Open-sky capsulorrhexis in triple procedure: with or without trypan blue?
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Capsulorhexis↗
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[To establish and observe the experimental lens regeneration model in rabbits].
PURPOSE: To establish the lens regeneration model in New Zealand rabbits, observe the lens regeneration process to investigate the mechanism of lens epithelial cell growth and lens regeneration. METHODS: Lens extraction by endocapsular phacoemulsification was performed on 8 experimental eyes in New Zealand albino rabbits weighing approximately 1.5 - 2.5 kg. To restore a relative intact capsule bag, a little needle tip was inserted through the limbal wound to perform a 2 mm-lined anterior capsulotomy, which just permitted the insertion of a 21G phacoemulsification tip. Phacoemulsification extraction was applied to remove all lens cortical material and then Healon was injected intracapsularly to distend the capsule bag. With slitlamp, the procedure of le ns regeneration were observed and taken photographs. A histologic study on regenerated lens were also performed. RESULTS: The relative 3 different results on experimental eyes according to the size of anterior capsulotomy in surgical procedure. In 4 eyes, when the size of anterior capsulotomy is approximately 2 mm and the capsule bag is relatively intact, lens regeneration occured and it has a relatively normal translucent cortex and central nuclear opacity. Among other 4 surgical eyes, the lower half part of lens regeneration was still observed in one eye though the upper half of anterior capsule was damaged, whereas in other 3, owing to the whole anterior capsule lack nearly, lens regrowth was not noted in areas of pupil under the slitlamp biomicroscopy observation and the posterior capsule appeared as gray-white membrane opacity. Histologic study showed that lens epithelial cells in equatorial zone proliferate and differentiate into lens fibers and continues to refill the whole capsule bag. Lens fiber alignment was regular in the periphery of regenerated lens, whereas in the center opacity nuclear, the bulk of the regenerated lens material consisted of an eosinophilic disorganized lens fibers. In addition, there were much of irregular cellular proliferation in capsule wrinkling. CONCLUSION: Capsule is the support material of lens epithelial cells regrowth. Lens regeneration occurred in rabbits after restoring lens capsular integrity following endocapsule phacoemulsification lens extraction, which was the result of the lens epithelial cells proliferation and differentiation. The cellular proliferation and differentiation was associated with the of capsule morphosis.
Animals↗
Comparison of 23 gauge and 25 gauge anterior capsulotomy forceps.
In cataract surgery, the most commonly-used procedure for incision of the anterior capsule is continuous curvilinear capsulorrhexis (CCC), developed by Gimbel and Neuhann. As Gimbel has reported, CCC is a safe technique for phacoemulsification and aspiration (PEA) and intraocular lens (IOL) implantation. The optimum incision method for CCC is thought to be that of using anterior capsulotomy forceps. Recently, I have developed the side-port 23 gauge anterior capsulotomy forceps (23G forceps), manufactured by Asico, which can be manipulated via a small incision, as well as the side-port 25 gauge anterior capsulotomy forceps (25G forceps) and 25/23 gauge tapered anterior capsulotomy forceps (tapered forceps), manufactured by Inami, which are thought to provide even better ease of handling. In view of the fact that the visibility, ease of handling, bending, adverse effect on the wound, and effect on the cornea of these various forceps are important, the present comparison study among these forceps was conducted on pig lenses by means of 0.1 % trypan blue staining of the anterior capsule. It was found that capsulorrhexis was difficult with the 25G forceps because of the strong bend of the shaft. However, the tapered forceps has little bend, and like the 23G forceps, it showed outstanding handling and visibility and had little adverse effect on the wound.
Animals↗
Anterior lens capsule management in pediatric cataract surgery.
