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PubMed2003

[Phacoemulsification in eyes with posterior polar cataract and foldable intraocular lens implantation].

PURPOSE: To study the surgical technique of phacoemulsification with foldable intraocular lens(IOL) implantation in eyes with posterior polar cataract and the managements of intraoperative or postoperative complications. METHODS: Phacoemulsification with removal of posterior plaque, or continuous curvilinear posterior capsulorhexis and foldable IOL implantation were carried out after topical anesthesia in 46 cases (61 eyes) with age ranging from 38 to 78 years old (average 57). RESULTS: All eyes were implanted foldable IOL. Fifty-one eyes revealed intact posterior capsule, six of which revealed posterior capsule opacification. Ten eyes developed posterior capsule rupture. However, four eyes need to perform anterior vitrectomy. Pars plana vitrectomy was performed in one eye with uveitis and secondary glaucoma induced by soft shell of nucleus sank into the vitreous cavity. Fifty-eight in 61 IOL were implanted in the capsular bags, while 3 IOLs were fixed in the ciliary sulcus. CONCLUSION: Phacoemulsification with foldable IOL implantation is an effective method to treat posterior polar cataract. Dealing with the posterior plaque during phacoemulsification carefully may decrease intraoperative and postoperative complications and remarkably improve postoperative visual acuity.

Adult↗
PubMed1992

[Comparison of various capsulectomy techniques in cataract surgery. An experimental study].

Radial tears at the edge of an anterior capsulectomy are often associated with the occurrence of intraocular lens (IOL) loops coming out of the capsular bag with subsequent IOL decentration. We analyzed the incidence of radial tear formation in 40 human eyes obtained postmortem. These eyes were randomly assigned to four groups: "can opener," linear capsulotomy, capsulopuncture ("postage stamp"), and continuous curvilinear capsulorhexis (CCC). The CCC appeared to be much less likely to be associated with anterior capsular radial tears as opposed to the other three techniques. With the nucleus expression technique used in this study, radial tears occurred in all cases of "can opener," linear capsulotomy and capsulopuncture, whereas no tears occurred with the CCC technique. The results of this study show that CCC is currently the best available anterior capsulectomy procedure for minimizing the incidence of radial tears and sequelae such as decentration.

Aged↗
PubMed1992

[The first stage of clinical trials of hydrogel lenses manufactured in Czechoslovakia].

The authors give an account of the results of the first stage of clinical trials of Czechoslovak disc-shaped hydrogel lenses made from the copolymer HEMA and methacrylic acid. Hitherto assembled experience provided evidence that the envelope technique for opening of the anterior capsule does not ensure sufficient stability of these lenses in the later stage and their decentration may cause serious complications. Therefore the optimal solution is to place the implant in the capsule after circular capsulorhexy. Improvement of the geometrical and optic properties of the lenses during the subsequent follow-up and their perfect harmony with the surgical technique will produce even better functional results in operated patients.

Aged↗
PubMed1992

Small-incision manual extracapsular cataract extraction using selective hydrodissection.

Hydrodissection is a technique in which balanced salt solution is injected through a cannula into various layers of a cataractous lens to separate the lens lamella in a nonspecific location. Selective hydrodissection allows separation of the lens lamella at different desired anatomical layers. The technique allows the smallest possible nucleus, ie, the hard-core nucleus, to be hydroexpressed as a separate entity, requiring, correspondingly, a relatively small capsulorhexis and limbal incision. Then, in a second maneuver, the epinucleus, which engulfs the hardcore nucleus to form the adult nucleus, also can be aspirated or hydroexpressed as a whole. Selective hydrodissection permits scleral incision and stitchless surgery in planned extracapsular cataract extraction and also may serve as an intermediate step for surgeons who wish to convert to or learn phacoemulsification techniques.

Cataract Extraction↗
PubMedDate not supplied

Phacoemulsification and foldable intraocular lens implantation in eyes filled with silicone oil.

