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PubMed2000

Choroidal effusions and hypotony caused by severe anterior lens capsule contraction after cataract surgery.

PURPOSE: To report the clinical features and management of two patients with pseudophakic anterior capsule contraction with secondary tractional ciliary body detachments and hypotonous choroidal effusions. METHODS: Case reports. RESULTS: In two eyes of two patients with pseudophakia, severe anterior lens capsule contraction and tractional ciliary body detachments, anterior capsulotomy (one Nd:YAG laser, one surgical), was followed by resolution of the ocular hypotony and resolution/nonrecurrence of the choroidal effusions. In both cases, continuous curvilinear capsulorhexis was used during cataract surgery. CONCLUSION: Anterior capsule contraction following pseudophakia may result in tractional ciliary detachment and secondary ocular hypotony. Radial anterior capsulotomy appeared to be effective in both cases.

Aged↗

PubMed2000

Induction of cataracts of varying degrees of hardness in human eyes obtained postmortem for cataract surgeon training.

PURPOSE: To report a method of inducing nuclear cataracts of varying degree of hardness using intralenticular injection of the Karnovsky solution. METHODS: Twelve postmortem human eyes were prepared according to the Miyake-Apple posterior video technique. After performing capsulorhexis and hydrodissection/delineation, 0.2 ml of the Karnovsky solution was injected into the lens nucleus of the eyes. Manual extracapular cataract extraction techniques and various two-handed phacoemulsification maneuvers were then practiced at various time intervals after the injection. RESULTS: Uniform nuclear cataracts with varying degrees of hardness were successfully induced in all globes. The optimum dose of the Karnovsky solution and time for induction of nuclear hardness of grade 3 (ideal for practicing two-handed phacoemulsification maneuvers) were 0.2 ml and 15 minutes, respectively. CONCLUSION: The Karnovsky solution can be successfully used for the induction of hard, uniform nuclear cataracts for learning/practicing extracapular cataract extraction and phacoemulsification.

Cataract↗

PubMed2006

Effect of diclofenac on prevention of posterior capsule opacification in human eyes.

BACKGROUND: Diclofenac sodium has been demonstrated to be effective in preventing proliferation of lens epithelial cells both in vitro and in animal studies. The effects of diclofenac sodium given during the hydrodissection stage of phacoemulsification surgery on posterior capsule opacification (PCO) were investigated. METHODS: Eleven patients undergoing phacoemulsification in both eyes were included. Patients with pseudoexfoliation, uveitis, and diabetes were excluded. Hydrodissection was done with only balanced salt solution in the first eyes. In the fellow eyes, 0.25 mg/mL diclofenac was given with hydrodissection. The same type of intraocular lens was implanted in both eyes of each patient. Follow-up was 21.8 (SD 3.5) months in the diclofenac group and 22.9 (3.7) months in the control group. PCO was evaluated clinically by dividing the posterior capsule into 24 zones. Mann-Whitney U test was used for statistical analysis. RESULTS: There were no statistically significant differences of age, diameter of capsulorhexis, pupillary width, visual acuity, intraocular pressure, or length of follow-up between groups. PCO score was 0.49 (SD 0.21) in eyes receiving diclofenac and 0.73 (0.23) in the contralateral fellow eyes. The difference was not statistically significant (p=0.053). INTERPRETATION: Diclofenac sodium given by hydrodissection in phacoemulsification decreased, but did not significantly prevent, the development of PCO.

Aged↗

PubMedDate not supplied

Management of posterior capsule tears.

Any breach in the continuity of the posterior capsule is defined as a posterior capsule tear. Posterior capsule tears can be preexisting (congenital or traumatic), spontaneous, or intrasurgical. Preexisting/congenital posterior capsule tears have been related to an intrauterine insult. Posterior capsule tears due to trauma may occur as a consequence of direct mechanical impact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these posterior capsule tears can have different features. Intrasurgical posterior capsule tears are the most common and can occur during any stage of cataract surgery. Also, they may be planned in the form of primary posterior capsulorhexis. The conventional management consists of prevention of mixture of cortical matter with vitreous, dry aspiration, and anterior vitrectomy, if required. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Dislocated nucleus or nuclear fragments require vitrectomy and the use of perfluorocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed in the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large.

