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PubMed2002

Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery.

PURPOSE: To determine the incidence of bacterial contamination of the anterior chamber after phacoemulsification cataract surgery with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia. METHODS: Ninety-eight consecutive eyes of 96 patients having phacoemulsification cataract surgery with IOL implantation were included in this prospective study. Two intraoperative anterior chamber aspirates were obtained from each patient, 1 taken at the start and the other at the conclusion of surgery. In addition, preoperative and postoperative conjunctival swabs were acquired. The 4 specimens were cultured using direct culturing techniques under aerobic and anaerobic conditions for 14 days. No preoperative antibiotics were used. RESULTS: The incidence of intraoperative anterior chamber contamination was 0% (95% confidence interval, 0%-3.7%) as all intraoperative anterior chamber samples proved culture negative. Sixty-five percent of the preoperative conjunctival swabs were positive for growth, with corynebacteria, coagulase-negative staphylococci, and Propionibacterium acnes being the most frequently cultured organisms. Sixteen percent of the postoperative conjunctival swabs were positive for growth, with corynebacteria and coagulase-negative staphylococci being the most common bacteria. One patient developed culture-positive postoperative endophthalmitis; using pulsed-field gel electrophoresis for further typing, the implicated Staphylococcus epidermidis was indistinguishable from that isolated from the patient's preoperative conjunctival swab. CONCLUSIONS: The bacterial contamination rate of the anterior chamber after phacoemulsification and IOL implantation was extremely low. Additional findings support the conjunctiva as being a primary source of bacteria causing postoperative endophthalmitis as well as the ability of povidone-iodine to reduce the conjunctival bacterial load.

Aged↗
PubMed2002

Comparison of ketorolac tromethamine 0.5% and loteprednol etabonate 0.5% for inflammation after phacoemulsification: prospective randomized double-masked study.

PURPOSE: To compare the efficacy of a topical nonsteroidal antiinflammatory agent (ketorolac tromethamine ophthalmic solution 0.5%) and a topical steroid (loteprednol etabonate ophthalmic suspension 0.5%) in controlling inflammation after cataract surgery. SETTING: Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Sixty patients were prospectively and randomly assigned to receive topical treatment with ketorolac tromethamine ophthalmic solution 0.5% or loteprednol etabonate ophthalmic suspension 0.5% starting the day after routine phacoemulsification for cataract extraction. Both patient and investigator were masked to treatment. All patients had uneventful small-incision phacoemulsification with placement of a foldable posterior chamber intraocular lens (IOL). Patients used 1 of the 2 antiinflammatory agents 4 times a day starting 24 hours after surgery. Signs and symptoms of inflammation as documented by external slitlamp examination, intraocular pressure (IOP), and Kowa cell and flare measurements were evaluated on postoperative days 1, 4, 7, and 30. RESULTS: There was no statistically significant difference in any measurement of postoperative inflammation between the 2 groups. There was no difference in objective or subjective cell and flare measurements or in IOP between groups. No patient in either group was removed from the study for lack of treatment efficiency. CONCLUSIONS: Ketorolac tromethamine ophthalmic solution 0.5% was as effective as loteprednol etabonate ophthalmic suspension 0.5% in reducing inflammation after routine phacoemulsification and IOL implantation. These results suggest that ketorolac tromethamine 0.5% is a safe and effective antiinflammatory alternative to steroids after cataract extraction.

Aged↗
PubMed2002

Combined lidocaine 1% and hydroxypropyl methylcellulose 2.25% as a single anesthetic/ viscoelastic agent in phacoemulsification.