BACKGROUND AND OBJECTIVE: To evaluate the visual outcome of phacoemulsification and foldable intraocular lens (IOL) implantation in eyes already filled with silicone oil. PATIENTS AND METHODS: Following vitrectomy and silicone oil injection, 16 eyes of 16 consecutive patients undergoing phacoemulsification and IOL implantation were included in the study. RESULTS: The mean age of patients was 58.3 +/- 9.2 years (range, 38 to 71 years). The time interval between the cataract surgery and silicone oil injection was 5.8 +/- 1.7 months (range, 4 to 9 months). The mean number of previous surgeries was 2.0 +/- 0.8 (range, 1 to 4). Trypan blue (0.4%) was used for anterior capsule staining in 3 eyes with white cataract. Dispersive viscoelastic material was used during all steps of phacoemulsification. A capsular tension ring was inserted after capsulorhexis and hydrodissection in all cases. An IOL with a 6.0-mm optic was implanted in all eyes. The preoperative best-corrected visual acuity ranged from hand motions to 0.3. The mean postoperative best-corrected visual acuity was 0.3 +/- 0.1 (range, 0.1 to 0.6); best-corrected visual acuity increased in all eyes. A small amount of silicone oil moved into the anterior chamber during phacoemulsification in 1 eye and was evacuated. In all eyes, no silicone oil was present in the anterior chamber postoperatively. CONCLUSION: The use of dispersive viscoelastic and a capsular tension ring provides safer phacoemulsification and foldable IOL implantation in eyes already filled with silicone oil.

Adult↗
PubMed2003

Early postoperative capsular block syndrome.

BACKGROUND: Postoperative capsular block syndrome (CBS) is a unique and rare complication of continuous curvilinear capsulorhexis (CCC). The purpose of this study was to analyze the clinical characteristics and results of early postoperative CBS. METHODS: Patients who developed early postoperative CBS after cataract surgery from October 1998 through September 2002 were retrospectively identified. All eyes underwent smooth phacoemulsification after anterior CCC. An intraocular lens (IOL) was implanted into the capsular bag. Neodymuim:YAG (Nd:YAG) laser peripheral anterior capsulotomy or posterior capsulotomy was performed when resolution did not occur or the intracoular pressure was elevated. RESULTS: Eight eyes of eight patients were included in the study. These patients presented with a shallow anterior chamber, anteriorly displaced IOL, distended capsular bag, and myopic shift within the first week after the surgery. One eye was associated with secondary angle-closure glaucoma. No CBS resolved without intervention during the follow-up period. The Nd:YAG laser peripheral anterior capsulotomy (4 eyes) and posterior capsulotomy (4 eyes) were successful in resolving the CBS in all eyes, and normalized the intraocular pressure in the eye with secondary angle-closure glaucoma. CONCLUSION: Postoperative CBS did not resolve spontaneously in most cases. Only a small percentage of early postoperative CBS was associated with secondary glaucoma. The Nd:YAG laser peripheral anterior capsulotomy and posterior capsulotomy were successful in treating postoperative CBS.

Adult↗
PubMed1992

[Phacoemulsification. The method of choice in cataract surgery].

Complications and problems in the first 300 patients operated on by phacoemulsification technique are described. In the first 100 cases the procedure began with the creation of the corneoscleral incision and the anterior capsule was opened in a "can opener" fashion. In the second group of 200 patients we preferred the scleral incision, and the anterior capsule was opened mainly by capsulorhexis. The phacoemulsification was predominantly performed in the capsular bag or in the iris plane. The wound was closed with interrupted sutures. The most common and the most serious complication as well in the first 100 cases was posterior capsule rupture (11%). Then the percentage of this most common complication was diminished significantly with increasing experience of the surgeon (2.5% in 200 cases). The same problems which the authors had in their first operations appeared again, though in a smaller amount as soon as they started to work with phacoemulsification as a method of choice of cataract surgery.

Cataract Extraction↗
PubMed2004

[Phacoemulsification--personal experience on my first 507 cases].

