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PubMed2003

Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology.

PURPOSE: To report the preoperative, intraoperative, and postoperative outcomes of combining phacoemulsification and posterior chamber intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal pathology. DESIGN: Retrospective, consecutive, interventional case series. METHODS: Charts of patients undergoing combined procedures at the Wilmer Ophthalmologic Institute between March 1995 and May 2000 were reviewed. RESULTS: In all, 122 eyes of 111 patients were identified. Patient ages ranged from 27 to 89 years (mean 65). Forty-three eyes had diabetic retinopathy; 11 had undergone vitrectomy previously. Macular pathology (hole, membrane, choridal neovascularization) was present in 69 eyes. The most common indications for surgery were diabetic vitreous hemorrhage, macular hole, epiretinal membrane, and retinal detachment. In all cases, phacoemulsification and IOL implantation were performed before vitreoretinal surgery. Preoperative vision ranged from 20/30 to light perception and postoperative vision ranged from 20/20 to no light perception. In 105 patients vision improved, in 7 there was no change, and in 10 vision decreased. Postoperative complications included opacification of the posterior capsule, increased intraocular pressure, corneal epithelial defects, vitreous hemorrhage, retinal detachment and iris capture by the IOL. CONCLUSIONS: Combined surgery is a reasonable alternative in selected patients. Techniques that may simplify surgery and reduce complications include: careful, limited, curvilinear capsulorhexis; in-the-bag placement of IOLs; use of IOLs with larger optics; suturing of cataract wounds before vitrectomy; use of miotics and avoidance of long-acting dilating drops in patients with intravitreal gas; and use of wide-field viewing systems.

Adult↗
PubMed2004

Foldable acrylic versus rigid polymethylmethacrylate intraocular lens in combined phacoemulsification and trabeculectomy.

BACKGROUND: Combined trabeculectomy and phacoemulsification is a widely accepted option in treating patients with glaucoma who also have cataracts. Implantation of a foldable intraocular lens (IOL) in cataract surgery has several theoretical advantages. We performed a study to determine the results of combined phacoemulsification and trabeculectomy with mitomycin C and implantation of either a foldable acrylic or rigid polymethylmethacrylate (PMMA) IOL. METHODS: Review of the charts of 58 consecutive patients (60 eyes) who underwent combined phacotrabeculectomy for concomitant cataract and glaucoma at a university-affiliated hospital in Montreal between September 2001 and December 2002. Forty-one eyes received a foldable acrylic lens (3.2-mm-wide incision), and 19 eyes received a rigid PMMA lens (5.2-mm-wide incision). Outcome measures included visual acuity, intraocular pressure (IOP) and postoperative complications. The results in the two groups were compared. RESULTS: There were no differences in baseline characteristics between the two groups. Earlier recovery of visual acuity was noted in the foldable IOL group than in the rigid IOL group (p = 0.013 for the difference at day 7). IOP control was similar in the two groups, as was the incidence of IOP spikes in the early postoperative period. INTERPRETATION: The results suggest that combined phacotrabeculectomy with mitomycin C using a foldable acrylic IOL allows for good postoperative IOP control and earlier visual recovery than the same procedure with insertion of a rigid PMMA lens.

Aged↗
PubMed2001

Pain, photophobia, and retinal and optic nerve function after phacoemulsification with intracameral lidocaine.

