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[An electronically guided peristalsis pump with an irrigation and suction cannula for extracapsular cataract extraction].

To improve extracapsular cataract extraction the author's team developed, in collaboration with the Geuder eye instruments company, an electronically controlled aspiration pump and an irrigation aspiration needle. Using this apparatus it is possible, with a deep anterior chamber, to remove the lens cortex completely and easily without damaging the posterior lens capsule. The rate of aspiration and the vacuum have to be adjusted in relation to the aspiration hole in the needle. The method of operating the pump, the aspiration and vacuum values so far determined and the surgical technique are described in detail.

Cataract Extraction↗

Longitudinal study on visual outcome and spectacle use after intracapsular cataract extraction in northern India.

PURPOSE: More than 3 million cataract extractions are undertaken in India annually. Almost 60% of these operations are intracapsular Cataract Extractions. The subsequent optical correction is provided by aphakic spectacles. The aim of this study is to assess visual outcome and perceived benefits of post-operative use of aphakic spectacles. METHODS: One hundred and sixty-seven persons who had undergone intracapsular cataract extraction and had been given best corrected aphakic spectacles were evaluated one year following prescription of the best corrected aphakic spectacles. Out of these, 82.6% were re-examined in this interview-based longitudinal study. RESULTS: The mean age of the male participants was 65.95 years and that of females was 71.26 years. 81.2% of the participants were using the provided spectacles. There was no significant association between the spectacle use and gender of the participant. The commonest reason stated by the respondents, for the non-use of the spectacles was 'poor vision'. 61.7% of the current users of provided spectacles had a visual acuity of 6/18 or better. 91.1% of the current users were very satisfied with the spectacles. All the current users could now manage personal activities and the spectacles had facilitated independent mobility. There was no difference in the level of satisfaction between mono-aphakics and bi-aphakics. Among the satisfied users, the modal spherical power was +10 D followed by +11 D. About one-third of these required a cylindrical correction. CONCLUSION: Following intracapsular cataract extraction, provision of the best correction after cataract surgery is desirable to obtain an optimal visual outcome.

Aged↗

Visual outcome and complications after cataract extraction in Saudi Arabia.

Cataract is the leading cause of blindness in Saudi Arabia. The author studied 1383 patients who had undergone cataract extraction (total of 1520 procedures) from October 1985 to March 1986 at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. All patients were observed for at least two months. Of 1520 eyes 555 (37%) achieved a visual acuity of 20/40 or better, 309 (20%) a visual acuity of 20/50-20/60 after surgery, and 656 (43%) eyes a visual acuity of 20/70 or less. The number of eyes that had intraoperative complications was 176 (12%). The number of eyes that had postoperative complications was 539 (35%). Some eyes had more than one complication. The main factors responsible for failure to achieve visual acuity of 20/40 or better were: (1) error of refraction in 492 (32%) eyes; (2) pre-existing corneal scarring and opacity in 211 (14%) eyes; (3) climatic droplet keratopathy in 134 (9%); and (4) presumed visual loss due to glaucoma in 134 (9%) eyes.

Adult↗

Cataract extraction after retinal detachment surgery.

Extracapsular cataract extraction (ECCE) was done in 31 eyes of 27 patients after previous retinal reattachment surgery with scleral buckling. A posterior chamber intraocular lens (IOL) was implanted in 21 eyes. No significant modifications in the cataract surgical technique were necessary. Final visual acuity was 20/40 or better in 26 eyes (84%). The complication rate was low. One patient was found to have a retinal detachment (RD) after cataract extraction that probably predated the cataract surgery. No recurrent retinal tears or detachment developed in any patients during an average 24-month follow-up period.

Adolescent↗

Cataract extraction in Behçet's disease.

