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PubMedDate not supplied

Posterior capsule opacification.

A complication of extracapsular cataract extraction with or without posterior chamber intraocular lens (PC-IOL) implantation is posterior capsule opacification. This condition is usually secondary to a proliferation and migration of residual lens epithelial cells. Opacification may be reduced by atraumatic surgery and thorough cortical clean-up. Clinical, pathological and experimental studies have shown that use of hydrodissection, the continuous curvilinear capsulorhexis and specific IOL designs may help reduce the incidence of this complication. Capsular-fixated, one-piece all-polymethylmethacrylate PC-IOLs with a C-shaped loop configuration and a posterior convexity of the optic are effective. Polymethylmethacrylate loops that retain "memory" create a symmetric, radial stretch on the posterior capsule after in-the-bag placement, leading to a more complete contact between the posterior surface of the IOL optic and the taut capsule. This may help form a barrier against central migration of epithelial cells into the visual axis. Various pharmacological and immunological methods are being investigated but conclusive data on these modalities are not yet available.

Cataract↗

PubMed2004

Biomechanical changes in the anterior lens capsule after trypan blue staining.

PURPOSE: To examine the effect of trypan blue staining on the biomechanical behavior of the porcine anterior lens capsule. SETTING: Department of Ophthalmology, Technical University of Dresden, Dresden, Germany. METHODS: Fifty-five anterior lens capsules from porcine cadaver eyes were used. Two parallel 8.0 mm x 4.0 mm large capsule strips were prepared from each capsule. After trypan blue staining for various time intervals combined with exposure to white light (6000 lux) or with no light exposure, biomechanical stress-strain measurements were performed using an automated material tester. Untreated specimens and specimens treated with glutaraldehyde 0.1% were used as controls. The absorption spectrum of trypan blue 0.1% solution and the emission spectrum of the light source were measured. RESULTS: After treatment with light and trypan blue, at 25% strain, there was a statistically significant increase in stress of up to 70.1% and in elastic stiffness of 47% and a decrease in the ultimate mechanical strain of up to 13%. There were no biomechanical changes in capsules with trypan blue staining in the absence of light or after a short illumination time of 30 seconds, indicating a light-dependent process. After 30 minutes of glutaraldehyde 0.1% treatment, there was an increase in stress of 321.6% at 25% strain and a decrease in the ultimate strain of 47.6%. The emission spectrum of the light source included the absorption peak for trypan blue at 580 nm. CONCLUSIONS: Trypan blue staining of the lens capsule combined with light irradiation for at least 1 minute led to an increase in elastic stiffness at 25% strain and a reduction in the ultimate extensibility. This effect is probably due to the photosensitizing action of trypan blue, leading to light-induced collagen crosslinking of the capsule collagen similar to age-related crosslinking. Nucleus expression might be impeded by the increased capsule stiffness. Continuous curvilinear capsulorhexis is facilitated.

Animals↗

PubMed2004

Uveal and capsular biocompatibility of a single-piece, sharp-edged hydrophilic acrylic intraocular lens with collagen (Collamer): 1-year results.

PURPOSE: To analyze uveal and capsular biocompatibility 1 year following implantation of a sharp-edged, hydrophilic, collagen-containing posterior chamber intraocular lens (IOL). SETTING: Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria. METHOD: In a prospective study, a Collamer CC4204BF IOL was implanted in 30 eyes of patients with senile cataract. A standardized surgical technique and postoperative regimen were applied. To assess uveal biocompatibility, cellular inflammation on the anterior IOL surface was evaluated with a specular microscope. Capsular biocompatibility was registered semiquantitatively with a biomicroscope, based on an assessment of fibrosis on the anterior and posterior capsules. Tyndall values were measured with the Kowa FC-1000 laser flare-cell meter. Decentration of the lens was also registered. RESULTS: One year after implantation, the values of flare and cell count in the anterior chamber were lower than preoperatively. Round and spindle-shaped, epithelioid, and foreign-body giant cells were not found on the anterior surface of the IOL. The capsulorhexis rim was moderately fibrosed in 56.6% of cases. Fibrosis of the capsule over the optic was also moderate in 36.6%. The central portion of the posterior capsule was devoid of fibrosis in 43.3% and mildly fibrosed in 50%. Three lenses revealed outgrowth of lens epithelial cells to the anterior surface of the IOL. A neodymium:YAG capsulotomy had to be performed in 1 case. All lenses were well centered in the capsular bag 1 year after implantation. CONCLUSIONS: The absence of inflammatory cells on the anterior surface of the IOL indicates the high uveal biocompatibility of the lens. In terms of capsular biocompatibility, the results were satisfactory.

