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Capsular bag distension syndrome after endophacoemulsification and in-the-bag intraocular lens (IOL) implantation has been reported. We describe 2 cases in which sulcus implantation of a posterior chamber IOL caused marked capsular bag distension. Both cases resolved with conservative treatment or a neodymium:YAG posterior capsulotomy.
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The endocapsular tension ring has helped in the management of patients with moderate loss of zonular support. However, the eye with profound zonular dialysis or weakness may require scleral fixation of the ring for centration and long-term stabilization. We used a new, modified endocapsular tension ring designed to provide scleral support without violating the integrity of the capsular bag in 4 patients. All patients had extreme loss of zonular support preoperatively or a significant risk of progressive zonular weakness. In each case, the new ring provided excellent support and centration of the capsular bag and intraocular lens intraoperatively and postoperatively.
PURPOSE: To determine the frequency and nature of intraoperative complications of endocapsular phacoemulsification cataract surgery. SETTING: Dalcross Private Hospital and the Departments of Ophthalmology, Concord Hospital and Prince of Wales Hospital, Sydney, Australia. METHODS: This prospective study included the first 1000 cases of planned endocapsular phacoemulsification cataract surgery performed by an experienced surgeon. A standardized proforma was completed at the time of surgery. Data recorded included pre-existing ocular abnormalities, duration of surgery, nuclear sclerosis grade, and intraoperative complications. RESULTS: Major complications comprised posterior capsule tears with vitreous loss (1.4%), isolated posterior capsule tears (0.7%), and zonulysis (0.1%). Minor complications included anterior capsule tears (3.8%), iris prolapse (0.6%), and ciliary body incision (0.2%). There was a significant trend toward complications as the nuclear sclerosis grade increased. The incidence of major complications was 9.3% in the first 150 cases and 0.9% in the last 850. This represents a relative risk of 9.9 (95% confidence interval 4.2 to 23.0) of a major complication occurring in the first 150 compared with the later 850 cases. CONCLUSION: The frequency of major and minor complications fell sharply after the first 150 operations and was maintained. This study may provide a guide for beginning phacoemulsification surgeons and a basis for experienced surgeons to compare their performance outcomes.
PURPOSE: To compare contrast sensitivity and glare disability provided by diffractive and refractive multifocal intraocular lenses (IOLs). SETTING: University Eye Clinic Vienna, Austria. METHOD: This study evaluated the contrast sensitivity and glare disability in 29 eyes with a diffractive multifocal IOL (3M815LE) and 12 with a three-piece, five-zone refractive multifocal IOL (AMO Array SSM 26 NB). The Brightness Acuity Tester (Mentor, Inc.) was used with stationary sinusoidal gratings at spatial frequencies of 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd) generated on a television monitor (Nicolet CS 2000). RESULTS: The contrast sensitivity functions of both multifocal IOL groups were within the reference range and were identical at 0.5, 1, and 22.8 cpd spatial frequencies. At 3, 6, and 11.4 cpd, the contrast sensitivity function in the diffractive IOL group was 6, 9, and 10% lower than in the refractive IOL group, and the difference between groups was statistically significant at 6 cpd. When glare was present, contrast sensitivity in the diffractive IOL group was generally in the lower limit of the reference range and remained below at 3 and 6 cpd. Contrast sensitivity in the refractive IOL group remained below the reference range at 3 cpd. At 0.5 and 1 cpd, there were no differences between the groups. At the middle and high spatial frequencies (3, 6, 11.4, 22.8 cpd), contrast sensitivity in the diffractive group was 8, 16, 11, and 12% lower than in the refractive group. At 6 cpd, the between-group difference was statistically significant. CONCLUSION: Diffractive multifocal IOLs provided decreased contrast sensitivity and greater glare disability than refractive multifocal IOLs.
