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Minimal astigmatism after sutureless planned extracapsular cataract extraction.

PURPOSE: To evaluate astigmatism after mini-nuc extracapsular cataract extraction (ECCE) in which a chevron incision is enlarged to 6.0 to 7.0 mm for easier nucleus removal and to compare the results with those using a 5.0 mm incision. SETTING: Department of Ophthalmology, The Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Holon, Israel. METHODS: Thirty eyes of 29 patients were enrolled in this study. Keratometry was performed preoperatively and 3 to 9 months postoperatively. The incision length was 6.0 mm in 6 eyes, 6.5 mm in 10 eyes, and 7.0 mm in 14 eyes that had mature cataract. RESULTS: The mean induced astigmatism calculated by simple subtraction was 0.12 diopter (D) +/- 0.51 (SD), 0.16 +/- 0.98 D, and 0.67 +/- 0.91 D for the 6.0 mm, 6.5 mm, and 7.0 mm incision, respectively. By vector analysis, the mean induced astigmatism was 0.60 +/- 0.30 D, 0.75 +/- 0.67 D, and 1.36 +/- 0.77 D, respectively. Results by both methods showed no significant difference between the previously reported 5.0 mm incision and the 6.0 mm and 6.5 mm incisions. The 7.0 mm group had statistically significantly greater induced astigmatism than the 5.0 mm group (P =.01, simple subtraction; P =.002, vector analysis). CONCLUSIONS: Enlarging the size of the chevron incision up to 7.0 mm resulted in a small increase in induced astigmatism. The enlarged incision simplified the operative technique.

Adult↗

Extracapsular cataract extraction to phacoemulsification: why and how?

PURPOSE: To determine what factors influence a decision to move from extracapsular cataract extraction to phacoemulsification as the cataract removal technique of first choice, and to investigate how the transition is managed. METHOD: Questionnaire surveys were carried out in 1996 and 1997 of consultant ophthalmologists in the former Oxford Region. RESULT: 'Evidence of clinical benefit' was the strongest factor influencing a decision to change technique, but 'fear of becoming a dinosaur' and 'peer pressure' were also important factors. Beliefs about advantages of phacoemulsification were little changed with increasing experience, but personal contraindications to phacoemulsification diminished with time. Hard nuclei, mature cataracts and poor zonular support remained relatively strong contraindications to phacoemulsification by the second survey. Only 46% of 14 respondents had performed phacoemulsification under supervision before 'going solo', but 64% felt well or adequately prepared for their first solo phacoemulsification. Influence of non-clinical factors such as equipment availability on the choice of technique did not diminish significantly between surveys. Increasing experience of phacoemulsification appeared to reinforce beliefs about its advantages. CONCLUSIONS: Respondents appear to have adopted phacoemulsification with careful preparation, and enthusiasm for the technique has been reinforced by increasing experience. Courses and wet-labs provide limited preparatory experience, but peer supervision is difficult to arrange for consultants. Respondents generally felt that learning phacoemulsification had been stressful, but not as difficult as feared. Implications for the introduction of new surgical techniques into ophthalmological practice in the future are discussed.

Cataract Extraction↗

The correction of diplopia after cataract extraction.

The records of 12 patients with persistent diplopia after cataract extraction were reviewed. All patients were corrected surgically using an adjustable-suture technique. After strabismus surgery, the diplopia in nine of the 12 patients resolved without adjunctive therapy. Three patients had occasional diplopia postoperatively. Prismatic correction postoperatively was unwarranted in two patients because diplopia occurred on rare occasions, but the third required postsurgical prismatic correction with improvement.

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[Modern methods of cataract extraction].

The authors describe their own manual technique of extracapsular cataract extraction with subsequent implantation of a synthetic intraocular lens. They give an account of results assembled in 83 patients after ECE, incl. 60 where an intraocular lens was implanted. They achieved very satisfactory results with a minimal number of complications, one of which was more serious. In the conclusion the authors emphasize that final evaluation calls for a longer follow-up period.

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