AIMS/BACKGROUND: To assess the outcome and complications of cataract extraction in patients with Behçet's disease. METHODS: Thirty-six Behçet's disease patients underwent cataract surgery without intraocular lens implantation. Twenty-six patients had phacoemulsification or extracapsular cataract extraction, and ten patients had pars plana lensectomy/vitrectomy. The follow-up period ranged from 24 to 84 months (mean, 38 months). RESULTS: There was no statistically significant difference in the follow-up period of patients who underwent phacoemulsification, extracapsular cataract extraction, or pars plana lensectomy/vitrectomy. Sixteen (62%) of 26 patients who had extracapsular cataract extraction or phacoemulsification had a visual acuity of 20/200 or better compared with none of the 10 patients who had pars plana lensectomy/vitrectomy. Three (30%) of ten eyes which underwent pars plana lensectomy/vitrectomy eventuated in phthisis bulbi while none of the eyes that underwent extracapsular cataract extraction or phacoemulsification developed phthisis bulbi. CONCLUSION: Extracapsular cataract extraction or phacoemulsification had a better visual outcome and fewer postoperative complications than pars plana lensectomy/vitrectomy in patients with Behçet's disease.

Adult↗

Incidence of cataract extraction after diabetic vitrectomy.

PURPOSE: To determine the frequency of visually significant cataracts after vitrectomy for complications of diabetic retinopathy. METHODS: We studied 40 patients and 56 concurrent control patients in a retrospective, consecutive, comparative case series in an institutional setting. Entry criteria included phakic patients with a clear lens or mild lens opacity undergoing anatomically successful diabetic vitrectomy, without lens removal at the time of vitrectomy, without intraocular gas or silicone oil use, and with at least 1 year of postoperative follow-up examination information. Two comparative phakic control groups with the diagnosis of macular hole or epiretinal membrane were selected, also with follow-up examination information of at least 1 year postoperatively. The occurrence of cataract extraction was the principal outcome measure. Its validity as a measure of cataract formation was evaluated by ascertainment of improved visual acuity after cataract extraction. A secondary endpoint analysis included eyes that needed cataract extraction at the final follow-up examination. RESULTS: For the primary analyses (clear lens preoperatively), there were 26 patients in the study group, 38 in the macular hole control group, and 18 in the epiretinal membrane control group. The cumulative cataract extraction rates at 2 years were 15%, 66%, and 53% respectively. By using multivariate survival analysis, the patient age was an important factor, with a younger age associated with a lower rate of progression to nuclear sclerosis. After controlling for age, the difference in these three groups was still statistically significant. In the four patients with diabetes undergoing cataract surgery, the visual acuity improved at least two lines in only one of the eyes and did not change in three eyes. After expanding the outcome measures to include study patients with mild lens opacities at baseline or those judged to be in need of cataract surgery at the final follow-up examination, there was still a strongly statistically significant difference between the three groups. CONCLUSION: The rate of cataract extraction after vitrectomy in patients with diabetes is lower than in patients without diabetes undergoing vitrectomy and suggests a lower rate of cataract formation. This inference should be considered when attributing subnormal vision in a patient who has had a diabetic vitrectomy to a cataract. This is especially significant because the risk ratio in patients with diabetes in general and in patients with a previous vitrectomy is likely less favorable compared with the general population.

Adult↗

Determining whether delayed nonarteritic ischemic optic neuropathy associated with cataract extraction is a true entity.

PURPOSE: To evaluate cases of delayed nonarteritic anterior and posterior ischemic optic neuropathy after cataract extraction and to evaluate the need for centralized prospective reporting of nonarteritic ischemic optic neuropathy after cataract extraction. SETTING: Neuro-ophthalmology Clinics, University of Colorado Health Sciences Center and Denver Veterans Affairs Medical Center, Denver, Colorado, USA. METHODS: A retrospective review of all patients referred to the Neuro-ophthalmology Divisions, University of Colorado Health Sciences Center and Denver Veterans Affairs Medical Center, from January 2001 to October 2005 was performed. All patients with a diagnosis of nonarteritic anterior or posterior ischemic optic neuropathy were identified. Patients with ischemic optic neuropathy that occurred between 2 months and 12 months after cataract extraction were selected for evaluation. RESULTS: Six eyes with nonarteritic ischemic optic neuropathy that occurred 2 to 6 months after cataract extraction in 4 patients (2 bilateral nonarteritic ischemic optic neuropathy) and 1 eye with nonarteritic ischemic optic neuropathy that occurred after 6 months in 1 patient were identified. One patient had nonarteritic ischemic optic neuropathy in 1 eye 3 months after cataract extraction and 4 years later had nonarteritic ischemic optic neuropathy in the fellow eye 5 months after cataract extraction. Follow-up after the last cataract extraction was 1 to 3 years for all patients. CONCLUSIONS: Although an association between cataract extraction and delayed nonarteritic anterior and posterior ischemic optic neuropathy has been suggested, current data do not support a causal relationship. In addition, the window of postoperative susceptibility for delayed ischemic optic neuropathy after cataract extraction is unclear.

