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PubMed1993

Effect of anterior capsulotomy on decentration of a two-zone multifocal intraocular lens.

A study was undertaken to determine if can-opener (CO) or continuous curvilinear capsulorhexis (CCC) anterior lens capsulotomy influences decentration of a two-zone multifocal intraocular lens (IOL). Fifty IOLs (25 with polypropylene haptics and 25 with poly[methyl methacrylate] haptics) were implanted following CO, 42 with poly(methyl methacrylate) haptics, following CCC. The extent and direction of decentration was estimated using a photogeometric technique. The haptic material may influence decentration. Continuous curvilinear capsulorhexis was associated with less decentration than CO (0.36 mm and 0.43 mm, respectively). The difference, however, was not statistically significant.

Adult↗

PubMed1994

Current trends in the use of intraocular lenses in children.

We present an overview of current practice patterns as they apply to intraocular lens (IOL) implantation in children. Two hundred and thirty-four members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and 1,039 members of the American Society of Cataract and Refractive Surgery (ASCRS) responded to a questionnaire. Forty-six percent of AAPOS respondents and 27% of ASCRS respondents reported that they are currently implanting IOLs in children. Although the majority have implanted lenses in children older than six years, 16 AAPOS members and 41 ASCRS members reported implanting IOLs in patients in their first two years of life. Eighty-four percent of the respondents use the continuous curvilinear capsulorhexis technique of anterior capsulotomy in children. When a primary posterior capsulotomy is performed, 63 ASCRS surgeons (38%) reported using posterior continuous curvilinear capsulorhexis. Fixation of an IOL in the ciliary sulcus in a child was acceptable to 67% of the surgeons; however, 86% would not consider implanting an anterior chamber IOL in a child. Implications of the survey data are discussed.

Adolescent↗

PubMed1990

Evaluation of 150 consecutive cases of poly HEMA posterior chamber lenses implanted in the bag using a small-incision technique.

We report the results of 150 capsular bag implantations of the IOGEL PC-12 hydrogel lens. Mean follow-up was seven months. Following capsulorhexis and phacoemulsification, a Faulkner folder was used to insert the lens through a 3.5 mm to 4.0 mm scleral tunnel incision. Initially, a number of surgical complications were encountered. Because of increasing experience and modified instrumentation and technique, these did not occur in the later cases. Visual results were good, all eyes gaining a best case visual acuity of 20/40 or better and 97% achieving 20/25 or better. Morphological results were satisfactory. Generally the lenses remained centered and at a distance from the iris. Retention of viscoelastic substance or debris between the lens and the posterior capsule, occasionally observed at the start of the series, has been avoided by retrolental aspiration. Persistent pigment dispersion, which was observed when the lens had been implanted in the sulcus, was not seen. Tolerance of the lens material was generally satisfactory. There were six cases (4%) of fibrinoid uveitis, which is a relatively high incidence. From our experience and results we conclude that this implantation procedure allowed controlled insertion and placement of the IOGEL lens, provided that adequate instrumentation and technique was used; visual performance was comparable to that of poly(methyl methacrylate) lenses; capsular bag fixation furnished satisfactory morphological results, provided an adequately shaped capsulorhexis was performed.

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PubMed1992

Evaluation of 200 consecutive IOGEL 1103 capsular-bag lenses implanted through a small incision.

We evaluated 200 consecutive IOGEL 1103 capsular bag intraocular lenses. We performed a 5 to 6 mm capsulorhexis and inserted the intraocular lens (IOL) through a 3.5 to 4.0 mm scleral tunnel with a Faulkner folder. Twenty-two cases were combined with trabeculectomy and ten with keratoplasty using a temporary keratoprosthesis. Mean follow-up was six months. The implant centered well and resisted capsular shrinkage. Iris touch to the optic was rare and did not provoke persistent pigment dispersion. In one third of the cases a cleft was discernible between the posterior convex IOL surface and the extended capsule despite thorough aspiration of viscoelastic and debris from the retrolental space. In 8% of cases, white flakes of unknown origin were observed at the IOL-capsule interface. In cases associated with pre-existing iritis or intraoperative iris trauma (iris manipulation, iridectomy, or synechiolysis in glaucoma patients), fibrin exudation as well as iridocapsular synechial formation and macrophage precipitation often ensued. Cellular precipitates, as evaluated by biomicroscopy and specular microscopy, were less pronounced and more transient than on poly(methyl methacrylate) IOLs. Best case visual acuity results were comparable to those with conventional implants; all eyes attained 20/40 or better and 97% achieved 20/25 or better. The 1103 was easier to implant through a capsulorhexis opening and suited the dimensions of the capsular bag better than the PC-12 model.

