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PubMed1998

Is eye padding routinely necessary after uncomplicated phacoemulsification?

PURPOSE: To investigate the value of eye padding following uncomplicated phacoemulsification under peribulbar anaesthesia. METHODS: A prospective randomised controlled study was conducted to compare the effect of a conventional eye pad and shield with that of a clear eye shield applied without a pad in 83 patients undergoing routine phacoemulsification under peribulbar anaesthesia without lid block. The primary outcome measures were corneal fluorescein staining, discomfort, diplopia and mobility. RESULTS: Moderate or severe corneal fluorescein staining on the first post-operative day was significantly more common in the pad and shield group (39%) than in the clear shield group (19%) (p < 0.01). There was no significant difference in post-operative pain as measured either by visual analogue scale or by categorical pain scale. Forty per cent of the clear shield group reported transient post-operative diplopia during the immediate post-operative period compared with 7% of the pad and shield group (p < 0.001). There was no significant difference in reported mobility between the two groups. CONCLUSIONS: Following phacoemulsification under peribulbar anaesthesia, the use of a gauze eye pad is associated with greater corneal fluorescein staining than a clear plastic shield without pad and offers no reduction in discomfort. A clear shield protects the globe against direct trauma, is associated with reduced moderate to severe corneal staining and facilitates vision in the early post-operative period. Transient diplopia reported by some patients given a clear shield is not disabling and would not be expected to occur in patients with one seeing eye. The use of a clear shield alone is a safe alternative to eye padding and offers important advantages in patients with one seeing eye.

Aged↗
PubMed1998

The effect of intracameral, per-operative antibiotics on microbial contamination of anterior chamber aspirates during phacoemulsification.

PURPOSE: To assess the effect of per-operative antibiotics on contamination of anterior chamber (AC) aspirates during phacoemulsification. METHODS: Two hundred and twenty patients undergoing phacoemulsification of cataract were randomly allocated to receive an irrigation infusion fluid containing either balanced salt solution (BSS) alone or BSS with vancomycin (20 mg/l) and gentamicin (8 mg/l) during surgery. Conjunctival swabs were obtained from all patients immediately before pre-operative preparation. At the end of surgery 20 ml of the AC aspirate was sent for direct and enrichment cultures. Qualitative and quantitative microbiological studies were undertaken. The chi-squared test was used to compare differences between the two groups. RESULTS: There was no significant difference between the positive culture rates of the conjunctival swabs (28 vs 27; p > 0.8). In the group that received BSS alone there were 22 (20%) positive AC aspirate cultures, 18 of which were from enrichment cultures. There were 3 positive (2.7%) cultures from the group that received antibiotics added to the BSS (p < 0.0001). CONCLUSION: The addition of gentamicin and vancomycin to the irrigation fluid during phacoemulsification results in a highly significant reduction in the microbial contamination of AC aspirates.

Anterior Chamber↗
PubMed1999

Effect of intracameral carbachol on intraocular pressure following clear corneal phacoemulsification.

PURPOSE: To investigate the effect of 0.01% carbachol on early intraocular pressure (IOP) after cataract extraction with phacoemulsification. METHODS: Fifty-one patients who underwent cataract extraction with phacoemulsification and intraocular lens implantation were prospectively randomly assigned to one of two groups. Twenty-seven patients were given 0.5 ml carbachol intracamerally (carbachol group); the other 24 patients were given the same amount of balanced salt solution intracamerally (control group). IOPs were measured by Goldmann applantation tonometry on the day before surgery, and at 8 h, 24 h and 7 days post-operatively. RESULTS: There was no difference between the mean IOPs of the groups pre-operatively (p > 0.5). All the mean post-operative IOP values of the carbachol group were lower than those of the control group. At 8 and 24 h post-operatively the mean IOP was 12.4 +/- 3.4 mmHg and 13.1 +/- 4.5 mmHg respectively in the carbachol group, 19.4 +/- 6.4 mmHg and 17.2 +/- 4.2 mmHg respectively in the control group. The differences were significant (p < 0.04 and p < 0.05). There was no significant difference between the values at 7 days post-operatively (p > 0.8). An IOP greater than 25 mmHg was recorded at 8 h and 24 h post-operatively in 8 (33%) and 4 (17%) of the control group and in 1 (4%) and 1 (4%) of the carbachol group. All the IOPs were 20 mmHg or lower in both groups at 7 days post-operatively. CONCLUSION: Patients treated with intracameral carbachol following uncomplicated clear corneal phacoemulsification and posterior chamber intraocular lens implantation demonstrate lower early post-operative IOP.

