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PubMed1994

National outcomes of cataract extraction. Retinal detachment and endophthalmitis after outpatient cataract surgery. Cataract Patient Outcomes Research Team.

BACKGROUND: A near-total shift to cataract extraction on an outpatient basis occurred as a result of an administrative ruling by the Health Care Financing Administration. No national study has been conducted to assess the possible effects of that decision on clinical outcomes of surgery. The authors compared the rates of retinal detachment (RD) repair and hospitalization for endophthalmitis after extracapsular cataract extraction (ECCE) (including phacoemulsification) in 1986 and 1987 with those following inpatient cataract extraction in 1984. METHODS: Using the 5% random sample of Medicare beneficiaries, we analyzed the claims of all individuals 66 years of age or older who underwent ECCE by nuclear expression or phacoemulsification in 1986 and 1987. A total of 57,103 patients were identified and followed to the end of 1988. Cumulative probability of RD repair and hospitalization for endophthalmitis was calculated by standard lifetable methods. These findings were compared with the cumulative probability of the same complications in a cohort of 330,000 patients who underwent cataract extraction on an inpatient basis in 1984. RESULTS: In the 1986-to-1987 cohort, the cumulative probability of RD within 3 years after cataract surgery was 0.81% and the cumulative probability of endophthalmitis within 1 year was 0.08%. The rate of RD is similar to that which we previously reported for 330,000 patients who underwent inpatient surgery in 1984, but the rate of endophthalmitis is significantly lower in the 1986-to-1987 outpatient cohort (0.08% versus 0.12%; z = 2.42; P = 0.01). CONCLUSIONS: The shift to outpatient cataract surgery was accompanied by no significant increase in the probability of RD repair and possibly a significant decrease in the rate of hospitalization for endophthalmitis.

Aged↗
PubMed1987

Comparison of sodium hyaluronate and methylcellulose in extracapsular cataract extraction.

Extracapsular cataract surgery with posterior chamber lens implantation was performed in a total of 30 patients. These were randomly divided into two groups. In one group sodium hyaluronate 1% (Healon) was used as a tool in surgery, in the other group methylcellulose 2% was used. The viscous substances were irrigated out of the eyes at the conclusion of surgery. Central corneal thickness, intraocular pressure, and aqueous flare were recorded until one month post-operatively. There was no difference in corneal thickness between the two groups. The mean intraocular pressure was lower than pre-operatively in both groups with a lower pressure in the methylcellulose group compared to the sodium hyaluronate group during the first part of the observation period.

Aqueous Humor↗
PubMed1999

Mortality rates after cataract extraction.

Senile cataract may be a marker of generalized tissue aging. We examined this hypothesis using population-based linked health data. We hypothesized that any such association would diminish with increased use of cataract surgery. Mortality rates of those 50-95 years of age undergoing cataract surgery in British Columbia during either 1985 or 1989 were compared with the provincial population of comparable age who did not undergo cataract surgery during the study period. The 1985 cohort included 8,262 patients undergoing surgery and a comparison population of 804,303, and the 1989 cohort included 11,952 patients and a comparison population of 839,393. Using Cox regression, for the 1985 cohort, the hazard ratios for dying during follow-up were 3.2 for males 50-54.9 years of age [95% confidence limits (CL) = 2.0, 5.0] and 3.3 for females (95% CL = 1.9, 5.7). Hazard ratios for older age groups decreased with age. We also fit an additive risk model that produced excess mortalities that were less age dependent. In the 1985 analysis, these ranged from +7.1 per 1,000 (95% CL = +0.44, +13.76) to +20.3 (95% CL = +13.24, +27.36) for males and -17.5 (95% CL = -28.28, -6.72) to +2.0 (95% CL = -2.12, +6.12) for females. Findings for the 1989 analyses were similar, indicating that the association between cataracts and generalized aging remained constant despite a large increase in the use of cataract surgery.

Age Distribution↗
PubMed1978

Bilateral versus unilateral cataract extraction: advantages and complications.

