Effect of aphakia upon the vitreous.
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Aphakia, Postcataract↗
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Aphakia versus pseudophakia. A clinico-pathological study.
Eighteen enucleated pseudophakic and 14 aphakic eyes were histopathologically described. An analysis was made of the histologic data in combination with clinical information. In conclusion, cataract extraction with subsequent implantation of an artificial lens seems to bear a higher risk than cataract extraction alone, notwithstanding-perhaps--better technical work during implant surgery. The presence of an intraocular lens may induce either fatal inflammations or complications necessitating other surgical interventions, which may contribute to a fatal outcome. However the proportion of enucleated eyes to the total number of lens implantations is almost negligible, it probably reflects the clinical complications.
Adult↗
Helping the aphakic neonate to see.
The treatment of the infant who is born with sensory deprivation amblyopia is one of the most difficult therapeutic problem sets facing the ophthalmologist today. This group of anomalies has many forms, the most common of which seems to be unilateral and bilateral cataracts. Substantial advances have been made, however, in many aspects of therapy for infants who have this set of problems. We have come to realize that it is essential to address these conditions at the first moment that is consistent with the safety of the child. New techniques in cataract extraction have reduced the time course of surgical treatment, reduced the frequency of secondary cataracts, and sustained the patency of the visual pathway. Unfortunately, practitioners who engage in the surgery may not have the back-up skills in advanced contact lens fitting, correction of aniseikonia, and, in some instances, the strabismological complications which are encountered. Further, improved means of assessment of visual acuity, binocular vision, and other visual characteristics of these infants are only in the developmental stages at this time. Thus, we propose to present the problem in an orderly manner. We shall first review the types of cases and problems. We will then discuss surgical techniques and the information which must be determined during examination under anesthesia (EUA) for the purposes of visual correction. We will then describe the designs of the spectacle lens and/or spectacle/contact lens combinations that are used to correct the resultant aniseikonia and anisometropia. We will address the approaches to patching and techniques on how to best achieve binocular vision in these patients. Separately, means and methods of assessment of vision by preferential looking, visual evoked response, optokinetic nystagmus, and tests of other visual functions will be explored. In summary, we will try to tie together the entire therapeutic regimen that can be used in the treatment of these patients.
Amblyopia↗
Timolol and intra-ocular pressure elevation following neodymium: YAG laser surgery.
The intra-ocular pressure in 76 patients, undergoing Neodymium: YAG laser surgery was measured just before treatment, and one and two hours afterwards. The fellow eye served as a control. Serious elevation of the intra-ocular pressure was demonstrated, especially in capsulotomy in the aphakic eye, to a lesser extent in pseudophakic eyes. Intra-ocular pressure elevation of more than 20 mm was seen in iridectomies. Timolol 1/2% eyedrops given before Neodymium: YAG laser treatment minimized the elevation of the intra-ocular pressure. Prolonged follow-up of the intra-ocular pressure is recommended.
Aphakia, Postcataract↗
Lens injury in children treated with irido-capsula supported intra-ocular lenses.
The treatment of lens injury in children with irido-capsula supported intraocular lenses is described. A consecutive series of 73 children is analyzed as to the functional results and complications. Surgery and anaesthesia are discussed in detail. Guidelines are given for future straightforward management of eye injury in children, using this promising possibility of visual rehabilitation.
Adolescent↗
Effects of near ultraviolet radiation on the lens and retina.
This communication represents a consideration of non-visual interactions between environmental light and the eye. It covers the following topics: light in the environment; light entering the eye and transmission to the retina; observed light damage; mechanisms of light damage; and considerations of the absorptive properties of artificial lenses. The intention of this paper is to summarize the available information and some of the current thinking about the non-visual interactions of the eye with short wave-length radiation. Many more experiments must be done for us to appreciate the full significance of this information for the benefit of man.
Adolescent↗
Intraocular pressure response to the replacement of pilocarpine or carbachol with echothiophate.
In 20 patients with open-angle glaucoma in aphakia or pseudophakia whose intraocular pressure had remained uncontrolled on their current medical therapy, the medication was changed from pilocarpine or carbachol to echothiophate iodide. In all, 12 patients (60%) showed a statistically significant improvement in pressure control, 7 (35%) showed no change, and 1 had higher pressure. One-third of the patients with improved intraocular-pressure control eventually required laser or incisional surgery after a mean of 23 months, whereas the remaining subjects were controlled for the duration of the follow-up, which averaged 26 months. Side effects encountered during echothiophate iodide treatment included ocular irritation, decreased vision, and one retinal detachment.
Aphakia↗
Visual results in congenital cataract with the use of contact lenses.
The results obtained in 29 infants with congenital bilateral cataract and 24 with congenital unilateral cataract who underwent surgery at the Munich University Eye Hospital between April 1985 and August 1988 are reported. Postoperatively, the majority of patients were fitted with extended-wear contact lenses. Detailed functional results are reported on nine children with unilateral aphakia and nine with bilateral aphakia who were fitted with contact lenses within the 1st year of life. Whereas the functional results in bilateral aphakia were very satisfactory in the absence of neuroophthalmogical problems, the limited visual prognosis in unilateral aphakia continues to be a problem despite an intensive occlusion regimen. The functional results are compared with those of other authors who have used similar treatment modalities. These are discussed in terms of alternative correction modalities, i.e. intraocular lens implants and epikeratophakia.
Aphakia, Postcataract↗
Lens capsule opacification in aphakic and pseudophakic eyes.
