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Results for “Capsulorhexis”

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At least 595 records · Page 33Linked to original sources

PubMed1996

Postoperative inflammatory response to phacoemulsification and extracapsular cataract surgery: aqueous flare and cells.

PURPOSE: To compare the postoperative blood-aqueous barrier (BAB) breakdown induced by phacoemulsification with continuous curvilinear capsulorhexis (CCC) and by extracapsular cataract extraction (ECCE) with a linear capsulotomy. SETTING: Cataract and Refractive Surgery Research Unit, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: Anterior chamber flare and cells were measured preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively in two parallel groups of 31 consecutive cataractous eyes. In Group 1, one surgeon performed ECCE with a linear capsulotomy; in Group 2, a second surgeon performed divide and conquer phacoemulsification with CCC. The preoperative, intraoperative, and postoperative medication regimen was the same in both groups. RESULTS: Group 2 eyes had significantly lower anterior chamber flare and cell measurements in the first postoperative month than Group 1 eyes (.01 < P < .00001). CONCLUSIONS: Phacoemulsification with CCC induced a less severe BAB breakdown than ECCE with a linear capsulotomy. Phacoemulsification with CCC may be preferable in high-risk eyes such as those with glaucoma, diabetes, or uveitis, which are prone to complications resulting from postoperative BAB breakdown.

Aged↗

PubMed1996

Comparison of diclofenac sodium and flurbiprofen for inhibition of surgically induced miosis.

PURPOSE: To compare the efficacy of two topical nonsteroidal anti-inflammatory drugs, diclofenac sodium and flurbiprofen, commonly used prior to cataract surgery to inhibit surgically induced miosis. SETTING: Department of Ophthalmology, Cornell University Medical College, The New York Hospital, New York, New York. METHODS: Fifty-one patients having phacoemulsification were randomly assigned to receive topical treatment with either diclofenac sodium 0.1% or flurbiprofen 0.03% every 15 minutes for four doses along with their dilating drops beginning 1 hour before surgery. All surgeries were videotaped, with the magnification calibrated. The videotapes were analyzed and the horizontal and vertical diameters of the pupil were measured just before the initial conjunctival incision (baseline) and then every 5 minutes during the procedure. Measurements were also made at the beginning of capsulorhexis, the beginning of phacoemulsification, the end of phacoemulsification, the end of cortical cleanup, and before and after implantation of an intraocular lens. RESULTS: There was no statistically significant difference between the two treatment groups in baseline pupil dilation; however, regardless of the drug received, the light irides were, on average, more dilated at baseline than the dark ones. After surgery began, there were no statistically significant differences between the two groups at any time or surgical interval except at the start of phacoemulsification, at which point the flurbiprofen-treated eyes were more dilated than the diclofenac-treated eyes. CONCLUSION: Diclofenac sodium and flurbiprofen were equally effective in maintaining intraoperative mydriasis during cataract surgery.

Administration, Topical↗

PubMed1996

Effect of intraocular sustained release of indomethacin on postoperative inflammation and posterior capsule opacification.

PURPOSE: To assess whether the sustained release of indomethacin significantly reduces postoperative inflammation and posterior capsule opacification (PCO). SETTING: Nishi Eye Hospital, Jinshikai Medical Foundation, Osaka, Japan. METHODS: A 7 mm diameter, 1 mm thick polylactic-polyglycolic acid disk containing 7 mg of indomethacin was implanted in five rabbit eyes after continuous curvilinear capsulorhexis and phacoemulsification. The disk and an IOL placed above it were implanted in the capsular bag. The contralateral eyes, which served as controls, received a disk without indomethacin and the same type IOL in the same manner. RESULTS: The indomethacin was fully released within 3 weeks in vitro, a release rate of about 14 micrograms/h. Postoperatively, aqueous flare intensity was significantly lower at days 2, 3, and 4 and at weeks 1, 2, and 3. Prostaglandin E2 was not detectable in the aqueous humor of the indomethacin-treated eyes on day 3 and at week 4. In the control eyes, mean concentration was 491 pg/ml +/- 54 (SD) and 990 +/- 243 pg/ml, respectively. Histopathological examination showed no significant decrease in PCO. CONCLUSION: Although sustained release of indomethacin significantly decreased inflammation, it did not reduce PCO.

