Biomedical subjects
N S Jaffe
Publications and source records attributed to N S Jaffe.
The intracapsular-extracapsular controversy.
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Extracapsular cataract extraction with and without intraocular lenses.
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Surgical results of cataract and lens implant surgery.
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Bilateral intraocular lens implantation.
A study of 1796 consecutive cataract patients in a posterior chamber intraocular lens implant (IOL) series revealed 373 patients (20.8%) who had bilateral IOLs. Visual acuity was 20/40 or better in 87% of first eyes operated and 90% in second eyes. The major cause of vision less than 20/40 was senile macular choroidal degeneration in both first and second eyes. The surgical reintervention rate was 11.8% in first eyes and 3.7% in second eyes. Ninety-two percent of patients had an interval of six months or more between surgery on the first and second eyes.
The way things were and are. Changing indications for intraocular lens implantation.
In the midst of a rapidly exploding technology, guidelines for intraocular lens implantation in the United States were conservative several years ago in order to ensure good results and patient safety. Many of the views held then are now obsolete. The indications for its use should be left to the judgment of the surgeon and a properly informed patient. Intraocular lenses need no longer be restricted to the elderly, although caution is recommended in children and young adults. Restricting lens implants to one eye is obsolete, but there should be a reasonable time period of success before an implant is placed in the second eye. The approach to the one-eyed patient and those with other ocular pathology may now be modified.
A comparison of ICCE-Binkhorst intraocular lens and ECCE-posterior chamber intraocular lens, thirty-four to forty months postoperatively.
A retrospective study of 450 consecutive intracapsular cataract extractions with a Binkhorst lens implant, and 450 consecutive extracapsular cataract extractions with a posterior chamber lens implant, was performed. All patients were examined between 34 and 40 months postoperatively, except for those patients who died before this time, those lost to followup, or those who were otherwise unavailable during this time. The results suggest that the extracapsular series had a more favorable outcome than the intracapsular series, especially with regard to final visual acuity and the incidence of clinical cystoid macular edema.
Cystoid macular edema after intracapsular and extracapsular cataract extraction with and without an intraocular lens.
A prospective cystoid macular edema study of aphakic and pseudophakic patients showed that extracapsular cataract surgery has a lower rate than intracapsular surgery when the surgery is uncomplicated. There was no difference in the rates with intracapsular surgery with and without an intraocular lens. A complicated extracapsular with an intraocular lens has a higher rate than when the surgery is uncomplicated. In extracapsular surgery with complications, there is no difference in the rates with and without an intraocular lens. When complications occur, the ratio of clinical to angiographic-proven cases is higher than when the surgery is uncomplicated. This study included four series of uncomplicated cataract extractions and three series of complicated cataract extractions. A fluorescein angiogram was performed on every patient at least one year after surgery.
The intracapsular-extracapsular controversy.
There has been a trend toward increasing popularity of the extracapsular method of cataract extraction. The advantages of this method over the intracapsular technique center around protection of the cornea and retina. A cornea-retina syndrome following intracapsular cataract extraction appears to be due to the greater endophthalmodonesis compared to the extracapsular method. The alleged advantages of the extracapsular method are discussed. Some appear valid while others are theoretical at this time. A personal angiographic cystoid macular edema study heavily favours the extracapsular method over the intracapsular. Four groups of patients were studied: 1. Intracapsular cataract extraction with a Binkhorst -loop lens. . Intracapsular cataract extraction with no lens implant. . Extracapsular cataract extraction with a Binkhorst lens; all with intact posterior capsules. 4. Extracapsular cataract extraction with a posterior chamber lens; all with primary posterior capsulotomy.
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.
The intracapsular-extracapsular controversy.
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Cystoid macular oedema after intracapsular and extracapsular cataract extraction with and without an intraocular lens.
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Extracapsular cataract extraction with a posterior chamber intraocular lens-technique and results.
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The results of extracapsular cataract extraction with a Shearing posterior chamber lens implant 34 to 40 months after surgery.
A series of 300 consecutive extracapsular cataract extractions with a Shearing posterior chamber lens implant (plus 13 with a surgical complication necessitating another kind of lens implant or no implant) was evaluated 34 to 40 months after surgery, except for those who died before this time (21 patients) and those lost to follow-up (15 patients). Ninety-one percent of the 264 patients who were examined achieved 20/40 or better visual acuity. Ninety-one percent of the 300 patients (those examined plus those who died and those lost to follow-up according to their last recorded examination) achieved 20/40 or better visual acuity. This series was compared to a previously reported series of 300 consecutive intracapsular cataract extractions with a Binkhorst iris clip lens implant examined 34 to 40 months after surgery.
A fluorescein angiographic study of cystoid macular edema.
We performed a prospective fluorescein angiographic study on 66 patients who had undergone extracapsular cataract extractions with implantation of a Shearing posterior chamber intraocular lens. A primary posterior capsulotomy was performed in every case. The eyes were studied 11 to 23 months postoperatively. The incidence of cystoid macular edema (3%) was lower than that found in three series of cataract extractions previously reported. Extracapsular cataract extraction with either (1) a Shearing posterior chamber intraocular lens and a primary posterior capsulotomy or (2) a Binkhorst intraocular lens and an intact posterior capsule produces a lower rate of cystoid macular edema than does intracapsular cataract extraction either with a Binkhorst intraocular lens or without an intraocular lens. There was no significant difference in the incidence of cystoid macular edema in the two extracapsular series, indicating that preservation of an intact posterior capsule was not a significant factor.
Intraocular lenses, axial length, and retinal detachment.
A large series of patients with intraocular lens implants had an overall 0.98% incidence of retinal detachment (eight detachments in 819 eyes). Within this group, patients with axial lengths of more than 25 mm had a statistically significantly higher incidence of retinal detachment (P = .054).
Polyethylene terephthalate (Dacron) in intraocular surgery.
Polyethylene terephthalate (Dacron) exhibits properties that make it highly suitable for use in intraocular surgery. These include high breaking and knot strength, good tensile strength retention in vivo, low tissue reaction, high resistance to hydrolysis, and good resistance to light. As a result of a series of animal experiments by Peyman and co-workers, Dacron has been shown to be suitable for fixation of an intraocular lens. Based on this, a series of human experiments was performed. Nine subjects received Dacron-wrapped loop iridocapsular or Dacron-wrapped loop iris fixation lens implants after an extracapsular or an intracapsular cataract extraction (study group). Nine subjects received the same style lens implants without Dacron-wrapped loops (control group). The complications in the study group were insignificant, and postoperative visual acuity was good in all patients. Fixation of the Dacron-wrapped loops to the back of the iris was demonstrated in eight of the nine eyes.