A newly described complication of neodymium-YAG laser capsulotomy: exacerbation of an intraocular infection. Case report.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
D J Apple
Publications and source records attributed to D J Apple.
Transcorneal extrusion of anterior chamber intraocular lenses. A report of three cases.
We examined three cases of transcorneal extrusion of anterior chamber intraocular lenses. In each case a preexisting condition (rheumatoid arthritis, glaucoma, and herpes zoster ophthalmicus, respectively) contributed to corneal necrosis and subsequent extrusion of the pseudophakos. The clinicopathologic correlations of this condition are discussed, as well as some causes of corneal decompensation associated with anterior chamber lenses. We emphasize the need for careful evaluation of patients who have preexisting disease before intraocular lens implantation.
Aged↗
Activation of complement in human serum by some synthetic polymers used for intraocular lenses.
Determination of the potential to activate complement can be used as one criterion in testing the biocompatibility of various synthetic polymers that are utilized in the medical field. Intraocular lenses (IOLs) made of poly(methyl methacrylate) (PMMA) with PMMA loops, poly(hydroxyethyl methacrylate) (PHEMA) lenses, silicone lenses, and PMMA lenses with polypropylene loops were examined in this study. The concentrations of the activation peptides C3a, C4a and C5a were measured by radioimmunoassay (r.i.a.) in human serum after incubation with and without IOLs for up to 12 h. The presence of silicone lenses caused an increase in C3a levels. In the presence of polypropylene loops, the concentrations of both C3a and C5a were significantly higher than in serum incubated alone. There was no statistically significant increase in the concentration of C4a caused by any of the materials tested. The results suggest that IOLs made from silicone or lenses with polypropylene loops activate the complement system via the alternative pathway.
Biocompatible Materials↗
Visual aberrations caused by optic components of posterior chamber intraocular lenses.
A 58-year-old airline pilot had cataract surgery with implantation of a posterior chamber intraocular lens with four positioning holes around the optic edge. During periods of maximum pupil dilation, such as at night, visual aberrations including glare, monocular diplopia, and haloes occurred and he was unable to work in his occupation. The symptoms were severe enough that lens exchange was required, and a posterior chamber lens with no positioning holes was successfully implanted. The symptoms immediately subsided postoperatively and his last known visual acuity was 20/15. This case, and the report of another patient with similar postoperative problems, illustrates that implantation of lens optics with a larger effective optical zone for posterior chamber lens implantation is desirable. This is particularly true now that younger, more active patients, many still engaged in occupations, are having lens implantations.
Cataract Extraction↗
Localized endophthalmitis: a newly described cause of the so-called toxic lens syndrome.
We report five cases of post-extracapsular cataract extraction infection in which subsequent pathologic analyses identified the organisms and found the infection to be localized or confined to the lens capsular sac. The most common offending organisms were gram-positive pleomorphic bacilli. In one case, we were able to identify the bacteria as Propionibacterium acnes. We designate this condition a localized endophthalmitis. It should be considered any time a persistent, smoldering, postoperative inflammation occurs, and in the differential diagnosis of phacoanaphylactic endophthalmitis. The condition itself is not new, but undoubtedly many such cases have gone unrecognized or have been misdiagnosed as the so-called toxic lens syndrome. In localized endophthalmitis, a clinically visible inflammatory process may occur even when multiple diagnostic taps are negative, although when the cases first appeared, the surgeons were not aware of the entity and anaerobic cultures were not always obtained. A negative tap may be explained by the fact that metabolic products from the organisms are released from the bag into the anterior segment and vitreous. A synergistic reaction may occur between these organisms and retained lens cortical remnants that may cause or exacerbate a hypersensitivity reaction. The condition may be worsened by Nd:YAG capsulotomy. The pathogenesis of localized endophthalmitis has nothing to do with the type of intraocular lens fixation (lens capsular sac or ciliary sulcus); rather, the simple presence of a capsular sac after extracapsular cataract extraction is the prerequisite for the clinical condition.
Aged↗
Anterior chamber lenses. Part I: Complications and pathology and a review of designs.
