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PubMedDate not supplied

Effect of apraclonidine versus dorzolamide on intraocular pressure after phacoemulsification.

BACKGROUND AND OBJECTIVE: To investigate the efficacy of 1% apraclonidine hydrochloride and 2% dorzolamide hydrochloride in controlling postoperative intraocular pressure elevation in patients undergoing phacoemulsification. PATIENTS AND METHODS: A prospective, randomized, double-blind, placebo-controlled study was conducted. Seventy-five patients were randomized to receive either 1% apraclonidine hydrochloride, 2% dorzolamide hydrochloride, or artificial tears immediately after uncomplicated phacoemulsification. Intraocular pressure was measured by Goldmann applanation tonometer 1 to 3 hours preoperatively and 24 hours and 5 days postoperatively. RESULTS: Mean intraocular pressure measured at 24 hours and 5 days after surgery was not significantly different between groups. None of the patients had an elevated intraocular pressure of 30 mm Hg or higher. No marked difference was observed in patient age, preoperative intraocular pressure, mean ultrasound time, degree of nuclear hardness, and amount of postoperative intraocular inflammation between groups. CONCLUSION: Uneventful phacoemulsification involving meticulous cortical and viscoelastic removal does not cause a significant increase in intraocular pressure 24 hours following surgery.

Adrenergic alpha-Agonists↗
PubMed2005

[Therapeutic effect of phacoemulsification for closed-angle glaucoma].

OBJECTIVE: To investigate the therapeutic effect of phacoemulsification for primary closed-angle glaucoma complicated with cataract. METHODS: Phacoemulsification with posterior chamber foldable intraocular lens implantation was performed in 55 cases (58 eyes) of acute or chronic primary closed-angle glaucoma complicated with cataract. The changes of visual acuity, intraocular pressure, central anterior chamber depth and anterior chamber angle were observed after operation and the patients were followed up for 6 months. RESULTS: Compared with those before operation, the postoperative best corrected visual acuity and anterior chamber depth were improved, the intraocular pressure was reduced, and the closed chamber angle was partially reopened. CONCLUSION: Phacoemulsification with posterior chamber foldable intraocular lens implantation not only improves the visual acuity but also controls the intraocular pressure, and can be a valuable method for treating primary closed-angle glaucoma with cataract.

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PubMed2005

Long-term intraocular pressure change after clear corneal phacoemulsification in Thai glaucoma patients.

OBJECTIVES: To evaluate long-term intraocular pressure (IOP) changes after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. DESIGN: Retrospective study. SETTING: Eye Clinic, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. MATERIAL AND METHOD: The medical records of 218 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 160 normal controls. Follow-up was 12 to 18 months. Outcome measures were postoperative IOP and number of glaucoma medications. RESULTS: Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.4 mm Hg +/- 3.8 (SD) at 12 months and 1.6 +/- 4.2 mm Hg at 18 months. The mean number of medications decreased significantly at 12 months (0.51 +/- 0.75) and at 18 months (0.41 +/- 0.83) (P = .04). The control group also had a significant decrease in IOP, with a mean decrease of 0.83 +/- 2.8 mm Hg at 12 months (P = .01) and 1.26 +/- 2.9 mm Hg at 18 months (P < .0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. CONCLUSION: These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively safe and simple surgical option in patients with cataract and well-controlled glaucoma. The approach provided favorable long-term IOP change and led to rapid visual rehabilitation in both the glaucoma and control group.

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PubMed2005

Intraocular pressure control following phacoemulsification in patients with chronic angle closure glaucoma.