Carbachol↗
PubMed2000

Randomised fellow eye comparison of the effectiveness of dorzolamide and apraclonidine on intraocular pressure following phacoemulsification cataract surgery.

PURPOSE: To compare the effectiveness of 2% dorzolamide and 0.5% apraclonidine on intraocular pressure (IOP) following phacoemulsification cataract surgery. METHODS: This prospective, randomised study comprised 54 eyes of 27 consecutive patients with age-related cataract scheduled for cataract surgery in both eyes. In each patient the eye with the higher degree of cataract was randomly assigned to receive one drop of either dorzolamide or apraclonidine immediately after surgery. The fellow eye was operated on later and received the other treatment. Cataract surgery was performed with a superior 6.0 mm sutureless frown incision, phacoemulsification and implantation of a three-piece PMMA intraocular lens. The IOP was measured pre-operatively as well as 6 h and 20-24 h and 1 week post-operatively. RESULTS: The mean pre-operative IOP was not significantly different between the groups (dorzolamide group, 14.9 +/- 2.3 mmHg; apraclonidine group, 14.6 +/- 2.5 mmHg; p = 0.450). At 6 h post-operatively, the mean IOP was significantly lower in the dorzolamide than in the apraclonidine group (15.6 +/- 3.9 mmHg vs 18.0 +/- 4.0 mmHg; p < 0.001). An IOP increase of more than 5 mmHg at 6 h post-operatively occurred in 3 (12%) eyes in the dorzolamide group and in 9 (36%) eyes in the apraclonidine group (p = 0.034). At 20-24 h post-operatively and at 1 week post-operatively no difference was found between the groups. CONCLUSIONS: 2% Dorzolamide is more effective than 0.5% apraclonidine in preventing the early post-operative IOP increase following phacoemulsification cataract surgery.

Adrenergic alpha-Agonists↗
PubMed2000

The phacoemulsification learning curve: per-operative complications in the first 3000 cases of an experienced surgeon.

PURPOSE: To assess the per-operative complications occurring during the first 3000 phacoemulsification cases performed by an experienced consultant surgeon. METHODS: A prospective analysis of 3000 consecutive cases performed without supervision between November 1992 and November 1998 was carried out. Data recorded for each case included details of per-operative complications, pre-operative best corrected visual acuity, nuclear density, history of previous pars plana vitrectomy, and whether phacoemulsification was performed as part of a phacotrabeculectomy procedure. RESULTS: The overall rate of vitreous loss was 1.3%. Nuclear fragments were lost to the vitreous in 6 cases (0.2%). The initial rate of vitreous loss was 4.0% in the first 300 cases falling to 0.7% in the last 300 cases. Capsulorhexis failure was the commonest per-operative complication observed, but the risk of subsequent posterior capsule rupture fell significantly from 9 of 45 (20.0%) in the first 100 cases to 1 of 49 (2.0%) in the next 2000 cases (p = 0.0061, Fisher's exact test). There was a significant increase in risk with denser cataracts, especially for capsulorhexis failure, rising to over 35% in the densest cases. The increases in posterior capsule rupture and vitreous loss were less dramatic but nonetheless very significant. There was no significant increase in the risk of per-operative complications with phacotrabeculectomy, and no increased risk in patients who had previously undergone pars plana vitrectomy. Posterior capsule rupture occurred in 22 of 612 (3.6%) local anaesthesia cases compared with 31 of 2269 (1.4%) topical anaesthesia cases. Per-operative best corrected visual acuity of 6/9 or better was recorded in 2.0% of the first 1000 cases compared with 13.9% of the last 1000 cases. CONCLUSIONS: (1) Per-operative surgical risks could be reduced to low levels during the learning curve, but complications continued to occur at a low frequency. (2) The risk of per-operative complications was not significantly elevated in previously vitrectomised eyes. (3) Nuclear density correlated significantly with per-operative complication risk. (4) The visual threshold for cataract surgery fell dramatically with increasing experience of phacoemulsification. (5) Topical anaesthesia was not associated with an increased risk of per-operative complications.