Aged↗

PubMed1997

Glaucoma after cataract extraction and posterior chamber lens implantation in children.

PURPOSE: To evaluate the incidence of postoperative glaucoma in children who have cataract extraction and posterior chamber intraocular lens (IOL) implantation. SETTING: Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. METHODS: The incidence of glaucoma of all etiologies was evaluated in 45 eyes of 37 selected consecutive patients aged 1 to 18 years who had cataract extraction and posterior chamber IOL implantation from 1991 to 1994. Mean follow-up was 23 months (range 6 to 38 months). Nineteen patients had traumatic and 18 had developmental cataract. Exclusion criteria were microcornea smaller than 9.0 mm in diameter, preoperative glaucoma, or poor pupil dilation. The surgical technique comprised a continuous curvilinear anterior capsulorhexis in most cases, extracapsular aspiration by Ocutome or phacoemulsification, and retention of the posterior capsule. A peripheral iridectomy was done in 7 eyes (16%). Postoperative medications included topical atropine combined with topical, subconjunctival, and systemic corticosteroids and antibiotics. RESULTS: Three patients with traumatic cataract developed postoperative glaucoma during the follow-up. One developed pseudophakic pupillary block; however, a peripheral iridectomy prevented glaucoma. Two other patients developed late-onset glaucoma: one secondary to angle recession and the other to peripheral anterior synechias. No patient with developmental cataract developed glaucoma. CONCLUSION: Careful patient selection, atraumatic surgical technique, continuous curvilinear capsulorhexis, in-the-bag IOL placement, postoperative atropine, and topical and systemic corticosteroids significantly lower the incidence of pseudophakic pupillary block and glaucoma. Although no patient developed glaucoma, lifelong follow-up is mandatory to detect chronic open-angle and traumatic angle-recession glaucoma.

Adolescent↗

PubMed1997

Comparison of space-maintaining capabilities of Healon and Healon GV during phacoemulsification.

PURPOSE: To determine whether Healon GV or Healon (both sodium hyaluronate products) maintains space better during phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Friedrich-Schiller-University of Jena, Germany. METHODS: This double-blind, randomized clinical trial comprised 60 patients (30 Healon GV, 30 Healon) eligible for cataract surgery. Patients were evaluated 6 and 24 hours and 5 days postoperatively. A digital slide gauge mounted on an operating microscope was used to measure the distance between the iris and epithelial side of the cornea before surgery and before and after capsulorhexis. The distance between the anterior and posterior lens capsules (i.e., space in the capsular bag) was also measured before and after IOL insertion. The surgeon's objective opinion of the products was evaluated. RESULTS: The mean anterior chamber depth after capsulorhexis was significantly greater in the Healon GV than in the Healon group (P = .003). The mean distance between the anterior and the posterior lens capsules was significantly larger in the Healon GV than in the Healon group before and after IOL insertion. The subjective evaluation of space-maintaining capacity during surgery also favored Healon GV. Healon was considered easier to inject and remove from the eye. CONCLUSION: Healon GV had better space-maintaining capacity than Healon during cataract surgery with phacoemulsification and IOL insertion.

Aged↗

PubMed1998

Decentration of 3-piece versus plate-haptic silicone intraocular lenses.

