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PubMed1998

Conversion from phacoemulsification to extracapsular cataract extraction: incidence, risk factors, and visual outcome.

PURPOSE: To evaluate the incidence, risk factors, and visual outcome in cases converted from phacoemulsification to routine extracapsular cataract extraction (ECCE). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: A retrospective study was performed in 540 eyes that had clear corneal phacoemulsification performed by an experienced phacoemulsification surgeon. The cases in which phacoemulsification was initiated and then converted to ECCE were studied. The main parameters evaluated were the factors responsible for the conversion, corneal endothelial cell loss, and visual outcome. RESULTS: Twenty eyes (3.7%) required conversion to ECCE during phacoemulsification. Pupillary miosis (6 cases), posterior capsule rupture (5 cases), prolonged phaco time (4 cases), posterior extension of the capsulorhexis (2 cases), corneal thermal burn (1 case), subluxation of the lens (1 case), and malfunctioning of the ultrasonic handpiece (1 case) were the reasons for the conversion. The mean percentage of endothelial cell loss was 11.06% +/- 2.3 (SD); 18 cases (90.0%) achieved a visual acuity of 20/40 or better at 6 weeks. CONCLUSIONS: Intraoperative pupillary miosis, posterior capsule rupture, and very hard nuclear cataract causing prolonged phacoemulsification were the major risk factors for conversion to ECCE. Optimal preoperative preparation and prompt recognition of complications during phacoemulsification can lead to timely conversion to ECCE to achieve a good visual outcome.

Cell Count↗

PubMed1998

Relationship between lens and capsular bag size.

PURPOSE: To measure the size of the lens and the empty capsular bag and evaluate the relationship between them. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: In 46 eye-bank eyes, the equatorial diameter of the lens was measured after a corneoscleral button and the iris were removed. Empty capsular bag diameter was measured after extracapsular cataract extraction through an intact capsulorhexis. RESULTS: Mean lens size was 10.20 mm +/- 0.38 (SD) and mean capsular bag size, 10.38 +/- 0.35 mm. The difference between the size of the lens and that of the empty capsular bag varied from 0 to 0.50 mm (mean 0.20 +/- 0.17 mm). Lenses measuring less than 10.25 mm in diameter showed an increase of 0.25 mm while lenses larger than 10.25 mm showed an increase of 0.09 mm. CONCLUSION: Lens size was larger in our population than in previous studies. The increase in the empty capsular bag size was related to initial lens size.

Aged↗

PubMed1998

Analysis of zonular-free zone and lens size in relation to axial length of eye with age.

PURPOSE: To evaluate the anatomical relationships of the zonular-free zone (ZFZ) of the anterior capsule and crystalline lens diameter in relation to the axial length of the eye with age. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea, and Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHOD: Various ocular structures in 122 eyes obtained post-mortem were measured without prior preparation. The correlation between age, anterior-posterior (A-P) length and globe size, and diameters of the cornea, crystalline lens, and ZFZ were analyzed. RESULTS: The average A-P globe length, and corneal, lens, and ZFZ diameters were 24.48, 11.67, 9.65, and 6.93 mm, respectively. There was no significant relationship between A-P length and globe size and corneal diameter in different age groups. The ZFZ size varied negligibly among age groups. There was a statistically significant correlation between lens diameter and age (correlation coefficient = 0.2647; P < .01) and lens diameter and A-P globe length (correlation coefficient = 0.3183; P < .001). CONCLUSIONS: When choosing an intraocular lens, one should consider the patient's age and the A-P globe length. Six eyes (5%) showed unusual anterior insertion of zonular attachment, which reminds us to be prudent with a large paracentral capsulorhexis.

Adult↗

PubMed1999

Course of postoperative inflammation after implantation of 4 types of foldable intraocular lenses.

PURPOSE: To compare the course of postoperative inflammation after small incision cataract surgery with implantation of 4 types of foldable intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University Hospital of Vienna, Austria. METHODS: One hundred twenty eyes were prospectively randomized to receive a foldable silicone (Pharmacia 920), hydrogel (Bausch & Lomb Hydroview), methyl methacrylate/hydroxyethyl methacrylate (Mentor MemoryLens), or acrylic (Alcon AcrySof) IOL. All surgery was performed by the same experienced surgeon using a standardized surgical protocol: clear corneal incision, capsulorhexis, phacoemulsification, and in-the-bag implantation of the IOL. All patients received standardized postoperative medication and follow-up. Postoperative inflammation was evaluated by measuring aqueous flare preoperatively and 1, 3, 7, 14, 28, 90, and 180 days after surgery using the Kowa 1000 laser flare-cell meter. RESULTS: Except on the first day after surgery, when the AcrySof group had higher flare values than the other groups (P = .0265), no significant differences were found up to 6 months. Re-establishment of the blood-aqueous barrier was similar in eyes with the AcrySof, Hydroview, and MemoryLens IOLs; the course of postoperative inflammation was different in eyes with the silicone IOL. CONCLUSION: Comparison of postoperative flare values after implantation of 4 foldable IOLs showed no clinically relevant differences in the course of postoperative inflammation.