OBJECTIVE: To evaluate differences in pain, photophobia, retinal and optic nerve function in test eyes given intracameral lidocaine compared with control eyes given intracameral saline after phacoemulsification under topical anesthesia. DESIGN: Prospective paired-eye intervention study with random treatment allocation. PARTICIPANTS: Thirty eyes of 15 patients underwent cataract surgery in both eyes under topical anesthesia. INTERVENTION: The first eye of each patient was randomly assigned to either 0.5 ml preservative-free 2% intracameral lidocaine or 0.5 ml of intracameral sterile saline. Within 5 months, the second eye automatically received intracameral saline if the first eye received intracameral lidocaine or vice versa. MAIN OUTCOME MEASURES: The duration of surgery was recorded. Immediately after surgery, each patient was asked to evaluate the degree of pain and photophobia experienced during surgery using a nominal scale. In addition, in five patients, electroretinography (ERG) and visual evoked response (VER) were performed within 1 week before surgery, immediately after surgery, and 1 day after surgery. Amplitudes and latencies were calculated. RESULTS: There was no difference in the duration of surgery comparing test eyes given intracameral lidocaine with control eyes given sterile saline (P = 0.81). There was no significant difference in the level of pain reported when comparing test eyes given intracameral lidocaine with control eyes (P = 1.00). None of the patients reported any significant difference in photophobia between their two eyes (P = 1.00). When comparing ERG measurements, test eyes given intracameral lidocaine did not show any significant decrease in ERG amplitudes or prolonged latencies compared with control eyes. When comparing VER measurements, test eyes given intracameral lidocaine did not show any increase in P1 latencies compared with control eyes (P = 0.31). When evaluating all postoperative ERG results 1 day after surgery, there was a suggestion of improved cone function. CONCLUSIONS: Although intracameral lidocaine does not depress retinal or optic nerve function, the addition of intracameral lidocaine to topical anesthesia during phacoemulsification does not significantly reduce intraoperative pain or photophobia.

Adult↗
PubMed2003

Ultrasound biomicroscopic study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation.

PURPOSE: To report quantitative changes in the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation by means of ultrasound biomicroscopy (UBM). DESIGN: Prospective, nonrandomized, comparative (self-controlled) trial. PARTICIPANTS: Twenty-one eyes of 19 patients with senile or presenile cataracts and no other ocular illness. METHODS: Patients were examined with UBM before and 1 and 3 months after surgery. At each UBM examination, axial images of the anterior chamber and radial sections of the angle at the superior, lateral, inferior, and medial quadrants were obtained. MAIN OUTCOME MEASURES: Central anterior chamber depth (ACD), iris-lens contact distance, iris-lens angle (ILA), angle opening distance at points 250 (AOD250) and 500 microm (AOD500) from the scleral spur, trabecular-iris angle (TIA), iris thickness 500 microm from the scleral spur (IT), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), iris-zonule distance, iris-sclera angle (ISA), and ciliary process-sclera angle (CPSA). After surgery, central anterior chamber depth was also measured from the cornea to the IOL (ACD) and from the cornea to the pupillary plane (ACD2). Each variable was measured twice in different days by the same observer. RESULTS: The variables IT, TCPD, ICPD, IZD, and CPSA did not significantly change after surgery (P > 0.01). Central anterior chamber depth increased approximately 30% after surgery (approximately 850 microm; P < 0.001), by both measurement methods used (ACD x ACD and ACD x ACD2). Anterior chamber angle significantly increased, by approximately 50% of the initial value, by the three measurement methods used: AOD250 (P <or= 0.002), AOD500 (P < 0.001), and TIA (P <or= 0.003). The ISA increased by approximately 10 degrees (30%) after surgery (P < 0.001). The ILCD and ILA did not exist after surgery, except in two eyes. CONCLUSIONS: After phacoemulsification and foldable IOL implantation, UBM revealed that the iris diaphragm shifted backward, deepening the anterior chamber by approximately 850 microm and widening its angle by approximately 10 degrees. These findings may be of clinical significance in eyes with angle-closure glaucoma or with occludable angles.

Acrylic Resins↗
PubMed1997

Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity.

PURPOSE: The purpose of the study is to evaluate the effect of vitrectomy on secondary glaucoma and visual acuity outcomes in patients with retained lens fragments after phacoemulsification. METHODS: A retrospective analysis of 126 patients who had vitrectomy for retained lens fragments after phacoemulsification during the 3-year period between January 1, 1993, and December 31, 1995. RESULTS: Glaucoma, defined as an intraocular pressure of greater than or equal to 30 mmHg, occurred in 42 (36.8%) of 114 patients before vitrectomy and in 4 patients (3.2%) of 126 after vitrectomy. There were no differences in the rates of persistent glaucoma regardless of the intervals between cataract surgery and the vitrectomy: less than or equal to 1 week, 2 patients (4.1%); greater than 1 week to less than or equal to 4 weeks, 1 patient (2.5%) and greater than 4 weeks, 1 patient (2.6%). The visual acuity was 20/40 or better in 13 patients (11.4%) before vitrectomy and in 75 patients (59.5%) after vitrectomy. The rates of visual acuity 20/40 or better also were similar for all intervals: less than or equal to 1 week, 29 patients (59.2%); greater than 1 week to less than or equal to 4 weeks, 22 patients (56.4%) and greater than 4 weeks, 24 patients (63.1%). CONCLUSIONS: Vitrectomy for removal of retained lens fragments reduces secondary glaucoma and yields favorable visual acuity outcomes. In eyes with elevated intraocular pressure, early vitrectomy generally is recommended, but delayed vitrectomy also has favorable outcomes.

