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We describe a modified closed-chamber capsulorhexis technique that facilitates cataract extraction and intraocular lens insertion combined with penetrating keratoplasty. This technique eliminates most of the risks associated with can-opener capsulotomies, offers the benefits of capsulorhexis, and enhances the safety of the triple procedure.
This paper discusses the clinical application of a simplified irrigation-aspiration system for extracapsular cataract extraction. This simplified apparatus represents a reasonably-priced alternative to the existing expensive and complicated systems. When the surgeon has gained sufficient practice in the use of this method it is a useful complement to the expensive electronic systems.
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PURPOSE: A clinical double-blind study was performed in patients who had undergone extracapsular cataract extraction and intraocular lens implantation (ECCE+IOL) to compare the anti-inflammatory effects of diclofenac sodium 0.1% and flurbiprofen 0.03% eye drops. METHODS: The diclofenac group included 21 eyes of 21 patients and the flurbiprofen group included 22 eyes of 22 patients. The parameters compared were pachymetry of the cornea, corneal surface changes, intraocular pressure (IOP) and the degree of inflammation of the anterior chamber at one, three and six weeks after cataract surgery. RESULTS: There was no statistically significant difference between the two treatment groups in corneal pachymetry, corneal surface changes, IOP and the anterior chamber inflammation (p>0.05). CONCLUSION: Both drugs were well tolerated and may be safely used to reduce inflammation for cataract surgery.
A new cannula for use during vitreotomy is proposed with the object of improving extracapsular cataract extraction techniques. The cannula offers the advantages of allowing infusion through the aspiration opening to produce an immediate deep anterior chamber, of easy cleaning of the opening without the need for removal from the anterior chamber, and of the possibility of removing small remnants of the anterior lens capsule.
The authors describe the technique of extracapsular cataract extraction and posterior chamber lens implantation in conjunction with pars plana vitrectomy. In persons with the sequelae of proliferative diabetic retinopathy and retinal branch vein obstruction, as well as those with rhegmatogenous retinal detachment, the procedure enables visual rehabilitation with one operation and seemingly no increase in morbidity.
A total of 240 extracapsular cataract extractions were performed on 214 dogs at the University of Illinois between 1968 and 1980. Overall success of the surgery, defined as restoration of functional vision for at least 6 weeks after surgery, was 79%. The success rates, on the basis of various parameters, were compared with the following results. The greater the number of years experience each surgeon had, the greater the surgical success rate. In dogs in which a second eye was operated on, the overall success rate on the second eye was approximately 20% less than that for the study as a whole. There was a significant difference in success rates between surgery on congenital and juvenile cataracts when compared with surgery on diabetic and senile cataracts, the first being 15% higher than the second. The success rate was 18% less for lensectomy with concurrent iridectomy than for lensectomy without iridectomy. There was no significant difference in success rates among the 3 procedures for extracapsular extraction used in this study, nor among the various breeds studied. There was no significant difference in the success rate of surgeries on the left eye, compared with surgeries on the right eye.
A report is given on a method for cataract extraction after fistulizing operation. The incision is made in a straight line on the cornea underneath the fistula, so that the two ends of the incision are in the limbal region. This corneo-limbla incision does not injure the fistula. The closure is performed under the microscope with a continuous suture. The results obtained support the security of this method.
We studied 15 patients with Fuchs' heterochromic iridocyclitis who underwent extracapsular cataract extraction. Ten patients also had capsular-fixated posterior chamber intraocular lens implantation. The patients were followed up for a mean of 23 months (range, six to 48 months). The clinical course and visual outcome were favorable. All patients had a postoperative best-corrected visual acuity of 20/40 or better. There were no major surgical, intraoperative, or postoperative complications.
One hundred fifty elderly female patients undergoing cataract extraction were divided into three groups. Fifty patients were premedicated with droperidol, pethidine and atropine; another group of 50 patients with pethidine and atropine. They were operated on under local anesthesia. The control group consisted of 50 patients premedicated with pethidine and atropine, and they were given general anesthesia. Postoperative nausea and vomiting were registered until noon the next day. Comparison of different groups showed that droperidol decreases the occurrence of postoperative sickness.
Management of zonular dialysis and posterior capsule rupture during extracapsular cataract extraction is described. The Heslin gravity cannula is advocated to maintain the normal structure of the anterior segment in a closed chamber technique. Lens cortical material is stripped away using the manual technique described by Gills and McIntyre to avoid vitreous loss. It is then possible to proceed with posterior chamber lens implantation. If vitreous loss occurs, an adequate anterior vitrectomy with an automated vitreous cutter is recommended. A posterior chamber lens implant is preferred if there is adequate capsule to support the lens.
PURPOSE: To evaluate the course of age-related maculopathy after cataract surgery. METHODS: Included were 47 patients with bilateral, symmetric, early age-related macular degeneration (AMD), documented by fluorescein angiography, who underwent extracapsular cataract extraction with intraocular lens implantation in one eye. The fellow eye served as the control. The patients were retrospectively reviewed or prospectively followed. RESULTS: Wet AMD developed in nine eyes (19.1%) that were treated with surgery compared with two fellow eyes (4.3%). It was detected within 3 months of surgery in four (44.4%) of the nine affected eyes and within 6 to 12 months of surgery in four other eyes (44.4%). Progression to wet AMD occurred significantly more often in men than in women (P < 0.05). Soft drusen were found as a significant ocular risk factor (P < 0.05). The final visual outcome was poor in all eyes with such progression. CONCLUSIONS: In this study, progression of AMD occurred more often in the surgical eyes compared with the fellow eyes. However, the reasons for the progression of AMD after cataract surgery are still uncertain. Further prospective studies are needed to investigate this observation.