OBJECTIVES: To evaluate intraocular pressure (IOP) and glaucoma control following phacoemulsification with posterior chamber intraocular lens implantation in patients who had chronic angle closure glaucoma (CACG) whose peripheral anterior synechiae (PAS) were less than 270 degrees. DESIGN: Non-randomized consecutive cases series. PARTICIPANTS: CACG cases at the glaucoma service, Ramathibodi Hospital who underwent Neodymium YAG laser peripheral iridotomy (PI) and subsequently received or did not receive anti-glaucoma medication. MATERIAL AND METHOD: Retrospective analysis of CACG patients who had PAS 270 degrees or less and underwent YAG-PI with or without anti-glaucoma medication to control IOP at 21 mmHg or less. The IOP and number of anti-glaucoma medication used at 1, 3 and 6 months were measured. Patients were classified into 2 Groups according to degree of PAS: Group 1 were patients who had PAS 180 degrees or less and Group 2 were those whose PAS was between 181 degrees and 270 degrees. MAIN OUTCOME MEASURES: The IOP and number of anti-glaucoma medication at baseline and postoperatively at 1, 3 and 6 months were compared by nonparametric statistics. RESULTS: There were 28 patients (48 eyes) in the present study. Twenty two were females and 6 were males. Patients' age ranged from 45 to 76 years old with a mean of 55 +/- 6.5 years. Of the 48 eyes, 34 were in Group 1 and 14 were in Group 2. In Group 1, the mean baseline IOP was 20 +/- 2.5 mmHg. and the average number of preoperative anti-glaucoma medication used was 0.08. At 1, 3 and 6 months postoperatively, the IOPs were 16.2 +/- 2.2, 17.1 +/- 2.0, 18.1 +/- 1.4 mmHg. respectively with an average number of anti-glaucoma medications of 0, 0.3 and 0.3, respectively, whereas in Group 2, the mean baseline IOP was 22 +/- 3.8 mmHg and mean preoperative number of anti-glaucoma was 1.8, whereas postoperatively, the IOPs at 1, 3 and 6 months were 17.1 +/- 2.2, 17.3 +/- 1.8, and 17.1 +/- 1.7 mmHg, with an average number of 1.1, 1.4 and 1.4 anti-glaucoma medications used, respectively. When compared between the 2 Groups, Group 1 had a significant difference in IOP control at 1 and 3 months and less use of antiglaucoma medications than Group 2 up to at least 6 months. CONCLUSION: Phacoemulsification in CACG helped control of glaucoma. There was a statistically significant difference in IOP reduction and number of anti-glaucoma medication used before and after phacoemulsification in the CACG patients whose PAS did not exceed 270 degrees at least up to 6 months.

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PubMed2006

[Results of bimanual phacoemulsification with intraocular lens implantation through the micro incision].

PURPOSE: To evaluate the postoperative results of bimanual, cold phacoemulsification with foldable lens implantation through 1.7 mm incision. MATERIAL AND METHODS: Thirty four bimanual cold phacoemulsifications with Acri. Smart (AcriTec) IOL implantation through 1.7 mm incision were performed in the Department of Ophthalmology, Medical University of Lódź, between March and May 2004. In the group of 34 patients, 24 were women and 10 were men. The mean age of patients was 67 years (range between 42 and 77). Preoperative visual acuity ranged from 0.5/50 to 5/10. Mean visual acuity was 0.3. Preoperative astigmatism ranged from 0.15 to 2.3 diopters (mean 0.7). Preoperatively, nuclear density was estimated according to LOCS III classification. Twenty patients (59%) had 1 to 3 nuclear density, and 14 (41%) had 4 to 6 nuclear density. All surgeries were performed with Oertli machine using the burst mode with a sleeveless phaco tip. Postoperative examinations were conducted on the 1st and the 7th day, and I month after the surgery. Visual acuity, astigmatism, status of the cornea and IOL centration were evaluated. RESULTS: No intraoperative complications were observed. All 34 patients maintained corneal transparency with no signs of thermal damage around the wound. Visual acuity improved in all cases. Mean visual acuity in 33 patients who had no coexisting ocular diseases I month after surgery was 0.98 and the mean induced astigmatism was 0.2 diopters. In all cases IOLs were very well centred. CONCLUSIONS: Bimanual phacoemulsification is a very safe method allowing to minimise corneal incision. Using Acri. Smart IOLs, the induced astigmatism is very small, almost imperceptible to patients.

