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At least 685 records · Page 38Linked to original sources

PubMed2001

Intraindividual comparison of the effects of a fixed dorzolamide-timolol combination and latanoprost on intraocular pressure after small incision cataract surgery.

To compare the effect of a fixed dorzolamide-timolol combination with that of latanoprost on intraocular pressure (IOP) after small incision cataract surgery. Department of Ophthalmology, University of Vienna, Vienna, Austria. This prospective randomized study comprised 60 eyes of 30 patients scheduled for small incision cataract surgery in both eyes. The patients were randomly assigned to receive 1 drop of a fixed dorzolamide-timolol combination or latanoprost immediately after cataract surgery in the first eye. The second eye received the other antiglaucomatous agent. Cataract surgery was performed under sodium hyaluronate 1% with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. Six hours after surgery, the mean IOP decreased by -0.8 mm Hg +/- 3.2 (SD) (P =.184) in the dorzolamide-timolol group and increased by 3.6 mm Hg +/- 3.5 (P <.001) in the latanoprost group. Twenty to 24 hours after surgery, the mean IOP decreased by -2.8 +/- 2.4 mm Hg (P <.001) in the dorzolamide-timolol group and increased by 0.6 +/- 3.5 mm Hg (P =.353) in the latanoprost group. The differences between groups were significant at 6 hours (P <.001) and 20 to 24 hours (P <.001). The fixed dorzolamide-timolol combination was more effective than latanoprost in reducing IOP after small incision cataract surgery. Only the fixed dorzolamide-timolol combination prevented a postoperative IOP increase and occasional IOP spikes of 30 mm Hg or higher.

Antihypertensive Agents↗

PubMed2001

Effect of topical brimonidine on intraocular pressure after small incision cataract surgery.

PURPOSE: To evaluate the effect of brimonidine 0.2% on intraocular pressure (IOP) after small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 80 eyes of 40 patients scheduled for small incision cataract surgery in both eyes. In each patient, 1 eye was randomly assigned to receive 1 drop of brimonidine 0.2% or no treatment (control) immediately after surgery. The fellow eye received the other assigned treatment. All patients had standardized surgery by the same surgeon with sodium hyaluronate 1%, a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was 4.7 mm Hg +/- 6.1 (SD) in the brimonidine group and 4.6 +/- 5.3 mm Hg in the control group. In each group, 17 eyes (43%) had an IOP increase of 5 mm Hg or more. Twenty to 24 hours after surgery, the mean increase in IOP was 1.5 +/- 4.2 mm Hg in the brimonidine group and 1.6 +/- 4.4 mm Hg in the control group. There were no statistically significant between-group differences at any measurement. CONCLUSIONS: In both groups, IOP significantly increased 6 hours and 20 to 24 hours after small incision cataract surgery. Brimonidine 0.2% failed to reduce the IOP increase observed after small incision cataract surgery.

Administration, Topical↗

PubMed2002

Implantation and capsular bag stability of single-piece, foldable EasAcryl 1 intraocular lenses.

PURPOSE: To assess the folding and implantation of the single-piece EasAcryl 1 intraocular lens (IOL) and the maintenance of the tunnel structure and capsular bag stability after implantation. SETTING: S. Orsola Hospital Department of Pathophysiologic Optics, University of Bologna, Bologna, Italy. METHODS: This study comprised 300 cases of EasAcryl 1 IOL implantation. First, a 3.2 mm corneal incision was made according to preoperative astigmatism followed by a 5.5 mm +/- 0.3 (SD) capsulorhexis. After sutureless phacoemulsification using a venturi pump, the 6.0 mm optic, 11.0 mm diameter IOL was implanted using a hexagonal cartridge. The IOLs were implanted using a 2-step maneuver when the superior haptic was grasped with the forceps (first case) or a 1-step maneuver when only the Microsert injector was used. The cartridge was never pushed beyond the tunnel. The preoperative and postoperative incision size and the corneal surgically induced astigmatism were recorded. The IOL rotation was measured 30 +/- 5 days and 8 +/- 1 months postoperatively. RESULTS: No intraoperative complications occurred after the learning curve. No alteration in astigmatism was observed. The mean IOL rotation was 1.04 +/- 0.5 degrees at 30 +/- 5 days and 1.02 +/- 0.2 degrees at 8 +/- 1 months. CONCLUSIONS: The EasAcryl 1 was easily implantation through a 3.2 mm tunnel without altering the natural architecture. The unfolding of the IOL was well controlled, and the IOL remained well centered. A short learning curve is required.

Acrylic Resins↗

PubMed2002

Implantable contact lens for high myopia.