PURPOSE: To describe and analyze pediatric anterior capsulotomy techniques and make recommendations. METHODS: Five anterior capsulotomy techniques were compared using a porcine model. Extensibility was measured by calculating the mean stretch-to-rupture circumference of each capsulotomy (20 eyes per technique) as a percentage of its circumference at rest. Edge characteristics were reviewed using scanning electron microscopy. A 10-year review of consecutive pediatric cataract surgeries performed by the author focused on the anterior capsulotomy results. A worldwide survey was used to determine current practice patterns. RESULTS: Manual continuous curvilinear capsulorrhexis (CCC) produced the most extensible porcine capsulotomy (185%) with the most regular edge and is preferred by surgeons for patients aged 2 years and older. In the pseudophakic clinical cases reviewed, a radial tear developed in 3 (6.5%) of 46 manual CCC cases. Vitrectorhexis (porcine extensibility, 161%) is preferred by surgeons during the first 2 years of life. A radial tear developed in 16 (7.7%) of 208 vitrectorhexis pseudophakic eyes (29 tears in 284 pseudophakic eyes [10.2%] overall). The Kloti diathermy unit, Fugo plasma blade, and "can-opener" technique produced porcine capsulotomies of 145%, 170%, and 149% extensibility, respectively, and radial tears numbering 4 (21%) of 19, 5 of 8, and 1 of 2, respectively, in the clinical series. CONCLUSIONS: All five capsulotomy techniques are recommendable for children. Only the vitrectorhexis and manual CCC are commonly used today. Vitrectorhexis is well suited for use in infants and young children; manual CCC is best used beyond infancy, and it produces the most stable edge.
Animals↗
The 23 gauge capsulorrhexis forceps having a cystotome function.
We evaluate the operational performance of the 23 gauge capsulorrhexis forceps with a cystotome function. The 23 gauge capsulorrhexis forceps were applied in 6 complex cases such as cataract surgery after closed-angle glaucoma with shallow anterior chamber, mal mydriasis, or lens subluxation. In all cases, we measured each patient's gonio angle level and degree of mydriasis. The forceps can be used in all cases even shallow anterior chamber glaucoma, because the forceps have both the functions of forceps and a cystotome with 55 degrees angulated needle. Although lens subluxation was found in 5 out of the 6 cases during continuous curvi-linear capsulorrhexis (CCC), implantation of the intraocular lens (IOL) in the capsular bag was successfully completed in these 5 cases. The 23 gauge forceps were effective particularly in cases for cataract surgery after glaucoma operation.
Aged↗
[The surgical treatment for posterior capsule opacification in children with pseudophakic eyes].
OBJECTIVE: To evaluate the surgical technique and outcome of pars plana capsulotomy and vitrectomy with infusion through the limbus to remove the posterior capsule opacification (PCO) in children with pseudophakic eyes. METHODS: This technique was performed in 51 cases (57 eyes) of complicated PCO with pseudophakic eyes, which was almost impossible to remove through the Nd:YAG capsulotomy. Pre- and post-operative visual acuity, intraocular pressure, density of cornea endothelium and complications during and after the operation were observed. The mean follow up time was 30 months. RESULTS: The central opaque posterior capsule and anterior vitreous were successfully removed in all patients without complication. A round hole with 3-4 mm diameter was obtained at the central part of the posterior capsule. In all 57 eyes, a clear visual axis was obtained. The visual acuity in all patients was improved and achieved the best level in their history. Visual acuity equal to or better than 0.3 was obtained in 51.9% of all eyes at 3 months. There were no complications during the postoperative follow-up period, such as dislocation or damage of the IOL, corneal edema, vitreous prolapse, retina detachment and reocclusion of the visual axis. CONCLUSION: Pars plana capsulotomy and vitrectomy with infusion through the limbus is a safe and effective procedure to remove the PCO in pseudophakic eye, especially for the cases with dense and thick opaque capsule formed after IOL implantation in the children, which cannot be removed through the Nd:YAG capsulotomy.
Adolescent↗
[Combined laser instrumental extraction of congenital cataracts in children].
The authors have developed a new method for removal of congenital cataract in children, by taking into account its clinical forms, namely, combined laser instrumental extraction including YAG-laser anterior capsular rhexis, followed by removal of lens debris by the aspiration-irrigation technique. A differential technology of YAG-laser anterior capsular rhexis has been developed, by taking into account of age-specific features of the lens and eyes in children. The optimum energy modes and techniques have been defined for different clinical forms of congenital forms of congenital cataracts. An analysis of the outcomes and complications of extraction of congenital cataracts has indicated that the authors' combined laser instrumental extract procedure (75 operations) assures the better quality of anterior capsular excision, improves optical and functional effects, and reduces the frequency of some complications as compared to the routine instrumental procedure (107 operations) (p < 0.05-0.001). Clinicofunctional and immunological studies have provided evidence for that the YAG-laser technique has no significant effect on the child's eye. Combined laser instrumental extraction is indicated for the treatment of any forms of congenital cataracts in children.
