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PubMed1997

Comparison of phacoemulsification and planned extracapsular extraction.

76% of cataract surgeons in German speaking countries use phacoemulsification (phaco) as the procedure of choice for cataract extraction while the other 24% still use the planned extracapsular extraction (ECCE). The opening technique of the anterior capsule is chosen accordingly: for phaco capsulorhexis is preferred, while for ECCE can opener or letter box technique is usually done. The length of the sclerocorneal incision is 3.2 mm in phaco, 6.2 mm for a PMMA posterior chamber lens implantation and 9-13 mm for the ECCE. We prospectively compared both procedures with each group including 100 consecutive patients. The mean irrigation volume was 96.6 +/- 48.8 ml in the phaco group as opposed to 48.1 +/- 26 ml in the ECCE group. The mean duration of irrigation was 130 +/- 67 s in the first versus 129 +/- 76 s in the second group; mean endothelial cell loss was 7.9 versus 7.1%. No correlation was found between endothelial cell loss and duration of irrigation. Mean postoperative astigmatism measured 1.0 +/- 0.49 in the first group as compared to 3.3 +/- 1.7 dpt in the second group. Except for the astigmatism, our study could not detect significant differences regarding the outcome between both procedures. There are advantages to the phacoemulsification procedure, however, such as a smaller incision (e.g. tunnel technique), a closed irrigation-aspiration system, controlled intraocular pressure and the more frequent use of capsulorhexis. Preferred indications are zonulolysis or previously performed fistulating surgery.

Astigmatism↗
PubMedDate not supplied

Prevention and management of posterior capsule rupture.

PURPOSE: To present the means and technique used in our Department for prevention and management of posterior capsule rupture during planned extracapsular cataract extraction. METHODS: Prospective analysis of 550 extracapsular cataract operations from October 1993 to March 1994. Our technique (a slight modification of Blumenthal's technique) included a triplanar watertight small scleral incision, a relatively large continuous curvilinear capsulorhexis, or can-opener capsulotomy, nucleus hydrodissection and hydroexpression, use of an anterior chamber maintainer and residual cortex removal through a 10 o'clock side-port corneal incision. RESULTS: Best corrected postoperative visual acuity ranged from 7-10/10 in 93.45% of our cases. Posterior capsule rupture with or without vitreous loss occurred in 1.63% and 2.72% of the cases, respectively. These rates are much lower than those, observed, when we used the sclerocorneal incision and nucleus extraction with external pressure. CONCLUSIONS: The combination of a triplanar watertight small scleral incision. A relatively large continuous curvilinear capsulorhexis, an anterior chamber maintainer and residual cortex aspiration through the 10 o'clock side-port corneal incision greatly reduced the posterior capsule rupture rate.

Cataract Extraction↗
PubMedDate not supplied

Implantation in children.

With the development of posterior chamber lenses and continuous curvilinear capsulorhexis, and with the availability of viscoelastic agents, the use of intraocular lenses (IOLs) in children is becoming more popular. Since 1982, we have implanted posterior chamber IOLs (PC-IOLs) in the capsular bags of 61 cataractous eyes of 46 children and adolescents. The goal was in-the-bag placement facilitated by the use of a small capsulectomy, and, since 1984, by the use of the continuous curvilinear capsulorhexis. Forty-four cataracts were congenital, 13 were traumatic, and 4 were developmental. Cataract extraction with IOL implantation was performed in 16 (26%) preschool cases (ages 2 through 5), in 31 (51%) child cases (ages 6 through 12), and 14 (23%) adolescent cases (ages 13 through 18). Surgical and postoperative complications were minimal. Visual results were good. Fifty-six percent of preschoolers, 87% of children, and 86% of adolescents achieved 20/40 or better best corrected vision, with 79% of the total cohort achieving 20/40 or better. Overall, 35% achieved an uncorrected visual acuity of 20/40 or better. All but two cases had improvement in best corrected vision; if 20/20 was not attained, the cause was mainly due to deprivation amblyopia. Forty-eight percent of patients were within a diopter of emmetropia.

Adolescent↗
PubMedDate not supplied

Management of the anterior and posterior lens capsules and vitreous in pediatric cataract surgery.

