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PubMed1951

Cataract extraction with erisophake.

Today the erisophake offers the most successful means for the intracapsular extraction of cataracts. The advantages of this method are that no counterpressure is required so that the incidence of vitreous loss is reduced; the vacuum cup provides a firmer grasp of the lens with less danger of rupture of the lens capsule; and the vacuum cup can be used for the delivery of practically all types of cataract in the adult, including intumescent and Morgagnian cataracts as well as lenses with exfoliating and friable capsules. While the forceps method of intracapsular extraction is generally successful in not more than 70 to 75 per cent of cases, the erisophake may offer success in 90 per cent of cases.

Adult↗
PubMed1995

Retinal detachment following intracapsular and extracapsular cataract extraction.

In 1984, our ophthalmology department switched from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE). We reviewed the postoperative incidence of retinal detachment (RD) in two consecutive series: (1) 604 eyes operated on by ICCE from 1982 to 1983 and (2) 1726 eyes operated on by ECCE from 1985 to 1986. Follow-up averaged 39 months in both groups. The RD incidence was 1.30% after ICCE and 0.41% after ECCE, a statistically significant difference. In both groups, the risk of RD was high for patients less than 70 years of age at the time of surgery but minimal for patients older than 70 years. The proportion of younger patients was significantly higher in the ICCE group (29.5%) than in the ECCE group (23.2%). When the data were stratified by age and the difference in age composition adjusted for statistically, the difference between the two groups in the incidence of postoperative RD was less pronounced. We conclude that although not significant at the 5% level after adjusting for age distribution, our results suggest a decreased risk of RD with ECCE.

Aged↗
PubMedDate not supplied

A preliminary review of extracapsular cataract extraction with posterior chamber intraocular lens implantation in Kaduna, Nigeria.

BACKGROUND: Extracapsular cataract extraction with posterior chamber intraocular lens implantation came into vogue recently in many ophthalmic centres in Nigeria for the management of cataract and its accompanying aphakia. Evaluation of this procedure in the hands of surgeons who converted newly to extracapsular cataract extraction with intraocular lens implant microsurgery was reviewed. This is with the view to assess and improve on their surgical skill considering their delayed take off due to lack of facility in the centre. METHOD: A retrospective study of the first 48 patients (50 eyes) who had extracapsular cataract extraction with posterior chamber intraocular lens implantation between September 1999 and December 2000 was carried out. RESULT: Forty-six patients had extracapsular cataract extraction with posterior chamber intraocular lens implant in one eye only, while 2 had the procedure in both eyes. Fifty-six (56%) percent of the patients were above 55 years old. Male to female ratio was 1.8:1.0. The preoperative visual acuity in 92% of eyes was equal to or less than 3/60. Six (6%) percent of the eyes had good visual outcome (6/6-6/18), 70% had borderline (6/24-6/60) on the 1st postoperative day. Visual outcome improved steadily with the passage of time as the immediate postoperative complications resolved. The main intra-operative complications were large anterior capsular tags (35.7%) and cortical lens remnants (50%); while striae keratopathy and corneal oedema (54.5%) constituted the main postoperative complications. CONCLUSION: Good visual outcome of greater than 80% with available correction is possible in the early postoperative period. Improved surgeons skill through re-training and refresher courses will guarantee a good outcome. Finally, microsurgical facilities must be put in place before a conversion course or training.

Adolescent↗
PubMed1992

Natural course of intraocular pressure after cataract extraction and the effect of intracameral carbachol.

Intraocular pressure (IOP) is known to increase after intracapsular cataract extraction, extracapsular cataract extraction (ECCE), and ECCE with intraocular lens (IOL) implantation. Many pharmacological agents have been used to prevent this IOP rise. We conducted a two-phase, randomized, prospective study to evaluate the natural behavior of IOP after cataract surgery and the effect of intraoperative intracameral carbachol on it. In phase 1, 102 cases were randomly assigned to three groups for recording IOP at 24, 48, or 72 hours after ECCE. The IOP at 24 (mean 20.3 mm Hg) and 48 hours (mean 22.3 mm Hg) was significantly higher than the preoperative IOP (mean 16.1 mm Hg); 26.3% of cases in group 1A (24 hours) and 44.1% of cases in group 1B (48 hours) had IOPs greater than or equal to 25 mm Hg. In phase II, intracameral carbachol (0.01%) was used in 30 cases of ECCE and in 30 cases of ECCE with IOL implantation. The IOP at 24 hours (mean 16.3 mm Hg) was not significantly higher than the preoperative IOP and only 11.6% of the cases had IOPs greater than or equal to 25 mm Hg. The mean IOP at 24 hours without carbachol was significantly higher than the mean IOP at 24 hours with it. There was no statistically significant difference between IOP in the two groups one week after surgery.

