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PubMed1991

Divide and conquer nucleofractis phacoemulsification: development and variations.

Cataract extraction by phacoemulsification of the lens in situ can be accomplished by a technique incorporating continuous curvilinear capsulorhexis (CCC), deep central sculpting of the nucleus, and manual cracking ("nucleofractis") and subsequent fragmentation and emulsification of the remaining nucleus. This "divide and conquer" nucleofractis technique of phacoemulsification is uniquely suited to the constraints that CCC, which provides excellent conditions for well-centered in-the-bag placement of intraocular lenses, imposes upon cataract extraction. The cracking and fragmentation maneuvers allow phacoemulsification to be extended to patients with hypermature and brunescent lenses, as well as small pupils, who are not normally considered good candidates for the technique.

Cataract Extraction↗

PubMed1991

The chip and flip phacoemulsification technique.

The "chip and flip" phacoemulsification technique increases safety and control within the capsular bag. The surgical maneuvers use a two-handed technique through a small curvilinear capsulorhexis.

Cataract Extraction↗

PubMed1990

Systematic surgical procedures to secure more stable in-the-bag intraocular lens fixation.

Several conditions have to be fulfilled to retain the integrity of the capsular bag for a long period after intraocular lens fixation: (1) The anterior capsular window should be small (5 mm) and round, with no radial tears; (2) the equator of the capsular bag should be almost circular; (3) the retained capsular wall should be transparent and (4) it should have no deformity. To meet these conditions, systematization of several innovative procedures is required. The system that we propose comprises continuous circular capsulorhexis (Neuhann and Gimbel), hydrodelamination (Brint), roundel phacoemulsification (Hara and Hara), new IOL designs, and intraoperative extensive lens epithelial cell removal. A description of each procedure is presented.

Cryosurgery↗

PubMed1990

Capsular bag distension after endophacoemulsification and posterior chamber intraocular lens implantation.

Six cases of capsular bag distension after capsulorhexis, endophacoemulsification, and posterior chamber intraocular lens (IOL) implantation are presented. Five cases had prominent posterior subcapsular cataracts preoperatively. In three cases, the anterior chamber depths were shallower and the apparent refractive errors were more myopic than normal after surgery. All six cases exhibited an apparent early complete sealing of the anterior capsular remnant against the anterior IOL optic. In each case, the capsular bag contained moderate particulate debris and flare while the adjacent vitreous and anterior chambers were clear. I suspect the particles are epithelial cell and cortical debris suspended in a fluid comprising lens epithelial protein, cellular breakdown products, balanced salt solution, and water. Five cases have received no specific treatment. In one case, a neodymium:YAG laser anterior capsulotomy allowed a forward egress of fluid from the distended capsular bag and a return to normal pseudophakic anatomy.

Aged↗

PubMed1992

Postoperative capsular bag distension.

Seven cases of capsular bag distension following capsulorhexis and phacoemulsification with posterior chamber intraocular lens insertion are presented. The proposed physiological mechanism, associated consequences, and complications and treatment are presented.

Aged↗

PubMed1993

Long-term results and biocompatibility of heparin-surface-modified intraocular lenses.

A prospective in vivo study of 50 intraocular lenses was done to document the long-term results and biocompatibility of heparin-surface-modified poly(methyl methacrylate) posterior chamber lenses. Continuous curvilinear capsulorhexis and phacoemulsification were performed throughout and examinations were by slit-lamp and specular microscopy. Decentrations of more than 1 mm were seen in 4% of eyes. Stress folds from the haptic traction forces were detected in 16%. A posterior capsulotomy was performed in 10% because of fibrosis or Elschnig pearl formation. Fine fibers were found on the lens surface in 76%. During the first postoperative days only a moderate number of fibroblast-like cells was observed. Foreign-body giant cells were seen in 8%. All cases with foreign-body giant cells had posterior synechias. Visual performance and clinical results were comparable to those of other well-approved intraocular lenses. The low percentage of cellular reaction on the lens surface suggests good biocompatibility.

Adult↗

PubMed1993

Postoperative complications and uncorrected acuities after implantation of plate haptic silicone and three-piece silicone intraocular lenses.

Complications after implantation of 503 plate haptic silicone intraocular lenses were compared with those after implantation of 253 silicone three-piece polypropylene loop lenses. The uncorrected visual acuities were also compared. Capsulorhexis and endocapsular phacoemulsification were used in all cases. The incidence of cystoid macular edema and posterior capsule opacification requiring a YAG capsulotomy were significantly higher in the cases with polypropylene three-piece loop lenses. Pigment dispersion and decentration also occurred more frequently in this group. This is probably because the 10.5 mm plate haptic lens is more rigid than the polypropylene loop lens. It also fixates more posteriorly within the capsular bag than the anteriorly located polypropylene lens. Patients implanted with a plate haptic silicone intraocular lens through a 3.5 mm scleral incision had significantly better uncorrected visual acuity at five to six weeks postoperatively than those with a three-piece silicone lens that required a 4.5 mm incision for insertion.