Biocompatible Materials↗

PubMed2004

Posterior capsule opacification in rabbit eyes implanted with hydrophilic acrylic intraocular lenses with enhanced square edge.

PURPOSE: To evaluate the development of posterior capsule opacification (PCO) after implantation of single-piece hydrophilic acrylic intraocular lenses (IOLs) with an enhanced square edge. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: The standard 570H Centerflex (Rayner Ltd.) design was compared to 2 new designs with enhanced square edges: the 570E and the 570C. Ten IOLs of each type were implanted in a randomized manner by the same surgeon in 15 pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and the eyes were analyzed from the posterior view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was graded from 0 to 4. The area of Soemmering's ring was graded from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL edge and IOL centration and fixation. Results from the posterior view were complemented by histopathological evaluation. RESULTS: Posterior capsule opacification was lowest in the 570C group, highest in the 570H group, and intermediate in the 570E group. There was a statistically significant difference between the 3 groups in peripheral PCO (P = .039). No significant difference was found between the groups in the other parameters analyzed. When cell ingrowth occurred with the 570H, it started at the optic-haptic junctions, as observed during the clinical follow-up and confirmed by gross and histopathological analyses. CONCLUSIONS: The square optic edge is the most important IOL design feature for PCO prevention. However, it should be present for 360 degrees around the IOL optic to provide an effective barrier effect.

Acrylic Resins↗

PubMed2005

Comparison of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses.

PURPOSE: To determine the amount of tilt and decentration of 1-piece and 3-piece hydrophobic acrylic intraocular lenses (IOLs) in patients having cataract surgery. SETTING: Department of Ophthalmology, Gulhane Military Medical Academy and Medical School, Ankara, Turkey. METHODS: Eighty-eight patients having phacoemulsification with IOL implantation were divided into 2 groups. One group received a 3-piece hydrophobic acrylic IOL with 12.5 mm poly(methyl methacrylate) haptics and the other, a 1-piece hydrophobic acrylic IOL with 12.5 mm haptics. The amount of IOL decentration and tilt was quantitated using Purkinje reflections and photographic documentation at the last postoperative control. The results of the 2 groups were compared. RESULTS: Bag fixation of the IOL and an intact continuous curvilinear capsulorhexis (CCC) were confirmed in all cases at the last postoperative control, which was at a mean of 27.1 months +/- 5.4 (SD) and 26.7 +/- 4.4 months in the 3-piece group and 1-piece group, respectively (P = 0.659). There was no significant difference between groups in the percentage of patients with measurable tilt and decentration and of patients without measurable tilt and decentration (P = .956). The mean IOL tilt was 2.72 +/- 0.55 degrees in the 3-piece group and 2.70 +/- 0.84 degrees in the 1-piece group and the mean IOL decentration, 0.39 +/- 0.13 mm and 0.34 +/- 0.08 mm, respectively. There were no significant between-group differences in tilt or decentration (P = .897 and P = .103, respectively). CONCLUSION: There were no significant differences in tilt and decentration between 1-piece and 3-piece hydrophobic acrylic IOLs in eyes with capsular bag IOL implantation and an intact CCC.

Acrylic Resins↗

PubMed2004

In vivo digital imaging of the square-edged barrier effect of a silicone intraocular lens.

