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Results for “Capsulorhexis”

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PubMed1998

Anterior capsule contraction and intraocular lens dislocation in eyes with pseudoexfoliation syndrome.

AIMS: To examine the extent of anterior capsule contraction as well as intraocular lens (IOL) decentration and tilt following implant surgery in eyes with pseudoexfoliation syndrome (PE). METHODS: 53 eyes from 53 patients with PE and 53 control eyes from 53 age matched patients, undergoing phacoemulsification and implant surgery, were recruited. The anterior capsule opening area and the amounts of IOL decentration and tilt after undergoing continuous curvilinear capsulorhexis were measured using the Scheimpflug videophotography system at 1 week and 1, 3, 6, 9, and 12 months postoperatively. RESULTS: The mean area of the anterior capsule opening in the PE group was significantly smaller than that in the control group at 1 month postoperatively and later. The percentage reductions in the PE group were approximately 25%, while they were less than 10% in the control group. The degree of IOL tilt was also larger in the PE group than in the control group. Five eyes (9.4%) in the PE group underwent a neodymium: YAG laser anterior capsulotomy, but none in the control group underwent a capsulotomy. CONCLUSIONS: The contraction of the anterior capsule opening was more extensive in the PE eyes than in the control eyes, thus resulting in a high Nd:YAG laser anterior capsulotomy rate. The IOL tilt was also greater in the PE eyes than in the control eyes.

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PubMed2000

Quantitative measurement of the PCCC area in the postoperative period.

BACKGROUND/AIMS: The major complication of extracapsular cataract extraction (ECCE) is posterior capsule opacification (PCO). Posterior continuous circular capsulorhexis (PCCC) seems to be very promising in preventing PCO. This study was aimed at determining if the PCCC area changes as a function of time and if pearl formation could influence it. METHODS: 24 eyes of 23 patients underwent ECCE with PCCC. Retroillumination photographs were taken at 6 months and then yearly. To measure the PCCC area, the computerised program EPCO (evaluation of posterior capsule opacification) was used. The ratio of the PCCC area in relation to the IOL surface was calculated for the different time stages and the presence of pearl formation was noted. Firstly, proportional changes in diameter were compared in PCCC areas measured after 6 months and after 1 year (group I, n=13) and after 1 year and 2 years (group II, n=14). Secondly, PCCC areas were compared between two time stages in patients with (group III, n=19) and without pearl formation (group IV, n=8). RESULTS: No statistically significant difference was found in diameter change in either group. The PCCC area remains stabile between 6 months to 1 year and 1 year to 2 years. No differences are found between eyes with or without pearl formation. CONCLUSIONS: The PCCC area remains stable as a function of time and is not influenced by pearl formation.

Adult↗

PubMedDate not supplied

Open-sky capsulorrhexis in triple procedure: with or without trypan blue?

PURPOSE: To establish the beneficial effects of trypan blue 0.1% capsule staining in open-sky capsulorrhexis during triple procedure. METHODS: Patients who underwent penetrating keratoplasty (PK) with phacoemulsification and intraocular lens (IOL) implantation were divided into two groups. Group 1 consisted of 31 eyes of 26 patients with a mean age 64.4 +/- 6.9 years and anterior lens capsule was stained with trypan blue 0.1% to perform open-sky capsulorrhexis. In Group 2, capsulorhexis was performed without staining of the anterior capsule in 19 eyes of 17 patients with a mean age 60.6 +/- 5.3 years. The rates of complete capsulorrhexis and intra- and postoperative capsule-related complications were compared between the groups. RESULTS: The most common diagnosis before PK was corneal opacification in both groups. Open-sky capsulorrhexis was not completed in 3 eyes (9.6%) in Group 1 and in 9 eyes (47.3%) in Group 2. The rates of incomplete capsulorrhexis, posterior capsule tear, and transscleral fixation IOL implantation were higher in Group 2 (for each, p < 0.05). The diameters of capsulorrhexis were smaller than 4.5 mm in one eye in Group 1 and in two eyes in Group 2, and larger than 6.5 mm in two eyes in Group 1 and in three eyes in Group 2. Malposition of IOL, zonular dialysis, retinal detachment, and pupil capture were only observed in eyes in Group 2. In the follow-up period, there were no adverse reactions due to application of trypan blue in Group 1. CONCLUSIONS: Trypan blue staining of the anterior capsule during triple procedure helps the surgeon perform open-sky capsulorrhexis more easily and safely and in proper dimensions, provides positive effects on the other steps of the surgery, and decreases the rate of posterior capsule tear formation.