Aged↗

PubMed1993

Surgical complications and visual acuity results in 536 cases of plate haptic silicone lens implantation.

Implantation of a plate haptic intraocular lens was planned in 536 cases. This paper reports the uncorrected and corrected visual acuities and complications in 33 patients in whom there were surgical complications that prevented implantation of the plate haptic lens. Excluding five patients (15%) who had pre-existing pathology, 21 (75%) had uncorrected acuity of 20/40 or better and 27 (96%) had corrected acuity of 20/40 or better five to six weeks postoperatively. The plate haptic lens can only be used with capsulorhexis and an intact anterior capsular rim and posterior capsule. Two alternative backup lens styles--a loop lens for placement in the torn bag or the sulcus and an anterior chamber lens--have to be in the operating room for each surgery.

Cataract Extraction↗

PubMed1991

Staining of zonules during posterior chamber lens implantation in a cadaver eye model.

A cadaver eye model was used to study the effects of extracapsular lens removal and implantation on the zonules and capsule. Five staining solutions were instilled in the posterior and anterior chambers of human cadaver eyes and washed out three to five minutes later. Gomori's chrom hematoxylin-eosin most clearly revealed the zonules. Three eyes stained in this way had lens removal (including the continuous circular capsulorhexis technique for anterior capsulectomy) and intraocular lens implantation. The effects of the surgery on the zonules and capsule were clearly visualized and appeared quite satisfactory. This staining technique may prove useful in other cadaver eye models.

Cataract Extraction↗

PubMed1991

Nucleus-splitting phacoemulsification technique.

A technique for phacoemulsification that can be used with or without capsulorhexis and that allows surgery to be performed at the 12 o'clock position is described. Following central sculpting, the nucleus is tipped superiorly to the level of the iris plane with a second instrument and the phacoemulsification tip. The hard nucleus is split from the soft nucleus, leaving two bowl-shaped pieces. The nucleus is rotated and the hard nucleus is removed with a phacoemulsification tip while the softer nucleus or epinucleus is ignored. Once the hard nucleus has been removed, the epinucleus follows easily into the phacoemulsification tip. The technique is advantageous for beginning phacoemulsification surgeons and offers an alternative for very hard nuclei with small pupils.

Cataract Extraction↗

PubMed1989

Double-hook extraction technique.

To prevent the occurrence of a radial tear at the edge of the continuous circular capsulorhexis at nucleus extraction, I have been performing a new nucleus extraction technique called double-hook extraction. This technique consists of three steps: Step 1, fluid dissection; Step 2, double-hook extraction; Step 3, extraction of the nucleus from the eye. This technique is an easy, safe, and effective way to maintain capsular integrity and implant posterior chamber lenses completely in the bag after planned extracapsular cataract extraction.

Cataract Extraction↗

PubMed1989

Bimodal capsular bag phacoemulsification: a serial cutting and suction ultrasonic nuclear dissection technique.

A technique for emulsifying the lens nucleus within the capsular bag is presented. The circular continuous tear anterior capsulotomy (capsulorhexis) and nucleus hydrodissection, which are components of the technique, are identified. The concept of isolated cutting and suction as independent actions of the 45-degree ultrasonic phaco-emulsification tip is discussed. The two actions are achieved by alternating the orientation and action of the 45-degree ultrasonic tip in a multiple rotation nuclear dissection technique. The nucleus is collapsed and drawn centrally without aspirating nuclear material while the tip's aperture is near the lens capsule. This technique prevents the ultrasonic tip aperture from bursting through the peripheral nuclear shell and thus reduces the risk of capsular aspiration and vitreous loss.

Cataract Extraction↗

PubMed1989

Further development of experimental techniques for refilling the lens of animal eyes with a balloon.

Various techniques for experimental refilling of the lens of animal eyes are possible. We describe two new methods: Balloon insertion after endocapsular phacoemulsification and after phacoemulsification with circular capsulorhexis. The feasibility of these techniques was tested in both rabbit eyes and pig cadaver eyes. With organo-silicone gel as the balloon filling material, post-operative refractive changes of up to 4 diopters of residual hyperopia were achieved; accommodation changes were up to -1 diopter. The technique of refilling the lens with a balloon to avoid leakage of filling material warrants further study.

Animals↗

PubMed1996

Stop, chop, chop, and stuff.

We describe a variation of stop and chop phacoemulsification. During chopping the chopper's vertical element is depressed posteriorly toward the optic nerve and is placed well within the capsulorhexis margin, leading to in situ chopping. Each fragment is continuously chopped, and the small pieces are stuffed inside the phaco probe port with the left hand. The phaco probe is used more for aspiration than for cutting. This technique is particularly useful in eyes with hard nuclei or small pupils.

Humans↗

PubMed1996

Neodymium: YAG capsulotomy rates after phacoemulsification with silicone posterior chamber intraocular lenses.

