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PubMed1996

[The postoperative change of depth of anterior chamber, refraction and anterior capsulorhexis size after intraocular lens implantation].

We evaluated postoperative shrinkage of anterior capsule, depth of anterior chamber, and refraction in 161 eyes, on which we performed continuous curvilinear capsulorhexis and phacoemulsification, and then implanted an intraocular lens in the capsular bag. We measured the depth of anterior chamber, anterior capsulorhexis size, contact surface with intraocular lens, and quantity and rate of anterior capsular shrinkage on the basis of anterior segment photographs before the operation, and 1 week, 1 month, and 3 months after the operation. After operation the depth of the anterior chamber deepened gradually, anterior capsulorhexis size narrowed, and refraction tended to hyperopia. There was a correlation in anterior chamber depth and anterior capsulorhexis size between preoperative and postoperative values but no correlation in refraction. The depth of the anterior chamber was dependent on the degree of anterior capsular shrinkage. There was a correlation between the depth of anterior chamber and the degree of anterior capsular shrinkage.

Aged↗
PubMed1996

[Posterior capsulorhexis in adults].

PURPOSE: To evaluate the feasibility and the risks of posterior capsulorhexis. MATERIAL AND METHODS: Retrospective analysis of 504 cases operated by phacoemulsification or manual extracapsular cataract extraction with a circular posterior capsulectomy. These cataracts were due to age or of unknown etiology. We analysed the intraoperative and postoperative complications. Fluorescein angiography was performed in a sample of unselected cases. RESULTS: The intraoperative complications consisted in 5 uncontrolled tearing and 7 prolapses of vitreous (4 of the 7 only in the posterior capsulectomy). Eleven of these twelve incidents occurred in case of positive posterior pressure. In the postoperative period, 3 additional prolapses of the vitreous in the pupil were observed; two of these capsulorhexis had been made larger than the optic of the intraocular lens. Three eyes with 25.79; 34.69 and 26.3 mm axial length presented a retinal detachment. Among 49 cases submitted to fluorescein angiography, 3 showed cystoid macular edema. CONCLUSIONS: Posterior capsulorhexis would be feasible in the cataract-implant surgery in adults, except in case of positive pressure. The diameter of the capsulorhexis has to be smaller to the diameter of the intraocular lens optic.

Adult↗
PubMed1998

Liquefied aftercataract: a complication of continuous curvilinear capsulorhexis and intraocular lens implantation in the lens capsule.

PURPOSE: To describe a new type of aftercataract that contains a liquefied, milky white substance between the lens optic and the posterior lens capsule. METHOD: We reviewed the medical records of 41 patients identified as having this type of aftercataract. RESULTS: All 41 eyes (41 patients) underwent uneventful phacoemulsification after continuous curvilinear capsulorhexis and implantation of a posterior chamber intraocular lens made from polymethylmethacrylate. Two months to 6 years after surgery (average+/-SD, 3.8+/-1.7 years), fibrosis was noted evenly along the entire circumference and between the anterior surface of the intraocular lens optic and the edge of the capsular opening created by continuous curvilinear capsulorhexis. This led to formation of a closed chamber between the intraocular lens and the posterior lens capsule, which then accumulated a liquefied, milky white substance. Twenty-three of the 41 eyes showed liquefied aftercataract in conjunction with other types of aftercataract: in 12 eyes with fibrosis, in 11 eyes with Elschnig pearls, and in one eye with a Soemmering ring. None of the eyes had any signs of inflammation; six of the 41 eyes had reduced visual acuity caused exclusively by the liquefied aftercataract. Before cataract surgery, 14 eyes were diagnosed with diabetic retinopathy, four with glaucoma, and two with uveitis. CONCLUSION: We report a new type of aftercataract characterized by a liquefied, milky white substance that accumulates between the lens optic and the posterior lens capsule when the anterior capsular opening, originally created by continuous curvilinear capsulorhexis, becomes occluded with the lens optic.

Adult↗
PubMed2001

Phacoemulsification combined with silicone oil removal through a posterior capsulorhexis.