Adult↗
PubMed1997

A randomized study of mitomycin augmentation in combined phacoemulsification and trabeculectomy.

PURPOSE: The purpose of the study is to determine whether the intraoperative application of subconjunctival mitomycin C (MMC), during combined phacoemulsification and trabeculectomy, is an effective means of improving filtration, defined as overall lower intraocular pressure (IOP) and less antiglaucoma medication use. METHODS: Twenty-nine patients with a visually significant cataract and glaucoma were randomized, in a double-masked fashion, to receive intraoperative MMC (0.5 mg/ml) or placebo. RESULTS: Follow-up ranged from 6 to 30 months (mean, 20 months). Postoperative visual acuity at 1 year was 20/40 or better in 14 of 15 eyes operated on in the placebo group and 13 of 14 eyes operated on in the MMC group. Intraocular pressure at 8 months averaged 15.2 +/- 1.5 mmHg in the placebo-treated eyes versus 12.3 +/- 1.6 mmHg in the MMC-treated eyes. At 12 months, IOPs averaged 16.2 +/- 1.5 mmHg in the placebo-treated eyes versus 12.6 +/- 1.0 mmHg in the MMC-treated eyes. On average, the MMC group had postoperative IOP levels 3.0 mmHg lower than did the placebo group (P = 0.04) throughout the study. In the placebo group, laser suture lysis was required in a greater number of patients (80% versus 43%) and to a greater extent (mean = 2.0 versus 0.7 suture lysed) (P < 0.05). At 12 months, 5 of the 15 patients in the placebo group required an average of 1.8 medications for IOP control, whereas 0 of the 14 patients in the MMC group needed IOP-lowering medications. A late endophthalmitis developed through an intact bleb in one patient in the MMC group; otherwise, complications were minimal in each group. CONCLUSION: These results suggest that intraoperative MMC application, during combined phacoemulsification and trabeculectomy surgery, does improve early filtration as shown by overall lower IOPs and less antiglaucoma medication use.

Aged↗
PubMed1997

Limbus- versus fornix-based conjunctival flaps in combined phacoemulsification and mitomycin C trabeculectomy surgery.

PURPOSE: The authors compared the effectiveness of limbus- and fornix-based conjunctival flaps in patients undergoing combined phacoemulsification, intraocular lens implantation, and mitomycin C trabeculectomy. METHODS: The authors conducted a retrospective review of the records of 52 consecutive eyes of 45 patients who underwent combined surgery with limbus- and fornix-based conjunctival flaps. All surgery was by done by one surgeon on predominantly white patients in a suburban glaucoma subspecialty practice. Seven patients had both limbus- and fornix-based surgery, permitting fellow eye comparisons in these patients. All patients had at least 6 months and a median of 17 months follow-up. None of the eyes that were operated on had undergone intraocular surgery previously. RESULTS: No clinically significant difference in postoperative pressure reduction, bleb survival, or visual acuity was seen between the fornix- and limbus-based groups. Results in the fellow eye comparison subgroups were similar. The mean intraocular pressure decreased from 20.4 mmHg before surgery to a mean of 12.4 mmHg at the last follow-up visit. Forty-seven (90.3%) of 52 eyes had a final best-corrected visual acuity of 20/ 40 or better. Forty eyes (76.9%) no longer needed antiglaucoma medications at the end of follow-up. Five eyes had intraoperative posterior capsule rupture; all of these occurred in the limbus-based group. Shallow serous choroidal effusions were more common in the fornix-based group, but none were clinically significant. No difference in postoperative astigmatism between the limbus- or fornix-based group was seen. Intraoperative pupilloplasty, synechialysis, or postoperative neodymium:YAG capsulotomy had no appreciable effect on final intraocular pressure or bleb survival. Endophthalmitis, aqueous misdirection, or hypotony maculopathy did not develop in any patient. CONCLUSION: The effectiveness of limbus- and fornix-based conjunctival flaps appears to be similar. The limbus-based technique may result in a higher incidence of posterior capsular rupture, but the safety of limbus- and fornix-based flaps is otherwise similar. Combined phacoemulsification and mitomycin C trabeculectomy appears to be safe and effective for treating selected patients with coexisting glaucoma and cataract.

