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PubMed1993

[The comparative analysis of the complications of extracapsular cataract extraction with and without posterior chamber intraocular lens implantation].

Three-hundred and fourteen eyes that underwent extracapsular cataract extraction (ECCE) were analyzed. ECCE with posterior chamber intraocular lens implantation (PC IOL) was performed in 168 eyes and ECCE alone was performed in 146 eyes. The complications and visual acuity were compared in the two groups. The PC IOL group showed a low incidence of complications. In addition, vitreous loss occurred in 2.38%, cystoid macular edema occurred in 0.6%, and visual acuity recovered to 0.5 or better in 97.62% of the eyes. The incidence of complications in the ECCE group was slightly higher. The postoperative visual acuity in the ECCE group was lower than that in PC IOL group.

Adult↗
PubMed2002

Combined cataract extraction and Baerveldt glaucoma drainage implant: indications and outcomes.

PURPOSE: To report the indications and outcomes of simultaneous cataract extraction (CE) and Baerveldt glaucoma drainage implant surgery. DESIGN: Noncomparative, interventional, retrospective, consecutive case series. PARTICIPANTS: Thirty-three eyes of 33 patients. INTERVENTION: Combined phacoemulsification CE and Baerveldt glaucoma drainage implant (BGI) surgery at two tertiary care referral centers. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure (IOP), and complications. RESULTS: The study included 33 eyes of 33 patients followed for an average of 15.4 months (range, 3.0-46.9). The most common indication for combined CE and Baerveldt glaucoma drainage implant surgery was a history of prior failed trabeculectomy. Postoperative visual acuity at last follow-up was > or =20/40 in 12 of 33 patients (36%). IOP was reduced from a mean (+/- standard deviation) of 21 +/- 7.3 mmHg preoperatively to 13.1 +/- 3.5 mmHg at last follow-up visit ( P < 0.001). The number of antiglaucoma medications was reduced from a mean (+/- standard deviation) of 2.3 +/- 1.0 preoperatively to 0.7 +/- 1.1 at last follow-up (P < 0.001). Three eyes met our criteria for failure, and cumulative survival of the glaucoma surgery at 18 months was 89%. Intraoperative complications were all related to the cataract surgery, whereas early and late postoperative complications were related both to the CE and BGI surgery. CONCLUSIONS: Combined CE and Baerveldt glaucoma drainage implant placement seems to be a safe and effective surgical option and may be preferred in certain clinical situations.

Adult↗
PubMed1995

Vitreous loss in planned extracapsular cataract extraction does lead to a poorer visual outcome.

Forty-six cases of vitreous loss during planned extracapsular cataract extraction salvaged by anterior vitrectomy and primary anterior chamber lens implantation were compared in a retrospective cohort study with 92 individually matched controls. The postoperative visual outcome for cases with vitreous loss was significantly poorer than that for controls even after adjustment for confounding variables. Part of this visual morbidity was explained by cystoid macular oedema and retinal detachment, but even after adjusting for these two complications visual outcome remained worse among cases than controls. There was a significantly higher incidence of clinically apparent cystoid macular oedema amongst cases compared with controls (20% versus 1%). Two retinal detachments occurred among the cases but this difference in incidence was not statistically significant.

Aged↗
PubMed1990

Persistently raised intraocular pressure following extracapsular cataract extraction.

In this population based study we have reviewed the files of all patients who underwent an extracapsular cataract extraction (ECCE) between 1984 and 1987, were normotensives prior to surgery, and were followed up for at least 10 months after the ECCE. From a total of 1047 operations 746 qualified for the inclusion criteria; of these, 16 (2.1%) were found to have a consistently raised intraocular pressure (greater than 21 mmHg) on more than two occasions) at four months or later after surgery and throughout at least a six-month period. An increased incidence of secondary aphakic glaucoma was associated with anterior chamber IOL implantation (p less than 0.001) and posterior capsule rupture (p less than 0.01), but not with any of the other variables examined (age, sex, surgeon).

Adult↗
PubMed1983

Light-induced maculopathy from the operating microscope in extracapsular cataract extraction and intraocular lens implantation.

A characteristic macular lesion has been noted in six patients who underwent extracapsular cataract extraction with posterior chamber lens implantation. The lesion appeared similar to that which other investigators have produced in monkeys as a response to the coaxial illumination of the operating microscope. On the first or second postoperative day, the lesion appeared as an oval area of mild yellow-white discoloration of the retina; gradually it developed mottled pigmentation over the next few weeks. The pigmentary changes were often subtle, but fluorescein angiography revealed a characteristic sharply circumscribed lesion. In most of our patients the lesion was just above or below the foveola, so that central vision returned to normal, but a paracentral scotoma was present. These findings should encourage the clinician to heed the warnings of those laboratory studies which have shown the phototoxic potential of the operation microscope's unfiltered coaxial illumination and force us to re-examine our filters and operating techniques.