Acrylic Resins↗
PubMed2006

[Intraocular lens power calculation in cataract phacoemulsification after refractive surgery].

OBJECTIVE: To analyze the results of phacoemulsification cataract surgery in eyes that had refractive surgery and to compare the predictability of K value in Holladay II formula of intraocular lens power calculation. METHODS: Fifteen cases (15 eyes) were divided into 2 groups. Group 1 included 8 eyes, the IOL power was calculated with Holladay II formula and the K value was calculated using surgeon-entered k-value (KS). Group 2 included 7 eyes, the IOL power was calculated with Holladay II formula also, the K value was calculated using k-value from refractive data (KR). The achieved refraction after phacoemulsification was compared with target refraction to assess the predictability of the formula and the accuracy of k-value. RESULTS: The mean difference between target and achieved refractions after phacoemulsification was (0.90 +/- 0.22) D in group 1 and (0.99 +/- 0.22) D in group 2. CONCLUSIONS: Holladay II formula is accurate in the IOL power calculation after refractive surgery. There is no significant difference between the results calculated by Holladay II formula with KS or KR.

Adult↗
PubMed1996

[Dynamic viscosity and corneal endothelial protection with Healonid, Healon GV, Provisc and Viscoat during phacoemulsification].

PURPOSE: To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phacoemulsification, we conducted a double study. METHODS: We compared in vitro the corneal endothelial protection offered by Healon, Healon GV, Provisc and Viscoat after < > phacoemulsification. Eight samples of ten to fifteen freshly enucleated pig eyes were operated; the first four groups were the controls, whereas the other four tested the different viscous solutions. In parallel, we determined the rheologic properties of the four viscoelastic substances in a physicS laboratory. To measure the percentage of corneal endothelial cell damage, we used the Janus Green spectrometric technique. RESULTS: Corneal endothelial cell damage averaged 31.67% in eyes in which no viscoelastic substance was used. Damage was 14.29% in specimens that received Healon, 12.85% with Healon GV, 2.48% in the Viscoat group and 15.43 in those that received Provisc. There is a significant difference (p <0.001) between the Viscoat group and all other samples. The values of the viscosity at different shear rates and the graph of viscosities as a function of shear rate of the four viscous solutions are given. CONCLUSION: Viscoat has a very high dynamic viscosity at high shear rate. This property and a poor cohesion provide a better corneal endothelial protection during in vitro phacoemulsification.

Animals↗
PubMed1996

Three-millimeter versus 6-mm incisions in combined phacoemulsification and trabeculectomy.

BACKGROUND AND OBJECTIVE: To determine the results of phacoemulsification and combined trabeculectomy in subjects receiving either a 3- or a 6-mm scleral incision. PATIENTS AND METHODS: The authors evaluated consecutive patients who underwent combined phacoemulsification and trabeculectomy with a 3-mm incision. These patients were individually matched by age, diagnosis, previous surgery, and race to those having a 6-mm incision. RESULTS: The study found that 1 year following surgery, results were similar between the 3- and 6-mm incision groups for intraocular pressure (IOP), bleb height, bleb vascularity, number of glaucoma medicines, anterior chamber depth, visual acuity, spherical equivalent, cylinder, and axis (P > .05). No difference was observed between groups with the highest IOP within the first postoperative month (P > .05). Also, no marked differences in number of complications were noted between groups. CONCLUSION: This study suggests that 3- and 6-mm incision phacoemulsification combined with trabeculectomy provide similar postoperative IOP control and visual acuity results.

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PubMed1996

Combined phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative mitomycin-C: comparison between 3.2- and 6.0-mm incisions.