Adult↗
PubMed1998

Retinal detachment after cataract extraction in myopic eyes.

PURPOSE: To determine the incidence of retinal detachment (RD) after cataract extraction in people 40 years of age or older with axial myopia (i.e., axial length > or = 25.5 mm). SETTING: Fifteen Danish eye clinics. METHODS: Two hundred forty-five eyes had cataract extraction performed at 15 eye clinics; 237 eyes had extracapsular cataract extraction (ECCE) and 8 eyes, intracapsular cataract extraction (ICCE). Postoperative data were reported by the practicing ophthalmologists. Mean follow-up was 27 months (range 14 to 32 months). RESULTS: Five RDs occurred in the 245 eyes (2.0%). Excluding the ICCE cases and the two cases of combined cornea transplantation and ECCE, RD occurred in 4 of the 235 eyes that had ECCE (1.7%). The incidence after ECCE with posterior chamber lens implantation was 1.4%. Complete postoperative status was reported on 158 eyes. Forty-eight eyes (30.4%) had a neodymium:YAG capsulotomy and 3 (6.0%) developed an RD 1, 3.5, and 21 months after the capsulotomy. CONCLUSION: The RD incidence after ECCE with posterior chamber lens implantation was low but higher than that in unselected populations. The incidence increased after laser capsulotomy.

Adult↗
PubMed1995

One-year follow-up results of combined mitomycin C trabeculectomy and extracapsular cataract extraction.

PURPOSE: When patients with glaucoma require cataract surgery, combined procedures offer important advantages over cataract surgery alone. Because mitomycin C has improved the success rate of a trabeculectomy in patients at high risk for filtration failure, the authors investigated whether it also would increase the survival rate of functioning filters in combined procedures. METHODS: Patients with both cataract and glaucoma underwent combined mitomycin C trabeculectomy, extracapsular cataract extraction, and intraocular lens implantation. Mitomycin C (0.5 mg/ml) was applied topically to the trabeculectomy site for 5 minutes before the cataract extraction. Intraocular pressure (IOP), visual acuity, and astigmatism were measured preoperatively and postoperatively. One-year results are available for 74 patients. RESULTS: At 1 year, 54 (73%) of 74 patients had IOPs of 15 mmHg or less without glaucoma medications. Visual acuity was 20/40 or better in 44 (60%) of 74 patients. Ten (15%) patients had a shift of more than 2 diopters of astigmatism against the rule compared with preoperative values. No notable corneal epithelial toxicity was present. Postoperative symptomatic hypotony with the wound construction occurred in 3 (4%) of 74 patients, with 1 patient requiring surgical revision. Other potential complications of mitomycin C include endothelial toxicity (1 patient had decreased vision due to endothelial folds) and wound stability (1 patient had wound rupture after direct ocular trauma). CONCLUSION: The 1-year survival rate of a functioning trabeculectomy using mitomycin C in combined glaucoma and cataract surgery is encouraging. The longer-term benefits and possible adverse effects of mitomycin C in combined procedures are unknown and continue to be investigated.

Adult↗
PubMed1995

Cataract extraction in adults with retinopathy of prematurity.

