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PubMed2000

[Effect of phacoemulsification and posterior chamber lens implantation on intraocular pressure in patients with and without open-angle glaucoma].

BACKGROUND: Many of the previous studies which dealt with the influence of cataract surgery on intraocular pressure, were performed retrospectively and based on heterogeneous groups of patients. Therefore, the purpose of our study was to prospectively assess the effect of phacoemulsification and posterior chamber intraocular-lens (IOL)-implantation on intraocular pressure (IOP) under standardized conditions in patients with and without open-angle-glaucoma. PATIENTS AND METHODS: Overall 52 patients were recruited for the study. 34 eyes with normal IOP and 16 eyes with open-angle-glaucoma were operated with the same technique. RESULTS: Mean IOP in patients with cataract and without glaucoma was preoperatively 15.1 mmHg. 6 months postoperatively these patients showed a mean decrease of IOP of 11.9% (1.8 mmHg +/- 3.8; p = 0.027); after 12 months IOP showed a decrease of 18.5% (2.8 mmHg +/- 3.5; p = 0.0001). In patients with glaucoma mean IOP was preoperatively 17.3 mmHg. IOP was reduced by 23.7% (4.1 mmHg +/- 6.0; p = 0.017) 6 months after cataract surgery and 22.6% (3.9 mmHg +/- 4.5; p = 0.005) 12 months after the operation. In 6 of 16 eyes the antiglaucoma medication could be suspended. CONCLUSION: Reduction of IOP is a positive side effect of phacoemulsification and posterior chamber IOL implantation and should be considered when indicating cataract surgery in patients with glaucoma and only slight elevation of IOP.

Aged↗
PubMed2001

[Erbium:YAG laser phacoemulsification. Comparison of 2 different application systems].

BACKGROUND: The erbium:YAG laser a suitable energy source for photoablation of several tissues with only minimal thermal side effects. The application system is an important factor in increasing its efficiency. MATERIALS AND METHODS: We used an Er:YAG laser designed for clinical application. The energy was guided via a special coated zirconium fluoride fiber to handpieces of various designs. Twenty lenses of patient eyes were treated using two application systems with 0 degree and 30 degrees tips. RESULTS: Despite similar cataract density an average laser phacoemulsification took significantly less energy and less time using the 0 degree tip. CONCLUSIONS: Use of the Er:YAG laser is superior to ultrasound phacoemulsification in minimizing thermal energy required for lens removal. Certain parameters of the application system construction, in this case the 0 degree tip, can provide additional efficiency. Further developments should pay attention to these findings.

Equipment Design↗
PubMed2005

Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach.

PURPOSE: To report intra-and postoperative complications in pars plana vitrectomy, phacoemulsification and intraocular lens implantation. A comparison of the combined versus two step surgical approach is given. METHOD: Medical records and operative notes of 111 eyes with combined surgery and 50 eyes with sequential surgery were retrospectively analysed. Subgroup analysis was performed to evaluate differences in disease groups, the use of endotamponading or endolaser and cryocoagulation. Postoperative follow-up time was between 3 and 18 months. RESULTS: Combined surgery: 64 eyes (57.5%) showed no complications. 17 eyes (15.3%) showed transient intraocular pressure rise, 17 eyes (15.3%) fibrinous exudation in the anterior chamber. Posterior capsule tears occurred in 7 eyes (6,3%), formation of posterior synechia was observed in 7 eyes (6.3%). IOL dislocation was seen in 3 eyes (2.7%), heavy covering of macrophages in 3 eyes (2,7%). Rare complications included silicon oil efflux into the anterior chamber (1.8%), anterior chamber hemorrhage (1,8%) and iris incarceration into the corneoscleral incision (0,9%). One eye needed explantation of the IOL during the follow-up. Sequential surgery: 31 eyes (62%) showed no complication. Transient intraocular pressure rise occurred in 14 eyes (28%), fibrinous exudation in 2 eyes (4%). Formation of posterior synechia was observed in 1 eye (2%), posterior capsule tears occurred in 4 eyes (8%). Dislocation of the IOL was seen in 1 eye (2%). Subgroup analysis revealed fibrinous exudation in the anterior chamber to be significantly more frequent after combined surgery, particularly in cases of proliferative diabetic retinopathy. CONCLUSION: Combined pars plana vitrectomy, phacoemulsification and intraocular lens implantation as well as the two-step procedure are safe and effective. Sequential surgery could be advantageous to minimize the postoperative anterior chamber inflammatory response.

