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Results for “Capsulorhexis”

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At least 451 records · Page 25Linked to original sources

PubMed2003

Endoillumination-assisted cataract surgery in a patient with corneal opacity.

We present a technique to better visualize cataracts through corneal opacity. A 70-year-old Japanese woman with retinal detachment, cataract, and corneal opacity in the left eye was treated with phacoemulsification, 3-port vitrectomy, and intraocular lens implantation. To circumvent the difficulty of performing continuous curvilinear capsulorhexis (CCC) and subsequent cataract surgery through a hazy cornea, we used an endoilluminator as a light source outside the cornea for CCC and inside the anterior chamber for phacoemulsification. As a result, CCC and subsequent cataract surgery were successfully and easily performed despite potentially troublesome corneal opacity. The use of an endoilluminator can be an effective supportive measure for cataract surgery in patients with corneal opacity.

Aged↗

PubMed1997

Anterior capsule stability in eyes with intraocular lenses made of poly(methyl methacrylate), silicone, and AcrySof.

PURPOSE: To ascertain whether the movement of the anterior capsule is different with intraocular lenses (IOLs) made from different materials. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: Ninety patients had standardized extracapsular cataract extraction, continuous curvilinear capsulorhexis (CCC), and confirmed in-the-bag IOL placement performed by the same surgeon. Patients were randomized to receive a three-piece, 6.0 mm IOL made of poly(methyl methacrylate) (PMMA), silicone, or AcrySof, all with PMMA haptics, and received standardized postoperative medication. Except for material, the IOLs were of the same design. On days 7, 30, 90, 180, and 360, digitized retroillumination images were taken of the IOL. The movement of the anterior capsule between each visit was analyzed. RESULTS: The amount of anterior capsule movement was significantly less in the AcrySof lens group than in the PMMA or silicone lens groups in the first year after surgery (P = .0001). CONCLUSION: The AcrySof lens with PMMA haptics produced significantly less anterior capsule movement than PMMA or silicone lenses and thus is likely to cause less IOL decentration and capsular phimosis.

Acrylates↗

PubMed1997

Elschnig pearl formation along the posterior capsulotomy margin after neodymium:YAG capsulotomy.

PURPOSE: To determine the incidence of Elschnig pearl formation along the capsulotomy margin (string of pearls) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy and to elucidate its clinical features, predisposing factors, effect on visual function, and association with additional capsulotomy. SETTING: Keio University Hospital, Tokyo, Japan. METHODS: The records of 418 eyes that had had Nd:YAG posterior capsulotomy after cataract surgery were retrospectively reviewed. Of those, 315 were excluded for short follow-up (fewer than 12 months) or insufficient clinical examination data. In the remaining 103 eyes, the incidence of string of pearls was calculated, and its clinical features, predisposing factors, effect on visual function, and correlation with additional capsulotomy were evaluated. RESULTS: String of pearls was identified in 49 eyes (47.6%); 37 (75.5%) developed pearls within 1 year after Nd:YAG capsulotomy. The incidence was significantly higher in patients having intraocular lens implantation and continuous curvilinear capsulorhexis (CCC) than in those without (95.9 versus 61.1% and 97.9 versus 55.6%, respectively). No significant differences were found in patient age and sex, total Nd:YAG energy, and the presence of diabetes mellitus or high myopia. String of pearls caused visual disturbances in 17 eyes (34.7%). The rate of repeat capsulotomy was higher in patients with string of pearls than in those without (36.7 and 9.3%, respectively). CONCLUSIONS: String of pearls formation was a common and significant complication after Nd:YAG posterior capsulotomy. Intraocular lens implantation and CCC may promote its formation.

Adult↗

PubMed1998

Measuring the anterior capsule opening after cataract surgery to assess capsule shrinkage.

PURPOSE: To measure anterior capsule opening (ACO) size after acrylic intraocular lens (IOL) implantation and study the natural course of ACO reduction. SETTING: Kimura Eye and Internal Medicine Hospital, Hiroshima, Japan. METHODS: This study comprised 32 patients (38 eyes) having continuous curvilinear capsulorhexis, phacoemulsification, acrylic IOL implantation, and a self-sealing incision performed by 1 surgeon. A retroillumination photograph of the ACO was obtained with the Anterior Eye Segment Analysis System and converted to a computer image. The images were used to measure ACO size postoperatively and calculate the reduction ratio. Follow-up was 6 months. RESULTS: The postoperative reduction ratio in ACO size was 2.14% at 1 week, 3.83% at 1 month, 4.29% at 3 months, and 5.03% at 6 months. In a few cases, the reduction was progressively severe throughout the follow-up. CONCLUSIONS: The anterior capsule opening shrank rapidly during the first month after acrylic IOL implantation, followed by a slower progressive reduction in the subsequent 6 months. When severe, progressive shrinkage occurs, an anterior neodymium:YAG laser capsulotomy should be performed within 2 months postoperatively.

