[Outpatient treatment of postcataract using the neodymium-Yag laser].
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Aphakia, Postcataract↗
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A quality assessment of aphakic correction.
An assessment of the quality of care being provided to meet the needs of postcataract aphakes for refractive correction is presented. The procedure used was a review of patient records originally developed for inpatient care but was here applied to outpatient care in a centralized health facility. This paper demonstrates the feasibility and value of this method of quality assessment.
Adult↗
Retrospective comparison of surgical techniques to prevent secondary opacification in pediatric cataracts.
PURPOSE: To evaluate the effect of different surgical methods for management of the posterior capsule and anterior vitreous on the rate of posterior capsule opacification in pediatric cataracts. METHODS: Charts of 34 children (47 eyes) aged 40 days to 18 years (mean: 8.5 years) who had primary cataract surgery with or without posterior chamber intraocular lens (IOL) implantation during the past 5 years were reviewed. In 26 eyes, cataracts were managed with a posterior continuous curvilinear capsulorhexis, and in 21 eyes, the posterior capsule was left intact. Follow-up averaged 10 months (range: 6.5 months to 5 years). RESULTS: Visually significant secondary cataract developed in nine eyes with intact posterior capsules, and seven eyes required Nd:YAG laser posterior capsulotomy. The average time for YAG capsulotomy postcataract removal in the second group was 4 months. The visual axis remained clear in all eyes that had posterior continuous curvilinear capsulorhexis with or without posterior chamber IOL. Complications such as fibrinoid membrane, stromal edema, posterior synechiae, updrawn pupil, and transient glaucoma occurred in both groups at a similar rate. CONCLUSION: Primary posterior continuous curvilinear capsulorhexis is an effective method for preventing secondary cataract formation in pediatric cataracts.
Adolescent↗
Frequency and predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation.
PURPOSE: To determine the frequency and to identify predictors of retinal detachment after pediatric cataract surgery without primary intraocular lens implantation. METHODS: Retrospective review at an eye hospital identified 1017 eyes among 579 patients who underwent limbal-approach surgery without primary IOL implantation at age < or =16 years for cataract unassociated with other ocular abnormalities aside from microcornea. Patients had a minimum of 2 years postoperative follow-up. The outcome measure was the presence or absence of postcataract surgery retinal detachment, and analyses were performed on patients' eyes with adjustment for intrasubject correlation. RESULTS: Mean postcataract surgery follow-up was 6.8 +/- 3.6 years (range, 2.0 to 18.3 years). Retinal detachment developed in 33 (3.2%) of the 1017 patients' eyes and was diagnosed at a mean of 6.8 +/- 4.4 years postcataract surgery (range, 0.4 to 14.8 years). Multivariable Cox proportional hazards regression analysis with adjustment for intrasubject correlation identified an aphakic refractive error more myopic than the age-adjusted aphakic norm [hazard ratio (HR), 5.9; 95% confidence interval (CI), 1.9 to 18.0; P = 0.002] and postcataract surgery wound dehiscence (HR, 15.4; 95% CI, 2.2 to 108.5; P = 0.006) as predictors of retinal detachment; a primary posterior capsulotomy/anterior vitrectomy procedure was not predictive of retinal detachment. CONCLUSIONS: Retinal detachment is infrequent following pediatric cataract surgery without primary IOL implantation, at least with short-term follow-up. A postoperative aphakic refractive error more myopic (less hyperopic) than the age-adjusted aphakic norm is predictive of this complication.
Adolescent↗
[Increase in the intraocular pressure in postcataract surgery using a neodymium YAG laser].
In a prospective clinical study 54 postcataract membrane dissections (51 patients) were performed using a Q-switch Nd-YAG laser. Under standardized conditions all patients were pretreated with prostaglandin inhibitors and received topical steroids and beta-blockers in low concentrations, as well as carbonic anhydrase inhibitors orally. The changes in visual acuity and the response of IOP to total energy input were analyzed. There was no statistically significant correlation between postoperative rise in IOP and total energy input. The clinical relevance of the results is discussed.
