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At least 793 records · Page 44Linked to original sources
PubMed2005

Intraocular lens implantation after atopic cataract surgery decreases incidence of postoperative retinal detachment.

PURPOSE: To investigate the efficacy of intraocular lens (IOL) implantation in reducing the incidence of postoperative retinal detachment after cataract surgery in patients with atopic dermatitis. DESIGN: Retrospective review. PARTICIPANTS: One hundred sixty-nine eyes of 126 patients who underwent cataract surgery for atopic cataract were followed for more than 1 year. None of the eyes previously had a retinal detachment or retinal detachment surgery. METHODS: The eyes were divided into 132 eyes of 95 patients with an IOL implantation (IOL group) and 37 eyes of 31 patients without an IOL implantation (aphakia group). The postoperative visual acuity and incidence of postoperative retinal detachment were compared between the 2 groups. The effects of the location of the causative retinal breaks, intraoperative posterior capsule rupture, and postoperative posterior capsulotomy on the incidence of retinal detachments were evaluated. MAIN OUTCOME MEASURES: The postoperative corrected visual acuity, incidence of postoperative retinal detachment, and influence of intraoperative posterior capsule rupture on the retinal detachment. RESULTS: The final visual acuity was better than or equal to 20/20 in 128 eyes (97.0%) of the IOL group and in 29 eyes (78.4%) of the aphakia group (P = 0.0007). Retinal detachment after an uncomplicated cataract surgery occurred in 3 eyes (2.3%) of the IOL group and in 8 eyes (25.8%) of the aphakia group (P<0.0001, Mantel-Cox). Two of 3 eyes (66.7%) in the IOL group and 1 of 8 eyes (16.7%) in the aphakia group that later developed a retinal detachment had an intraoperative posterior capsule rupture. Posterior capsulotomy by yttrium-aluminum-garnet laser did not seem to alter the incidence of postoperative retinal detachment in either the IOL (2.0%) or the aphakia group (25.0%). CONCLUSIONS: The rate of postoperative retinal detachment in eyes with IOL and no intraoperative posterior capsule rupture seems to be low. Intraocular lens implantation with capsular bag fixation may reduce the incidence of postoperative retinal detachment triggered by lens surgery for atopic cataract.

Adolescent↗
PubMed2006

Five-year experience of the 2-incision push-pull technique for anterior and posterior capsulorrhexis in pediatric cataract surgery.

PURPOSE: To describe the authors' 5-year experience of the 2-incision push-pull (TIPP) technique for pediatric anterior and posterior capsulorrhexis formation. DESIGN: Retrospective descriptive study over a 5-year period. PARTICIPANTS: A total of 84 eyes of 63 patients who had undergone cataract surgery in 1 center. METHODS: Retrospective review of all consecutive patients who underwent pediatric cataract extraction with planned intraocular lens implantation and TIPP rhexis between January, 1999, and August, 2004. Any lost capsulorrhexis, or capsular tears at any stage of the operation, and the relation of optic size to anterior capsulorrhexis size were noted. MAIN OUTCOME MEASURES: Complications during TIPP rhexis formation and any late complications at last visit. RESULTS: The mean age at operation was 70.21 months (range, 4 weeks-18 years). All eyes had anterior TIPP rhexis; 41 eyes also had posterior TIPP rhexis, and there were no anterior or posterior capsulorrhexis loss or tears while performing the technique. In no patient in whom TIPP rhexis was performed for the posterior capsule was there an inadvertent vitreous loss during rhexis formation. All eyes had anterior rhexis diameters that were smaller than the optic diameter (5.5-6.0 mm), approximately 4 to 4.5 mm in diameter. Four capsular tears were reported; 1 tear occurred during irrigation and aspiration and the others during rigid lens insertion. No late complications were noted. CONCLUSIONS: Our 5-year experience with the TIPP rhexis in pediatric cataract surgery has shown this to be a reliable method for producing a consistent-size capsulorrhexis opening in both anterior and posterior capsulorrhexis.