Adult↗

PubMedDate not supplied

Stability of astigmatism over 3 years after corneal stretch incision.

PURPOSE: To assess long-term corneal stability of self-sealing clear corneal stretch incisions with implantation of 5 mm polymethylmethacrylate (PMMA) intraocular lenses. METHODS: Two hundred consecutive eyes of 3500 cataract patients who had capsulorhexis, phacoemulsification, and preparation of a 1.5 to 2.0 mm corneal tunnel that had an external width of 4.0 to 4.1 mm and an internal width of 6.5 to 7.0 mm (stretch incision), and implantation of a 5 mm PMMA intraocular lens were evaluated clinically and statistically. Slit-lamp microscopy, keratometry, and corneal topography were performed preoperatively and postoperatively after 1 week, 1, 2, and 3 years. RESULTS: The mean surgically induced astigmatism following superior corneal incision amounted to 1.59 +/- 1.06 D after 3 years; following lateral corneal incision, mean surgically induced astigmatism was 0.84 +/- 0.68 D. There were no corneal complications in the long-term follow-up study. CONCLUSION: Our 5-year experience shows that the self-sealing clear corneal stretch incision in connection with implantation of a 5 mm polymethylmethacrylate intraocular lens induces approximately 1.00 D of astigmatism. We prefer the lateral incision and recommend the superior incision only for high preoperative with-the-rule astigmatism.

Astigmatism↗

PubMed1999

[Scleral mini-incision without ultrasound in the treatment of congenital cataract].

PURPOSE: Congenital cataract surgery can be performed by pars plana or limbal incision. We report our experience with scleral incision without ultrasounds in congenital cataract surgery. MATERIAL AND METHODS: Fifteen children with congenital cataract underwent surgery of both eyes (30 eyes). The zonular ciliaris and the lens anlage were normal in all cases. All procedures were performed by the same surgeon. A 3.2 mm scleral tunnel incision was made 2 mm from the limbus. Large capsulorhexis or capsulopuncture were performed after injection of a viscoelastic substance in the anterior chamber. After hydrodissection, the nucleus and cortex were aspirated. The wound was closed by apposition suture. RESULTS: The mean age was 70.13 months (range 5 months to 130 months). Mean induced astimatism calculated with the Cravy method was 0.70 dipoters. A posterior capsular tear was observed in 1 case. CONCLUSION: Small scleral incision without ultrasounds has advantages. No expensive instruments are required and astimatism is not induced. The anterior chamber lies deep during the operation, protecting the endothelial cells and facilitating aspiration. Postoperative inflammation is minimal. The small scleral incision technique is useful in selected cases of congenital cataract.

Age Distribution↗

PubMed1997

[An experimental study of stretching capacity of lens anterior capsule].

OBJECTIVE: To study the stretching capacity of the lens anterior capsule. METHODS: After continuous circular capsulorhexis (CCC) was performed on 22 bull eyes, the capsular elasticity was measured by gradually opening a modified caliper until the capsular opening was torn. The ratio between the circumference of the opening at rupture and that of the original intact one was used as an index of capsular elasticity. RESULT: The circumference of the intact CCC could be enlarged to an additional 61% before a radial tear occurred. The area of the extended CCC was significantly larger than that of the original CCC and than the cross-section of a lens nucleus tilted 30 degrees. CONCLUSION: The anterior capsule was found to have remarkable stretching capacity, and a suitable size of CCC allows a safe removal of lens substance and intraocular lens implantation without radial tears.