Acrylic Resins↗

PubMed1998

Effect of intraocular lens design on neodymium:YAG laser capsulotomy rates.

PURPOSE: To compare the effect of 2 poly(methyl methacrylate) (PMMA), 1-piece biconvex intraocular lens (IOL) designs on the cumulative frequency of neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Department of Ophthamology, Mayo Clinic, Rochester, Minnesota, USA. METHODS: This retrospective study evaluated 369 eyes that had phacoemulsification with continuous curvilinear capsulorhexis (CCC) and IOL implantation in the capsular bag. Patients were placed in 1 of 2 groups based on the 1-piece, biconvex PMMA IOL design: large IOL, with a lens diameter of 13.50 to 13.75 mm, optic size of 6.5 mm, and 10 degree haptic angulation; small capsular IOL, with a lens diameter of 12.0 to 12.5 mm, optic size of 5.5 mm, and 2 degree haptic angulation. RESULTS: Using Kaplan-Meier analysis, the frequency of Nd:YAG laser posterior capsulotomy 1, 2, and 3 years after cataract surgery was 1.6, 12.3, and 26.5%, respectively, in the large IOL group and 3.4, 9.5, and 23.5%, respectively, in the small capsular IOL group. The cumulative frequency of Nd:YAG laser capsulotomy was not statistically different between the 2 groups. CONCLUSION: After phacoemulsification and CCC, there was no significant difference in the Nd:YAG laser capsulotomy rate in eyes with a small, capsular design, 1-piece, biconvex PMMA IOL and those with a larger, angulated, 1-piece, biconvex PMMA IOL.

Adolescent↗

PubMed1998

Pupillary block after pupillary capture of an AcrySof intraocular lens.

A 54-year-old man developed pupillary block resulting from pupillary capture 2 months after uneventful phacomulsification and AcrySof intraocular lens (IOL) implantation. The IOL was placed in the bag through a 6.0 mm continuous curvilinear capsulorhexis. The glaucoma was treated with intravenous drip infusion of a hyperosmotic diuretic, followed by peripheral iridectomy, iridocapsular synechiolysis, and IOL repositioning. The IOL loops were located completely in the bag. However, pupillary capture recurred 3 weeks after the surgery, at which time intraocular pressure was normal. The flexibility of the IOL optic and its large overall length and rigid, low-angulated loops were the probable causes for the recurrence of the pupillary capture. The IOL was exchanged for a sulcus-fixated, single-piece poly(methylmethacrylate) lens with 10 degree angulated loops. Pupillary capture did not recur during the follow-up.

Acrylic Resins↗

PubMed1998

Endothelial damage with cataract surgery techniques.

PURPOSE: To evaluate intraoperative endothelial damage after planned extracapsular cataract extraction (ECCE) with difference capsulotomy techniques and phacoemulsification. SETTING: San Carlos University Hospital, Castroviejo Institute, Madrid, Spain. METHODS: In this prospective, randomized study, 60 patients with senile cataract scheduled for cataract surgery were divided into three groups of 20 each: Group 1 had phacoemulsification; Group 2, planned ECCE with continuous curvilinear capsulorhexis; and Group 3, ECCE with letter-box capsulotomy. Preoperatively and 3 months postoperatively, endothelial cell density, percentage of hexagonality, and the cell size variation coefficient were determined by contact specular microscopy; endothelial permeability was examined by anterior segment fluorophotometry and central corneal thickness, by ultrasonic pachymetry. Results were analyzed using the two-tailed Student's t-test and analysis of variance. RESULTS: In all three groups, endothelial permeability and cell loss increased significantly from the preoperative values, but there were not significant differences among the postoperative values. Mean cell loss was 11.8% in Group 1, 12.8% in Group 2, and 10.1% in Group 3. There were no differences between the preoperative and postoperative morphometric indexes. Postoperative pachymetric measurements were not significant. CONCLUSIONS: Endothelial response was not statistically significantly different among the surgical techniques, although endothelial damage was lower in Group 3, which could indicate a protective effect of the anterior capsule during cataract extraction. Endothelial barrier function remained disturbed despite the apparent morphological stabilization.

Aged↗

PubMed1998

Area reduction in the anterior capsule opening in eyes of diabetes mellitus patients.