Animals↗

PubMed1996

Cellular reaction on the anterior surface of poly(methyl methacrylate) intraocular lenses.

PURPOSE: To assess the cellular reaction on the anterior surface of poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) implanted by phacoemulsification with continuous curvilinear capsulorhexis (CCC) or by extracapsular cataract extraction (ECCE) with a linear capsulotomy. SETTING: Cataract and Refractive Surgery Research Unit. Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. METHODS: To document morphology, topography, and severity of the cellular reaction, specular microscopy of the anterior IOL surface was performed at 1 day, 1 week, and 1 and 3 months postoperatively in two parallel groups of 31 consecutive cataractous eyes operated on by phacoemulsification with CCC or by ECCE with a linear capsulotomy. RESULTS: The local tissue response consisted of a nonspecific foreign-body reaction to the IOL and a lens epithelial cell reaction. The foreign-body reaction was significantly less severe in the phacoemulsification group than in the ECCE group, and the number of IOLs without inflammatory cells was significantly higher. CONCLUSION: The foreign-body reaction to PMMA IOLs is significantly reduced when the lens is implanted by phacoemulsification with CCC. This could be of clinical benefit in high-risk eyes prone to the inflammatory complications of cataract surgery.

Cataract Extraction↗

PubMed1996

Inhibition of migrating lens epithelial cells by sustained release of ethylenediaminetetraacetic acid.

PURPOSE: To evaluate the effect of the sustained-release of ethylenediaminetetraacetic acid (EDTA) chelating Ca++ on lens epithelial cell (LEC) migration. SETTING: Nishi Eye Hospital, Jinshikai Medical Foundation, Osaka, Japan. METHODS: Polylactic-glycolic acid disks containing 10% EDTA were placed in saline solution for about 2 weeks in vitro. About 60% (7 micrograms/hour) of the EDTA was released during that time. The disks with a posterior chamber intraocular lens placed above were implanted in the capsular bag in five rabbit eyes after continuous curvilinear capsulorhexis and phacoemulsification. A disk without EDTA and the same lens type were placed in the bag in the contralateral eyes, which served as controls. RESULTS: After 2 to 3 months, opacification in the central posterior capsule was significantly reduced in all eyes that received the disk with EDTA. CONCLUSION: The deprivation of Ca++ disrupted interaction between the posterior capsule and migrating LECs by inactivating the adhesion molecule integrin synthesized by LECs, significantly reducing LEC migration onto the posterior capsule.

Animals↗

PubMed1996

Total anterior capsule closure after silicone intraocular lens implantation.

An 84-year-old man with a nuclear cataract had phacoemulsification, continuous curvilinear capsulorhexis, and implantation of a silicone intraocular lens. Two months later, the patient had vision loss and severe anterior capsule fibrosis, leading to complete posterior chamber lens encapsulation. After a capsular opening was created with a neodymium:YAG laser, visual acuity returned to the preoperative level of 20/30.

Aged↗

PubMed1996

Anterior intraocular lens dislocation after combined cataract extraction trabeculectomy.

PURPOSE: To evaluate the incidence, cause, and effect of intraocular lens (IOL) dislocation after combined cataract extraction and trabeculectomy. SETTING: An ophthalmic ambulatory surgery center in Lynwood, California. METHODS: This retrospective study comprised 150 patients with open-angle glaucoma who had either planned extracapsular cataract extraction (ECCE) (n = 96) or phacoemulsification (n = 54) combined with IOL implantation and trabeculectomy. I reviewed type of cataract extraction, preoperative glaucoma medications, axial length, and amount of filtration achieved postoperatively. RESULTS: The lens dislocated in 20 eyes (13.3%), with the highest incidence after planned ECCE (18.7%) and the lowest after phacoemulsification with capsulorhexis (3.7%). Eighteen of 30 eyes (60%) that had excessive filtration also had IOL dislocation. Mean induced postoperative myopia in eyes with lens dislocation was-2.25 diopters (D) +/- 0.55 (SD). CONCLUSIONS: Anterior IOL dislocation was related to increased postoperative filtration and was more common after planned ECCE. In all cases, it caused a distorted pupil, posterior synechias, and induced myopia of over -1.00 D.