Aged↗
PubMed2003

[Evaluation of the dependence between the lens thickness and intraocular pressure after cataract extraction in patient with glaucoma].

PURPOSE: The main purpose of the study is the evaluation of the dependence between lens thickness in eyes with cataract and glaucoma and the intraocular pressure after cataract extraction with posterior chamber lens implantation. MATERIAL AND METHODS: 138 eyes with cataract and glaucoma were examined. Patients were divided into three groups according to the type of glaucoma: I open angle glaucoma II closed angle glaucoma III glaucoma with pseudoexfoliation syndrome All patients received preoperatively drugs reducing intraocular hypertension. The intraocular pressure was measured on operation day and on the first and fifth day after. The subsequent measurements were carried out one month, 3 months and nine months postoperatively. Lens thickness measurement was conducted with ultrasonography one day before operation. RESULTS: The dependence between lens thickness and intraocular pressure normalization (p < 0.005) has been found on the basis of statistical research with t-Student test in the closed angle glaucoma group with the greatest preoperative lens thickness. CONCLUSIONS: The statistically proven dependence between preoperative lens thickness and postoperative intraocular pressure reduction in patients with the closed angle glaucoma, has been found on the basis of conducted research.

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PubMed1985

Postoperative corneal astigmatism in cataract extraction: diamond knife versus Beaver blade.

Postoperative corneal astigmatism was studied in two groups of patients who had cataract extraction. The technique in both groups was identical except for the knife used for the partial-thickness limbal incision. In 49 patients the incision was performed with a Beaver blade and in 35 patients, with a diamond knife. Six weeks postoperatively the astigmatism was 1.27 +/- 0.90 diopters (D) in the diamond knife group, and 2.85 +/- 1.78 D in the Beaver blade group (P less than 0.0001). Sixty-one percent of the Beaver blade cases had with-the-rule astigmatism and 8% had no astigmatism. Thirty-one percent of the diamond knife cases had with-the-rule astigmatism and 26% had no astigmatism. At six months, the astigmatism was equal in both groups and practically identical to that found six weeks postoperatively in the diamond knife group. We conclude that incision of the limbal tissue with a diamond knife is associated with lower postoperative astigmatism and a more stable refractive state than incision with a Beaver blade.

Astigmatism↗
PubMed1995

Effectiveness of apraclonidine and acetazolamide in preventing postoperative intraocular pressure spikes after extracapsular cataract extraction.

We studied the effectiveness of two prophylactic agents in controlling early postoperative intraocular pressure (IOP) increases after cataract surgery. Fifty-four nonglaucomatous patients received either topical 1% apraclonidine, one drop before and after surgery, or sustained-release acetazolamide, 500 mg, or no medication at the completion of planned extracapsular cataract extraction (ECCE). Mean baseline IOPs were similar among patients randomized to the apraclonidine, acetazolamide, and control groups: 15.29 mm Hg, 15.33 mm Hg, and 14.26 mm Hg, respectively. At 3 hours postoperatively, IOPs were significantly lower in the apraclonidine group (11.13 mm Hg, P = .035), nonsignificantly lower in the acetazolamide group (13.3 mm Hg, P = .17), and significantly increased in the control group (21.32 mm Hg, P = .003). One eye in the apraclonidine group and six in the control group had IOPs greater than 30 mm Hg. At 24 hours, the only statistically significant difference was in the control group, whose mean IOPs remained elevated (21.83 mm Hg, P = .0008). One eye in the apraclonidine group, two in the acetazolamide group, and five in the control group had IOPs greater than 30 mm Hg. We found a significant early IOP reduction with apraclonidine given topically preoperatively and at the completion of planned ECCE.

Acetazolamide↗
PubMed1975

Bacterial flora in relation to cataract extraction. I. Material, methods and preoperative flora.

The conjunctival flora of 499 patients was studied the day before cataract extraction, no antibiotics or chemotherapeutical agents had been used before admission. Staphylococcus albus was by far the most common micro-organism (95.4%), followed by corynebacteria (44%), Staphylococcus aureus (14.9%), gram-negative bacilli (7.8%) and pneumo-streptococci (4.4%). Corynebacteria was isolated more frequently in the presence of S. albus, while S. aureus and gram-negative bacilli were found more frequently in the absence of S. albus. No relationship could be demonstrated between the occurrence of pneumo-streptococci and S. albus. The flora of the nose and skin of the face were studied and compared with the conjunctival flora, and a similarity could be observed. Furthermore, strains of S. aureus isolated at the same time from the two or three regions, in most cases, showed the same bacterio-phage type complex. The conjunctival flora was further correlated with sex, age, season, and number of polymorphonuclear neutrophils recovered from the conjunctival fluid. The incidence of corynebacteria and gram-negative bacilli was found to be higher in males, while corynebacteria was the only organism to show seasonal variation, i.e. was isolated more frequently in the second and third quarters of the year. No correlation could be found between age or number of neutrophils.