PURPOSE: The evaluation of the intra and post operative early complications of the phacoemulsification with posterior chamber artificial lens implant on my first 507 cases. METHODS: A retrospective study on 507 eyes operated by cataract through phacoemulsification technique at the Emergency Military Hospital from Cluj-Napoca during the 1st of May-30th of June 2002. The surgeries were performed by the same surgeon through a corneal or a scleral incision using rigid and foldable artificial lenses. The evaluation period lasted 2 months, the types and frequency of the intraoperative and early postoperative complications being analyzed. RESULTS: The intraoperative complications were represented by the posterior capsule's efraction in 17 cases (3.37%); zonular rupture in 3 cases (0.59%); the loss of the nucleus into vitreous 4 cases (0.79%); the luxation of the crystalline lens in the anterior chamber in 5 cases (0.99%); the hyphaema and iris trauma in 14 cases (2.76%); incomplete cortical clean-up in 9 cases (1.78%); the failed capsulorhexis in 7 cases (1.38%) and the conversion to ECCE in 8 cases (1.58%). The early postoperative complications met into the study were: the corneal edema in 34 cases (6.71%); raised IOP in 18 cases (3.55%); the retained lens material in 9 cases (1.78%); the late inflammatory reactions in 6 cases (1.18%); hypopyon in 3 cases (0.59%); endophthalmitis in 3 cases (0.59%); retinal detachment in 1 case (0.2%) and the anterior capsule fibrosis in 4 cases (0.79%). CONCLUSIONS: The phacoemulsification is a high security technique because of the small incision and the sharp accuracy. The complications correlate themselves with the surgeon experience and with some particularities of the cataract (the brunescent cataract at the old patient, the medium dilatation of the pupil, etc.).

Follow-Up Studies↗
PubMed2004

[Phacoemulsification and pseudoexfoliative syndrome].

PURPOSE: To compare the results and the complications of cataract surgery by phacoemulsification in eyes with pseudoexfoliation syndrome (PEX) and without pseudoexfoliation syndrome. METHODS: A retrospective clinical study (January 2001 - January 2004; mean follow-up 21.5 months) of 116 cases divided in two groups: group A (55 eyes) with senile cataract and pseudoexfoliation syndrome and group B (61 eyes) with senile cataract but without pseudoexfoliation syndrome. The eyes were without another associated ophthalmological diseases and the phacoemulsifications were performed by the same surgeon. Intraoperative observations included anterior chamber depth, pupil size after maximal mydriasis, zonular dehiscence, capsule tear, vitreous loss and postoperatively: best corrected visual acuity, intraocular pressure (IOP), aqueous flare response and IOL stability were evaluated at 1 day, 1 week, 1 month and until 3 years. The Student-t test was used for statistical analyses. RESULTS: There were determined significant correlations between pupil size, anterior chamber depth and the rate of complications in the group A. The visual acuities were similar in both groups. IOP reduction was superior in the eyes with PEX as compared with control group, but without statistically significantly difference. In group A, there were a non-statistically significantly percentage of IOL dislocation as compared with group B. In the eyes with PEX, it is necessary to utilize IOLs with bigger optic size. CONCLUSIONS: Phacoemulsification represents a safe method in cataract surgery in eyes with pseudoexfoliation syndrome in the presence of careful surgical technique: maximal mydriasis, circular continuous curvilinear capsulorhexis, adequate hydrodissection. On the long run, the postoperative results were comparable between eyes with PEX and the control group (without PEX).

Cataract↗
PubMed2005

[Refractive change and axial growth after bilateral intraocular lens implantation in children with congenital cataract].

OBJECTIVE: To observe refractive change and axial growth in children with bilateral congenital cataract after intraocular lens (IOL) implantation. METHODS: 38 patients (76 eyes) with congenital cataract, who undergone cataract extraction, posterior continuous curvilinear capsulorhexis, anterior vitrectomy and primary IOL implantation in the capsular bag, were included. Patients were divided into four groups based on their age at surgery: 2 - 3 years (group A), 4 - 5 years (group B), 6 - 7 years (group C) and 8 - 12 years (group D). The refraction, axial length and corneal curvature in the follow-up for five years were reviewed. The correlation between best corrected visual acuity (BCVA) and refractive or axial change was analyzed. RESULTS: The mean myopic shift was -2.06, -1.81, -0.56 and -0.25 D respectively in the four groups (P < 0.01). The axial elongation was 1.21,1.13,0.47 and 0.34 mm respectively (P < 0.01). There was no statistically significant difference among the four groups in corneal curvature preoperatively (P > 0.05) or postoperatively (P > 0.05). 50 eyes (65.8%) had a final BCVA of 0.5 or better. No statistically significant correlation was found between BCVA and refractive change (P > 0.05) or axial growth (P > 0.05). CONCLUSIONS: Cataract extraction combined with primary anterior vitrectomy and bilateral IOL implantation is safe and effective for bilateral congenital cataract. There is a mild trend of myopic shift postoperatively, and the pattern of axial length is similar to normal eyes. Refractive change and axial growth tend to be stable in older patients. It is recommended to set the immediate postoperative refraction under correction slightly in patients with age 2 - 5 years.