Age Factors↗
Trypan blue staining of the anterior capsule: the one-drop technique.
Capsule staining is usually a two- or three-stage procedure in which trypan blue is injected under air, a viscoelastic device, viscoelastic mixed with dye, or compartmentalized viscoelastic and balanced salt solution. In these techniques, the consequent irrigation of the anterior chamber with balanced salt solution may lead to a less stable anterior chamber, a decrease of pupil diameter, and damage of the corneal endothelium. A modification of current injection techniques for staining the anterior capsule under a dispersive viscoelastic device with 1 drop of trypan blue by an ordinary 27-gauge anterior chamber cannula is described.
Capsulorhexis↗
[Preliminary results of primary implantation of flexible intraocular lenses in infants under 1 year of age].
The paper presents the results of surgical treatment in 12 (12 eyes) infants aged 3 to 11 months who had different forms of unilateral congenital cataract. The surgical techniques involved the following stages: formation of a sclerocorneal tunnel cut, 3.5 mm in width, anterior continuous circular capsulotomy (anterior capsular rhexis), aspiration-irrigation techniques for removal lens masses, implantation of a flexible intraocular lens (IOL) into the capsular sac, graded opening of the posterior capsule with anterior vitrectomy in some infants. The authors could achieve symmetrical capsular rhexis in 75% and intracapsular IOL fixation in all the cases. During 3-month-to-2-year follow-ups after surgery, IOL held its position in the capsular sac; IOL dislocation and lenticular body capture were not observed in any case.
Age Factors↗
Combined pars plana vitrectomy and cataract surgery: outcome of phacoemulsification versus manual extracapsular cataract extraction through a sclerocorneal tunnel.
BACKGROUND AND OBJECTIVE: To compare the results of combined pars plana vitrectomy and cataract extraction with intraocular lens implantation by phacoemulsification versus manual extracapsular cataract extraction through a sclerocorneal tunnel. PATIENTS AND METHODS: Retrospective chart review of all patients who underwent combined pars plana vitrectomy with intraocular lens implantation and phacoemulsification or extracapsular cataract extraction through a sclerocorneal tunnel between March 1992 and July 2002. RESULTS: Fifty-four eyes of 51 patients were evaluated. Mean age was 69.68 +/- 9.11 years, and mean follow-up was 9 months. Phacoemulsification was performed in 35 cases (64%) and manual extraction in 19 cases (36%). Visual acuity improved from mean logarithm of the minimal angle of resolution 1.69 +/- 0.54 before surgery to 1.22 +/- 0.76 after surgery. There was a greater improvement of visual acuity in the phacoemulsification group (0.59 +/- 0.67) than in the extracapsular cataract extraction group (0.22 +/- 0.68) (P = .06). Final visual acuity was correlated to the vitreoretinal pathology. Ultrasound biomicroscopy showed well-positioned foldable or rigid intraocular lens in the bag or in the sulcus. CONCLUSION: Combined cataract extraction by phacoemulsification or extracapsular cataract extraction through sclerocorneal tunnel and pars plana vitrectomy are safe and effective procedures.
Adult↗
Visual function and late complications after cataract surgery by phacoemulsification with primary posterior capsulotomy and intracapsular foldable intraocular lens implantation.
PURPOSE: Evaluation of visual function and late complications after cataract phacoemulsification with primary posterior capsulotomy and intracapsular foldable intraocular lens implantation in 22-months follow-up. MATERIAL AND METHODS: Twenty five eyes of 25 patients (mean age: 53 years) were included in the study. All the eyes underwent primary posterior thermal capsulotomy and in-the-bag foldable IOL (Acrysof) implantation. Postoperative visual acuity and complications were analyzed. RESULTS: The best corrected visual acuity 1.0 (Snellen chart) was achieved in 92% (23/25) of the eyes. The most frequent complication was a slight vitreous dislocation to the anterior chamber (4/25 of eyes--16%), resulting in the pupil deformation in two eyes (2/25 of eyes--8%). In one eye (1/25 of eyes--4%) retinal detachment was observed. None of the patients presented CME. CONCLUSIONS: A very good visual function and low rate of serious late complications suggest, that cataract phacoemulsification with primary posterior capsulotomy and in-the-bag foldable IOL implantation should be taken into consideration, as an option for preventing PCO. The results of the present study suggest the risk of retinal detachment and CME does not appear, to increase after the primary posterior capsulotomy. However, this conclusion has to be confirmed by randomized studies with longer follow-up period and larger series of patients.