PURPOSE: To evaluate and compare by high-magnification digital photography the lens epithelial cell (LEC) response and capsule dynamics in vivo after implantation of a square-edged and a round-edged silicone intraocular lens (IOL) in a fellow-eye study. SETTING: Private practice and Royal Victoria Hospital, Barrie, and Soldiers' Memorial Hospital, Orillia, Ontario, Canada. METHODS: After phacoemulsification, a single surgeon implanted a square-edged silicone IOL (SoFlex SE, Bausch & Lomb) in 25 patients who had previously had a conventional round-edged version of the same IOL (SoFlex Li61U, Bausch & Lomb) implanted in their contralateral eye within a 6-week period. SoFlex SE IOL recipients were selected sequentially from those scheduled for surgery within a 3-day period. The IOLs were sequentially photographed 1 week and 1, 3, 6, and 9 months after surgery using magnification of at least x64 through a biomicroscope and a high-resolution digital camera with adapter. Images were transferred to a graphics computer and compared over time. RESULTS: At 1 week, both designs had evidence of LEC migration along the posterior capsule, with the highest cell density around the 6 o'clock position. At 1 month, both IOL designs showed 360 degrees of anterior and posterior capsule adhesion to the edge of the optic. At 1 month, however, migrating LECs encountered a "damming" effect at the square posterior edge but not at the round edge. A thin fibrotic ring began to form around the SoFlex SE edge at 2 months and was complete for 360 degrees at 3 months. At 9 months, there was no evidence of LEC migration beyond this ring. With round-edged IOLs, the fibrotic ring never fully formed and LEC migration continued posterior to the optic. There was a tight capsule shrink-wrap effect with the square-edged IOLs with the fibrotic ring, allowing minimal IOL movement between 1 month and 9 months. The round-edged IOLs tended to decenter and rotate. Anterior capsulorhexis contraction was greater at every time point with the round-edged IOLs than with the square-edged IOLs. CONCLUSION: Early contact inhibition of LECs by a square-edged IOL design and its effects were demonstrated in vivo with sequential, high-resolution digital photography and commercially available graphics software.

Aged↗

PubMed2005

Posterior capsule opacification in rabbit eyes implanted with 1-piece and 3-piece hydrophobic acrylic intraocular lenses.

PURPOSE: To evaluate the outcome of posterior capsule opacification (PCO) after implantation in rabbit eyes of currently available 3-piece and 1-piece hydrophobic acrylic intraocular lenses (IOLs) with square optic edges. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: The 3-piece designs evaluated were the AR40e (Advanced Medical Optics Inc.) and the MA60AC (Alcon, Inc.); the 1-piece designs were the SA60AT and the SA30AT (Alcon, Inc.). Nine lenses of each type were implanted in a randomized manner by the same surgeon in 18 Dutch Belted pigmented rabbits. After a follow-up of 3 weeks, the rabbits were killed and analyses of the enucleated eyes were performed from the posterior or Miyake-Apple view. The intensity of central PCO, peripheral PCO, and Soemmering's ring formation was scored from 0 to 4. The area of Soemmering's ring formation was also scored from 0 to 4 based on the number of quadrants involved. Other parameters analyzed were capsulorhexis coverage of the IOL anterior surface, IOL centration, fixation, and presence of striae. Results from the posterior view were complemented by histopathologic evaluation of the eyes. RESULTS: No statistically significant difference was found between the 4 groups of IOLs in the parameters analyzed from the posterior view. When cell ingrowth occurred with the 1-piece designs, causing peripheral and central PCO formation, it was more likely to start at the optic-haptic junctions, as observed during the clinical follow-up with slitlamp examination and confirmed by gross and histopathologic analyses of the enucleated eyes. CONCLUSIONS: The square, truncated optic edge is the most important IOL design feature for PCO prevention. The optic-haptic junctions of the 1-piece designs appear to be sites where the barrier effect of the truncated optic edge is less effective.

Acrylic Resins↗

PubMed2005

Comparison of posterior capsule opacification rates between hydrophilic and hydrophobic single-piece acrylic intraocular lenses.

PURPOSE: To determine the effect of intraocular lens (IOL) material on the development of posterior capsule opacification (PCO) at 1 year. SETTING: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: One hundred six eyes of 53 patients with bilateral cataract and no other ocular comorbidity were prospectively randomized to receive a hydrophobic acrylic or hydrophilic acrylic single-piece IOL in the first eye to have surgery. The alternate IOL was implanted in the fellow eye 4 to 6 weeks later. All surgery was performed by a single surgeon. Postoperative follow-up was 1 day, 1 and 6 months, and 1 year. At each visit, the best corrected high- and low-contrast visual acuities were assessed and a high-intensity digital retroillumination photograph was taken. Posterior capsule opacification was assessed from the digital images by a single operator using a dedicated software program and calculated as the percentage area of opacified capsule. RESULTS: One year postoperatively, the median percentage area of PCO was 50.3% in the hydrophilic IOL group and 4.9% in the hydrophobic IOL group (P<.001). The difference in PCO was not accounted for by loss of contact between the capsulorhexis and IOL surface. Further analysis showed that lens epithelial cells tended to invade the posterior capsule at the haptic-optic junction. This was more marked in the hydrophilic IOL group. CONCLUSIONS: The rate of PCO was significantly higher with the hydrophilic IOL. However, the results cannot be attributed to the IOL material alone as they show the importance of both IOL material and design.