Acrylic Resins↗

PubMed1999

Posterior capsule striae.

PURPOSE: To find the incidence, contributing factors, outcomes, and clinical impact of intraoperative posterior capsule striae. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: In a prospective study, 100 consecutive eyes had phacoemulsification and intraocular lens (IOL) (AcrySof MA30BA) implantation. The presence of striae was noted at the end of the operation, and factors contributing to their development were identified. Follow-up was done at regular intervals, and the clinical impact of striae on patients' vision was evaluated. RESULTS: Striae were observed in 56 eyes (Group 1) but were absent in 44 (Group 2). Mean age in Group 1 was 65.96 years +/- 9.15 (SD) and in Group 2, 59.20 +/- 10.36 years (P = .0012). Mean axial lengths were 23.47 +/- 1.63 and 24.12 +/- 1.49 mm, respectively (P = .0419). Average lens thickness was greater in Group 1 (4.50 +/- 0.43 mm) than in Group 2 (4.13 +/- 0.41 mm) (P = .0001). The sex of patient, capsulorhexis size and centration, grade of cataract hardness, scleral rigidity, and IOL centration were not found to contribute to striae development. The striae disappeared by 5 months postoperatively and did not show a positive Maddox rod phenomenon. CONCLUSION: Intraoperative striae observed in many patients were associated with relatively older age, greater lens thickness, and shorter axial length. The striae eventually disappeared and had no effect on vision.

Cataract Extraction↗

PubMed1999

Effect of tranilast eyedrops in preventing posterior capsule opacification: preliminary report.

PURPOSE: To evaluate the effect of tranilast eyedrops in preventing fibrous opacification of the posterior lens capsule after cataract extraction and intraocular lens (IOL) implantation. SETTING: The Second Department of Ophthalmology, Toho University School of Medicine, Tokyo, and Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. METHODS: This study comprised eyes having continuous curvilinear capsulorhexis and phacoemulsification/aspiration followed by implantation of a posterior chamber IOL in the capsular bag. In this prospective, randomized, controlled, and double-masked trial, tranilast 0.5% (Rizaben) eyedrops (15 eyes) or its placebo eyedrops (20 eyes) were given 4 times a day for 3 months after surgery. An anterior eye segment analysis system (EAS 1000, Nidek Co., Ltd.) was used to evaluate the degree of fibrous posterior capsule opacification (PCO) 1 week and 1 and 3 months after surgery. RESULTS: The mean PCO density in the tranilast group was 17.1 cct +/- 4.6 (SD), 20.0 +/- 3.6 cct, and 23.0 +/- 7.7 cct (cct = computer compatible tape) at 1 week and 1 and 3 months, respectively. In the control group, it was 18.2 +/- 5.3, 30.2 +/- 7.8, and 38.4 +/- 8.0 cct, respectively. There was a significant difference in the 1 and 3 month findings between the 2 groups (P < .001). CONCLUSION: Tranilast was effective in preventing fibrous PCO at an early postoperative stage. The possible mechanisms of its effect may be prevention of collagen synthesis by minimizing transforming growth factor type beta released during lens epithelial cell metaplasia.

Aged↗

PubMed1999

Microhook capsule stabilization for phacoemulsification in eyes with pseudoexfoliation-syndrome-induced lens instability.

Cataract extraction in eyes with pseudoexfoliation syndrome is known to result in a high incidence of intraoperative and postoperative complications. Lens instability--phacodonesis--is often present and may lead to zonular rupture, capsule tears, and vitreous loss. We describe the use of microhook iris retractors to stretch and fixate the capsulorhexis relative to the sclera, which stabilizes the capsular bag and facilitates safe phacoemulsification in eyes with pseudoexfoliation-syndrome-induced lens instability. Results of this technique in 8 eyes are reported.