Aged↗
PubMed1998

Phacoemulsification and silicone oil removal through a single corneal incision.

OBJECTIVE: Cataracts are a frequent complication after silicone oil infusion for the repair of complicated retinal detachments, occurring in up to 100% of eyes retaining silicone oil for 6 months or more. The authors devised a combined procedure for cataract and silicone oil removal with intraocular lens (IOL) implantation through a single corneal incision and evaluated their results. DESIGN: A prospective, noncomparative case series. PARTICIPANTS: Thirty-four eyes of 34 consecutive patients with a history of retinal detachment repair requiring silicone oil placement in whom a clinically significant cataract subsequently developed were identified when removal of silicone oil was scheduled. INTERVENTION: All 34 eyes were prospectively entered into a study to evaluate the efficacy and potential complications of a combined procedure for cataract and silicone oil removal with posterior chamber lens implantation. All patients underwent uncomplicated phacoemulsification removal of cataract followed by removal of silicone oil and placement of an IOL through a single corneal incision. MAIN OUTCOME MEASURE: Recurrent retinal detachment and IOL-related complications were measured. RESULTS: Ten eyes had recurrent retinal detachments develop. Final visual acuity ranged from 6/12 to hand movements with 25 eyes (74%) showing stabilized or improved vision. Pre-existing macular pathology and recurrent retinal detachment generally were responsible for poor visual outcome. CONCLUSIONS: Combined phacoemulsification, IOL implant with silicone oil removal is a useful procedure in these complicated eyes. Visual outcome generally is good with improvement in visual acuity, even with recurrent retinal detachment or pre-existing macular pathology or both.

Adult↗
PubMed1998

Phacoemulsification and lens implantation after pars plana vitrectomy.

OBJECTIVE: This study aimed to describe the intraoperative and postoperative complications and visual acuity outcomes of patients undergoing Kelman phacoemulsification (KPE) and intraocular lens (IOL) implantation after pars plana vitrectomy (PPV). DESIGN: The study design was a retrospective review of a consecutive surgical series. PARTICIPANTS: Forty-four eyes of 43 patients who underwent surgery at the Jules Stein Eye Institute, Los Angeles, California, or Advanced Vision Care, West Hills, California, were studied. INTERVENTION: Office records, referring retina specialists' records, and operative reports were reviewed for demographic information, indications for PPV, preoperative cataract severity, unplanned intraoperative events and complications, early and late postoperative complications, and postoperative visual acuities. MAIN OUTCOME MEASURES: Complications and postoperative visual acuities were measured. RESULTS: The mean interval from PPV to KPE was 20 months. The mean interval from KPE to final examination was 19 months. Primary indications for PPV included development of a macular epiretinal membrane, macular hole, proliferative diabetic retinopathy, retinal detachment, vitreous abscess, and vitreous hemorrhage. The degree of nuclear sclerosis in postvitrectomy eyes was greater than that in typical cataract eyes (P = 0.00002). The most common intraoperative problem was the discovery of a posterior capsule plaque. In a few cases, surgery was made difficult by unusual fluctuations in anterior chamber depth and lens zonule instability. The most common early postoperative complication was corneal edema; the most common late complication was the need for neodymium:YAG (Nd:YAG) laser posterior capsulotomy. An IOL was implanted in every eye. There were no retinal detachments. Median visual acuity improved from 20/125 before cataract surgery to 20/40 6 weeks after surgery to 20/30 on final examination. Visual acuity of 20/40 or better was achieved by 63.6% of eyes at 6 weeks and by 72.7% of eyes by final examination. CONCLUSIONS: Kelman phacoemulsification and IOL implantation can be performed safely after PPV. Intraoperative and postoperative complications are uncommon. Pre-existing posterior segment pathology limits the ultimate improvement in visual acuity, but substantial gains in visual acuity are realized by most patients.