PURPOSE: To compare surgical results between 3.2- and 6.0-mm incisions in combined phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative mitomycin-C. METHODS: Fifty-seven consecutive eyes of 45 patients in a referral practice underwent combined phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative mitomycin-C. The first 24 eyes had a 6.0-mm incision and the next 33 eyes had a 3.2-mm incision; the procedures were otherwise identical. The postoperative intraocular pressures, number of antiglaucoma medications, presence of filtration blebs, visual acuity, and complications at 1 day, 1 week, 1 month, and 1 year were subjected to multivariate analysis. RESULTS: There were no statistical differences in the intraocular pressure control, number of antiglaucoma medications, or presence of filtration bleb between the two groups at any of the postoperative visits. Visual acuity was significantly better (p = 0.02) for the 3.2-mm incision group throughout the evaluation period. CONCLUSIONS: Both large- and small-incision phacoemulsification, intraocular lens implant, and trabeculectomy with intraoperative Mitomycin-C provide good intermediate range (1 year) postoperative IOP in eyes with coexisting cataract and glaucoma. In addition, small-incision surgery results in earlier and better visual rehabilitation than large-incision surgery.

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PubMedDate not supplied

Comparison of combined cataract and glaucoma surgery using planned extracapsular and phacoemulsification techniques.

BACKGROUND AND OBJECTIVE: The surgical management of coexisting cataract and glaucoma is a common problem for the ophthalmologist. PATIENTS AND METHODS: We evaluated intraocular pressure (IOP) reduction and bleb formation in combined cataract and filtration surgery, comparing planned extracapsular cataract extraction (ECCE) and phacoemulsification approaches coupled with similar trabeculectomy techniques. Seventy-two eyes with primary open-angle or pseudoexfoliation glaucoma underwent combined cataract and filtration surgery. Thirty-five eyes underwent planned ECCE, intraocular lens (IOL) implantation, and trabeculectomy, and 37 eyes underwent phacoemulsification, IOL implantation and trabeculectomy. Minimum follow-up for both groups was 1 year with a mean of 16 months. RESULTS: The mean IOP reduction for phacoemulsification/trabeculectomy eyes (5.0 +/- 4.3 mm Hg) was significantly lower than the mean IOP reduction for ECCE/trabeculectomy eyes (2.9 +/- 4.1 mm Hg; P < 0.03). There was no significant difference between the groups in terms of visual acuity improvement or glaucoma medication reduction. CONCLUSION: Combined cataract and filtration surgery using phacoemulsification is associated with greater IOP reduction than combined surgery using ECCE.

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PubMed1997

Comparative results of combined procedures for glaucoma and cataract: I. Extracapsular cataract extraction versus phacoemulsification and foldable versus rigid intraocular lenses.

BACKGROUND AND OBJECTIVES: The refinements of small-incision cataract surgery by phacoemulsification with foldable intraocular lens (IOL) implantation have recently permitted new options for combined trabeculectomy with cataract extraction. The objectives of this study were to compare the long-term intraocular pressure (IOP) control and visual outcome between trabeculectomies combined with extracapsular cataract extraction (ECCE) versus those with phacoemulsification, and to analyze these same factors for foldable versus rigid IOLs. PATIENTS AND METHODS: The authors retrospectively reviewed the charts of 311 patients (397 eyes) who underwent combined trabeculectomy with cataract extraction and posterior chamber IOL implantation. In all of the surgeries, releasable scleral flap sutures were used. The mean follow-up was 22.9 +/- 15.1 months, with a minimum follow-up of 12 months. RESULTS: Trabeculectomy combined with phacoemulsification had a lower postoperative complication rate and was more effective than trabeculectomy combined with ECCE in reducing IOP to less than 20 mm Hg with or without medication (95% vs 82%) and in improving vision to levels of 20/40 or better (71% vs 52%) (P < .001). Regarding IOLs, foldable silicone lenses were found to be an effective alternative to polymethylmethacrylate lenses in combined surgeries in terms of a controlled IOP of less than 20 mm Hg (97% vs 97%) and visual recovery to 20/40 or better (78% vs 63%). CONCLUSION: The combination of trabeculectomy with releasable scleral flap sutures and small incision cataract surgery with foldable IOL implantation has improved postoperative IOP control and visual rehabilitation.

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PubMed1997

Combined phacoemulsification and trabeculectomy with mitomycin-C.