Clinicopathologic data to assist ophthalmologists in choosing a safe and efficacious anterior chamber intraocular lens (IOL) are rapidly becoming available. Two important factors that have led to an increased success rate with some anterior chamber IOL styles are (1) attention to lens design and (2) attention to modern manufacturing and lens finishing techniques. We now know much more about how to achieve appropriate lens flexibility, which decreases the need for perfect sizing. Increased attention has been given to the anterior-posterior vaulting characteristics of IOLs. This has reduced the incidence of various complications such as the intermittent touch syndrome and the uveal chafing syndrome. We recognize several design flaws in some lens styles. For example, there is now a considerable decrease in the number of small-diameter, round-looped anterior chamber IOLs being implanted, particularly those with a closed-loop configuration. Several problems have been and continue to be caused by some poorly manufactured anterior chamber lenses with sharp optic and haptic edges. Technology to assure smooth lens finishing and polishing is available and readily accessible to all manufacturers. Defective lenses should soon be a thing of the past.
Anterior Chamber↗
Anterior chamber lenses. Part II: A laboratory study.
An analysis of 606 surgically removed anterior chamber intraocular lens (IOL) specimens revealed that 351 or 58% of these were small-diameter, round loop, closed-loop styles. Because of the extremely high percentage of IOLs with this design received in our laboratory and the correlation of clinical histories with our histopathologic findings, we have concluded that such IOLs do not provide the safety and efficacy achieved by other anterior chamber lens designs. The finely polished, one-piece, all-PMMA styles fared well in our study. Although these one-piece styles comprise well over 50% of the American market share of anterior chamber IOLs, they comprise only 14% of all anterior chamber IOLs accessioned in our laboratory, compared to 58% for closed-loop designs. We believe that implantation of anterior chamber lenses with small-diameter, round, closed loops is no longer warranted. Patients in whom these IOLs have already been implanted should be carefully followed. It is our opinion that the FDA should recall or closely monitor all IOLs of this design and that implantation of closed-loop lenses should be discontinued in the United States. Furthermore, we believe that an IOL deemed to be not medically sound or worthy of implantation in the United States should not be marketed or donated outside of this country.
Anterior Chamber↗
In vivo fracture of an extruded polymethylmethacrylate intraocular lens loop.
The inferior loop of a semiflexible, closed-loop anterior chamber intraocular lens in the eye of a 72-year-old female fractured at two sites. The loop was composed of extruded polymethylmethacrylate. The inferotemporal portion of the loop was first noted to be broken 25 months postoperatively, and the fractured nasal portion of the same loop was first observed 55 months after implantation. The patient denied any excessive rubbing of the eye or major trauma to the eye or head. Both fractures occurred near the loop-optic junction. The intermittent touch of the cornea by the broken loop caused endothelial damage and edema in the lower one third of the cornea. The two portions of the lens were removed and exchanged with another style of anterior chamber lens. The visual acuity at six weeks postexchange was 20/30.
Aged↗
Comparative histopathologic study of various lens biomaterials in primates after Nd:YAG laser treatment.
A Nd:YAG laser was used to perform posterior capsulotomies on primates in whom one-piece silicone or three-piece polymethylmethacrylate intraocular lenses were in place for more than one year. The eyes were followed for eight weeks after treatment before enucleation. Histologically, no toxic effects caused by the dispersion of any of the biomaterial within the eyes and no significant inflammatory reactions were seen. The silicone lenses used in this study compared favorably with traditional polymethylmethacrylate lenses when posterior capsulotomies with a Nd:YAG laser were performed.
Animals↗
Unexplained intraocular toxicity after cataract-intraocular lens surgery.
Explore the source record for details and available documents.
Aged↗
Paranasal sinusitis, orbital abscess, and inflammatory tumors of the orbit.
