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We present a case of pupillary block glaucoma that developed after cataract extraction in a pediatric patient. To prevent pupillary block and secondary glaucoma after cataract surgery we recommend that all pediatric cataract patients be given a prophylactic peripheral iridectomy.
This study was performed to investigate the correlation between the contamination of the anterior chamber and the technique of extracapsular cataract extraction (ECCE). Three different methods were used: uncomplicated planned ECCE, phacoemulsification involving suturing method, and sutureless technique. All patients had posterior chamber intraocular lenses implanted. Two hundred and thirty consecutive patients were included in this prospective study, and preoperative smears of the conjunctiva and intraoperative aspirates of the anterior chamber were investigated. Samples of the aqueous humor were taken at the beginning and at the end of the operation. Cultures were incubated and held for 14 days. More than 71% of the preoperative smears were contaminated by coagulase-negative staphylococci, the most commonly isolated bacteria. However, 27% of the patients had culture-positive anterior chamber aspirates intraoperatively, also with coagulase-negative staphylococci as the most frequent organisms. In no case did postoperative endophthalmitis develop. Preliminary results in a small population show that the contamination of the aqueous humor is statistically significantly less frequent if the cataract extraction is performed by phacoemulsification than if it is done without phacoemulsification. Another interesting finding is that anterior chamber contamination is not significantly more frequent, if a sutureless technique is used for cataract surgery.
AIM: The purpose of the investigation was to evaluate the presence of IL-1 beta, IL-2, IL-6, IL-8, TNF-alpha, IFN-gamma in aqueous humor of patients with cataract. MATERIALS AND METHOD: Aqueous humor was taken from 29 patients during extracapsular cataract extraction. The presence of cytokines was evaluated using immunoenzymatic methods. RESULTS: IL-2, IL-6, IL-8, TNF-alpha and IFN-gamma were found in all aqueous humor samples. There was no evidence for the presence of IL-1 beta. CONCLUSION: Cytokines may play role in the inflammation process after extracapsular cataract extraction.
AIMS: Intraocular lens (IOP) implantation in sub-Saharan Africa is not the routine procedure of choice in the treatment of cataract. Previous series consist of small numbers of selected patients. The purpose of this study was to evaluate routine posterior chamber lens implantation in large numbers of consecutive patients. METHODS: 1059 cataract extractions with planned IOL (744 patients) were performed over a 1 year period from August 1993 to July 1994. RESULTS: 94.6% (1002) of eyes showed an improvement in visual acuity. A postoperative uncorrected acuity of 6/18 or better was attained in 41.7% of eyes, while 27.1% attained an uncorrected acuity of < 6/18 to 6/60. The commonest operative complication was posterior capsule rupture (11.4%). CONCLUSION: Extracapsular cataract extraction with posterior chamber lens implantation, performed in a well equipped clinic, can give satisfactory results in a developing country. Uncorrected visual acuity can be taken as an acceptable endpoint in the majority of cases.
PURPOSE: To compare the results of a triple procedure using either extracapsular cataract extraction (ECCE) or one of two phacoemulsification techniques combined with trabeculotomy ab externo and intraocular lens (IOL) implantation. SETTING: Kyoto University Hospital, Kyoto, Japan, and Nagata Eye Hospital, Nara, Japan. METHODS: In this comparative study, 25 eyes with primary open-angle glaucoma had ECCE combined with trabeculotomy ab externo and IOL implantation and 22 had the same procedure using phacoemulsification instead of ECCE. Of the eyes that had phacoemulsification, 10 had a single-flap and 12 had a double-flap procedure. RESULTS: All 22 eyes that had phacoemulsification had a postoperative IOP of 21 mm Hg or less, as did all ECCE eyes except 2. Although the self-sealing incision might have caused the higher incidence of IOP spikes in the immediate postoperative period, IOPs in the phacoemulsification groups were lower after 3 months. Results were similar in the single-flap and double-flap phacoemulsification groups. There were no significant complications. CONCLUSION: Cataract extraction by phacoemulsification or ECCE combined with IOL implantation and trabeculotomy ab externo is a safe, effective treatment for patients with coexisting glaucoma and cataract.