PURPOSE: To review and discuss the advantages and disadvantages of various methods of managing anterior and posterior lens capsules and anterior vitreous in pediatric cataract surgery. METHODS: We reviewed the literature related to pediatric cataract surgery on PubMed and subclassified the subject into subtopics for managing the anterior lens capsule, posterior lens capsule, and anterior vitreous. RESULTS: After a review of the literature, we summarized the advantages and disadvantages of various approaches related to surgical managements of the anterior lens capsule, posterior lens capsule, and anterior vitreous in pediatric cataract surgery. We discussed recommendations from the literature and commented on our experiences related to the above subtopics. CONCLUSION: In the surgical management of pediatric cataract, anterior continuous curvilinear capsulorhexis provides the most reliable and tear-resistant capsular opening. Vitrectorhexis and radiofrequency diathermy, on the other hand, are alternative approaches (depending on the surgeon's personal preference). Primary posterior continuous curvilinear capsulorhexis may delay the onset of posterior capsule opacification. Anterior vitrectomy may be necessary to prevent or eliminate the onset of posterior capsule opacification in young children.

Cataract↗
PubMed1999

[Capsule contraction syndrome].

AIM: To analyse the occurrence of the anterior capsule contraction following cataract surgery. Capsule contraction syndrome (CCS) is defined as an extreme reduction in diameter of anterior capsulectomy, capsular bag diameter and, occasionally, displacement of the IOL after extracapsular cataract extraction. It is relatively frequent in pseudoexfoliation, advanced age, in association with uveitis, pars planitis and myotonic muscular dystrophy. MATERIALS AND METHODS: 5965 eyes of patients were operated on cataract between 1.01.1994 and 31.12.1997 in Tadeusz Krwawicz Chair of Ophthalmology and 1st Eye Hospital, Medical School in Lublin. Two types of surgical procedures were performed: "divide and conquer" phacoemulsification with 4.5-8 mm continuous curvilinear capsulorhexis (3385 eyes) and extracapsular cataract extraction with "can opener" capsulotomy (2580 eyes). RESULTS: 20 cases of clinically apparent CCS were referred to the Department: in the course of intensive postoperative inflammation--5, in patients over 80--4, in pseudoexfoliation syndrome--2, myotonic dystrophy--1, ectopia lentis--2, other causes--6. In order to improve visual acuity in 4 cases surgical removal of the distorted and opaque anterior capsule was performed, in 3 cases relaxing radial tears were done, in 3 cases secondary anterior capsulotomy was performed using Q-switched Nd:YAG laser. CONCLUSIONS: In cases where the occurrence of CCS is especially high large diameter capsulorhexis should be performed and IOL designed to provide maximal peripheral capsular bag expansion should be implanted.

Adult↗
PubMed2001

[The management of posterior capsular in cataract operations of high myopia].

OBJECTIVE: To study the management of posterior capsular in cataract operation of high myopia in order to avoid posterior capsular opacity(PCO). METHODS: Twenty-two cases(30 eyes) of high myopia with an average axial length of 31.62 mm were analyzed. Cataract phacoemulsification were performed in all cases, among which 12 eyes were operated with continuous curvilinear capsulorhexis (group I) of posteror capsular and 18 eyes were operated with capsulorectomy combined with anterior segment vitrectomy (group II). No artificial lenses were implanted in all cases. RESULTS: The post-operative naked vision were improved in both groups. Group I: The VA > or = 0.1 in all 12 eyes(100%), > or = 0.3 in seven eyes (58.3%) and no complication happened. Group II: The VA > or = 0.1 in 16 eyes(88.9%), > or = 0.3 in nine eyes (50%), and one eye with hemmorhage choroid detachment in the operation and three eyes with retina tear after the operation. CONCLUSION: Continuous curvilinear capsulorhexis of posteror capsular in treating PCO of high myopia with cataract is a safe effective and economic way compared with capsulorectomy combined with anterior segment vitrectomy.

Adult↗
PubMed2003

[Changes of lens capsule after phacoemulsification].