PURPOSE: To determine depth of focus and visual quality after implantation of a diffractive intraocular lens (IOL) and a refractive IOL. SETTING: University Eye Clinic, Vienna, Austria. METHOD: This study comprised 10 eyes of 9 patients with a diffractive IOL (3M 825x + 4) and 13 eyes of 9 patients with a refractive lens (AMO Array SSM 26NB). Depth of focus was evaluated in a defocused range of -6.0 to +3.0 diopters (D), and Snellen visual acuity was recorded. RESULTS: Distance acuity peaked at 1.0 +/- 0.2 (3M group) and 0.91 +/- 0.13 (AMO group). The near acuity peaks were at 0.82 +/- 0.15 and 0.55 +/- 0.14, respectively. Visual acuity of 0.5 was possible in a range of defocus of +1.0 to -4.0 D (3M) and +1.0 to -3.5 D (AMO). CONCLUSION: Pseudoaccommodation and full distance visual acuity were realized with both types of multifocal lenses. For intermediate distances, visual acuity may be limited to activities that do not require optimal vision. At near distances, the 3M lens provided statistically significantly better visual acuity.
PURPOSE: To determine the ideal size of an intraocular lens (IOL) for proper capsular bag fixation in different sizes of evacuated capsular bags. SETTING: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea, and Storm Eye Institute Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Fifteen eyes obtained post-mortem were divided by crystalline lens size into three groups. Intraocular lenses of five different sizes were implanted in each capsular bag. The arc of contact between the haptics and capsular equator and the capsular bag distortion with each IOL were measured and compared using posterior-view analysis. RESULTS: The arc of contact was directly proportional to the IOL size and inversely related to the lens size. The smallest arc of contact was 2.0 mm with the smallest IOL implanted in the largest lens group. The maximum capsular bag distortion was 2.6 mm in the case of the largest IOL implantation in the smallest lens group. CONCLUSION: Implanting an IOL smaller than 12.5 mm in a large capsular bag can result in unstable fixation, while implanting an IOL larger than 12.5 mm in a small capsular bag can result in excessive stretching and distortion of the capsular bag and surrounding zonules.
In a hyperopic cataract patient, surgery was performed with implantation of 2 foldable, acrylic, posterior chamber intraocular lenses (IOLs) in the bag. The IOLs showed a central contact zone during surgery. This contact zone remained after surgery and was documented 2 months postoperatively. The contact zone may induce multifocality similar to that seen with multifocal IOLs.
PURPOSE: To evaluate the performance of heparin-surface-modified (HSM) intraocular lenses (IOLs) in pediatric eyes after cataract surgery. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This prospective, randomized, double-masked, controlled clinical trial comprised 90 children aged 2 to 14 years with cataract. The patients were consecutively randomized to receive an HSM (Group 1) or an unmodified (Group 2) poly(methyl methacrylate) (PMMA) IOL. Extracapsular cataract extraction (ECCE) with IOL implantation was performed in children 8 years and older and ECCE with primary posterior capsulotomy, anterior vitrectomy, and IOL implantation in children younger than 8 years. Outcome parameters were inflammatory cell deposits on the IOL surface, posterior synechias, and anterior chamber reaction. RESULTS: Follow-up data were available for 73, 70, 60, and 68 patients at 1 week, 1 month, 3 months, and 6 months, respectively. Significantly fewer cell deposits were noted in Group 1 at 1, 3, and 6 months (P < .001). Synechia formation and anterior chamber reaction were comparable in the 2 groups. CONCLUSION: The lower incidence of inflammatory cell deposit formation in eyes with HSM PMMA IOLs indicates that these IOLs have greater bicompatibility than unmodified IOLs in pediatric cataract surgery.
PURPOSE: To compare the results of a limbal versus a pars plana approach for primary posterior capsulectomy and anterior vitrectomy in the management of childhood cataract. SETTING: Department of Ophthalmology, Labbafinejad Medical Center, Tehran, Iran. METHODS: A randomized, controlled, double-masked clinical trial of 45 eyes was conducted. After being matched, 38 eyes were included in the study and were divided into 2 equal groups for data analysis. All eyes had lensectomy and posterior chamber intraocular lens (PC IOL) implantation. Primary posterior capsulectomy and anterior vitrectomy were performed through the limbus in half of the eyes and the pars plana in the other half. Main outcome measures included visual acuity, estimated red reflex, postsurgical inflammatory reaction, corneal clarity, posterior synechias, iris capture, IOL position, capsulectomy size, glaucoma, cystoid macular edema, retinal tear, and postoperative refraction. RESULTS: No statistically significant differences were found between the 2 approaches in the outcome measures. CONCLUSION: The anatomic and visual results were encouraging when posterior capsulectomy and anterior vitrectomy, using a limbal or pars plana approach, were combined with lensectomy and PC IOL implantation in children. The application of these techniques depends on surgeon experience and skill.