Anesthesia, Local↗
PubMed2000

Is the first post-operative day review necessary following uncomplicated phacoemulsification surgery?

PURPOSE: To assess the necessity for first post-operative day review in determining the need for post-operative intervention in patients who had uncomplicated phacoemulsification surgery. METHODS: A retrospective study was carried out to review the first post-operative day findings in patients who underwent uncomplicated phacoemulsification surgery by a single surgeon between January 1997 and March 1998. The findings analysed were wound integrity, corneal clarity, anterior chamber activity, intraocular pressure and the intraocular lens status. The need for medical or surgical intervention was also analysed. Those eyes that had coexisting ocular pathology such as glaucoma, ocular hypertension, uveitis, trauma or previous intraocular surgery were excluded from the study. Fisher's exact test was used to compare the difference between the groups. RESULTS: Seventy-one eyes of 71 patients who underwent an uncomplicated phacoemulsification procedure were included in the study. Intraocular pressure of 30 mmHg or greater was found in 7 eyes (10%), all of which also had corneal oedema. These patients received acetazolamide SR 250 mg twice daily for 3 days. Another 21 eyes (30%) had corneal oedema for which no specific treatment was given. The intraocular pressure had returned to baseline and corneal oedema resolved by the first clinic follow-up in 1-2 weeks. None of the 71 patients needed surgical intervention in the post-operative period. CONCLUSION: First post-operative day review is necessary as it gives an opportunity to manage the post-operative rise in intraocular pressure.

Adult↗
PubMed2001

Phacoemulsification with intraocular lens implantation in patients with uveitis.

PURPOSE: To investigate the safety and efficacy of phacoemulsification with intraocular lens implantation in eyes affected by uveitis. METHODS: A retrospective case series is presented including casenote review and update patient examinations. Patient data were withdrawn from the Uveitis Clinic database. All uveitis patients undergoing phacoemulsification with intraocular lens implantation from August 1995 to November 2000 were included. A pre-operative preparation protocol was used. Operative and post-operative complications, degree of postoperative inflammation, best-corrected and final visual acuity were the main outcome measures. RESULTS: Eighty-six eyes of 75 patients underwent surgery, which in 11 cases was combined with trabeculectomy. Mean follow-up was 24.1 months. Eight eyes (10%) had severe or fibrinous uveitis post-operatively. The mean delay between surgery and return to baseline treatment was 8.6 weeks. Posterior capsule opacification occurred in 42% of eyes and Nd-YAG capsulotomy was required in 21%. Cystoid macular oedema was seen in 2 eyes. Seventy-two per cent of eyes retain a visual acuity of 6/9 or better, and 87% of eyes retain a post-operative improvement of 2 or more lines of Snellen acuity. CONCLUSIONS: With careful patient selection, appropriate pre-operative preparation, diligent surgery and close post-operative supervision, phacoemulsification with intraocular lens implantation is safe and effective in the great majority of eyes with uveitis.

Administration, Topical↗
PubMed2001

A nationwide survey of post-operative instructions following uncomplicated phacoemulsification cataract surgery.

