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PubMedDate not supplied

[Simultaneous extracapsular cataract extraction with trabeculectomy after uveitis].

Simultaneous cataract extraction and anti-glaucoma operation was performed in 11 patients (16 eyes) who suffered uveitis. In all the cases extracapsular extraction and double trabeculectomy were performed according to personal modifications. The cataract was extracted by extracapsular method and subsequently the trabeculectomy was executed at 11 and 1 o'clock. Normalization of the IOP was attained in 13 eyes, 3 eyes needed application of Timolol. The results encourage to further use of this procedure.

Cataract↗
PubMed1999

Retinal complications after cataract extraction in patients with high myopia.

OBJECTIVE: To assess risk factors and incidence of retinal complications after cataract extraction in patients with high myopia. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: One hundred eighteen patients with highly myopic eyes who had an axial length of 26 mm or more (mean axial length, 30.13 +/- 2.08 mm) and who underwent cataract surgery over a period of 6 years were studied. INTERVENTION: Patients underwent cataract extraction either by extracapsular cataract extraction (ECCE) or phacoemulsification. Prophylactic argon laser photocoagulation was performed in 13 eyes for retinal tears recognized before surgery and in 13 eyes after surgery; neodymium:YAG (Nd:YAG) laser capsulotomy was performed for patients with posterior capsule opacification (PCO) that affected the vision. MAIN OUTCOME MEASURES: Incidence of retinal detachment and PCO and percentage of prophylactic argon laser or of Nd:YAG laser treatments. RESULTS: Of the 118 eyes, 73 (61.9%) underwent ECCE and 45 (38.1%) underwent phacoemulsification. Posterior capsule opacification was the most common complication and was found in 30 eyes (25.4%). Thirteen patients (11%) received prophylactic laser treatment for retinal tears before cataract operation, and 13 more patients (11%) had postoperative retinal tears requiring laser treatments. None of these patients developed retinal detachment. Two patients (1.69%) developed retinal detachment within 6 months after their operations. There were no intraoperative complications, and postoperative Nd:YAG capsulotomy was not performed in these two patients. CONCLUSIONS: Active searching and prophylactic laser treatments for retinal tears developed before and after cataract extraction in patients with high myopia are recommended. This may lower the incidence of postoperative retinal detachment.

Adult↗
PubMed1997

Intraocular pressure increments after cataract extraction in glaucomatous eyes with functioning filtering blebs.

BACKGROUND AND OBJECTIVE: The effects of cataract extraction on intraocular pressure (IOP) were studied in glaucoma patients who had previously undergone trabeculectomy. PATIENTS AND METHODS: The files of 22 patients with 25 glaucomatous eyes with functioning filtering blebs who underwent cataract extraction were retrospectively reviewed. All patients had undergone pretrabeculectomy examination and had at least 18 months of follow-up after cataract surgery. Visual acuity, IOP, status of the filtering bleb, and the number of medications applied were recorded. RESULTS: The mean increase in IOP was 3.63 mm Hg, 3.84 mm Hg, 5.4 mm Hg, and 2.8 mm Hg at 3, 6, 12, and 18 months after cataract extraction, respectively. This elevation was statistically significant 3 months postoperatively (P < .001) and remained relatively constant thereafter. The postoperative IOP was still significantly lower than the pretrabeculectomy IOP (P < .001). CONCLUSIONS: Cataract extraction through corneal incisions in patients with functioning filtering blebs is followed by an increase in IOP. Cataract surgery in these patients does not neutralize the pressure-lowering effect achieved by the trabeculectomy, but it tends to elevate the post-trabeculectomy baseline pressure.

Aged↗
PubMed1997

Anesthesia providers' interventions during cataract extraction under monitored anesthesia care.

In 1993 Medicare paid more money to anesthesia providers for cataract surgery than for any other surgical procedure. Patients undergoing cataract surgery often receive monitored anesthesia care (MAC). Thus, cuts in anesthesia payments from Medicare for cataract surgery may be forthcoming. If few interventions were being done after a retrobulbar block was placed, then a registered nurse might be a safe alternative to an anesthesia provider to monitor the patient. The goal of this study was to describe interventions of anesthesia providers during cataract extraction after the placement of a retrobulbar block. Anesthetic records were reviewed for 560 consecutive cases of cataract extraction using MAC at a large tertiary medical center. Anesthesia providers performed interventions (e.g., administration of drugs) on 33% of patients after the retrobulbar block was in place (95% confidence bound, < 36%). In conclusion, insufficient evidence exists for managed care organizations or other groups to justify a change in practice toward a registered nurse monitoring patients undergoing cataract extraction with a retrobulbar block. Furthermore, until a prospective randomized study has been done, such organizations lack justification for decreasing the amount of time that anesthesia providers spend caring for such patients undergoing cataract extraction.