Aged↗

[Intracapsular cataract extraction using cyclodialysis. A useful method].

Thirty patients requiring cataract extraction for improved vision, and having concurrent primary open-angle glaucoma controlled with varying success by medication, had combined intracapsular cataract extraction and cyclodialysis performed by one surgeon. The average duration of follow-up was 22 months. Visual acuity deteriorated in one case in whom vision was limited to finger counting preoperatively. This patient had very advanced glaucoma and severe optic nerve damage; loss of vision was due to progression of visual field loss involving fixation. Visual acuity was unchanged in three cases; 2 had fingercounting vision, while one patient could discern hand movement preoperatively. All these patients also had far-advanced glaucomatous field loss and one, in addition, had senile macular degeneration. In all other cases there was a significant improvement in visual acuity. The mean intraocular pressure preoperatively was 22.8 mm Hg; three days post-operatively it was 13.6 mm Hg, after three months 17.6 mm Hg, after one year 17.8 mm Hg, and at the final follow-up visit 14.4 mm Hg. The number of medications required to control intraocular pressure decreased markedly. Combined cataract extraction with cyclodialysis appears to be a satisfactory procedure where there is an indication for combined cataract extraction with a glaucoma procedure. It should not be used in candidates who have had previous inflammatory glaucoma or who are not expected to tolerate long-term usage of echothiophate eyedrops following surgery.

Aged↗

Macular hole following cataract extraction.

Macular hole formation is a rare complication of cataract extraction. Although the exact etiology is unclear, macular holes can be classified into pre-existing holes that may not have been visible prior to cataract surgery, early stage macular holes that progressed to a more advanced stage, symptomatic holes following cataract extraction, and de novo symptomatic macular holes. Antero-posterior (A-P) tractional forces as well as macular edema are thought to play a role in the pathogenesis of these macular holes. In the traction hypothesis, A-P forces are thought to induce either an acute detachment of the posterior cortical gel or significant traction of the vitreous gel around the fovea, resulting in formation, or rapid progression of, macular holes. In late reopening of macular holes after cataract extraction, subclinical macular edema and epiretinal membrane formation have been suggested as possible causes. Current treatment options, including combining cataract extraction with macular hole repair, are reviewed.

Cataract Extraction↗

[Simultaneous bilateral cataract extraction--a retrospective study].

BACKGROUND: In patients with bilateral cataracts and contraindications for local anaesthesia a simultaneous bilateral cataract extraction under general anaesthesia is worth considering. PATIENTS AND METHODS: The retrospective study includes all 19 patients (aged 58 to 94 years, mean age 81.5 years) who underwent simultaneous bilateral cataract extraction at our hospital in a period of two years. While the majority of patients had bilateral phacoemulsification, five eyes of three patients underwent planned extracapsular cataract extraction. The preoperative ophthalmic and anaesthetic data and the perioperative and postoperative follow-up data are evaluated. Additionally patient satisfaction and financial aspects are investigated (coverage of the second eye surgery by health-insurance). RESULTS: In none of the 19 patients did severe complications occur. The majority of patients showed a fast visual rehabilitation with a striking improvement in their quality of life. The majority of eyes (20/38; 52.6 %) achieved a visual acuity of 20/30 or better. The analysis of financial aspects disclosed disadvantages for the hospital. CONCLUSIONS: Simultaneous bilateral cataract extraction can be considered as a safe and effective method for a selective group of patients with bilateral cataracts.

Aged↗

Reactivations of ocular toxoplasmosis after cataract extraction.

