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PubMed2005

The effect of capsular tension ring on posterior capsular opacity in cataract surgery.

This study was performed to evaluate the efficacy and safety of the capsular tension ring on posterior capsular opacity in comparison with cases undergoing intraocular lens (IOL) implantation alone. We analyzed 127 eyes which had undergone cataract surgery, including capsular tension ring insertion, along with 127 eyes which had undergone IOL implantation alone by the same surgeon from September 1998 to March 2003. In the insertion group, 41 eyes (group A) had been followed up for more than one year after silicone IOL implantation, as had 40 eyes (group B) in the control group. We compared the incidence, type, and degree of capsular opacity between A and B groups and also endothelial cell loss after surgery between the two groups. For insertion group A, the frequency of posterior capsular opacity was lower(7.3%), the duration to development was longer, and the energy required for Nd-Yag capsulotomy of PCO was less than for control group B (25%) (p=0.037). The endothelial cell count loss rate was not significantly different between the two groups (p=0.522). The capsular tension ring is associated with a significantly reduced incidence of posterior capsular opacity and is a safe procedure.

Adult↗
PubMedDate not supplied

Infantile lensectomy and intraocular lens implantation with long-term follow-up in a monkey model.

PURPOSE: To report the long-term clinical and histopathologic findings in infant monkeys following a lensectomy and intraocular lens (IOL) implantation using two different surgical techniques. METHODS: A lensectomy and IOL implantation was performed on the right eye of 10 infant monkeys. A posterior capsulotomy was performed using a limbal approach in 5 monkeys (Group 1), and a pars plana approach in 5 other monkeys (Group 2). The residual refractive error in the pseudophakic eye was then corrected with a contact lens and the fellow eye was occluded for 70% of the daylight hours. The monkeys were then examined at regular intervals for 2 to 4 years. Visual acuity was assessed using operant testing and sweep visual evoked potentials (VEPs). At the end of the study, the pseudophakic eyes were studied histopathologically. RESULTS: The only complications that required reoperation were diaphanous fibrin membranes on the lens optic (n=10) and lens reproliferation into the pupillary space (n=5). The visual outcome was similar in Groups 1 and 2, with better acuities in the phakic eyes compared with the pseudophakic eyes. A higher percentage of both haptics were found in the capsular bag for the monkeys in Group 2 (n=3) than in Group 1 (n=1). CONCLUSIONS: Although haptic placement was superior using a pars plana approach to perform the primary posterior capsulotomy, no clinically discernable difference was noted in IOL centration between the monkeys undergoing a limbal versus a pars plana posterior capsulotomy and no difference was noted in the visual outcome.

Animals↗
PubMed2005

Manual small incision cataract surgery in eyes with white cataracts.

PURPOSE: To assess the safety and efficacy of Manual Small Incision Cataract Surgery (MSICS) in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorthexis (CCC). MATERIALS AND METHODS: Prospective observational study on 100 consecutive eyes of 100 patients with white cataract who had undergone MSICS with trypan blue assisted CCC. The nucleus was prolapsed into anterior chamber by using a sinskey hook and extracted out of the eye using irrigating vectis. Intraoperative and postoperative findings (according to OCTET classification) as well as postoperative visual outcomes were used as main measures to report the safety and efficacy of the surgery. RESULTS: Of the 100 eyes, 16 had intumescent, 67 had mature and 17 had hypermature cataract. Intraoperatively CCC was incomplete in 4 eyes (4%) and had to be converted to canopener capsulotomy. None of the eyes had posterior capsular rupture or zonular dialysis and no eyes were converted to conventional Extra Capsular Cataract Extraction (ECCE). Postoperatively, 6 eyes (6%) developed corneal oedema with >10 Descemets folds and 7 eyes (7%) had corneal oedema with CONCLUSION: In developing countries like India where phacoemulsification may not be affordable to a majority of those requiring cataract surgery, MSICS proves to be a safe and efficacious alternative for white cataracts especially with the adjunctive use of trypan blue dye.