Animals↗

PubMed2001

[Clinical and histopathologic analyses of after cataract in rabbit eyes having undergone three different cataract surgeries].

OBJECTIVE: To discuss the surgical method which can efficiently prevent the occurrence of after cataract. METHODS: Eighteen experimental rabbits were randomly divided into 3 groups. Group A was treated with phacoemulsification, group B with phacoemulsification combined with posterior continuous curvilinear capsulorhexis (PCCC) and Group C phacoemulsification combined with PCCC and anterior vitrectomy. Post-operatively, all the surgical eyes were checked with slit lamp microscope and ophthalmoscope. At the post-operative 3 months, histopathologic examinations were performed. RESULTS: There were no post-operative complications, such as retinal detachment, cystoid macular edema, etc. There were Elschnig's pearls and fibers in the peripheral area of the posterior capsule, and the amount was about the same in the 3 groups. There were Elschnig's pearls and fibers at the central area in group A. The fibrous membrane grew from the edge of the PCCC in group B. But in group C, the central area of the posterior capsule was clear, and there was no obvious pathological changes. CONCLUSION: Phacoemulsification combined with PCCC and anterior vitrectomy is a safe cataract surgical method which can effectively prevent the formation of after cataract.

Animals↗

PubMed2000

[Phacoemulsification in white cataract].

OBJECTIVE: To evaluate the value and technique of Phacoemulsification in white cataract. METHODS: Ninty eyes of senile cataract were divided into two groups by the density of the nuclei. Different operative technique was done in two groups. RESULTS: The success rate of the continuous curvilinear capsulorhexis was 88.9%. Seventy five eyes have got the visual acuity over 0.5 on the first day after the operation. There was significant difference between two groups. The complications of operation were mild corneal edema and posterior capsule tear. CONCLUSIONS: It's difficult to complete the phacoemulsification of white cataract. The surgeons are required the skillful technique and experience. However, phacoemulsification is valuable in white cataract.

Adult↗

PubMed1991

An experimental study comparing various anterior capsulectomy techniques.

Radial tears at the margin of an anterior capsulectomy may be associated with the exit of at least one loop of an intraocular lens out of the capsular bag ("pea pod" effect) and subsequent decentration. Many ophthalmologists have gained a clinical impression that the anterior capsule is more likely to remain intact if the continuous circular capsulorhexis (CCC) technique is used. However, controlled comparison of the incidence of radial tears with the use of different capsulectomies under standardized conditions has not been performed, to date. In this study, we analyzed the incidence of radial tear formation in 40 human eyes that were obtained post mortem. These eyes were randomized to four technique groups: (1) "can opener," (2) linear capsulotomy, (3) capsulopuncture, and (4) CCC. We demonstrated that the CCC technique is much less likely to cause or be associated with anterior capsular radial tears as opposed to the other three techniques. With the technique of nuclear expression used in this study, radial tears occurred in 100% of cases treated with the can opener, linear capsulotomy, and capsulopuncture techniques, whereas no tears occurred with the CCC technique. This study provides convincing evidence that the CCC is the best available anterior capsulectomy procedure to minimize the incidence of radial tears.

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PubMed1990

Anterior capsule-supported intraocular lens. A new lens for small-incision surgery and for sealing the capsular opening.

A new intraocular lens made of PMMA and fixed in the anterior capsular opening is introduced. The lens diameter is 4 mm and the lens has no haptics in the conventional sense but is finely grooved around the circumference edge. The lens is inserted into the anterior capsule via a very small-diameter opening created by mini-circular capsulorhexis. The anterior capsular opening, with a round, smooth-edged margin, avoids stress concentration and, therefore, the capsule does not easily tear. This opening catches the lens and chokes it along the grooved edge. In animal experiments, firm fixation was obtained. This lens may be adequate for small-incision surgery, and in the future it may be used to prevent leakage of filling material during refilling of the lens, since it acts as a part of the anterior capsule and seals the capsular opening completely.

Animals↗

PubMed1994

Hydrosonic intercapsular piecemeal phacoemulsification or the 'HIPP' technique.