PURPOSE: To determine the risk of reactivation of ocular toxoplasmosis following cataract extraction. DESIGN: Retrospective case-control study. PARTICIPANTS: Out of 154 patients with ocular toxoplasmosis, 14 patients (15 eyes) who had undergone a cataract extraction and 45 age- and sex- matched controls without cataract were selected. INTERVENTION: A review of the medical records of 14 patients with ocular toxoplasmosis and cataract and 45 control patients with ocular toxoplasmosis but without cataract. The clinical records of the controls and patients were assessed for an identical 4-month period following the date of the cataract extraction in the index patients. MAIN OUTCOME MEASURES: Development of a new active retinal lesion within 4 months after cataract surgery in patients and age -and sex matched-controls. The presence of risk factors such as sex, congenital or postnatal acquisition of ocular toxoplasmosis, age at first clinical manifestation of ocular toxoplasmosis, total number of attacks per affected eye, type of cataract, age at the time of cataract surgery and the intervals between surgery and first clinical manifestation of ocular toxoplasmosis and between surgery and the last recurrence of ocular toxoplasmosis, as well as the use of antiparasitic medication during surgery, type and complications of surgery and optimal visual acuity before and after cataract surgery. RESULTS: Reactivations of ocular toxoplasmosis following cataract extraction occurred in 5/14 patients (5/15 eyes), which was higher than the incidence of recurrences in age -and sex-matched controls (p < 0.001). No additional risk factors for the development of recurrences of ocular toxoplasmosis after cataract surgery were found. Incidence of recurrences preceding surgery did not differ between patients and controls. CONCLUSION: We identified an increased risk of reactivation of ocular toxoplasmosis following cataract extraction which implies that prophylactic treatment with antiparasitic drugs during and after the cataract surgery might be worthwhile for patients at risk of visual loss.

Adolescent↗

Trabeculectomy combined with cataract extraction.

In a combined trabeculectomy and cataract extraction procedure on 17 eyes of 16 patients, there was a 50% average decrease in intraocular pressure. Visual acuity improved in 14 eyes, remained unchanged in two eyes, and declined in one eye. The postoperative complications were few and appreciable in only two cases. According to our follow-up findings, the combined technique is no more traumatic than an ordinary cataract extraction.

Aged↗

Cataract formation and cataract extraction after penetrating keratoplasty.

PURPOSE: This retrospective study was done to identify risk factors for cataract formation and cataract extraction after penetrating keratoplasty to determine whether a combined procedure (simultaneous cataract extraction with keratoplasty) or penetrating keratoplasty alone should be performed. METHODS: Variables from 342 phakic eyes having undergone penetrating keratoplasties were studied with univariate and multivariate analyses, including diagnosis, race, sex, age, preoperative lens opacities, preoperative vision, and length of follow-up. RESULTS: For cataract formation, age was the only independent risk factor found by multivariate analysis (P = 0.0001). For cataract extraction after penetrating keratoplasty, independent risk factors included age, sex, diagnosis, and preoperative lens opacities (P < or = 0.03). For example, the probability of a 65-year-old patient with Fuchs dystrophy requiring a cataract extraction within 5 years of keratoplasty is 81%. CONCLUSION: The likelihood of cataract formation and cataract extraction subsequent to penetrating keratoplasty increases greatly after 50 years of age, regardless of the diagnosis leading to the need for keratoplasty. The need for cataract extraction also is increased for female patients, for patients with Fuchs dystrophy, and for those with early preoperative lens opacity.

Adolescent↗

Clear corneal section and cataract extraction.

The technic of clear corneal cataract extraction was used in 365 cases, and the visual and postoperative results are reviewed. Visual acuity of 20/30 or better was obtained in 71% of cases, and there was corneal astigmatism of one diopter or less in 33%. Hyphema and shallow anterior chamber were encountered in less than 2% of cases. No instance of epithelial downgrowth was encountered. A renewal of interest in this technic of cataract extraction is encouraged.

Cataract Extraction↗

Alcohol consumption and risk of cataract extraction: a prospective cohort study of women.