Adult↗
Recent developments in ophthalmology. Advances in correction of the optical problems of the postoperative cataract patient.
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Aphakia, Postcataract↗
Visual outcomes following lensectomy and vitrectomy for combined anterior and posterior persistent hyperplastic primary vitreous.
OBJECTIVE: To determine the visual outcome after surgery for persistent hyperplastic primary vitreous using modern vitreoretinal techniques. DESIGN: Retrospective medical record review during a 5-year period (June 1992 to June 1997). Information recorded for each patient included age, medical history, sex, results of preoperative ocular examination, age at diagnosis, procedure performed, intraoperative and postoperative complications, location and number of sclerotomy sites, type of aphakic rehabilitation, amblyopic therapy given, final visual acuity, and length of follow-up. RESULTS: Fourteen patients who underwent surgical management of combined anterior and posterior persistent hyperplastic primary vitreous were identified. Eleven patients underwent aphakic rehabilitation and aggressive amblyopic therapy consisting of occlusive therapy for several waking hours each day. One additional older patient received aphakic rehabilitation only. Ten eyes (71%) achieved a visual acuity of 20/300 or better, and 8 (57%) obtained a final visual acuity of 20/100 or better. Average length of follow-up was 22 months (range, 4-57 months). Nine patients were fitted with an aphakic soft contact lens, 2 older patients had a posterior chamber intraocular lens placed at the time of vitrectomy, and 1 patient wore aphakic spectacles. CONCLUSIONS: With modern vitreoretinal techniques, aphakic rehabilitation, and aggressive amblyopic therapy, useful vision can be obtained in the majority of patients with combined anterior and posterior persistent hyperplastic primary vitreous.
Amblyopia↗
Pneumatic retinopexy: results in eyes with classic vs relative indications.
OBJECTIVE: To compare the results of pneumatic retinopexy in 3 groups of eyes with rhegmatogenous retinal detachment. METHODS: In this retrospective, consecutive study, 44 eyes of 44 patients who underwent pneumatic retinopexy were divided into 3 groups: eyes with vitreoretinal abnormalities (group A), pseudopakic or aphakic eyes (group B), and phakic eyes without vitreoretinal abnormalities (group C). RESULTS: Single retinopexy success was achieved in 10 (71%) of 14 eyes in group A, 7 (64%) of 11 eyes in group B, and 16 (84%) of 19 eyes in group C (P=.42). Final success after reoperation was achieved in 13 (93%) of 14 eyes in group A, 10 (91%) of 11 eyes in group B, and in all 19 eyes in group C (P=.44). In group B, the rate of single retinopexy success using cryotherapy was significantly higher (5/5; 100%) than when laser photocoagulation was used (1/5; 20%) (P=.015). The final visual outcome obtained in the 3 groups was similar. There were no significant intergroup differences in either early or late complications. CONCLUSIONS: The best results were achieved in eyes with classic indications for pneumatic retinopexy, though the differences between these results and those in the nonclassic indications were not significant. In pseudophakic or aphakic eyes, the rate of single operation success after cryopexy was significantly higher than the rate after laser photocoagulation.
Adolescent↗
Aphakic glaucoma after congenital cataract surgery.