PURPOSE: To evaluate the use of a mixture of hydroxypropyl methylcellulose 2.25% (HPMC) and lidocaine 1% (final concentrations) as a single viscoelastic/anesthetic agent to achieve proper anesthesia and viscoelastic properties during phacoemulsification. SETTINGS: Department of Ophthalmology, Cairo University, Cairo, Egypt. METHODS: This prospective randomized study comprised 70 eyes having routine phacoemulsification. Patients had the HPMC-lidocaine mixture (n = 35) or pure HPMC 2.25% (n = 35) injected before capsulorhexis and again before intraocular lens implantation. The results were evaluated by a pain/discomfort score postoperatively. RESULTS: The difference in medians of the overall intraoperative pain/discomfort scores between the 2 groups was not statistically significant. However, mild pain/discomfort was reported by 60.0% in the pure HPMC group and by 31.4% in the HPMC-lidocaine mixture group. Moderate pain/discomfort was reported by 28.6% and 5.7%, respectively. The difference between the 2 groups was statistically significant (P =.001). CONCLUSION: The use of a mixture of HPMC 2.25% and lidocaine 1% rather than a regular viscoelastic agent resulted in clinically and statistically significantly reduced pain/discomfort during phacoemulsification.

Adult↗
PubMed2002

Ultrasonic phacoemulsification using a 1.4 mm incision: clinical results.

PURPOSE: To evaluate the intraoperative complications and postoperative results of bimanual phacoemulsification and aspiration using a sleeveless phaco tip inserted through an ultra-small incision. SETTING: Department of Ophthalmology, Jikei University, Tokyo, Japan. METHODS: This study comprised 637 eyes having cataract extraction using conventional phacoemulsification equipment. A 20-gauge phaco tip with the sleeve removed was inserted through a 19-gauge corneal incision. A 20-gauge hooked cannula with the wall thinned to increase the inner diameter was used for infusion. After the crystalline lens was removed, the incision was widened to 2.8 to 4.1 mm and and an intraocular lens (IOL) was implanted. Study parameters were operating time, amount of infusion solution used, incidence of intraoperative complications, and early postoperative results. RESULTS: The mean operating time was 8 minutes 42 seconds. Although the nuclear hardness was grade 4 or above in 35 eyes, there were no cases of thermal burn. The amount of infusion solution and the rate of postoperative decrease in corneal endothelial cell density did not differ greatly from results of conventional methods. This technique induced considerably less corneal astigmatism than surgery using conventional corneal incisions. CONCLUSIONS: A sleeveless phaco tip was used to perform successful bimanual phacoemulsification using conventional phaco machines and familiar surgical techniques. The cataracts were safely removed through an incision of 1.4 mm or smaller that was widened for IOL insertion.

Humans↗
PubMed2002

Sulcus implantation of a 3-piece, 6.0 mm optic, hydrophobic foldable acrylic intraocular lens in phacoemulsification complicated by posterior capsule rupture.

To evaluate the safety of implanting a 3-piece, 6.0 mm optic, foldable acrylic intraocular lens (IOL) in cases of posterior capsule rupture during phacoemulsification. Department of Ophthalmology, Ahepa Hospital, Aristotle University Medical School, and Interbalkan Medical Center, Thessaloniki, Greece. This prospective noncomparative case series included 28 eyes (28 patients) having phacoemulsification complicated by extensive posterior capsule rupture with or without vitreous loss. In all eyes, a 3-piece, 6.0 mm optic, foldable acrylic IOL (AcrySof MA60BM, Alcon) was implanted in the sulcus. Postoperative examination included best corrected visual acuity (BCVA), anterior segment biomicroscopy, IOL centralization and position, intraocular pressure (IOP), and fundus biomicroscopy. The follow-up was 6 months. The most common postoperative complications were transient corneal edema in 12 eyes and increased IOP in 11 eyes. Slight asymptomatic decentralization from the center of the pupil (1.0 to 2.0 mm) and pseudophacodonesis were observed in 5 eyes each. Friction of the IOL with the iris occurred in 1 eye. Clinically significant cystoid macular edema occurred in 3 eyes. The final BCVA was between 20/15 and 20/25 in 18 patients, 20/30 in 2, between 20/40 and 20/50 in 4, and between 20/60 and 20/200 in 4. AcrySof IOL implantation in the sulcus during phacoemulsification complicated by posterior capsule rupture preserved the advantages of small-incision surgery. The postoperative behavior and centralization of the IOLs resembled those of poly(methyl methacrylate) lenses.

