report of the patients' comfort were assessed and compared by Friedman rank time analysis. RESULTS: Regarding the primary outcome efficacy of inflammation control the assessment of cells did not differ (p=0.165), while flare in the anterior chamber was lowest (p=0.008) in the non-steroidal anti-inflammatory drug (NSAID) group. Surface inflammation was lowest with prednisolone (p=0.002). Regarding safety, visual acuity did not differ among the groups. In the prednisolone group one patient, however, responded to steroid treatment with elevated IOP and had to be excluded. In the remaining patients IOP was even lower in the two steroidal treatment groups than with ketorolac (p=0.030). One patient receiving ketorolac had to be excluded because a corneal erosion developed. Patient comfort was highest with prednisolone (p=0.041). CONCLUSIONS: Ketorolac tromethamine provides good control of intraocular inflammation after cataract extraction without the risk of a steroidal IOP increase, which was also not observed under rimexolone therapy. The best surface inflammation control and patient comfort was observed with prednisolone, which remains a good choice.