PURPOSE: To compare the incidence of decentration with 2 types of silicone intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, University of Utah Medical Center, Salt Lake City, Utah, USA. METHODS: Selection criteria for this retrospective study included patients who had uncomplicated cataract surgery with a clear cornea or scleral tunnel incision with a curvilinear capsulorhexis and capsular bag implantation of a silicone IOL. After a mean follow-up of 14 months (range 12 to 18 months), 54 eyes implanted with a 3-piece lens (AMO SI-30) and 58 eyes implanted with a plate-haptic lens (Staar AA403) were examined for posterior chamber IOL decentration. The decentration criterion was 0.5 mm or more from the center of the pupil. Detailed chart review of preoperative and postoperative measurements was performed for each patient. RESULTS: Eighteen of the 3-piece IOLs (33%) and 11 of the plate-haptic IOLs (20%) were decentered 0.5 mm or more (P = .129). Using photographic analysis, the mean IOL decentration with the 3-piece IOL (1.12 mm +/- 0.198 [SD]) was significantly greater than with the plate-haptic IOL (0.632 +/- 0.278 mm)(P < .001). No statistically significant correlation was found between the centered or decentered IOL groups' preoperative refraction, axial length, capsulorhexis size, type of incision, or rate of neodymium:YAG laser capsulotomy. CONCLUSIONS: No statistically significant difference was seen between the decentration rates of 3-piece and plate-hepatic IOLs; however, the amount of decentration with the 3-piece IOL was significantly greater than with the plate-hepatic IOL. Other factors did not contribute to IOL decentration.

Follow-Up Studies↗

PubMed2003

[Cataract and keratoplasty--simultaneous or sequential surgery?].

BACKGROUND AND PURPOSE: Since the introduction of the triple procedure (simultaneous penetrating keratoplasty [PK], extracapsular cataract extraction [CE] and implantation of a posterior chamber intraocular lens [PCIOL]) in the mid-seventies, there is an ongoing discussion among corneal surgeons concerning the best approach for combined corneal disease and cataract. METHODS: Besides the classical triple procedure (1), two alternative microsurgical approaches are feasible: (2) CE + PCIOL prior to PK and (3) CE + PCIOL after PK. For the refractive results after TRIPLE some intraoperative details are crucial: Trephination of recipient and donor from the epithelial side without major oversize (Guided Trephine System or Nonmechanical Excimer Laser Trephination) should preserve the preoperative corneal curvature. Graft and the PCIOL placed in the bag after continuous curvilinear capsulorhexis should be centered along the optical axis. If possible, performing the capsulorhexis under controlled intraocular pressure conditions prior to trephination may help to minimise the risk of capsular ruptures. RESULTS: The major advantage of the TRIPLE is the faster visual rehabilitation and less efforts for the mostly elderly patients. However, two intraocular interventions with approach (2) and (3) bear an increased risk of infection and suprachoroidal haemorrhage. Approach (2) requires a cornea that is still transparent enough to perform cataract surgery, and the risk of intraocular pressure rise after PK seems to be increased. Approach (3) has the potential of a simultaneous reduction of astigmatism during CE (appropriate location of the incision, simultaneous refractive keratotomies or implantation of a toric PCIOL). Disadvantages may include the loss of graft endothelial cells and the theoretically increased risk of immunological allograft reactions. After TRIPLE, major deviations from target refraction have been reported. However, individual multiple regression analysis may help to minimise this problem with appropriate methods of trephination. Since suture removal after PK may result in major individual changes of the corneal curvature, IOL power calculation for approach (3) requires all sutures to be removed at the time of CE. However, even after complete suture removal the abnormal proportions between anterior and posterior curvatures and/or the irregular topographies after PK may be responsible for marked IOL power miscalculations in the individual case. CONCLUSIONS: The postulated better refractive outcome and better uncorrected visual acuity after the sequential approach is opposed by a markedly delayed visual rehabilitation. For this reason, we consider the TRIPLE procedure including CE via open sky in general anesthesia as the method of choice for combined lens and corneal opacities. Because of the often rapidly progressive nuclear cataracts after PK, we recommend the simultaneous approach in elderly patients with Fuchs' dystrophy even with incipient lens opacities.