Adolescent↗
PubMed2001

Influence of cataract surgery on automated perimetry in patients with glaucoma.

PURPOSE: To investigate the influence of cataract surgery on automated perimetry in patients with glaucoma. DESIGN: Interventional case series. METHODS: A total of 105 eyes of 105 consecutive patients with glaucoma who were scheduled for cataract surgery underwent Humphrey static threshold testing (30-2 program) before and at 1 month after surgery. These eyes were divided into two groups based on the presence of absolute or near absolute (dense) scotomata before surgery (minimum threshold value 5 decibels or less). Changes in numbers of the dense scotomata, mean deviation, pattern standard deviation, and corrected pattern standard deviation were analyzed. RESULTS: No significant changes were found in the numbers of dense scotomata and central dense scotomata within five-degree visual fields between before and after surgery. In the group with dense scotomata, the mean pattern standard deviation and corrected pattern standard deviation worsened significantly after surgery, whereas the mean deviation improved significantly. However, in the group without dense scotomata, the pattern standard deviation and corrected pattern standard deviation showed a slight improvement, whereas the mean deviation improved significantly. When the central scotoma was present in two or fewer meridians before surgery, the mean visual acuity after surgery reached 20/25 and was better than that in patients with three or four central scotomata (P =.0014). CONCLUSIONS: Cataract does not produce a dense scotoma on automated perimetry. However, because it does produce relative scotomata, actual glaucomatous visual field defects may be hidden to some extent. When a central dense scotoma is present before surgery in two or fewer meridians, the patient may well achieve substantial improvement in postoperative visual acuity.

Adult↗
PubMed2003

Surgical management of cataracts in children with juvenile rheumatoid arthritis-associated uveitis.

PURPOSE: To evaluate outcomes of cataract surgery with posterior chamber intraocular lens (IOL) implantation with or without trabeculectomy in children with juvenile rheumatoid arthritis (JRA)-associated uveitis. DESIGN: Interventional case series. METHOD: Retrospective chart review of five patients aged 12 years or younger with JRA-associated uveitis who underwent cataract surgery with posterior chamber IOL with or without trabeculectomy at the Cleveland Clinic Foundation from December 1995 to October 2001. RESULTS: Four female patients and one male patient ranging from age 7 to 12 years were identified. One patient had bilateral involvement; six eyes were included in the study. Three eyes underwent cataract extraction with posterior chamber IOL, and three underwent combined cataract surgery with posterior chamber IOL and trabeculectomy. Median age at surgery was 8.5 years, with a median follow-up of 43.5 months. Four of five children (five eyes) were on systemic methotrexate immunosuppressive therapy for a median length of 1.25 years before surgery. Two of five patients (three eyes) were also on additional systemic immunosuppressive or anti-inflammatory treatments. All eyes received frequent topical corticosteroid therapy for a median of 2 weeks preoperatively and 8.5 weeks postoperatively. A final postoperative Snellen visual acuity of 20/40 or better was achieved in all children. A median final visual acuity improvement of 7 Snellen lines was observed after cataract surgery. CONCLUSIONS: With adequate long-term preoperative and postoperative control of intraocular inflammation with systemic immunosuppressive therapy in addition to intensive topical corticosteroid treatment, children with JRA-associated uveitis can demonstrate favorable surgical outcomes after cataract surgery with posterior chamber IOL.

Administration, Topical↗
PubMedDate not supplied

The effect of polymethylmethacrylate and acrysof intraocular lenses on the posterior capsule in patients with a large capsulorrhexis.