Eye Injuries↗

PubMed1991

Anterior capsular tears and loop fixation of posterior chamber intraocular lenses.

Two hundred fifty consecutive postmortem eyes containing posterior chamber intraocular lenses (PC IOLs) were analyzed according to the presence and number of radial anterior capsular tears. Over 90% of cases had been done with the "can opener" technique. A surprisingly high percentage of cases, 86%, had one to five radial tears. Furthermore, our analysis showed that the most consistent and most permanent in-the-bag fixation was achieved when only one tear or less was present in the anterior capsule. Because this study shows that the incidence of radial tears is very high after nuclear expression with "can opener" capsulectomy, it provides a scientific basis supporting the transition toward the continuous circular capsulorhexis technique that is slowly evolving. The latter technique has been shown to minimize the incidence of anterior capsular radial tears. This may ultimately serve to decrease the incidence of PC IOL decentration, an important goal if the use of bimultifocal IOLs and IOLs with small or aspheric optics is to be successful.

Aged↗

PubMed1993

Clinicopathologic study of the effect of radial tears and loop fixation on intraocular lens decentration.

PURPOSE: The purpose of this study is to determine the effect of loop fixation and anterior capsular tears on intraocular lens (IOL) decentration. METHODS: A retrospective measurement of IOL decentration was performed on 144 human eyes with posterior chamber (PC) IOLs obtained after death. RESULTS: Decentration in eyes with asymmetrical bag-sulcus fixation (mean +/- standard deviation, 0.64 +/- 0.39 mm) was significantly higher than eyes with symmetrical fixation. In the presence of radial tears, symmetrically fixated IOLs in either the capsular bag or the ciliary sulcus decentered to a similar degree, 0.35 +/- 0.25 mm and 0.4 +/- 0.26 mm, respectively. The least decentration was observed with capsular fixation and no radial tears (0.18 +/- 0.09 mm). This was significantly less decentration than with any other form of fixation in the presence of radial tears. CONCLUSION: This study shows that capsular fixation with no radial tears, as can be achieved by using the continuous curvilinear capsulorhexis, is associated with the least decentration.

Adult↗

PubMed1996

A modified preparation technique for closed-system ocular surgery of human eyes obtained postmortem: an improved research and teaching tool.

PURPOSE: In addition to use for corneal transplantation, human autopsy eyes also are used for teaching and vision research. The valuable posterior video technique of Miyake usually is done with an "open-sky" preparation. Closed-system surgery in postmortem eyes is difficult because of postmortem decrease of corneal clarity and myosis. The authors have developed an improved preparation technique that allows closed-system ocular surgery in human postmortem eyes. METHOD: The cornea is dehydrated using a hyper osmolar (15 percent) dextran solution (Swinger-Kornmehl solution), which clarifies the cornea for several hours. The pupil is dilated mechanically by injecting dextran solution into the anterior chamber, and the iris is fixated using formaldehyde (10 percent) and Karnovsky solution. RESULTS AND CONCLUSIONS: This technique can be used in autopsy eyes up to 4 days postmortem without other fixation. Incision techniques, capsulorhexis, phacoemulsification, and intraocular lens implantation, as well as other surgical procedures such as glaucoma surgery, transcleral fixation of posterior chamber lenses and vitrectomies, can be performed. Neodymium:YAG laser capsulectomies or other laser surgical procedures are also possible. This technique is not only excellent for residency training and postgraduate wet laboratories, but is also a viable tool for research purposes.

Education, Medical↗

PubMed2000

Anterior capsule opacification: a histopathological study comparing different IOL styles.