Aged↗
PubMed2002

Antiinflammatory effect of preoperative ketorolac in phacoemulsification.

We report the antiinflammatory effect and efficacy of preoperative treatment with ketorolac in a patient with rheumatoid arthritis having phacoemulsification. This 70-year-old woman was on a maintenance dose of systemic methylprednisolone at the time of uneventful phacoemulsification in the left eye. She developed a sterile hypopyon on the first postoperative day and was treated aggressively with topical and systemic therapy, resulting in a gradual resolution of the inflammatory response. The patient subsequently had phacoemulsification in the right eye. The only significant difference in the preoperative management this time was that the patient received topical ofloxacin and ketorolac 4 days before surgery. The postoperative inflammatory response was much more controlled. The patient was continued on ketorolac and prednisolone acetate, resulting in the usual postoperative inflammatory response.

Aged↗
PubMed2002

Bimanual phacoemulsification through 2 stab incisions. A wound-temperature study.

PURPOSE: To determine the thermal parameters of bimanual ultrasound-based phacoemulsification through 2 stab incisions with a bare aspiration needle. SETTING: In vitro laboratory. METHODS: The Sovereign phacoemulsification unit (Allergan) was used in 3 modes in conjunction with the Olson irrigating chopper (ASICO) in 6 fresh human cadaver eye-bank eyes to determine the temperature at which a wound burn would occur. A wound burn was defined as temperature exceeding 45 degrees C, whitening around the wound, or wound contraction. RESULTS: One hundred percent ultrasound power was required to create a wound burn in the unoccluded mode in continuous ultrasound and the burst mode. The time to create the wound burn was 160 and 180 seconds in 2 eyes in continuous ultrasound and 42 and 50 seconds in 2 eyes in the burst mode; it was 58 and 70 seconds in continuous ultrasound with complete occlusion and required 80% power. CONCLUSIONS: The energy necessary to obtain a wound burn during 2-incision bimanual ultrasound-based phacoemulsification with a bare aspiration needle in human cadaver eyes was extremely high. The parameters necessary to create a wound burn in each modality occurred well beyond normal clinical settings and provide evidence that 2-stab ultrasound-based lens extraction can be performed safely with the Sovereign machine.

Anterior Eye Segment↗
PubMed2002

Phacoemulsification in patients with Fuchs' heterochromic uveitis.

PURPOSE: To evaluate the results of phacoemulsification with capsular bag fixation of a poly(methyl methacrylate) (PMMA), acrylic, or silicone intraocular lens (IOL) in patients with complicated cataract resulting from Fuchs' heterochromic uveitis (FHU). SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study evaluated 20 eyes of 19 patients with FHU and cataract who had uneventful phacoemulsification with endocapsular implantation of an IOL and completed a 1-year follow-up. RESULTS: Preoperatively, loss of the iris collarette and fine keratic precipitates were seen in all 20 eyes, iris heterochromia in 16, iris atrophy in 12, and iris nodules in 2. Fourteen eyes had mild or negligible preoperative anterior chamber inflammation. No eye had increased intraocular pressure. An acrylic IOL was implanted in 10 eyes, a silicone IOL in 4, and a PMMA IOL in 6. There were no significant differences in outcomes among the 3 IOL groups. Three patients had intraoperative hyphema that resolved spontaneously. Postoperatively, 16 eyes had mild anterior chamber reaction. Four patients had significant anterior chamber inflammation necessitating the use of frequent topical steroids. No case had secondary glaucoma or posterior synechias. The best corrected visual acuity was 6/5 in 6 eyes, 6/6 in 11, and 6/9 in 3. CONCLUSIONS: Uneventful phacoemulsification with endocapsular IOL implantation visually rehabilitated patients with FHU. All 3 IOLs yielded similar results except for increased early postoperative inflammation and late dense anterior capsule opacification in the silicone group. Further studies comparing the outcome of different IOL materials are required to determine their effectiveness in patients with FHU.

Acrylates↗
PubMed2002

Factors affecting visual outcomes after small-incision phacoemulsification in diabetic patients.