Cataract Extraction↗
PubMed1982

Extracapsular cataract extraction with hyaluronate sodium.

Extracapsular cataract extraction may result in a lower incidence of cystoid macular edema, but it may be a different operation from a technical standpoint. We tried a method using 1% hyaluronate sodium (Healon) as the irrigating vehicle during the procedure. The high viscosity of hyaluronate prevents posterior capsule rupture and its coating effect protects the corneal endothelium from trauma. In the study 20 eyes received the extracapsular extraction using a traditional technique with balanced salt solution. Another 20 eyes received the surgery using hyaluronate. The resulting endothelial cell counts, postoperatively, showing significantly less loss of endothelial cell using hyaluronate.

Adolescent↗
PubMed1992

Neuroleptanalgesia and extracapsular cataract extraction.

Peribulbar and retrobulbar anaesthesia are commonly used techniques in cataract extraction. They offer satisfactory analgesia and akinesia but serious complications although uncommon are consistently reported. Intravenous sedation combined with a facial nerve block offers an alternative method of anaesthesia. This is a retrospective study of patients who underwent extracapsular cataract extraction using this technique between 1 January 1986 and 1 September 1990. The operating conditions were judged to be very suitable with minimal peroperative complications. The postoperative ocular complication rate was low (minimum follow-up 3 months) and no serious medical complications were noted: 93.8% of patients achieved 6/12 vision or better. This study demonstrates that it is possible to achieve satisfactory ocular analgesia and akinesia during cataract extraction under local anaesthesia without the use of a periocular injection.

Adult↗
PubMed1990

[Extracapsular cataract extraction for highly myopic patients].

Extracapsular cataract extraction was performed on 54 cataract cases with high myopia. During a follow-up of 5-18 months, the corrected visual acuity was 0.1-0.2 in 18 cases (33%), 0.3-0.5 in 16 cases (30%), 0.6-0.9 in 8 cases (15%), and 1.0 or over in 7 cases (13%). The major complications included intraoperative posterior capsular tear in 3 cases, secondary glaucoma due to residual cortex in 2 cases, posterior capsular opacity in 7 cases, cystoid macular edema in 1 case, and retinal detachment in 1 case. The study indicated that ECCE was safe and desirable for highly myopic patients.

Adult↗
PubMed2006

The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series.

PURPOSE: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. MATERIALS AND METHODS: Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. RESULTS: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). CONCLUSIONS: In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.

Aged↗
PubMed2001

[Grave complications of local anesthesia for cataract extraction: reports of 8 cases].

Cataract extraction performed under local anesthesia is not so safe. During a 2 years period, 8 patients have presented a complication: 3 patients are presented with diplopia, 4 patients are presented with eyeball perforation and 1 patient developed a central complication. All those complications are caused by the superior peribulbar injections of anesthetics. A survey of the different etiologies of the superior rectus muscle blow and of eyeball perforation is given.

Adult↗
PubMed1982

Simultaneous trabeculectomy and cataract extraction.

A combined trabeculectomy and cataract extraction was performed on 46 eyes of 39 patients. The average follow-up period was of 27 months. The intraocular pressure remained controlled without the need of postoperative medication in 33 eyes (71.74%); 12 eyes (26.09%) needed further medical treatment; and in one eye the pressure remained uncontrolled and further surgery was necessary. After surgery the visual acuity improved considerably and the complications were few. The combined procedure has many advantages. The patient is cured by one surgical procedure, his visual acuity improves, his intraocular pressure is reduced to normal, and he is relieved from the need for medication postoperatively. By a single stay in hospital and by reducing the number of postoperative medical routine controls the expenses are reduced considerably. Owing to these advantages the combined procedure deserves to be considered in cases of glaucoma and cataract.

Aged↗
PubMed1998

Association of inhaled corticosteroid use with cataract extraction in elderly patients.

CONTEXT: The use of systemic corticosteroids is a known risk factor for the development of cataracts. OBJECTIVE: To determine whether treatment with inhaled corticosteroids is associated with cataract extraction in the elderly. DESIGN: Case-control study. SETTING: Quebec universal health insurance program for all elderly (provincial health insurance plan database [RAMQ database]). PATIENTS: RAMQ enrollees 70 years and older. The 3677 cases were patients with a cataract extraction between 1992 and 1994. The 21868 controls were randomly selected from patients who did not have a diagnosis of cataract and matched to cases on the index date of the case. MAIN OUTCOME MEASURES: Odds ratio of cataract extraction in patients with prolonged cumulative exposure to inhaled corticosteroids compared with nonusers. RESULTS: Excluding patients with systemic steroid treatment and after adjusting for age, sex, diabetes, systemic hypertension, glaucoma, ophthalmic steroids, and the number of physician claims for services, use of inhaled corticosteroids for more than 3 years was associated with undergoing cataract extraction (odds ratio [OR], 3.06; 95% confidence interval [CI], 1.53-6.13). For high average daily doses of beclomethasone or budesonide (>1 mg), the OR was elevated after more than 2 years of treatment (OR, 3.40; 95% CI, 1.49-7.76), whereas for low to medium doses (< or =1 mg) of these drugs, the OR was 1.63 (95% CI, 0.85-3.13) after 2 years. CONCLUSION: Prolonged administration of high doses of inhaled corticosteroids increases the likelihood of undergoing cataract extraction in elderly patients. Further studies are needed to investigate the risk of developing cataracts for low to medium doses over longer periods.

