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PubMed1998

Phacoemulsification of white mature cataracts.

PURPOSE: To evaluate the intraoperative difficulties associated with phacoemulsification of white mature cataracts and develop a strategy for consistently achieving continuous curvilinear capsulorhexis (CCC) in these cases. SETTING: Raghudeep Eye Clinic, Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective study comprised 60 eyes of 60 patients with senile white mature cataract. Mean follow-up was 7 months. Detailed preoperative and intraoperative notes were made including intraoperative subjective assessment of the intracapsular pressure and cataract hardness. A small capsulorhexis was attempted initially. Endophacoemulsification was performed using the stop, chop, chop, and stuff technique. The capsulorhexis was enlarged before intraocular lens implantation. An initial cut in the capsulorhexis margin was made with a cystotome needle while a spatula supported the anterior capsule. The capsulorhexis was then enlarged with forceps. RESULTS: A CCC was achieved in 57 eyes (95%). Intracapsular pressure was judged to be raised in 24 eyes (40%). Of these, CCC was accomplished in 21 eyes (88%). Statistical analysis confirmed that raised intracapsular pressure was a significant factor. Capsule opacification or plaque was detected at the end of the surgery in 20 eyes (33%); 50% of the nuclei were of grade 5 hardness. CONCLUSION: If a CCC can be achieved, the results of white cataract phacoemulsification are comparable to those of routine cataract surgery. When using the two-stage technique, one should be prepared to deal with a hard cataract through a small capsulorhexis.

Adult↗
PubMed2005

Comparison of dyes for cataract surgery. Part 2: efficacy of capsule staining in a rabbit model.

PURPOSE: To investigate the efficacy of various dyes for anterior capsule staining to facilitate capsulorhexis during cataract surgery. SETTING: Department of Ophthalmology and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. METHODS: Various concentrations of indocyanine green (ICG), methylene blue (MB), gentian violet (GV), trypan blue (TB), and fluorescein sodium (FS) were used to stain rabbit lenses in vitro. After 1 minute of exposure, the staining of each lens was evaluated using a semiquantitative scoring system in which 0 represented no staining/no contrast between the capsule and cortex and 4 represented excellent staining/remarkable contrast between the stained capsule and unstained cortex. The lowest concentration of dye with a score of 4 was considered the lowest effective concentration for capsulorhexis. RESULTS: Based on our scoring system, the lowest effective concentrations for capsulorhexis were ICG 0.25%, MB 0.10%, GV 0.01%, TB 0.10%, and FS 1.25%. The lowest effective concentrations of the 5 dyes provided comparable contrast. Increased concentrations of dye decreased contrast between the capsule and the cortex and were considered less effective for capsulorhexis. CONCLUSION: Any of the following concentrations of dyes can be used for optimal enhancement of anterior capsule visibility for capsulorhexis: ICG 0.25%, MB 0.10%, GV 0.01%, TB 0.10%, and FS 1.25%.

Animals↗
PubMed2005

Influence of optic edge design, optic material, and haptic design on capsular bend configuration.

PURPOSE: To assess and classify capsular bend configuration at the optic rim and its association with posterior capsule (PCO) and anterior capsule opacification (ACO) and capsulorhexis contraction with various intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A total of 659 post-cataract surgery eyes of 370 patients from different prospective randomized studies were evaluated. All eyes had standardized phacoemulsification surgery with implantation of an IOL in the capsular bag. The IOLs had a sharp or round optic edge design and were made of silicone, acrylic, or poly(methyl methacrylate) optic materials. One year postoperatively, the configuration of the capsular bend at the optic rim was assessed at the slitlamp, and standardized slitlamp images of ACO and fibrotic PCO were taken. One week, 1 year, and 3 years postoperatively, digital retroillumination images were taken for objective quantification of regeneratory PCO and the capsulorhexis area. The outcome measures were the type of capsular bend configuration, ACO score (0% to 100%), regeneratory PCO score (0 to 10), fibrotic PCO score (0 to 3), and amount of capsulorhexis contraction (mm(2)). RESULTS: Four main types of capsular bend configuration were classified: parallel, "Y," right angle, and wrapping. The right-angle type was observed in the most cases (52%). Eyes with a wrapping capsular bend configuration had significantly less PCO, more capsulorhexis contraction, and more ACO than eyes with the other configurations. Wrapping capsule configuration was seen most often (55%) in round-edged silicone IOLs that had a thin optic rim. CONCLUSION: The design and material of IOLs influenced the long-term capsular bend configuration at the optic rim. The right-angle type was the most common capsular bend configuration. Intraocular lenses with silicone optic material and a thin optic rim caused a wrapping capsule configuration and resulted in more capsulorhexis contraction and ACO, but less PCO.