Adult↗
PubMed2005

Descemet's membrane detachment after cataract extraction.

BACKGROUND: Descemet's membrane detachment is a rare but potentially serious complication of intraocular surgery, most commonly cataract extraction. Small Descemet's membrane detachments typically resolve with topical medical therapy; however, larger detachments require surgical intervention. The most common surgical procedure is a gas-fluid exchange with 20% sulfur hexafluoride (SF6) or 14% perfluropropane (C3F8), which is typically performed at the biomicroscope and is nontoxic to the endothelium. CASE: A 77-year-old man underwent phacoemulsification with a posterior chamber lens implantation by clear corneal incision in the left eye. Visual acuity was 20/40 in the left eye 1 month postoperatively with persistent corneal edema. Visual acuity continued to deteriorate to counting fingers (CF), despite the use of topical hyperosmotics and steroids. At 2 months, a scrolled Descemet's membrane detachment was present from the incision site to the central cornea causing extensive edema. Anterior chamber injection of 14% C3F8 successfully reattached Descemet's membrane. Six weeks after surgery, the gas bubble had resolved, the central cornea was clear, and a curvilinear scar was present from 5:00 to 11:00. Visual acuity remained at CF owing to anterior capsular fibrosis. Anterior YAG capsulotomy improved the vision to 20/40. CONCLUSION: Descemet's membrane detachment can have a devastating effect on vision. Timely management is imperative to preserve vision. This case shows the successful repair of Descemet's membrane detachment with 14% C3F8 after unsuccessful topical treatment.

Aged↗
PubMed1998

Vision-specific function and quality of life after cataract extraction in south India.

PURPOSE: To assess visual and overall patient function after intracapsular (ICCE) and extracapsular (ECCE) cataract extraction in rural South India. SETTING: Aravind Eye Hospital, Tirunelveli, Tamil Nadu, South India, and the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland, USA. METHODS: This study evaluated preoperative visual acuity and demographic information and postoperative visual acuity and functional status measures in 71 patients having ECCE with posterior chamber intraocular lens (IOL) placement and 73 patients having ICCE with aphakic spectacle correction at Aravind-Tirunelveli Eye Hospital, Tamil Nadu, India. The principal outcomes assessed were visual acuity; quality-of-life score (possible range 0 to 100%); visual function measurement (possible range 0 to 100%). RESULTS: Patients in the ECCE group scored 10.17 (P = .0001) points higher than those in the ICCE group on the visual function scale after adjustment for differences in age, sex, level of education, marital status, residence, and type of employment. The ECCE group scored 7.69 points higher on visual function when adjusting for the differences in best corrected visual acuity, which was also better in the ECCE group. In the quality-of-life assessment, 77.1% in the ECCE group and 46.6% in the ICCE group scored 90% or better (OR 3.85; P = .006). CONCLUSIONS: Patients in rural south India having ECCE with posterior chamber IOL implantation obtained better postoperative visual function, quality of life, and visual acuity than those receiving ICCE with aphakic spectacle correction. These differences, which were not significantly affected by adjustment for age, sex, education, marital status, type of residence, and occupation, indicate that ECCE is clearly superior to ICCE.

Adult↗
PubMed1997

Corneal endothelial function after extracapsular cataract extraction and phacoemulsification.

PURPOSE: To compare the morphology and function of the corneal endothelium in the early postoperative period after extracapsular cataract extraction (ECCE) and phacoemulsification. SETTING: University Eye Clinic of Trieste, Italy. METHODS: In this prospective, randomized study of patients scheduled for cataract surgery, 40 patients were divided into two groups of 20 patients each. Group 1 had ECCE and Group 2, phacoemulsification; both had capsular bag intraocular lens (IOL) implantation. Preoperatively and 7 and 30 days postoperatively, a complete ophthalmological examination, endothelial specular microscopy, ultrasonic pachymetry, and anterior segment fluorophotometry were done. Visual acuity, endothelial cell density, cell size variation coefficient, corneal thickness, endothelial permeability coefficient, and endothelial pump function were studied. RESULTS: Visual acuity was better 7 days after phacoemulsification than after ECCE, but no differences were observed after 30 days. No significant differences in postoperative loss of endothelial cells were found between the two groups. Coefficient of variation in size, corneal thickness, and endothelial permeability significantly increased in both groups 7 days postoperatively, but only in the ECCE group 30 days postoperatively; the differences between the two groups were statistically significant. Endothelial pump function significantly increased after 7 days in only the phacoemulsification group. CONCLUSIONS: Functional endothelial failure occurred in the early period after ECCE. Phacoemulsification seemed to minimize postoperative functional damage to the endothelium.