PURPOSE: To determine the heterogeneity of post-operative instructions following uncomplicated phacoemulsification cataract surgery. METHODS: A survey was sent to a random sample of 115 cataract centres in the United Kingdom. Eighty questionnaires were returned, corresponding to a response rate of 70%. RESULTS: The time at which post-operative advice was given, the nature of post-operative problems, and advice regarding the instillation of post-operative eye drops were all very similar among centres. There was mild variability among centres in the advice given on post-operative analgesia, eye cleaning and hair washing. However, there were marked differences in the advice given to patients regarding how long an eyeshield should be worn, and also regarding daily activities such as lifting objects and driving. Thirty-five per cent of centres adopted a single post-operative review. No centre had more than three post-operative reviews for an uncomplicated phacoemulsification. The final refraction was conducted by at least 30% of centres within the first month, and by at least 92% within 2 months. CONCLUSIONS: Phacoemulsification with a self-sealing tunnel is now the technique of choice for an uncomplicated cataract extraction and is increasingly conducted on a daycase basis. However, our survey reveals that there is considerable heterogeneity in the postoperative instructions given to patients following this procedure, and we would suggest that considerable benefits would result from further work in this area. Standard guidelines would not only benefit the patient in terms of improved patient education and rehabilitation, but would also result in economic benefits from reduced post-operative visits.

Humans↗
PubMed2004

Diabetic retinopathy progression and visual outcome after phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes.

PURPOSE: To determine diabetic retinopathy or maculopathy progression and visual outcome following phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes. METHODS: Review of notes of patients with type II diabetes undergoing phacoemulsification by one surgeon. The inclusion criteria were: (a) South-Asian or Afro-Caribbean ethnicity, (b) monocular cases with a minimum postoperative follow-up of 6 months, and (c) binocular cases with an interval of at least 6 months between the operation in the two eyes. The nonoperated eye was used as control. The development or progression of diabetic retinopathy or maculopathy and final visual acuity were recorded. RESULTS: In all, 30 diabetic patients were included. There were 19 South-Asians (Pakistani, Indian, and Bangladeshi) and 11 Afro-Caribbeans. The mean (+/-SD) age was 68.9 (+/-10) years. Retinopathy or maculopathy progression was noted in seven patients (23.4%), two South-Asians, and five Afro-Caribbeans. There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively. Progression of retinopathy or maculopathy occurred more often in Afro-Caribbeans compared to South-Asians (P=0.02, logistic regression analysis). The mean (+/-SD) postoperative follow-up was 12.4 (+/-6.5) months. Visual acuity improved by at least two or more Snellen lines in 19 eyes (63.3%); 26 eyes (86.7%) achieved a final visual acuity of at least 6/12. CONCLUSIONS: Afro-Caribbeans may be at a higher risk of progression of retinopathy or maculopathy after phacoemulsification.

Adult↗
PubMed2004

Disorders of the blood-aqueous barrier after phacoemulsification in diabetic patients.