Adult↗
PubMed2004

Retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification.

PURPOSE: To report a method of retinal protection using a viscoadaptive viscoelastic agent during removal of a luxated crystalline lens by intravitreal phacoemulsification. DESIGN: Interventional case report. METHODS: A 65-year-old man presented with a totally luxated crystalline lens in the vitreous cavity of the left eye. After total vitrectomy was performed, a viscoadaptive viscoelastic agent was applied over the retina and optic disk. Then the luxated lens was removed by intravitreal phacoemulsification. The lens dropped several times during the surgery but the thick viscoadaptive viscoelastic agent protected the posterior retina. RESULTS: In two cases treated this way, no complications occurred at six months after surgery. CONCLUSION: This method may be useful for protecting the retina from damage by a luxated crystalline lens and is less costly than perfluorocarbon liquid.

Aged↗
PubMed2004

Extraction of endocapsular tension ring after phacoemulsification in eyes with pseudoexfoliation.

PURPOSE: To describe an easy and effective surgical technique for removing the endocapsular tension ring (CTR) after phacoemulsification. DESIGN: New surgical technique. METHODS: One 10-0 polypropylene suture needle is passed through the hole at one end of the CTR. Then, the CTR is introduced into the capsular bag before phacoemulsification. If the posterior capsule ruptures, the CTR can be removed by pulling the suture toward the corneal incision and rotating the CTR to remove it. RESULTS: We performed this technique in 23 cases with a risk of zonular damage and did not encounter complications at any point in the procedure. CONCLUSIONS: We recommend this procedure in eyes with risk of zonular dialysis and posterior capsule rupture, especially in advanced pseudoexfoliative cataracts or if the surgeon has limited experience with these cases.

Device Removal↗
PubMed2004

Visual experience during phacoemulsification under topical versus retrobulbar anesthesia: results of a prospective, randomized, controlled trial.

PURPOSE: To compare the subjective visual experience of cataract patients during phacoemulsification and intraocular lens implantation under topical anesthesia (TA) vs retrobulbar anesthesia (RA). DESIGN: Prospective, randomized, controlled trial. METHODS: Three hundred six cataract patients eligible for phacoemulsification and intraocular lens implantation were randomized to receive either TA or RA during surgery by one of three surgeons. The surgeons were familiar with both anesthetic techniques and operated on the patients using the technique to which the patients were randomized. A masked interviewer conducted in-person interviews with the patients using a standardized questionnaire about their intraoperative visual experience and their reaction to their visual experience between 30 minutes and 4 hours after the surgery. RESULTS: Two patients (one in each group) had intraoperative posterior capsule rupture and were excluded from analysis. There was no statistically significant difference between TA (n = 154) and RA (n = 150) groups, except that more males compared with females had TA (P = .03). More patients who had TA reported perception of light (P < .001) and colors (P < .001) and a change (either increase or decrease) in light brightness during the course of the surgery (P < .001). There was no statistically significant difference in the proportions of patients who saw movements, flashes, instruments, or the surgeon or medical staff during the operation and who found their visual sensations frightening in the two groups. However, 10.4% in the TA group and 9.3% in the RA group found their visual experience frightening. CONCLUSIONS: More patients undergoing cataract surgery under TA compared with RA reported perception of light, colors, and a change in light brightness. A significant proportion of patients in both groups found the visual experience frightening.