PURPOSE: To study the pattern of postoperative complications following extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation in pediatric eyes. SETTING: Tertiary eye care center, New Delhi, India. METHODS: A retrospective analysis of 39 eyes of 28 children referred for complications after ECCE with IOL implantation was performed. The results evaluated were visual acuity, iridocapsular problems, and IOL-related complications. Additional interventions such as neodymium:YAG (Nd:YAG) capsulotomy, surgical membranectomy, and penetrating keratoplasty (PKP) were done when necessary. Visual acuity was measured 1 week following intervention and at the last follow-up. RESULTS: Congenital (17 eyes, 43.6%), developmental (11 eyes, 28.2%), and traumatic (11 eyes, 28.2%) cataract were the indications for surgery. Posterior capsule opacification (34 eyes, 87.2%), updrawn pupil (15 eyes, 38.5%), decentered IOL (13 eyes, 33.3%), and pupillary capture (12 eyes, 30.8%) were the major complications. An Nd:YAG capsulotomy was attempted in 19 eyes (48.7%). Surgical membranectomy was performed in 10 eyes (25.6%); PKP was performed in 2 eyes (5.1%) to treat pseudophakic bullous keratopathy. One eye had to be eviscerated because of uncontrolled endophthalmitis. In 31 eyes in which visual acuity could be measured, 27 had an acuity of 6/60 or worse at the time of presentation. Following intervention and amblyopia therapy, 19 eyes achieved a visual acuity of 6/18 or better. CONCLUSION: Routine ECCE with IOL implantation in pediatric eyes is associated with various problems and may lead to permanent visual disability.
PURPOSE: To experimentally analyze the role and efficacy of hydrodissection in achieving maximal cortical cleanup. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Phacoemulsification and irrigation/aspiration were performed in 10 pairs of human eyes (20 eyes) obtained postmortem. Ten eyes had previous hydrodissection and 10 eyes, no hydrodissection. The time (seconds) required for complete lens substance removal in each procedure was measured. In addition, a qualitative evaluation of difficulty of surgery was noted. RESULTS: Phacoemulsification required 28.6% less time in eyes with previous hydrodissection than in those without. Irrigation/aspiration time was reduced by 50.9% when hydrodissection was performed. The total time of each procedure required for complete evacuation of the capsular bag was reduced by an average of 37.7% in eyes with hydrodissection. Furthermore, qualitatively the procedure was far easier, less stressful, and caused less posterior capsule stress or rupture when copious hydrodissection was performed. CONCLUSIONS: Hydrodissection enhances the general safety and efficiency of cortical cleanup, especially at 12 o'clock. Hydrodissection is the best available, practical, immediately implementable, and inexpensive means to help remove equatorial E-cells and thus alleviate the incidence of posterior capsule opacification.
PURPOSE: To study the long-term results of implantation of the 3M diffractive multifocal intraocular lens (IOL). SETTING: Eye Department, ASA, Arendal, Norway. METHODS: The study comprised 97 eyes in 72 patients. Follow-up was 8 years. Distance and near visual acuities, refractive results, contrast sensitivity, IOL centration, and neodymium:YAG (Nd:YAG) capsulotomies to treat posterior capsule opacification were evaluated. RESULTS: All patients without ocular pathology achieved a best corrected visual acuity (BCVA) of 0.5 or better (i.e., 98.7% had a BCVA of 1.0 or better). Without correction, 73.8% of eyes had a Jaeger acuity of J3 or better and with distance correction, 92.1%. Emmetropia or within +/-0.25 diopter (D) of it was achieved in 58.8% of eyes. An astigmatic shift of 0.827 D cylinder correction was induced. This shift was mainly against the rule (0.717 D). Contrast sensitivity was reduced with spatial frequencies of 6 to 18 cycles per degree. No need for spectacles was reported by 54.2% of patients and by 68.0% of those with bilateral implantation. For near tasks, 63.9% of patients never used spectacles. The IOLs were well centered or minimally decentered in 99.0% of eyes. Posterior capsule opacification was treated by Nd:YAG laser capsulotomy in 55.7% of eyes, with a mean time between surgery and treatment of 34.0 months +/- 23.2 (SD). CONCLUSION: This long-term study proved the 3M diffractive IOL to be safe and effective despite some reduction in contrast sensitivity at higher spatial frequencies. More than half the patients never wore spectacles; 2 of 3 patients with IOLs in both eyes never wore spectacles. Proper patient selection is crucial.