Biocompatible Materials↗
PubMed2006

Fate of anterior capsule tears during cataract surgery.

PURPOSE: To determine the incidence of anterior capsule tears, at what stage of surgery they occurred, and their intraoperative behavior. SETTING: Ambulatory surgery center, Cincinnati Eye Institute, Cincinnati, Ohio, USA. METHODS: This 5-year retrospective study was of patients having phacoemulsification with posterior chamber intraocular lens (IOL) implantation complicated by unplanned peripheral extension of the capsulorhexis tear or a radial anterior capsule tear. The operative notes and a videotape of the surgery were reviewed. The stage at which the tear was initially observed and when it extended were identified, as was whether the tear extended to the posterior capsule. Anterior vitrectomy and the design and location of the IOL implanted were also analyzed. RESULTS: A discontinuous anterior capsulorhexis or a break in the anterior capsule rim was observed in 21 eyes of 2646 cases, for an overall incidence of 0.79%. Anterior capsule tears were identified during ophthalmic viscosurgical device injection in 1 eye, capsulorhexis in 13 eyes, hydrodissection in 2 eyes, phacoemulsification in 3 eyes, irrigation/aspiration (I/A) in 1 eye, and implantation of a prosthetic iris device in 1 eye. Seven of the 13 tears identified during the capsulorhexis were managed by redirecting the second edge of the "safety" capsulorhexis to incorporate the tear. In 14 eyes, the tear in the anterior capsule extended into the zonules; 4 of these tears were limited. Ten tears extended around the equator and through the posterior capsule, occurring during the hydrodissection in 1 eye, phacoemulsification in 2 eyes, I/A in 1 eye, and IOL implantation in 6 eyes. An anterior vitrectomy was required in 4 eyes that had posterior capsule involvement. Endocapsular fixation of a 1-piece acrylic IOL was achieved in 18 eyes. Three eyes required implantation of a 3-piece acrylic IOL in the ciliary sulcus. CONCLUSIONS: Extension of an anterior capsule tear can complicate cataract surgery at any stage. Extension of the tear through the posterior capsule occurred in almost half the eyes with an anterior capsule tear, often requiring an anterior vitrectomy. Managing an anterior capsule tear can be challenging yet compatible with implantation of a posterior chamber IOL.

Capsulorhexis↗
PubMed2001

Visual outcomes and complications of posterior chamber intraocular lens implantation in the first year of life.

PURPOSE: To document the visual outcome and postoperative complications in infants who had congenital cataract surgery with posterior chamber intraocular lens (PC IOL) implantation in the first year of life. SETTING: The Children's Hospital, Dublin, Ireland. METHODS: Twenty-seven eyes of 20 infants were reviewed. Seven infants (14 eyes) had bilateral congenital cataract and 13 (13 eyes), uniocular cataract. The mean age at surgery was 4 months (range 3 weeks to 11 months). A standard surgical technique involved anterior capsulorhexis, phacoemulsification with or without posterior capsulorhexis with in-the-bag PC IOL implantation, and no anterior vitrectomy. Surgery was performed by 1 surgeon. The mean follow-up was 41 months (range 6 to 88 months). RESULTS: The main complication was lens reproliferation into the visual axis. Of the 11 eyes that did not have a primary posterior capsulorhexis, 10 had 1 or more capsulotomies. Seven required a neodymium:YAG (Nd:YAG) laser capsulotomy a mean of 6 months postoperatively, and 2 had 2 Nd:YAG capsulotomies. Six eyes also had a surgical capsulotomy when the membrane was deemed too thick for further laser treatment. Fourteen of 25 eyes had a primary posterior capsulorhexis; 8 had no further intervention. Four eyes had persistent hyperplastic primary vitreous (PHPV), 3 required a surgical capsulotomy, 2 had an Nd:YAG laser capsulotomy, 2 had an anterior vitrectomy, and 1 developed open-angle glaucoma. There was a mean refractive shift of 6.0 diopters after a mean follow-up of 41 months, with most of the myopic shift occurring in the first 24 months. CONCLUSIONS: Visual axis reopacification was the main complication of IOL implantation in infants, with PHPV leading to more complications and repeat procedures. Anterior vitrectomy appeared to reduce the reoperation rate. Results indicate that primary posterior capsulorhexis is important and Nd:YAG capsulotomy is not satisfactory in infants. In addition, the reduction in glaucoma with IOL implantation, if borne out over the long term, is a significant advantage in cases of congenital cataract.