PURPOSE: To examine the factors affecting visual outcome after phacoemulsification and evaluate the use of preoperative visual potential in assessing the visual prognosis in diabetic patients. SETTING: Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA. METHODS: In a retrospective chart review of 1345 consecutive patients who had uneventful small-incision phacoemulsification, operated eyes from 106 diabetic and 55 nondiabetic control patients were selected. Data on demographics, level of retinopathy, perioperative glycosylated hemoglobin (HbA(Ic)), surgical duration, preoperative best corrected visual acuity (BCVA), and visual potential were collected. RESULTS: The age, sex, preoperative BCVA, and visual potential in the diabetic and control eyes were comparable. Throughout the postoperative period, BCVA was worse of the diabetic group. At 1 year, BCVA was 20/40 in 82.1% of the diabetic group and 94.7% of the control group (P =.01). The most important factors affecting postoperative BCVA included coexisting diabetes and preoperative level of retinopathy. No correlation was found between perioperative and postoperative BCVA. Diabetic patients were less likely than control patients to achieve a BCVA better than or equal to the preoperative visual potential at 4 years (hazard ratio 0.6; 95% confidence interval, 0.4-0.9; P =.011). Patients with nonproliferative diabetic retinopathy were nearly 5 times less likely (P =.023) and patients with proliferative diabetic retinopathy 30 times less likely (P <.0001) to achieve a postoperative BCVA of 20/40 than diabetic patients without retinopathy. CONCLUSIONS: Although uneventful small-incision phacoemulsification improved visual acuity in diabetic patients, this group had an overall worse visual outcome than nondiabetic patients. The most important predictors of visual outcome were coexisting diabetes and the extent of preoperative retinopathy. Methods used to assess preoperative visual potential provided a reasonable estimate of postoperative BCVA in diabetic patients. Given the inverse association between the level of retinopathy and visual outcome, it may be better to perform cataract extraction in diabetic patients during earlier stages of retinopathy.

Adult↗
PubMed2002

Latanoprost and clinically significant cystoid macular edema after uneventful phacoemulsification with intraocular lens implantation.

PURPOSE: To elucidate an association between latanoprost and clinically significant cystoid macular edema (CME) in patients after uneventful phacoemulsification with intraocular lens implantation. SETTING: Bergman Eye Center, Department of Ophthalmology, The University of Chicago Hospitals, Chicago, Illinois, USA. METHODS: One hundred forty-five consecutive patients (162 eyes) who had phacoemulsification from July 1999 to December 2000 were retrospectively reviewed to determine which patients developed CME. Patients with a history of inflammation and pseudoexfoliation, previous intraocular procedures, or current intraoperative complications were excluded from the study. All cases of CME were diagnosed on the basis of a fundus examination showing typical CME accompanied by a decrease in visual acuity. Upon diagnosis, latanoprost was discontinued and ketorolac was prescribed. The data were analyzed using the Fisher exact test. Of the records reviewed, 134 patients (151 eyes) were included in the study; 11 eyes were excluded secondary to intraoperative complications, a history of ocular inflammation, or both. Among the patients included, 12 were receiving latanoprost preoperatively. RESULTS: Four cases of CME were identified; all 4 patients were taking latanoprost. Latanoprost was discontinued in 8 patients 1 week preoperatively, and none of them developed CME. Therefore, in this series, only patients receiving latanoprost developed CME after uneventful cataract surgery. This difference was statistically significant. In addition, all cases of CME resolved upon discontinuation of latanoprost and administration of ketorolac. CONCLUSIONS: his retrospective study shows a clinical association between latanoprost use and postoperative CME after uneventful phacoemulsification. Given the absence of other coexisting risk factors for CME, this series suggests latanoprost is a significant etiologic factor for the development of postoperative CME.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes.