OBJECTIVE: To compare the degree of anterior capsule opacification (ACO) in human eyes obtained post-mortem containing various rigid and foldable posterior chamber intraocular lens (PC-IOL) designs. DESIGN: Comparative autopsy tissue study with clinicopathologic correlations. MATERIALS: Four hundred sixty human globes containing the following PC-IOL styles were analyzed: (1) one-piece polymethylmethacrylate (PMMA) optic-PMMA haptic (n = 50), (2) one-piece silicone-plate IOL, large hole (n = 40), (3) one-piece silicone-plate IOL, small hole (n = 67), (4) three-piece PMMA optic-PMMA/Prolene haptic (n = 51), (5) three-piece acrylic optic-PMMA haptic (n = 96), (6) three-piece silicone optic-PMMA haptic (n = 24), (7) three-piece silicone optic-polyimide haptic (n = 40), and (8) three-piece silicone optic-prolene haptic (n = 92). TESTING: The globes were sectioned in the equatorial plane for gross examination and then processed through paraffin; sectioned, and stained with hematoxylin-eosin, periodic acid-Schiff, and Masson's trichrome stains; and examined by light microscopy. MAIN OUTCOME MEASURES: Anterior capsule opacification was scored in each eye by grading the histologic sections from 0 to III, according to the amount (thickness) of proliferative tissue and cells measured in sagittal sections on the inner surface of the anterior capsule at the capsulorhexis margin. RESULTS: The difference among the eight groups was significant (P < 0.0001). Mean ACO scores were highest with the large and small hole one-piece silicone-plate lenses (1.77 +/- 0.86 and 1.28 +/- 0.77, respectively). The lowest mean score was observed in the group of three-piece acrylic optic-PMMA haptics lenses (0.51 +/- 0.52). CONCLUSIONS: Our results confirm previous clinical observations that the rate of ACO is relatively high with plate-haptic silicone IOLs. The lowest rate was noted with the three-piece acrylic optic-PMMA haptic IOL. The IOL design and IOL material are significant factors in the development of ACO.

Cataract↗

PubMed2000

Phacoemulsification in eyes with a small pupil.

PURPOSE: To evaluate the intraoperative difficulties and long-term outcome of phacoemulsification through a small pupil using minimal iris manipulation. SETTINGS: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective study included 30 consecutive eyes with a maximally dilated pupil size of 4.0 mm or smaller. Except synechiolysis and occasional pupil retraction with a chopper, no iris manipulation was performed. The phacoemulsification technique included creation of deep central space, use of a low aspiration flow rate with appropriate vacuum, and step-by-step chop in situ and lateral separation of the nucleus. Patients were examined 1 day, 1 week, 1 and 3 months, and 1 year postoperatively. Specular microscopy was performed at 1 month and 1 year. RESULTS: Fourteen eyes had chronic iritis, 12 had glaucoma surgery, 2 had pseudoexfoliation, and 2 had a rigid pupil. Mean follow-up was 13.6 months. Eighteen eyes (60%) had hard cataract. Mean preoperative pupil size was 2.80 mm +/- 0.75 (SD). Mean pupil size before the capsulorhexis was initiated was 4.42 +/- 0.58 mm. The iris was bruised in 10 eyes during cortex removal. Trace amounts of cortex were left in 4 cases. Two eyes had increased intraocular pressure in the early postoperative period. Six patients had a minimal amount of retained viscoelastic material (pseudofibrin), and 2 patients developed a sterile hypopyon. Sixteen eyes had cell deposits on the IOL surface and 12 eyes, fine uveal pigments. In 2 eyes with previous glaucoma surgery and in all eyes with iritis except 2, posterior synechias reformed. CONCLUSIONS: Successful phacoemulsification was done with minimal or no pupil-widening maneuvers, restoring the preoperative pupil configuration.

Adult↗

PubMed2000

Dye-enhanced cataract surgery. Part 2: learning critical steps of phacoemulsification.

PURPOSE: To use capsule dyes to enhance visualization to learn and perform various critical steps of the phacoemulsification procedure in a laboratory setting using postmortem human eyes. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Indocyanine green 0.5% (ICG) and trypan blue 0.1% were used to enhance visualization for performing critical steps of phacoemulsification in 8 human eyes obtained postmortem. All eyes were prepared according to the Miyake-Apple posterior video technique. After a continuous curvilinear capsulorhexis (CCC) was made, the dyes were used to enhance visualization for hydrodissection, hydrodelineation, and various maneuvers for nuclear emulsification and cortical cleanup. In 8 eyes, all the aforementioned steps were performed without using dye (control group). RESULTS: Both dyes helped enhance visualization during the critical steps of phacoemulsification. The use of a dye solution instead of balanced salt solution (BSS) for hydrodissection/delineation helped localize the complete plane of cleavage between the capsule and cortex and the nucleus-epinucleus complex. During various nuclear sculpting maneuvers, the use of dye helped visualization of the position of the phaco tip and its relation to the posterior capsule. It also helped localize remaining cortical fibers, facilitating complete cleaning of the capsular bag. CONCLUSIONS: Dye-enhanced cataract surgery was useful in learning various critical steps of phacoemulsification in a wet laboratory setting.