PURPOSE: To evaluate the function of the blood-aqueous barrier after phacoemulsification with implantation of a foldable intraocular lens (IOL) in diabetic patients. METHODS: All patients were enrolled from those scheduled for phacoemulsification with intraocular lens implantation in Zhongshan Ophthalmic Center Guangzhou from March 2002 to June 2002. The classification on diabetic retinopathy (DR) was based on the fundus examination after cataract surgery. The blood-aqueous barrier function was examined using the laser flare cell meter (Kowa FC-2000) preoperatively and on postoperative days 1, 7, 30, and 90 by an independent examiner who was masked to the DR classification. Patients were operated by one experienced surgeon as per standard clinical protocol and were provided the same postoperative medical care. A linear regression and Wilcoxon test were used for the analysis. RESULTS: A total of 112 patients were divided into three groups: patients without diabetic mellitus as normal control (n=56), diabetic patients without diabetic retinopathy (n=2), with nonproliferation diabetic retinopathy (NPDR) (n=37), and diabetic patients with proliferation diabetic retinopathy (PDR) (n=17). All patients were examined and successfully followed up for 3 months after cataract surgery. Aqueous flare mean photon counts in PDR, NPDR, and control eyes were 8.94+/-0.57, 7.03+/-0.27, and 6.94+/-0.34 before surgery and increased to 32.42+/-0.67, 26.07+/-0.83, 26.27+/-1.37 on the first day after surgery (P<0.05), then decreased to 19.86+/-0.78, 14.08+/-0.54 and 13.96+/-1.05 at 7 days after surgery (P<0.05), 13.24+/-0.29, 9.86+/-0.33, and 9.07+/-0.43 at 30 days after surgery (P<0.05); eventually, the counting decreased to 11.25+/-0.31, 7.24+/-0.67, and 7.16+/-0.27 at 90 days after surgery (P<0.05). Linear regression model suggested that other potential variables, such as age, sex, eye (left/right), phaco time, phaco energy, and hypertension were not related to the outcome. For patients without diabetes mellitus and diabetic patients with NPDR, highly statistically significant differences (P<0.05) were found between preoperative flare value and those measured on days 1, 7, and 30 after surgery, but no statistically significant differences (P>0.05) were found between the preoperative flare value and those measured on postoperative days 90. However, patients with PDR still had a higher flare value even on postoperative day 90. The patients with intraoperative iris prolapse had a higher flare value between days 1 and 7 postoperatively. CONCLUSION: Phacoemulsification with a foldable intraocular lens implantation affects the blood-aqueous barrier more severely in diabetic patients with PDR than patients with NPDR and nondiabetic patients.

Aged↗
PubMed2005

Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification.

PURPOSE: To evaluate the intraocular pressure (IOP) lowering effect of travoprost and brinzolamide within the first 24 h after phacoemulsification cataract surgery. METHODS: This prospective, randomized, double-masked, controlled study comprised 90 eyes of 90 consecutive patients with senile cataract who had uneventful phacoemulsification surgery. Eyes in the first group received travoprost 0.0015%, second group received brinzolamide 1%. Eyes in the third group received balanced salt solution and were used as control. One drop was instilled immediately after surgery. IOP was measured 24 h preoperatively, 6 and 24 h postoperatively. Analysis of variance, Student's-t and chi2-tests were used for statistical analyses. RESULTS: Preoperatively IOP was not significantly different among the three groups (P = 0.653). At 6 and 24 h postoperatively IOP was lower in both travoprost and brinzolamide group when compared to control group (P = 0.018 and 0.015 at 6 h, P = 0.010 and 0.007 at 24 h between travoprost and brinzolamide group was not significant (P = 0.744 at 6 h and P = 0.672 at 24 h). CONCLUSION: Both travoprost and brinzolamide significantly lowered IOP after small incision phacoemulsification cataract surgery within the first 24 h without any side effect.

Adult↗
PubMed2005

Phacoemulsification with intravitreal triamcinolone in patients with cataract and coexisting diabetic macular oedema: a 6-month prospective pilot study.

AIMS: To assess the safety and efficacy of phacoemulsification with intravitreal triamcinolone (ivTA) injection in diabetics with cataract and clinically significant macular oedema (CSMO). METHODS: A total of 19 eyes of 15 consecutive diabetic patients with cataract and CSMO were prospectively recruited. Patients underwent phacoemulsification and intraocular lens implantation with 4 mg ivTA injection at completion of surgery. Patients were followed up on day 1, then weekly for 1 month, and thereafter monthly until 6 months postoperatively. Best corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography, and adverse events were recorded. RESULTS: In total, 17 eyes completed 6 months of follow-up. In all, 58.8% showed improvement in BCVA of >or=2 lines, with statistically significant improvement in mean Snellen BCVA of 2.4 lines at 6 months. The peak BCVA was achieved at 4 months. The mean CMT decreased from a baseline of 449 microm to a minimum of 321+/-148 microm (28.5% reduction) achieved at 2 months, with statistically significant reduction at all postoperative time intervals until 6 months. Of 17 eyes, 4 (23.5%) developed transiently elevated intraocular pressure that normalised by 6 months in all but one patient. No injection- or surgery-related complications were encountered. CONCLUSIONS: Phacoemulsification with concurrent 4 mg ivTA injection appears to be a safe option for managing diabetics with cataract and CSMO. However, large-scaled randomised controlled trials are necessary for delineating the relative contributions of cataract removal and CMT reduction to visual improvement. Moreover, the transient effect on CMT may warrant further studies to determine optimal timing and dosage of further ivTA injections.