PURPOSE: To investigate the association between alcohol consumption and the risk of cataract extraction. DESIGN: Population-based prospective cohort study. PARTICIPANTS: A total of 34,713 women participating in the Swedish Mammography Cohort, age 49 to 83 years, completed in 1997 a self-administered questionnaire about alcohol, smoking, and other lifestyle factors. METHODS: The women were followed from September 1997 through September 2004. The cohort was matched with registers of cataract extraction from the study area. MAIN OUTCOME MEASURES: Incident surgical extraction of age-related cataract. RESULTS: During 84 months of follow-up, we found 3587 incident cases of age-related cataract extraction. Compared with never drinkers, the relative risk of cataract extraction among current drinkers was 1.11 (95% confidence interval [CI] 1.02-1.21) after adjustment for age and other potential risk factors. In multivariate analysis, an increment of 13 g alcohol intake per day (corresponding to 1 drink = 330 ml of beer, 150 ml of wine, or 45 ml of liquor) was associated with a 7% increased risk of cataract extraction (relative risk, 1.07; 95% CI 1.02-1.12). Mean age at cataract extraction among nonsmoking women who used alcohol was 75 years, compared with 77.6 years among never drinkers. CONCLUSIONS: These prospective data suggest that daily use of >/=1 alcoholic drinks was associated with a modest increase of risk for cataract extraction. The risk increased with increasing alcohol consumption.

Aged↗

Amblyopia in the phakic eye after unilateral congenital cataract extraction.

The treatment of unilateral congenital cataract remains a challenge because form deprivation early in life leads to amblyopia. Visual outcomes after congenital cataract extraction have improved dramatically with earlier surgery, greater attention to optical correction of the aphakia, and part-time occlusion therapy of the phakic eye. A published review of unilateral congenital cataract studies between 1988 and 2004 found that 88% of patients with primary intraocular lens implantation achieved 20/200 or better visual acuity and a mean of 20% achieved 20/40 or better visual acuity. Improved outcomes are attributable, in part, to surgical intervention at an earlier age. It has been shown that surgical intervention during the first 6 weeks of age is associated with a better visual prognosis than surgery at a later age. In this report, we describe a patient with unilateral congenital cataract treated with cataract extraction and intraocular lens implantation at 8 weeks of age who had a better visual outcome in his operative eye than in his phakic eye.

Amblyopia↗

Extracapsular cataract extraction with or without posterior chamber intraocular lenses in eyes with cataract and high myopia.

PURPOSE: To compare the results of insertion of low-power or zero-power posterior chamber intraocular lenses (PC IOLs) after cataract extraction in eyes with high myopia with leaving the eye aphakic. METHODS: The outcome of extracapsular cataract extraction (ECCE) with low-power or zero-power PC IOLs in 184 consecutive highly myopic (axial length = 26.0 mm or longer) eyes was compared with 184 consecutive highly myopic eyes receiving ECCE without PC IOLs. Axial length, preoperative visual acuity, age, sex, and follow-up were similar between both groups. RESULTS: In the pseudophakic eyes, there was a statistically significantly better visual outcome (P = 0.006), decreased incidence of posterior capsule opacification (13.6% versus 33.2%, P < 0.01), and decreased requirement for YAG capsulotomy (6.5% versus 17.9%, P < 0.01). There were two retinal detachments in the pseudophakic eyes compared with four in the aphakic eyes. There were no sight-threatening complications in 12 pseudophakic eyes after YAG capsulotomy. There were four sight-threatening complications (2 retinal detachments, 2 cases of uveitis with secondary glaucoma) in 33 aphakic eyes after YAG capsulotomy. CONCLUSIONS: The use of PC IOLs may result in a lower complication rate and better visual outcome after ECCE in eyes with cataract and high myopia.

Adult↗

An evaluation of the anti-inflammatory effect of flurbiprofen after cataract extraction.

Thirty-eight patients requiring cataract extraction were randomly assigned to receive either flurbiprofen 100 mg twice daily in addition to routine postoperative therapy or the routine therapy alone. The trial was single blind with clinical assessments at postoperative days 1, 3, 7, 14, and 28. All measures of inflammatory response were significantly less in the group of patients receiving flurbiprofen, and in most cases the clinician's assessment as to which group each patient belonged to was correct. This trial suggests that flurbiprofen reduces inflammatory response in the eye in the first few days following cataract extraction and may therefore reduce the risk of severe and potentially disastrous reactions which sometimes occur.

Adult↗