Capsulorhexis↗
PubMed2002

[Cataract surgery and the "Blue Miracle"].

BACKGROUND: Continuous circular capsulorhexis enabling safe phacoemulsification and implantation of the PC-IOL in the bag is extremely difficult to perform in the absence of red reflex. Staining of the anterior capsule with a vital dye (Vision blue(R); DORC, The Netherlands) allows easy capsulorhexis under such conditions. PATIENTS AND METHODS: Because of missing or poor red reflex Vision blue(R) was applied to allow capsulorhexis in 26 eyes of 25 patients (aged 24 - 86 years). Sixteen patients had mature cataracts, two patients had dense vitreous opacities and 8 patients had pronounced anterior subcapsular opacifications. RESULTS: Continuos circular capsulorhexis was easy to perform in 22/26 eyes after staining the anterior capsule with Vision blue(R). Due to increased intracapsular pressure two eyes developed an uncontrolled tearing of the anterior capsule towards the periphery, and in two eyes capsulotomy had to be completed with high-frequency capsulotomy or scissors. Ten of sixteen eyes with mature cataracts had extremely hard nuclei requiring extended phacoemulsification time (more than 90 seconds calculated for 100 % power). There was no rupture of the posterior capsule nor vitreous loss. All PC-IOL's (23 x Acrysof(R); Alcon; 3 x 6.5 mm PMMA) were implanted into the capsular bag. Preoperatively 19/26 eyes had visual acuity of handmotions or less, postoperatively 18/26 eyes achieved 20/30 or better visual acuity. CONCLUSIONS: In the absence of red reflex staining of the anterior capsule with Vision blue(R) allows continuous circular capsulorhexis and implantation of the PC-IOL in the bag. An extremely hard nucleus requiring extended phacoemulsification time must be expected in elderly patients with mature cataracts.

Adult↗
PubMed2004

[Complete occlusion of the frontal capsule after cataract-operation in a patient with pseudoexfoliation syndrome--a case report and review of literature].

BACKGROUND: Pseudoexfoliation syndrome (PEX) is associated with an increased risk for the development of capsular fibrosis including capsular phimosis. A complete occlusion of the anterior capsular opening is, so far, a rarely reported phenomenon. PATIENT: Here we report the case of a 75-year-old female patient who suffered from a secondary open-angle glaucoma caused by PEX. Three months after an uneventful cataract surgery with capsulorhexis, phakoemulsification and implantation of a posterior chamber lens (PMMA) the anterior capsular opening of her left eye was completely occluded. RESULTS: The patient reported a slow loss of vision (20/40 immediately after cataract surgery to 20/200 at the follow-up visit three months later). The examination revealed a complete closure of the capsulorhexis with thick, central fibrous material. The diameter of the capsulorhexis was extensively diminished. Reopening of the anterior capsular opening utilizing a YAG laser was achieved and visual acuity increased to 20/40. Additionally, the fibrotic, secondary cataract of the posterior capsule was removed, again with a YAG laser, five weeks after the first intervention and, now with a free optical axis, the patient's visual acuity increased further to 20/30. CONCLUSION: The excessive production of fibrosis and the tendency towards a shrinkage of the diameter of the capsulorhexis postoperatively in patients with PEX may lead to a complete occlusion of the capsulorhexis. Even in such extreme cases, the reopening of the anterior and posterior capsule by a YAG laser is possible and, as demonstrated here, leads to a morphologically and functionally satisfying result.