PURPOSE: To compare the extent of area reduction in the anterior capsule opening after continuous curvilinear capsulorhexis in the eyes of diabetes mellitus (DM) patients with that in the eyes of patients without DM. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: Ninety-one eyes of 91 DM patients and 91 age-matched eyes of patients without DM (control group) having intraocular lens (IOL) implantation were recruited for this prospective study. The DM group comprised 36 eyes with diabetic retinopathy (DR) and 55 without retinopathy (NDR). The anterior capsule opening area was quantitated using Scheimpflug photography 1 week and 1, 3, and 6 months postoperatively. RESULTS: There was no statistically significant difference in mean anterior capsule opening area between the DM and control groups at 1 week or 1 month postoperatively. The area was significantly smaller in the DM group at 3 (P = .0221) and 6 (P = .0075) months. The percentage area reduction was also greater in the DM group than in the control group. The area in the DR group was significantly smaller than in the control group at 3 (P = .0392) and 6 (P = .0080) months. The percentage reduction in the DR group was larger than in the NDR or control group. CONCLUSIONS: After IOL implantation, contraction of the anterior capsule opening area was more extensive in eyes of DM patients than in those of patients without DM, especially in the case of DR.

Aged↗

PubMed1998

Retinal detachment following phacoemulsification in highly myopic cataract patients.

PURPOSE: To assess whether modern, small incision phacoemulsification techniques significantly reduce the retinal detachment (RD) risk in highly myopic patients who have visually significant cataracts. SETTING: University-associated ophthalmology practice. METHODS: This retrospective study included 80 eyes in 61 patients with preoperative myopia of 7.00 diopters (D) or more. Sixty-four eyes had an axial length of 25.0 mm or greater. All surgery was performed superiorly using a frown-shaped, self-sealing, scleral tunnel. The incision size ranged from 3.0 to 5.0 mm. Capsulorhexis was performed and then four-quadrant cracking phacoemulsification. The posterior capsule was routinely polished. A posterior chamber intraocular lens (IOL) was implanted in the capsular bag in all cases. RESULTS: No RDs occurred during the mean follow-up of 43 months (range 9 to 77 months) or the mean follow-up after neodymium:YAG capsulotomy of 20 months. No intraoperative complications occurred. Seventy-one of 80 eyes (89%) achieved best spectacle-corrected visual acuity of 20/25 or better. CONCLUSIONS: Retinal detachments following modern cataract surgery in high myopia are much less common than previously reported. We attribute this to small incision size, continued maintenance of the anterior chamber, posterior chamber IOL implantation, and lack of intraoperative complications.

Adult↗

PubMed1998

Viscoelastic-injecting cystotome.

This continuous curvilinear capsulorhexis (CCC) technique is for use in complicated surgical cases such as when the anterior chamber is shallow, the red reflex is not good, or eye movements are present. This technique is easier and safer in such cases because it uses a cystotome connected to a viscoelastic syringe. First, the anterior chamber is filled with viscoelastic material using a conventional cannula. The cannula is replaced with a bent needle (or cystotome), and the CCC is performed in the usual way. This instrument allows the surgeon to inject small amounts of viscoelastic material exactly where and when it is needed. The anterior chamber remains deep while the CCC is performed, and the anterior capsule tear is done in a more controlled fashion.

Anterior Chamber↗

PubMed1998

Mini-haptics to improve capsular fixation of plate-haptic silicone intraocular lenses.

PURPOSE: To evaluate the effects of a new mini-haptic design on the strength and stability of capsular bag fixation of plate-haptic silicone intraocular lenses (IOLs) and determine whether this design encourages the growth of regenerating lens material or fibrous tissue around the haptic biomaterial and thus improves lens fixation in the capsular bag. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Department of Ophthalmology, Charleston, South Carolina, USA. METHODS: Six rabbits had bilateral continuous curvilinear capsulorhexis, phacoemulsification, and plate-haptic silicone IOL implantation. Each rabbit had a small-hole plate IOL (Chiron C10UB) implanted in the right eye and a mini-haptic plate IOL (Chiron C40UB) in the left eye. All rabbits were killed at 2 months. The force required to extract one haptic from the capsular bag was measured with a digital force gauge. Histopathologic analysis was performed on all specimens. RESULTS: The mini-haptic style IOLs required significantly more extraction force than the small-hole design (P = .011). Histopathologically, proliferating lens epithelial cells were observed growing circumferentially around the mini-haptics, causing a 360 degree synechia formation. This formation did not occur with the conventional small-hole plate IOLs used as the control. CONCLUSIONS: Lens epithelial cell proliferation around the mini-haptics significantly improved capsular bag fixation of the plate-haptic silicone IOL. This should decrease the incidence of clinical decentration and dislocation.