PURPOSE: We have previously shown that patients who have a capsulorrhexis larger than the diameter of a polymethylmethacrylate (PMMA) intraocular lens (IOL) rapidly develop increased posterior capsule opacification (PCO), in effect, producing an example of enhanced PCO. This study focuses on the influence of AcrySof IOLs on this process. METHODS: Phacoemulsification was performed on two groups of patients. The first consisted of 38 patients with a large capsulorrhexis of 6-7 mm who received a 5.5-mm PMMA IOL. The second group of 32 patients had identical surgery and a 5.5-mm MA30 AcrySof IOL was implanted. On days 1,14, 28, 90, 180, and 360, high resolution digitized retroillumination images were taken of the posterior capsule. The PCO area was measured by image analysis at 90, 180, and 360 days. Wrinkling of the posterior capsule was determined at 90 days, and the progression or regression of lens epithelial cell (LEC) proliferation was established by examination of serial images at 28 and 180 days. RESULTS: At 90 days, 79% of the patients with PMMA IOLs had moderate to severe wrinkling of the posterior capsule, whereas the patients with AcrySof IOLs had none (P <.001). The percentage of PCO area was 69% for the PMMA IOLs and 24% for the AcrySof IOL group at 360 days (P <.0001). In the PMMA group, LEC progression occurred in 77%, LEC growth was stable in 15%, and LEC regression occurred in only 8%, compared to 69% of patients with AcrySof IOLs (P <.0001). CONCLUSIONS: In patients with a rhexis larger than the IOL, AcrySof IOLs potentially can prevent capsular wrinkling and cause less PCO than a PMMA IOL with a similar rhexis size. The LEC regression occurs with AcrySof between 28 and 180 days. The reasons for this are discussed.

Acrylic Resins↗
PubMedDate not supplied

Double-ring and double-layer sign of the anterior lens capsule during cataract surgery.

BACKGROUND: Splitting of the lens capsule with a double-ring contour during continuous curvilinear capsulorrhexis has not often been reported. CASE: An 86-year-old woman underwent phacoemulsification cataract extraction with intraocular lens implantation in the right eye. Preoperatively, the anterior lens capsule appeared normal. OBSERVATIONS: A double-ring sign was observed during capsulorrhexis. During intraocular lens implantation, the capsule developed radial tears, and a double layer of the capsule was noted. The patient's postoperative course was uneventful. CONCLUSIONS: The findings in our patient may be uncommon and may differ from but resemble true exfoliation.

Aged↗
PubMedDate not supplied

Postoperative changes over time in size of anterior capsulorrhexis in phacoemulsification/aspiration.

In the present study, we attempted to determine the extent to which an anterior capsulorrhexis carried out during cataract surgery contracts postoperatively. The size of the continuous curvilinear capsulorrhexis (CCC) was measured at the end of surgery and at the final follow-up examination in 52 eyes of 40 patients who underwent phacoemulsification/aspiration and implantation of an intraocular lens (IOL) with 6-mm optics. Images obtained by video during surgery and by slit-lamp microscopy were used to determine the CCC size with reference to the optics of the IOL. The average CCC size was 5.0 mm at the end of surgery; it contracted to 4.4 mm by the final postoperative examination. The contraction of the anterior capsule progressed rapidly in the first 50 days following surgery and then gradually thereafter. The extent of contraction was greater in older patients. The smaller the CCC size immediately after surgery, the more rapidly it contracted. The size of the capsulorrhexis contracted an average of 22% following cataract surgery. The contraction rate tended to be higher in older patients. The results suggest that the capsulorrhexis carried out in cataract surgery for elderly patients should be sufficiently large, but not larger than the optics size of the IOL.

Aged↗
PubMedDate not supplied

Phacoemulsification and modern cataract surgery.

The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction as the preferred technique to almost exclusively extracapsular techniques. Smaller incisions have become the standard, with phacoemulsification now being the method of choice for most surgeons. Along with these advances have come improved intraocular lens materials and designs, especially well suited for use with smaller incisions. Phacoemulsification as a method to remove the cataractous lens was first proposed more than 20 years ago. Advances in techniques and equipment have led to a dramatic increase in the popularity of phacoemulsification with increased safety and efficiency. Viscoelastic agents have been developed synchronously with modern phacoemulsification techniques, playing an integral role in the success of this new technology. Improved surgical techniques for removing the anterior lens capsule have decreased the incidence of both intraoperative and postoperative capsular complications. Nucleus removal, formerly performed primarily in the anterior chamber, is now performed in the posterior chamber, decreasing damage to the corneal endothelium. Improved wound construction allows many wounds to be left unsutured, and smaller wounds allow shorter recovery time and greater intraoperative control and safety. Intraocular lenses can have smaller optic sizes and still maintain accurate centration. Foldable intraocular lenses can take advantage of the smaller incision, even further shortening the time to visual recovery. Continual evolution of this technology promises to further improve patient outcomes after cataract surgery.