Aged↗
PubMed2006

Microincision bimanual phacoemulsification and Thinoptx implantation through a 1.70 mm incision.

PURPOSE: To prospectively assess the efficacy of bimanual phacoemulsification and implantation of Thinoptx, an injectable intraocular lens (IOL), inserted through 1.70 mm clear corneal incision. SETTING: Department of Ophthalmology, Southend Hospital NHS Trust, UK. METHODS: A total of 50 eyes of 49 randomly selected patients with cataracts had microincision clear corneal bimanual phacoemulsification (MICS) with implantation of Thinoptx IOL in the capsular bag. All patients underwent full preoperative assessment. Postoperative assessment was carried out at 3 and 6 weeks and at 15 months. RESULTS: In all 50 cases the IOL was inserted through 1.70 mm clear corneal incision. The mean best-corrected visual acuity was 0.02 (6/6-1) at 6 weeks and was 0.17 (6/10) at the final follow-up. The mean final surgically induced astigmatism at 6 weeks was 0.0106. Coloured haloes around artificial lights were perceived by 69.23% of patients at 6 weeks and by 61.29% at the final follow-up. One patient underwent IOL exchange for this. Posterior capsular opacification was noticed in 31.26% at 6 weeks and in 64.51% at 15 months. Anterior capsular opacification was noticed in 5.26% at 6 weeks and in 16.12% at 15 months. In one patient the IOL had to be exchanged because of tilt and displacement of the IOL due to anterior capsular phimosis. CONCLUSIONS: We conclude Thinoptx can be safely inserted through 1.70 mm incision used for bimanual phacoemulsification. Distance and near visual acuity achieved with this IOL is satisfactory. There is no significant change in keratometric astigmatism following this procedure. However, posterior capsular opacification rate was significantly higher with this IOL. Haloes around light sources were significant.

Cataract↗
PubMed2006

Feasibility of bimanual microincision phacoemulsification in hard cataracts.

PURPOSE: The purpose of this work was to assess the feasibility of bimanual phacoemulsification in hard cataracts of N3+ using WhiteStar technology of Soveriegn (Advanced Medical Optics, Santa Ana, CA, USA). SETTING: Ain-Shams University Hospitals, Ophthalmology Department, Cairo, Egypt. DESIGN: A randomized prospective noncomparative study. METHODS: A randomized prospective study of 33 consecutive cases (N3+ or more) was conducted, phacoemulsification using a bimanual microincision technique using the Sovereign with WhiteStar technology phacoemulsification machine. One phaco mode was used in all eyes. The ultrasound power was set at 30-25% according to the hardness of the nuclei, duty cycle of 33%, flow rate of 20-28 cm3/min, and vacuum of 240 mmHg. Occlusion mode was on. Nine eyes received rollable intraocular lenses (IOL) of ThinOptx, whereas 24 eyes had been implanted with hydrophobic acrylic foldable IOL (Sensar OptiEdge SA40e of AMO) through a third incision. Study parameters were effective phacotime (EPT), presence of wound burn, degree of immediate postoperative iritis, amount of infusion solution used, and total operating time. RESULTS: The mean EPT was 4.3 s with an average ultrasound used of 5.7%. The mean operating time was 11 min and 20 s. Although the nuclear hardness was of grade 3 or above (in a scale of 5), there were no cases of thermal burn; P=0.005. Only three eyes suffered postoperative iritis 2+, which resolved within 1 week on topical steroids, statistically nonsignificant, P=0.2. The amount of infusion solution was less than that used in conventional coaxial phaco. This technique induced considerably less corneal astigmatism than surgery using conventional corneal incisions. CONCLUSIONS: Hard cataracts of N3 or more could be safely removed through an incision of 1.4 mm incision using bimanual micro-phaco.