Anterior Chamber↗

PubMed1997

Iris hooks for phacoemulsification of the subluxated lens.

Phacoemulsification of the lens in eyes with zonular loss risks dislocation of the lens into the vitreous cavity. We describe the use of iris hooks after capsulorhexis to support the lens during surgery. With iris hooks, the lens can be stabilized, helping prevent additional loss of zonules and permitting retention of the capsule to support an intraocular lens.

Adult↗

PubMed1997

Security of capsular fixation: small-versus large-hole plate-hepatic lenses.

PURPOSE: To assess the effect of relatively large positioning holes on the security of capsular bag fixation of plate-haptic silicone intraocular lenses (IOLs). SETTING: Center for Research on Ocular Therapeutics and Biodevices, Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This study tested the hypothesis that larger holes allow ingrowth of lens material, fibrous tissue, or both through them, which helps fixate the lens more firmly in the capsular bag. Five rabbits had bilateral continuous curvilinear capsulorhexis, phacoemulsification, and implantation of a plate-haptic silicone IOL. An IOL with a small, round positioning hole (Staar AA-4203V) was implanted in the right eye in each rabbit, and a large-hole IOL (Staar AA-4203VF) was implanted in the left eye. After 2 months, all rabbits were killed. The force required to extract one haptic from the capsular bag was measured with a digital force meter. All eyes had histopathological analysis. RESULTS: It was slightly more difficult to extract a large-hole IOL from the capsular bag, although this trend was not statistically significant. However, histopathological analysis consistently showed 360 degree synechia formation through the holes, showing that the IOL could be securely fixed in position. CONCLUSIONS: Proliferation of lens epithelial cells through a large positioning hole in a plate-haptic silicone IOL may improve the long-term security of capsular bag fixation. This will help reduce the incidence of IOL decentration and dislocation.

Animals↗

PubMed1997

Noncorneal astigmatism related to poly(methyl methacrylate) and plate-haptic silicone intraocular lenses.

PURPOSE: To evaluate noncorneal astigmatism after implantation of a one-piece, plate-haptic silicone or one-piece poly(methyl methacrylate) PMMA intraocular lens (IOL). SETTING: Klinik und Poliklinik für Augenheilkunde der Universität Regensburg, Germany. METHODS: After a follow-up of at least 3 months, the degree of postoperative noncorneal astigmatism was calculated using the data from an auto refractometer. Sixty patients were evaluated: 30 with silicone IOLs (Group A) and 30 with PMMA lenses (Group B). RESULTS: Mean noncorneal astigmatism in Group A was 0.78 diopter (D) +/- 0.51 (SD), which was statistically significantly higher than that in Group B (0.51 +/- 0.27 D) (P = .013). The highest noncorneal astigmatism, 2.32 D, occurred in Group A. CONCLUSIONS: Based on these findings, we recommend noncorneal astigmatism be considered in eyes with a one-piece, plate-haptic silicone IOL and postoperative astigmatism. A prospective study with a standardized capsulorhexis size is needed to ascertain whether this IOL-related noncorneal astigmatism is caused by capsular shrinkage, which may then be treatable with a laser capsulotomy of the anterior capsule.

Aged↗

PubMed1997

Transscleral suture fixation of a subluxated posterior chamber lens within the capsular bag.

A 48-year-old man with cataract had uncomplicated phacoemulsification and implantation of a posterior chamber intraocular lens (IOL) into the continuous capsulorhexis. Three years later, part of the capsular bag and a haptic subluxated into the anterior chamber. At the time of repositioning surgery, partial zonular dehiscence and iridocapsular synechias were found. The IOL was repositioned behind the iris; however, subluxation of the lens recurred 1 year later. The IOL and capsular bag were successfully sutured to the sclera by introducing a double-armed polypropylene suture through a limbal stab incision.

Anterior Chamber↗

PubMedDate not supplied

Intraocular pressure change after neodymium:YAG capsulotomy.