Acrylic Resins↗

PubMed2005

Intralenticular bimanual irrigation: aspiration for subluxated lens in Marfan's syndrome.

We describe a new technique of aspiration of subluxated lens in young patients with Marfan's syndrome. Two small circular anterior capsulorhexis (1.5 mm to 2.0 mm) openings were created, and bimanual irrigation/aspiration was performed by introducing the irrigation cannula through 1 capsular opening and the aspiration cannula through the other. The irrigation cannula served the dual purpose of hydrating the lens matter and holding the lens in central position to ensure complete aspiration of the lens matter. The lens capsule was later removed and anterior vitrectomy performed by a vitrectomy cutter. This new technique of intralenticular irrigation/aspiration is effective and safe in performing lens aspiration in extensively dislocated crystalline lens in Marfan's syndrome.

Adolescent↗

PubMed2005

Results of cataract extraction after implantable contact lens removal.

PURPOSE: To evaluate the visual results following insertion of implantable contact lenses (ICLs) in ametropic eyes and the development of subcapsular opacification with visual loss and to examine the anterior capsule, including the subcapsular tissue alteration, by light microscopy. SETTING: Department of Ophthalmology, Schlosspark-Klinik, affiliated hospital of the Charité Berlin, Humbold University, Berlin, Germany. METHODS: A prospective noncomparative interventional case series of anterior subcapsular cataracts in 9 of 127 (7.1%) patient eyes receiving ICLs to correct myopia and hyperopia was studied. The cataracts were phacoemulsified due to visual loss, and an intraocular lens (IOL) was implanted in the bag. After capsulorhexis, the anterior capsule was withdrawn for light microscopy examination. Visual acuity in each eye was measured before and after ICL implantation and before and after cataract extraction. The age range of cataract patients was 39 to 53 years. RESULTS: Implantable contact lens removal and phacoemulsification with IOL implantation for emmetropia resulted in an increased visual acuity compared to initial vision. Four of 28 hyperopic eyes (14.3%) developed subcapsular central opacification after ICL implantation, whereas 5 of 99 myopic patients (5.1%) developed opacifications. CONCLUSIONS: Patients should be informed prior to ICL implantation, there is a possibility of secondary subcapsular cataract formation and vision reduction. Although the posterior chamber inlay as well as the cataract can be removed and better acuity can be restored, a possible complication due to the ICL implantation cannot be avoided and the accommodation in young patients lost.

Adult↗

PubMed2006

Superoxide dismutase activity in the lens capsule of patients with pseudoexfoliation syndrome and cataract.

PURPOSE: To evaluate the activity of the antioxidative enzyme superoxide dismutase (SOD) in the anterior lens capsule of patients with cataract complicating pseudoexfoliation syndrome (PEX) in an attempt to determine the role of the oxidative mechanisms in the etiopathogenesis of this disorder. SETTING: Departments of Ophthalmology and Biochemistry, Ankara University School of Medicine, Ankara, Turkey. METHODS: At the beginning of phacoemulsification surgery, the anterior lens capsules in 21 eyes with PEX and cataract (group A) and those in 24 eyes with cataract alone (group B) were collected with continuous curvilinear capsulorhexis and were frozen at -20 degrees C. At the time of analysis, the specimens were thawed and centrifuged and the supernatants of the homogenate obtained from the samples were analyzed for the activity of the enzyme SOD. RESULTS: The mean age of patients was 74.8 years +/- 5.5 (SD) in group A and 71.7 +/- 5.6 years in group B. The specific activity of SOD was 17.6 +/- 10.8 IU/mg and 4.36 +/- 1.80 IU/mL in group A and 9.9 +/- 12.9 IU/mg and 2.71 +/- 2.61 IU/mL in group B. Superoxide dismutase activity was significantly higher in group A patients than in group B patients (P = .022 and P = .011, respectively). CONCLUSIONS: The increase in SOD activity in the lens capsule of patients with PEX and cataract suggests that oxidative mechanisms play a role in the etiopathogenesis of cataract in PEX. This suggests that SOD activity may be increased as a compensatory mechanism to eliminate this oxidative stress.

Aged↗

PubMed2006

Aspiration curette for anterior capsule polishing: laboratory and clinical evaluation.