Aged↗

PubMed1997

[Use of of the high frequency capsulotomy instrument in cataract surgery--effect of coagulation on corneal endothelium].

UNLABELLED: Intumescent or hypermature cataracts make a safe capsulorhexis impossible. High frequency capsulotomy represents a satisfying solution for this problem. Primary goal of the present study was to investigate a possible damage to the corneal endothelium by this method. MATERIALS AND METHODS: 55 patients with an uncomplicated senile cataract were enclosed into a prospective randomized study undergoing cataract surgery with capsulorhexis or with high frequency capsulotomy. Corneal endothelium was examined preoperatively as well as postoperatively at several intervals. RESULTS: Concerning loss of endothelial cells and parameters of polymegatism and pleomorphism there were no statistically significant differences between both groups. CONCLUSION: The diathermy during high frequency capsulotomy does not show any clinically relevant negative effects on the corneal endothelium within cataract surgery.

Aged↗

PubMed1994

[Centering intraocular lenses with reference to capsular incision].

BACKGROUND: Can the capsulotomy with small radial incisions compared to the continuous curvilinear capsulorhexis with perfect IOL centration still be recommended? This problem should be clarified under standard conditions. METHOD: On 100 patients both procedures were applied alternating with corneoscleral incision, phacoemulsification and endocapsular implantation of a 6 mm one-piece PMMA lens. RESULTS: The perfect IOL-centration following capsulorhexis (0.25 +/- 0.31 mm) is confirmed. But the circular capsular fibrosis can make it difficult to examine the fundus periphery or to perform a secondary cataract aspiration. The IOL centration after capsulotomy is not always ideal (0.55 +/- 0.51 mm) but sufficient. Advantages are the simplicity of the procedure and an easy approach to the posterior capsule in case of secondary cataract. CONCLUSION: Both methods are still appropriate.

Aged↗

PubMed1994

[Visco-hydraulic irrigation of the lens cortex. A safe ECCE method].

BACKGROUND: The safe and effective Hydrojet nucleus expression (Klin Monatsbl Augenheilkd 1993; 202:288-291) should be completed by a safe non traumatic and easy to perform method of cortex removal. MATERIAL AND METHODS: OPERATION TECHNIQUE: 8-mm tunnel incision, spiral capsulorhexis, hydrodissection and viscodissection of the nucleus, hydrojet nucleus expression. The lens cortex can be separated from the lens capsule by injection of hydroxypropylmethylcellulose (Metho), the viscoelastic substance acts as a wedge to separate the cortex from the capsule step by step. Finally the cortex is expressed by the injection of Metho. The capsule remains so clean, that often polishing is not necessary. PMMA lenses with an over all diameter of 10 or 11-mm and 7-mm optics were implanted. In 100 consecutive cases complications which occurred intraoperatively or within the following 2 days were listed. RESULTS: The following complications occurred: Hyphaema (2x, the blood disappeared spontaneously within 4-5 days), small cortex flake in the anterior chamber (2x), rhexis rim not intact (1x, nevertheless exact lens centration in the bag). No lesion of the capsule/zonule diaphragm, no fibrin reaction, no corneal edema. CONCLUSION: The method described is a safe method for ECCE. Capsulorhexis and tunnel incision are required. The method does not need any high technology equipment.

Adult↗

PubMed1993

[Viscosurgically assisted hydro-jet irrigation of the lens nucleus. An effective procedure for extracapsular cataract extraction with capsulorhesis].