Cataract extraction was performed on 734 patients. These were followed up postoperatively for up to 1 year. In 448 cases the extraction was performed in both eyes during 1 operating session (896 eyes) and in 1 eye in 286 cases, a total of 1182 cataract extractions. Preoperatively more than 75% of the eyes in both groups had perception of light only. Postoperatively more than 85% of eyes in both groups achieved a visual acuity of 6/30 or better. The postoperative visual performance of an eye was not influenced by the mode of operation, bilateral or unilateral. The overall incidence of complications among the 1182 operated eyes was: accidental extra-capsular cataract extraction 10.2%, vitreous loss 11.0%, hyphaema 1.4%, flat anterior chamber 0.9%, dehiscence of the wound 0.5%, uveitis 1.2%, endophthalmitis 0.3%, secondary glaucoma 0.9%, severe bullous keratopathy 1.4%, oedema of the macula 0.5%, and retinal detachment 0.3%. The complications in both groups of patients were comparable. Only in 1 case operated in both eyes vision was not restored following a bilateral endophthalmitis.

Cataract Extraction↗
PubMed1976

Combined cyclodialysis and cataract extraction.

Combined cyclodialysis and cataract extraction was performed on 78 eyes in a consecutive series of 26 years duration. This operation was performed on eyes with severe glaucoma, inadequately controlled on maximum medical therapy, and with a cataract needing extraction. Glaucoma types included open-angle, angle-closure with peripheral anterior synechias, combined open-angle and angle-closure, and secondary to uveitis. Seventy of the 78 eyes had follow-up of six months or more and the results in these 70 eyes were analyzed. In thirteen percent of the eyes in this study the postoperative intraocular pressure was the same or higher than the preoperative level, or reductions of intraocular pressure were not clinically significant. Eighty-seven percent (61 eyes) had a clinically significant lowering of intraocular pressure following the combined procedure. Thirty-nine percent (27 eyes) of the 70 eyes in this study had a tension of 0-14 mm Hg, and 44% (31 eyes) had a tension of 15-20 mm Hg. Intraocular pressure was improved significantly more often in patients over 60 years of age. Resulting intraocular pressures of 14 mm Hg or less were more likely when the cyclodialysis was performed in the lower quadrant. The results of the combined procedure were not significantly influenced by the type of glaucoma involved or by a history of previous glaucoma surgery. Bleeding was a frequent complication, but was not related to resulting intraocular pressure. Other complications were rare. We conclude that combining cyclodialysis with cataract extraction is safe and effective, and is a suitable procedure when there is need for surgery to relieve severe glaucoma, along with a need for cataract extraction.

Adolescent↗
PubMed1992

Stereopsis after congenital monocular cataract extraction.

Congenital monocular cataract extraction was performed on a 1-day-old baby girl and a hydrophilic contact lens was fitted. A progressive regimen of part-time occlusive therapy was then instituted. Eight years later, the girl has a visual acuity of 20/25 in the operated-on eye and 50 seconds of arc of stereoacuity that has been confirmed by an independent pediatric ophthalmologist. This patient demonstrates the potential for high-grade stereopsis in congenital monocular aphakia.

Cataract↗
PubMed1993

[Comparison of phacoemulsification and planned extracapsular cataract extraction].

40% of cataract surgeons in German speaking countries use phacoemulsification as the procedure of choice for cataract extraction while the other 60% still use the planned extracapsular extraction. The more procedures a surgeon performs the stronger is the tendency toward performing phacoemulsification. The opening technique of the anterior capsule is chosen accordingly: for phacoemulsification capsulorhexis is preferred, while for the planned extracapsular extraction can opener - or letter box - technique is usually done. The length of the sclero-corneal incision is 3.2 mm in phacoemulsification, 6.2 mm for a PMMA posterior chamber lens implantation and 9-13 mm for the planned extracapsular extraction. We prospectively compared both procedures with each group including 100 consecutive patients. The mean irrigation volume was 96.6 +/- 48.8 ml in the phacoemulsification group as opposed to 48.1 +/- 26 ml in the planned extracapsular extraction group. The mean duration of irrigation was 130 +/- 67 sec in the first versus 129 +/- 76 sec in the second group; mean endothelial cell loss was 7.9% versus 7.1%. No correlation was found between endothelial cell loss and duration of irrigation. Mean postoperative astigmatism measured 1.0 +/- 0.49 in the first group as compared to 3.3 +/- 1.7 dpt in the second group. Except for the astigmatism, our study could not detect significant differences regarding the outcome between both procedures. There are advantages to the phacoemulsification procedure, however, such as a smaller incision (e.g. tunnel technique), a closed irrigation-aspiration system, controlled intraocular pressure and the more frequent use of capsulorrhexis. Preferred indications and possible advantages regarding intra- and postoperative complications are discussed.

Aged↗
PubMed1995

[How reproducible and stable is intraocular pressure reduction after extracapsular cataract extraction?].