Adult↗
PubMed1999

Combined phacoemulsification and goniosynechialysis for uncontrolled chronic angle-closure glaucoma after acute angle-closure glaucoma.

OBJECTIVE: To evaluate combined phacoemulsification, posterior chamber intraocular lens (PCIOL) implantation, and goniosynechialysis (phaco-GSL) prospectively in eyes with more than 180 degrees of peripheral anterior synechiae (PAS) and uncontrolled intraocular pressure (IOP) when performed within 6 months of an attack of acute angle-closure glaucoma (ACG). DESIGN: Prospective, noncontrolled clinical trial. PARTICIPANTS: Patients who had presented with acute ACG and had persistently uncontrolled IOP despite successful laser iridotomy for pupillary block and argon laser peripheral iridoplasty for continued appositional closure after iridotomy. INTERVENTION: After the completion of phacoemulsification and posterior chamber lens implantation, goniosynechialysis was performed in 52 eyes of 48 patients. MAIN OUTCOME MEASURES: Postoperative visual acuity, IOP, extent of PAS, and number of medications, if any, required for IOP control. RESULTS: Intraocular pressure was less than 20 mmHg in 47 eyes (90.4%) without medications; 4 were controlled with medications and 1 required filtration. Mean extent of PAS was reduced from 310 degrees to 60 degrees. Peripheral anterior synechiae formation or IOP elevation did not recur after 3 months after surgery up to 6 years. Eight patients achieved 20/20 visual acuity, while 44 patients had less than 20/20 visual acuity. No patient had worse visual acuity after surgery compared to before surgery. CONCLUSION: Phaco-GSL and PCIOL implantation is effective in reducing PAS and IOP and improving visual acuity in eyes with persistent chronic ACG when performed within 6 months after treatment for acute ACG.

Acute Disease↗
PubMed1999

Efficacy of supplementary intracameral lidocaine in routine phacoemulsification under topical anesthesia.

OBJECTIVE: To determine whether the routine use of supplementary intracameral lidocaine has any benefit over topical anesthesia alone when performing phacoemulsification surgery. DESIGN: A prospective single-center, randomized, double-masked, clinical trial. PARTICIPANTS: A total of 204 patients undergoing phacoemulsification surgery with lens implantation under planned topical anesthesia. METHODS: Patients were randomly allocated to receive either topical anesthesia plus 0.5 ml intracameral balanced salt solution or topical anesthesia plus 0.5 ml preservative-free 1% intracameral lidocaine. MAIN OUTCOME MEASURES: On the day after surgery, patients were asked to document the discomfort they had experienced using a visual analog scale. Intraoperative discomfort, postoperative discomfort, and discomfort caused by the microscope light were assessed. RESULTS: Multiple linear regression analysis did not show any significant relationship between the use of intracameral lidocaine and either intraoperative (P = 0.34) or postoperative (P = 0.45) pain scores. There was a small reduction in the discomfort caused by the operating microscope when intracameral lidocaine was used (P = 0.04). CONCLUSIONS: In this study, the routine use of intracameral lidocaine as a supplement to topical anesthesia was shown not to have a clinically useful role.

Aged↗
PubMed2006

[Combined surgery for lens extraction, vitrectomy, and implantation in the diabetic patient using phacoemulsification versus phacofragmentation].

INTRODUCTION: In diabetic patients, we often need to perform cataract and pars plana vitrectomy. Two different techniques are currently valid: 1) phacoemulsification and pars plana vitrectomy and 2)pars plana lensectomy and posterior vitrectomy. METHODS: Retrospective study of two different groups of type 2 diabetic patients: those receiving 1) phacoemulsification and pars plana vitrectomy or 2) pars plana lensectomy and posterior vitrectomy. RESULTS: On statistical analysis there were no differences in complications between the two groups. The effect on visual acuity was similar in both groups. DISCUSSION: The association of cataract surgery and posterior vitrectomy is a valid technique for treating diabetic retinopathy complications. In the present study, the complications of the two techniques were similar, the most important concerning only anterior chamber opening in the first group. CONCLUSION: The two techniques of cataract extraction and pars plana vitrectomy at the same time have no differences in their results and are valid for treatment of diabetic patients.