Cadaver↗

PubMed2000

Quarters extraction technique for manual phacofragmentation(1).

In the quarters extraction technique, the nucleus is manually split and the fragments then removed. A 5.5 to 6.5 mm sclerocorneal single-plane incision is made. After capsulorhexis, hydrodissection, hydrodelineation, and surface cortex aspiration, the edge of the nucleus is prolapsed into the anterior chamber. The front quarter of the nucleus is cut and removed with a nucleus puncher. A corner of the remaining three quarters of nucleus is wedged into the wound and rotated out with a claw vectis. Among the initial 120 cases, there were no posterior capsule ruptures, and the mean endothelial cell loss at 3 months was 8.7% +/- 6.5% (SD). Because there is no need to deeply insert instruments at the time of nuclear fragmentation, this technique can be performed safely and easily in most cases except in eyes with very large nuclei.

Aged↗

PubMed2001

Dislocation of a plate-haptic silicone intraocular lens into the anterior chamber.

Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.

Anterior Chamber↗

PubMed2001

Early decentration of plate-haptic silicone intraocular lenses.

We report 4 eyes of a consecutive series of 1299 that developed early decentration of a 10.5 mm diameter plate-haptic silicone intraocular lens (IOL) after uneventful phacoemulsification. All eyes had an intact continuous curvilinear capsulorhexis (CCC) with the IOL placed in the capsular bag. After an initial period of good vision, patients noted the onset of glare or monocular diplopia between 1 and 5 weeks after surgery. On examination, there was no significant anterior capsule contraction; however, the edge of the IOL optic was visible in the undilated pupil. There was adhesion between the anterior and posterior capsules at the margin of the CCC that maintained the IOL decentration. Decentration recurred in 1 eye after the IOL was rotated 90 degrees and recentered. Symptoms resolved in 3 eyes after the IOL was removed and replaced with a rigid IOL with a larger diameter optic.

Device Removal↗

PubMed2001

Clinical results of phacoemulsification with the use of Healon5 or Viscoat.

PURPOSE: To compare the ophthalmic viscosurgical devices Healon5 (viscoadaptive) and Viscoat (dispersive) regarding their overall clinical performance during phacoemulsification and posterior chamber intraocular lens (IOL) implantation as well as their influence on intraocular pressure (IOP). SETTING: Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. METHODS: In this prospective randomized patient- and observer-masked clinical study, the performance of Healon5 (sodium hyaluronate 2.3%) and Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) was assessed by 3 surgeons during cataract surgery in 90 patients. Surgeons used a 5-point scale for the subjective assessment of the ease of injection, maintenance capacity during continuous curvilinear capsulorhexis, remaining capacity during phacoemulsification, facilitation of IOL implantation, removal from the eye, transparency, and overall performance throughout surgery. Intraocular pressure was measured preoperatively and 24 hours and 7 days postoperatively. Best corrected visual acuity was assessed preoperatively and 7 days postoperatively. RESULTS: Overall intraoperative product performance was assessed as good or very good in 34 of 44 patients (77%) in the Healon5 group and in 16 of 46 patients (35%) in the Viscoat group (P <.001). Retention in the anterior chamber was graded good or very good in 36 patients (82%) in the Healon5 group and in 23 (50%) in the Viscoat group (P =.001). There were no statistically significant between-group differences in mean IOP preoperatively and 24 hours postoperatively. CONCLUSIONS: Surgeons graded Healon5 better than Viscoat in overall surgical performance and retention in the anterior chamber during phacoemulsification. These data support that Healon5 adapts to each step during surgery.

Aged↗

PubMed2001

Biometry of 3 types of intraocular lenses using Scheimpflug photography.