BACKGROUND: Extracapsular cataract extraction with implantation of a posterior chamber lens (ECCE+PCL) lowers intraocular pressure (IOP) in most eyes. However it is believed that this effect vanishes with time. PATIENTS AND METHODS: We measured IOP by Goldmann applanation tonometry in both eyes of 100 consecutive patients who were either bilaterally phakic, unilaterally pseudophakic or bilaterally pseudophakic. The posterior capsule was intact in all pseudophakic eyes and none of the eyes suffered from glaucoma. RESULTS: Median IOP was 12 mmHg for pseudophakic and 14 mm Hg for phacic eyes (p < 0.0001). The median ratio of IOPpseudophakic/IOPphakic (0.82) in unilaterally pseudophakics was significantly lower than the median ratio of IOP1. pseudophakic eye/IOP2. pseudophakic eye (1.02) in bilaterally pseudophakics (p < 0.0001). The ratio in bilaterally pseudophakic subjects was independent of the time passed since ECCE+PCL. The distribution of the ratio of IOPs was similar for the group of bilaterally pseudophakics and bilaterally phakics. CONCLUSION: We conclude that the amount of lowering of IOP induced by ECCE+PCL is characteristic for each patient. It is well reproducible, when the second eye is operated. The lowering of IOP does not fade with time but is stable. Possibly ECCE+PCL lowers the risk to develop glaucomatous optic nerve damage permanently.

Aged↗
PubMedDate not supplied

Cataract extraction in uveitis patients.

Cataracts are known to develop at an accelerated rate in many forms of uveitis. Until recently, cataract surgery in such eyes was regarded as a hazardous procedure that yielded unpredictable and often discouraging results. Recent evidence from a number of reports suggests that newer surgical techniques and careful medical management allow a significant number of patients with uveitis to undergo cataract extraction successfully. Intraocular lens implantation using in-the-bag posterior chamber lens technique has been successful in selected cases. Careful patient selection, coupled with the use of an appropriate surgical technique, appear to be of major importance. Herein we review the current literature on cataract extraction in uveitis and provide guidelines for patient and technique selection based on the type of inflammation present. The management of common surgical problems and complications is discussed, as is the role of the intraocular lens. Specific surgical techniques useful in the management of eyes with cataract and uveitis are discussed.

Arthritis, Juvenile↗
PubMed1978

Late wound separation after cataract extraction.

Many years after cataract extraction, blunt trauma ruptured limbal wounds in five eyes. Filtrations followed minor trauma in three patients, and occurred spontaneously in two others. Limbal wounds do not regain the tensile strength of adjacent normal stroma and may be further weakened by tissue incarcerations, vascularization, and other defects. Histologic studies after cataract extraction also reveal minimal collagen bridging of the stromal wound in some human eyes. Diagnosis and clinical significance are discussed.

Aged↗
PubMed1980

Cataract extraction in cases of cataract with vitreous abnormality.

Since good visibility of the deeper structures of the eye is a prerequisite for vitreous surgery, a lentectomy is often performed in combination with vitreous surgery even when the lens is only slightly cataractous. Clear lenses may have to be removed when complete intraocular gas tamponade is utilized (treatment of giant tears 180 degrees and larger). A pars plana approach is recommended, and the lens is removed with the vitrectomy instruments as long as the nucleus is not too hard. Otherwise, phacoemulsifying instruments are needed. The techniques are described. The worst complication of posterior lentectomy is loss of lens material into the vitreous cavity.

Cataract↗
PubMed2003

Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience.

PURPOSE: Phacoemulsification cataract surgery is one of the most important surgical procedures learned by ophthalmology residents during their residency training. We evaluated the visual outcomes and incidence of vitreous loss of phacoemulsification cataract surgeries performed by ophthalmology residents without prior planned extracapsular cataract extraction experience. DESIGN: Interventional case series. METHODS: A retrospective review was performed on 332 consecutive phacoemulsification cataract surgeries performed by third-year ophthalmology residents from July 1999 through June 2001. Data included are preoperative and postoperative best-corrected visual acuity, preexisting ocular comorbidities, and intraoperative and postoperative complications. RESULTS: Postoperative best-corrected visual acuity was 20/40 or better in 89% of eyes. After excluding the cases with preexisting ocular comorbidities, the percentage increased to 97.7%. Vitreous loss occurred in 4.8% of cases. CONCLUSIONS: Ophthalmology residents can learn to perform phacoemulsification cataract surgery safely and effectively without prior planned extracapsular cataract extraction experience.