BACKGROUND: Posterior capsule opacification (PCO) is the most common complication of lens extraction. Although intraocular lenses (IOLs) are thought to inhibit capsule opacification, the mechanisms by which they do this are poorly understood. This study was done to determine the effects of pseudophakia on secondary cataract and PCO in experimentally lentectomized dogs. METHODS: Twenty-four normal dogs were bilaterally lentectomized by phacoemulsification and unilaterally implanted with a plano-convex polymethylmethacrylate IOL. Secondary cataracts and capsule opacification were evaluated at weeks 1, 2, 4, 10, 14, and 20 after surgery by retrolillumination photography, light microscopy, and scanning and transmission electron microscopy. RESULTS: The pattern of secondary cataract and PCO in dogs was found to be similar to that in other animal species. Production of new lens material was prominent in the equatorial region, and PCO resulted from fibrous metaplasia of lens epithelium and subsequent capsular fibrosis and wrinkling. The presence of an IOL did not prevent the posterior migration of epithelium, nor did it prevent fibrous metaplasia. The presence of an IOL did, however, minimize the capsule-wrinkling effects of fibroplasia and limit the space available for lentoid formation. CONCLUSION: In pseudophakic eyes, IOLs influence secondary cataract formation by limiting the space available for lentoid formation and by maintaining a linear scaffolding for lens epithelial fibrous metaplasia.
Animals↗
Physical forces involved in pseudophacodonesis and iridodonesis.
Studies of high-speed motion pictures of the eyes of patients after extracapsular (EC) and intracapsular (IC) cataract extraction show that pseudophacodonesis and iridodonesis are the result of oscillations of the fluids in the anterior segment of the eye. These oscillations, initiated by movement of the eye, result in shearing forces on the corneal endothelium which may result in damage. Similar motion of the vitreous causes shearing forces which may damage the retina.
Aphakia, Postcataract↗
Iris fluorescein angiography and Irvine Gass' syndrome.
Iris fluorescein angiography and fundus fluorescein angiography were performed three months to three years after cataract extraction in two series of aphakic eyes--32 eyes with vitreous adherence to the wound, and 32 with no vitreous adherence to the wound. In these series there is a significant correlation between dye leakage on iris fluorescein angiography and vitreous adherence to the corneal wound since dye leakage was observed in 40.6% of eyes with vitreous adherence to the wound and only 3.1% of eyes with no vitreous adherence to the corneal wound. On the other hand cystoïd macular edema was observed in 100% of eyes with vitreous adherence to the wound associated with dye leakage on iris fluorescein angiography and in only 10% of eyes with vitreous adherence to the wound but no dye leakage on iris fluorescein angiography.
Aphakia, Postcataract↗
Regeneration of damaged ciliary epithelium in aphakic and pseudophakic eyes.
Mechanically damaged ciliary epithelium in aphakic and pseudophakic rabbit eyes was studied for up to 2 years after extracapsular lens extraction. Histopathological examination of the epithelium revealed more severe damage in pseudophakic eyes. The nonpigmented epithelium (NE) was missing from the middle to basal portion of each ciliary process. Regenerative ability of the NE was extremely poor. The damaged NE continued to disappear for at least 2 years, and only the pigmented epithelium (PE) covered the stroma. In some of the affected areas, the stroma of the ciliary body (CB) was substituted by fibrous materials.
Animals↗
Glaucoma as a problem in intraocular lens implantation.
The literature has been investigated on the prevalence of preexisting and complicating glaucoma in intraocular lens surgery. Few exact data are available. The problem of the management of preexisting primary or postoperative secondary glaucoma in pseudophakia is discussed, in particular the inevitable restrictions the intraocular lens imposes on medical therapy and eventual glaucoma surgery. Preexisting glaucoma should therefore be a relative contraindication to intraocular lens surgery.
Aphakia, Postcataract↗
Vitreous fluorophotometry studies in aphakia.
Vitreous fluorophotometry was performed on 63 patients undergoing cataract extraction. Pre- and postoperative studies demonstrated that this procedure always induces alterations in the blood-aqueous barrier. A correlation was found between the degree of this alteration and the frequency of cystoid macular edema.
Aged↗
Fusion ability lost and regained in visual adults.
The case reports are given of two adult patients who lost all fusion ability and had the signs and symptoms of central fusion disruption and intractable diplopia. Both patients suffered binocular sensory deprivation for several years caused by a combination of a traumatic cataract and uncorrected unilateral aphakia. One patient had a posterior chamber intraocular lens inserted to correct the aphakia and the other patient had a contact lens. Aniseikonia was not appreciated by either patient and did not appear to contribute to the fusion problem. Adjustable strabismus surgery, in both patients, and prism glasses, in one, enabled approximate superimposition of the visual axes. After several months, both patients began to develop some fusion with small amplitudes and the vertical bobbing typical of central fusion disruption disappeared.
Adult↗
Vitreous fluorophotometry in patients with cataract surgery.
Cystoid macular edema frequently complicates recovery from cataract surgery. Our understanding of this disease would be enhanced by more sensitive and quantitative methods to evaluate it. We performed vitreous fluorophotometry in 66 nondiabetic patients who had recently undergone cataract surgery. Eyes with definite macular edema on fluorescein angiography were ranked according to the severity of the leakage. The rank of the leakage correlated significantly with the vitreous fluorophotometry values (P less than 0.01). The mean fluorophotometry result in the eyes with cystoid macular edema was greater than that in the phakic, control group (P less than 0.01). However, eyes with minimal or no leakage visible on fluorescein angiography had fluorophotometry values indistinguishable from normal. The quantitative vitreous fluorophotometry results provided an indicator of cystoid macular edema that may prove useful in following this problem and evaluating therapy for it.
Aged↗
A mathematical model of the oscillations in the aphakic eye.
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Aphakia, Postcataract↗