Anesthesia, Local↗
PubMed2001

Multifocal intraocular lens implantation in pediatric cataract surgery.

OBJECTIVE: To evaluate implantation of a zonal-progressive multifocal intraocular lens (IOL) in children. STUDY DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Thirty-five eyes of 26 pediatric patients aged 2 to 14 years with multifocal IOL implantation at one institution with more than 1 year of follow-up. INTERVENTIONS: Standard surgical procedure comprised an anterior capsulorrhexis, lens material aspiration via two side-port incisions, temporal tunnel incision, and multifocal IOL (SA40-N; Allergan, Irvine, CA) implantation in all eyes. In 24 eyes (68%), a 5-mm posterior capsulorrhexis was created with forceps, followed by an anterior vitrectomy in 19 of those eyes (54%). RESULTS: Twenty-six patients (35 eyes) had an average follow-up of 27.4 +/- 12.7 months (range, 12-58 months). At last follow-up, best-corrected distance visual acuity improved significantly (P = 0.001), 71% of eyes with a visual acuity of 20/40 or better and 31% of eyes with a visual acuity of 20/25 or better. In the 9 bilateral cases, spectacle dependency was moderate, with only 2 children (22%) reporting the permanent use of an additional near correction. The remaining children were either using distance-correction only (4 patients; 44%) or no glasses at all (3 patients; 33%). Stereopsis also improved significantly after multifocal IOL implantation (P = 0.01). Sixteen eyes (46%) experienced obscuration of the entrance pupil that required intervention, with 10 requiring a second intraocular surgery. Four eyes required an anterior membranectomy for persistent fibrinous membrane. Intraocular lens decentration requiring surgical intervention developed in six eyes. CONCLUSIONS: Multifocal IOL implantation is a viable alternative to monofocal pseudophakia in this age group.

Adolescent↗
PubMed2001

Intraoperative management of posterior capsule tears in phacoemulsification and intraocular lens implantation.

OBJECTIVE: This paper presents the incidence, causes, and management of posterior capsule (PC) tears and their postoperative outcomes in a large series of eyes that underwent cataract removal and intraocular lens (IOL) implantation, operated on by one surgeon. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Eighteen thousand four hundred seventy consecutive eyes (1992-1999) were reviewed with the assistance of electronic medical records for incidence of PC tears in patients seeking treatment at an outpatient cataract surgery clinic. INTERVENTION: Eyes in this series underwent continuous curvilinear capsulorrhexis (CCC), nucleofractis phacoemulsification, and IOL implantation under topical anesthesia. Different intraoperative surgical strategies such as posterior continuous curvilinear capsulorrhexis (PCCC) were used in the management of PC tears. MAIN OUTCOME MEASURES: Routine preoperative and postoperative visual and refractive outcomes were recorded, including incidence of lens capsule tears, IOL position, and postoperative complications. RESULTS: Posterior capsule tears occurred in 83 of 18,470 eyes, resulting in an overall incidence of 0.45%. Of these 83 eyes with PC tears, 49% received vitrectomy. Fifty-one of 83 PC tears (61.4%) were amenable to be converted to PCCC. Of these 51 procedures, 50 eyes had PC IOL in-the-bag fixation. One eye had PCCC with optic capture. There were no eyes with dropped nuclei or nuclear fragments requiring pars plana vitrectomy. Seventeen eyes (20.5%) had Neuhann anterior capsule rhexis fixation with the haptics placed in the sulcus and IOL securely in the bag. Ten eyes (12.1%) had the IOL placed in the sulcus, and 5 eyes (6.0%) required anterior chamber IOL fixation. None of the 83 PC tears resulted in clinically evident cystoid macular edema, retinal detachment, or endophthalmitis. CONCLUSIONS: With an intact CCC and with conversion of PC tears to PCCC, in-the-bag fixation of IOLs can be achieved in most eyes.