Capsular fibrosis or fibrotic after-cataract results from transdifferation of anterior lens epithelial cells into myofibroblasts with consequent contraction and collagen deposition. To avoid possible complications, an instrument was designed for efficient and safe polishing of the anterior capsule leaf. The curette features an upward-facing slit with sharp-edged flanks and rounded turning points and an optional bypass hole. It is introduced through 3 equidistant 20-gauge paracentesis openings. In a laboratory test, vacuum rise time and vacuum levels under occlusion and the effect of adding a bypass hole were investigated for various pump settings. In a clinical pilot series, efficiency and safety of various designs were tested and vacuum and flow settings titrated for optimum performance; the clinical effect was determined in prospectively randomized bilateral studies. Optimum pump settings were 5 mL/min and 10 mm Hg with the nonventing curette and 7 to 10 mL/min and 50 mm Hg with the venting curette. A bypass hole delayed the vacuum rise and reduced the mean vacuum level on full occlusion. It also allowed fine-tuning the vacuum at the slit by varying the flow rate with the foot pedal. Anterior capsule polishing significantly decreased capsule fibrosis and is recommended when posterior capsulorhexis and optic buttonholing are combined.

Epithelial Cells↗

PubMed2000

Clinical assessment of long-term safety and efficacy of a widely implanted polyacrylic intraocular lens material.

PURPOSE: To evaluate the long-term safety and efficacy, in a large series of patients, of polyacrylic intraocular lens implants 1 and 3 years after surgery, compared with polymethylmethacrylate intraocular lens implants. METHODS: This was a randomized, prospective study of 1,514 eyes of 1,202 patients that were examined for a 1-year follow-up study and 1,264 eyes of 990 patients that were examined for a 3-year follow-up study. All the patients were prospectively randomized to receive a polyacrylic or polymethylmethacrylate intraocular lens implant. A standardized surgical protocol was performed using a phacoemulsification technique and capsulorhexis. Any surgical complications were excluded, and all patients had standard postoperative medication and follow-up. Postoperative measurements included spectacle-corrected visual acuity, occurrence of postoperative sight-threatening or lens-related complications, and adverse reactions. Results were compared between the polyacrylic intraocular lens and polymethylmethacrylate intraocular lens groups. Results were also compared with standards for polymethylmethacrylate intraocular lens that were established by the US Food and Drug Administration and a previous study for silicone lens. RESULTS: The overall complete follow-up rates were 79.9% for 1-year follow-up and 69.5% for 3-year follow-up. At 1 year, the mean logarithm of the minimum angle of resolution (logMAR) of visual acuity was 0.037 +/- 0.150 and 0.042 +/- 0.154 in best case patients of the polyacrylic intraocular lens group and polymethylmethacrylate intraocular lens group, respectively. At 3 years, the mean logMAR visual acuity was 0.038 +/- 0.155 and 0.054 +/- 0.181 in best case patients in the polyacrylic intraocular lens group and polymethylmethacrylate intraocular lens group. There was no significant difference between groups at 1 and 3 years. At 1 year, 96.8% of best case patients in the polyacrylic intraocular lens group and 95.8% of those in the polymethylmethacrylate intraocular lens group achieved corrected visual acuity of 0.5 or better. At 3 years, 96.4% of best case patients in the polyacrylic intraocular lens group and 94.9% of those in the polymethylmethacrylate group achieved a corrected visual acuity of 0.5 or better; no significant difference was found at 1 and 3 years. The rate of sight-threatening complications was 1. 2% for the polyacrylic intraocular lens group of all patients and 1. 5% for the polymethylmethacrylate intraocular lens group at 1 year, and 1.6% for the polyacrylic intraocular lens group and 1.4% for the polymethylmethacrylate intraocular lens group at 3 years. No significant difference was found between the groups. The cumulative rate of Nd:YAG capsulotomy for the polyacrylic intraocular lens group (7.1%) was significantly lower than that for the polymethylmethacrylate intraocular lens group (38.1%) through 3 years (P <.0001). CONCLUSIONS: Polyacrylic intraocular lenses demonstrated safe and effective performance through long-term follow-up at a level equal to or better than polymethylmethacrylate intraocular lenses. Patients undergoing polyacrylic intraocular lens implantation achieved excellent postoperative visual acuity and experienced a low rate of postoperative complications, adverse reactions, and Nd:YAG capsulotomy. These long-term clinical results are an important outcome database for the ongoing use of this foldable optic material.

Acrylic Resins↗

PubMed2003

Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology.

PURPOSE: To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between March 1995 and May 2000 were reviewed. RESULTS: In all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89 years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. In 105 patients vision improved, in 7 there was no change, and in 10 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL. CONCLUSIONS: Combined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.