PURPOSE: To evaluate the technique of silicone oil removal through a posterior capsulorhexis combined with phacoemulsification and intraocular lens (IOL) implantation. SETTING: Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi, India. METHODS: Fifteen eyes of 15 patients had phacoemulsification with removal of silicone oil, which had been used for intraocular tamponade after a previous pars plana vitrectomy. Eyes with a stable retina were included in the series. In all eyes, the silicone oil was removed through a planned posterior capsulorhexis after phacoemulsification. The parameters evaluated were the primary diagnosis, duration between silicone oil instillation and phacoemulsification, type of cataract, preoperative and postoperative best corrected visual acuities (BCVAs), and complications such as frequency of retinal redetachment and secondary cataract. RESULTS: Vitreoretinal surgery with silicone oil instillation was performed for rhegmatogenous-tractional detachment resulting from Eales' disease in 6 eyes and from proliferative diabetic retinopathy in 2 eyes, for primary rhegmatogenous retinal detachment in 6 eyes, and for traumatic rhegmatogenous detachment in 1 eye. The mean duration between the silicone oil instillation and phacoemulsification was 7.5 months +/- 3.8 (SD). Fourteen eyes had posterior subcapsular cataract, and 10 had nuclear sclerosis. Preoperative BCVA was worse than 6/60 in all eyes. The BCVA was 6/60 or better in 9 eyes after a minimum follow-up of 6 months. Two eyes had choroidal detachment in the early postoperative period. No eye had vitreous hemorrhage, retinal redetachment, secondary cataract, clinically significant endothelial decompensation or macular edema, or a dislocated IOL. CONCLUSION: The results indicate that silicone oil removal through a posterior capsulorhexis during phacoemulsification is a viable option and can be performed in selected cases of cataract with previous silicone oil instillation and a stable retina.

Adolescent↗
PubMed2004

Anterior capsule staining for capsulorhexis in cases of white cataract: comparative clinical study.

PURPOSE: To compare the safety and efficacy of trypan blue 0.1%, gentian violet 0.001%, indocyanine green 0.5% (ICG), fluorescein 2%, and the patient's autologous blood for anterior capsule staining in cases of white cataract. SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: Fifty eyes of 50 patients with age-related white cataract had anterior capsule staining with trypan blue, ICG, or gentian violet under an air bubble or subcapsularly with fluorescein or autologous blood followed by phacoemulsification with foldable intraocular lens implantation. Each stain was used in 10 eyes. The ease of creating a continuous curvilinear capsulorhexis (CCC) and the complications during the surgery were noted. Postoperative examinations at 6 hours, 1 day, 1 week, and 1 month included slitlamp microscopy, uncorrected visual acuity, and best corrected visual acuity (BCVA). The staining patterns on the anterior capsule, side port, corneal tunnel, and anterior cortex were assessed intraoperatively and within 6 hours and at 1 day. The intraocular pressure (IOP) was assessed at 1 day; pachymetry, at 1 day and 1 month; and the endothelial cell count, at 1 month. RESULTS: The surgeon had best visualization during the anterior capsulorhexis with trypan blue, ICG, and gentian violet, and a complete CCC was achieved in all eyes in the 3 groups. Two eyes each in the fluorescein and autologous blood groups had extension of the CCC so that the capsulorhexis was complete but not curvilinear. Anterior capsule fibrosis was detected with trypan blue (1 eye) and ICG (2 eyes). The anterior vitreous was stained with fluorescein in 2 eyes. All eyes achieved a BCVA of 20/30 or better from 1 week postoperatively to the last follow-up. The side port and corneal tunnel were stained most intensely with gentian violet followed by trypan blue and ICG and less intensely with fluorescein and autologous blood. The IOP, pachymetry, and endothelial cell loss were comparable between the stains. CONCLUSION: Although trypan blue, ICG, gentian violet, fluorescein, and autologous blood were safely used to stain the anterior capsule for phacoemulsification in eyes with white cataract, trypan blue, ICG, and gentian violet were more effective in staining the capsule.

Anterior Eye Segment↗
PubMed1998

Blunt, bent needle for continuous curvilinear capsulorhexis.

We describe an anterior continuous curvilinear capsulorhexis (CCC) technique that uses a dull needle. The needle's blunt tip prevents inadvertent tearing of the anterior capsule, and its rough surface allows the surgeon to transmit a power vector of different amplitude and direction to the edge of the capsulorhexis to continue the tear as desired. For biomechanical reasons, we prefer an arcade-shaped CCC because this configuration provides a greater circumference than a circular CCC. The blunt needle allows one to perform a single-step capsulorhexis in a safe and controlled manner and reduces surgical time. Even in cases of white and liquified cortex, the dull needle has proved a useful, safe tool.