PURPOSE: To evaluate the efficacy, safety, and biocompatibility of a collagen polymer implantable contact lens (ICL) (Staar Collamer) as a posterior chamber phakic intraocular lens (IOL) to correct high myopia. SETTING: Departments of Ophthalmology, Helsinki University Central Hospital, Helsinki, and Tampere University Hospital, Tampere, Finland. METHODS: A Staar Collamer posterior chamber phakic IOL was implanted in 38 eyes of 22 patients with a mean age of 39 years (range 24 to 54 years). The mean preoperative myopia was -15.10 diopters (D) (range -7.75 to -29.00 D). Surgical implantation was performed through a 3.0 mm clear corneal sutureless incision using paraocular anesthesia. The patients were followed clinically up to 3 years. The mean follow-up was 13.6 months (range 6 to 24 months) for refractive data and 22.3 months (range 6 to 35 months) for complications. The possible inflammatory response to the ICL was measured using a laser flare meter in 12 eyes. RESULTS: Postoperatively, all eyes had a significant increase in uncorrected visual acuity, allowing all but 3 patients (5 eyes) to manage most activities without spectacles. The mean spherical equivalent refraction at the last examination was -2.00 D +/- 2.48 (SD) (range +0.13 to -13.00 D), within +/-1.00 D of the targeted refraction in 31 eyes (81.6%) and within +/-0.50 D in 27 eyes (71.1%). In eyes in which the preoperative myopia was less than -18.00 D (n = 28), the achieved refraction was within +/-1.00 D of the intended refraction in 27 eyes (96.4%) and within +/-0.50 D in 24 eyes (85.7%). The refraction remained stable with a statistically insignificant change (P >.05) at each interval during the follow-up. The best corrected visual acuity (BCVA) improved by 1 or more lines in 23 of 32 eyes (71.9%) at 1 year. Two eyes (6.3%) lost 1 line of BCVA. Laser flare photometry showed normal aqueous flare values (11.71 +/- 6.61 photon counts/ms) in the 12 eyes measured at least 6 months after ICL implantation. Pupillary block glaucoma requiring surgical intervention occurred in 3 patients (7.9%). One patient (2.6%) developed cataract 1.5 years after ICL implantation; both ICLs were removed, and the refractive errors were corrected by lensectomy and implantation of low-power posterior chamber IOLs. One patient (2.6%) showed progression of dry macular degeneration at 17 months. CONCLUSION: At 1 year, ICL implantation had good visual and refractive results with excellent biocompatibility. Long-term follow-up is required to confirm that significant complications do not occur in most patients over time.

Adult↗

PubMed2002

Phacoemulsification with a blow-out fracture in the early postoperative period.

An 81-year-old woman had uneventful phacoemulsification through a self-sealing clear corneal wound. The postoperative course was complicated by a fall 10 days after surgery during which she hit her face on the carpet with sufficient force to cause an orbital floor blow-out fracture. Despite the blow, the corneal wound remained intact. As well as the advantage of rapid visual rehabilitation, sutureless corneal wounds provide a secure incision that has the ability to avoid leakage and iris prolapse despite great forces that may be applied to them.

Accidental Falls↗

PubMed2002

Preventing intraocular pressure increase after phacoemulsification and the role of perioperative apraclonidine.

PURPOSE: To evaluate the effectiveness of prophylactic topical apraclonidine 1% in preventing an intraocular pressure (IOP) rise in the early period after uneventful phacoemulsification with intraocular lens (IOL) implantation. SETTING: District general hospital, United Kingdom. METHODS: In this prospective masked randomized trial, 61 patients had elective, routine, corneal tunnel, sutureless phacoemulsification with in-the-bag foldable IOL implantation. A single surgeon operated on all the patients. Patients were randomized to receive topical apraclonidine 1% eyedrops (n = 31) or artificial tears (control group, n = 30) 1 hour preoperatively and at the end of the surgery. An observer masked to the perioperative drops used measured the IOP preoperatively and 3 to 6 hours and 16 to 24 hours postoperatively. The primary outcome was the change in IOP between the baseline and the 2 postoperative intervals. The IOP changes within and between the groups were analyzed using the t test and chi-square test. RESULTS: The changes between the postoperative and preoperative IOPs in the study groups were statistically significant (apraclonidine, P = 0.018 and P = 0.007, respectively; artificial tears, P = 0.028 and P = 0.023, respectively; paired t test). There was no significant difference in the postoperative IOP between the apraclonidine and control groups 3 to 6 hours and 16 to 24 hours postoperatively (P = 0.717 and P = 0.497, respectively; independent t test). The mean difference was 0.2 mm Hg (95% confidence interval [CI], -3.4 to 3.1) in the apraclonidine group and 2.2 mm Hg (95% CI, -2.5 to 7.0) in the control group. In each group, a few patients had an IOP greater than 30 mm Hg in the first 24 hours. CONCLUSION: Prophylactic topical perioperative apraclonidine 1% did not cause a significant reduction in the postoperative IOP when compared with a control group.