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness of combined phacoemulsification and trabeculectomy with mitomycin-C with respect to visual rehabilitation and control of intraocular pressure in patients with coexisting cataract and glaucoma. PATIENTS AND METHODS: The authors retrospectively studied 20 consecutive cases of phacoemulsification with posterior chamber intraocular lens implantation combined with trabeculectomy using mitomycin-C. They included in their study 20 eyes of 19 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, inflammatory glaucoma, chronic angle-closure glaucoma, and normal tension glaucoma. RESULTS: After a mean postoperative follow-up time of 14.4 +/- 3.1 months, intraocular pressure was reduced from a preoperative mean of 19.2 +/- 6.1 mm Hg to a postoperative mean of 13.4 +/- 3.9 mm Hg (P = .0004). The number of required intraocular pressure-lowering medications dropped from a preoperative mean of 2.3 +/- 0.7 medications to 0.2 +/- 0.4 medications postoperatively (P < .0001), with only 4 eyes requiring the restarting of a single medication each. Mean log10 (minimum angle of resolution) visual acuity improved from a preoperative 0.66 +/- 0.53 (Snellen 20/91) to a postoperative 0.30 +/- 0.40 (Snellen 20/40) (P < .0005). The most frequent complication was a bleb leak (8 of 20 eyes [40%]), usually occurring early and responding to conservative management. One eye with later-onset bleb leak incurred endophthalmitis. In another eye, hypotony with maculopathy developed. CONCLUSIONS: Phacoemulsification combined with trabeculectomy using mitomycin-C appears to be an effective approach to the management of cataract in patients with glaucoma. It offers potential for good improvement in visual acuity as well as long-term control of intraocular pressure with reduced or no dependence on medications. Potential vision-threatening complications of this procedure, specifically hypotony maculopathy and late-onset bleb leaks, should be considered in the decision to use mitomycin-C.

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PubMed1997

[Personal results of cataract phacoemulsification with tunnel incision without sutures].

PURPOSE: Early and late evaluation of no-stitch cataract phacoemulsification with tunnel incision. SETTING: Department of Ophthalmology, Bydgoszcz. MATERIAL AND METHODS: No-stitch phacoemulsification of cataract with sclero-corneal tunnel incision. Foldable PC IOL were implanted in 40 eyes of patients between 30-67 years of age. Observation period: 1-5 years. RESULTS: Very good anatomical and functional results. Fast visual rehabilitation. CONCLUSIONS: No-stitch cataract surgery: phacoemulsification with implantation of foldable PC IOL through tunnel incision is a method worth wide recommendation.

Adult↗
PubMed1997

Cornea refractive changes after clear cornea phacoemulsification with foldable intraocular lens.

BACKGROUND: Clear cornea incision for phacoemulsification is the current trend of cataract surgery, with the benefits of small incision, quick rehabilitation and stable wound architecture. In our Oriental eyes with small palpebral fissure the cornea curvature is easily affected by the tight lid compression. Evaluation of the postoperative cornea topographic change after this procedure in our patient is thus necessary. METHODS: Forty eyes with simple cataract were enrolled in this study. Among them 22 were right eyes and 18 were left eyes. All of them were through temporal clear cornea incision. A 2.65 mm length incision for phacoemulsification then enlarged to 3.5 mm for foldable intraocular lens implantation. The wound remained self-healing without suture. Color topographies were taken before and then one and three months after surgery. Palpebral fissures were measured before surgery. RESULTS: Induced cornea astigmatism measured as 0.30 +/- 0.35 diopter in the first postoperative month, and 0.50 +/- 0.43 diopter in the third postoperative month. All the induced astigmatism was toward the incision axis and with the rule shifting. CONCLUSIONS: Tolerable with-the-rule astigmatism shifting around 0.5 diopter was noted postoperatively via temporal clear cornea phacoemulsification with foldable intraocular lens implantation in our patients.

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PubMed1998

Changes in anterior chamber depth and intraocular pressure after phacoemulsification and posterior chamber intraocular lens implantation.