Capsulorhexis↗
PubMed1998

Severe capsulorhexis contracture after cataract surgery in myotonic dystrophy.

A 42-year-old woman with myotonic dystrophy developed bilateral severe capsulorhexis contracture after uneventful phacoemulsification cataract surgery with implantation of 1-piece poly(methyl methacrylate) intraocular lenses (IOLs). The anterior capsular opening in her right eye constricted to a diameter of 0.7 mm, reducing visual acuity to counting fingers. Complete closure of the capsulorhexis with IOL encapsulation developed in her left eye, reducing visual acuity to hand movements. Surgical anterior capsulectomies restored visual acuity to 6/9 in both eyes. Myotonic dystrophy may predispose to the development of severe capsulorhexis contracture after cataract surgery.

Adult↗
PubMed1999

Primary posterior capsulorhexis without anterior vitrectomy in pediatric cataract surgery: longer-term outcome.

PURPOSE: To assess the effectiveness of primary posterior capsulorhexis without anterior vitrectomy in preventing posterior capsule opacification (PCO) in pediatric cataract surgery. SETTING: Children's Hospital, Dublin, Republic of Ireland. METHODS: The study comprised 32 eyes of 22 pediatric patients who had cataract extraction between 1994 and 1998. Extracapsular cataract extraction was performed using radiofrequency diathermy capsulorhexis to the anterior and posterior capsules without an anterior vitrectomy. Posterior chamber intraocular lens implantation was performed in 20 eyes. There were 23 congenital, 6 developmental, and 3 traumatic cataracts. RESULTS: Patient age ranged from 1 month to 12 years. Mean follow-up was 19 months (range 6 to 50 months). Twenty-seven of 32 eyes (84.4%) had a clear visual axis at last follow-up. Five eyes required a neodymium: YAG capsulotomy, which was performed a mean of 5 months postoperatively (range 1 to 9 months). The incidence of PCO requiring capsulotomy was 15.6%. CONCLUSION: Primary posterior capsulorhexis without anterior vitrectomy was safe and effective, with a low reopacification rate. Long-term follow-up of this patient cohort is necessary.

Anterior Eye Segment↗
PubMed1999

Capsulorhexis in intumescent cataract.

This technique of anterior capsulorhexis is for use in eyes with high intralenticular pressure and absence of red reflex as encountered in intumescent cataract. The initial steps of fashioning the anterior capsular flap and lens decompression are done under the microscope's high magnification and noncoaxial oblique illumination. Intralenticular pressure is controlled by filling the anterior chamber with a viscoelastic agent. Once the lens is decompressed, the capsulorhexis is completed with a capsule forceps and an endoilluminator is used as an oblique source of illumination. This technique allows controlled capsulorhexis in eyes with intumescent cataract.

Adult↗
PubMed1999

Capsule contraction after continuous curvilinear capsulorhexis: poly(methyl methacrylate) versus silicone intraocular lenses.

PURPOSE: To evaluate the progressive contraction of the anterior capsule opening after in-the-bag implantation of 2 types of intraocular lenses (IOLs). SETTING: Department of Ophthalmology, University of Brest, Brest, France. METHODS: In this prospective study, 32 single-piece poly(methyl methacrylate) (PMMA) (Pharmacia 812 C) and 30 3-piece silicone IOLs with PMMA haptics (Allergan SI-40NB) were implanted in the bag after standardized phacoemulsification performed by the same surgeon. All patients were older than 70 years, and none had zonular weakness. The surface of continuous curvilinear capsulorhexis (CCC) was measured 1, 30, and 150 days postoperatively using a 3 charge-coupled device camera and a digitized computer analysis system. RESULTS: A significant progressive constriction was observed at 150 days in 70% in the silicone group and 32% in the PMMA group. In addition, CCC contraction was greater in silicone group (P < .05). The mean surface decrease was 4.20 mm2 in the silicone group and 1.53 mm2 in the PMMA group. There was no correlation between sex, age, initial capsulorhexis area, final capsule shrinkage. In some eyes, especially in those with a single-piece PMMA IOL (41%), there was no constriction, but fine changes in the capsule opening were seen. CONCLUSION: Evolutive anterior capsulorhexis modifications were observed in all patients; however, the contraction rate was statistically higher in the silicone group. These results suggest that silicone IOL implantation should be avoided in eyes at risk for CCC constriction.