Alberta↗
PubMed2002

Elapsed time for capsular apposition to intraocular lens after cataract surgery.

OBJECTIVE: To examine when the anterior and posterior lens capsule completely become apposed to optics of silicone and acrylic intraocular lenses (IOLs) implanted after cataract surgery and to determine whether the different IOL materials influence the timing of completion of capsular contact. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Seventy eyes of 70 patients who were scheduled to undergo cataract surgery were randomly assigned to two groups using random number tables based on the type of IOL implanted: silicone or acrylic. Thirty-two patients in each group completed the follow-up. INTERVENTION: All eyes underwent phacoemulsification surgery with implantation of either a silicone or acrylic IOL. All IOLs were accurately placed into the capsular bag. MAIN OUTCOME MEASURES: Contact of the anterior and posterior lens capsule with the IOL optic surface was evaluated using the Scheimpflug videophotography system at 3, 5, 7, 9, 11, 14, 21, and 28 days after surgery. The postoperative day at which each capsule was completely apposed to the IOL optic was determined. In addition, anterior chamber depth was also measured. RESULTS: The anterior capsule was in contact with the IOL optic on the same day or earlier than the posterior capsule in all patients. Complete apposition of the IOL was observed significantly earlier with silicone IOLs than with acrylic IOLs with both the anterior capsule (6.2 versus 3.6 postoperative days; P < 0.0001) and the posterior capsule (11.1 versus 7.4 postoperative days; P = 0.0339). No significant change in mean anterior chamber depth was observed with the silicone IOL, whereas there was significant anterior shift after implantation of the acrylic IOL. CONCLUSIONS: Capsular contact with the IOL optic is completed within approximately 8 days after cataract surgery with silicone IOLs and 11 days with acrylic IOLs. Complete apposition to both the anterior and posterior capsule was significantly earlier with silicone IOLs than with acrylic IOLs.

Acrylic Resins↗
PubMed2003

Quantification of posterior capsule opacification with round and sharp edge intraocular lenses.

PURPOSE: To quantitatively evaluate and compare intraocular lenses (IOLs) with a round or sharp optic edge design for posterior capsule opacification (PCO). STUDY DESIGN: Prospective comparative observational case series. PARTICIPANTS/MATERIALS: Photographs from 174 eyes were analyzed for PCO at the Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany. MAIN OUTCOME MEASURES: Part I: 121 eyes of 121 patients were analyzed for quantification of PCO. IOLs evaluated were Corneal ACR6 (n = 21), Alcon Acrysof (n = 20), Allergan AR40 (n = 27), Pharmacia 811 one-piece polymethyl methacrylate (PMMA) IOL (n = 24), and Pharmacia 911A silicone IOL (n = 29). Mean follow-up was 14.01 +/- 2.81 months; mean patient age was 73.2 +/- 7.3 years. The morphologic PCO formation was evaluated for the entire optic and in the central 3-mm zone. Part II: In 53 eyes of 46 patients aged 73.4 +/- 10.8 years with an Alcon Acrysof IOL, PCO formation and capsulorrhexis/optic overlapping were analyzed 34.2 +/- 4 months after cataract surgery using EPCO Software. RESULTS: Part I: The PCO values of the entire optic were for Corneal ACR6, 1.93 +/- 0.62; PMMA, 0.64 +/- 0.63; AR40, 0.55 +/- 0.28; Alcon Acrysof, 0.145 +/- 0.27; and 0.161 +/- 0.181 for the Pharmacia 911A IOL (P < 0.01). The PCO values of the central 3-mm zone were for Corneal ACR6, 1.64 +/- 0.96; PMMA, 0.49 +/- 0.39; AR40, 0.22 +/- 0.32; Alcon Acrysof, 0.08 +/- 0.21; and 0.06 +/- 0.11 for the Pharmacia 911A IOL (P < 0.01). Part II: Average overlapping of capsulorrhexis and Acrysof IOL optic was 40.5% +/- 12.4%. There was a significant correlation between PCO values and overlapping (r = -0.69, P < 0.001). CONCLUSIONS: The sharp-edge IOL types (Alcon Acrysof and Pharmacia 911A silicone IOL) resulted in statistically significantly lower PCO values for analysis of the entire optic area and central 3-mm zone. There was no statistically significant difference in PCO values between the two sharp-edge optic IOLs. An overlapping of capsulorrhexis rim and the anterior IOL optic surface of more than 20% resulted in significantly lower PCO values with the Acrysof IOL.