Clinical Competence↗
PubMed1985

Combined trabeculectomy and cataract extraction.

Combined trepanotrabeculectomy (TTE) and intracapsular cataract extraction for advanced cataract and severe open angle glaucoma proved to be successful in 84% of the operated eyes which were followed for one to 11 years. Complications were infrequent as compared to other combined procedures. The frequency of postoperative flat anterior chamber in particular was much lower. In 77% of the eyes the surgical scars were covered by normal conjunctiva without evidence of extraocular filtration. No avascular cystic blebs formed. The same operation performed as a secondary procedure seems to be equally successful. Eight eyes, which previously had successful trepanotrabeculectomy, developed cataract, which was removed without impinging on the function of the trabeculectomy scars. If the two operations are to be performed in separate sittings, it is advisable to perform the TTE first, followed by cataract extraction.

Adult↗
PubMed1996

Atherosclerotic disease in patients undergoing cataract extraction. A nationwide case-control study. The Cataract Patient Outcomes Research Team.

OBJECTIVE: To evaluate the association between cataract extraction and atherosclerosis and its complications. DESIGN: A nationwide case-control study. SETTING AND PARTICIPANTS: Using a 5% random sample of all Medicare beneficiaries, we analyzed Medicare claims data on 60803 persons 65 years of age and older who underwent cataract extraction in 1986 or 1987 and a control group of 63765 persons matched to the cases for age, race, sex, ZIP code, and reason for Medicare entitlement. MAIN OUTCOME MEASURE: Atherosclerosis and atherosclerosis-related disease and procedures were defined by International Classification of Diseases, Ninth Revision, Clinical Modification, codes or by Health Care Financing Administration Common Procedure Classification System (Current Procedural Terminology) codes. The strength of evidence for atherosclerotic disease was categorized on the basis of the types of bills in the Medicare claims file. RESULTS: Odds of atherosclerosis-related morbidity and procedures were higher for cases than for controls. The association decreased with patient age and was strongest in beneficiaries aged 65 to 69 years (odds ratio, 1.30; 95% confidence interval, 1.13-1.48). CONCLUSION: Our findings suggest that there is a weak association between a visually significant cataract requiring surgery and atherosclerosis in the younger elderly.

Aged↗
PubMed2004

Cataract extraction following penetrating keratoplasty.

OBJECTIVE: To assess the safety of cataract extraction following penetrating keratoplasty for corneal graft survival and to evaluate visual and refractive outcomes in corneal graft patients undergoing cataract extraction. METHODS: Retrospective chart review of 29 eyes of 24 patients with corneal grafts who underwent cataract extraction from January 1, 1993 to December 31, 2002, followed on the Cornea Service at Wills Eye Hospital. RESULTS: The mean time from penetrating keratoplasty to cataract extraction was 8.4 years (range 2 months to 36 years). Following cataract extraction, the corneal grafts remained clear in all but 1 eye (3%), during an average follow-up time of 44.5 months (range 3-118 months). All of the remaining patients benefited from improved visual acuity, with 15 of 28 patients having a postoperative best-corrected visual acuity of 20/30 or better. Patients also benefited from decreased absolute spherical refractive error, with a preoperative mean value of 6.6 +/- 3.4 D compared with 2.4 +/- 1.6 D postoperatively, while cylindrical refractive error remained relatively stable at 3.2 +/- 2.9 D preoperatively and 2.8 +/- 2.4 postoperatively. The patient who developed graft failure had 3 episodes of preoperative endothelial rejection and a clear corneal graft at the time of cataract surgery. CONCLUSIONS: Cataract surgery following penetrating keratoplasty is a safe and effective procedure, with a low but definite risk of corneal graft failure. In patients with clear grafts and visually significant cataracts, cataract extraction alone is preferred over repeat penetrating keratoplasty and cataract extraction.

Aged↗
PubMed1980

Extracapsular cataract extraction, lens implantation and cyclodialysis.

Combined extracapsular cataract extraction, lens implantation and cyclodialysis appear to have good functional results, as seen in our clinical experience with 238 cases. Glaucoma medications were eliminated in 54% of the cases with 87% reaching postoperative control of the intraocular pressure. There were no significant complications, and it appears that the combined operation is preferable to doing a glaucoma procedure and a cataract extraction at separate times with an interval in between. When a cataract extraction is indicated in a glaucomatous eye, we recommend a cyclodialysis be performed at the time of an extracapsular cataract extraction with lens implantation.

Cataract↗