Fluorescein angiography was safely performed in 100 consecutive cases of cataract extraction during the first postoperative week. Seventy-five percent of the 100 eyes had good quality fluorescein angiograms. Four eyes demonstrated cystoid macular edema. Therefore, the incidence of cystoid macular edema in the first week after cataract surgery was low when compared to the reported incidence (40%) four to six weeks postoperatively.
The basic cause of iris-lens diaphragm bulging during cataract extraction is thought to be increased choroidal venous congestive pressure. This is shown to be controlled by hyperventilation under general anesthesia.
PURPOSE: To assess the endothelial cell loss after cataract extraction using a fluid-based system and compare it with conventional ultrasound. METHODS: A total of 46 eyes of 23 patients with up to 3+ bilateral cataract were included. The first eye was randomized to either fluid-based system or conventional ultrasound, and the fellow eye received the alternate system. Visual acuity and ultrasound pachymetry were measured preoperatively and at 1 day, 1 week, and 1 and 3 months postoperatively. Specular microscopy was performed preoperatively and 3 months after the surgery. Data was analyzed using the paired t test and Wilcoxon signed rank test. A P value less than 0.05 was considered statistically significant. RESULTS: Postoperatively, no significant differences were found among the groups. However, there was a significant difference (P < 0.01, analysis of variance with Tukey as posttest) in corneal pachymetry at day 1 after the surgery compared with baseline in both groups. There was a 6.3% and 7.9% loss of endothelial cells in the fluid-based system and ultrasound group, respectively. CONCLUSION: Visual acuity, pachymetry, and endothelial cell loss after cataract extraction and intraocular lens implantation using a fluid-based system is similar to conventional ultrasound.
An alternative surgical technique for cataract extraction using an overlapping scleral flap is described for patients in whom removal of the lens is not possible through the pars plana prior to vitrectomy.
Eighty patients were randomised in a single-masked parallel-group study to receive topically either the test drug, a diclofenac and gentamicin combination, or a betamethasone and neomycin combination after routine cataract extraction and intraocular lens implantation. Each group was assessed over a 6 week period for post-operative inflammation. The two drug combinations were equally effective in suppressing inflammation in the early post-operative stages and the diclofenac-gentamicin combination was slightly more effective in the later stages. The test drug was well tolerated and showed no adverse effects. We feel it is an effective and relatively safe drug which has a role as an anti-inflammatory agent after cataract extraction and has potential advantages in certain circumstances.
Seventeen women underwent simple penetrating keratoplasty for pseudophakic bullous keratopathy after extracapsular cataract extraction. Corneal edema occurred an average of eight months after cataract surgery (range, zero to 32 months). Of 17 corneal grafts, 16 (94%) have remained clear during an average follow-up period of 14 months (range, two to 32 months). One eye had a nonimmunologic graft failure. Of 16 eyes with clear grafts, 14 (87%) achieved a visual acuity of 20/40 or better after surgery. Two eyes with a visual acuity of 20/50 and 20/200 had opacified posterior capsules and one demonstrated age-related macular degeneration. One eye with a postoperative visual acuity of 20/40 demonstrated cystoid macular edema. Fifteen of 17 contralateral eyes showed slit-lamp evidence of endothelial dystrophy.
BACKGROUND AND OBJECTIVE: To evaluate the outcomes of phacoemulsification cataract extraction and intraocular lens implantation in patients with Behçet's disease. PATIENTS AND METHODS: This prospective study was based on 40 eyes of 34 patients with Behçet's disease who underwent phacoemulsification cataract extraction and intraocular lens implantation between May 2000 and February 2003. Their postoperative ocular complications and visual outcomes were observed during a mean follow-up period of 18.35 +/- 6.17 months (range, 6 to 32 months). RESULTS: Postoperative visual acuity increased in 29 eyes (72.5%) and was 20/40 or better in 18 eyes (45%). It decreased in 7 eyes (17.5%), resulting in a visual acuity of 20/400 or worse. The most frequent postoperative complication was posterior capsular opacification, which developed in 15 eyes (37.5%). Other complications were posterior synechiae formation in 7 eyes (17.5%), severe inflammation in 5 eyes (12.5%), cystoid macular edema in 5 eyes (12.5%), epiretinal membrane in 3 eyes (7.5%), and optic atrophy in 2 eyes (5%). CONCLUSION: With appropriate preoperative and postoperative suppression of inflammation, phacoemulsification and intraocular lens implantation are safe procedures leading to visual improvement in patients with Behçet's disease without preexisting fundus lesions.