Hydrosonic Inter-capsular Phaco emulsification is a small incision cataract extraction technique performed totally within the confines of the intact capsular bag through a small peripheral anterior capsulorhexis located at 12 o'clock close to the external incision. In addition to the obvious protective advantages to the corneal endothelium and other structures of the anterior segment, the technique has inherent Hydrodynamics properties that increase the precision and safety of the procedure. Thorough Hydrodissection and Hydrofragmentation which are essential steps of the procedure are accomplished with the Hydrosonic handpiece. The following is a detailed description of the technique.

Cataract Extraction↗

PubMedDate not supplied

Ultrastructure of the anterior lens capsule after vitrectomy with silicone oil injection. Correlation of clinical and morphological features.

To clarify the mechanical difficulties experienced when performing anterior capsulorhexis in vitrectomized eyes filled with silicone oil. Five anterior lens capsules removed from eyes with a silicone oil history were submitted to light and electron microscopic analysis and then compared to two capsules from eyes with trauma history and seven capsules from eyes without silicone oil or trauma history. Comparable abnormalities of the inner and outer surface of the anterior lens capsule were consistently observed after silicone oil fill of the vitreous cavity or after traumatic impact to the lens: patches of multilayer epithelial cells with interspersed capsule material and connective tissue were observed on the posterior surface of the anterior lens capsule. The development of this anterior subcapsular tissue plaque is obviously influenced not only by the PVR process or by side effects of the surgical procedure but also by the silicone oil tamponade or a trauma history. The plaque can be considered primarily responsible for the increased mechanical resistance of the lens capsule in all eyes with silicone oil / trauma history examined in this study.

Cataract Extraction↗

PubMed1998

Ocular complications and a new surgical approach to lens dislocation in homocystinuria due to cystathionine-beta-synthetase deficiency.

The ocular findings in patients with homocystinuria due to cystathionine-beta-synthetase (CBS) deficiency are reviewed and a new approach to lens surgery is presented. Lens surgery in CBS deficiency was reported to be accompanied by a high risk of secondary complications like vitreal prolapse and retinal detachment. So far an operative procedure for these patients that allows a complete preservation of the anterior vitreous cortex, the posterior lens capsule and an implantation of an artificial lens is not established. A minimal invasive method of lens surgery was developed in vitro and applied in the case of a 10-year-old patient with an uncorrectable refractive situation due to progressed lens dislocation. Principle steps of the evolved operative procedure are (1) visco-elastic stabilization of the anterior chamber; (2) small (1.5 mm) peripheral capsulorhexis; (3) manual endocapsular aspiration of lens material and removal of lens epithelium; (4) ab externo introduction of a transcleral fixation suture; (5) positioning of the haptic into the ciliary sulcus in the inferior position; (6) resection of the anterior lens capsule; and (7) positioning of the second haptic into the ciliary sulcus. The first patient treated according to this method presented a stable position of the pseudophakos during the follow up of 1 year. Visual acuity improved from a level of 20/200 (O.D.) and 10/200 (O.S.) to 18/20 in both eyes. The surgical procedure presented in this report seems to be useful for dealing with dislocated lenses due to zonular deficiency in patients with CBS deficiency and hopefully with Marfan disease. It allows a minimal invasive removal of the lens, a complete preservation of the anterior vitreous cortex and at the same time a stable fixation of an artificial intraocular lens.

Child↗

PubMed1998

[Late dislocation of a plate haptic silicone lens into the vitreous body after Nd:YAG capsulotomy. A case report].