Acrylic Resins↗
PubMed2003

Cataract surgery as a risk factor for retinal detachment in very highly myopic eyes.

PURPOSE: To evaluate the incidence of retinal detachment (RD) after cataract surgery performed by phacoemulsification in very highly myopic eyes. DESIGN: Retrospective, paired-eye, case-control trial. PARTICIPANTS AND INTERVENTION: We assessed the development of RD in 930 eyes from 930 subjects (mean age = 62.5 +/- 8.5 years) affected by very high myopia (between -15 and -30 diopters) undergoing cataract surgery after uncomplicated phacoemulsification (cataract-subjected [CS] eyes). Fellow eyes served as controls. Follow-up was 36 months. MAIN OUTCOME MEASURE: Detachment of the retina. RESULTS: Retinal detachment was observed in 8.0% of CS eyes compared with 1.2% of control eyes (P<0.01, chi-square test). In CS eyes, posterior RD was most common (52.7% of eyes with RD). In control eyes, peripheral detachments with or without macular involvement were most common (47.3% of eyes with RD). CONCLUSION: Cataract surgery, despite the use of a safe technique such as phacoemulsification, increases the risk of RD development in very highly myopic eyes.

Adult↗
PubMed1998

Refractive and keratometric results after the triple procedure: experience with early and late suture removal.

OBJECTIVE: The objective of this study was to determine the outcome of early and late suture removal after the triple procedure (i.e., penetrating keratoplasty, cataract extraction, lens implant). DESIGN AND PARTICIPANTS: The refractive and keratometric results of 106 eyes undergoing the triple procedure were reviewed. The target postoperative refractive error was -1 diopter (D). RESULTS: Average length of follow-up was 40.3 months. Twenty eyes had sutures removed early (<18 months after surgery), 39 had sutures removed late (> or = 18 months after surgery), and 47 had sutures still intact at last follow-up. A best spectacle-corrected visual acuity of 20/40 or better was achieved in 90% of eyes with sutures removed early, 82.1% with sutures removed late, and 70.2% with sutures in place. For all eyes, the mean spherical equivalent at last follow-up was -2.50 D, with 75% of eyes falling between -4 and +2 D. The mean final refractive error was -3.40 +/- 3.53 D for eyes with sutures removed early and -1.79 +/- 3.99 D for eyes with sutures removed late. Eyes with sutures remaining had a mean final refractive error of -0.33 +/- 2.25 D. There was an overall decrease in refractive and keratometric astigmatism after both early and late suture removal with no significant difference between groups. However, there was a wide range of change with some eyes experiencing a decrease and others an increase in astigmatism. Mean postoperative K readings increased significantly for both groups after suture removal (final mean K, 47.00 D) but remained stable for eyes with sutures in. CONCLUSION: The authors data suggest that the final refractive error and net change in refractive and keratometric astigmatism after the triple procedure are not dependent on the timing of suture removal.

Aged↗
PubMed1998

Intraocular lens changes after short- and long-term exposure to intraocular silicone oil. An in vivo study.