OBJECTIVE: To observe the changes in the lens capsule after phacoemulsification and its effects on the position of intraocular lens (IOL) and to demonstrate the best position of IOL in relation to the anterior capsule. METHODS: The present series comprised 141 eyes in 127 patients underwent phacoemulsification and foldable lens implantation with 5 mm continuous curvilinear capsulorhexis. The changes in the lens capsule and the position of IOL with dilated pupil were observed using slit lamp microscope 3 months after the operation. RESULTS: Capsular bag shrinkage and white Soemmering ring along the margin of capsulorhexis were observed in all cases. Three different kinds of relationship between anterior capsule opening and the IOL optic surface were found, including the non-capture (68 eyes), partial-capture (52 eyes) and total-capture (21 eyes) relationships. The incidence of central posterior capsule opacification (PCO) was significantly higher in the total-capture group (47.6%) than that in the non-capture (11.7%) and partial-capture (21.2%) groups (P < 0.01). IOL in well centered position was significantly higher in the non-capture (91.2%) and total-capture (81.0%) groups than that in the partial-capture group (42.3%) (P < 0.01). CONCLUSION: In the present study, various changes in the lens capsule were observed after phacoemulsification and foldable lens implantation. It is suggested that keeping the IOL in a non-capture position is a key point to avoid the occurrence of PCO and IOL decentration.

Aged↗
PubMed1992

[An experimental study of the surgical trauma on the rabbit's lens suspensory apparatus after cataract surgery].

Extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation requires that the posterior capsule and the zonules remain sufficiently intact. To assess the surgical trauma on the lens suspensory apparatus of the enucleated rabbit eye, we developed a new fine pressure gauge that could quantitate its strength. The cornea and the iris of enucleated eyes were removed to allow clear visualization of the anterior surface of the lens to the equator. Afterwards several types of anterior capsulotomy were performed for ECCE and PC-IOL implantation. And then the lens of the pseudophakic eye was vertically pressed with the plastic rod of the fine pressure transducer, and the strength of the lens suspensory apparatus was simultaneously measured. The strength of the lens suspensory apparatus of the pseudophakic eye decreased approximately 35% compared with that of the phakic eye. Moreover the integrity of the lens capsule of animals with circular capsulorhexis with tears or linear capsulotomy decreased approximately 43% compared with that of continuous circular capsulorhexis (CCC) and also zonular rupture and vitreous loss occurred as a result of the expansion of radial tears in the anterior capsule. The present study indicates that the strength of the lens suspensory apparatus decreases with cataract surgery, suggesting that much more attention to cataract surgery is needed if the anterior capsule had radial tears. It is also suggested that CCC is the best type of anterior capsulectomy procedure.

Animals↗
PubMed1992

[Postoperative anterior chamber inflammation after posterior chamber intraocular lens implantation concurrent with pars plana vitrectomy and lensectomy].

The authors compared postoperative anterior chamber inflammation of triple procedure; diabetic pars plana vitrectomy, lensectomy with anterior capsule left intact and posterior chamber intraocular lens implantation anterior to anterior capsule, to those of various cataract surgeries with posterior chamber intraocular lens implantation and vitrectomies in diabetic retinopathy eyes. The inflammation was evaluated in terms of the incidence of inflammatory complications (fibrin reaction and posterior synechia of iris), and by periodical measurement of flare counts for postoperative 6 months using a laser flare-cell meter. The inflammation was more intense than those after the following 3 surgeries; phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis, extracapsular extraction and in the bag intraocular lens implantation after can opener capsulotomy, and vitrectomy alone. The inflammation, however, was less intense compared with that of another method of triple procedure; pars plana vitrectomy, phacoemulsification and in the bag intraocular lens implantation after continuous curvilinear capsulorhexis or can opener capsulotomy, and development of posterior synechia was rarely observed.

Adult↗
PubMedDate not supplied

Automated irrigation/aspiration before phacoemulsification in eyes with white cataracts.

BACKGROUND AND OBJECTIVE: A white mature cataract still presents a significant challenge for the cataract surgeon. Because of the reduced visibility and increased intracapsular pressure in such cases, it is difficult to consistently achieve controlled continuous curvilinear capsulorhexis. Several simple procedures for treatment of eyes with white mature cataract are described. PATIENTS AND METHODS: Seven consecutive patients (7 eyes) with white cataracts were enrolled for cataract surgery from July 2002 to February 2003. A small, central anterior capsular opening was created after carefully filling the anterior chamber with viscoelastic agents. Automated irrigation/aspiration by lowering of a connected bottle of balanced salt solution was used to aspirate the liquefied milky lens contents and decrease intracapsular pressure. RESULTS: All patients obtained controlled capsulorhexis, safe cataract phacoemulsification, and in-the-bag intraocular lens implantation. CONCLUSION: Automated irrigation/aspiration before phacoemulsification is safe and effective for eyes with white cataracts.