Cataract↗

PubMed2000

Analysis of liquid accumulated in the distended capsular bag in early postoperative capsular block syndrome.

PURPOSE: To analyze the transparent liquid between the posterior lens capsule and the posterior chamber intraocular lens (PC IOL) in early postoperative capsular block syndrome and discuss the mechanism of posterior capsule distention. SETTING: Department of Ophthalmology, Tokyo University School of Medicine, and Tokyo Research Institute, Seikagaku Corporation, Tokyo, Japan. METHODS: This study evaluated 3 cases of capsular block syndrome presenting with transparent liquid in the distended capsular bag 1 day after cataract surgery. The transparent liquid material between the posterior capsule and PC IOL was aspirated and analyzed using high-performance liquid chromatography (HPLC). Also, sodium hyaluronate was diluted using a dialyzer to determine whether the aqueous humor was drawn into the capsular bag by an osmotic gradient across the capsule. RESULTS: The elution time of the samples was almost the same as that of sodium hyaluronate 1.0% (Healon) The concentration of the samples ranged from 3.29 to 9. 01 mg/mL by HPLC analysis. The sodium hyaluronate absorbed the physiological salt solutions through the dialyzer and expanded to 1. 9 times its original volume. CONCLUSIONS: These results indicate that the main ingredient of the transparent liquid in capsular bags is sodium hyaluronate and that the distention is caused by aqueous humor being drawn into the capsular bag by an osmotic gradient across the capsule when the capsulorhexis diameter is smaller than that of the PC IOL and by viscoelastic material retained and trapped in the bag intraoperatively.

Aged↗

PubMed2000

Interlenticular opacification: clinicopathological correlation of a complication of posterior chamber piggyback intraocular lenses.

PURPOSE: To present a clinicopathological correlation of 2 pairs of piggyback posterior chamber intraocular lenses (PC IOLs) explanted because of opacification between the lens optics. SETTING: Gayton Health Center, Eyesight Associates of Middle Georgia, Warner Robins, Georgia, and Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Two pairs of piggyback AcrySof lenses were explanted from 2 patients with significant visual loss related to opacification between the optics. They were submitted for pathological analysis. Gross and histopathological examinations were performed, and photomicroscopy was used to document the results. RESULTS: Gross examination showed accumulation of a membrane-like white material between the lenses. Histopathological examination revealed that the tissue consisted of retained/proliferative lens epithelial cells (bladder cells or pearls) mixed with lens cortical material. CONCLUSION: Piggyback PC IOLs were explanted in 2 cases because of a newly described complication, interlenticular opacification. Three surgical means may help prevent this complication: meticulous cortical cleanup, especially in the equatorial region; creation of a relatively large continuous curvilinear capsulorhexis to sequester retained cells peripheral to the IOL optic within the equatorial fornix; insertion of the posterior IOL in the capsular bag and the anterior IOL in the ciliary sulcus to isolate retained cells from the interlenticular space.

Acrylic Resins↗

PubMed2000

Small incision extracapsular cataract surgery with manual phacotrisection.

PURPOSE: To evaluate the safety and efficacy of small incision extracapsular cataract extraction (ECCE) using the manual phacotrisection technique. SETTING: Department of Ophthalmology, Turgut Ozal Medical Center, InönüUniversity, Malatya, Turkey. METHODS: Fifty-nine eyes of 54 patients had small incision ECCE by the manual phacotrisection technique. Mean follow-up was 10 months. After capsulorhexis and hydrodissection were performed, the endonucleus was prolapsed into the anterior chamber and trisected using an anteriorly positioned triangular trisector and posteriorly placed solid vectis. Pieces were extracted with a forceps through a small incision. RESULTS: Postoperatively, best spectacle-corrected visual acuity of 20/40 or better was achieved in 48 eyes (83%) and of 20/25 or better in 28 eyes (47%). The most frequent intraoperative complication was posterior capsule rupture (n = 5). Of eyes that developed posterior capsule rupture, 3 had vitreous loss and 2 had implantation of an anterior chamber intraocular lens (IOL). In 44 eyes, the IOL was implanted in the bag and in 12 eyes, in the ciliary sulcus. The most significant postoperative complication was transient corneal edema, which developed in 32 eyes (54%). No permanent complications (e.g., corneal endothelial decompensation) occurred in any case. CONCLUSIONS: Manual phacotrisection has several advantages such as nucleus safety, less dependence on assistant personnel, the elimination of the phaco machine, and cost effectiveness.