Aged↗
PubMed1999

Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery.

A capsulorhexis may be difficult to perform in the absence of a red fundus reflex. Using 0.1 mL of trypan blue 0.1% to stain the anterior capsule in 30 patients with a mature cataract enabled us to visualize the capsulorhexis during phacoemulsification. No adverse reactions were observed up to 12 months after surgery. Trypan blue staining of the anterior capsule appears to be a safe technique to facilitate the performance of a capsulorhexis in the absence of a red fundus reflex.

Capsulorhexis↗
PubMed1999

Elastic properties and scanning electron microscopic appearance of manual continuous curvilinear capsulorhexis and vitrectorhexis in an animal model of pediatric cataract.

PURPOSE: To compare the tear resistance of anterior capsulotomies using manual continuous curvilinear capsulorhexis (CCC) and vitrector-cut capsulotomy (vitrectorhexis) techniques in an animal model of the pediatric eye and in 2 pairs of human infant eyes. SETTING: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Continuous curvilinear capsulorhexis and automated vitrectorhexis capsulotomy techniques were performed in 20 pig eyes, 10 with each technique. The capsules were then stretched until they ruptured. The forces required for rupture after each technique were compared. The forces required for rupture of the pig eye lens capsule were also compared with those required for the human infant eye lens capsule. Scanning electron microscopy was performed in each group following intraocular lens (IOL) insertion. RESULTS: All capsules stretched adequately for IOL insertion. The percentage of stretch prior to rupture was higher in the capsulorhexis group (mean 157%, range 147% to 169%) than in the vitrectorhexis group (mean 135%, range 124% to 147%) (P < .001). The percentage of stretch in the human infant eyes was not statistically different from that in the porcine eyes (P > .05). CONCLUSIONS: The manual CCC offered greater resistance to capsule tearing than the vitrectorhexis and also revealed a more smooth, regular edge. It therefore remains the gold standard. However, the vitrectorhexis displayed more than adequate resistance to unwanted anterior capsule tears when used for IOL insertion through capsulotomy sizes currently used in clinical practice.

Animals↗
PubMed1999

[Staining the lens capsule with trypan blue for visualizing capsulorhexis in surgery of mature cataracts].

BACKGROUND: A capsulorhexis may be difficult to perform in the absence of a red fundus reflex. PATIENTS AND METHODS: After application of 0.3 mL trypan blue 0.1%, a quick and homogeneous staining of the anterior lens capsule was obtained in 100 patients with a mature cataract, to visualize the capsulorhexis during a phacoemulsification procedure. RESULTS: No adverse reactions related to the dye were observed up to 18 months after surgery. CONCLUSION: Trypan blue staining of the anterior lens capsule may therefore be a safe technique to facilitate the performance of a capsulorhexis in the absence of a red fundus reflex.

Capsulorhexis↗
PubMed1999

[Cataract extraction combined with trans-pupillary silicone oil drainage by planned posterior capsulorhexis].

BACKGROUND: A cataract is frequently observed after pars plana vitrectomy with silicone oil endotamponade. PATIENTS AND METHODS: Forty-three consecutive patients underwent cataract surgery combined with transpupillary removal of silicone oil. After phacoemulsification of the lens material through a sclerocorneal tunnel incision, a planned posterior capsulorhexis with a diameter of 3-4 mm was performed. By injecting saline through the capsulorhexis into the vitreous cavity, the silicone oil was rinsed out. Widening of the sclerocorneal tunnel facilitated the drainage of the silicone oil through the pupil and tunnel. After ophthalmoscopic evaluation of the fundus, a plano-convex PMMA posterior chamber lens was implanted into the capsular bag or ciliary sulcus, and the corneoscleral tunnel was closed by a 10-0 nylon suture. RESULTS: Depending on the underlying retinal disease the visual acuity improved in some eyes. Silicone oil bubbles left behind in the vitreous cavity were smaller than 0.5 mm in diameter. Persisting corneal decompensation or a clinically detectable cystoid macular edema related to cataract surgery did not occur. Due to the posterior capsulorhexis, secondary cataract did not develop postoperatively. Small postoperative vitreous hemorrhages resolved during the first three post-operative days. Retinal detachment recurred in 11 eyes (11/42 or 26.2%). In one eye, dislocation of the pseudophacos occurred which had to be corrected surgically. Since the pars plana region remained untouched, direct retinal lesions in the periphery of the fundus or marked vitreous hemorrhages were not encountered. CONCLUSIONS: Silicone oil removal can be combined with cataract surgery with transpupillary drainage of the silicone oil.