PURPOSE: To evaluate the effectiveness and safety of combined phacoemulsification, pars plana vitrectomy (PPV), and intraocular lens (IOL) implantation in diabetic and nondiabetic patients and compare the clinical results with those of sequential surgery. SETTING: Seoul National University College of Medicine, Seoul, South Korea. METHODS: The results of combined phacoemulsification, PPV, and IOL implantation in 52 patients (52 eyes) were retrospectively analyzed. The main outcome measures were preoperative and postoperative best corrected visual acuity (BCVA), postoperative BCVA of 20/40 or better, and intraoperative and postoperative complications. Combined surgery and sequential surgery were also compared using the same outcome measures. RESULTS: Postoperatively, the BCVA was better in 44 eyes (84.6%); 12 eyes (23.1%) achieved a BCVA of 20/40 or better. Postoperative complications consisted of a transient intraocular pressure increase in 29 eyes (55.8%), hyphema in 10 (19.2%), neovascular glaucoma in 8 (15.4%), anterior chamber fibrin exudation in 7 (13.5%), vitreous hemorrhage in 7 (13.5%), retinal detachment in 3 (5.8%), and posterior capsule opacification in 1 (1.9%). In the diabetic patients, postoperative visual outcomes between the combined-surgery group and the sequential-surgery group were not significantly different; however, neovascular glaucoma occurred only in the combined-surgery group. Other complications were not different between the combined-surgery group and the sequential-surgery group. In the nondiabetic patients, the postoperative visual outcomes and complications between the 2 groups were not significantly different. CONCLUSIONS: Combined phacoemulsification, PPV, and IOL implantation was safe and effective in selected patients, with the clinical outcomes comparable to those of sequential surgery.

Adult↗
PubMed2002

Surgeon experience and patient comfort during clear corneal phacoemulsification under topical local anesthesia.

PURPOSE: To evaluate patient comfort during topical anesthesia clear corneal phacoemulsification surgery performed by a surgeon in the learning curve or by an experienced surgeon. SETTING: Royal Alexandra Hospital, Paisley, Scotland, United Kingdom. METHODS: This study comprised 46 consecutive patients having phacoemulsification under topical anesthesia of proparacaine 0.5% (Proxymetacaine. Surgery was performed by a surgeon during his learning curve (n = 20) or by an experienced surgeon (n = 26). No sedation or intracameral anesthesia was used in either group. All patients had clear corneal phacoemulsification with foldable acrylic posterior chamber intraocular lens implantation. Each patient's subjective experience of overall pain perioperatively (period immediately surrounding and during surgery) and worst pain perceived during surgery was measured immediately after surgery using a 10-point visual analog scale. RESULTS: There was no significant difference in patient-reported pain scores for overall pain perioperatively (P =.47, Wilcoxon rank sum test) and the worst pain perceived during surgery (P =.32, Wilcoxon rank sum test). CONCLUSIONS: Topical anesthesia with proparacaine provided similar and reasonable analgesic effects in patients having surgery by a surgeon in the learning curve and those having surgery by an experienced surgeon. The discomfort perceived during surgery performed by an experienced surgeon was less, although not statistically significantly different.

Aged↗
PubMed2002

Outcomes of phacoemulsification in patients with dry eye.

PURPOSE: To evaluate the outcomes of phacoemulsification in patients with dry eye. SETTING: Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study included 25 eyes of 23 patients with dry eye having phacoemulsification. Dry eye was defined as Schirmer I with lidocaine hydrochloride (Xylocaine) score of 5.0 mm after 5 minutes, a tear-film breakup time (TFBUT) of less than 5 seconds, or both. Data were retrospectively analyzed for preoperative and postoperative tear function, postoperative complications, and final visual outcomes. RESULTS: Of the 23 patients, 18 had age-related dry eye and 5 had secondary Sjögren's syndrome. Twenty-two eyes had predominant aqueous deficiency (Schirmer I with Xylocaine score of 5.0 mm or less), and 3 had a Schirmer score between 6.0 mm and 9.0 mm. The TFBUT was 5 seconds or less in 17 eyes and between 6 seconds and 9 seconds in 8 eyes. The mean preoperative Schirmer score was 4.80 mm +/- 2.01 (SD) (range 2.0 to 9.0 mm) and the mean postoperative score, 3.80 +/- 2.40 mm (range 0 to 7.0 mm). The mean preoperative TFBUT was 4.00 +/- 1.87 seconds (range 0 to 9 seconds) and the mean score at the last follow-up, 3.40 +/- 1.60 seconds (range 0 to 8 seconds). Postoperatively, 8 eyes had superficial punctate keratopathy and 8 had an epithelial defect. The final visual acuity was 6/6 in 13 eyes, 6/9 to 6/12 in 8 eyes, and 6/18 to 6/60 in 4 eyes. CONCLUSION: Phacoemulsification was safe and led to minimal complications in patients with age-related dry eye with or without associated systemic disorders.