Aged↗
PubMed2004

Surgical technique and postoperative complications in pediatric cataract surgery: retrospective analysis of 21 cases.

AIM: To evaluate postoperative complications of different surgical techniques for cataract treatment in children. METHODS: We reviewed clinical records of 21 children (33 eyes) who underwent cataract surgery between January 1998 and December 2002. The median age of children at the time of cataract surgery was 39 months (range, 4-115 months). The median follow up was 26 months (range, 6-58 months). A posterior continuous curvilinear capsulorhexis with anterior vitrectomy was performed in 24 eyes, and posterior continuous curvilinear capsulorhexis without anterior vitrectomy in 9 eyes (children older than 7 years). Nine eyes were left aphakic and intraocular lens was implanted in 24 eyes. RESULTS: Opacification of the visual axis was the most frequent complication. One of nine eyes in the group of children undergoing posterior continuous curvilinear capsulorhexis developed posterior capsule opacification. This also occurred in 6 out of 24 eyes with posterior continuous curvilinear capsulorhexis and anterior vitrectomy. In 5 eyes with secondary opacification Nd:YAG laser capsulotomy was performed as a secondary procedure. In uncooperative children (2 eyes) more extensive anterior vitrectomy was repeated. Other postoperative complications included aphakic glaucoma (n=1), synechia formation (n=4), intraocular lens deposits (n=2), and pupil capture (n=1). CONCLUSIONS: The main complication in the pediatric cataract surgery was posterior capsule opacification, and the management of posterior capsule seems to be a very important factor. In younger children, cataract surgery with posterior capsulorhexis and anterior vitrectomy was advantageous, whereas in older children a clear visual axis was achieved without vitrectomy.

Capsulorhexis↗
PubMed1999

The triple procedure: in the bag placement versus ciliary sulcus placement of the intraocular lens.

AIMS: To evaluate the influence of intraocular lens (IOL) placement on triple procedure clinical results and to investigate whether it is appropriate to use phacoemulsification in patients with large lens nucleus. METHODS: 40 consecutive penetrating keratoplasties combined with cataract extraction performed in a single institution were studied. Whenever possible a capsulorhexis was performed and the IOL was placed into the capsular bag. Phacoemulsification was used when the nucleus was too large to pass through the capsulorhexis. RESULTS: Out of 25 patients with an intact capsulorhexis phacoemulsification was used in 13 (52.0%) whereas the entire nucleus passed through the capsulorhexis in the remaining 12 patients (48%). The average 12 month visual acuity was 0.46 (SD 0.21) in patients with in the bag IOL (n = 23) and 0.29 (0.08) in patients with ciliary sulcus IOL (n = 13) (p = 0.04). Elevated intraocular pressure occurred in 26.1% (6/23) of patients with in the bag IOL and 61.5% (8/13) of patients with ciliary sulcus IOL (p = 0.08). The average postoperative graft thickness at 18 months was 552 (27) microns in the former group and 650 (29) microns in the latter group (p = 0.04). No significant difference in graft survival, postoperative endothelial cell density, astigmatism, and videokeratoscopic measurements was found between both groups. CONCLUSION: In the bag placement of the intraocular lens during the triple procedure results in better outcome of transplantation than ciliary sulcus placement of the IOL. Phacoemulsification allows removal of large nuclei through a 5 mm capsulorhexis without performing relaxing incisions out towards the periphery of the capsule.

Adolescent↗
PubMed1992

Comparison of function and fixation of small incision circular and oval poly(methyl methacrylate) intraocular lenses.