Administration, Topical↗
PubMed2005

Pigmented-membrane formation on acrylic intraocular lenses after phacoemulsification.

PURPOSE: To report the formation of pigmented membranes on acrylic intraocular lenses (IOLs) after phacoemulsification and to determine the clinical characteristics of these pigmented membranes. DESIGN: Observational case series. METHODS: Four eyes of three patients were found to have pigmented membranes on their acrylic IOLs (Sensar AR40). Their medical records were reviewed. RESULTS: The pigmented membranes were observed at 4- to 9-month intervals after phacoemulsification. Their best-corrected Snellen visual acuity (BCVA) decreased by more than 2 lines, ranging from 20/63 to 20/40. After Nd:YAG laser treatment, BCVA improved 2 to 4 lines. At 5- to 12-week intervals after Nd:YAG laser treatment, recurrences of the pigmented membranes were observed with decreased BCVA. CONCLUSIONS: We have observed visually significant, recurrent, pigmented membrane formation in eyes implanted with Sensar AR40 acrylic IOLs. To the best of our knowledge, pigmented membranes on acrylic IOLs have not been described previously.

Acrylic Resins↗
PubMed2005

Choosing the location of corneal incision based on preexisting astigmatism in phacoemulsification.

PURPOSE: To investigate the best location of clear-cornea incision in phacoemulsification, depending on preexisting corneal astigmatism. DESIGN: Randomized clinical trial and noncomparative interventional case series. METHODS: A total of 574 patients in five stages were assigned to the following incisions: superior or temporal (n = 89), superior (n = 141), superior or superior plus relaxing (n = 102), nasal or temporal (n = 156), and incisions based on applying conclusions of preceding and current studies (n = 86). Visual acuity, refraction, biomicroscopy, keratometry, and videokeratography (Fourier analysis) were performed before and after phacoemulsification and intraocular lens implantation (3.5-mm incision). main outcome measures: Corneal refractive and surface regularity index change between preoperative and 6-month postoperative examination. Visual acuity at 6 months. RESULTS: In patients without corneal astigmatism, corneal changes induced were greater in superior than temporal incision. After a superior incision (preoperative steep axis at 90 degrees), a shift of the axis 90 degrees away was less likely with at least 1.5 diopters of astigmatism. A perpendicular relaxing limbal incision decreased corneal changes. Nasal incision induced greater corneal change than temporal incision (preoperative steep axis at 180 degrees). A shift of this axis 90 degrees away was more likely with astigmatism < 0.75 diopters in temporal incision and < 1.25 diopters in nasal incision. CONCLUSIONS: Superior incision is recommended with at least 1.5 diopters of astigmatism and steep axis at 90 degrees. Temporal incision is recommended with astigmatism < 1.5 diopters and steep axis at 90 degrees, negligible astigmatism, or astigmatism < 0.75 diopters and steep axis at 180 degrees. Nasal incision is recommended with at least 0.75 diopters of astigmatism and steep axis at 180 degrees.

Aged↗
PubMed2006

A survey about phacoemulsification incision thermal contraction incidence and causal relationships.

PURPOSE: To ascertain the rate and related factors of phacoemulsification wound burns. DESIGN: Survey. METHODS: We conducted a survey of 523 ophthalmologists in Utah, Colorado, Montana, South Dakota, and Oregon. RESULTS: One hundred six doctors (20.3%) responded and provided data on 76,581 procedures and 75 wound burns (0.98/1000 procedures). Twenty-one wounds (28%) occurred during early sculpting, and 53 wounds (71%) occurred during fragment removal. Wound burns were found to be associated with surgical approach (P = .003), phacoemulsification unit (P = .007), and unit settings (P < .001). CONCLUSION: Wound burns continue to be a serious complication; however, advances in technology and surgical technique help.

Body Temperature↗
PubMed2006

Face-to-face seated positioning for phacoemulsification in patients unable to lie flat for cataract surgery.

