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PubMed1993

Reduction of postoperative against-the-rule astigmatism by lateral incision technique.

A group of 80 preoperative against-the-rule (AR) eyes had cataract removal and intraocular lens implantation with lateral (temporal) incision and suturing. Fifty-six of the 80 eyes had extracapsular cataract extraction (ECCE) and 24 had phacoemulsification (KPE) with capsulorhexis. For both procedures, subgroups (21 of ECCE, ten of KPE) with high preoperative AR astigmatism (> or = -2.0 D) were evaluated. Analysis of the postoperative data provided the following: (1) induced postoperative cylinder decrease, (2) effect of cutting and not cutting sutures, (3) induced axial shift, (4) postoperative astigmatic change as a function of time, and (5) comparative effectiveness of ECCE and KPE lateral incision procedures in reducing postoperative AR astigmatism.

Astigmatism↗

PubMed1993

Split and lift: nuclear quadrant management for phacoemulsification.

A bimanual technique for handling the nuclear quadrants created during "in situ fracture" or "divide-and-conquer" phacoemulsification after capsulorhexis is described. This technique involves lifting the sharp apex of each nuclear quadrant anteriorly, permitting centralization of the quadrant for emulsification. Complications and difficulties associated with other methods of nuclear quadrant handling, such as tumbling and use of high vacuum level settings, are avoided.

Cataract Extraction↗

PubMed1993

The gliding nucleus.

The lens glide is a disposable sterile plastic piece designed to achieve smooth, easy, safe expression of the nucleus in planned extracapsular cataract extraction. The advantages of the technique include prevention of iris prolapse or iris trauma, controlled nucleus extraction without sudden nucleus expulsion, direction of the nucleus toward the external opening, and prevention of malengagement of the nucleus to the anterior chamber angle or vitreous cavity. Using the glide facilitates extraction of a nucleus through a small limbal or scleral incision. Combining the glide with other modern surgical techniques, such as scleral tunnel small incision, capsulorhexis, and hydrodissection, results in a no-stitch low astigmatic wound and stable intraocular lens fixation in the capsular bag.

Cataract Extraction↗

PubMed1995

Comparison of endothelial cell loss and phacoemulsification energy during endocapsular phacoemulsification surgery.

We counted central corneal endothelial cells and measured corneal thickness in 64 human eyes before and three months after cataract extraction and posterior chamber lens implantation. Cataract surgery was the same in all patients and included capsulorhexis and posterior chamber phacoemulsification of the nucleus. Total phacoemulsification energy and time were recorded. A heparin-surface-modified intraocular lens or a regular poly(methyl methacrylate) lens, both having the same design and a 5.0 mm optic, was implanted in the capsular bag with the aid of sodium hyaluronate (Healon). Mean endothelial cell loss was 4%. However, the change in cell density did not correlate with the total phacoemulsification energy used during surgery. Three months after surgery, the central corneal thickness was the same as it had been preoperatively. The results suggest that phacoemulsification in the posterior chamber is a safe procedure even in cases with a hard nucleus.

Aged↗

PubMed1995

Effect of intraocular lens size on posterior capsule opacification after phacoemulsification.

Posterior capsule opacification (PCO) is one of the most common complications of phacoemulsification with intraocular lens (IOL) implantation. This retrospective study evaluated the incidence of neodymium: YAG (Nd:YAG) laser capsulotomies for PCO in two groups of patients with different sizes of poly(methyl methacrylate) (PMMA), capsular bag-fixated IOLs. We evaluated 437 eyes that had phacoemulsification with continuous curvilinear capsulorhexis over a four-year period. Patients were placed in one of two groups, based on IOL size: large IOL (lens length 13.5 mm or greater) and small IOL (lens length less than 13.5 mm). In the large IOL group, 106 of 280 patients (38%) required YAG laser posterior capsulotomy; in the small IOL group, 25 of 157 patients (16%) did. This difference was statistically significant even though the average follow-up was 84.1 weeks in the large IOL group and 54.1 weeks in the small IOL group.

Cataract↗

PubMed1995

Healon GV versus Healon in demanding cataract surgery.

This study compared how well two sodium hyaluronate viscoelastics maintained the anterior chamber during cataract surgery in eyes at risk for high vitreous pressure. Patients were divided into two groups based on the sodium hyaluronate used: Healon or Healon GV. Qualitative data were obtained with a digital slide gauge attached to the operating microscope. After capsulorhexis, mean anterior chamber depth (distance of the corneal apex to the iris plane) was significantly greater in the Healon GV group (P = .0012). Subjective intraoperative evaluation by surgeons also favored Healon GV. There was no difference between the groups in postoperative inflammation, corneal edema, intraocular pressure, or visual acuity. Therefore, although the two viscoelastics are equally safe, Healon GV maintains the anterior chamber better during cataract surgery.