A prospective study of function and fixation was done on 40 patients implanted with small incision poly(methyl methacrylate), single piece, biconvex intraocular lenses after in situ phacoemulsification cataract extraction via a continuous curvilinear capsulorhexis. A 5.0 mm circular optic (Pharmacia 740 P), 14 mm length lens was compared with an oval 5.0 x 6.0 mm optic (IntraOptics SP18UB), 12.75 mm lens. Twenty patients were implanted with each design and were surveyed three months postsurgery. Satisfactory visual acuity and absence of motor vehicle headlight glare was found in all 40 patients. One glare disability of 35% occurred in a patient with an off-center capsulorhexis that formed a Soemmering's ring partially posterior to a circular optic lens. Fixation was clinically central in all patients. A space between optic and posterior capsule persisted in seven eyes with an oval optic lens and in eight eyes with a circular optic lens. Therefore both designs were associated with a "no space, no cells" situation that should decrease eventual pearl formation. Total Soemmering's rings formed posterior to 9 of 20 circular optic lenses if the capsulorhexis was 5 mm or larger in diameter (only one oval optic lens formed a Soemmering's ring). Compression of the posterior capsule occurred in seven of the nine patients with circular optic lenses and total Soemmering's rings. I conclude that the circular optic design was best implanted via a 5 mm or slightly larger central capsulorhexis to promote both Soemmering's ring formation and posterior capsule compression. Both designs provided satisfactory clinical results.

Cataract Extraction↗
PubMed1993

[Capsular sack suture PMMA intraocular lens. Comparative study of centering behavior after phacoemulsification and planned extracapsular cataract extraction].

The position of bag-fixated intraocular lenses after phacoemulsification or extracapsular cataract extraction (ECCE) was compared in order to determine the relationship to the method of operation and the type of capsular opening. Photographs were taken from 71 eyes 6 months after in-the-bag implantation of a one-piece posterior chamber lens. Centering was determined with respect to the pupillary center. Forty-six eyes were operated on by phacoemulsification after continuous circular capsulorhexis with closed edges and 25 eyes by ECCE after capsulorhexis with a radial incision of the capsular rim at the 12 o'clock position. Ninety-four percent of the intraocular lenses implanted after phacoemulsification and 92% of the intraocular lenses implanted after ECCE were decentered less than 0.5 mm. The centering of bag-fixated intraocular lenses is related to the technique of opening the anterior capsule. Phacoemulsification with continuous capsulorhexis offers conditions similar to that in ECCE with capsulorhexis and radial capsular rim incision for good centering of one-piece posterior chamber lenses.

Adult↗
PubMed1998

[Posterior pars plana high frequency capsulotomy].

UNLABELLED: In special forms of complicated secondary cataract, especially after a cataract operation in eyes with proliferative disease and after a cataract operation associated with pars plana vitrectomy and silicone oil instillation, surgical capsulotomy must be performed. METHODS: We developed a new surgical technique for posterior capsulorhexis via pars plana by using the high-frequency capsulotomy method developed by Klöti. We analyzed 14 consecutive patients undergoing late pars plana capsulotomy using a specially designed instrument for radiofrequency capsulorhexis. The indication for surgical capsulotomy was extreme secondary cataract; in 6 eyes fibrosis was associated with vascularizations. RESULTS: The high-frequency technique for posterior capsulotomy allowed reliable and precise tissue cutting. The cutting required minimal application of pressure to the capsule, and therefore damage to zonula fibers is minimized. Furthermore, use of the radiofrequency technique permitted hemostatic incision in vascularized membranes by inducing a fine coagulation margin. CONCLUSIONS: Posterior capsulorhexis using radiofrequency offers precise and effective tissue cutting if surgical capsulotomy is necessary.

Capsulorhexis↗
PubMed2003

Histopathological study of the anterior lens capsule with a double-ring sign.

BACKGROUND: A 'double-ring' sign may be seen during continuous curvilinear anterior capsulorhexis in cataract surgery. This sign has been attributed to partial splitting of the anterior lens capsule at the continuous curvilinear anterior capsulorhexis edge. Because horizontal intracapsular splits away from the capsule edge have also been reported, a double-ring sign has been hypothesized to be a precursor to true exfoliation. We report new histopathological findings for both anterior capsule and lens epithelium changes, the latter being similar to those of true exfoliation. METHODS: Three anterior capsules from two patients with a double-ring sign during capsulorhexis were examined via light and transmission electron microscopy. RESULTS: Light microscopy revealed step formations in the capsule edges and surface-parallel intracapsular splits in the anterior capsules. Transmission electron microscopy revealed stratified, banded structures consisting of alternating electron-dense and -lucent granular belts (300-400 nm) at the central area of the anterior capsule, as well as vacuole-like spaces and expansion of intercellular spaces in the lens epithelium. CONCLUSIONS: The thickened, stratified structure of the anterior capsule suggests abnormal lens epithelium in patients with a double-ring sign. The horizontal splits in the anterior capsule, with concomitant epithelial changes, i.e., the vacuole-like spaces and widened intercellular spaces, support the relation between a double-ring sign and true exfoliation.