Animals↗

PubMed1998

Relationship between intraocular lens biomaterials and posterior capsule opacification.

PURPOSE: To determine whether posterior capsule opacification (PCO) is influenced by intraocular lens (IOL) material. SETTING: A British teaching hospital eye department. METHODS: Ninety eyes were prospectively randomized to receive a poly(methyl methacrylate) (PMMA), silicone, or AcrySof IOL. All lenses had 6.0 mm optics and PMMA haptics. A standardized surgical protocol was performed by a single surgeon using an extracapsular technique with capsulorhexis. Patients having surgical complications were excluded and all patients had standardized medication and follow-up. Posterior capsule opacification was assessed by a digital retroillumination camera using a dedicated software program based on the analysis of texture in the image and calculated as the percentage area of opacified capsule. Data were analyzed 2 years postoperatively. RESULTS: There was a significant difference in percentage of PCO at 2 years among the three lens types (P < .0001). The AcrySof lenses were associated with less PCO (median 11.75%) than PMMA (43.65%) and silicone (33.50%) lenses (P < .001 and P = .025, respectively). The difference between PMMA and silicone lenses was not statistically significant. CONCLUSION: Intraocular lenses made from AcrySof were associated with a significantly reduced degree of PCO.

Acrylates↗

PubMed1998

Biocompatibility of poly(methyl methacrylate), silicone, and AcrySof intraocular lenses: randomized comparison of the cellular reaction on the anterior lens surface.

PURPOSE: To determine the foreign-body response to three intraocular lens (IOL) biomaterials (poly[methyl methacrylate] [PMMA], silicone, and AcrySof) and use this as an indicator of their comparative biocompatibility postoperatively within the eye. SETTING: A British teaching hospital eye department. METHODS: Ninety eyes were prospectively randomized to receive a PMMA, silicone, or AcrySof IOL. All lenses had 6.0 mm optics with PMMA haptics. A standardized surgical protocol was performed by a single surgeon using an extracapsular technique with capsulorhexis; eyes that experienced a surgical complication were excluded. All patients had standardized postoperative medication and follow-up. Specular microscopy of the anterior IOL surface was carried out after pupil dilation on days 1, 7, 30, 90, 180, 360, and 720 to assess small cell and giant cell reactions. RESULTS: All three IOL types produced a mild degree of nonspecific foreign-body response, which resolved over the study period without detrimental effect. The silicone group had significantly higher small cell counts than the PMMA and AcrySof groups (P = .02); the AcrySof group had significantly lower giant cell counts than the other two groups (P = .003). CONCLUSION: The three IOL types were sufficiently biocompatible to function in normal eyes with age-related cataracts. However, AcrySof IOLs were associated with lower giant cell counts than PMMA and silicone IOLs and might produce better results in eyes with pre-existing blood-aqueous barrier damage.

Acrylates↗

PubMed1999

Creating cataract in a pig eye.

The purpose of this study was to create a uniform, reproducible hardened lens nucleus and an anterior capsule in a pig eye that approximate those in the human eye for use in cataract surgery training. The lens nuclei was hardened and anterior capsule elasticity was reduced in pig eyes by injecting the lens with mixtures of formalin and alcohol (ethanol, 2-propanol, or both). A 30 gauge needle was used to pierce the lens 3.0 mm from the limbus. Then, 0.2 mL of the formalin and alcohol mixture was injected. The most effective mixture was formalin, ethanol, and 2-propanol in the ratio 4:3:3. Fifteen minutes after this mixture was injected, the pig eye had nuclear cataract with grade III hardness and an anterior capsule that approximated the capsule in a human cataractous eye. The cataract created by this method will be useful in teaching continuous curvilinear capsulorhexis, divide and conquer and phaco chop phacoemulsification, and nuclear hydrodelineation and rotation.

2-Propanol↗

PubMed1999

Accumulation of milky fluid: a late complication of cataract surgery.

We describe 3 patients who presented with an accumulation of homogeneous milky fluid in the capsular bag several years after continuous curvilinear capsulorhexis, phacoemulsification, and posterior chamber intraocular lens (IOL) implantation. In each case, the entire edge of the anterior capsule opening was tightly attached to the peripheral IOL optic. The milky fluid was present in the closed chamber between the IOL optic and the posterior capsule. The fluid was sampled in 2 patients, and its concentration of sodium hyaluronate was determined by high-performance liquid chromatography. The concentration of sodium hyaluronate resembled that in normal aqueous humor. In 1 case, the protein concentration was measured and found to be elevated. Electrophoresis showed that human serum albumin was the main protein constituent. While the outcome was favorable in all 3 patients, this delayed complication of cataract surgery merits further study to clarify its etiology and pathogenesis.