Adult↗
Current trends in cataract surgery in Thailand--2004 survey.
OBJECTIVES: To survey and investigate the current trend of cataract surgery in Thai ophthalmologists in 2004. MATERIAL AND METHOD: Questionnaires were sent to 600 ophthalmologists who were the members of the Ophthalmological Society and Royal Colleges of Ophthalmologists of Thailand. Data received from 248 (41.3%) of the recipients were analyzed and compared with those from the previous survey. RESULTS: The majority of respondents were male (63.3%) while 36.7% were female. In cataract surgery, 99.2% were still doing cataract surgery, the average number of cataract surgery procedures per surgeon per month was 25.6, 89.8% preferred phacoemulsification, and 42.5% preferred acrylic lens. The posterior capsular tear was the most common complication. CONCLUSION: There are trends toward more cataract surgical procedures performed by a surgeon, increasing preference of topical anesthesia, small incision wound and foldable acrylic lenses which reflected the popularity of phacoemulsification.
Adult↗
Late postoperative capsular block syndrome.
The authors report the case of a 61-year-old man with late postoperative capsular block syndrome who had undergone phacoemulsification and posterior chamber intraocular lens (IOL) implantation 3 years earlier. He presented with a decreased vision in the right eye caused by the accumulation of liquefied milky fluid in the space between the posterior surface of IOL optic and the posterior capsule. Neodymium: YAG laser posterior capsulotomy allowed a resolution of the milky fluid and the improvement of the visual acuity to 20/20.
Capsulorhexis↗
Rates of posterior capsule rupture during cataract surgery among different races in Singapore.
INTRODUCTION: The aim of this study was to determine if racial differences exist in the rate of posterior capsule rupture (PCR) during cataract surgery in Singapore. MATERIALS AND METHODS: All intraoperative complications during cataract surgery were prospectively reported as part of a clinical audit programme. A retrospective review of all patients who sustained a PCR during cataract surgery between July 1995 and December 1998 was performed. RESULTS: Of 8230 consecutive eyes which underwent cataract surgery, 6951 (84.5%) were Chinese, 597 (7.3%) were Malay, 524 (6.4%) were Indian, and 158 (1.9%) were of other races. The overall incidence of PCR was 1.9%. The PCR rates were 1.8% [125 of 6951; 95% confidence interval (CI), 1.49 to 2.11] in Chinese, 2.0% (12 of 597; 95% CI, 1.01 to 3.57) in Malay, 2.7% (14 of 524; 95% CI, 1.13 to 3.56) in Indian, and 2.5% (4 of 158; 95% CI, 0.00 to 4.98) in other races. There was no statistical difference between the PCR rates (P = 0.62, chi-square test). CONCLUSION: Racial differences in Singapore do not have an effect on the rates of PCR during cataract surgery.
Adult↗
In ophthalmology new possibilities for the use Nd:YAG laser.
Results of the technical development in laser technology created new possibilities in ophthalmic surgery, too. The easy access to various lasers offers an extraordinary opportunity for eye surgeons. At the Department of Ophthalmology of the University Medical School of Debrecen we performed 1400 laser treatments in 1996. Out of that 1100 were retinal Argon laser coagulations because of diabetic retinopathy, 200 YAG laser capsulotomies because of secondary cataract, and 30 laser iridotomies because of glaucoma. Additional 70 laser treatments were performed for special indications. During the laser treatment of the retina and the choroid we use Argon gas lasers, whereas the Nd:YAG laser used in the anterior segment of the eye is a solid-state laser. Our pulse mode modus synchronized Nd:YAG apparatus can produce megawatts of energy in nanoseconds. Authors give an account of the Nd:YAG lasers' possibilities in therapy (capsulotomy, iridotomy), present the most frequent indications of treatments in 1996, and compare it with international literature data. Authors demonstrate the newest principles of the Nd:YAG laser treatment of secondary membranes that are occasionally formed in the anterior chamber especially in the area of the pupil following cataract surgery.
Aluminum Silicates↗