Adult↗
PubMed2006

[Choroidal effusion and retinal detachment after capsulotomy with YAG-LASER].

CASE REPORT: A 74-year-old woman presented complaining of blurred vision in her left eye. She had an anterior chamber lens in both eyes and an opaque posterior capsule in her left eye, for which a YAG-LASER capsulotomy was performed. Thirteen days later she re-presented with a choroidal effusion and a retinal detachment requiring surgery. DISCUSSION: There is no consensus as to the exact time at which a capsulotomy should be done. Timing of the procedure requires evaluation as a whole and consideration of the potential complications of IOL dislocation, recurrent uveitis, ocular hypertension and the most devastating choroidal effusion and retinal detachment.

Aged↗
PubMed2000

[Pediatric cataract surgery with posterior capsulorrhexis and optic capture of the intraocular lens].

We evaluated the result of the pediatric cataract surgery with optic capture. The intraocular lens (IOL) optic is subluxated to the vitreous body side through the posterior continuous curvilinear capsulorrhexis (PCCC). Five eyes with congenital or developmental cataracts were treated with phacoemulsification and IOL implantation, and then PCCC and optic capture was done. Three of the cases were bilateral and one case was unilateral. All cases have remained in good condition without secondary fibrous membrane formation, which influences visual acuity, and transparency of the posterior capsule was maintained in the visual axis area. We found one case of anterior capsule contraction. Long-term follow up should be continued.

Capsulorhexis↗
PubMed2000

[Contribution of the Kansas technique for reducing complications of mature cataract surgery].

PURPOSE: We report our experience with the Kansas technique of phakosection which eliminates or limits most complications of classic manual extracapsular extraction. PATIENTS AND METHODS: This retrospective study included our first 80 patients undergoing surgery for mature cataract between May 1996 and May 1998 where we used the Kansas technique. We compared outcome with a group of 30 patients who underwent classic manual extracapsular extraction in a study performed in 1995 by the same surgeon in the same hospital. RESULTS: Per- and post-operative complications were significantly lower with phakosection. Functional rehabilitation was quicker, better and provided better patient comfort. DISCUSSION: Despite some difficulties encountered in a public hospital (viscoelastic excessively fluid and in small quantity, lack of suitable knives or reuse of sterilized disposable knives), we found that the Kansas technique is very well adapted to mature cataracts and our working conditions. CONCLUSION: Phakosection allowed us to give our patients with mature or very mature cataracts the benefit of small incisions. With a moderate increase in cost, this technique significantly reduced our per- and post-operative complication rates and gave quicker and better visual recovery. In our countries, this technique provides better care than phakoemulsification.

Adult↗
PubMed2000

Towards achieving small-incision cataract surgery 99.8% of the time.

A surgical approach designed to reliably attain the modern goal of small incision cataract surgery 99.8% of the time is described. Phacoemulsification as well as a manual small incision technique is utilised to achieve the desired outcome as often as possible and for all types of cataracts. The logic, and required surgical steps are described and illustrated. This surgical technique allows the advantages of small incision surgery to be reliably achieved. The method is flexible and allows decisions and steps to be modified depending on the skill and comfort zone of the individual surgeon.

Anterior Chamber↗
PubMed2000

[Cataract extraction after angle closure glaucoma].

The best therapeutic approach to angle closure with cataract is phacoemulsification and foldable implant. The surgery is performed as soon as the acute crisis is over. Both dispersive and cohesive visco-elastic substance are used in the narrow anterior chamber. Poor mydriasis is best managed by means of iris hooks.

Capsulorhexis↗
PubMedDate not supplied

Clinical applications of capsular tension rings in cataract surgery.