Adult↗
PubMed2002

Nausea and vomiting after phacoemulsification using topical or retrobulbar anesthesia.

PURPOSE: To determine and compare the incidence of postoperative nausea and vomiting in patients having phacoemulsification under topical or retrobulbar anesthesia. SETTING: Department of Ophthalmology, United Christian Hospital, Hong Kong, China. METHODS: In this prospective randomized clinical trial, patients scheduled for routine phacoemulsification with posterior chamber intraocular lens implantation under local anesthesia without sedation were randomized to receive topical anesthesia or retrobulbar anesthesia. One hundred seven eyes of 107 Chinese patients were included. There were 49 patients and 58 patients of similar age and sex distribution in the retrobulbar group and topical group, respectively. Postoperative nausea and vomiting (PONV), the need for an antiemetic, and intraocular pressure (IOP) were recorded 1 day after surgery. Also recorded were the patient's preexisting risk factors for PONV (if any), fasting time, duration of surgery, and intraoperative complications or need for supplementary anesthesia or analgesia. RESULTS: The overall incidence of PONV in the entire study group was 3.7% (4 patients). No statistically significant differences in PONV were found between the 2 anesthesia techniques, although 6.1% (3 of 49) in the topical group had nausea compared with 1.7% (1 of 58) in the retrobulbar group. No significant differences were found in the fasting time, duration of surgery, or postoperative IOP between patients who had PONV and those who did not. CONCLUSIONS: Topical and retrobulbar anesthesia were associated with a low incidence of PONV in routine phacoemulsification. There were no statistically significant differences in PONV between the 2 anesthesia techniques. No significant correlation was found between the incidence of PONV and the duration of surgery, presence of complications, fasting time, postoperative IOP, or history of PONV or motion sickness.

Aged↗
PubMed2002

Microbial contamination of the anterior chamber during phacoemulsification.

PURPOSE: To study the nature and frequency of anterior chamber contamination during phacoemulsification. SETTING: Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. METHODS: Eighty eyes of 80 patients having routine phacoemulsification cataract surgery were recruited into this prospective study. Bacterial cultures from the intraoperative anterior chamber aspirates from the patients were assessed. RESULTS: Anterior chamber fluid aspirates were positive for bacteria in 37 eyes (46.25%). Coagulase-negative Staphylococcus was the most common aerobe and Propionibacterium acnes, the most common anaerobe. CONCLUSION: Results indicate that phacoemulsification has no proven advantage over conventional extracapsular cataract extraction in reducing intraoperative bacterial contamination.

Anterior Chamber↗
PubMed2002

Long-term effect of cataract surgery on intraocular pressure after trabeculectomy: extracapsular extraction versus phacoemulsification.

PURPOSE: To compare the effect of phacoemulsification with intraocular lens (IOL) implantation on long-term intraocular pressure (IOP) control in glaucoma patients who had previous trabeculectomy with the effect on IOP control in similar patients after extracapsular cataract extraction (ECCE) with IOL implantation. SETTING: Oxford Eye Hospital, Oxford, England. METHODS: Twenty-eight consecutive patients who had phacoemulsification with IOL implantation (phaco group) at least 3 months after trabeculectomy were identified from hospital records, and 28 patients who had ECCE with IOL implantation (ECCE group) were matched retrospectively to the phaco group with respect to age, sex, diagnosis, and IOP. In both groups, the IOP before cataract extraction was compared with the IOP at intervals up to 2 years after cataract extraction. A Kaplan-Meier survival analysis was performed. RESULTS: The mean IOP in the phaco group did not differ significantly from the mean IOP before cataract extraction at any interval. Twelve months after cataract extraction, the mean IOP in the ECCE group was significantly higher than preoperatively (P =.01); however, the mean IOP did not differ between groups over time (P =.704). There was significantly better long-term IOP control in the phaco group as determined by Kaplan-Meier survival analysis and the log-rank test (P =.038). CONCLUSION: After trabeculectomy, phacoemulsification provided better long-term IOP control than ECCE; however, the mean IOP was not significantly lower.

