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Results for “Capsulorhexis”

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At least 811 records · Page 45Linked to original sources
PubMed1999

Efficacy of supplementary intracameral lidocaine in routine phacoemulsification under topical anesthesia.

OBJECTIVE: To determine whether the routine use of supplementary intracameral lidocaine has any benefit over topical anesthesia alone when performing phacoemulsification surgery. DESIGN: A prospective single-center, randomized, double-masked, clinical trial. PARTICIPANTS: A total of 204 patients undergoing phacoemulsification surgery with lens implantation under planned topical anesthesia. METHODS: Patients were randomly allocated to receive either topical anesthesia plus 0.5 ml intracameral balanced salt solution or topical anesthesia plus 0.5 ml preservative-free 1% intracameral lidocaine. MAIN OUTCOME MEASURES: On the day after surgery, patients were asked to document the discomfort they had experienced using a visual analog scale. Intraoperative discomfort, postoperative discomfort, and discomfort caused by the microscope light were assessed. RESULTS: Multiple linear regression analysis did not show any significant relationship between the use of intracameral lidocaine and either intraoperative (P = 0.34) or postoperative (P = 0.45) pain scores. There was a small reduction in the discomfort caused by the operating microscope when intracameral lidocaine was used (P = 0.04). CONCLUSIONS: In this study, the routine use of intracameral lidocaine as a supplement to topical anesthesia was shown not to have a clinically useful role.

Aged↗
PubMed1999

Ultrasonographic classification and phacoemulsification of white senile cataracts.

OBJECTIVE: To classify the white senile cataracts and report the results of phacoemulsification of white cataracts. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: One hundred eyes were included. INTERVENTION: White cataracts were examined biomicroscopically before surgery, and their acoustic structure was analyzed with standardized A-scan echography. White cataract surgery was performed with phacoemulsification via a superior temporal near-limbus corneal approach using a bimanual divide-and-conquer or stop-and-chop technique. Patients were followed after surgery for a period of 9 months. MAIN OUTCOMES MEASURES: The A-scan acoustic structure of white cataracts; successful accomplishment of capsulorrhexis; mean phacoemulsification time, power, and energy; intraoperative and postoperative complications of phacoemulsification; and visual acuity at 9 months after surgery. RESULTS: White senile cataracts were categorized into three different types. Type I included intumescent, white cataracts with cortex liquefaction and high internal acoustic reflections (44 eyes), type II included white cataracts with voluminous nuclei, little amount of whitish solid cortex, and low internal acoustic reflections (49 eyes), and type III included white cataracts with fibrosed anterior capsule and low internal echospikes (7 eyes). Circular capsulorrhexis was completed in 79 eyes and was significantly less successful in eyes with type I intumescent, white cataracts compared with type II white cataracts (P = 0.0034). Mean phacoemulsification time and energy were higher in type II and type III white cataracts. Posterior capsule rupture occurred in ten eyes, and three of these eyes were complicated by vitreous loss. In 95 eyes, the posterior chamber lens was implanted in the capsular bag and in five eyes in the sulcus. After surgery, a transient corneal edema developed in 31 eyes. At the final 6-month examination, the mean postoperative visual acuity was 20/30. CONCLUSION: Current phacoemulsification techniques can safely manage eyes with senile white cataracts. The increased risk of difficulty with continuous capsulorrhexis in type-I and type-III white cataracts and the substantial nuclear hardness in type-II and mainly type-III white cataracts would suggest that current phacoemulsification techniques might not be as successful in these patients as they are in ordinary earlier cataracts.

Aged↗
PubMed1999

Postoperative intraocular lens rotation: a randomized comparison of plate and loop haptic implants.