BACKGROUND: Although the open capsular tension ring was designed to manage zonular dialysis during cataract surgery, it also lowers the incidence of capsule contraction, stabilizes the capsular bag, and enhances IOL centration. With appendages, it provides a partial solution for those eyes with colobomata and aniridia. MATERIALS AND TECHNIQUES: Subsequent modifications to the capsular tension ring include the Cionni ring, capsular edge ring, coloboma ring, and aniridia ring. A square-edge design may inhibit posterior capsule opacification, and the aniridia and coloboma rings with appendages create an artificial it is in traumatic or congenital colobomata. RESULTS: Designs, functions, indications, and results of different types of capsular tension rings are reviewed, as well as applications in pediatric cases, and considerations for their routine use in adult cataract surgery. CONCLUSIONS: The potential benefits of capsular edge ring implantation in pediatric cataract surgery cases are explored.

Adult↗
PubMed2002

[Corneal endothelial cell changes in triple procedure].

PURPOSE: A retrospective study was performed to examine time-related changes in the corneal endothelium in eyes that underwent a triple procedure consisting of penetrating keratoplasty, extracapsular excision, and intraocular lens (IOL) insertion. MATERIALS AND METHODS: We studied 39 eyes from 36 patients who underwent a triple procedure associated with corneal transplantation at Tokyo Medical University between February 1989 and May 1996. The ages of the patients at the time of operation ranged from 61 to 91 years (mean, 70.9 +/- 10.8 years). The postoperative follow-up period ranged from 13.6 to 107.5 months (mean, 53.4 +/- 27.1 months). The following were evaluated: 1) cure rate of transparency, 2) complications, 3) time-related changes of endothelial cell density during 7 years after operation, and 4) comparison of changes in endothelial cell density associated with various factors such as primary disease, graft, IOL, and rejection. RESULT: The following results were obtained. 1. The cure rate of transparency of the graft at the last examination(a mean of 53.4 +/- 27.1 months after surgery) was 82.1%. 2. The incidence of rejection at the last examination was 35.9%. 3. The mean endothelial cell density in the graft was 2945.8 cells/mm2 before operation, and decreased to 1806.7 cells/mm2 one year after operation, and further to 1161.1 cells/mm2 five years after operation, showing a reduction of 60.6% compared to the mean before operation. 4. The annual rate of endothelial cell reduction in the same patient was approximately 25% the first year after operation and gradually lessened from the second year, reaching a stable level of 6% after the third year. 5. The punching method(done from the epithelial side), diameter of optical zone of IOL (6 mm or less), and rejection contributed to the reduction of endothelial cell density by one year after the operation. CONCLUSION: The triple procedure is considered to be a technique that may be chosen actively.

Aged↗
PubMed2001

[Capsulectomy via the pars plana--one of the possible definitive treatments for opacification of the posterior capsule] ].

The author demonstrates on a group of 27 eyes a possible definite solution of a serious complication of successful operation of cataract, i.e. secondary cataract. The latter reduces due to its frequent incidence markedly the visual acuity. The approach with a vitrectome via the pars plana is a simple and permanent solution which beyond doubt has advantages as compared with YAG capsulotomy and polishing of the posterior capsule. The method is effective, cheap and the incidence of complications is minimal. Fluoroangiographic findings confirm its safety.

Capsulorhexis↗
PubMed2000

[Cataract extraction with rotated-chipping phacoemulsification in the capsule].

OBJECTIVE: To observe the clinical effects of rotated-chipping phacoemulsification in the capsule. METHODS: The operation of continuous circular capsulectomy, nuclear hydrodissection, cataract extraction with rotated-chipping phacoemulsification in capsule and intraocular lens implantation was performed on 215 eyes. RESULTS: Rotated-chipping technique was successfully completed in 215 eyes. In the operation 2 to 4 circles were rotated with the ultrasonic energy 19.3% for 12 seconds on average. The rate of corneal endothelium loss was 7.5%. CONCLUSION: The technique of rotated-chipping phacoemulsification in capsule is safe and rapid which can be used for cataracts with nuclei of various degrees in sclerosis.

Aged↗