PURPOSE: To describe a technique of phacoemulsification for patients unable to lie flat. DESIGN: Prospective interventional case report. METHODS: Two patients unable to lie flat during phacoemulsification underwent this technique in a University Ophthalmology Department in the United Kingdom. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. The surgeon sat beside the patient, and while facing him or her, operated at nearly arm's length. RESULTS: The intraoperative and postoperative periods were uneventful in both patients, with good visual outcomes after surgery. CONCLUSIONS: This technique is valuable for situations where the patient or the eye requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.

Aged↗
PubMed2006

Scheimpflug imaging in late Capsular Bag Distention syndrome after phacoemulsification.

PURPOSE: To describe two cases of late Capsular Bag Distention syndrome (CBDS) and posterior capsular opacification (PCO) as documented on Pentacam. DESIGN: Case series. METHODS: A 55-year-old male and a 72-year-old female presented three years after phacoemulsification and intraocular lens (IOL) implantation with a complaint of decreased vision. Scheimpflug imaging was done using Pentacam. Patients underwent Nd:YAG capsulotomy for PCO, and postcapsulotomy capsular bag dynamics were imaged on Pentacam. RESULTS: Three years after phacoemulsification, patients presented with blurred vision and posterior bowing of opacified posterior capsule. Anterior capsular opening was apparently sealed by lens optic, and space between IOL and opacified posterior capsule was filled with turbid fluid. Nd:YAG laser capsulotomy was done. All findings, including collapse of distended bag, were precisely documented on Scheimpflug images. CONCLUSIONS: Pentacam Scheimpflug imaging is a useful technique to diagnose and document the presence and progress of CBDS and PCO.

Aged↗
PubMed2004

Intraocular pressure rise after phacoemulsification surgery in glaucoma patients.

PURPOSE: To examine the changes in intraocular pressure (IOP) and the incidence of substantial rises in IOP in the early period after cataract surgery in eyes with open-angle glaucoma (OAG). SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: The study included 32 eyes of 32 patients with OAG and 31 control eyes of 31 age-matched patients scheduled for phacoemulsification surgery. The IOP was measured preoperatively and 1, 2, 3, 5, 7, 14, and 28 days postoperatively. The incidence of a substantial rise in IOP postoperatively was evaluated, with the criterion being an IOP higher than 30 mm Hg. RESULTS: In the OAG group, the mean IOP increased 1, 2, and 3 days postsurgery and then decreased, whereas in the control group, it decreased from day 1 postsurgery. Although no significant differences were found between groups preoperatively, the mean IOP in the OAG group was significantly higher than in the control group postoperatively. Furthermore, the mean IOP decrease was also less in the OAG group than in the control group. A substantial increase in IOP occurred at day 1 postsurgery in 4 eyes (12.5%) in the OAG group, whereas no eyes in the control group showed such an increase; this difference was significant (P =.0419). CONCLUSIONS: A substantial increase in IOP occurred in an approximately 13% of eyes with OAG 1 day after phacoemulsification surgery. The IOP shortly after surgery was significantly greater in the eyes with OAG than in nonglaucomatous eyes.

Aged↗
PubMed2004

Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles.