OBJECTIVE: A case is described of a patient with X-linked megalocornea (XLM) who underwent bilateral consecutive phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. METHODS: A 49-year-old man referred to us for cataract extraction was found to have XLM with mosaic corneal dystrophy. Pseudoexfoliation of the lens capsule was present in the right eye. Phacoemulsification was planned, and the Holladay II formula was used to calculate the IOL power. RESULTS: During phacoemulsification, anomalies of the capsule and zonule were observed bilaterally. At the last examination (follow-up 28 months OS, 13 months OD), best spectacle-corrected vision was 20/20 in both eyes, but the IOL was slightly decentered in the right eye. CONCLUSIONS: Corneal enlargement and mosaic dystrophy are obvious features of XLM. Anomalies involving the anterior structures of the eye and in particular the lens capsule and zonule are also frequent. Cataract extraction with phacoemulsification and PC IOL implantation can be successful, but special attention must be paid to both surgical technique and IOL selection.
The successful use of continuous curvilinear (circular) capsulorhexis (CCC) in planned extracapsular cataract extraction (ECCE) is dependent on the feasibility of safe nuclear delivery through the smaller anterior capsular opening. Experimental evidence supports the proposition that the anterior capsular rim can stretch without tearing to dimensions which allow for safe nucleus delivery. Clinical reports of accidental intracapsular expression during nucleus delivery in CCC seemingly contradict the experimental evidence. This paper examines this apparent contradiction and presents clinical evidence in the form of a series of 210 cases of planned ECCE with CCC. The technique used and a detailed analysis of the operative complications are presented. The results indicate that using a modified technique for nucleus delivery, CCC and planned ECCE are fully compatible techniques.
PURPOSE: To evaluate the effectiveness of subconjunctival anesthesia in conventional extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation. SETTING: Eye Hospital, Colombo, Sri Lanka. METHODS: This prospective study evaluated the complications related to the use of subconjunctival anesthesia in conventional ECCE with IOL implantation. Patient-reported pain during surgery in the first 100 consecutive cases was also evaluated. RESULTS: Complications from the subconjunctival anesthesia technique were few. Patients did not report intraoperative pain severe enough to cause the procedure to be abandoned or the anesthesia reinforced; surgery was successfully performed in all cases. CONCLUSIONS: Circumcorneal perilimbal anesthesia was effective for ECCE with IOL implantation. It is important that the surgeon is experienced in the technique and that patients are carefully selected.
The prevalence of capsular opacification was studied in a group of patients who had extracapsular cataract extraction from 1978 to 1980 by one surgeon. In 94 eyes the follow-up was longer than four years. Capsular opacification developed in 41% of these eyes. In 72% of the eyes with opacification the diagnosis was made more than two years after surgery. In the patients who were operated on during 1980, capsular opacification appeared later and less frequently than in those operated on during 1978. Although the difference was not statistically significant, it probably reflects improved technique and more meticulous cleaning of residual cortex. Patients younger than 40 years had a higher prevalence of capsular opacification (70%) than those older than 40 years (37%). Pseudophakic and aphakic patients had a similar prevalence--47.6% and 39.7%, respectively.
PURPOSE: To evaluate early and late astigmatism appearing after extracapsular cataract extraction with PC IOL implantation. MATERIAL AND METHODS: Astigmatism was examined in one hundred consecutive patients before operation and one week, 6 months and 12 months postoperatively. RESULTS: During the first week after surgery most patients (82%) had with the rule astigmatism, which decreased gradually from 3.95 D cyl (mean value) to 0.08 D cyl after a year. Against the rule astigmatism was present in 14% of cases and increased from 2.40 D cyl (mean value) to 3.07 D cyl in the same period of time. On the last examination 35% of patients didn't use any astigmatic correction. CONCLUSIONS: Traditional ECCE with PC IOLs causes postoperative astigmatism in most patients. Majority of them has with the rule astigmatism, which decreases gradually during the first postoperative year and may change into against the rule astigmatism.
In an experimental study using albino Rex rabbits, the intercapsular cataract extraction (ICCE) technique was performed in 20 eyes with a small anterior capsulotomy. A large, can opener capsulotomy was performed in another 20 eyes, and 10 unoperated eyes served as controls. Endothelial cell loss was determined by vital staining with Trypan blue and Alizarin red S stains. Average endothelial cell loss with the ICCE technique was 1.2%; with the can opener technique, the average cell loss was 6.6%. This difference was statistically significant (P less than 0.01). The percentage of endothelial cell loss in the control eyes was 0.5. A positive correlation between endothelial cell loss related to phacoemulsification time and/or the amount of irrigating fluid used existed for the can opener group only (P less than 0.01). These results demonstrate that the presence of an almost intact anterior lens capsule during removal of lens substance is protective to the corneal endothelium.