BACKGROUND: To reduce costs and to be independent of high technology equipment it is desirable to perform cataract operations of high quality manually. MATERIALS AND METHODS: The manual operation includes a spiral shaped capsulorhexis, hydrodissection of the nucleous and its consequent delamination by means of hydroxypropylmethylcellulose (Metho). A bent cannula is used to create a jet stream of fluid separating the nucleous from the cortex and pressing the nucleous out of the bag. The cannula is connected to an infusion system 80 cm above the patient's eye. The nucleous slips into the anterior chamber and is delivered by injection of Metho, the injection cannula acts as a spatula to facilitate nucleous delivery. The nucleous also can be fragmentated for reduced incision length. The method was combined with an 8 mm tunnel incision. The implanted lenses had 7 mm optics and 10 or 11 mm haptics. In 100 consecutive operations (48 in males and 52 in females respectively) daily clinical examination was carried out for 7 days including the day of operation. Complications occurring during this time were listed. RESULTS: No lesion of the capsule/zonule diaphragm occurred. In 3 cases corneal edema was observed, which disappeared within 5 days totally. In 2 cases a continuous rhexis was not achieved, but the lens was situated in the bag and centered well in these cases as well as in the 98 eyes with intact capsulorhexis. CONCLUSIONS: The method described is safe. Using a purely manual operation technique it is possible to achieve an excellent lens fixation in the bag with undamaged rehexis rim and scleral tunnel incision.

Aged↗

PubMed2004

Influence of indocyanine green staining on the biomechanical properties of porcine anterior lens capsule.

PURPOSE: Indocyanine green (ICG) has recently been introduced in cataract surgery to stain the anterior lens capsule for better visualization of the capsulorhexis. The aim of the current in vitro study was to examine the effect of ICG staining on the biomechanical strength of the anterior porcine lens capsule. METHODS: Two parallel, 8 mm anterior lens capsule strips were prepared from each of 65 porcine postmortem eyes. ICG staining combined with white light exposure of 0.5, 1, 3, and 30 min duration was conducted. Unstained, nonilluminated and 0.1% glutaraldehyde-treated specimens were used as controls. Biomechanical stress-strain measurements were performed using an automated material tester. The absorption spectrum of the 0.5% ICG solution and the emission spectrum of the light source were controlled. RESULTS: After ICG staining combined with at least 3 min light exposure, a significant increase of stress (31%) at 25% strain and a significant decrease (7%) in ultimate strain was found. Without light exposure, there was no such effect, suggesting a light-dependent process. After 30 min of 0.1% glutaraldehyde treatment, there was a similar increase in stress (322%) at 25% strain and a decrease (47.6%) in ultimate strain. CONCLUSIONS: ICG staining of the lens capsule causes a significant increase in elastic stiffness and a reduction in ultimate extensibility, thereby facilitating a smooth continuous capsulorhexis. The effect is due to a photosensitizing effect of ICG, leading to collagen cross-linking.

Animals↗

PubMed1999

Surgical techniques for difficult cataracts.

This article reviews some of the advances that have taken place in the surgical techniques for difficult cataracts such as rock-hard, white, and posterior polar cataracts. Fashioning a central space, modified chopping maneuvers, and creation of multiple small fragments have enabled the surgeon to consistently achieve a successful outcome. A judicious combination of chop and separation movement in a step-by-step manner reduce the stress of the procedure and make it safer. Raised intracapsular pressure and poor visibility are dealt with through various innovative techniques. Use of high-viscosity sodium hyaluronate and double capsulorhexis allow the surgeon to achieve capsulorhexis with a high success rate. A controlled and gentle approach to phacoemulsification has proven to be the key factor for success in posterior polar cataracts.

Cataract↗

PubMed2004

Primary IOL implantation in children: a risk analysis of foldable acrylic v PMMA lenses.