We present the clinical, radiological, and histopathological findings from a case of unilateral inflammatory mass of the right orbit, originating in the ipsilateral paranasal sinuses. A connection between inflammatory tumors of the orbit and paranasal sinusitis has been suspected for many years. This case shows a definite association between chronic paranasal sinusitis, orbital cellulitis, subperiosteal abscess, and formation of an inflammatory orbital tumor. Early diagnosis combined with appropriate therapeutic measures is essential in order to prevent adverse consequences, which can include severe visual loss.
Abscess↗
Solar retinopathy from sungazing in Medjugorje.
Explore the source record for details and available documents.
Adult↗
Lens injury following iridotomy with a Q-switched neodymium-YAG laser.
By scanning electron microscopy, we studied eight lenses from eyes that had received a neodymium-YAG laser iridotomy one day prior to elective intracapsular cataract extraction. In some of these cases, pitting lesions were found on the anterior-equatorial lens surface, thereby showing that lenticular damage may occur following this procedure if the iridotomy is applied too centrally. It is recommended that care be taken to ensure that the iridotomy be placed at a site peripheral to the outer circumference of the lens.
Corneal Opacity↗
Histopathologic and scanning electron microscopic study of one type of intraocular lens.
We performed clinicopathologic analyses of 28 explanted anterior chamber intraocular lenses (Stableflex). Two factors strongly indicated that this lens can be difficult to remove: (1) the clinical histories obtained from the explanting surgeons who, with few exceptions, stated that removal was extremely difficult; and (2) our scanning electron microscopic findings, which documented extensive tissue encapsulation around loops as well as multiple sites of loop severance required at the time of lens removal. The general efficacy of this intraocular lens compared with other anterior chamber lenses was not addressed in this study.
Humans↗
Intraocular lenses. Notes from an interested observer.
Explore the source record for details and available documents.
Humans↗
Dominantly inherited keratitis.
A new, autosomal dominant keratitis is presented. The onset occurs in early childhood with episodes of red, irritated eyes but not recurrent erosions. There are no associated systemic abnormalities. The primary histopathologic features are vascularization and inflammation of the anterior corneal stroma, and replacement of Bowman's layer by fibrovascular tissue. Thus, this disease demonstrates characteristics of both a dystrophy with familial occurrence and early onset, and a degeneration with primary inflammation and vascularization.
Adult↗
Sterile hypopyon secondary to ultrasonic cleaning solution.
During a 20-week period, 21 cases of sterile hypopyon occurred 24 hours after uncomplicated extracapsular cataract extraction and in-the-bag posterior chamber intraocular lens implantation at the Valley Eye Institute. While all cases responded to steroid treatment and exhibited no residual ocular effects, the cause of the hypopyon remained a mystery despite an on-going reevaluation of the surgical procedure and sterilization techniques. Several suspected causes were investigated and eliminated. It was clinically determined that surgical instruments placed in older ultrasonic cleaning solution caused the hypopyons. Further analysis at the Center for Intraocular Research at the University of Utah revealed that the instruments were contaminated by a heat-stable endotoxin that remained on the instruments through the autoclaving process. Surgeons currently using ultrasonic instrument cleaners should be aware that, with some models, following the manufacturer's recommended fluid changing procedures could result in endotoxic contamination of surgical instruments which could, in turn, cause severe inflammatory reactions in the immediate postoperative period.
Animals↗
Pathologic findings of an explanted silicone intraocular lens.
We present a clinicopathological analysis of an explanted STAAR model B silicone intraocular lens (IOL) that was sent to the Center for Intraocular Lens Research for evaluation. Extracapsular cataract extraction (ECCE), using phacoemulsification and insertion of the silicone IOL, had been accomplished through a 3-mm scleral tunnel incision. The IOL was folded and inserted into the ciliary sulcus. Complications, including blurred vision, movement of the IOL within the eye, and glaucoma, eventually led to IOL exchange at three months post-ECCE. After removal of the silicone IOL, a modified J-loop IOL was placed in the intact capsular bag, with subsequent resolution of the increased intraocular pressure and a 20/20 + 3 visual acuity. Pathologic examination of the explanted silicone lens revealed grooves indented into the optic, extensive molding flash, and opalescence of the optic.
Aged↗