Aged↗
PubMedDate not supplied

[The specificity of surgery of congenital cataract with implantation of folding "Acrysof" IOL in children].

Described in the paper are the results of surgical treatment of 25 children (37 eyes), aged 3 months to 12 years, with congenital and secondary cataracts. The treatment schemes were based on new technologies including tunnel incisions, continuous round anterior capsulorhexis and aspiration-irrigation as well as implantation of different-model posterior-chamber flexible "Acrysof' IOLs into the capsular sac or ciliary sulcus. A high treatment efficiency as well as a need in a differentiated approach to choosing an IOL fixation, diameter and technique of anterior capsulorhexis and a model of the implanted "Acrysof' IOL made with respect to individual age and clinical peculiarities of eyes of children with congenital cataracts as well as with respect to a potential general somatic pathology (galactosemia) are demonstrated.

Acrylic Resins↗
PubMedDate not supplied

Capsular phimosis following phacotrabeculectomy.

Three cases of severe capsular phimosis following augmented phacotrabeculectomy complicated by intense postoperative fibrinous uveitis are described. The marked inflammation was possibly related to the combined procedure itself, the excessive intraoperative manipulation to stretch the pupil, and the compromised blood-aqueous barrier after prolonged use of pilocarpine. The combination of fibrinous uveitis and the small size of capsulorhexis attained through a stretched pupil are possible risk factors for developing severe capsular phimosis in the absence of zonular weakness or preoperative uveitis. For patients with similar risk factors, two separate surgical procedures should be considered. Alternatively, a larger capsulorhexis or radial relieving incisions should be attempted during phacotrabeculectomy to prevent this complication, which could jeopardize the outcome of otherwise successful surgery.

Aged↗
PubMed1991

The relationship between the stretching capability of the anterior capsule and zonules.

The stretching capability of the zonules was studied in 40 human eyes obtained postmortem from 27 patients. A continuous circular capsulorhexis (CCC) (2.2-6.8 mm) was performed, and the lenses were removed by either phacoemulsification (26 eyes) or planned extracapsular cataract extraction (ECCE) (14 eyes). Maximal zonular stretch was calculated as the difference in distance between the ciliary processes and the zonular insertion at rest and after maximal stretch. This zonular stretch test showed that zonules can stretch to a mean distance of 3.82 mm before rupturing. Capsular elasticity was measured in 35 of the eyes by gradually opening a modified caliper until the capsular opening was torn. The ratio between the circumference at rupture and the circumference at rest was used as an index of capsular elasticity. Circumference of the intact capsulorhexis could be enlarged an additional 62% before a radial tear occurred. In most cases, no significant correlation was seen between the capsular and zonular capability to stretch. Maximal zonular stretch decreased significantly with age by approximately 0.5 mm for every 5 yr, whereas capsular elasticity did not show a significant correlation with age. Two eyes with pseudoexfoliation had relatively friable zonules but the capsular elasticity was within normal limits. Patient age is probably the best indicator of the stretching capability of the zonules.

Age Factors↗
PubMed1990

Irrigating capsule retractor for posterior nucleus hydrodissection.

An irrigating capsule retractor for safe nucleus delivery in planned extracapsular cataract extraction (ECCE), particularly after circular capsulorhexis and curvilinear capsulotomy using an envelope technique, is introduced. This retractor, which consists of a 20-gauge needle with a flattened top, provided with a fine-wire hook, can be used to bring the upper nucleus equator out of the capsular bag as well as to perform posterior nucleus hydrodissection. The cannula is especially helpful in performing circular capsulorhexis in a small diameter.

Cataract Extraction↗
PubMedDate not supplied

The "anchor" anterior capsulectomy.