BACKGROUND: /aims: To compare the relative risks of poly (methylmethacrylate) (PMMA) and soft acrylic (AcrySof) primary intraocular lens (IOL) implantation in paediatric cataract surgery. METHODS: A retrospective analysis of clinical data was performed on eyes of 61 infants and children who underwent cataract surgery with primary IOL implantation. Age at operation ranged from 3 weeks to 15 years. Mean follow up duration was 24.5 months (range 0.5-68 months). Factors examined included type of IOL (PMMA, acrylic), performance of a primary posterior continuous curvilinear capsulorhexis (PCCC) or capsulotomy with limited anterior vitrectomy, perioperative complications, and subsequent intervention for posterior capsule opacification (PCO). Risk factors for perioperative complications were examined with 2x2 tables to give odds ratios (OR) as measures of association. A survival analysis was performed to assess risk of subsequent intervention for PCO with different IOL types. Relative risks (hazards) and confidence intervals (CI) were calculated with Cox regression to adjust for potential confounding. RESULTS: Compared to acrylic, PMMA IOLs were significantly associated with perioperative complications (OR 5.2, 95% CI 1.4 to 19, p = 0.01). However, IOL and type of section were highly correlated factors, and this finding may reflect risks associated with larger scleral wounds used for PMMA IOLs. No statistically significant difference in risk of subsequent intervention for PCO was found between different IOL types. Mean times till intervention for PMMA and acrylic IOLs were 30.1 months (95% CI 22 to 38) and 19.8 months (95% CI 12 to 27) respectively (log rank test statistic 1.53, one degree of freedom, p = 0.22). At 12 months post-implant surgery, 76% (95% CI 59 to 93) of PMMA cases and 54% (95% CI 35 to 72) of acrylic cases had not required intervention for PCO; these proportions fell to 55% (95% CI 35 to 75) and 38% (95% CI 14 to 61) for PMMA and acrylic cases respectively at 2 years post-surgery. After adjustment for age at surgery, primary posterior capsulorhexis, and perioperative complications relative risk of intervention after acrylic IOL implantation was 1.6 (95% CI 0.66 to 3.9, p = 0.29). CONCLUSION: Primary implantation of foldable soft acrylic IOLs in paediatric eyes may allow fewer perioperative complications than rigid PMMA IOLs. Short term safety profiles of primary implantation in paediatric cataract surgery are otherwise comparable for PMMA and soft acrylic IOLs.

Acrylic Resins↗

PubMed2002

Trypan blue assisted phacoemulsification in corneal opacities.

AIM: To evaluate the efficacy of trypan blue for enhancing visualisation during phacoemulsification and foldable lens implantation in cases of cataract with corneal opacities. METHODS: 11 eyes of 11 patients with nebulomacular corneal opacities involving the visual axis with partially and visually debilitating cataract underwent trypan blue assisted phacoemulsification with foldable intraocular lens implantation. The patients were followed at the first day, first week, first month, and third month postoperatively. Completion of capsulorhexis, phacoemulsification with foldable lens implantation, and postoperative best corrected visual acuity were measured. RESULTS: The dye improved visualisation of the anterior capsule and a complete capsulorhexis could be performed successfully in all eyes. In all but one eye phacoemulsification was accomplished successfully. In one eye with Fuchs' dystrophy penetrating keratoplasty was performed later. Visual acuity was < or = 6/60 preoperatively in all eyes and improved to > or = 6/24 in eight eyes postoperatively. CONCLUSION: Trypan blue assisted phacoemulsification may be performed in selected cases of corneal haze/opacification with cataract. It provides acceptable visual outcome in cases awaiting penetrating keratoplasty or in cases where it is not feasible or promising.

Adult↗

PubMed2003

Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts.

AIM: To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation. METHODS: 82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months. RESULTS: Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05). CONCLUSIONS: A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.

Aged↗

PubMed1993

Long-term results with Iogel IOLs.

130 single piece hydrogel Iogel intraocular lenses (IOL) were implanted in the capsular bag after planned extracapsular cataract extraction. Anterior capsulotomy was performed by capsulorhexis in 59 patients while the envelope technique was used in 71 cases. The mean follow-up was 22 months and the average visual acuity was more than 8/10 in 78.5% of cases. In the capsulorhexis group a higher percentage of IOL was placed right into the capsular bag. No significant inflammatory and noninflammatory postoperative complications occurred. Lens decentration, observed in 5 cases, was due to asymmetric lens placement with one flange in the bag and the other in the ciliary sulcus. In both groups endothelial cell loss was about 7%. Results of the study indicate the safety and the efficacy of the Iogel lens as an intraocular implant. To prevent postoperative decentration and deformation of the IOL unnecessary intraocular manipulation and 'in-out' positioning should be avoided.

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