Cataract↗
PubMed2005

[Thinoptix implant--the last border in modern cataract surgery. After 7 months, results of first implants in România].

PURPOSE: To present the rollable implant and the firsts results after 7 months of usage. MATERIAL AND METHODS: The implant: ThinOptX Ultra Choice 001 in a rolled state can be implanted through 1.34 mm. 53 patients: 86.8% RF capsulorhexis, cold phacoemulsification, followed for 21 days-7 months. One implantation on broken posterior capsule. RESULTS: The objective astigmometry was unchanged in 51.3% and slightly altered in the rest of cases. In most cases, both distance UCVA and BCVA was under 5/10 in the first 3 days and better than 5/10 afterwards. Unlike the "fat" lens implanted patients, most of ThinOptX implanted patients continued to read the last line even after the correction was changed with 1.5-2 D. The near UCVA in 79.2% = J3, but for a long and comfortable reading the patients needed an addition of 0 D in 32 cases, 1 D in 8 cases, 1.5 D in 6 cases, 2 D in 6 cases and 3 D in one case. CONCLUSIONS: 1. ThinOptX Ultra Choice 001 solves the greatest part of aberrations so that the quality of vision is almost identical with the one of an emmetropic eye with 4 mm pupil and better than when the pupil is 6 mm wide; 2. Both UCVA and BCVA are in good concordance with biometry data; 3. Due to pseudo-accommodation and to an increased focus deepness, the UCVA covers both distance, intermediate and--frequently--the near vision; 4. ThinOptX implant does not put pressure on capsule equator, so that it can be implanted in a broken capsular bag without the risk of break enlargement; 5. The only discomfort, rarely observed, consists in the perception of colored halos around light sources.

Acrylic Resins↗
PubMed2005

[Pathological cataracts in systemic diseases].

PURPOSE: To show the physiopathological mechanisms which determines the appearance of the pathological cataract and types of cataract and clinical manifestations of the systemic disease and operative complications. METHOD: Retrospective study that includes 22 patients hospitalized in clinic with pathological cataract diagnosis, appeared in following systemic disease: diabetes mellitus, skin disease, endocrine disease, SNC disease. RESULTS: Generally the patients had posterior subcapsular cataract or nuclear and posterior subcapsular cataract with fast evolution to intumescent cataract. Phacoemulsification with IOLCP performed at all patients. Good evolution and not surgery complications. CONCLUSIONS: The difficult of the surgery was connected with the risk of the posterior capsular break ( the majority cases were soft cataract) and also connected with the capsulorhexis making in intumescent cataracts. The post surgery evolution was not different compared with a usually cataract.

Adult↗
PubMed2005

Global gene profiling reveals novel glucocorticoid induced changes in gene expression of human lens epithelial cells.

PURPOSE: Prolonged use of glucocorticoids can lead to the formation of a cataract, however the mechanism is not known. We recently reported the presence of the functional glucocorticoid receptor in immortalized cultured mammalian lens epithelial cells (LECs), but the biological effect is not known. This study seeks to determine if freshly isolated human LECs respond to glucocorticoid treatment and to examine glucocorticoid induced changes in global gene expression in LECs. METHODS: Capsulorhexis specimens obtained in surgery from eyes with cataract were cultured. Primary lens cultures were transfected, in triplicate, with pGRE.Luc, which drives the expression of firefly luciferase, and treated with dexamethasone (Dex) or vehicle (Veh). RNA isolated from HLE B-3 cells, treated with Dex or Veh for 4 or 16 h in triplicate, was used to analyze global changes in gene expression by microarray hybridization. Data and cluster analyses were performed using Microarray Suite 5.0, GeneSpring 6.1, EASE, NetAffx, and SAM. Real Time PCR was used to confirm microarray data in RNA isolated from HLE B-3 cells in triplicate and a primary culture of human lens epithelial cells. RESULTS: Transfected primary cultures of human LECs treated with Dex demonstrated a glucocorticoid response with a greater than 4 fold increase in firefly luciferase activity over controls. Microarray data revealed that 136 genes were modulated with 4 h treatment with Dex. Of the 136 genes, 93 transcripts were upregulated and 43 were downregulated by greater than 1.5 fold. Eighty-six genes were modulated with 16 h Dex treatment. Of the 86 genes, 30 transcripts were upregulated and 56 were downregulated by greater than 1.5 fold. Microarray results were verified by Real Time PCR in both the HLE B-3 and primary cultures of lens epithelial cell. CONCLUSIONS: The activation of a GRE reporter gene in primary cultures of human LECs demonstrates that the glucocorticoid receptor is functional in non-immortalized human lens cells. Microarray studies at 2 time periods demonstrate that glucocorticoids modulate gene expression in immortalized human LECs, reveal novel changes in gene expression, and confirm an endogenous genomic lens glucocorticoid response. This study demonstrates that primary cultures of lens epithelial cells and microarray technology can be used to determine pathways involved in a lens glucocorticoid response and lead to a better understanding of the formation of a steroid induced cataract.