OBJECTIVE: To compare the postoperative rotation of plate and loop haptic implants of spherical power to ascertain the optimal design appropriate for toric intraocular lenses (IOLs). DESIGN: Randomized, controlled trial. PARTICIPANTS: Forty-eight patients attending for routine cataract surgery by phacoemulsification. METHOD: Patients with cataract as the only ocular disease were randomly implanted with plate or loop haptic implants after uncomplicated phacoemulsification. The baseline position of the IOL was determined from a video frame acquired at the conclusion of surgery. Postoperative IOL position was documented using digital retroillumination images at 2 weeks and 6 months after surgery. Capsular fusion patterns were recorded using slit-lamp biomicroscopy. Correlation of IOL rotation with axial length, capsular contraction, and fusion was attempted. MAIN OUTCOME MEASURES: Early IOL rotation, occurring between surgery and 2 weeks after surgery, was graded as mild (<10 degrees), moderate (10 degrees < to <30 degrees), or severe (>30 degrees) by a semiobjective online comparison of the images. Late IOL rotation, occurring between 2 weeks and 6 months, was measured more precisely using software developed specifically for the study. RESULTS: Twenty-three patients were allocated the loop haptic and 25 the plate haptic IOL. The groups were comparable for demographic variables and numbers of patients excluded from analysis (P > 0.05). Five (24%) of 21 of plate haptic IOLs underwent severe early rotation compared to 2 (9%) of 22 loop haptics (P = 0.36). The median late rotation was 6.8 degrees for loop haptics compared to 0.6 degrees for plate haptics (P = 0.0073). Between 2 weeks and 6 months, anticlockwise rotation had occurred in 16 (89%) of 18 loop haptic IOLs compared to 11 (52%) of 21 plate haptic IOLs (P = 0.0081). CONCLUSIONS: Plate haptic IOLs show greater rotational stability than do loop haptics made from polypropylene once capsular fusion has taken place. Loop haptics invariably rotate anticlockwise after 2 weeks.

Capsulorhexis↗
PubMed2000

Complications of endocapsular tension ring implantation in a child with Marfan's syndrome.

A 4-year-old boy with Marfan's syndrome had severe visual impairment after subluxation of the crystalline lens with bisection of the pupil. In the first eye, a capsular tension ring and an intraocular lens (IOL) were uneventfully placed in the capsular bag after phacoemulsification. During implantation of the endocapsular tension ring in the second eye, an inadvertent tear of the anterior capsule occurred, and the posterior chamber IOL was placed in the sulcus. In both eyes, severe lens epithelial proliferation with secondary IOL decentration developed postoperatively. Several surgical revisions were necessary to keep the IOL within the optical axis. In the eye with the sulcus-implanted IOL, the endocapsular tension ring was markedly decentered.

Capsulorhexis↗
PubMed2000

Double-masked prospective ocular safety study of a lens epithelial cell antibody to prevent posterior capsule opacification.

PURPOSE: To evaluate the intraocular safety of an immunoconjugate (MDX-RA) developed to prevent posterior capsule opacification (PCO) in human eyes. SETTING: St. Thomas's Hospital Eye Department, London, United Kingdom. METHODS: Twenty-six patients had phacoemulsification and implantation of an intraocular lens (IOL). All were randomly allocated at the end of surgery to receive a 0.1 mL placebo or 0.1 mL of the immunotoxin MDX-RA intracamerally. Two doses of the drug were tested: 8 patients with a low dose (50 units), 9 patients with a high dose (100 units), and 9 with placebo. Follow-up at days 1, 14, 30, 60, 90, and 180 consisted of visual acuity measured by the Early Treatment of Diabetic Retinopathy Study test, contrast sensitivity, aqueous flare, specular microscopy of the IOL's anterior surface, and corneal endothelial counts. The percentage area of PCO was measured from retroillumination images of the posterior capsule. RESULTS: There was no decrease in corneal endothelial cell count in toxin-treated patients. Early postoperative flare, anterior chamber cell count, and corneal pachymetry were higher in toxin-treated patients. The median percentage area of PCO at 1 year was 32.0 in the placebo group, 3.8 in the low-dose group, and 7.4 in the high-dose group (P = .06). CONCLUSION: This prospective, randomized, placebo-controlled trial confirmed that MDX-RA is safe for intraocular use and is of potential value for further clinical trials of the prevention of PCO.

Aged↗
PubMed2000

Complete capsular bag distension syndrome.

After conventional extracapsular cataract extraction and in-the-bag intr aocular lens (IOL) implantation 3 years previously, the partially cut su perior one-third of the anterior capsulotomy flap resealed in the eye of a 55-year-old woman. With the integrity of the capsular bag restored, it distended fully; the IOL was in the center and milky fluid accumulated inside. A neodymium:YAG laser was used to drain the milky fluid and di srupt the opacified anterior and posterior capsules, restoring vision.

Capsulorhexis↗
PubMed2000

Effect of large positioning holes on capsule fixation of plate-haptic intraocular lenses.