Aged↗

PubMed1994

Late hyphema after small incision cataract surgery.

A 68-year-old patient presented with a spontaneous hyphema 11 months after successful small incision cataract surgery. There was evidence of neovascularization of the wound. The intraocular lens was sequestered in the capsular bag within an intact capsulorhexis. Wound neovascularization as a complication of cataract surgery has become extremely rare with the increase in the popularity of the corneal incision for extracapsular cataract surgery. But the complication could become more common with the return to scleral incisions for phacoemulsification. Precise wound construction is necessary to avoid this complication.

Aged↗

PubMed1993

Phacoemulsification with poorly dilated pupils.

Tilting the viewing angle of the operating microscope during phacoemulsification provides the surgeon a better view of the cataractous lens. This technique, combined with continuous curvilinear capsulorhexis, divide and conquer nucleofractis, and lens rotation in the capsular bag, allows the surgeon to perform most of the phacoemulsification procedure near a well-visualized 6 o'clock meridian. This procedure can eliminate the need for iris surgery in cases with small pupils. Also discussed is the removal of the upper half of the cortical substance in patients with small pupils.

Cataract Extraction↗

PubMed1994

Intraocular lens implantation in infants with congenital cataracts.

We evaluated 21 eyes of 13 infants between two and eight months old who had primary posterior chamber intraocular lens (IOL) implantation for congenital cataracts between 1988 and 1993. Twelve eyes had a posterior capsulorhexis or plaque peeling at the time of implantation and one eye had a vitrectomy. Eight eyes had no posterior capsule procedure during the initial surgery. Follow-up ranged from six months to five years. All eyes developed one or multiple posterior synechias and all, except one, required secondary capsulectomy and vitrectomy between one month and one year. Twenty eyes attained stable IOL fixation and a clear visual axis. In one eye, the IOL decentered downward. Patients with bilateral cataracts had greater visual improvement than those with a cataract in one eye only. No patient could manage spectacles postoperatively. Our findings show the benefits of posterior capsulectomy and anterior vitrectomy done in the early postoperative period and that IOL implantation in infants is a reasonable treatment in some parts of the world.

Cataract↗

PubMed1994

Endocapsular hematoma with biconvex posterior chamber intraocular lenses.

We describe ten cases of endocapsular hematoma that developed in the early postoperative period after cataract or combined glaucoma and cataract surgery. After capsulorhexis and phacoemulsification, one of three types of posterior chamber lenses with biconvex optics was implanted in nine eyes. In one eye, a convex-plano poly(methyl methacrylate) lens was implanted. All lenses were implanted in the bag. Postoperatively, an anterior chamber hyphema was observed in four eyes and erythrocytes in another five. Subsequently observed endocapsular hematomas disappeared gradually over the next several months. A narrow space was visible between the posterior optic surface and the posterior chamber in all eyes with a biconvex lens. We believe that blood from the hematoma seeped behind the anterior capsular leaf into that space. A YAG capsulotomy was not necessary in any case.

Aged↗

PubMed1991

Sutureless one-handed intercapsular phacoemulsification. The keyhole technique.

Advances in the phacoemulsification technique have made small incision cataract surgery with lens implantation and sutureless incision closure a reality. This paper describes a step-by-step technique of small incision construction (the key), capsulorhexis (the keyhole), hydrodissection, intercapsular phacoemulsification (the doorway), and small incision lens implantation without the need for suture closure. A review of 200 cases with follow-up at one year is described. Evaluation of a postmortem eye at eight weeks following this sutureless technique indicates that these incisions are self-sealing, do not leak, do not induce astigmatic change, and allow rapid visual recovery.

Aged↗

PubMed1990

Multilamellar hydrodissection in phacoemulsification and planned extracapsular surgery.

Multilamellar hydrodissection is the injection of balanced salt solution into multiple lamellae of the lens, cleaving it into a small nucleus and multiple layers of cortex. In phacoemulsification, the smaller nucleus reduces phacoemulsification time, and the thicker bed of cortex provides greater protection for the posterior capsule. In extracapsular extraction, the smaller nucleus can be more readily extracted, which is particularly advantageous when capsulorhexis is performed. Creation of multiple cortical lamellae facilitates their aspiration, either with the phacoemulsification or irrigation/aspiration tips. Multilamellar hydrodissection increases the predictability and safety of phacoemulsification and planned extracapsular cataract extraction.

Cataract Extraction↗

PubMed1990

Displacement of bag-placed hydrogel lenses into the vitreous following neodymium: YAG laser capsulotomy.