Administration, Inhalation↗
PubMed2006

Stenotrophomonas maltophilia Endophthalmitis after cataract extraction.

PURPOSE: To report the clinical course, treatment response, and prognosis of Stenotrophomonas maltophilia endophthalmitis following cataract extraction. METHODS: The clinical records of six cases of S. maltophilia endophthalmitis after cataract extraction were retrospectively reviewed. Data were collected for surgical characteristics, disease course, culture growth, antibiotic sensitivity of the pathogen, response to treatment, and final visual acuity. RESULTS: Four patients underwent uncomplicated cataract extraction with phacoemulsification (PHACO) and intracapsular intraocular lens (IOL) implantation. One case was complicated by inadvertent posterior capsular tear during PHACO and IOL implantation. One patient underwent a combined extracapsular cataract extraction (ECCE) with IOL implantation and trabeculectomy, but vitrectomy was also performed because of cortical material loss into the vitreous cavity after a capsular tear. Symptoms began between postoperative days 1 and 19. All patients underwent a vitreous tap and intravitreal injections of antibiotics. Medical therapy alone was sufficient in five patients to treat the infection. One patient had four episodes of recurrence. Pars plana vitrectomy with subsequent capsulectomy and IOL extraction were performed in this patient to complete remission. CONCLUSION: S. maltophilia should be considered a pathogenic organism possibly causing endophthalmitis after PHACO+IOL implantation. The clinical picture resembles acute bacterial endophthalmitis. When the pathogen has settled in the capsular bag, the infection may persist and become refractory to medical treatment.

Aged↗
PubMed2001

Cataract extraction rates among Chinese, Malays, and Indians in Singapore: a population-based analysis.

OBJECTIVE: To describe the rates of cataract extraction among Chinese, Malays, and Indians in an urban population in Asia. DESIGN: Population-based incidence study using data from a medical savings fund. STUDY POPULATION: Chinese, Malay, and Indian residents in Singapore. METHODS: Data on all cataract operations performed for "senile cataract" (International Classification of Diseases, Ninth Revision, Clinical Modification code 366.1) between 1991 and 1996 were retrieved from Medisave, a population-wide, government-administered medical savings fund. The Singapore census was used as a denominator to allow an estimation of age, sex, and race-specific annual rates of cataract surgery. RESULTS: Between 1991 and 1996, 61 210 cataract operations for "senile cataract" were performed on Singapore residents, which is equivalent to an average rate of 356.4 cataract operations per 100 000 persons per year (95% confidence interval [CI], 353.6-359.2). The average rate was highest for Indians (age-sex adjusted rate of 396.5 per 100 000/year), followed by Chinese (371.2 per 100 000/year), and lowest for Malays (237.2 per 100 000/year). Women had higher rates of cataract extraction than men (age-adjusted relative risk, 1.14; 95% CI, 1.11-1.17), with this pattern consistent across the 3 racial groups. The rate of cataract extraction increased by an average of 40 operations per 100 000/year (95% CI, 28.6-52.8) between 1991 and 1996. Overall, the proportion of cataract extraction without concurrent intraocular lens implantation was low (n = 762, 1.2%), but rates still decreased by an average of 0.8 per 100 000 per year (95% CI, 0.03-1.5) during the 6 years. CONCLUSIONS: The rate of cataract extraction in Singapore is consistent with rates seen in developed countries in the West. Racial variation in rates suggests varying predisposition to cataract development and/or threshold for cataract surgery between Chinese, Malay, and Indian populations in Singapore.

Adult↗
PubMed1997

Effect of cataract extraction on the results of automated perimetry in glaucoma.