Aged↗
PubMed2006

Comparison of two acrylic intraocular lenses with different haptic designs in patients with combined phacoemulsification and pars plana vitrectomy.

PURPOSE: The intra- and postoperative characteristics of two foldable single-piece intraocular lenses (IOL) with identical hydrophilic acrylic material, but different haptic designs (Akreos Adapt and Akreos Fit), were compared in combined phacoemulsification and pars plana vitrectomy (PPV). METHODS: This was a prospective, randomized study in patients with simultaneous cataract and vitreoretinal surgery. Group A (n=47 patients) included implantation of Akreos Fit IOL (two-point haptic) and group B (n=46 patients) implantation of Akreos Adapt IOL (four-point haptic). All intraoperative modifications of small-incision phacoemulsification and three-port PPV and IOL implantation and centration were documented. At 1 and 2 days and 6 months after surgery, best-corrected visual acuity (BCVA), slit-lamp appearance (including inflammation, IOL centration, capsulorhexis diameter, posterior capsule opacification (PCO), tonometry, and fundus findings were evaluated. RESULTS: The groups did not differ with respect to age, surgical indications and modifications, intraoperative IOL handling, and centration. At day 2, inflammation and capsulorhexis diameters were similar, but IOL decentration was slightly more frequent with Akreos-Fit IOLs. Six months after surgery, the rates of PCO, posterior synechiae, and BCVA were similar. Akreos-Fit had slightly smaller capsulorhexis diameters and slightly more capsular contraction and IOL decentration (P>0.05). CONCLUSIONS: Both of the Akreos IOL are feasible for combined phacoemulsification and PPV. Although similar in intraoperative handling, BCVA, and PCO, IOL centration was slightly better with Akreos-Adapt than with Akreos-Fit after combined surgery.

Aged↗
PubMed2004

Comparing phacoemulsification and extracapsular cataract extraction in eyes with pseudoexfoliation syndrome, small pupil, and phacodonesis.

BACKGROUND: This study aims to compare the frequency of intraoperative and postoperative complications between the modern phacoemulsification technique and the extracapsular cataract extraction technique in patients with pseudoexfoliation syndrome. PATIENTS AND METHODS: A prospective randomized study comprised 94 eyes with cataract, pseudoexfoliation syndrome, small pupil and slight to moderate phacodonesis. These eyes were randomly assigned into two groups. In the first group all patients (47 eyes) were operated on using a standard phacoemulsification technique (iris hooks, anterior capsule staining and capsular tension ring after capsulorhexis), while in the second group all patients (47 eyes) underwent a classic extracapsular cataract extraction. The main outcome measures were the frequency of intraoperative zonular tears, capsular rupture, vitreous loss and corneal edema, as well as the best-corrected visual acuity. RESULTS: Intraoperative zonular separation was recorded in one eye (2.1 %) and in 15 eyes (31.9 %) for the first and second groups, respectively (P < 0.001). Posterior capsule rupture with or without zonular separation occurred in two eyes (4.2 %) of the first group and in eight eyes (17.0 %) of the second group (P < 0.05). Vitreous loss also had a higher rate in the second group (17.0 % versus 4.2 %, P < 0.05). The postoperative difference in best-corrected visual acuity was also significant between the two groups, being higher in patients operated on using phacoemulsification technique (P < 0.001). CONCLUSIONS: In the difficult cases of cataract associated with pseudoexfoliation syndrome, small pupil and phacodonesis, the modern small-incision cataract surgery provides better results with a low rate of intraoperative and postoperative complications when compared with the extracapsular cataract extraction technique.