PURPOSE: To investigate the influence of uneventful phacoemulsification on anterior chamber depth (ACD), iridocorneal angle (ICA) width, and intraocular pressure (IOP) in nonglaucomatous eyes with open ICA preoperatively. SETTING: Beyoglu Eye Education and Research Hospital, Istanbul, Turkey. METHODS: Fifty-three eyes of 49 patients were evaluated for 6 months postoperatively. The nonparametric Wilcoxon signed rank test was used to compare preoperative and postoperative IOP, ACD, and ICA width. Univariate and multivariate regression analyses were used to evaluate the relationships between IOP, ACD, and ICA width and between preoperative patient characteristics. RESULTS: The mean preoperative IOP of 15.1 mm Hg +/- 2.8 (SD) dropped postoperatively to 13.4 +/- 3.4 mm Hg at 1 day, 13.3 +/- 2.6 mm Hg at 1 week, 13.2 +/- 3.1 mm Hg at 1 month, 13.3 +/- 2.7 mm Hg at 3 months, and 14.1 +/- 2.5 mm Hg at 6 months (P<.05). The mean preoperative ICA grade of 2.97 +/- 0.72 increased to 3.55 +/- 0.48 at 1 week and 3.68 +/- 0.45 at 1 month (P<.05). The mean preoperative ACD of 3.06 +/- 0.49 mm increased to 3.57 +/- 0.47 mm at 4 weeks, 3.69 +/- 0.32 mm at 1 month, and 3.70 +/- 0.36 mm at 3 months (P<.05). The IOP decrease was not correlated with the changes in ICA width or ACD. Multiple regression analysis showed preoperative IOP was the single predictor of the postoperative IOP drop (P<.001). CONCLUSIONS: In nonglaucomatous eyes with an open ICA preoperatively, uneventful phacoemulsification reduced IOP, increased ACD, and widened the ICA. The changes were statistically significant over 6 months.

Aged↗
PubMed2004

Safety and efficacy of a dexamethasone anterior segment drug delivery system in patients after phacoemulsification.

PURPOSE: To compare the safety and efficacy of the Surodex dexamethasone anterior segment drug delivery system (Oculex Pharmaceuticals, Inc.) and dexamethasone 0.1% eyedrops (Maxidex) in patients with inflammation after cataract surgery. SETTING: Cataract Service, Department of Ophthalmology, Lothian University Hospitals, Edinburgh, United Kingdom. METHODS: This comparative single-masked parallel-group study comprised 1 eye of 19 patients having phacoemulsification cataract extraction and posterior chamber intraocular lens implantation. The Surodex group had the dexamethasone drug delivery system inserted into the anterior chamber (AC) angle during surgery and was treated with saline eyedrops (Isopto Plain) for 4 weeks. The control group had no drug delivery system or a placebo inserted at surgery and were treated with dexamethasone 0.1% eyedrops for 4 weeks. A Kowa FM-500 laser flare meter was used to objectively measure AC flare, the main outcome measure. Slitlamp biomicroscopy to grade AC flare and cells, intraocular pressure measurement, and corneal endothelial specular microscopy, performed up to 60 days after surgery, were the secondary outcome measures. The Surodex group had safety follow-ups after completion of the initial study period. RESULTS: Both groups had a steady increase in laser flare meter readings postoperatively. The readings peaked at 3 days in the control group and at 7 days in the Surodex group. This was followed by a gradual decline toward baseline values up to 28 days, after which the values remained at a similar level to 60 days in both groups. There were no significant differences in flare meter readings between the groups throughout the study. There were also no significant between-group differences in subjective assessment of intraocular inflammation and in impact on corneal endothelial cell count (P =.67). Surodex remnants persisted up to a mean of 22.0 months +/- 2.5 (SD) postoperatively in 6 eyes (54%). Neither group had a severe adverse event. CONCLUSION: Surodex appeared to be as effective as dexamethasone 0.1% eyedrops in controlling intraocular inflammation after cataract surgery by phacoemulsification, and both methods had a similar safety profile.

Aged↗
PubMed2003

Efficacy of brimonidine 0.2% in controlling acute postoperative intraocular pressure elevation after phacoemulsification.