Aged↗
PubMed2005

Experimental evaluation of the Corneal Concept 360 intraocular lens with the Miyake-Apple view.

PURPOSE: To evaluate a new single-piece, hydrophilic acrylic intraocular lens (IOL) designed to keep the anterior capsule away from the IOL optic, create the effect of a capsular tension ring, and prevent posterior capsule opacification (PCO). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. MATERIALS AND METHODS: Four Concept 360 IOLs (Corneal Laboratoire) were implanted in 4 human cadaver eyes of various sizes (Miyake-Apple technique). Lens centration, ovalization of the capsular bag and capsulorhexis opening, distance between the anterior optic surface and the anterior capsule and between the posterior optic surface and the posterior capsule, as well as presence of capsular striae were evaluated. The capsular bag was stained with trypan blue, and the ophthalmic viscosurgical device (OVD) was stained with fluorescein to enhance visualization. RESULTS: In each eye, the lens conformed to the capsular bag with precise centration. No ovalization or distortion of the capsular bag or the capsulorhexis and no posterior capsule striae were observed. Measurements of the capsulorhexis diameter before and after IOL implantation were the same. The anterior capsule remained at distance from the anterior optic surface for 360 degrees, and tight contact between the posterior optic edge and the posterior capsule was observed. CONCLUSIONS: Use of the Miyake-Apple technique is useful in the evaluation of new IOL designs in experimental studies. Design features of the Concept 360 IOL are likely to decrease the outcome of postoperative capsular bag opacification. Long-term clinical studies are necessary to confirm these findings.

Acrylic Resins↗
PubMed2005

Prospective evaluation of phacoemulsification in adults younger than 50 years.

PURPOSE: To evaluate intraoperative performance and long-term outcome of phacoemulsification in patients younger than 50 years. SETTING: Iladevi cataract and IOL Research Centre, Ahmedabad, India. METHODS: A prospective observational study was conducted comprising 54 patients (35 men and 19 women) under age 50 who had phacoemulsification. Preoperative evaluation included specular microscopy. Phacoemulsification with implantation of an AcrySof MA30BA intraocular lens (IOL) was performed. Intraoperatively, peripheral extension of capsulorhexis, intraoperative posterior capsule opacification (PCO; plaque), and serious complications (eg, posterior capsule rupture, vitreous loss) were noted. Postoperatively, endothelial cell loss, postoperative PCO, neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, and best corrected visual acuity (BCVA) were assessed for 3 years. Patients with intraoperative PCO were analyzed separately. RESULTS: Mean patient age was 42.7 years +/- 5.2 SD (men) and 43.1 +/- 3.25 years (women). Continuous curvilinear capsulorhexis was achieved in 49 patients (90.7%). Intraoperative PCO was present in 14 (25.92%) patients. An Nd:YAG laser posterior capsulotomy was performed in 4 patients (28.5%). Posterior capsule rupture leading to vitreous loss occurred in 1 patient (1.85%). At 3-year follow-up, endothelial cell loss was 5.9%. Postoperative PCO developed in 8 patients (22.2%), and Nd:YAG laser posterior capsulotomy was performed in 5 patients (13.8%). The BCVA was > or = 20/40 in 47 patients (94%). CONCLUSION: Young patients pose a challenge in creating a capsulorhexis and display significant incidence of intraoperative and postoperative PCO.

Adult↗
PubMed2002

Pseudophakic pupillary block caused by pupillary capture after phacoemulsification and in-the-bag AcrySof lens implantation.

