Biomedical subjects
Publications and source records attributed to J J Alpar.
I report seven patients with monocular traumatic cataract who had either preinjury or postinjury extraocular muscle deviation. All but one were managed with cataract extraction and intraocular lens implantation, without muscle surgery. If muscle surgery is required in such cases, I recommend that it be delayed until at least a year after the cataract and lens implantation surgery.
Performing a peripheral iridectomy is a safe and effective means of atraumatically removing cortex at the 12 o'clock position. It prevents pupillary block as well as adhesions between the iris and capsule. Also, it serves to position the anterior capsular flap and the superior edge of the intraocular lens.
In 1346 consecutive patients undergoing cataract surgery and intraocular lens implantation, we prospectively studied the complications associated with iris iridectomies or iridotomies as compared with those occurring when iris openings were made. We found that the transfixion of the iris with the discission knife is easy, relatively harmless, and prevents a number of complications seen when no iridectomy was performed or if a large iris opening had been made with scissors.
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A relatively simple and effective method is described for suturing the haptics of a posterior chamber lens to the iris when there is no capsular support to keep the lens in place. A thin plastic strip is used to keep the lens body in the front of the iris and to elevate the haptics for easier localization and placement of McCannel-type sutures.
Sixty patients were randomly assigned to Healon (20 patients) or Viscoat (40 patients) treatment during extracapsular cataract extraction and intraocular lens implantation surgery. The 40 patients in the Viscoat group were randomly subdivided into two groups. In one group (20 patients), Viscoat was irrigated/aspirated from the eye at the close of surgery, while in the second group of 20 patients, Viscoat was left in the eye. In all Healon cases, the viscoelastic substance was removed from the eye at the end of the surgical procedure. Compared with Viscoat, Healon better facilitated the surgical procedure and appeared to be a more advantageous viscoelastic preparation. Viscoat, in many cases, caused rises in intraocular pressure in the immediate postoperative period when either removed or left in the eye at the close of surgery.
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New findings concerning the use of anterior chamber angle-fixated lenses, especially with flexible loops, and posterior chamber lenses placed in the ciliary sulcus and in the bag reinforce previous findings that the safest procedure for diabetics is controlled extracapsular surgery with careful cleaning of the cortical material and in-the-bag implantation of a posterior chamber intraocular lens.
Removal of intraocular lenses are often performed without adequate reason. I attempted to clarify indications and describe certain methods to remove intraocular lenses safely. I also defined the terminology used in conjunction with intraocular lens removal. (Table).
The effect of the intracameral application of 1% sodium hyaluronate (Healon) in various cataract extraction techniques was evaluated in four groups of ten cats each whose natural lenses were removed using four different techniques. In a fifth group, the intraocular lenses (IOLs) were implanted over the crystalline lens. Each animal's right eye was treated with Healon and each left eye with balanced salt solution (BSS). Healon-treated eyes lost almost 50% fewer endothelial cells and had a smaller increase in corneal thickness than their counterpart eyes treated with BSS. Lens implantation and phacoemulsification procedures caused the greatest endothelial cell loss, while neodymium YAG laser capsulotomy, a less traumatic procedure, minimized this loss.
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Patients with preexisting corneal pathology who needed cataract extraction had an anterior capsulotomy performed with a Q-switched Nd:YAG laser (LASAG Microruptor II). Thirty-two patients had no sodium hyaluronate (Healon) and 36 patients had Healon injected into the anterior chamber prior to the laser surgery. The non-Healon group had a higher incidence of corneal damage from the YAG laser and, as a result, a higher incidence of endothelial corneal decompensation than the patients with the Healon-filled chamber.
On-the-table posterior capsulotomies were performed in 38 patients with a 30-gauge bent needle behind a bag-fixated posterior chamber J-loop lens with 10-degree angled loops. Ten of the patients (26.30%) developed fluorescein cystoid macular edema (CME) and four patients (10.52%) developed clinical CME within three months. A similar procedure was performed on 36 patients who received 1% sodium hyaluronate (Healon) between the posterior capsule and the vitreous prior to completion of the capsulotomy. One of these patients (2.78%) developed fluorescein CME within three months. In this investigation, no topical indomethacin eyedrops were used. The results seem to indicate that by maintaining a space between the posterior capsule and the anterior hyaloid membrane 1% sodium hyaluronate prevented the development of CME in a significant number of cases. This adds support to the theory that it is the anterior hyaloid membrane that protects the posterior segment of the eye.
Thirty-three patients who had corneal damage from the original corneal surgery and incomplete vitrectomy and who had a vitreous incarceration were divided into two groups. In one group, Nd:YAG laser therapy was performed without using a viscoelastic material in the anterior chamber. In the other group, the anterior chamber was filled with 1% sodium hyaluronate (Healon). Postoperative corneal complications were reduced in the group whose anterior chamber had been cushioned. Preoperatively present uveitis cleared upon severing the vitreous incarceration and cystoid macular edema improved in all cases except two in which the cornea decompensated six weeks and six months after the YAG intervention.
We present a retrospective study of our patients who had penetrating keratoplasty in eyes which had intraocular lenses in situ. Our results show that although the short-term result was good with any kind of intraocular lenses, the long-term (more than five years) graft survival was better if intraocular lenses with pre-iridial optics were removed and/or replaced at the time of the grafting with posterior chamber lenses.
In this study the effect of seven different non-automated nuclear evacuation techniques and the role of sodium hyaluronate (Healon) were evaluated. Thirty-five cats (seven groups) and 140 human patients (seven groups) were included in the study. Each experimental animal and human group was operated using one of the seven non-automated techniques. In each animal, one eye was operated with sodium hyaluronate and the other with Balanced Saline Solution (BSS). In each human group of 20 patients during cataract extraction and IOL implantation, sodium hyaluronate was used in half of the patients and BSS was used in the remaining ten. Eyes treated with sodium hyaluronate lost approximately 50% fewer endothelial cells and had approximately 50% less increase in corneal thickness than their counterparts treated with BSS. Based on the results of the endothelial cell loss and the corneal thickness, it is concluded that the most traumatic used technique was no. 2, followed by that of no. 5. The technique no. 7 may be considered as the most atraumatic of the tested procedures. Sodium hyaluronate effectively protected the endothelium, and its routine use in cataract surgery is recommended.