PURPOSE: To determine the efficacy of brimonidine tartrate 0.2% drops given 2 times a day in reducing intraocular pressure (IOP) spikes during the first 24 hours after phacoemulsification cataract surgery. SETTING: Department of Ophthalmology, General Hospital of Patras Agios Andreas, Patras, Greece. METHODS: In this prospective double-blind placebo-controlled study, 1 eye of 40 consecutive normotensive cataract patients having small-incision cataract surgery was randomized into 1 of 2 treatment arms. Twenty patients received a placebo (artificial tears) and 20 patients received brimonidine tartrate 0.2% drops 2 times a day the day before and the day of surgery. Diurnal IOP variation was the primary efficacy variable; IOP was measured at baseline, before surgery, and 4, 6, 12, and 24 hours postoperatively. RESULTS: The placebo group had higher IOPs at every time point after surgery. Peak elevation of IOP occurred 6 hours after surgery. The mean IOP in the placebo group (27.71 mm Hg +/- 3.75 [SD]) was statistically significantly higher than in the brimonidine group (21.45 +/- 1.32 mm Hg) (P<.001). A major IOP rise (>/=20 mm Hg above baseline IOP) occurred in 1 patient (5%) in the placebo group who required emergency hypotensive therapy. Twenty-four hours after surgery, 11 eyes (55%) in the brimonidine group and 4 eyes (20%) in the placebo group had an IOP lower than baseline. CONCLUSION: Prophylactic treatment with brimonidine tartrate 0.2% 2 times a day for 2 days was effective in reducing IOP peaks throughout the first 24 hours after phacoemulsification surgery.

Acute Disease↗
PubMed2004

Orbital cellulitis after phacoemulsification and intraocular lens implantation.

We report a case of orbital cellulitis after uneventful phacoemulsification and intraocular lens implantation under peribulbar injection. The eyelid skin was prepared with chlorhexidine gluconate before the peribulbar injection, and the eyelid and conjunctival cul-de-sac were prepared with povidone-iodine before phacoemulsification. Five days postoperatively, the patient presented with reduced visual acuity and lid swelling. Ocular examination showed signs of orbital cellulitis, which was confirmed by a computed tomography scan. Oral erythromycin and metronidazole were given, after which the symptoms improved with successful outcomes.

Anti-Infective Agents↗
PubMed2004

Phacoemulsification and foldable intraocular lens implantation combined with vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy.

PURPOSE: To determine the clinical outcomes of phacoemulsification and foldable intraocular lens (IOL) implantation combined with primary vitrectomy and silicone oil tamponade to treat severe proliferative diabetic retinopathy (PDR). SETTING: Department of Ophthalmology, Seoul National University College of Medicine, and Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea. METHODS: The results of combined cataract surgery and silicone oil injection in 20 eyes (20 patients) were retrospectively analyzed. All patients had tractional or tractional-rhegmatogenous retinal detachment and clinically significant lens opacities; none had previous intraocular surgery. An acrylic foldable IOL was implanted in the capsular bag or ciliary sulcus. RESULTS: Primary anatomic success was achieved in 90% of eyes. Functional success was attained in 60% of eyes after a mean follow-up of 7.6 months. The postoperative visual acuity improved in 60% of patients, was unchanged in 20%, and was worse in 20%. Silicone oil was removed in 80% of patients without complications after a mean of 3.4 months. The mean absolute value of the difference between the predicted refraction and postoperative refraction was 0.74 diopter (D) (range 0.03 to 1.74 D). CONCLUSION: Phacoemulsification and foldable IOL implantation combined with primary vitrectomy and silicone oil tamponade was performed safely with favorable anatomic and visual outcomes in eyes with severe PDR.

Adult↗
PubMed2004

Management of lens-iris diaphragm retropulsion syndrome during phacoemulsification.

Lens-iris diaphragm retropulsion syndrome (LIDRS) occurs more often than recognized during small-incision phacoemulsification. This syndrome requires an infusion of fluid into the anterior chamber and is characterized by posterior displacement of the lens-iris diaphragm, marked deepening of the anterior chamber, posterior iris bowing, pupil dilation, and often significant patient discomfort. Using microendoscopy, we have observed that LIDRS is essentially a reverse pupillary block. We describe a surgical technique to mechanically break the iridocapsular block to restore normal chamber depth, relieve patient discomfort, and allow the surgeon to proceed safely with phacoemulsification.

Adult↗