We describe a 50-year-old patient who developed pupillary block caused by pupillary capture 1 week after uneventful phacoemulsification and implantation of an AcrySof foldable intraocular lens (IOL). The patient had a large but intact capsulorhexis with the haptics lying in the bag; the optic lay in the pupillary area anterior to the capsulorhexis. This case was successfully managed by a neodymium: YAG laser iridotomy, IOL explantation, and subsequent implantation of a poly(methyl methacrylate) posterior chamber IOL. To prevent this complication, we suggest the optic be larger than the capsulorhexis and advocate correct, gentle insertion of the foldable IOL.

Acrylic Resins↗
PubMed2003

Effect of ophthalmic viscosurgical devices on lens epithelial cells: a morphological study.

PURPOSE: To investigate the morphological effects of Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%) on lens epithelial cells (LECs). SETTING: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA, and the Laboratory of Ultrastructural Morphology, Zoological Institute, University of Liège, Liège, Belgium. METHODS: Human LECs collected via capsulorhexis were examined by light microscopy (LM) and transmission electron microscopy (TEM). Lens epithelial cells from rabbit capsulorhexis samples were studied by LM and TEM following exposure to Provisc (sodium hyaluronate 1.0%) or Viscoat ophthalmic viscoelastic device (OVD). Since Viscoat is hypertonic (340 mOsm), hypertonic, isotonic, and hypotonic solutions were compared to investigate a possible mechanism for the observed effects. The effects of Provisc and Viscoat on rabbit LECs in the intact lens were also compared. RESULTS: Human LECs gathered via capsulorhexis following exposure to Viscoat were generally thinner than control samples and often had condensed nuclei and increased intracellular vacuolization. Rabbit capsular tissue exposed in situ to Viscoat demonstrated changes similar to those seen in humans. Cells exposed to Provisc were similar to cells in untreated controls in humans and rabbits. Corneal endothelial cells exposed to either agent were unaffected. Experiments with hypertonic and hypotonic buffers induced some of the changes noted with Viscoat, but the effects were less severe. Lens epithelial cells in intact rabbit lenses exposed to Viscoat appeared similar to LECs in the control samples. CONCLUSIONS: Light microscopy and TEM of human lens capsule tissue suggest that Viscoat induces significant morphological changes in LECs during cataract surgery. The changes may underlie the improved visualization of these cells that has been reported during cataract surgery. Corneal endothelial cells were unaffected by exposure to Viscoat. Studies in a rabbit model suggest that the hyperosmolarity of Viscoat may play a partial role in the LEC changes.

Animals↗
PubMed1999

Comparative evaluation of plate haptic lenses with smaller and larger positioning holes.

PURPOSE: To evaluate the visual outcome, intraoperative problems and postoperative complications of plate haptic intraocular lenses with smaller foot plate positioning holes and larger holes. METHODS: Fifty eyes of 50 patients underwent clear corneal phacoemulsification with implantation of either small hole plate haptics (25 eyes) or large hole plate haptic lenses (25 eyes). The intraoperative complications were noted and the postoperative parameters were evaluated on the first day, 1 week, 1 month, 3 months, 6 months and 12 months. These included the best corrected visual acuities, intraocular lens (IOL) decentring, diameter of anterior capsulorhexis and posterior capsule opacification. RESULTS: The mean duration of follow-up was 14.8+/-2.1 months in the group with the small foot plate positioning holes (Chiron C10UB) lens and 15.6+/-3.2 months in the group with the large feet plate positioning holes (Chiron C11UB) lens. The was no significant difference in the visual acuities of the two groups. The mean IOL decentring was 0.42+/-0.28 mm in the C10UB lenses and 0.24+/-0.10 mm in the C11UB lenses (P = 0.05). The mean diameter of the anterior capsulorhexis was 4.68+/-0.23 mm in the former, while it was 4.21+/-0.68 mm in the latter (P = 0.0027). The posterior capsule opacification was significantly increased in the C11UB group (P = 0.0298). Neodymium : yttrium aluminium garnet (Nd: YAG) laser capsulotomy was required in 8% of the C10UB group, compared to 28% in the C11UB group. CONCLUSION: Results are similar with the two types of plate haptic lenses. The lenses with larger holes have a significantly higher posterior capsule opacification and more anterior capsulorhexis contracture, although the IOL decentring is less with these lenses.

Aged↗