Aged↗
PubMed2005

[Results of phacoemulsification during the learning phase].

BACKGROUND: The subjective and objective results during the training phase of phacoemulsification using a 6 mm sclero-corneal tunnel incision at 12 h were evaluated. PATIENTS AND METHODS: In a prospective study we evaluated the first 221 cases of phacoemulsification by a cataract surgeon during his training phase. Objective parameters which were analyzed included intraoperative complications, preoperative, early postoperative (p. o.) (1 - 13 days) and late p. o. (to the third month) assessment of refraction, visual acuity and corneal astigmatism. Calculation of the induced astigmatism was performed using the subtraction method and the vector analysis according to Jaffé. For evaluation of subjective results we used a questionnaire in the late p. o. phase. The questionnaire contained questions concerning satisfaction with the explanation of the surgical procedure, the medical personnel, the procedure itself and the result of the operation. RESULTS: During surgery, 6 posterior capsular ruptures (2.7 %) and 3 zonular dialyses (1.4 %) occurred. In 6 cases (2.7 %) an anterior vitrectomy was necessary, in two cases (0.9 %) an anterior-chamber lenses had to be implanted. Preoperatively, the average visual acuity was 0.5 +/- 0.14 (n = 221), the early p. o. visual acuity was 0.49 +/- 0.23 (n = 220) and the late p. o. visual acuity was 0.73 +/- 0.31 (n = 121). The average spheric equivalent was early p. o. 0.04 D +/- 1.18 D (n = 208) and late p. o. 0.11 D +/- 1.08 D (n = 118). The difference to the planned refraction was early p. o. 0.68 D +/- 1.13 D, and late p. o. 1.39 D +/- 1.18 D. The mean induced astigmatism early p. o. was 0.55 D +/- 0.97 D (n = 166) and late p. o. 0.37 D +/- 0.87 D (n = 121) (subtraction method). Utilizing vector analysis for calculation of the induced astigmatism we obtained 1.43 D +/- 0.86 D (n = 121) for the early p. o. situation and 1.22D +/- 0.88 D (n = 121) for the late p. o. situation, respectively. 80 % of the patients (n = 119) were satisfied with the results (highest rating), 3 % were unhappy (lowest rating). CONCLUSION: The results of this study reveal that phacoemulsification is a safe and satisfactory procedure for patient, even during the training phase of a cataract surgeon.

Aged↗
PubMed2005

[Phacoemulsification combined with cyclophotocoagulation].

INTRODUCTION: Cyclophotocoagulation and phacoemulsification procedures may be combined to treat patients with glaucoma and cataract. To the best of our knowledge data concerning this combination have not been published as yet. PATIENTS AND METHODS: 28 eyes (23 patients, mean age 78.1 +/- 7.6 years) were operated upon between 9.04.2002 and 29.06.2004. Patients were compared to a group with phacoemulsification alone. RESULTS: A median of 15 laser flashes (duration 2000 ms, power 1750 mW) were applied. Complications at discharge from hospital (and after 6 weeks) were: corneal oedema 18 % (4.0 %), fibrinous reaction 25 % (7.1 %), hyphaema 7.1 % (0 %), 1 decentred IOL, 7.1 % capsular tear. Visual acuity increased statistically significantly from 0.3 to 0.5. Mean intraocular pressure decreased statistically significantly from 23.7 +/- 5.6 mmHg to 16.0 +/- 3.4 mmHg after 166 days. Success rate was 76 % after 6 weeks and 85.7 % after 166 days. The mean number of antiglaucomatous drugs could be reduced from 1.6 to 1.1 after 166 days. In the control group there was a transient corneal edema in 14.3 % (7.1 % cornea guttata), other complications were not found. CONCLUSION: The combination of cyclophotocoagulation and phacoemulsification is as successful as other combinations of cataract and glaucoma surgery with a similar or lower complication rates. Cyclophotocoagulation is cost efficient, can be repeated and is adaptable to the intraocular pressure.

Aged↗