Adult↗

PubMed1996

Dislocation of the lens nucleus into the vitreous cavity after standard hydrodissection.

PURPOSE: Having encountered dislocation of the lens nucleus into the vitreous cavity immediately after continuous tear capsulorhexis and hydrodissection of the nucleus, we examined common features of eyes with this complication. METHODS: We reviewed consecutive cases of cataract extraction. RESULTS: The complication occurred in four of 10,126 eyes. All four eyes were in elderly patients and except for the patient whose contralateral eye had pseudoexfoliation syndrome, all eyes had an increased axial length. CONCLUSION: In elderly patients with eyes that have a long axial length or pseudoexfoliation, we recommend performing hydrodissection with extreme care and only when necessary.

Aged↗

PubMed1995

Membranous outgrowth suggesting lens epithelial cell proliferation in pseudophakic eyes.

PURPOSE: We sought to determine the incidence and structure of membranous outgrowth, which extends from the anterior capsular opening onto the intraocular lens surface in pseudophakic eyes. METHODS: Thirty-four eyes of 31 patients with age-related cataract were prospectively studied. No patient had any abnormality other than cataract. Each patient underwent continuous circular capsulorhexis, phacoemulsification, and implantation within the capsule of a three-piece posterior chamber lens. A slit lamp and specular microscope were used to observe and photograph the intraocular lens surface and anterior capsular opening every day for the first postoperative week, and at days 14, 21, and 28. We counted the number of eyes with the membranous outgrowth and graded the outgrowth according to its shape and length at each postoperative period. RESULTS: In total, 27 of 34 (79%) eyes had the membranous outgrowth from the anterior capsular opening onto the intraocular lens surface. The membrane was first observed on day 3. Three of 34 eyes had the dendritic or fan-shaped structure, which extended less than 0.5 mm from the capsular edge. The membranes were most frequently found on day 7. Twenty-five of 34 eyes had the outgrowth in various grades. After four weeks, no membranes were observed. CONCLUSIONS: The time course and structure of the membranous outgrowth we observed were comparable to those of the outgrowth of lens epithelial cells under tissue culture conditions. The membranous outgrowth may be the result of a transient but active proliferation of human lens epithelial cells onto the intraocular lens surface.

Aged↗

PubMed1994

Pupillary block during cataract surgery.

Sudden phakic pupillary block occurred immediately upon cortical cleaving hydrodissection during cataract surgery in two patients. We believe this unique complication is related to the recent introduction of viscoelastics with properties that enhance the maintenance of the anterior chamber during capsulorhexis. We postulate that the cause of the block was a combination of O-ring capsulocortical and iridocapsular seals that tamponade hydrodissection fluid posteriorly. Additional precipitating factors were diabetes, poorly dilating pupils, and increased vitreous pressure, which may have contributed to the sudden and irreversible nature of this block. If this complication is not recognized, an aqueous misdirection syndrome may ensue, requiring pars plana vitrectomy. Immediate mechanical breakage of the pupillary and capsular block, resulting in an immediate decrease in intraocular pressure from greater than 70 mm Hg, may cause severe retinal vascular damage. These cases stress the importance of mechanical pupil dilation to prevent this serious complication of cataract surgery.

Aged↗

PubMed1998

Delayed dislocation of foldable plate-haptic silicone lenses after Nd:YAG laser anterior capsulotomy.

PURPOSE: To report two eyes (two patients) that had plate haptic silicone intraocular lenses that dislocated 4 weeks after Nd:YAG laser anterior capsulotomy to relieve capsular contraction. METHODS: Case reports. The clinical records of two patients were reviewed. RESULTS: After uncomplicated phacoemulsification with implantation of plate haptic silicone lenses in the capsular bag, two eyes of two patients developed visually notable early contraction of the capsulorhexis. Three radial-relieving incisions approximately 1 mm long were made with a Nd:YAG laser in each eye to enlarge the capsulotomy. Although vision improved, both patients experienced sudden further reduction of vision after approximately 4 weeks. Upon examination of both patients, we noted an extension of an anterior radial capsulotomy incision peripherally, and the intraocular lenses had dislocated from the capsular bag into the ciliary sulcus. CONCLUSIONS: Tears may extend after radial-relieving incisions have been used to enlarge a contracted anterior capsulotomy, possibly because of continued capsular fibrosis. This may allow extrusion of a foldable intraocular lens from the capsular bag.

Cataract↗