Administration, Topical↗

PubMed2002

Analyzing small-incision cataract surgery by Orbscan II fourth-dimensional pachymetry mapping.

PURPOSE: To assess the changes in pachymetry after routine corneal and scleral tunnel phacoemulsification. SETTING: Discipline of Ophthalmology, University of Auckland, Auckland, New Zealand. METHOD: This prospective study comprised 174 eyes of 174 consecutive patients having uneventful, small-incision, sutureless, phacoemulsification cataract surgery; 124 patients had a clear corneal incision and 50, a superior scleral tunnel incision. Difference pachymetry maps were derived from Orbscan II elevation topography data obtained before and 4 weeks after surgery. Corneal thickness changes at 12 midperipheral areas located in 12 meridians were derived from difference (subtraction) maps. The mean corneal thickness within a single area corresponding to the center of the surgical incision was compared to the mean pachymetry readings of all 12 midperipheral measurements. RESULTS: The overall mean midperipheral corneal thickness (12 samples per cornea) increased by a mean of 5.89 microm +/- 16.09 (SD) in the clear corneal incision group and 6.89 +/- 14.50 microm in the scleral tunnel group. The mean central corneal thickness increased by 7.28 +/- 20.98 microm and 7.74 +/- 21.34 microm, respectively. The corneal thickness in the meridian closest to the incision was significantly higher than the mean value of the 12 meridians measured in both groups, with means of 14.95 +/- 26.86 microm in the clear corneal group (P =.001) and 16.22 +/- 21.23 microm in the scleral tunnel group (P =.002). There were no statistically significant postoperative differences in the central, midperipheral, or incision-site corneal thickness measurements between the 2 surgical techniques (P =.77). CONCLUSIONS: Time-dependent (fourth-dimensional) pachymetry subtraction maps are useful for following corneal dynamics over time. This study found that small-incision phacoemulsification techniques--scleral and corneal tunnel--had a minor but similar effect on corneal thickness 4 weeks after surgery.

Adult↗

PubMed2003

Use of indocyanine green in deep lamellar endothelial keratoplasty.

A new technique using indocyanine green (ICG) during deep lamellar endothelial keratoplasty (DLEK) to stain the corneal stroma of the donor disk facilitated surgical placement of the disk in the host corneal opening created to match the donor disk. Two female patients, aged 82 and 77 years, had ICG staining of the donor corneal disk during DLEK for pseudophakic bullous keratopathy and Fuchs' corneal dystrophy. By 24 hours postoperatively, no ICG was detected clinically by biomicroscopy of the sutureless (no corneal sutures) lamellar transplanted corneas. This is the first report of the use of ICG during DLEK and the first intrastromal use of ICG in the human cornea. The use of ICG facilitated the DLEK procedure and appears to be safe for intraoperative use in the cornea.

Aged↗

PubMed2003

Combined phacoemulsification, pars plana vitrectomy, and foldable intraocular lens implantation.

We describe a technique for combined cataract and vitreoretinal surgery using sutureless sclerocorneal and sclerotomy incisions and a foldable intraocular lens. This technique, with its variations for cases with and without gas-fluid exchange, was successfully performed in 40 consecutive cases over a 5-month period. No significant complications related to the surgical procedures were encountered. The rationale and advantages of this technique are discussed.

Aged↗

PubMed2003

Postoperative astigmatism and rotational stability after artisan toric phakic intraocular lens implantation.

PURPOSE: To evaluate deviations in the axis (intended versus achieved) and postoperative astigmatism after implantation of an Artisan toric phakic intraocular lens (IOL). SETTING: University Eye Hospital, Mainz, Germany. METHODS: This prospective study comprised 29 eyes with high ametropia and astigmatism. All eyes had uneventful implantation of a toric phakic IOL through a superior scleral tunnel incision at 12 o'clock. After a minimum of 6 months, the uncorrected visual acuity (UCVA), best correct visual acuity, refraction, and astigmatism were analyzed in all eyes. A multivariate analysis of postoperative astigmatism was performed. RESULTS: After a follow-up of at least 6 months, 95% of eyes were within +/-1.00 diopter (D) of emmetropia and 85% of eyes has a UCVA of 20/30 or better. The difference between the mean intended cylinder axis and achieved cylinder axis was 3.9 degrees (median 3 degrees; range to 13 degrees). The difference between the mean intended axis and the achieved axis between miosis and mydriasis was 1.8 degrees (median 1.5 degrees; range 0 to 5 degrees). The mean postoperative astigmatism after 6 months was 0.56 D with an axis of 31 degrees. Doubled-angle scatterplot analysis showed a tendency toward more flattening in the vertical meridian. CONCLUSIONS: During the 6-month follow-up, no significant rotation was observed after implantation of Artisan toric phakic IOLs to correct high ametropia. A sutureless sclerocorneal superior approach for phakic IOL insertion resulted in moderate to low astigmatism. Induced astigmatism should be taken into consideration during preoperative planning.