OBJECTIVE: To review the results of lensectomies performed to remove visually significant cataracts in adults with regressed retinopathy of prematurity, with special reference to postoperative vision and retinal complications. METHODS: A chart review of consecutive cases of cataract extraction in eyes with visually significant lens opacities and regressed retinopathy of prematurity was conducted. RESULTS: Fourteen consecutive eyes with retinopathy of prematurity in 10 adult patients were identified as having undergone lensectomy to manage a visually significant cataract. These cataract extractions were performed between June 1970 and February 1993. There were eight women and two men aged 16 to 43 years at the time of lensectomy. A variety of lenticular opacities were noted, the most common of which was nuclear sclerosis. Additionally, the nuclei were frequently much harder than would be expected for the patient's age. Phacoemulsification with implantation of a posterior chamber intraocular lens was the most common technique for cataract extraction. Eight eyes experienced improvement in visual acuity. However, when preoperative visual acuity was less than 20/200, postoperative acuity of 20/60 or better was uncommon. Six eyes were being treated for glaucoma before lensectomy. Glaucoma control was facilitated after lensectomy in six eyes. No combined cataract extraction and filtering procedures were performed. One eye developed a rhegmatogenous retinal detachment 76 months after cataract extraction. The retina was successfully reattached, but the eye suffered a substantial decrease in visual acuity. CONCLUSION: Cataract extraction in adult patients with retinopathy of prematurity may improve visual acuity, facilitate examination and treatment of the posterior segment, and aid in the management of glaucoma. The risk of retinal complications in these patients does not appear to be excessive.

Adolescent↗
PubMed1992

Cataract extraction after proton beam irradiation for malignant melanoma of the eye.

We evaluated visual outcome and risk of metastases in patients who underwent cataract extraction after protonbeam irradiation of a uveal melanoma. A total of 84 patients underwent cataract extraction between 2 months and 11 years after irradiation. One year after cataract extraction, approximately half of the patients had visual acuity of 20/100 or better, and approximately one third had an acuity of 20/40 or better. Larger tumor size was highly correlated with poor visual outcome 1 year after extraction. Six patients underwent enucleation after cataract removal, five due to blind, painful eyes and one due to continued growth of a previously undiagnosed ring melanoma. The rate of metastases was not higher among patients who underwent cataract extraction (adjusted rate ratio, 0.83). Results suggest that cataract extraction offers improvement of vision in selected eyes previously irradiated for a uveal melanoma, without adding to the risk of metastases among patients undergoing the procedure.

Adult↗
PubMed1978

[Obligation to tolerance and reasonability of cataract extraction (author's transl)].

The reasonability of cataract extractions is mentioned with exposition of the interests of the insuring bodies and of the patient. We discuss individually the terms "medical treatment", "obligation to tolerance" and "reasonability". The surgical method and the general physical assessment of the patient earn special consideration for a "reasonable" cataract extraction. We also discuss the special situation of the surgeon.

Adult↗
PubMed1981

Medicare payments and changes in the rate of cataract extraction.

The influence of Medicare payments on cataract extraction was studied. This operation is now the most frequent one performed on Medicare beneficiaries. The rate per 1,000 has more than doubled. The aggregate number of operations has tripled since 1965. As the number of persons over 65 has only increased by 27% in that time and the number of ophthalmologists by 25%, it is evident that each surgeon is doing more cases. Analysis of two representative years of Medicare's payment records indicated that many more surgeons received high payments in 1977 than in 1972. This reflected an increase in fees, but also an increased number of cases. Just over 2% of surgeons received more than $75,000 for cataract surgery on Medicare beneficiaries. The suggested reasons for the findings are an absence of mutually accepted criteria for cataract extraction, Medicare's fee system, and public attitudes.

Aged↗
PubMed1994

Improved visual function and attenuation of declines in health-related quality of life after cataract extraction.

OBJECTIVE: To measure the effect of cataract extraction and lens implantation on elderly persons' health-related quality of life and on their ability to perform visual activities. DESIGN: Evaluations of health status were conducted preoperatively and at 3 and 12 months after surgery on patients scheduled for cataract extraction. SETTING: Patients were enrolled from the General Eye Service of the Massachusetts Eye and Ear Infirmary and 33 Boston practices. PATIENTS: The cohort consisted of 464 patients aged 65 years or older who were identified from the surgical schedule of the Massachusetts Eye and Ear Infirmary. At 3 to 12 months after surgery, 458 (99%) of the participants were successfully contacted. Health-related quality of life data were available for 419 (90%) to assess changes after surgery. MAIN OUTCOME MEASURES: Ophthalmologic examinations were performed preoperatively and during the follow-up period. The Activities of Daily Vision Scale (ADVS) and the Medical Outcomes Study 36-item short from (SF-36) were administered before surgery and at 3 and 12 months postoperatively to assess changes in health status. RESULTS: At 12 months after surgery, 95% of patients had improved Snellen visual acuity, 80% had improved ADVS scores, but only 36% had improved SF-36 physical functioning. Average scores on seven of eight SF-36 subscales worsened at 12 months. Patients with improved ADVS scores had significantly smaller declines across all SF-36 dimensions except for role limitations due to emotional problems. CONCLUSION: Improved visual function after cataract surgery was associated with better health-related quality of life, suggesting that age-related declines in health may be attenuated by improvements in visual function.