UNLABELLED: We describe a case that was referred 10 months after Nd:YAG laser treatment with a posteriorly dislocated silicone intraocular lens (IOL) into the vitreous cavity. PATIENT: A 70-year old white woman underwent uncomplicated phacoemulsification with in-the-bag placement of a Chiron silicone plate haptic lens through a 5.5- mm continuous circular capsulorhexis. The patient was fine until 9 months postoperatively when she complained of a decrease in visual acuity due to capsular fibrosis. A successful Nd:YAG laser capsulotomy was performed, resulting in an increase in visual acuity. Ten months later, the patient noted acute and atraumatic loss of vision, and the IOL was found to have dislocated posteriorly onto the retina. RESULTS: The dislocated IOL was removed via the anterior chamber following pars plana vitrectomy. Perfluorocarbon liquid was used to elevate the slippery lens from the retinal surface. The IOL was removed by a Sato Knife from the anterior chamber, followed by implantation of a one-piece PMMA IOL in the ciliary sulcus. CONCLUSION: Silicone plate haptic IOLs seem to present special risks for dislocation. Shrinkage of the anterior capsule exerts centripetal forces on the ends of the plate haptic, causing the optic to move posteriorly and to exert pressure against the posterior capsule. If either the posterior or anterior capsule is disrupted by Nd:YAG laser treatment, the forces created by capsular contraction against the flexible lens may cause extension of radial tears and appear to be a substantial risk for further capsule-tearing, releasing the IOL into the vitreous cavity, even months later. The forces of capsular contraction can impart a spring-loading effect on plate haptic silicone lenses. Due to inadequate capsular adherence, these lenses are at risk of posterior dislocation from capsular rents following Nd:YAG laser treatment.

Aged↗

PubMed1999

[Capsular bent ring. Improvement of the capsular tension ring].

Since the first introduction of the capsular ring in 1991, the open capsular tension ring proved to be efficient in various indications and applications: e.g. in zonular dialysis or or weakness, with integrated tinted sector shield in sector or aniridia, to facilitate primary posterior capsulorhexis, for prophylaxis of intraocular lens decentration or as an intraocular measuring gauge. Nishi modified this capsular tension ring mainly by increasing the width to 0.7 mm and created a rectangular edge, thus facilitating the creation of a sharp, discontinuous bend in the equatorial capsule. This band-shaped, sharp-edged capsule-bending ring prevented the anterior capsule from coming into contact with the posterior capsule. This is most likely due to the 0.7 mm width of the capsule-bending ring, which significantly prevented anterior capsule opacification, which commonly occurs within one month postoperatively. Posterior capsule opacification seems to be reduced as well, but final evaluation is needed for a longer period of time. The capsular tension ring as well as the capsular bending ring enlarge our surgical options in modern cataract surgery. Both can be considered as a useful instrument and promising innovation.

Aged↗

PubMed2001

[Refraction, anterior chamber depth, decentration and tilt after implantation of monofocal and multifocal silicone lenses].

BACKGROUND: We prospectively investigated changes in refraction, anterior chamber depth, decentration and tilt after implantation of multifocal (MIOL) and monofocal (MONO) intraocular lenses (IOL). PATIENTS AND METHODS: We examined 103 cataractous eyes from 103 patients receiving either a three-piece monofocal or multifocal silicone IOL. Anterior chamber depth (ACD), amount of IOL decentration, and degree of IOL tilt were quantified using retroillumination and Scheimpflug photographs. Examinations, including subjective refraction, were performed preoperatively, one week and 6 months postoperatively. RESULTS: All eyes were within 2 dpt (spherical equivalent) from the target refraction, and 93% of eyes with a MIOL were within 1 dpt. No significant refractive shift or ACD change occurred during the postoperative course. Median tilt in the MIOL group at 6 months was 1.1 degrees (0-2.6) and that in the MONO group 1.0 degree (0-2.5). There was no statistically significant change in intraindividual IOL decentration or tilt. CONCLUSION: Three-piece silicone MIOLs and MONOs with polymethylmethacrylate haptics implanted in the capsular bag after circular capsulorhexis provide good centration and very little tilt without statistically significant change up to 6 months after surgery. Postoperative refractive shift is of minor concern for 6 months after surgery.

Adult↗

PubMed2003

Results and complications of hydrophobic acrylic vs PMMA posterior chamber lenses in children under 17 years of age.