Adult↗

PubMed2003

Effect of central corneal thickness on surgically induced astigmatism in cataract surgery.

PURPOSE: To evaluate the effect of central corneal thickness (CCT) on surgically induced astigmatism (SIA) in cataract surgery using temporal clear corneal incisions. SETTING: Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. METHODS: The retrospective nonrandomized clinical study comprised 129 eyes that had cataract surgery performed through a sutureless temporal clear corneal incision. Eyes were categorized according to the axis of the preoperative astigmatism: against the rule (ATR, 0 to 45 degrees; n = 64) or with the rule (WTR, 46 to 90 degrees; n =65). Corneal topography was taken preoperatively and 1 day and 2 months postoperatively to evaluate the change in the cornea. The SIA was calculated using the polar method from simulated keratometric readings obtained with topography. Correlations between SIA and CCT were analyzed by linear regression analysis and compared between the ATR and the WTR groups. RESULTS: One day postoperatively, the SIA was negatively correlated with CCT in the ATR group but not in the WTR group (P =.050 versus P =.92; linear regression analysis). At 2 months, the correlation between CCT and SIA was no longer statistically significant. CONCLUSIONS: Central corneal thickness was negatively correlated with the amount of SIA immediately postoperatively when the preoperative astigmatism was ATR. The correlation was not present 2 months after surgery. These results may be applied to abnormally thin corneas such as those after keratorefractive surgery.

Aged↗

PubMed1994

Corneoscleral abscess resulting from a broken suture after cataract surgery.

An 82-year-old man had pain and decreased vision in his right eye 15 months after uncomplicated cataract surgery. Examination revealed a large corneoscleral abscess with a 2 mm x 1 mm area of fluorescein staining at the base of a broken protruding 10-0 nylon suture. Streptococcus pneumoniae was isolated from both the suture and base of the ulcer. Despite intensive topical, subconjunctival, and systemic antibiotics, a large corneal perforation developed, necessitating a 10 mm tectonic penetrating keratoplasty. Long-term follow-up of patients after cataract surgery is important and should include an inspection of the limbal wound and removal of loose or broken exposed sutures. Suture-related complications will be eliminated if clinical studies prove the safety and efficacy of sutureless cataract surgery.

Abscess↗

PubMed1995

Evaluation of tissue adhesives in closure of scleral tunnel incisions.

Using a biomechanical wound strength model, we compared the efficacy of cyanoacrylate and fibrin glues used to close scleral tunnel incisions. Scleral tunnel incisions were made in four groups of rabbits: (1) traditional self-sealing incision, (2) modified non-self-sealing incision, (3) method 2, closed with cyanoacrylate glue, or (4) method 2, closed with fibrin glue. Overall, Groups 1 and 4 showed the least clinical reaction, the slightest decrease in intraocular pressure (which recovered to baseline by day 7), and the most significant recovery of postoperative astigmatism. Initially, the bursting pressure in Groups 1 and 3 was statistically the highest (P < .005). By day 3, wound strengths in Groups 1 and 4 were comparable. Bursting pressure decreased in Groups 2 and 3 by day 7. Our results indicate that clinical responses, intraocular pressure, induced astigmatism, and ultimately wound strength were comparable in fibrin-glue-closed scleral pocket and sutureless self-sealing cataract incisions. Although cyanoacrylate glue cures immediately and initially demonstrates a strong adhesive quality, it causes a severe inflammatory response that inhibits subsequent collagen remodeling. Fibrin tissue adhesives may have an application as adjunctive means of closing scleral tunnel incisions.

Analysis of Variance↗

PubMed1995

Delayed iris prolapse with unsutured 5.1 mm clear corneal incisions.