The results of 3,047 extracapsular cataract extractions are analyzed. They indicate that anterior segment complications are greater with certain types of intraocular lenses, and the incidence of retinal detachment and cystoid macular edema is lower when the posterior capsule is intact for one year postoperatively.
The surgical management of cataract in patients with chronic posterior uveitis is described. Of 41 eyes, 88% acquired improvement of the visual acuity 4 months postoperatively, which then remained stable in most of the cases during a follow-up of one year. The type of cataract extraction, extracapsular or intracapsular, did not influence these results, nor did the implantation of an intraocular lens. Recurrence of the uveitis occurred in about one third of the cases. Postoperative complications consisted of macular edema, retinal detachment and vitreous hemorrhage.
In four cases of marginal corneal ulceration after uncomplicated intracapsular cataract extraction three of the ulcers appeared within three months after the surgery. In all patients the ulcers were located anteriorly to the site of limbal incision and were progressive. Conservative management was successful in three patients, including one after recurrence of the ulcer after surgery, and one patient resisted medical and surgical management.
Between November 1983 and January 1984, 13 cases of Candida parapsilosis endophthalmitis occurred in Florida, Georgia, and Tennessee in patients who had had an intraocular lens implantation (IOLI) or cataract extraction with an IOLI. This outbreak followed the introduction in July 1983 of a new brand of balanced salt solution (BSS) used as an intraoperative ophthalmic irrigation solution. This product was subsequently recalled because of intrinsic fungal contamination. A retrospective cohort study including 704 ophthalmology patients at risk for exposure to this brand of BSS revealed that definite exposure to that product was a significant risk factor for C. parapsilosis endophthalmitis (P less than 0.001, Fisher exact test). A retrospective case control study including 203 control patients with definite exposure to BSS suggested that exposure to systemic steroids (P = 0.007, Fisher exact test) was an additional risk factor for C. parapsilosis endophthalmitis. Treatment modalities among the 13 patients included topical, intraocular, or systemic antifungal therapy (or a combination of these modalities) in 13 patients and vitrectomy in 10 patients. No patients had systemic symptoms or complete visual loss. Laboratory investigations showed a 6.7% overall contamination of the product with C. parapsilosis. After recall of the product by the manufacturer, no patients having a cataract extraction or IOLI at the institutions studied are known to have developed C. parapsilosis endophthalmitis.
The authors report a case of Propionibacterium acnes endophthalmitis after intracapsular cataract extraction with implantation of an anterior chamber intraocular lens. The patient's chronic inflammation persisted for 5 years after cataract surgery despite treatment with pars plana vitrectomy, intraocular lens removal, topical and oral steroids, and topical fortified antibiotics. Fluctuations in the inflammation were paralleled by changes in the size and appearance of a white plaque on the posterior corneal surface. Anterior chamber tap cultures were positive for P. acnes after 8 days of incubation under anaerobic conditions. The inflammation was not controlled until the posterior corneal plaque, which was the presumed nidus of the chronic infection, was removed and the patient was treated with intravitreal and oral antibiotics.
Nanophthalmos is a rare ophthalmic condition with potential sight-threatening complications. In addition, nanophthalmic eyes have a high incidence of intraoperative and postoperative complications, including uveal effusion and retinal detachment. Prophylactic measures to prevent these complications may be used. The case is presented where cataract extraction for a nanophthalmic eye was performed from a posterior approach in combination with a pars plana vitrectomy and gas procedure. To the authors' knowledge, this method of cataract extraction has not been reported before for this condition.