BACKGROUND AND OBJECTIVE: To determine anterior chamber depth (ACD) and intraocular pressure (IOP) following uncomplicated cataract extraction with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. PATIENTS AND METHODS: The ACDs and IOPs of 56 patients were prospectively evaluated after phacoemulsification and IOL implantation. Measurements of ACD were performed using ultrasonography and measurements of IOP were performed using a Goldmann applanation tonometer preoperatively and at 1 week and 1, 3, 6, and 9 months postoperatively. RESULTS: The mean IOP had decreased and the mean ACD had increased significantly by 1 month postoperatively (P < .03 and P < .01, respectively). Between 1 and 3 months, a significant increase in ACD (P < .05) and decrease in IOP (P < .01) was also observed. The ACD peaked (3.51 +/- 0.45 mm) and the IOP reached its lowest value (10.05 +/- 2.23 mm Hg) at 3 months postoperatively. The reduction in IOP and increase in ACD remained significant during the follow-up period, compared with the preoperative values. CONCLUSION: These results suggest that increases in ACD and decreases in IOP occur in selected patients after uncomplicated cataract extraction by phacoemulsification with IOL implantation.

Adult↗
PubMed1998

A comparison of the effectiveness of dorzolamide and acetazolamide in preventing post-operative intraocular pressure rise following phacoemulsification surgery.

The aim of this study was to evaluate the effectiveness of topical dorzolamide versus systemic acetazolamide in preventing the intraocular pressure (IOP) spike, following routine phacoemulsification surgery. In this prospective study, 59 eyes (59 patients), undergoing routine phacoemulsification surgery with posterior intraocular implant, were divided into three groups. Group 1 received acetazolamide 250 mg SR orally, immediately post-operatively. Group 2 received one drop of dorzolamide immediately after surgery. Group 3 or control, received neither. The IOP, was checked 4 h, 24 h and 2 weeks post-operatively. When compared with mean baseline pre-operative IOP, the 4 h mean post-operative IOP was slightly higher in the dorzolamide group by a mean of +2.49 mmHg (P = 0.2502). It was significantly higher in the acetazolamide group by a mean of +6.13 mmHg (P = 0.0034) and in the control group by a mean of +11.81 mmHg (P = 0.000). At 24 h the mean IOP in the control group remained significantly elevated by a mean of +5.87 mmHg (P = 0.003). Topical dorzolamide is effective in reducing the early IOP rise during the first 24 h following routine uncomplicated phacoemulsification surgery.

Acetazolamide↗
PubMed1998

Endothelial cell loss secondary to two different phacoemulsification techniques.

BACKGROUND AND OBJECTIVE: The endothelial cell count after phacoemulsification serves as a sensitive indicator for the level of corneal damage caused by different phacoemulsification techniques. PATIENTS AND METHODS: In a prospective and randomized study, the "Reversed Tip and Snip" technique and the "Divide and Conquer" technique were performed in groups of 30 patients each. The corneal endothelial cell count was measured preoperatively as well as 4 weeks and 3 months postoperatively. RESULTS: The endothelial cell count showed significant (P < .001) reduction by approximately 10% after the "Reversed Tip and Snip" technique and by approximately 15% (P < .001) after the "Divide and Conquer" technique. The latter produced a significantly (P < .001) greater cell loss. CONCLUSIONS: The "Reversed Tip and Snip" phacoemulsification technique produces less endothelial cell loss than the "Divide and Conquer" technique.

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PubMed1978

Endothelial damage with phacoemulsification and intraocular lens implantation.

Specular microscopy was used to study the corneal endothelium in a series of patients undergoing phacoemulsification with and without intraocular lens implantation by one experienced surgeon. Cell loss after phacoemulsification alone was variable, but the mean was 18%, with a median of 11%. The patients undergoing phacoemulsification plus lens implantation showed a mean cell loss of 26%, with a median of 17%. This is considerably lower than has been reported with standard intracapsular extraction plus lens implantation. The decreased endothelial damage is attributed to the technique of inserting the lens through a small incision and maintaining an air bubble between the lens and the cornea throughout lens insertion and wound closure.

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