PURPOSE: To study intraocular pressure (IOP) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy in eyes that had phacoemulsification, anterior continuous curvilinear capsulotomy, in-the-bag intraocular lens (IOL) implantation, and no apparent communication between the aqueous and vitreous compartments after the Nd:YAG capsulotomy. SETTING: Northwest Kansas Eye Clinic, Hays, Kansas. METHODS: This study comprised 101 eyes. All patients received one drop of apraclonidine hydrochloride 0.5% (lopidine) 30 to 60 minutes before and then after Nd:YAG capsulotomy, intraocular pressure was measured preoperatively before administration of lopidine and at 1 to 3 and 24 hours, 1 week, and 1 month postoperatively. RESULTS: Within 24 hours after the Nd:YAG capsulotomy, no significant IOP elevations occurred. Although there was one case of modest IOP elevation at 1 week postcapsulotomy, none was seen at 4 weeks. There was no relation between change in IOP and number of laser pulses, energy per pulse, or total energy. CONCLUSION: The results indicate that lack of communication between the aqueous and vitreous compartments with an intact capsulorhexis over the lens optic rim prevented obstruction of the trabecular network by cellular debris or vitreous. This, coupled with the reduction in aqueous formation by lopidine, prevented significant IOP elevation. In patients meeting the study criteria, routine IOP measurements 1 to 3 hours and 1 day after capsulotomy may not be necessary.

Aged↗

PubMed1997

Supracapsular phacoemulsification: a capsule-free posterior chamber approach.

We describe a technique that relocates the phacoemulsification process outside the capsular bag by transposing the nucleus through an intact 5.0 to 6.0 mm capsulorhexis. The upside-down nucleus is then returned to the posterior chamber, positioned above the anterior capsule in the "supracapsular space" where it remains throughout the phacoemulsification procedure of choice: cracking, chopping, manual prechoping, or traditional sculpting. The chief advantage of supracapsular phacoemulsification is greater efficiency, which is manifested in reduced emulsification time and energy. Disadvantages include the possibility of mild postoperative corneal edema during the earliest part of the learning curve, as well as inadvertent damage to the iris in cases with suboptimal pupil dilation.

Humans↗

PubMedDate not supplied

Flexible iris hooks for phacoemulsification.

Flexible iris hooks can be used to facilitate phacoemulsification in eyes with small pupils or damaged zonules. In addition to their conventional use as an iris retractor, the hooks can create a tenting effect that, when combined with pupil and continuous curvilinear capsulorhexis (CCC) enlargement, can prevent anterior capsule damage during phacoemulsification in eyes with small pupils. In addition, CCC enlargement stabilizes the lens in eyes with zonular damage.

Humans↗

PubMed1997

Incidence of posterior capsular plaque in cataract surgery.

OBJECTIVE: To determine the incidence of posterior capsular plaque detected during cataract surgery, its association with age and type of cataract, and its impact on vision. SETTING: Raghudeep Eye Clinic and Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective study comprised 256 consecutive eyes having extracapsular cataract extraction with posterior chamber intraocular lens implantation. The presence of plaque on the posterior capsule was noted and charted. Plaque peeling or posterior capsulorhexis was not done at the time of surgery. Mean patient age was 59 years (range 24 to 83 years). Follow-up was up to 1 year. RESULTS: The overall incidence of plaque was 10.16%. The incidence by type of cataract was 5.13%, nuclear sclerotic; 12.50%, posterior subcapsular; 9.68%, mixed; 27.27%, mature (P < .05). The difference in incidence according to cataract type was highly significant between patients older than 50 years and those younger than 50 years (P < .001). At the end of 1 year, 61.54% of patients with plaque maintained a visual acuity of 20/20 to 20/30; 30.77%, 20/40; 7.69%, 20/60 or worse. CONCLUSION: The incidence of plaque was higher in eyes with mature cataract at any age and in eyes with posterior subcapsular cataract in younger patients. Its presence was compatible with reasonable vision at the end of 1 year.

Adult↗

PubMed1997

Phacoemulsification with a bevel-down phaco tip: phaco-drill.