PURPOSE: To compare results and complications of implantation of hydrophobic acrylic foldable intraocular lenses in children with those of polymethylmethacrylate (PMMA) intraocular lenses. METHODS: In a retrospective study, we analyzed results of cataract surgery with posterior chamber lens implantation in 30 eyes of 30 patients aged 1-16 years. In 10 eyes, acrylic (Alcon AcrySof) intraocular lenses, and in 20 eyes, single-piece PMMA posterior chamber lenses were implanted. Indications for cataract surgery (blunt or penetrating trauma, zonular cataract, cataracta polaris posterior, posterior lenticonus) and mean age at implantation were comparable in the two groups. Mean patient age at surgery was 8.6+/-4.6 years (range 3-16 years) for the acrylic vs 6.3+/-4.3 years (range 1-16 years) for the PMMA group. Mean follow-up was 1.0+/-0.7 years (range 0.1-2.2 years) in the acrylic group and 1.8+/-1.5 years (range 0.1-5.7 years) in the PMMA group. Primary anterior vitrectomy was performed in 7 eyes in the PMMA group and in 3 eyes in the acrylic group. In addition, one additional posterior capsulorhexis without anterior vitrectomy was performed in each group. Primary outcome measure was the occurrence of postoperative "complications" (fibrin, synechiae, posterior capsular opacification). For statistical evaluation, the Fisher exact test was used. RESULTS: When evaluating all complications together (at least one complication vs no complication), there were significantly less complications in the acrylic group (2 of 10 vs 15 of 20; p=0.007. For early complications (postoperative fibrin, synechiae) the difference was also significant (1 of 10 in the acrylic vs 11 of 20 in the PMMA group; p=0.02). The rate of posterior capsular opacification necessitating YAG capsulotomy was lower in the acrylic group (1 of 10 eyes) than in the PMMA group (7 of 20 eyes), but the difference did not reach statistical significance ( p=0.67). The postoperative time point of YAG capsulotomy was 21 months in the acrylic group and 19+/-10 months (range 6-33 months) in the PMMA group. IOL dislocation was not observed in any of the patients. Postoperative visual acuity was comparable in the two groups: 0.57+/-0.35 (0.03-1.0) in the acrylic vs 0.39+/-0.34 (0.001-0.9) in the PMMA group ( p=0.83). CONCLUSIONS: Implantation of hydrophobic acrylic intraocular lenses in the capsular bag in children may be associated with less postoperative complications compared with implantation of PMMA lenses. This appears also to be true in children under age 6 years. The visual results seem comparable and correspond mainly to the underlying ocular pathology.

Acrylates↗

PubMed1998

Causes of severe decentration and subluxation of intraocular lenses.

BACKGROUND: Severe decentration and subluxation of intraocular lenses (IOLs) may lead to double vision, glare and deterioration of vision to the point of functional aphakia. The purpose of the present study was to analyse causes for severe IOL dislocation. MATERIAL AND METHODS: Between January 1989 and January 1996, 37 patients required IOL exchange because of decentrated or subluxated posterior chamber lenses. Twenty-five of the exchanged lenses were implanted in our hospital, 12 lenses elsewhere. After explantation the lenses were examined by light and electron microscopy. RESULTS: In 10 eyes, asymmetric implantation of the posterior chamber lens was responsible for decentration. Three of the lenser concerned were multifocal IOLs. Asymmetric implantation led to a significantly higher rate of explantations in eyes with multifocal lenses (P < 0.005). In five eyes decentration developed due to asymmetric capsular shrinkage, in four eyes due to posterior synechiae. A lens subluxation developed in three eyes as a result of rupture of the posterior capsule and in nine eyes because of zonular defects. In three cases decentrations were induced by an extensive secondary cataract. Macroscopically visible changed geometry of the haptics was found in nine lenses; eight of these had polypropylene haptics. Seven lenses showed severely altered haptics on electron-microscopic examination. In four eyes subluxated lenses had to be explanted together with the capsular bag because of severe defects of the zonula, which caused decentration in nine eyes. CONCLUSIONS: Asymmetric implantation of posterior chamber lenses should be strictly avoided. Multifocal lenses require special attention concerning symmetric capsulorhexis and positioning of their haptics.

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