OBJECTIVE: To investigate the effect of cataract extraction on the results of automated perimetry in persons with glaucomatous visual field loss. SUBJECTS: Subjects from a retrospective study of visual field progression who underwent cataract extraction during follow-up were identified. Subjects came from the glaucoma service of a hospital-based tertiary referral center. METHODS: Subjects had at least 7 Humphrey 24-2 or 30-2 visual fields over 5 years or more, with an abnormal glaucoma hemifield test result on the first 2 examinations. Visual field data were transferred to a microcomputer and comparison of the visual fields immediately before and after cataract extraction was performed. RESULTS: Sixty-five eyes of 50 subjects (mean age, 71.8 years) were included in the analysis. A mean improvement in mean deviation (MD) of 1.68 dB (P<.001), and a mean worsening in corrected pattern SD (CPSD) of 0.54 dB (P=.09) was observed. The mean unweighted change in threshold in the 52 points of program 24-2 was 1.58 dB, corresponding to a 43.9% increase in sensitivity. A significant correlation between improvement in visual acuity and improvement in MD was also found. A mean increase in CPSD of 1.61 dB (P=.005) occurred in subjects with dense scotomas (minimum threshold value < or = 5 dB) and preoperative CPSD of 8 dB or less. CONCLUSIONS: In persons with glaucomatous visual field defects, cataract extraction produces only a modest improvement in MD. After cataract surgery, the CPSD index worsened in many subjects with dense scotomas. This suggests that the development of cataract can mask progressive glaucomatous visual field loss in such persons.

Aged↗
PubMed1995

Transscleral suture fixation of posterior-chamber lenses after cataract extraction associated with vitreous loss.

From 1987 to 1993, 21 patients who had undergone complicated cataract extraction that was associated with vitreous loss and transscleral suture fixation of the posterior-chamber lens (PC-IOL) in one eye (group A) and uncomplicated in-the-bag implantation of the PC-IOL in the fellow eye (group B) were followed prospectively. The follow-up period was 29.5 months (SD, +/- 17.0 months) in group A and 36.6 months (+/- 24.0 months) in group B. Visual acuity did not differ significantly between the two groups (P = 0.60, Wilcoxon test). In all, 17/21 patients in group A and 16/21 patients in group B achieved a visual acuity of > or = 20/40. Postoperative refractions measured in group A were +0.68 D more hyperopic than those measured in group B (P < 0.04). This result was consistent with the postoperative finding of a significantly deeper anterior chamber in group A (mean, 0.44 mm; P < 0.03). The accuracy of the desired postoperative refraction was poorer in group A. The risk for retinal detachment, cystoid macular edema, and intraocular pressure elevation was increased in patients who had had capsular defects and vitreous loss during cataract extraction. Nevertheless, transscleral suture fixation of PC-IOLs in patients with complicated cataract extractions associated with vitreous loss can give acceptable visual results. We recommend that +0.5 D be added to the calculated IOL power when severe complications require transscleral suture fixation of the PC-IOL during cataract extraction.

Aged↗
PubMed1982

Extracapsular cataract extraction with a posterior chamber intraocular lens-technique and results.

The author's preferred technique for extracapsular cataract extraction with insertion of a posterior chamber intraocular lens implant is described. Although automated devices are not available and are unattractive to many ophthalmologists, the author finds such equipment provides the safest means of making the conversion from intracapsular to extracapsular cataract extraction. In the planned extracapsular cataract extraction, a "beer can" anterior capsulotomy is performed and the nucleus is removed as described. The residual lens cortical material is aspirated using the Cavitron machine. The Cavitron machine is also used for phacoemulsification which is performed in the posterior chamber. A Shearing type posterior chamber lens is used when indicated. A primary posterior capsulotomy is performed routinely. An analysis of the first 800 such procedures is made with each case being examined 11-14 months postoperatively. Compared to intracapsular cataract extraction with an intraocular lens, the results are favourable, especially regarding the rate of cystoid macular edema, retinal detachment, and corneal edema.

Aged↗
PubMed2005

Duration of self assessed benefit of cataract extraction: a long term study.

AIM: To investigate how long patients' improved visual function lasts after a cataract extraction. METHODS: Patients' self assessed visual function was evaluated using the Catquest questionnaire both before and 6 months after a cataract extraction. The study population consisted of 615 patients undergoing a cataract extraction during 1995-2002. A final follow up with a new questionnaire was performed in 2003, between 1 year and 8 years after surgery. RESULTS: 445 (72.4%) patients were alive at follow up and agreed to participate in the study. The number of subjects still showing improved visual function after surgery decreased with longer follow up. After 7 years, 80% had improved visual function compared with before surgery. 50% of all originally operated subjects were alive 7 years postoperatively and enjoyed better visual function than they had done before surgery. Ocular co-morbidity in the operated eye or self assessed poor visual function before surgery was significantly related to deteriorated visual function at follow up. CONCLUSION: The number of subjects who experienced improved visual function after a cataract extraction decreased over the course of time postoperatively. Presence of ocular co-morbidity was significantly related to worsened function.

Aged↗