Adult↗

PubMed1999

Manual tunnel incision extracapsular cataract extraction using the sandwich technique.

Small incision extracapsular cataract extraction (ECCE) using the sandwich technique is described. After capsulorhexis, hydrodissection, and hydrodelineation, the endonucleus is moved into the anterior chamber and extracted by sandwiching it between the irrigating vectis and iris spatula. In a series of 37 eyes, most achieved a best corrected visual acuity of 5/10 or better postoperatively. Complications were posterior capsule rupture, vitreous loss, and transient corneal edema. Small incision ECCE using the sandwich technique is safe, easy, and does not require expensive instrumentation.

Adult↗

PubMed1999

Effect of expandable full-size intraocular lenses on lens centration and capsule opacification in rabbits.

PURPOSE: To study the effects of expandable, hydrogel, full-size lenses (FSLs) on lens centration and posterior capsule opacification (PCO) in the rabbit model. SETTING: Center for intraocular Lens Research, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Small FSLs designed for human eyes were implanted unilaterally in 20 rabbit eyes. Lens centration and PCO in these eyes were compared with those in eyes with conventional poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) or aphakia in the fellow eyes. In a second experiment, medium-size or large FSLs designed for rabbit eyes were implanted in 20 rabbit eyes and the results compared with those in eyes with conventional PMMA IOLs. Slitlamp examination of all eyes was performed regularly, after enucleation, gross inspection and microscopic studies were performed. RESULTS: Decentration of FSLs occurred in the presence of an anterior capsule tear or very large capsulorhexis. Posterior capsule opacification developed only at sites where the implanted lens was not in contact with the capsule. Aphakic eyes and looped IOLs developed Soemmering's rings peripherally. In eyes with small FSLs, PCO developed between the lens and the center of the posterior capsule, whereas in eyes with large FSLs, only small amounts of central PCO developed. Retained high-viscosity viscoelastic material had no effect on PCO development. CONCLUSIONS: Complete refilling of the capsular bag by a full-size IOL was associated with excellent centration and only a small degree of PCO. Elastic lenses may thus serve as a starting point for the development of an artificial lens with accommodative function.

Animals↗

PubMed1997

Phacoemulsification at King Khaled Eye Specialist Hospital--the experience of the past.

OBJECTIVE: To study the outcome of phacoemulsification (PE) compared to standard extracapsular surgery before the introduction of state-of-the-art techniques (capsulorhexis, hydrodissection, nuclear cracking, nuclear chopping, sutureless incisions) and sophisticated equipment. STUDY DESIGN: Charts from 375 patients (453 eyes) undergoing PE between 1984 and 1989 were randomly selected and studied retrospectively. A minimum age of 35 years, and a minimum follow-up of three months were required. SETTING: A large eye hospital in the Kingdom of Saudi Arabia staffed with an international faculty of ophthalmic surgeons. PATIENTS: Patients over 35 years of age undergoing PE for immature, mature and traumatic cataract. MAIN OUTCOME MEASURES: Postoperative visual acuity, and rate or frequency of intraoperative complications. RESULTS: 66.5% achieved visual acuity of 20/40 or better, which compares favourably with the 36.5% of eyes reaching this level of visual acuity after mainly standard extracapsular cataract surgery in another study at our hospital. Posterior capsule ruptures occurred in 7.5% and vitreous loss in 5.5%. Other ocular disease (odds ratio 7.51 confidence interval 4.43-12.7) and intraoperative complications (odds ratio 2.97 confidence interval 1.38-6.42) were statistically significant predictors for final visual acuity of under 20/40 (p = < 0.001 and 0.005 respectively). CONCLUSION: The outcome of PE was better than that of standard extracapsular cataract extraction in the same setting. However, since PE appeared to be used selectively, no clear advantage compared to extracapsular cataract extraction is evident in the period before the introduction of modern state-of-the-art PE-techniques.

Adult↗

PubMed1999

Practice styles and preferences of Finnish cataract surgeons - 1998 survey.

PURPOSE: To collect information of current cataract surgery techniques in Finland. METHODS: A questionnaire of 36 multiple choice questions about practice styles and preferences in cataract surgery was sent to 153 ophthalmologists in Finland. In three weeks, 75 respondents returned the questionnaire (49%), and of these 68 (44%) reported doing cataract surgery. RESULTS AND CONCLUSIONS: Topical anesthesia, temporal approach for the incision, either clear corneal or frown scleral, no suture closure of the wound, continuous circular capsulorhexis, phacoemulsification technique and foldable IOLs are often preferred in Finland. It can be calculated that this survey represents roughly 70-80% of all performed cataract operations in Finland and thus these results may be regarded as a reliable picture of current cataract surgery techniques in Finland.