PURPOSE: To compare 1-site and 2-site combined phacoemulsification with foldable intraocular lens (IOL) implantation and trabeculectomy. SETTING: El-Maghraby Eye Hospital, Jeddah, Saudi Arabia. METHODS: Seventy-six eyes with coexisting cataract and glaucoma were randomly assigned to have a mitomycin-C trabeculectomy in a superior quadrant combined with phacoemulsification and foldable IOL implantation through the same incision (1-site group) or a separate, temporal, clear corneal incision (2-site group). Postoperative evaluation included visual acuity, intraocular pressure (IOP), bleb assessment, and number of antiglaucoma medications. Follow-up ranged from 12 to 18 months. RESULTS: Mean preoperative IOP was 28.1 mm Hg +/- 7.1 (SD) in the 2-site group and 26.2 +/- 6.5 mm Hg in the 1-site group. At 6 months postoperatively, mean IOP was 16.9 +/- 4.3 and 16.8 +/- 3.8 mm Hg, respectively (P = .9) and at 12 months, 17.6 +/- 3.3 and 19.1 +/- 3.1 mm Hg, respectively (P = .044). Twenty-three of 39 eyes (59%) in the 2-site group and 14 of 37 (38%) in the 1-site group had clinically apparent filtering blebs at 12 months (P = .065). Postoperative astigmatic change and complications were comparable. CONCLUSION: Mitomycin-C trabeculectomy superiorly combined with separate temporal clear corneal phacoemulsification provided 1 year IOP control comparable to that with single-incision (1-site) combined cataract and glaucoma surgery.
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Phaco slice and separate retains the advantages of the chopping techniques of Nagahara, Koch, and Fukasaku but replaces chopping or snapping with slicing across the center of the phaco-tip-stabilized nucleus using a Nagahara chopper and then repositioning the chopper to optimally separate the divided lens halves. As the lens is rotated in the capsular bag, small pieces of the nuclear pie are sliced off, separated, emulsified, and aspirated. Emulsification and aspiration can alternatively be left until most or all the slices have been made. This technique works with a broader range of lens densities than other chopping techniques and uses no sculpting and very little phaco time. The phaco time required for this technique is relatively independent of nuclear density compared with a sculpting technique.
PURPOSE: The purpose of this study was to evaluate visual acuity and binocular function after primary posterior chamber intraocular lens (IOL) implantation in children. PATIENTS AND METHODS: A retrospective chart review of 39 eyes of 31 children was performed. Fifteen eyes with traumatic, 17 with developmental, and 7 with congenital cataracts without any other ophthalmologic problems were examined before and after cataract surgery (irrigation/aspiration procedure with implantation of a posterior chamber IOL). Twelve eyes also received a posterior capsulorrhexis and anterior vitrectomy. The mean age at surgery was 6.9 +/- 3 years (range, 3-12 years). RESULTS: Twenty (51%) of 39 eyes achieved a best-corrected postoperative visual acuity of 20/40 or better (range, 20/200-20/20). The mean postoperative visual acuity was 20/40 in the traumatic and developmental cataract groups and 20/100 in the congenital cataract group. There was a positive correlation between cataract morphology and visual acuity (P<.05). Bilateral cataracts had a better postoperative visual acuity than unilateral cataracts (P <.005). Nineteen (70%) of 27 eyes in which no primary posterior capsulorrhexis had been performed had posterior capsule opacification. Stereopsis was found in 10 of the 31 patients: 43% of the traumatic cataract group, 30% of the developmental cataract group, and 14% of the congenital cataract group. CONCLUSIONS: After capsular bag-fixated IOL, visual acuity and binocular function in children older than 3 years were favorable and the complication rate, excluding posterior capsule opacification, was low.