PURPOSE: To compare the centration and fixation of silicone plate-haptic intraocular lenses (IOLs) with different-sized positioning holes. SETTING: Eye Clinic of the Johannes Gutenberg-University Mainz, Mainz, Germany. METHODS: In a prospective randomized study, 51 Chiroflex C10 and 56 Chiroflex C11 IOLs were implanted under standardized conditions by the same surgeon. The IOL position was documented at the end of surgery and by retroillumination on the first day and 5 months postoperatively. The positioning-hole area was evaluated by ultrasound biomicroscopy (50 MHz) 5 months postoperatively. RESULTS: One day postoperatively, no IOL in either group was decentered more than 1.0 mm. After 5 months, 33% of the C10 and 42% of the C11 IOLs were decentered between 0.5 and 1.0 mm, and 11% of the C10 and 8% of the C11 IOLs were decentered more than 1.0 mm (maximum 1.23 mm and 1.41 mm, respectively). Up to the first postoperative day, 20% of the C10 and 22% of the C11 lenses were rotated more than 15 degrees. At 5 months, an additional 15% of the C10 and 19% of the C11 lenses were rotated. Ultrasound biomicroscopy showed no tissue or capsule adhesion in the holes in most cases (85% C10 group; 71% C11 group). No difference was statistically significant. CONCLUSIONS: Larger positioning holes did not prevent IOL decentration or rotation; thus, this IOL design appears unsuitable for correcting astigmatism. Because tissue in the positioning hole was rare with both lens types, it is doubtful that enlarged plate-haptic perforations will prevent IOL luxation into the vitreous cavity after capsulotomy.

Aged↗
PubMed2000

Delayed posterior dislocation of silicone plate-haptic lenses after neodymium:yag capsulotomy.

We report 4 cases of posterior dislocation of silicone plate-haptic intraocular lenses (iols) into the vitreous cavity occurring a mean of 16 months after neodymium:YAG laser posterior capsulotomy. In each case, no peripheral capsule defect was observed at the time of laser capsulotomy or at subsequent follow-ups. One case was treated with sulcus implantation of a 3-piece IOL, with the plate-haptic IOL left in the vitreous cavity. The other cases were managed with vitrectomy (2 pars plana, 1 anterior) to remove the plate-haptic lens with subsequent sulcus placement of a 3-piece IOL. Patients should be informed that posterior dislocation is an infrequent but possible complication of these lenses and may occur months and even years after implantation or laser capsulotomy.

Aged↗
PubMed2001

Experimental studies of capsular equator rings of soft latex.

PURPOSE: To determine the efficacy of wide equatorial rings of various materials in reducing posterior capsule opacification (PCO) and maintaining the circular contour of the capsular equator in a rabbit model. SETTING: Laboratory for Intraocular Microsurgery and Implants, Goldschleger Eye Research Institute, Tel-Aviv University, Sheba Medical Center, Tel-Hashomer, Israel. METHODS: Closed rings made of poly(methyl methacrylate), Teflon(R), polyurethane, and latex were introduced into the capsular bags of rabbit eyes after removal of the lens material. The soft latex rings were deemed the only practical rings for atraumatic implantation through a small incision. Latex rings of 2 dimensions with rectangular edges were implanted in 8 rabbits. One eye served as a control after lens removal and no ring implantation. The eyes were followed for up to 5 months and then evaluated by light microscopy. RESULTS: Posterior capsule opacification was minimal or absent in all animals implanted with the latex rings. Mild to moderate inflammatory reaction was noted in most eyes. It was caused by the ring material or secondary to long-standing pressure on the ciliary tissue. The rings also maintained well the circular contour of the capsular bags. CONCLUSIONS: Equatorial rings of soft latex with sharp rectangular edges were effective in minimizing PCO and maintaining the shape of the capsule after lens removal in rabbits. Soft rings made of a biocompatible material may be effective in humans.

Animals↗
PubMed2001

Morphological appearance and size of contact zones of piggyback intraocular lenses.