Activities of Daily Living↗
PubMed1998

Trabeculectomy function after cataract extraction.

OBJECTIVE: To examine the effect of cataract extraction (CE) after trabeculectomy on intraocular pressure (IOP) control. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: A total of 115 consecutive patients who underwent extracapsular CE (N = 58) or phacoemulsification (N = 57) with intraocular lens (IOL) placement after trabeculectomy were studied. INTERVENTION: Cataract extraction with IOL after trabeculectomy was performed. MAIN OUTCOME MEASURES: Preoperative, intraoperative, and postoperative factors were evaluated for association with loss of IOP control requiring additional medications, bleb needling, or further glaucoma surgery, using Kaplan-Meier survival analysis and Cox multivariate proportional hazards survival regression. RESULTS: After mean postoperative follow-up of 21.1 +/- 14.3 months, additional glaucoma medication or needling of the filtering bleb to maintain IOP control was required in 35 eyes (30.4%) and was significantly associated with intraoperative iris manipulation and early postoperative peak IOP greater than 25 mmHg. Additional glaucoma surgery was eventually required in 11 eyes (9.6%) and was significantly associated with age of 50 years or younger, preoperative IOP greater than 10 mmHg, and early postoperative peak IOP greater than 25 mmHg. The cumulative proportion of patients who did not require reoperation for glaucoma was 93% and 90% at 1 and 2 years, respectively. The mean IOP at last visit had increased 1.6 mmHg above the pre-CE level and did not vary significantly after the first postoperative month. The median interval from CE to the addition of glaucoma medication or bleb needling was 1.6 months (within 3 months in 20 of 33 eyes) and that from nonsurgical intervention to further glaucoma surgery was 3.6 months (before the 7th postoperative month in 6 of 11 eyes). Of 19 eyes with hypotony (IOP < or = 6 mmHg) before CE, 11 eyes remained hypotonous after CE despite an increase in the mean IOP from 4.6 to 7.5 mmHg. CONCLUSIONS: When CE is performed after trabeculectomy, age of 50 years or younger, preoperative IOP greater than 10 mmHg, intraoperative iris manipulation, and early postoperative IOP greater than 25 mmHg are associated with worsened postoperative IOP control. Most bleb failures occur soon after CE. Resolution of pre-existing hypotony after CE is unpredictable.

Adolescent↗
PubMed1999

Audit of extracapsular cataract extraction and posterior chamber lens implantation as a routine treatment for age related cataract in east Africa.

AIMS: To evaluate the outcome of extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens implantation (PC-IOL) in an African eye clinic during the transition from intracapsular cataract extraction to ECCE and PC-IOL. METHODS: A retrospective survey of 461 consecutive operations for age related cataract with a mean follow up of 52.9 weeks (range 0-275) and a minimum follow up of 4 weeks in 87.9% of eyes. RESULTS: A best corrected vision of 6/18 or better was obtained in 94.3% of eyes, and an uncorrected vision of 6/18 or better in 78.2% of eyes. Six eyes (1.5%) had a best corrected vision of less than 6/60. The visual acuity at 2 months was strongly predictive of the vision at 1 year or more after surgery. Preoperative biometry and IOL power calculation increased the proportion of eyes obtaining an uncorrected vision of 6/18 or better from 73.8% to 81.3%. Four eyes developed visually significant posterior capsule opacity. CONCLUSION: ECCE and PC-IOL can give very good results in an African setting. A better visual outcome should lead to increased demand for cataract surgery, which will eventually reduce the number of cataract blind people in Africa.

Aged↗
PubMed1996

Effect of cataract extraction with intraocular lens implantation on ocular hemodynamics.