PURPOSE: To retrospectively evaluate the incidence of neodymium: YAG (Nd:YAG) laser capsulotomies for posterior capsule opacification (PCO) in eyes receiving one of two types of capsular-bag-fixated silicone posterior chamber intraocular lenses (IOLs) over 7 years. SETTING: John Moran Eye Center, University of Utah, Salt Lake City. METHODS: Four hundred eighty-eight eyes that had cataract extraction with a continuous curvilinear capsulorhexis and implantation of one of two kinds of silicone posterior chamber IOLs were evaluated to assess the incidence of PCO. One hundred thirty-nine received a one-piece, plate-type IOL (Staar) and 349, a three-piece, modified C-loop IOL (AMO). RESULTS: With an average follow-up of 84.3 weeks in the Staar IOL group and 93.5 weeks in the AMO IOL group, the incidence of posterior Nd:YAG laser capsulotomy for PCO was 30.2% and 39.1%, respectively. CONCLUSION: The incidence of Nd:YAG laser capsulotomy after phacoemulsification with implantation of a silicone posterior chamber IOL was still relatively high with long-term follow-up. Although the proportion of patients with a one-piece silicone IOL requiring Nd:YAG capsulotomy was less than that in the three-piece silicone IOL group, the difference was not statistically significant.

Aged↗

PubMed1996

Posterior capsule opacification and capsulotomy rates with taco-style hydrogel intraocular lenses.

PURPOSE: To evaluate posterior capsule opacification (PCO) formation and neodymium: YAG (Nd:YAG) laser capsulotomy results in eyes with an logel intraocular lens (IOL). SETTING: First University Hospital, Vienna, Austria. METHODS: A retrospective study was done of 108 eyes with one of three types of an logel IOL that had decreased vision from PCO and required posterior capsule discission. RESULTS: In general, in eyes with sulcus-placed IOLs, a Soemmering's ring formed and the capsulorhexis rim tightly adhered to the posterior capsule, sealing the capsular bag periphery. Elschnig pearls had broken the barrier, invading the retrolental space. In eyes with bag-placed IOLs, there was a gap between the IOL and posterior capsule in which Elschnig pearls had accumulated. This gap frequently extended beneath the flanges to the periphery of the capsular bag, allowing residual lens epithelial cells to proliferate and migrate centrally. CONCLUSION: The logel lenses led to a high incidence of regeneratory PCO within the gap between the lens and capsule that might be the result of the properties of the lens' hydrogel material rather than its design.

Cataract↗

PubMed1996

Capsular bag distension with an acrylic intraocular lens.

PURPOSE: To describe the postoperative capsular bag distension that occurs with in-the-bag implantation of the soft acrylic (AcrySof) intraocular lens (IOL). SETTING: Jules Stein Eye Institute, University of California, Los Angeles. METHODS: Nine eyes in nine patients had uncomplicated continuous curvilinear capsulorhexis, phacoemulsification, and in-the-bag implantation of the AcrySof lens. Comprehensive ophthalmic examinations were performed 1 day and 1 and 6 weeks postoperatively. Patients had neodymium:YAG laser posterior capsulotomy; refractions were done before and after the capsulotomy. RESULTS: Comprehensive ophthalmic examination revealed variable degrees of anterior chamber shallowing, anterior displacement of the IOL within the bag, and distension of the posterior capsule away from the IOL. Unexpected postoperative myopic correction was seen in all patients. Postcapsulotomy mean spherical equivalent refractive shift was +3.6 diopters (D) with a shift of at least +4.0 D in four of nine eyes. CONCLUSIONS: Capsular bag distension is a previously described postoperative complication that we observed in association with the AcrySof IOL.

Acrylates↗

PubMed1996

Long-term results of clear lens extraction for severe myopia.

PURPOSE: To evaluate the efficacy and safety of clear lens extraction in the management of severe myopia. SETTING: Seoul National University Hospital, Seoul, Korea. METHODS: This retrospective study comprised 24 eyes of 16 patients who had clear lens extraction to treat myopia of 12.00 diopters (D) or more. A scleral pocket incision and continuous curvilinear capsulorhexis were made followed by lens extraction by phacoemulsification and low-power posterior chamber intraocular lens implantation. Mean follow-up was 15 months. RESULTS: Fifteen eyes (62.0%) were within 1.00 D of targeted refractive error postoperatively; 22 (91.7%) were within +2.00 D. Uncorrected visual acuity improved in all eyes. All except 1 (95.8%) gained two or more Snellen lines. Best corrected visual acuity improved in 20 eyes (83.3%); 15 (75.0%) gained two or more lines. Best corrected visual acuity after surgery was 20/40 or better in 19 eyes (79.2%), a 37.5% increase over the preoperative number. Posterior capsule opacification developed in 1 eye; a neodymium: YAG laser posterior capsulotomy was performed at 4 months postoperatively. No retinal breaks, retinal detachments, or cystoid macular edema were observed during the follow-up. CONCLUSION: Clear lens extraction was effective in correcting severe myopia; however, longer follow-up of a large number of cases is needed to fully assess possible complications.

Adult↗