PURPOSE: To characterize the morphology, size, and change in size of the contact zone of piggyback intraocular lenses (IOLs) of different materials and optic designs. SETTING: Department of Ophthalmology, Vienna General Hospital, Vienna, Austria. METHODS: In a prospective study, 9 eyes of 7 patients received piggyback IOLs of the following materials: poly(methyl methacrylate) (PMMA), acrylic, hydrogel, and silicone. The contact zone between the anterior and posterior IOLs was photodocumented from 1 day to 1 year after surgery using specular microscopy. The contact zone area was measured. RESULTS: A contact zone was present with all IOL materials studied. The area of contact, however, differed significantly. With PMMA IOLs, the contact zone was small and surrounded by Newton rings, indicating the tiny gap between the IOLs. With IOLs of soft material, such as silicone and hydrogel, it was larger than with PMMA IOLs and had a slightly irregular shape. With foldable acrylic IOLs, it was regular, round, and slightly larger than with the soft materials. The contact area enlarged primarily during the first 3 months after surgery. After 1 year, 2 eyes with acrylic piggyback IOLs had a membrane formation around the contact zone and 2 eyes developed Elschnig pearls between the IOLs. CONCLUSION: In piggyback IOL eyes, the shape and size of the contact zone were strongly dependent on the IOL material and optic design. Contact area enlargement seemed to be induced by capsule shrinkage. Fibrous membrane formation around the contact zone and Elschnig pearl formation between the piggyback IOLs were long-term complications of this technique.

Acrylates↗
PubMed2000

Mini-nuc technique.

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Anterior Chamber↗
PubMed2001

Topical anesthesia for cataract surgery: a population-based perspective.

PURPOSE: To analyze the anesthetic regimen and sedation in a population-based cohort of unselected cataract surgery cases operated on with the goal of maximizing the percentage of patients with topical anesthesia and no sedation. SETTING: Department of Ophthalmology, Norrlands University Hospital, Umeå, Sweden. METHODS: This prospective observational population-based study comprised all patients having cataract surgery during a 1 year period at 1 institution. Data were collected from the patients' records, which were standardized. Outcome measures were use of preoperative sedation, type of anesthesia, intraoperative complications, and adverse events. RESULTS: The study comprised 890 cases performed by 4 surgeons. Seventy-two percent of patients had no sedation and topical anesthesia only. All patients except 1 who had previous cataract surgery with topical anesthesia chose the same method for their second-eye surgery. The rate of posterior capsule rupture was in the expected range for a population with high incidences of pseudoexfoliation and mature cataract. CONCLUSIONS: It is possible to achieve a high percentage of effective topical anesthesia for cataract surgery in a population-based setting. The findings have implications for cost-containment in health services.

Administration, Oral↗
PubMed2001

Vitrectomy to remove a posteriorly dislocated endocapsular tension ring.

We treated a patient who had a posteriorly dislocated endocapsular ring associated with decreased vision and intravitreal cortical remnants. The ring was removed by uneventful pars plana vitrectomy. By the last examination, best corrected visual acuity had improved to 6/12 and intraocular pressure had stabilized to within normal limits. A posteriorly dislocated endocapsular ring is a rare complication of cataract surgery. Its removal by pars plana vitrectomy under direct observation is effective and safe.

Aged↗
PubMed2001

Aqueous flare induced by heparin-surface-modified poly(methyl methacrylate) and acrylic lenses implanted through the same-size incision in patients with diabetes.

PURPOSE: To compare the degree of blood-aqueous barrier (BAB) breakdown in eyes of diabetic patients after phacoemulsification and implantation of heparin-surface-modified poly(methyl methacrylate) (PMMA) or soft hydrophobic acrylic intraocular lenses (IOLs) performed using the same technique with the same incision size to determine the influence of the IOLs on postoperative inflammation independent of other surgical factors. SETTING: Department of Ophthalmology, University of Paris XIII, Bobigny, France. METHODS: In a prospective study, 44 eyes of 31 diabetic patients with or without mild to moderate diabetic retinopathy were randomly assigned to receive an HSM PMMA IOL (22 eyes) or a soft hydrophobic acrylic IOL (22 eyes) after standardized phacoemulsification surgery. Both types of IOLs had a 6.0 mm optic, were inserted unfolded, and were placed in the bag through a calibrated 6.0 mm superior scleral incision. Anterior chamber flare was measured preoperatively and 1, 7, 30, and 240 days postoperatively using the Kowa 500 laser flare meter. RESULTS: The mean flare value was higher on the first postoperative day in both groups. There were no statistically significant between-group differences in flare scores or clinical parameters preoperatively or at any postoperative visit. CONCLUSIONS: No significant difference was observed in inflammation between eyes having HSM PMMA IOL implantation or those having soft hydrophobic acrylic IOL implantation through the same-size incision. This indicates that hydrophobic acrylic and HSM PMMA materials induce the same degree of BAB breakdown after phacoemulsification in eyes of diabetic patients.

Acrylic Resins↗