Aged↗
PubMed2000

Cataract in enucleated goat eyes: training model for phacoemulsification.

We developed an inexpensive, reproducible technique of inducing cataract in enucleated animal eyes for phacoemulsification training. Injection of 0.3 to 0.5 mL of formalin 20% in the central and paracentral portion of the crystalline lens in a goat's eye induced cataract in about 5 to 10 minutes. Varying the interval would enable novice surgeons to practice different techniques of phacoemulsification based on cataract hardness.

Animals↗
PubMed2000

Flexible iris hooks for phacoemulsification in patients with iridoschisis.

Flexible iris hooks, or retractors, can be used to facilitate cataract removal by phacoemulsification in patients with primary iridoschisis. This rare condition is associated with fibrillary degeneration of the iris, narrow drainage angles, and cataract. In addition to their conventional use as iris retractors, iris hooks can control the degenerate fibrillary iris stroma to improve the view and access to the lens, preventing further damage during phacoemulsification and cortical cleanup. Iris hooks are widely available, easily handled, and can transform a difficult case into one that is almost routine.

Aged↗
PubMed2001

Crater-and-chop technique for phacoemulsification of hard cataracts.

We describe a technique of in-the-bag phacoemulsification of large, hard, leathery brown nuclear cataracts. A large crater approximately 6.0 mm diameter is created by down-slope sculpting up to 90% of nuclear thickness, leaving the outer nuclear rim intact. The edge of the crater is held with the phaco probe using high vacuum, and small wedge-shaped pieces are created with a chopper. These small pieces are emulsified in the space created by the crater. This technique permits in-the-bag phacoemulsification of large brown cataracts without complications.

Cataract↗
PubMed2001

Management of posterior capsule rupture during phacoemulsification using the dry technique.

To manage posterior capsule rupture during phacoemulsification, we use a dry technique in which all procedures are performed without an irrigation/aspiration system. The dry technique is characterized by (1) continuous viscoelastic injection instead of fluid irrigation to maintain anterior chamber depth with the posterior capsule and vitreous located posteriorly and (2) static removal of most residual lens material by viscoexpression and/or manual small incision extracapsular cataract extraction without aspiration and dynamic water flow. In 16 cases of posterior capsule rupture managed using the dry technique, the residual nucleus and cortex were readily removed with minimum extension of the ruptured area and new vitreous loss. Although large amounts of viscoelastic material (mean 5.8 mL) were required, rapid and stable visual recovery was comparable to that in patients having uneventful surgery. The dry system is a safe and reliable technique for managing posterior capsule rupture during phacoemulsification.

Eye Injuries↗
PubMed2001

Comparative evaluation of corneal epithelial permeability after the use of diclofenac 0.1% and flurbiprofen 0.03% after phacoemulsification.

PURPOSE: To assess the corneal epithelial function after prolonged topical administration of diclofenac 0.1% and flurbiprofen 0.03% single-dose eyedrops. SETTING: University Eye Clinic of Trieste, Trieste, Italy. METHODS: This randomized prospective study comprised 24 patients scheduled for phacoemulsification. The patients were randomly assigned to receive diclofenac or flurbiprofen eyedrops for 2 months after surgery. Corneal epithelial permeability was determined by fluorophotometry 7, 37, and 67 days after surgery. RESULTS: An increase in corneal epithelial permeability was observed in the diclofenac group 37 and 67 days after surgery. No epithelial function alterations occurred in the flurbiprofen group. CONCLUSIONS: Subclinical impairment of the epithelial function was observed during topical treatment with diclofenac 0.1% single-dose eyedrops after phacoemulsification. The mechanism responsible for this effect remains unknown.

Aged↗
PubMed2001

Pars plana vitreous tap for phacoemulsification in the crowded eye.

This technique facilitates phacoemulsification and foldable intraocular lens (IOL) implantation in eyes with extremely crowded anterior segments. An automated pars plana vitreous tap is used to expand the anterior segment when extremely shallow anterior chambers do not deepen sufficiently with viscoelastic injection alone. This technique permits successful completion of pupilloplasty, capsulorhexis, phacoemulsification, and foldable IOL implantation in these high-risk eyes.

Aged↗