Adult↗
PubMed2006

Trypan-blue-assisted anterior continuous curvilinear capsulorhexis in a case of ocular pemphigoid.

PURPOSE: To report on trypan-blue-assisted anterior continuous curvilinear capsulorhexis (ACCC) in a case of ocular pemphigoid. METHODS: Interventional case report. RESULTS: Due to the reduced visibility especially in the corneal periphery caused by the ocular pemphigoid, trypan blue 0,06% (Acri.Blue) was used to stain the anterior capsule of the lens. Then anterior continuous curvilinear capsulorhexis was performed. Due to the blue staining, the visualization of the margin of the rhexis was always good and phacoemulsification procedure was successfully performed afterwards. During the follow-up period of 12-months-postsurgically, no exacerbation of the ocular pemphigoid occurred. CONCLUSIONS: The use of trypan blue staining of the anterior capsule enabled the surgeon to perform a safe anterior continuous curvilinear capsulorhexis and a subsequent phacoemulsification in ocular pemphigoid. No progression of the ocular pemphigoid was seen within the 12-months-post-surgery period.

Capsulorhexis↗
PubMed2005

YAG curios #2: Nd:YAG laser treatment following suction posterior capsulorhexis.

Suction posterior capsulorhexis (SPC) is a relatively new technique for creating a posterior capsulorhexis. We present a case series of seven patients who required Nd:YAG laser treatment 27 months after SPC. No patient had pre-existing risk factors for increased postoperative inflammation and all received a one-piece polymethylmethacrylate intraocular lens placed in-the-bag. Although it reduces the need for Nd:YAG laser treatment, SPC, like the more usual forceps posterior capsulorhexis, does not completely eliminate it.

Aged↗
PubMed1997

[Posterior continuous curvilinear capsulorhexis in congenital cataract with opaque posterior capsule].

OBJECTIVE: To study the management of the opacified posterior lens capsule in congenital cataract extraction with intraocular lens (IOL) implantation. METHODS: Posterior continuous curvilinear capsulorhexis was performed on 36 eyes of congenital cataract with opaque posterior capsule. After the removal of cortical material and implantation of IOL, a perforation was made near the center of the posterior capsule through the equator of IOL, Healon was directed toward the opening and injected into the interspace between the posterior capsule and the anterior limiting membrane of the vitreous, and a 4 mm diameter posterior capsulorhexis was performed with a forceps. RESULTS: All the eyes achieved a clear visual axis. There was vitreous prolapse in two eyes. IOL decentration did not occur in any case. CONCLUSION: Posterior continuous capsulorhexis could remain the integrity of the peripheral capsular bag with a clear visual axis in the eye with congenital cataract and an opaque posterior capsule.

Adolescent↗
PubMed1999

[Diathermic high-frequency capsulorhexis in cataract surgery].

PURPOSE: To evaluate the efficiency of diathermic high-frequency capsulorhexis in cataract surgery. METHODS: After injection of viscoelastic material into the anterior chamber, a continuous circular capsulotomy (CCC) was performed using a diathermic high-frequency capsulorhexis machine in 34 eyes of 30 cataract patients during extracapsular cataract extraction (ECCE) combined with intraocular lens (IOL) implantation. RESULTS: Successfully CCC was made in 31 eyes. A small peripheral radial capsular tear was detected in 3 eyes. No postoperative corneal edema and other complications were found in all eyes. The postoperative corrected visual acuity > or = 0.5 was accounted for 91.2%. CONCLUSION: Diathermic high-frequency capsulorhexis is a simple, safe and effective method for ECCE (or Phacoemulsification) combined with IOL implantation. It is especially indicated for those eyes with hypermature cataract, traumatic cataract and children with congenital cataract.

Aged↗