We present a technique for in situ lens nucleus emulsification using low phaco power and high vacuum, a continuous curvilinear capsulorhexis, and hydrodelineation. Emulsification is done with the phaco tip slanted down 30 or 45 degrees. Cutting and aspiration do not cause an undesirable energy loss. This technique can be combined with the nuclear chopping or divide and conquer methods because of its ability to drill and hold the nucleus. Posterior capsular rupture is prevented because the separated epinucleus acts as a barrier between the nucleus and the cortex. The low power used minimizes the energy transfer to the corneal endothelium. This technique is particularly useful in eyes with brunescent cataract.

Humans↗

PubMed1997

Morphologic compatibility or intraocular lens haptics and the lens capsule.

PURPOSE: To evaluate the mechanical relationship between the intraocular lens (IOL) haptic and the capsular bag by quantitatively analyzing the fit of the haptic with the capsule equator and the capsular bag deformity induced by the implanted lens haptics. SETTING: Division of Morphogenesis, Department of Developmental Biology, National Institute for Basic Biology, Okazaki, Japan. METHODS: Following implantation of a poly(methyl methacrylate)(PMMA) ring in three excised human capsular bags with continuous curvilinear capsulorhexis (CCC), IOLs with different overall lengths or haptic designs were implanted in the bags and photographed. The straight length of the area of contact between the haptic and the capsule equator on the photographs was measured to provide a quantitative index of in-the-bag fixation and the length from the external margin of the PMMA ring to the external margin of the loop along the maximal diameter of the capsular bag, to indicate the quantitative degree of capsular deformity induced by an IOL. RESULTS: An IOL with modified-C loops produced better fit along the capsule equator and less deformity than an IOL with modified-J loops, and an IOL with an overall length of 12.0 or 12.5 mm produced a sufficiently good fit and less distortion of the capsular bag than an IOL with an overall length over 13.0 mm. CONCLUSION: An IOL with modified-C loops and an overall length of 12.0 or 12.5 mm is adequate for in-the-bag implantation following CCC.

Adult↗

PubMed1998

Lens refilling with injectable silicone in rabbit eyes.

PURPOSE: To evaluate the technique of refilling the lens capsule with injectable silicone and assess the postoperative findings. SETTING: Jinshikai Medical Foundation, Nishi Eye Hospital, Osaka, Japan. METHODS: The lens capsules in the eyes of 16 rabbits weighing 1.5 to 2.0 kg were refilled with 0.2 mL of silicone polymer (about 66% bag volume) after endocapsular phacoemulsification through an upper minicircular capsulorhexis 1.5 to 1.8 mm in diameter. The capsule opening was sealed with a silicone plug to prevent leakage of the injected silicone. Main outcome measures were surgical success rate, inflammation, endothelial cell loss, refractive change after pilocarpine 4% instillation, and capsule opacification. RESULTS: The lens capsule could be refilled in 10 eyes. The failures were caused by capsule rupture during phacoemulsification (n = 3) and profuse leakage of the injected silicone. Silicone that leaked minimally during surgery was easily washed away. Silicone that leaked and polymerized in the anterior chamber postoperatively (n = 3) was easily removed by surgery the following day. Mean endothelial cell loss was 10.2% 1 month after surgery. Aqueous flare intensity was significantly lower on days 2 and 4 than after conventional intraocular lens implantation in a control group. The respective mean preoperative and postoperative refractions were 0.7 diopters (D) +/- 1.0 (SD) and 19.1 +/- 1.0 D and the mean change (difference between the refractions before and after topical application of pilocarpine 4%), -0.4 +/- 0.6 and 1.1 +/- 0.4 D (P < .01). Posterior capsule opacification (PCO) was noted after 3 weeks in all eyes. CONCLUSIONS: Lens capsule refilling and capsular plug use to prevent silicone leakage was shown to be feasible and avoided complications caused by leakage. Refractive changes suggest that the procedure could yield accommodation in primates> Although neodymium: YAG laser capsulotomy did not cause herniation of the injected silicone, PCO prevention is an essential issue in lens refilling because the capsulotomy may annul the attained accommodation.

Animals↗