We report two cases in which hydrogel lens implants have dislocated posteriorly into the vitreous body following YAG laser capsulotomy. These lenses were placed in the bag in conjunction with a capsulorhexis. A comparison with our results using silicone and poly(methyl methacrylate) implants indicates that this phenomenon has occurred only with hydrogel implants. Analysis of the various parameters associated with the laser capsulotomy procedure suggests that the overall length and design of the hydrogel implants were key factors. Because of the severity of this complication, we have discontinued the use of this type of implant.

Adult↗

PubMed1990

Capsular bag fixation of one-piece silicone lenses.

One hundred sixteen (116) one-piece silicone implants (STAAR 4203C) designed for capsular bag placement have been implanted since July 1987 and followed for up to two years. It appears that the posterior capsular opacification rate is significantly less than with sulcus-fixated one-piece silicone implants. This has been achieved by incorporating the small round capsulotomy using the capsulorhexis technique in addition to a modified endocapsular phacoemulsification technique. The percentage of posterior capsules requiring neodymium:YAG laser treatment in the first four months was 4.3 for the 4203C silicone IOLs and 20.0 for the sulcus-fixated one-piece silicone IOLs. The opacification rates for the one-year follow-up were 11% and 31%, respectively.

Cataract↗

PubMed1990

New posterior chamber lens with open circular haptic for a small capsular opening: preliminary report.

This report describes a single-piece poly-(methyl methacrylate) posterior chamber lens for implantation through a small capsular opening. It has open circular loops with an eyelet at each loop end. The optic is 6 mm in diameter and the overall diameter of the intraocular lens (IOL) is 11 mm. The lens diameter can be reduced to 7 mm by grasping the eyelets at both open loop ends with a specially designed holding forceps. The IOL is inserted in the capsular bag after circular capsulorhexis or through a linear capsulotomy in the intercapsular technique. This IOL is adaptable to a small capsular opening and maintains the usual shape of the capsular bag, similar to a disc lens.

Aged↗

PubMed1990

Hybrid nuclear dissection technique for capsular bag phacoemulsification.

A bimanual phacoemulsification technique for dissecting and removing the firm lens nucleus is described. The technique is a surgical hybrid that combines concepts developed by several surgeons. Bimanual posterior and peripheral nuclear bowl fiber separation (nuclear fracture) has been incorporated into the anatomic dissection of the lens within the capsular bag. This dissection is accomplished with the 45-degree tip on separated nuclear components in situ after capsulorhexis. Combining the best features of various techniques permits this hybrid method to be applied to firm cataracts by most surgeons currently performing phacoemulsification.

Cataract Extraction↗

PubMed1990

Noncicatricial oval deformation of the pupil induced by sulcus-fixated one-piece posterior chamber lenses.

A retrospective analysis of 40 cases of sulcus-fixated one-piece poly(methyl methacrylate) posterior chamber lenses revealed ten cases (25%) that demonstrated oval deformation of the pupil, similar to the condition associated with anterior chamber lenses. This complication was not noted until several weeks after surgery, appears to be progressive, and might be the cause of glare symptoms. Possible mechanisms of the pupillary deformation include mechanical stretching of the iris by oversized lenses and fibroproliferation on the posterior iris surface. Prevention rests upon firm capsular bag fixation aided by capsulorhexis and reduction of the overall lens loop diameter.

Humans↗

PubMed1990

The torn posterior capsule: its intraoperative behavior, surgical management, and long-term consequences.

A retrospective study of cataract surgery performed between January 1983 and December 31, 1989, disclosed 48 eyes in which the posterior capsule was torn. The overall incidence of this complication was approximately 1% but was further reduced when the technique of capsulorhexis was mastered. Our review of the video tapes of these surgical procedures revealed that the tear occurred most frequently during nucleus removal (41%) and posterior capsular vacuuming (28%). The anatomy of each tear was classified and related to the event responsible for the torn capsule, as well as to the likelihood of vitreous involvement. Vitreous presented through the tear in 32% of the 48 cases, entered the wound in 6%, and remained posterior to the torn capsule in 62%. Intraocular lenses were implanted in every case; only posterior chamber lenses were used during the last four years of the study. Vitreous-related complications included vitreous prolapse, peaked pupils, and vitreous-induced pupillary block. Acute postoperative intraocular pressure elevation was a frequent finding and was managed by conservative therapy. Transient cystoid macular edema developed in one case which had a rotating anterior chamber intraocular lens. No retinal detachments occurred in this series. Final visual acuity of 20/40 or better was achieved in 89% of the 48 cases. When properly managed, a torn posterior capsule is compatible with an excellent visual outcome.

Adult↗