Aged↗

PubMed1999

Fibrous membrane formation at the capsular margin in capsule contraction syndrome.

PURPOSE: To determine whether the pathogenesis of capsule contraction syndrome involves the outgrowth of the fibrous membrane from the anterior capsule margin. SETTING: Department of Ophthalmology, Keio University School of Medicine, Tokyo, and the Ando Eye Clinic, Kanagawa, Japan. METHODS: A retrospective review of medical records and slitlamp photographs was conducted in 12 eyes (10 patients) that had required treatment for a narrowed anterior capsule opening after cataract surgery. All patients had had continuous curvilinear capsulorhexis and phacoemulsification with implantation of an intraocular lens in the capsular bag. Specimens of surgically removed fibrous membrane were examined by histopathological methods. RESULTS: Fibrous membrane on the inner surface of the anterior capsule and the linear folds of the anterior capsule were present in each eye. In 10 eyes of 8 patients, the fibrous membrane was on the outer surface of the anterior capsule and covered the capsular folds at its margin. Pathological study showed that this fibrous membrane consisted of the flattened lens epithelial cells that proliferated on the inner and outer surfaces of the shrunken anterior capsule. The outgrowth of this membrane from the margin of the anterior capsule to the center of the opening of the anterior capsule was noted. CONCLUSION: In this study, capsule contraction syndrome involved contraction of the fibrous membrane as well as its outgrowth from the capsule margin.

Actins↗

PubMed1999

Small incision nucleus capture: results of 200 cases.

PURPOSE: To compare the learning curve in a series of 200 cataract surgeries performed using small incision nucleus capture with that of phacoemulsification as reported in the literature. SETTING: Department of Ophthalmology, University of Genoa, Genoa, Italy. METHODS: Two hundred eyes of 163 consecutive patients with cataract had small incision nucleus capture, a relatively new cataract surgery technique that allows small incisions and in-the-bag intraocular lens implantation. Patients were divided into 4 groups of 50 each according to when they had surgery between August 1996 and October 1997. The incidence of intraoperative complications (capsule break with or without vitreous loss, capsulorhexis tears, Descemet's detachment, transient iris damage) and postoperative complications (raised intraocular pressure, corneal epithelial edema, Descemet's folds, and permanent iris damage) were evaluated at the different time points. Also recorded was final visual acuity. These results were compared with those obtained with phacoemulsification. RESULTS: The study comprised 92 women and 71 men with an age range of 41 to 93 years. Overall final results showed that the learning curve of nucleus capture is comparable to that of phacoemulsification. CONCLUSION: Nucleus capture cataract extraction resulted in a low incidence of complications and good visual recovery that was comparable to that obtained with phacoemulsification.

Adult↗

PubMed1999

Effect of intraocular lens and anterior capsule opening type on posterior capsule opacification.

PURPOSE: To determine the effect of intraocular lens (IOL) type and anterior capsulectomy technique on the incidence of posterior capsule opacification. SETTING: Department of Ophthalmology, Medical Faculty, University of Ondokuz Mayis, Samsun, Turkey. METHODS: Three hundred two eyes of 294 patients were examined retrospectively after IOL implantation in the capsular bag performed between February 1991 and November 1996. Patients were divided into 3 groups according to IOL type: poly(methyl methacrylate) (PMMA); heparin-surface-modified PMMA (HSM PMMA); plate-haptic silicone. Envelope capsulectomy or continuous curvilinear capsulorhexis (CCC) was used. Mean follow-up was 27 months (range 12 to 33 months). RESULTS: Posterior capsule opacification developed in 47 cases (15.6%): 21.7% in the PMMA lens group after planned extracapsular cataract extraction (ECCE), 17.4% in the HSM PMMA lens group after planned ECCE, and 7.7% in the plate-haptic silicone lens group after phacoemulsification. Posterior capsule opacification occurred less in patients who had anterior capsulectomy using the CCC technique (11.5%) than in those having an envelope capsulectomy (24.5%) (P < .05). Posterior capsule opacification was significantly less in eyes with a capsular-bag-fixated plate-haptic silicone lens than in those with a PMMA or HSM PMMA IOL (P < .05). CONCLUSION: This study demonstrated that the anterior capsulectomy technique and the IOL type influence the incidence of PCO.

Aged↗