Cells, Cultured↗
PubMedDate not supplied

Sutureless limited vitrectomy for positive vitreous pressure in cataract surgery.

A sutureless transconjunctival pars plana vitrectomy with the 25-gauge transconjunctival vitrectomy system is used to facilitate phacoemulsification in eyes with positive posterior vitreous pressure and shallow anterior chamber. Peribulbar local anesthesia is administered. In eyes with shallow anterior chamber, if an injection of a viscoelastic substance through anterior chamber paracentesis fails to deepen the anterior chamber, a limited pars plana vitrectomy is performed to remove a small amount of retro-lental vitreous (approximately 0.2 to 0.3 cc) with a 25-gauge high-speed cutter. Phacoemulsification is subsequently performed. The limited pars plana vitrectomy reduces the chances of intraoperative vitreous loss and suprachoroidal hemorrhage. It also increases the anterior chamber depth, facilitates intraoperative steps such as pupil stretching and capsulorhexis, and results in a phacoemulsification procedure that is less complex and safer.

Equipment Design↗
PubMed2006

[Biometry of intraocular lenses using Pentacam Scheimpflug images].

PURPOSE: To compare differences in intraocular lens (IOL) decentration, tilt and anterior chamber depth (ACD) using Pentacam-Scheimpflug System images in eyes having phacoemulsification with implantation of 1 of 3 types of IOLs. METHODS: This study comprised 117 cataractous eyes of 109 patients having phacoemulsification and IOL implantation. The eyes were randomized into 3 groups based on IOL type. The degree of IOL decentration, tilt and ACD was measured using Oculus Pentacam System 1 day and 1, 3, 6 and 12 months after surgery. RESULTS: There was no significant change during the 12 months follow-up period in decentration or tilt in each group (P > 0.05). There was no significant difference among the groups in IOL decentration or tilt at any time point (P > 0.05). The ACD did not change after surgery in the Acrysof SA60AT group (P > 0.05) but showed significant shallowing in the Tecnis Z9001 group and the Sensar AR40e group (P < 0.05). There was significant difference among the groups in ACD only at 1 day after surgery (P < 0.05). CONCLUSIONS: The IOL stability in eyes that received a 1-piece Acrysof SA60AT IOL with flexible haptics was better than the results with normal capsular bag IOL implantation and an intact continuous curvilinear capsulorhexis that received a 3-piece IOL with rigid haptics.

Aged↗
PubMedDate not supplied

Flexible iris retractors for management of zonular dialysis during planned phacoemulsification.

BACKGROUND: The aim of this study was to determine the use of flexible iris retractors in four patients with zonular dialysis occurring during cataract surgery. METHODS: We describe the use of flexible iris retractors to stretch and fixate the capsulorhexis over the zonular dehiscence sector for patients with traumatic zonular disruption occurring during phacoemulsification, which stabilizes the capsular bag and facilitates cataract extraction without complications. RESULTS: Each of the four eyes was implanted with posterior chamber intraocular lens (PCIOL) successfully. The intraocular lenses (IOLs) remained well centered during the 12-month follow-up period and the patients enjoyed improved vision without complications. CONCLUSION: Flexible iris retractor is a simple, convenient and useful instrument for managing zonular dehiscence that occurred during cataract extraction. It facilitates the removal of the residual lens material and IOL implantation without major complications.

Aged↗
PubMed1991

Small capsulotomy and great implant lens.

The envelope technique provokes in all cases a rupture of the zonules. With capsulorhexis, the advantages of working inside the envelope are lost, but the zonules are better protected. The capsulokleisis--or similar capsulotomies--combines the advantages of both systems. The Miyake technique indicates that the ideal lens for the capsular bag is a circular lens filling completely the capsular bag like the phacodrop.

Cataract Extraction↗