PURPOSE: To investigate the effect of cataract extraction on ocular hemodynamics. SETTING: University Eye Clinic of Ulm, Germany. METHODS: In 51 consecutive patients assigned for cataract surgery, pulse amplitude, pulse volume, and pulsatile ocular blood flow were measured 1 day before and 3 days and 12 months after cataract extraction using an ocular blood flow tonograph. Statistical analysis was performed with Student's t-test and Wilcoxon signed-rank test. RESULTS: In the study eyes, 3 days after cataract surgery pulse amplitude, pulse volume, and pulsatile ocular blood flow had decreased from 2.5 to 2.1 mm Hg (P = .0014), 5.0 to 4.4 microliters (P = .0059), and 836.2 to 728.0 microliters/min (P = .0017), respectively. No statistically significant change between preoperative and 3 day postoperative measurements occurred in the fellow eyes. There was no significant difference in systemic blood pressure, heart rate, or IOP in study and fellow eyes before and 3 days after cataract surgery. The early reduction of pulse amplitude, pulse volume, and pulsatile ocular blood flow in the study eyes was not present 1 year postoperatively. CONCLUSION: Uncomplicated cataract extraction is associated with a temporary ipsilateral impairment of ocular hemodynamics. A neural mechanism triggered by cataract extraction may be involved in these temporary changes.

Adult↗
PubMed1987

10-Hz flash visual evoked potentials predict post-cataract extraction visual acuity.

Cataract patients suspected of having disease which might interfere with good postoperative visual function were referred for evaluation. Monocular steady-state luminance visual evoked potentials (VEPs) were elicited with closed eyes at a stimulus rate of 10 flashes/sec. VEPs were rated as either normal or abnormal. Patients with normal VEPs were predicted to have an acuity of 6/15 (20/50) or better. Patients with abnormal VEPs were predicted to have acuities of 6/18 (20/60) or worse. Postoperative acuities were determined for all patients who underwent surgery and who had no intraoperative or early postoperative complications. The association of preoperative VEPs and observed postoperative acuities were quantitatively compared by a 2 x 2 contingency table for the 59 eyes which met these criteria. The chi-square was significant (p less than 0.001). The overall accuracy of prediction was 76%. Accuracy was 80% for patients with a preoperative acuity of 6/60 (20/200) or better and 75% for those whose postoperative acuity was 6/120 (20/400) or worse. This difference was not statistically significant.

Cataract Extraction↗
PubMed1983

Cataract extraction in the 'nineties'.

A total of 55 cataract extractions were performed on 53 patients aged 90 years or more in the period 1972 to 1982. Assessment of the outcome was based on data from hospital records and on questionnaires to the patient's ophthalmologist and general practitioner. Cataract surgery had improved visual acuity in 42 patients. Only 25 patients (47%) could, however, utilize the improved visual acuity, and obtain some practical benefit from the cataract extraction. Thus, the benefits of cataract surgery seem to be reduced in this age group. The reasons appear to be a high frequency of severe macula degeneration, some degree of senility hindering the adaptation to aphakic spectacles, and a somewhat higher frequency of per- and post-operative complications. This suggests that indications for cataract surgery in very old patients should be limited, at least if rehabilitation with aphakic spectacles is planned. An earlier surgical intervention would probably have been advantageous in the majority of these patients.

Age Factors↗
PubMed2003

Iridociliary apposition in plateau iris syndrome persists after cataract extraction.

PURPOSE: To evaluate the ultrasound biomicroscopic appearance of the anterior segment before and after cataract extraction in eyes with plateau iris syndrome and to determine the effect of postoperative zonular relaxation on ciliary body position. DESIGN: Interventional case series. METHODS: Eyes with plateau iris syndrome scanned before and after cataract extraction between January 1994 and September 2001 were enrolled. The iridociliary relationship and the anterior chamber depth at a distance of 3 mm from the scleral spur were assessed. RESULTS: We examined six eyes of six patients. Mean patient age was 74.2 +/- 6.4 years (standard deviation [SD]) (range, 65-81 years). Mean refractive error was + 1.0 +/- 3.9 diopters [D] (range, -5.75-+5.50), and mean axial length was 21.85 +/- 0.77 mm (range, 20.90-22.95 mm). All eyes had undergone laser iridotomy and argon laser peripheral iridoplasty before cataract extraction. Ultrasound biomicroscopy examination revealed a narrow angle and absence of a ciliary body sulcus in all eyes with focal areas of iridotrabecular apposition in three eyes. Following cataract extraction, the anterior chamber depth increased (P =.0006, paired t test), while the iridociliary contact remained unchanged. CONCLUSIONS: Iridociliary apposition persists after cataract extraction in plateau iris syndrome. Whether the cause is congenital or acquired, or both, remains to be determined.

Aged↗