In recent years, continuous circular capsulorhexis (CCC) has become the preferred anterior capsulectomy in many ophthalmic centers. Yet, many ocular surgeons are still uncomfortable with it, especially when tearing the capsule on its lower semicircle, since this often results in corneal endothelial injury, and, thus, postoperative lower corneal edema. We present a modified anterior capsulectomy, which consists of a crescent capsulorhexis and a perpendicular discission, followed by circular tearing of the resulting capsular flaps. This "anchor" anterior capsulectomy (AAC) was used in 14 cases of elective extracapsular cataract extraction, followed by intraocular lens (IOL) implantation. The capsulectomy was successful in 12, and IOL implantation was successful in 12. The procedure was relatively easy to perform and resulted in good "in-the-bag" implantation, regardless of the IOL's overall length and the optic's size. AAC can serve as an intermediate step in learning CCC as well as a reliable alternative anterior capsulectomy.

Cataract Extraction↗
PubMedDate not supplied

Open-sky phacoemulsification during corneal transplantation.

A continuous, circular capsulorhexis maintains the integrity of the anterior capsule. During corneal transplantation, a capsulorhexis may be combined with phacoemulsification, allowing the cataractous lens to be delivered in small fragments, thereby maintaining the integrity of the anterior capsular margin. This approach allows stable "in-the-bag" placement of a posterior chamber intraocular lens (PC-IOL) during combined cataract extraction and corneal transplantation. The technique also minimizes the risk of radial anterior capsular tears and subsequent decentration of the PC-IOL.

Cataract Extraction↗
PubMed1994

Phacoemulsification--a senior surgeon's learning curve.

We sought to prospectively document and evaluate the learning curve of an experienced extracapsular surgeon making a supervised transition from extracapsular cataract extraction (ECCE) to phacoemulsification. Over a period of 2 weeks, 51 phacoemulsification procedures using an endocapsular nucleofractis technique were performed by a single senior surgeon at the Christian Medical College in Vellore, India under the supervision of a visiting US expert with more than 15 years' experience in the technique. Vitreous loss occurred in seven eyes (six prior to the stage of cortical aspiration); failure of capsulorhexis necessitated conversion to standard ECCE in four. Injury to the inferior iris during phacoemulsification was cosmetically significant in three eyes. Two eyes had mild persistent localized corneal edema, but there were no instances of permanent corneal damage. One eye had intraoperative displacement of the nucleus into the vitreous. In one eye with vitreous loss, the implanted intraocular lens dislocated into the vitreous cavity. Two patients had clinically detectable cystoid macular edema at 6 weeks. Eleven patients were lost to follow up after 3 weeks. Six weeks after surgery, 36 of the remaining 40 eyes (90%) had achieved a best-corrected visual acuity of 6/6. We conclude that phacoemulsification requires supervised learning, even for an experienced surgeon. Complications still occurred, but were restricted to the unfamiliar steps of the surgery. Factors identified in the first 2 days of surgery (10 cases) as critical in the smooth transition to phacoemulsification were careful selection of initial cases, a successful capsulorhexis, and hydrodissection with vigorous nucleus mobilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Astigmatism↗
PubMed1994

[Combined pars plana vitrectomy, lens removal and intraocular lens implantation for complications of diabetic retinopathy. Surgical results in 120 cases].

We performed combined vitrectomy, lens removal and posterior chamber intraocular lens implantation for proliferative diabetic retinopathy in 120 eyes of 101 patients. Follow-up periods ranged from 3 to 63 months, with a mean of 17 months. Three lens removal methods were used: extracapsular cataract extraction (14 eyes), phacoemulsification and aspiration (49 eyes), and pars plana phacoemulsification (57 eyes). Preoperative rubeosis iridis or neovascular glaucoma was found in 21 eyes. Gas or temporary silicone oil tamponade was employed in 32 eyes. Surgical results were good, and the postoperative vision was finger counts or below only in 13 eyes. Thus the combined surgery proved to have no serious problems. Our results indicate two important points. (1) It is best to chose either of the following two methods for the lens surgery: phacoemulsification with continuous circular capsulorhexis, self sealing sclerocorneal incision, and in-the-bag fixation of the posterior chamber lens, or pars plana phacoemulsification leaving the anterior capsule, rub off and aspirating the lens epithelial cells, continuous circular capsulorhexis, and posterior chamber lens implantation in front of the anterior capsule from a self-sealing sclerocorneal wound. (2) It is mandatory to do complete vitrectomy and cut out the vitreous gels incarcerated in the sclerotomy site.

Adult↗