Aged↗
PubMed2003

Efficacy of a capsular tension ring for phacoemulsification in eyes with zonular dialysis.

PURPOSE: To determine the safety and efficacy of capsular tension ring (CTR) insertion in eyes with zonular dialysis of less than 150 degrees having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. SETTING: Dr. Agarwal's Eye Hospital, Chennai, India. METHODS: This prospective study comprised 21 eyes of 19 patients with zonular dialysis of less than approximately 150 degrees determined preoperatively or intraoperatively. After insertion of a CTR, phacoemulsification with PC IOL implantation was performed. The mean follow-up was 242.33 days. RESULTS: Capsule collapse did not occur in any eye with a CTR. Intraoperative extension of the dialysis occurred in 2 eyes (9.52%). The IOL was placed in the bag in all the eyes except 1 that had traumatic cataract and received a scleral-fixated IOL during a subsequent surgery. Postoperatively, there was minimal corneal edema in 2 eyes (9.52%) and mild iritis in 5 eyes (23.80%). Three eyes (14.28%) developed raised intraocular pressure that responded well to medical therapy. The symptoms resolved in the 3 patients with preoperative diplopia. Fifteen eyes (71.42%) had a final visual acuity of 6/12 or better. Six eyes had a final best corrected visual acuity of worse than 6/12 because of coexisting fundus pathology. A dilated pupil examination at 6 months showed a well-centered IOL in all eyes. CONCLUSIONS: Phacoemulsification with in-the-bag PC IOL and CTR implantation in eyes with zonular dialysis of up to approximately 150 degrees had a success rate of 90.47%. Visual recovery was not as good as in normal eyes because of the problems associated with zonular dialysis.

Adolescent↗
PubMed2003

Corneal endothelial cell protection with a dispersive viscoelastic material and an irrigating solution during phacoemulsification: low-cost versus expensive combination.

PURPOSE: To evaluate the protective effect on corneal endothelial cells of a low-cost and an expensive combination of a dispersive viscoelastic material and an irrigating solution during phacoemulsification. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized examiner- and patient-masked study comprised 90 eyes of 45 consecutive patients with age-related cataract in both eyes. For each patient, the first eye was randomly assigned to receive hydroxypropyl methylcellulose 2% (Ocucoat) and Ringer's solution (low-cost combination) or sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat) and an enriched balanced salt solution (BSS Plus) (expensive combination) during phacoemulsification. The contralateral eye received the other treatment. Endothelial cell function was evaluated by measuring corneal thickness (CT) using partial coherence interferometry, morphology assessment, and endothelial cell counts. RESULTS: The acute postoperative increase in CT was +9.8 microm in the low-cost group and +10.9 microm in the expensive group; the difference between groups was not significant. After 1 month, the CT still differed significantly from baseline in the low-cost group. Three months after surgery, the CT had returned to baseline values in both groups. There was no significant between-group difference in endothelial cell counts or morphology. CONCLUSIONS: During phacoemulsification in a nonselected patient population, there was no difference in acute postoperative corneal edema and endothelial cell morphology after 3 months between a Viscoat and BSS Plus combination and an Ocucoat and Ringer's solution combination. Eyes receiving the expensive combination had marginally faster recovery of corneal swelling by 3 months. However, the cost of Viscoat and 500 mL BSS Plus is 5 times that of Ocucoat and Ringer's solution.

Aged↗