OBJECTIVE: Silicone oil frequently is used as a vitreous substitute after complex vitreoretinal procedures. The authors sought to study the effect of short- and long-term exposure to silicone oil on polymethyl methacrylate (PMMA, MC60BM; Alcon, Ft. Worth, TX), silicone (SI-30NB; AMO, Irvine, CA), and soft acrylic (MA60BM; Alcon) intraocular lenses (IOLs). DESIGN: An experimental animal study. INTERVENTION: Forty-one New Zealand white rabbits underwent lensectomy, vitrectomy, capsulotomy, and placement of one of the three types of IOLs into the ciliary sulcus. All lenses were weighed before implantation and 24 hours after explanation. In the short-term study, an fluid-air exchange was performed followed by the use of silicone oil (1000 centistokes) to coat the posterior lens surface. Immediately thereafter, an air-fluid exchange was performed and the remaining silicone on the posterior lens surface was aspirated or wiped or both for 1 minute using a soft-tipped extrusion cannula for 1 minute. In the long-term study, the posterior segment was filled with 1000 centistokes silicone oil after fluid-air exchange. Animals were observed by slit-lamp biomicroscopy and photographed at 1 week, 1 month, and 3 months after surgery. At 3 months, all animals underwent silicone-fluid exchange, an attempt to manually remove any remaining silicone oil, and lens explanation. RESULTS: In the short-term study, no silicone oil remained after manual wiping and/or aspiration in any of the four rabbits implanted with PMMA or acrylic IOLs. In the animals with silicone IOLs, a significant amount of silicone oil remained on the posterior lens surface of all lenses (P < 0.01 for silicone vs. acrylic and silicone vs. PMMA). No statistically significant difference was found when comparing the lens weights in each group before and after implantation. In the long-term study, aqueous droplet formation was found on the posterior lens surface of six of nine PMMA IOLs and ten of ten silicone IOLs at 3 months. No opacities were observed in the group with acrylic IOLs (P < 0.001 for acrylic vs. silicone, P = 0.0018 for acrylic vs. PMMA, and P = 0.047 for PMMA vs. silicone). Adherent silicone oil remained on two of nine PMMA IOLs and on none of ten acrylic IOLs. In contrast, a significant amount of silicone oil remained on the posterior lens surface of ten of ten silicone IOLs (P < 0.001 for silicone vs. acrylic and silicone vs. PMMA). Furthermore, there was a statistically significant increase in lens weights before and after implantation in the silicone IOL group but not in the PMMA or acrylic group (P < 0.01). CONCLUSIONS: It is extremely difficult or impossible to remove remaining silicone oil from the posterior surface of a silicone IOL after short- or long-term exposure to silicone oil. This oil may interfere with the surgeon's view of the retina and may diminish the patient's visual acuity. In contrast, oil is readily removed from the posterior surface of an acrylic IOL. The authors therefore recommend the use of a soft acrylic or PMMA IOL over a silicone IOL when choosing a lens for implantation in patients who may require vitreoretinal procedures with silicone oil tamponade.

Acrylic Resins↗
PubMed2000

A randomized controlled trial of intracameral lidocaine during phacoemulsification under topical anesthesia.

OBJECTIVE: To test the hypothesis that adjunctive intracameral 1% lidocaine reduces intraoperative pain during phacoemulsification using topical anesthesia. DESIGN: Prospective, double-masked, randomized, controlled trial. PARTICIPANTS: A total of 200 patients undergoing routine phacoemulsification under topical 1% tetracaine were studied. INTERVENTION: Randomization to 0.5 ml intracameral, unpreserved, epinephrine-free 1% lidocaine or placebo was conducted. MAIN OUTCOME MEASURE: Intraoperative pain was quantified by the patients using a 0-10 visual analog pain scale. RESULTS: Intraoperative pain scores (+/- standard deviation) for the lidocaine and control groups were 1.29 +/-1.24 and 1.44 +/- 1.33, respectively (P > 0.35). CONCLUSIONS: In a rigorously double-masked, prospective, randomized, controlled trial there was no significant reduction in intraoperative pain when intracameral 1% lidocaine was used during phacoemulsification under topical anesthesia.

Adult↗