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PubMed1986

Survival of patients following second eye cataract extraction.

One hundred and seventy-seven patients aged 65 years or older were studied retrospectively following second eye cataract extraction, having already had successful surgery to their first eye. The period of follow up was 5 to 13.5 years and during this period 109 (62 per cent) patients had died. Analysis of the data showed being male was the only risk factor influencing survival, with female patients living significantly longer. The five year survival of the 60 male patients was 47 per cent while that of 117 female patients was 75 per cent. The figures reflect the shorter life expectancy of males found in the general population and also support the hypothesis that the development of cataract reflects an ageing process in the patient as a whole.

Age Factors↗
PubMed2001

Effects of anti-inflammatory drugs following cataract extraction.

Cycloplegics, corticosteroids, and nonsteroidal anti-inflammatory drugs have been applied in the treatment of postoperative inflammation following cataract extraction. Of these, topical preparations of nonsteroidal anti-inflammatory drugs, such as ketorolac tromethamine 0.5% and diclofenac sodium 0.1%, offer comparable efficacy to corticosteroids in the reduction of postoperative inflammation, and offer lower risks of adverse events in most patients. Comparative studies of these drugs from the past 5 years are highlighted.

Anti-Inflammatory Agents↗
PubMed1996

Cataract extraction and intraocular lens implantation with anterior vitrectomy in children.

OBJECTIVE: Extracapsular cataract extraction (ECCE) with selective intraocular lens (IOL) implantation has been the choice of the treatment for children with cataracts. With regard to surgical technique, ECCE with anterior segment vitrectomy has shown some success in reducing complications. Formation of a secondary membrane and opacity of the posterior capsule, however, are still major postoperative complications. To reduce these complications, we modified current surgical procedures with minimal incisions and manipulations. PATIENTS AND METHODS: ECCE with anterior segment vitrectomy was performed using Storz Protage's system in 84 eyes of 58 children ranging in age from 14 months to 14 years. Of 70 eyes of children aged above 3 years, IOLs were implanted simultaneously. Vision improvement and incidence of postoperative complications were compared with other standard procedures to determine the benefits of the operation for children with cataracts. After the anterior capsule was opened by continuous circular capsulorhexis or envelope-form capsulectomy, the lens cortex was excised. Subsequently, the IOL was implanted into the bag. RESULTS: Nine-30 months follow-up showed that all of the central area of the posterior capsule remained clear except one eye in which a secondary membrane was partially formed on the anterior surface of vitreous. No other operative or postoperative complications occurred. CONCLUSIONS: The results indicate that the modified procedure is beneficial in the prevention of secondary cataract formation and other postoperative complications in a short term follow-up, however, a long-term follow-up is warranted to evaluate its role in pediatric cataract surgery.

Adolescent↗
PubMed1988

Extracapsular cataract extraction using a temporal limbal approach after filtering operations.

We reviewed the charts of 29 patients who underwent extracapsular cataract extraction after filtering surgery. Seven of these patients also had simultaneous implantation of a posterior chamber intraocular lens. All eyes were operated on using a temporal limbal approach. The median postoperative follow-up was 13 months. There was no statistically significant difference between the preoperative and postoperative intraocular pressures, but there tended to be an increase in the number of antiglaucoma medications administered postoperatively. None of these patients, however, required further surgery for intraocular pressure control.

Adult↗
PubMed1984

Limited choroidal hemorrhage associated with intracapsular cataract extraction.

In a prospective study, limited choroidal hemorrhage (LCH) was found in 16 of 521 eyes (3.07%) subjected to cataract extraction. It developed in ten of 69 highly myopic eyes (14.49%), three of 64 moderately myopic eyes (4.49%), and three of 388 eyes without clinically significant myopia (0.77%). A positive correlation was found between LCH and vitreous loss in myopic eyes. A cause and effect relationship was not established. Of systemic factors investigated, an association was found between LCH and cardiovascular disease (14 of 16 cases). The ophthalmoscopic appearance and clinical findings support the hypothesis that LCH and expulsive choroidal hemorrhage are manifestations of the same disease processes and share common pathophysiologic mechanisms. The cause in any one case is probably multifactorial.

Aged↗