I describe two cases of iris prolapse after sutureless 5.1 mm clear corneal incision cataract surgery with implantation of a 5 mm poly(methyl methacrylate) lens. Both patients reported having exerted localized digital pressure on the globe peripheral to the temporally located incision. Following resection of the prolapse, the pupil was reconstructed in situ using a translimbal transfixation technique. The prolapse and other observed complications (e.g., transient pupillary capture, delayed endophthalmitis) indicate that 5.1 mm clear corneal incisions do not provide adequate stability if localized pressure is exerted peripheral to the wound. Thus, securing the incisions with a radial 10-0 nylon suture is strongly advocated to provide sufficient wound stability against deformation.

Aged↗

PubMed1994

Relative strength of scleral corneal and clear corneal incisions constructed in cadaver eyes.

Square scleral corneal, square clear corneal, and rectangular clear corneal incisions were constructed in six cadaver eyes that had no previous intraocular surgery. The 3.2 mm or smaller wounds had sutureless closures. To determine their relative abilities to resist leakage and iris prolapse, eyes were tested at external pressures of up to 525 pounds per square inch (psi) at one of two intraocular pressure (IOP) ranges: 10 to 15 mm Hg or 20 to 25 mm Hg. The square scleral corneal (3.2 mm x 3.2 mm) and square clear corneal wounds (3.2 mm x 3.2 mm, 2.0 mm x 2.0 mm, 1.0 mm x 1.0 mm) withstood external pressure without effect at both IOP ranges, up to the maximum 525 psi. This level of external pressure was far greater than pressures withstood by rectangular clear corneal wounds, especially the wound usually constructed in clinical practice (3.2 mm x 2.0 mm), which leaked and demonstrated iris prolapse at 13 psi at the lower IOP. The square clear corneal wounds that were stable at 525 psi, however, are either clinically impractical (visual axis encroachment from 3.2 mm x 3.2 mm wound) or not technologically feasible until the size of phacoemulsification tips and intraocular lenses can be further reduced. Thus, of the procedures for small incision cataract surgery presently in use, the square scleral corneal incision with 1.5 mm internal corneal lip appears to offer greater stability and safety than the conventional rectangular clear corneal incision (3.2 mm x 2.0 mm).

Cadaver↗

PubMed1991

Rupturing pressure in cadaver eyes with three types of cataract incisions.

A study was designed to determine the rupturing pressures of two types of sutureless surgery--a 5.2 mm incision and a 4.0 mm incision with a Prodigy inserter--and to compare them with the rupturing pressure of a standard limbal incision with 10-0 nylon suture closure. The 5.2 mm self-sealing incision ruptured at a pressure four times greater than the sutured limbal incision. The 4.0 mm self-sealing incision with a Prodigy inserter ruptured at a pressure similar to that of the sutured limbal incision. Suturing the self-sealing incisions did not significantly change the rupturing pressure.

Cataract Extraction↗

PubMed1996

Evaluating surgically induced astigmatism by Fourier analysis of corneal topography data.

PURPOSE: To evaluate surgically induced astigmatism using Fourier harmonic series analysis of corneal topography data. SETTING: Aarhus Kommunehospital, Aarhus University, Denmark. METHODS: We evaluated the results of 46 phacoemulsifications with a 4 or 6 mm scleral tunnel sutureless incision based on the axis of the steepest meridian. We performed conventional keratometry and corneal topography before and up to 1 month after surgery. Using Fourier analysis, the corneal topographic images were broken into spherical power, regular astigmatism, and nonregular astigmatism for individual or aggregate analysis of surgically induced astigmatism. The induced refractive change (average of the difference between preoperative and postoperative corneal topographies) was analyzed and normalized according to the surgical meridian and to right/left eye. RESULTS: Regular astigmatism calculated by Fourier analysis of mires from the keratometer zone correlated well with conventional keratometry readings. Surgery induced a localized flattening in the superior region and a with-the-rule regular astigmatism component in the central area. CONCLUSION: Surgically induced corneal topography changes can be analyzed by Fourier series harmonic analysis, allowing aggregate data to be broken into optically meaningful quantities.

Adult↗

PubMedDate not supplied

Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision.

PURPOSE: To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters. METHODS: Fifty-eight patients had phacoemulsification through temporal, two-step clear corneal tunnel incisions. In Group A (n = 28), a one-piece, plate-haptic foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color-coded, computer-assisted specular microscopy was used for special cell analysis after 1 year. RESULTS: Collective data showed an ECL of 7.9 +/- 4.1% (mean +/- standard deviation) at 2 to 5 days postoperatively, 6.7 +/- 2.9% after 6 months, and 7.3 +/- 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST < or = 11/2 minutes, 6.7% with UST > 11/2 to 21/2 min, and 9.6% with UST > 21/2 to 31/2 min; in Group B it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age-related cell parameters 1 year postoperatively. CONCLUSIONS: Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.

Aged↗