OBJECTIVE: To describe the largest series of patients who developed aphakic glaucoma after lensectomy for congenital cataracts. METHODS: A retrospective review was performed of all patients seen by a pediatric glaucoma specialist between October 1, 1970, and November 30, 2002. Patients with intraocular pressures greater than 25 mm Hg after lensectomy were studied. Patients with either conditions independently associated with glaucoma or any signs of glaucoma before lensectomy were excluded. RESULTS: We studied 170 eyes of 117 patients. The mean +/- SD follow-up period was 8.6 +/- 7.6 years. The most common cataract types were complete (40.8%) and nuclear (22.5%). For the lensectomies, 103 eyes underwent modern vitrectomy techniques, and 10 underwent older techniques. Lensectomies were performed in 80.6% of eyes before age 1 year. Onset of glaucoma after lensectomy was by 1 year in 37.1% of eyes, by 6 years in 75.9%, and by 33 years in 100%. Of eyes that had gonioscopy, 93.9% had open angles. Glaucoma surgery was needed in 57.1% of eyes. The median final visual acuity was 20/400. CONCLUSIONS: Most cases of aphakic glaucoma are of the open-angle type. Various risk factors are suggested, and the prognosis is guarded. Lifelong follow-up is needed to screen for glaucoma.
Aphakia, Postcataract↗
Prevalence of cataract and pseudophakia/aphakia among adults in the United States.
OBJECTIVES: To determine the prevalence of cataract and pseudophakia/aphakia in the United States and to project the expected change in these prevalence figures by 2020. METHODS: Summary prevalence estimates of cataract and of pseudophakia/aphakia were prepared separately for black, white, and Hispanic persons (for whom only cataract surgery data were available) in 5-year age intervals starting at 40 years for women and men. The estimates were based on a standardized definition of various types of cataract: cortical, greater than 25% of the lens involved; posterior subcapsular, present according to the grading system used in each study; and nuclear, greater than or equal to the penultimate grade in the system used. Data were collected from major population-based studies in the United States, and, where appropriate, Australia, Barbados, and Western Europe. The age-, gender-, and race/ethnicity-specific rates were applied to 2000 US Census data, and projected population figures for 2020, to obtain overall estimates. RESULTS: An estimated 20.5 million (17.2%) Americans older than 40 years have cataract in either eye, and 6.1 million (5.1%) have pseudophakia/aphakia. Women have a significantly (odds ratio = 1.37; 95% confidence interval, 1.26-1.50) higher age-adjusted prevalence of cataract than men in the United States. The total number of persons who have cataract is estimated to rise to 30.1 million by 2020; and for those who are expected to have pseudophakia/aphakia, to 9.5 million. CONCLUSION: The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years as the US population ages.
Adult↗
Blood-aqueous barrier changes after the use of prostaglandin analogues in patients with pseudophakia and aphakia: a 6-month randomized trial.
OBJECTIVES: To investigate the effects of prostaglandin analogues on the blood-aqueous barrier and to evaluate the occurrence of cystoid macular edema in aphakic or pseudophakic patients with glaucoma. METHODS: In this randomized, masked-observer, 6-month clinical trial, patients with primary open-angle, pseudophakic, or aphakic glaucoma were treated once daily with bimatoprost (n = 16), latanoprost (n = 15), or travoprost (n = 17) or twice daily with unoprostone (n = 16) or lubricant drops (control group) (n = 16). Blood-aqueous barrier status, which was assessed using a laser flare meter; intraocular pressure; the occurrence of angiographic cystoid macular edema; and conjunctival hyperemia were evaluated. RESULTS: Mean flare values were significantly higher in the bimatoprost, latanoprost, and travoprost groups throughout follow-up (P < .02). Four latanoprost-treated eyes, 1 bimatoprost-treated eye, and 1 travoprost-treated eye developed cystoid macular edema; all cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac sodium. Mean intraocular pressure reductions after 6 months were higher for the latanoprost (26%), bimatoprost (28%), and travoprost (29%) groups than for the control (3%) and unoprostone (14%) groups (P< .05). Bimatoprost induced significantly higher hyperemia scores than latanoprost, unoprostone, and placebo (P< .01). CONCLUSION: Bimatoprost, latanoprost, and travoprost use may lead to disruption of the blood-aqueous barrier in patients with pseudophakia and aphakia.
Aged↗
Spontaneous anterior capsular rupture associated with anterior polar cataract.