Anesthesia↗

PubMed1995

Implantation of foldable intraocular lenses in the presence of anterior capsular tears.

A consecutive series of patients who had undergone small-incision phacoemulsification cataract surgery with foldable lens implantation were reviewed. Seven patients had sustained anterior capsular tears during surgery. In all cases a three-piece foldable intraocular lens (IOL) was successfully inserted by careful positioning of the haptics. In all 6 patients available for long-term assessment the IOL remained stable and well centred, the tears having been sealed by fibrous tissue. We show that, if logical measures are taken to limit tear extension, the lack of an intact capsulorhexis need not result in conversion to extracapsular cataract extraction.

Astigmatism↗

PubMed1998

Combined phacoemulsification, pars plana vitrectomy, removal of intraocular foreign body (IOFB), and primary intraocular lens implantation for patients with IOFB and traumatic cataract.

PURPOSE AND METHODS: Small-incision cataract extraction by phacoemulsification through an anterior continuous circular capsulorhexis, pars plana vitrectomy, forceps removal of intraocular foreign body (IOFB) and primary intraocular lens implantation were performed in 4 eyes (4 patients) with IOFB and traumatic cataract, as an emergency combined procedure. RESULTS: At a mean follow-up of 12.3 months (range 7-19 months) the best corrected visual acuity of the 4 eyes ranged from 6/6 to 6/12. The only complication encountered in our series was an opacified posterior capsule that developed 10 months post-operatively in one case. This was easily dealt with by neodymium:YAG laser capsulotomy, with good final visual outcome. CONCLUSIONS: The results of combined one-stage instead of sequential surgeries, and phacoemulsification instead of lensectomy or extracapsular cataract extraction for patients with IOFB and cataract are encouraging. It could be a good option in selected cases. However, the safety and efficacy of this combined procedure need to be evaluated further by a larger-scale, longer follow-up study.

Adult↗

PubMed1999

Posterior capsular opacification after cataract surgery.

This is a review of the current status of clinical research on the prevention of posterior capsular opacification (PCO), which is now the commonest complication of cataract surgery occurring in up to 50% of patients by 2 to 3 years after the operation. PCO is caused by lens epithelial cells retained in the capsular bag following surgery which then proliferate, migrate and transform to myofibroblasts. Interest in the prevention of PCO has centred around surgical technique, pharmacological methods to remove or destroy lens epithelial cells and changes in intraocular lens material and design. Changes in surgical technique have little effect in prevention of PCO although a capsulorhexis size which lies on the optic diameter appears to be beneficial. Many different cytotoxic drugs and pharmacological agents have been used experimentally to prevent PCO but the problem has limited damage only to lens epithelial cells. So far, no method has been shown to be safe for clinical use. Current interest is centred once again on the intraocular lens itself, particularly the material that it is made from and changes in its edge profile.

Cataract↗

PubMed2006

Lamellar corneal dissection for visualization of the anterior chamber before triple procedure.

PURPOSE: Open-sky cataract extraction during triple procedure can be associated with higher risk of complications owing to the missing counterbalance by the cornea. Herein, we present a fast and easy technique for visualization of the anterior chamber and the lens in eyes with opaque corneas planed for triple procedure. MATERIALS AND METHODS: Four patients with corneal oedema due to Fuchs' endothelial dystrophy and cataract underwent triple procedure. As the anterior chamber view was limited, the central 7.0 mm of the cornea was marked. Then, 60-80% of the corneal thickness was removed by lamellar dissection and filled with hydroxypropylmethylcellulose. Continuous curvilinear capsulorhexis (CCC) and phacoemulsification with intraocular lens implantation through a corneoscleral tunnel were then performed and at the end the remaining corneal tissue was excised and the donor tissue fixed with a single running continuous suture. RESULTS: Lamellar corneal dissection enhances the anterior chamber view and CCC can be performed under stable anterior chamber condition. Phacoemulsification via sclerocorneal tunnel could be easily performed under good anterior chamber view in all cases. The operation time was 60-75 min in all cases. CONCLUSION: Lamellar corneal dissection in opaque corneas before cataract extraction is a useful technique for enhancing anterior chamber view in cases of triple procedure.

Anterior Chamber↗