PURPOSE: To compare differences in intraocular lens (IOL) decentration and tilt and anterior chamber depth (ACD) using Scheimpflug photography as well as best corrected visual acuity (BCVA) in eyes having phacoemulsification with implantation of 1 of 3 types of IOLs. SETTING: Chung-Ang University Hospital, Seoul, Korea. METHODS: This study comprised 137 cataractous eyes of 108 patients having phacoemulsification and IOL implantation. Eyes were randomized into 3 groups based on IOL type: poly(methyl methacrylate) (PMMA) (n = 65); silicone (n = 47); soft acrylic (n = 25). Biometric analysis was performed with an EAS-1000 Scheimpflug camera 1, 3, and 6 months after surgery. Best corrected visual acuity was also measured at these visits. RESULTS: The anterior chamber was deeper 1 month after surgery, with no statistical difference among groups. There were no significant differences among groups in IOL decentration and tilt or final BCVA during the follow-up. CONCLUSIONS: In this study in which a properly constructed continuous curvilinear capsulorhexis was created and IOLs were accurately placed in normal capsular bags, changes in ACD, IOL decentration and tilt, and BCVA were similar in eyes with a PMMA, silicone, or soft acrylic IOL.

Acrylic Resins↗

PubMed2001

Misalignment of flexible iris hook retractors for small pupil cataract surgery: effects on pupil circumference.

A graphical method was used to assess the effect on pupil shape and circumference of various flexible iris hook malpositions. Results confirmed that all hook malpositions necessitate increased pupil stretching to create space to perform a capsulorhexis of a given diameter. This method also confirmed that the addition of a fifth hook to create a pentagonal pupil reduces pupil stretching by 17%. A simple method of marking the limbus before hook insertion to ensure equidistant hook separation and thus minimize pupil stretching is suggested.

Cataract Extraction↗

PubMed2001

Effect of optic size on posterior capsule opacification: 5.5 mm versus 6.0 mm AcrySof intraocular lenses.

PURPOSE: To determine the effect of intraocular lens (IOL) optic diameter on posterior capsule opacification (PCO) using digital retroillumination images. SETTING: Eye Department, St. Thomas' Hospital, London, United Kingdom. METHODS: In this prospective study, 60 patients with senile cataract had routine phacoemulsification by a single surgeon and received standardized medication. The patients were divided into 2 equal groups. The first group received a 5.5 mm 3-piece AcrySof IOL (MA30BM, Alcon) inserted in the bag. The second group received a 6.0 mm 3-piece AcrySof IOL (MA60BM, Alcon). Retroillumination images were obtained 1, 30, 90, 180, and 360 days postoperatively. The percentage area of PCO was calculated objectively by dedicated software at 90, 180, and 360 days. At 1 day, the degree of capsulorhexis-IOL contact was determined by inspecting the images. RESULTS: Throughout the follow-up, there was less PCO in the 6.0 mm optic group than in the 5.5 mm optic group, and the difference reached significance 1 year postoperatively (P =.0017). At 1 year, the median percentage of PCO was 1.5% (95% confidence interval [CI] 1.4-5.3) in the 6.0 mm group and 6.9% (95% CI 5.8-18.0) in the 5.5 mm group. CONCLUSIONS: A larger IOL optic diameter was associated with less PCO.

Acrylic Resins↗

PubMed2002

Anterior capsule dyes and labeled viscoelastic solutions to enhance contrast in EAS-1000 Scheimpflug images.

PURPOSE: To enhance contrast in images produced by the EAS-1000 to facilitate evaluation of the rheological properties of viscoelastic substances during simulated cataract surgery. SETTING: Department of Preclinical Ophthalmology, Scientific Affairs, Pharmacia AB, Uppsala, Sweden. METHODS: Cataract surgery was performed in 200 fresh porcine cadaver eyes and documented by EAS-1000 Scheimpflug photography. The light scattering caused by anterior capsule dyes, labeled irrigation solutions, and labeled viscoelastic solutions was statistically analyzed in the images. RESULTS: Visualization by light scattering was significantly enhanced by a fluorescein labeled viscoelastic solution and by an eosin-Y- or phloxine-B-dyed capsule (P < .05). A side effect of eosin Y and phloxine B was that the capsule became fragile, making it difficult to perform a continuous curvilinear capsulorhexis. CONCLUSIONS: Fluorescein-labeled viscoelastic solutions are recommended to enhance contrast in the images when retention capacity is evaluated. Light scattering from capsule dyeing facilitated anterior chamber depth measurements in the images.

Animals↗