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Anterior Eye Segment↗
Correlation of epinephrine use and macular edema in aphakic glaucomatous eyes.
One hundred twenty-eight consecutive aphakic glaucomatous eyes of 91 patients were examined by fluorescein angiography. Macular edema was present in 16 (28%) of 56 eyes currently being treated with epinephrine and 9 (13%) of 72 eyes not currently being treated with epinephrine. This difference is statistically significant at the 95% confidence level. Epinephrine therapy was discontinued in seven eyes with macular edema. A follow-up of these patients for six months to one year with serial anglograms showed resolution of edema in six of seven eyes. In one eye without macular edema, administration of epinephrine was associated with appearance of edema. Discontinuing epinephrine therapy was associated with resolution of edema. No significant correlation was found between use of other antiglaucomatous medications and macular edema. It is evident from this study that there is statistical support for the concept of an epinephrine-induced macular edema.
Adult↗
Retinal detachment in the second eye.
Bilateral retinal detachment (RD) occurred in 13% of 737 patients, with an interval between detachments of up to 30 years. Bilateral RD was more common in male patients and in those having more than 3 diopters of myopia. Detachment in the second eye was caused by retinal breaks in previously observed degeneration in 43% and in unsuspected diseased retina 57%. A significant number of patients with bilateral RD had multiple breaks. Aphakic RD occurred in bilateral RD and in unilateral RD patients at a comparable frequency; 28% of bilateral (mean duration, four years) and 35% of unilateral aphakic RDs occurred within one year of cataract surgery. Symptoms from retinal breaks were not reliable prognostic factors; only 39% of patients had warning before RD. Patients with bilateral RD had more reoperations with fewer successes, factors suggesting greater severity than unilateral RD.
Adolescent↗
Clinical evaluation of the 6600 Autorefractor.
The 6600 Autorefractor was evaluated on 200 patients undergoing refraction. The automatic refractor showed a high degree of accuracy in determining the needed refractive correction, but the errors are sufficient that the automatic refractor alone without subjective refinement cannot be substituted for conventional complete refracting methods with subjective refinement. However, for aphakic patients and for patients with clear media and cylindric corrections over 0.50 diopters, the automatic refractor can be used as a substitute for retinoscopy in determining the starting point for a subjective refraction.
Adolescent↗
Transplant size and elevated intraocular pressure. Postkeratoplasty.
Elevated intraocular pressure after keratoplasty is a well-recognized phenomenon both in aphakia and in combined lens extraction and penetrating keratoplasty. Ninety-two consecutive cases of penetrating keratoplasty procedures were studied. These were randomly assigned to group A or B. Group A received a donor transplant 0.5 mm larger than the recipient bed. Group B received donor buttons equal in size to the recipient bed. Intraocular pressure was measured preoperatively and daily until the patients were discharged. Group A, which had aphakic penetrating keratoplasty or the combined procedure (0.5-mm larger button), also had significantly lower intraocular pressures (P less than .001) than group B (same size button). There was no difference in postoperative intraocular pressure between groups A and B for those who had phakic penetrating keratoplasties. A larger donor size can alleviate induced "aphakic keratoplasty glaucoma."
Aged↗
Aphakic keratoplasty. Determining donor tissue size to avoid elevated intraocular pressure.
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Aphakia, Postcataract↗
Determinants of graft clarity in penetrating kerotoplasty.
A total of 240 consecutive penetrating keratoplasties with a minimum six months' follow-up were examined to determine the influence of preoperative prognosis, donor age, death-enucleation time, death-surgery time, and surgical experience on graft clarity. Graft results, classified as clear, nebulous, or edematous, were compared within two prognostic categories in aphakic, combined, and phakic keratoplasty groups. Preoperative prognostic groups and surgical experience appeared to be most important in affecting graft clarity, whereas the donor age, death-enucleation time, and death-surgery time seemed to have little effect.
Age Factors↗